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Lord Carter: My Lords, after the Third Reading of the Care Standards Bill, my noble friend Lord Whitty will, with the leave of the House, repeat a Statement which is being made in another place on the housing Green Paper.

Business of the House: Debates, 5th April

Lord Carter: My Lords, on behalf of my noble friend the Leader of the House, I beg to move the Motion standing in her name on the Order Paper.

Moved, That the debate on the Motion in the name of the Lord Peyton of Yeovil set down for tomorrow shall be limited to two hours and that in the name of the Earl Peel set down for the same day to three and a half hours.--(Lord Carter.)

On Question, Motion agreed to.

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Care Standards Bill [H.L.]

3.6 p.m.

Read a third time.

Clause 4 [Other basic definitions]:

Baroness Masham of Ilton moved Amendment No. 1:

    Page 4, line 8, at end insert--

("( ) "Nursing and care staff agency" means any employment bureau supplying nurses in any part of the Register of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting.").

The noble Baroness said: My Lords, first of all I must declare an interest as I have to use nurses agencies for my husband. These agencies differ considerably, with huge variations in standards. There is no doubt in my mind that minimum standards should be laid down in the Care Standards Bill for all these agencies providing nurses and carers.

We employ two people for my husband at the moment. One is a trained nurse and the other is a carer. Because my husband is large, he needs two people. They come through the same agency. It seems quite ridiculous to me that the agency which provides them would be in the Care Standards Bill for the carer but not for the nurse. Both these people live in our house and I expect the same standards from each of them, even though the nurse could undertake some procedures that the carer could not.

I have my name to Amendments Nos. 1 and 3, and 2 and 4. The Royal College of Nursing prefers Amendment No. 2 because nurses registered with the United Kingdom central councils are trained nurses. But both amendments are supported by Action on Elder Abuse, Age Concern, the Anchor Trust, the Association for Residential Care, the British Federation of Care Home Proprietors, the British Healthcare Trades Association, BUPA, the Care Forum (Wales), the Carers National Association, the Continuing Care Conference, Counsel and Care, the Hampshire Care Association, Help the Aged, the Independent Healthcare Association, Marie Curie Cancer Care, Mencap, the National Care Homes Association, the NESTA Healthcare Group, the Recruitment and Employment Federation, the Registered Nursing Home Association, the Relatives and Residents Association, the Royal College of Nursing, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, and the United Kingdom Home Care Association.

Clause 91 of the Bill repeals the Nurses Agencies Act 1957 and brings nurses agencies under the Employment Agencies Act 1973. That means that, instead of being licensed by local authorities, nurses agencies will become regulated in the same way as all other employment agencies, with the Department of Trade and Industry holding ultimate responsibility.

The Royal College of Nursing's Nursing and Care Agencies Managers' Forum has around 1,000 members who own or manage nursing agencies throughout the UK. The RCN has long argued for the

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need to update the Nurses Agencies Act 1957. However, the RCN is concerned that the proposals to repeal the Nurses Agencies Act and to regulate nurses agencies under the Employment Agencies Act 1973 will not provide sufficient protection for the public, including some of the most vulnerable members of society.

There are serious concerns that the move to give the DTI responsibility for regulating nursing agencies under the Employment Agencies Act will lead to an even weaker regime. The Employment Agencies Act does not rely on an inspection and monitoring regime, but rather relies on complaints to trading standards officers to trigger investigations. That seems inadequate when vulnerable people's lives are at stake.

It seems advisable and desirable that nurses should supervise the recruitment and placement of nurses. Nurses agencies should be required to register with a regulatory body and should be routinely inspected to ensure standards for all patients at risk. There should be a register of nurses agencies, so that performance can be monitored and operators can be traced, controlled and excluded where a practice falls below standard.

