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Lord Clement-Jones: My Lords, I wish briefly to offer the strong support of these Benches to the amendments--particularly Amendments Nos. 8A and 10A. It is common ground between all speakers that the current system is not perfect. I do not think that

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anyone is making that claim. I was extremely interested to hear what the noble Lord, Lord Jenkin, had to say. I can think of few government departments less suitable for this role than the DTI. Perhaps the Treasury would be the best depository. It is extraordinary that the DTI should be suggested as the department to be responsible for governing the nursing agencies in these circumstances.

It is clear that we should bring the provisions of the Nurses Agencies Act into line with those for doctors agencies. After all, the Minister has made concessions in that area only today. We should seize the opportunity of this Bill to bring nurses agencies under the national care standards commission. Noble Lords on these Benches, in line with all other noble Lords who have spoken, strongly urge the Minister to do just that.

Baroness Gardner of Parkes: My Lords, I rise to add my comments on the amendment. I would have added my name to it, but by the time I came off the Woolsack last night and telephoned to do so, it had already gone to print. But I strongly support the amendment.

I have received a briefing from the Royal College of Nursing. Yesterday afternoon it attended a meeting with us and set out the points made by the noble Baroness, Lady Emerton. The RCN is quite aware that something needs to be done about the Nurses Agencies Act 1957 but it is clear that moving responsibility over to the DTI is no answer.

I have no interest to declare, but many years ago I ran an employment agency. When at that time one applied for an employment agency licence, one had to sign an undertaking that one would not attempt to deal with nursing staff of any kind. It was always clearly recognised that nurses required a type of procedure and regulation different from those applicable to other employment agencies. To put the two together now, all these many years later, would be a retrograde step.

At present, local authorities carry out inspection. Where that works well, it works very well. But in some areas it does not work at all well. Inspection is patchy over the whole country. The care standards agency could still use local authorities to carry out much of the day-to-day inspection. That would not throw a great deal of additional work on to the care standards agency, but it would mean that control was with the body that properly understood the situation. This is a very good amendment and I support it.

Lord Hunt of Kings Heath: My Lords, I certainly recognise the strength of feeling on this issue in your Lordships' House. I also recollect that due to the lateness of the hour in Committee we were not able to debate this matter thoroughly.

Noble Lords are agreed that the current system is not operating very effectively. In practice, it offers little protection for those receiving care from nurses supplied by agencies and little protection for the nurses themselves. The evidence seems to be that the Act is inconsistently applied throughout the country and is

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open to wide interpretation. The aim of the Government's proposals was intended to create a level playing field for nurses agencies. Bringing them under the Employment Agencies Act would therefore mean that they would be regulated under the same system as all other employment agencies.

Noble Lords have expressed concern about the repeal of the Nurses Agencies Act. It has been said that we are removing a system of inspection and licensing. Under the proposals before the House, nurses agencies would, like all other employment agencies, come under the remit of the Employment Agencies Standards Inspectorate. The inspectorate responds to concerns and complaints about agencies. That enables it to target its efforts where problems have been identified. The inspectorate also has the powers to carry out spot checks on agencies. It has strong enforcement powers and can prosecute agencies that do not comply with regulations. Prosecution can also result in fines being imposed. The DTI, which has not come in for universal approval in this area, can also seek to prohibit agencies from operating for up to 10 years.

The Employment Agencies Act provides a much tougher framework of protection for agency nurses and those they care for than in practice we have at the moment. Although the noble Earl, Lord Howe, described that framework of protection as being wholly inadequate, I remind him that it was the previous government who introduced that legislation. I believe that the framework is sufficient to provide the safeguards that people rightly require.

I turn to the specific amendment moved by the noble Baroness, Lady Masham.

Lord Jenkin of Roding: My Lords, the noble Lord has certainly succeeded in confusing me. We are all agreed that the Nurses Agencies Act is not working very well. However, if, when he referred to legislation introduced by another government--of which I might well have been member--he intended to refer to the Employment Agencies Act, that was not entirely clear from what he said.

Lord Hunt of Kings Heath: My Lords, I apologise to noble Lords. It was my intention to refer to the Employment Agencies Act.

Baroness Gardner of Parkes: My Lords, can the Minister also make it clear that currently the Employment Agencies Act does not cover nurses agencies?

Lord Hunt of Kings Heath: My Lords, I can. I referred to the inadequacies of the legislation that now applies to nurses agencies. All noble Lords agree that that is unsatisfactory. I refer to the potential of the Employment Agencies Act, if it applied to nurses agencies, compared with the current situation which all noble Lords agree is unsatisfactory.

I turn to the specific amendment moved by the noble Baroness, Lady Masham, and spoken to by the noble Lord, Lord Rix. We have carefully considered the

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option of requiring nurses agencies to be regulated by the commission, but there is a genuine issue as to whether nurses agencies should be treated differently from agencies that supply other healthcare professionals. We must also take into account the very strong regulatory framework within which nurses are regulated through the UKCC, which itself provides the public with a great deal of comfort and safeguards.

Baroness Gardner of Parkes: My Lords, the UKCC attended the meeting yesterday and made clear its understanding that at the moment the whole system was in the melting pot. Can the Minister confirm that? Is the noble Lord aware that the UKCC also supports this amendment?

Lord Hunt of Kings Heath: My Lords, various changes are proposed to the regulation of nurses alongside the regulation of other professional staff within the National Health Service. As to the successor body to the UKCC, I can assure noble Lords that the regulation of that profession will be no less robust than at present.

I make two other points in relation to how the Employment Agencies Act would operate if it embraced agency nurses. First, I assure noble Lords that we would closely monitor and keep under review the new arrangements so that if problems arose we could take further action. For example, under the Employment Agencies Act we would have power to make regulations directed specifically at nurses agencies if the need arose.

None the less, having intimated to noble Lords the reasons why the Government consider that to embrace nurses agencies within the Employment Agencies Act would be a better option than the present situation, we recognise the strength of feeling expressed this afternoon. With the leave of the House, I shall reflect on the matter between now and Third Reading. On that basis I ask the noble Baroness, Lady Masham, to withdraw her amendment. I do not disagree with the concerns expressed today by noble Lords. It is important to ensure that, whatever route is adopted, nurses agencies are regulated effectively. I believe that what we propose is satisfactory, but none the less I should like to consider the matter again.

4.15 p.m.

Earl Howe: My Lords, before the noble Lord sits down, is he able to answer the specific queries that I raised about nurses banks and VAT reclaims for NHS trusts?

Lord Hunt of Kings Heath: My Lords, that is a matter that I should like to consider. My understanding is that VAT would have minimal effect. If NHS nurse banks were to be embraced within the Employment Agencies Act, we would look at ways in which they could be exempted from it.

Baroness Masham of Ilton: My Lords, I thank all those who have supported the amendment. I do not want fragmentation; I am a supporter of joined-up

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government. I believe that to leave the largest group of employees--nurses--out of the Care Standards Bill is wrong. However, I am encouraged by the Minister's response. The noble Lord has assured the House that he will look at the matter again. The amendment has received a good deal of support, and I hope that the Minister will take note of it. I shall stay on the noble Lord's back. It would be better if the Government tabled their own amendment. We do not want nurses to be left out of the Bill because that would cause fragmentation. If the noble Lord does not table an amendment at Third Reading, I shall do so. On that basis, I beg leave to withdraw Amendment No. 8A.

Amendment, by leave, withdrawn.

[Amendment No. 9 not moved.]


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