Previous Section Back to Table of Contents Lords Hansard Home Page

Baroness Jay of Paddington: I am grateful to the noble Baroness for her reply. She has not addressed one of the points with which I am concerned. I refer to the difference between the technical ability of health authorities to hold all their meetings in public and the reality. In reality, progressively much business is discussed in seminar form (or whatever it may be called). There is discussion between members with the matter brought to the public view only at a time when decisions have been taken.

I understand the noble Baroness's almost ideological (if I may use that word) dislike of interfering in the local management of health authorities. However, there is the question of a slippage of public awareness. As I said in my opening remarks, there is the sense that sometimes public meetings are almost rehearsed because so many decisions have been taken earlier. One cannot be reassured unless there is a firmer understanding about how many of the authorities' meetings are to be held in public.

I understand the noble Baroness's points about flexibility as regards local business, and so on. But I am anxious about the way in which so many local authorities now use the opportunities afforded under the catch-all phrase to which I referred in the 1960 legislation to move into closed session in seminar format.

Therefore, although I shall not press the amendment at this stage, I hope that the Government will take the matter seriously. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

28 Mar 1995 : Column 1569

Lord Carter moved Amendment No. 11:

Insert the following new clause:

("Nurse Education Authority

. After section 8 of the National Health Service Act 1977 there shall be inserted—
"Nurse Education Authority.

.—(1) It shall be the duty of the Secretary of State to establish a Health Authority to be known as the Nurse Education Authority.
(2) The Secretary of State shall, by regulations made under any of sections 13 to 17 as appropriate, provide for the Authority established under subsection (1) above to have the duty of commissioning nurse education in England.
(3) The membership of the Authority shall be established in accordance with Part I of Schedule 5 to this Act.".").

The noble Lord said: The purpose of the amendment is clear from the wording. It deals with a problem which may arise: the important question of nurse education after reorganisation. As is clear, the amendment establishes a new authority responsible for the commissioning of nurse education at a national level. It is based on the argument that a national overview is needed to prevent nurse shortages which would be to the detriment of patients. It is clear that the abolition of the RHAs will have profound implications for the funding of nurse education. In the past the RHAs were responsible for determining the demands of employers for nurses and for purchasing education and training places to meet that demand. Indeed, the national balance sheet exercise was set up in 1991 to determine the future supply and demand within regions, and in England as a whole.

It would be helpful if the Minister would confirm that that will be the case. We understand that with the abolition of RHAs, the strategic overview or planning function will be devolved. It seems that the Government have devised a fairly complicated way of doing that. Initially, the regional offices of the NHS Executive will commission education programmes on the basis of proposals by healthcare purchasers and employers.

In the longer term—it has not been defined; it would be helpful if the Minister could do so—local consortia of health authorities and trusts will take on that role. Their plans should be overseen by a regional education development group in the new regional offices. That seems to us to be a recipe for muddle, confusion and overlap in particular as it appears—again I ask the Minister to confirm this—that there is no intention to continue with the national overview for nursing in England. Unless the business is carefully planned in the way in which I have described, it could end up in a fearsome muddle.

We are all aware of the implications for patient care if there is a shortage of qualified nurses. There has been a 33 per cent. reduction in training places for nurses between 1987 and 1994. The wastage rates have ceased to fall, and the turnover rates have risen. That indicates the greater mobility of the current nursing workforce. However, casualisation—the increasing use of short-term contracts, agencies, bank nurses and the like—is an increasing feature of the system. It is

28 Mar 1995 : Column 1570

certainly very different from the nursing profession which we have all been used to and the way in which nurses were employed.

There is also concern that the need for nurses beyond the health service should be planned for and recognised. There is concern that when deciding on the future need for nursing, the local consortia of authorities and trusts, overseen by the regional educational development, the groups of the NHS Executive and the civil servants, will focus solely on the needs of the health service, and, in the health service, perhaps on the needs of the hospital service. The need for nurses in local authorities, prisons, the growing nursing home sector, and in the workplace—the industrial nurses—may not have sufficient attention paid to it.

