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House of Lords

Monday, 20th April 1998.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Bath and Wells.

Nurse Prescribing

Baroness Cumberlege asked Her Majesty's Government:

    What is their policy on nurse prescribing.

The Minister of State, Department of Health (Baroness Jay of Paddington): My Lords, I am very grateful to the noble Baroness for giving me this opportunity to make a positive statement on behalf of the Government. I am delighted to tell the noble Baroness and the House that the Government announced this morning at the Royal College of Nursing congress that we shall provide £14 million to enable all health authorities to establish a national programme of nurse prescribing.

We are committed to extending and developing the professional role of nurses as outlined in our White Paper. National funding for training and support so that nurses can take the responsibility for prescribing is part of that programme.

Baroness Cumberlege: My Lords, is the noble Baroness aware that I am going to go out right now and crack open a bottle of champagne? I am absolutely thrilled to bits. For 12 years, with the nursing organisations, I have fought for this to happen and it really is a great day for me.

Before I get lost in all the euphoria, I understand that the Secretary of State suggested this morning that he would wish to take nurse prescribing still further, beyond district nursing and health visiting and into acute nursing. Will the Minister say whether a date has been set for that and whether a programme has been drawn up?

Baroness Jay of Paddington: My Lords, I am extremely grateful to the noble Baroness for her remarks. We are all aware of the long-running fight which she has conducted, both in and out of government, to establish nurse prescribing. I believe that she raised the issue originally in 1986, and so that is a long record.

In his speech this morning, my right honourable friend the Secretary of State for Health referred to extending the nurse prescribing situation. He referred also to the review being undertaken at present by Dr. June Crown, who is having a serious look at ways in which nurse prescribing can be extended. We are expecting the conclusion of that review later in the summer. We expect to be able to take forward some of those recommendations on extending nurse prescribing.

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There will be some legal obstacles--for example, changes which will need to be made in so-called group protocols--and we intend to take action on that as well.

Lord Naseby: My Lords, before the Minister drinks too much champagne, should she not look at the catastrophic reduction in the immunisation programme for MMR and should she not be giving that her top priority?

Baroness Jay of Paddington: My Lords, that is somewhat wide of the Question. As the noble Lord will be aware, the Chief Medical Officer made a very clear policy statement on that subject immediately before Easter in which he encouraged all parents not to be disturbed by the media discussion of that matter. He urged parents to take up MMR immunisation on behalf of their children.

Lord Quirk: My Lords, while welcoming the moves towards making greater use of our nurses and health visitors, might I ask if the Minister will consider making more systematic and structured use of our pharmacists, who also have a large amount of skill which is at our disposal in the community?

Baroness Jay of Paddington: My Lords, the Government certainly acknowledge the role of community pharmacists. Indeed, we are including them in our proposals for extending primary care arrangements in the same way as for nurses and health visitors.

Baroness Gardner of Parkes: My Lords, will the Minister tell us whether any thought is being given also to nurse anaesthetists? I welcome the nurse prescribing and I hope that the day will come when we shall have adequately trained nurse anaesthetists. But will she tell us what is to be done about the great shortage of nurses? Does she believe that the present very high entrance qualifications are deterring people? The drop-out figures were announced this morning as being very high. Does she think that there is now a need for a secondary level of nurses to be trained to replace those very highly skilled nurses whose services will no longer be available for more basic nursing?

Baroness Jay of Paddington: My Lords, several supplementary questions have been very wide of the original Question tabled by the noble Baroness, Lady Cumberlege. I should be delighted to have a general opportunity to discuss nursing policy, and perhaps the noble Baroness and others may wish to raise that in an Unstarred Question or in some other form of debate.

As regards improving the recruitment and retention of nurses, the Secretary of State referred to that in his speech this morning to the Royal College of Nursing congress. It is something which we are taking very seriously. Just before Easter I was involved in the launch of a nationally arranged resource pack for all local health authorities which is intended to encourage nurse

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recruitment. The Secretary of State announced this morning that an extra £4 million will be targeted on trying to establish better ways to achieve that locally.

Earl Howe: My Lords, picking up the point made by my noble friend Lady Cumberlege, is it not the case that in the pilot schemes that have been running until recently nurses have been able to prescribe only from the nurse formulary? Does the noble Baroness not agree that in the longer term it would be desirable for prescribing powers to be extended to specialist nurses and that all such nurses should be able to prescribe from the full British formulary?

Baroness Jay of Paddington: My Lords, the question that the noble Earl raises is part of the subject of the review by Dr. June Crown to which I referred in one of my answers to the noble Baroness, Lady Cumberlege. It is, of course, something which the Government will be looking at very positively. The noble Earl is right to express it in the longer term. At this point we do not want to put any exact date on that particular extension.

Lord Ewing of Kirkford: My Lords, as the Royal College of Nursing is a UK-wide college, can my noble friend say whether the statement made at its annual meeting this morning was UK-wide or does it apply just to England and Wales?

Baroness Jay of Paddington: My Lords, the plan described this morning relates only to those health regions which are in England. Wales, Northern Ireland and Scotland are at varying stages of piloting and developing their own versions of the scheme. It seems unlikely that they will reach very rapid conclusions in that respect, but they are carrying out the sort of pilots which might produce the same kind of decisions which were made by the English Department of Health this morning.

Baroness Cumberlege: My Lords, with regard to the £14 million which has been set aside and which I very much welcome, can the Minister say whether that is money which has been top-sliced from allocations to health authorities or whether it is new money?

Baroness Jay of Paddington: My Lords, this is new money to train nurses. As I am sure the noble Baroness is aware, there will be a substantial training programme involved. I believe that it is estimated that we will probably need to train nearly 20,000 nurses to take up this particular form of prescribing. That will obviously take some time actually to plan and achieve.

Nuclear Weapons in the Gulf

2.44 p.m.

Lord Jenkins of Putney asked Her Majesty's Government:

    Whether it is correct that they were not consulted by the US Government on the possible use of nuclear weapons in the Gulf area and are not involved in

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    nuclear war planning, and whether they agree that such discussions would undermine the non- proliferation treaty and nuclear disarmament.

The Minister of State, Ministry of Defence (Lord Gilbert): My Lords, we and other allies have regular discussions with the US over alliance nuclear planning. NATO's nuclear deterrent forces help ensure the peace and stability that will allow nuclear disarmament to be taken forward. Your Lordships may be relieved to know that Her Majesty's Government are not engaged in planning any nuclear wars at this time.

Lord Jenkins of Putney: My Lords, I thank my noble friend for that Answer. However, so that I may thank him with even greater conviction, will he be so good as to tell the House how he draws the line between consultations on nuclear matters with the US, in the circumstances which he has described, and discussions prohibited by the non-proliferation treaty?

Lord Gilbert: My Lords, as I am sure my noble friend is aware, various discussions are carried on from time to time under the procedures of the nuclear planning group. The details of those discussions are, of course, highly confidential.

Lord Chalfont: My Lords, just in case there should be any misunderstanding, can the Minister confirm that there is nothing whatever in the nuclear non- proliferation treaty which forbids consultation between nuclear weapons powers?

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