It seems to be the unanimous wish of all the associations concerned, including the Royal College of Nursing, that the national care standards commission should be the regulator for nurses agencies, and that to leave nurse agencies out of the Bill would be a big mistake. I hope that the Minister, representing the Government and your Lordships, will agree that the definition, "nursing and care staff agency", will be part of Clause 4 of the Bill. I shall be happy with whichever is the better amendment, so long as no agencies providing care to vulnerable people are left out. I ask the Minister to give an assurance that nurse assistants working in a hospital who come via an agency will be covered by the provisions of the Bill if Amendment No. 2 is preferred. I beg to move.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, with the leave of the House, it may be of assistance if I indicate that it is my intention to accept Amendment No. 2.

Earl Howe: My Lords, I should like to thank the Minister very much indeed for what he has just said. Perhaps I may speak to my Amendment No. 2. It may be helpful to the House if I add something to what the noble Baroness has said so ably. The difference between the noble Baroness's Amendment No. 1 and my amendment is merely technical in the light of drafting proposed by the Royal College of Nursing.

The noble Baroness has summarised the arguments very well. It seems extraordinary that we should have a Bill that regulates doctors' agencies and domiciliary care agencies but not nursing agencies. Nurses deliver care to people in all kinds of settings. That care can often be intimate; it can often involved dispensing medication and treatment; and not infrequently nurses

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are literally responsible for people's lives. Any agency that supplies nurses, whether to the NHS or direct to people's homes, must know what it is doing.

That means making sure, among other things, that the person responsible for the placements is accountable in a professional sense for the service given and is in a position to give proper support to the nurses. It is not satisfactory to have someone in charge of a nurses agency who knows nothing about the technical side of nursing or about issues such as medical confidentiality; yet that is what we could get if nurses agencies were to be regulated purely under the Employment Agencies Act.

I was particularly struck at Report stage by the intervention of my noble friend Lord Jenkin of Roding. The DTI, for all its many and varied talents, can hardly boast a great deal of expertise in the regulation of nurses agencies. That particular government department does not seem to be the right home in which to place this responsibility, especially because, when it comes to enforcement, its modus operandi is essentially reactive. Unless inspection and enforcement are regular and proactive, in a poorly run agency the damage might already have been done.

Like other noble Lords, I believe that this Bill--and in particular the commission--provides a much better vehicle for the regulation of nurses agencies. That is also the view of a great many providers and professional groups. Nothing in the amendment would prevent the DTI's employment agency protections from extending to nurses. Everyone is agreed that the Nurses Agencies Act 1957 has had its day. The question is what to put in its place. I am delighted that the Minister has taken the opportunity to reflect further on the matter and has seen fit to accept my amendment.

Lord Jenkin of Roding: My Lords, I should like to give my special thanks to the Minister for the promptness with which he has reflected on, and reacted to, the opinions expressed on all sides of the House. It is a wise move, and one which I hope the Front Bench opposite will imitate a great deal more often.

I was struck by one sentence in a letter I received. It said that people do not die of accountancy but they do die of inadequate nursing. That is the big difference. This decision is absolutely right and, again, I thank the Minister.

Baroness O'Cathain: My Lords, although I did not put my name to the amendment, I should have wanted to do so. I welcome what the Minister has said. However, I am slightly concerned that he has opted for Amendment No. 2 rather than Amendment No 1. I wonder whether "carers" employed by agencies will slip through the net. Many thousands of people employ not fully qualified nurses, but carers, in a domiciliary situation. Such people are often required to look after dysphasic patients--patients who do not need nursing as such, but who do need constant care because they are unable to do anything. Those employed are not necessarily nurses, but come through

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nursing agencies. I speak as someone who has employed such people for over eight years. Some of the qualities required of carers need to be, as it were, supervised, particularly if they are dealing with dysphasic or aphasic patients. They can get away, not literally with murder, but with not providing a satisfactory service.

Carers should be subject to the same regulations as nurses, and "nursing and care staff agency" would fit the bill. In my experience, employing carers through a "nursing agency" which has not been subjected to regulation has not been satisfactory on every occasion. I put that point to the Minister and hope that he will accept it.

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