What will happen to colleges of nursing and to nurse teachers? If predictions underestimate future demand for nurses, that will have an impact on education establishments which provide nurse training. It is clear that if health authorities in their new role fail to place a contract with an education establishment for a specific branch of nursing —the RCN gives an example of learning disability nursing —then the nurse tutors at the establishment are likely to be made redundant. If at a future date the demand prediction changes, then the infrastructure for education in the specialist sector has been lost.

We can all agree that planning the future of the nursing workforce is a highly complex exercise. It needs to be based on figures which have been closely researched and which include the analysis of the need for nursing outside the NHS, but, above all, which give a national overview of the demand for nurse education to ensure that the correct number of nurses with the necessary mix of skills are available to meet the future needs of patients. I beg to move.

Baroness McFarlane of Llandaff: The noble Lord has spoken comprehensively about the fears for nursing education in the future. Indeed, we are in the midst of some of those fears now. I was apprehensive to hear, for instance, that a region had budgeted for 10 training places for community nurses for the coming year. With all the developments in primary healthcare and community nursing that figure seemed to me to be completely inadequate.

While I am fully convinced that there needs to be a national overview of the commissioning for nursing education, I remain to be convinced that the creation of a special health authority for that purpose is the answer to those problems.

However, I am sure that we must not trespass on the statutory duties of the UKCC and the associated boards.

Baroness Cumberlege: I am sure that the Committee will agree that patients should have the highest quality care from nurses. That is why those closest to the delivery of that care should have a major influence on the volume and type of education commissioned. Our policy is to place patients' needs firmly at the centre of education and training.

28 Mar 1995 : Column 1571

We believe that the amendment would diminish this crucial influence and do so to the detriment of patient care. It would unnecessarily create a costly central bureaucracy, diverting funds from patient care.

We recognise the need to ensure an adequate national supply of appropriately trained nurses. I take the points made by the noble Baroness, Lady McFarlane: we need to keep the issue under close scrutiny. However, that is why we are putting in place arrangements to commission education and training which will take place within a policy framework and guidelines set by the NHS Executive Headquarters.

I hope that the noble Lord, Lord Carter, will be reassured that we have recently published guidance setting out the criteria for devolving purchasing to consortia. Local purchasing will begin when health authorities meet those criteria. That is why we said that it will happen in the longer term rather than immediately on 1st April 1996.

The NHS Executive will maintain a national overview of demand and supply, taking account of the needs of the NHS and other providers of healthcare. Most importantly, we are ensuring professional input at every level of the new arrangements. We will be supporting the development of workforce planning and education commissioning skills at local level.

As the noble Baroness said, Parliament has already established, the statutory bodies to set and maintain standards of education in nursing—the United Kingdom Central Council and the English National Board—with which we work closely. A nurse education authority would undermine the responsibility that Parliament has vested in those bodies.

More flexible working arrangements and better use of professional skills means that nurses and midwives are remaining in their posts longer and more people are returning to the profession after career breaks. Those factors are reflected in the reduced number of students. But, of course, the longer-term supply of nurses has to be kept constantly under review, which is what the policy framework and guidelines set by the NHS executive will do.

The noble Lord, Lord Carter, raised the issue of supply. I can reassure him that recruitment to nurse education is healthy. The number of qualified nursing and midwifery staff employed by the NHS has increased by 14 per cent.; that is 30,000 more nurses since 1981. There are more qualified nurses for every unqualified nurse now than there were in 1981. Practice nurse numbers in the family health service have grown by 674 per cent. over the past 12 years. I believe that this nation's nurses are educated and trained to the highest standards and that they are the best in the world. Thus, we believe that a nurse education authority will add nothing to what we are already doing. Therefore, I urge that the amendment be withdrawn.

Next Section Back to Table of Contents Lords Hansard Home Page