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The Countess of Mar: My Lords, can the Minister say how much of the £100 million fraud is perpetrated by patients and how much by doctors and pharmacists who appear to be in league with each other?

Baroness Jay of Paddington: My Lords, I am not sure that I necessarily support that last remark of the noble Countess. There are difficulties in establishing precisely the outcome of patient fraud and distinguishing that from the fraud which occurs because individual pharmacists may not be fulfilling their professional duty. As I understand it, the best estimate is that about £70 million of the £100 million to which I referred is fraud by patients.

Baroness Oppenheim-Barnes: My Lords, will the Minister consider, if she has not already done so, the point that when a patient passes on he often leaves behind cupboards full of expensive medicines? Is anything done to reclaim those medicines if, indeed, they could be used?

Baroness Jay of Paddington: My Lords, that is a helpful point. The noble Baroness may be aware that one of the changes that we made during the summer was to restrict the sales pack size of, for example, paracetamol drugs. That was intended primarily as a safety measure, but we also thought that if people had fewer drugs in their cupboards they might be used more effectively.

Earl Howe: My Lords, the Minister said that the total of prescription-related losses is estimated at £100 million a year. What proportion of that total do the Government realistically hope to recoup in the next financial year--that is, in 1998-99?

Baroness Jay of Paddington: My Lords, that question is still open because the speed with which we can implement some of the changes that I mentioned in my Answer will affect the final outcome. In the announcement which my right honourable friend the

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Secretary of State for Health made in another place about the additional money for the NHS which has been agreed between the Treasury and the Department of Health, he mentioned that £30 million of it would come from efficiency savings. We hope that a large proportion of that will come from changes relating to prescription practices.

Baroness Sharples: My Lords, does the Minister agree that a national identity card would help in this instance?

Baroness Jay of Paddington: My Lords, that is slightly wide of the Question, but the problem of trying to identify prescription possession with individual patients by some form of computerised system is, as I said, being considered.

Baroness Robson of Kiddington: My Lords, has not the new idea of issuing repeat prescription forms increased the danger of the misuse of prescriptions unless people can be identified by something such as a national identity card or the use of their national insurance number?

Baroness Jay of Paddington: My Lords, that is precisely the point. We are trying to identify more closely the person who is issued with the prescription and the person who receives it. The problem arises not so much with repeat prescriptions where someone genuinely receives that prescription but where people seek to evade the charges on their first or second prescription, or whatever.


3.14 p.m.

Lord Campbell of Croy asked Her Majesty's Government:

    Whether they will introduce regulations for the new profession of "counselling", to include registration and requirements for training and standards of proficiency.

Baroness Jay of Paddington: My Lords, we have no plans to introduce statutory registration. We believe that the existing mechanisms for voluntary registration and the regulation of professional practice are sufficient to ensure that the public and employers can know who is trained for work in this field and who is not. However, we continue to work actively with the professional bodies concerned and with health service staff to maintain and develop mechanisms for registration and regulation which are in the public interest.

Lord Campbell of Croy: My Lords, I thank the Minister for her Answer. Excluding counselling prescribed by the medical profession, can anyone put up a notice and offer counselling without any qualifications or any form of licence? Is the Minister aware that

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inexperienced counsellors, although often well meaning, have sometimes created more stress than was present in the first place?

Baroness Jay of Paddington: My Lords, I am afraid that the noble Lord's last point may be correct where inexperienced persons offer counselling. It is true that in the private sector anybody can, as the noble Lord said, put up a sign and offer their services. However, in the NHS, employers and those medical or other practitioners who refer people to counsellors, clinical psychologists or psychotherapists must ensure that the person to whom they refer the patient is qualified. Individuals could approach one of the professional bodies which regulate in this field. Two professional bodies which offer the registration of counsellors are the British Association for Counselling and the British Psychological Society.

Lord Walton of Detchant: My Lords, does the Minister accept that there is often confusion about the distinction between on the one hand a psychiatrist, who is a medically qualified individual concerned with the treatment of disorders of the mind, and, on the other hand, the graduate psychologist, who is concerned more with examining mental processes? In the specialty of psychology, there are those who receive postgraduate training in counselling and there are those who receive it in educational psychology and clinical psychology. Is it not therefore right that, as the British Psychological Society would wish, the profession of psychology should soon be subject to statutory registration and regulation?

Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord for that clear explanation of the confusion of titles in this area. Representatives of the British Psychological Society recently met my honourable friend the Parliamentary Under-Secretary of State for Health, Mr. Boateng, who has ministerial responsibility in this area, and he took the view that the case for registration was persuasive. However, given the very full parliamentary timetable, he thought that it was unlikely that time would be found to take the matter forward into legislation in the near future. I understand that he assured the society's representatives that officials will continue to work with the society to ensure that the existing systems of regulation and promotion are maintained.

The Earl of Lauderdale: My Lords, is the Minister aware that the services offered by the people from Cruse, which offers bereavement counselling, are well appreciated all over the country?

Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord for raising that point. It is sometimes easy to ridicule some aspects of counselling, but I am sure that we all know of people who have been greatly helped by supportive contact with professionals or in the more formal psychotherapy setting which the noble Lord, Lord Walton of Detchant, described.

Lord Annan: My Lords, is there not a danger of over-bureaucratisation in this matter? We already have

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large numbers of quangos; do we want to add yet another? Is it not true that over-registration could create a situation where if I tried to comfort a widower who had recently lost his wife and my comfort unfortunately resembled that of Job and the widower committed suicide, I might then be prosecuted because I do not have a diploma in counselling?

Baroness Jay of Paddington: My Lords, I believe that the noble Lord, Lord Annan, has indicated precisely the difficulty of establishing a professional watershed in this field. As I said in response to the previous Question, this is an easy area to over-bureaucratise or to ridicule. But the point with which the British Association for Counselling is concerned is the registration of individual professionals practising in this field, which is slightly different from setting up another quango.

Lord Peyton of Yeovil: My Lords, will the Minister accept congratulations for resisting any temptation to regulate the torrent which exists?

Baroness Jay of Paddington: My Lords, I believe that the torrent is fairly free-flowing as it is. When I asked for advice in this matter, I was informed that there were 17 national bodies representing people working in this field. One can understand the difficulties of trying to regulate that situation, even if one wished to.

Baroness Flather: My Lords, does the noble Baroness agree with me that counselling is not a new profession? I trained as a counsellor at the Tavistock Centre 20 years ago. I am disappointed. I hope that the Minister will make it clear that this is not a flash in the pan or something that has suddenly appeared. Newspapers have begun to talk about counselling. Counsellors have been working successfully in very difficult circumstances. I speak as a vice-president of the British Association for Counselling. Will the Minister make it clear that that body has a registration scheme and anyone who is in doubt can turn to it and ensure that he or she gets a trained and properly accredited person? That body accredits people all the time.

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