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Lord Clement-Jones: My Lords, the Minister referred to the number of training places that are being created--and, of course, they are welcome--but, as his own consultation document, A Health Service of all the talents: Developing the NHS workforce, acknowledged, the rule whereby 50 per cent of the cost of those training places must be borne by the trusts is one of the key problems in manpower planning at the moment. What can the Minister say about that? What has been the result of the consultations, which were due to finish in mid-June?

Lord Hunt of Kings Heath: My Lords, in essence, a national levy provides 50 per cent of the basic salary costs for senior house officers and specialist registrars. NHS trusts have to find the remainder of the costs. I recognise that this is a particular issue and that there have been concerns that some trusts were not prepared to fund the extra number of specialist registrar places. I am glad to say that trusts have indicated that they wish to take up the 40 extra places which will be coming on-stream this year. We shall, of course, keep the situation under review. We have made it clear to NHS trusts that we expect them to invest in these posts.

Baroness Trumpington: My Lords, forensic pathology plays a very important part in dealing with crime. Is there a shortage of forensic pathologists?

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Does that impact on the National Health Service? I should declare an interest as an honorary Fellow of the Royal College of Pathologists--why I do not know, except that I feel it may have designs on the two kippers that I call my lungs.

Lord Hunt of Kings Heath: My Lords, the royal college has certainly chosen well. The main shortage is in relation to histopathologists, whose role is to examine human tissues and undertake post mortems. I am not aware of the statistics in relation to forensic pathologists but I shall be happy to look into the matter further. My understanding is that the key problem is in relation to histopathologists, where we wish to see a large increase in the number of specialist registrar posts.

Lord Turnberg: My Lords, does my noble friend agree that the major problem concerns recruitment into histopathology? There are currently more than 100 unfilled histopathology posts in the UK, which is 10 per cent of the total. The problem goes back to recruitment into the training grade posts and the funding issue to which my noble friend referred. Does the Minister agree that the Government should focus their efforts on enhancing recruitment into the specialty and on ensuring that the trusts fund those posts?

Lord Hunt of Kings Heath: My Lords, I do not disagree with any of the points raised by my noble friend. Certainly the increase in the number of specialist registrar training places is based on the assumption that they will be funded by NHS trusts--which I fully expect them to be. That will mean that more people will be coming through in the future to fill consultant posts. Equally, I accept that we need to attract medical students into considering pathology as a suitable specialism for them to enter. We are working well with the Royal College of Pathologists. We need to work together to show medical students the attractions of the pathology profession. I believe that pathologists have a very important role to play in the NHS.

Earl Howe: My Lords, last year the Government announced a £10 million capital fund for modernising pathology services in the NHS. Can the Minister say whether all that money has been allocated and whether he thinks that £10 million is adequate?

Lord Hunt of Kings Heath: My Lords, we need to invest in pathology services. At the moment the National Health Service has a high level of pathology services, but there has been under-investment. Certainly in the future we need to look at ways to ensure that resources are made available in order to develop those services and to ensure that the quality of the kit and the actual facilities are of a high standard. In terms of future investment, within the national plan

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we are in the process of developing proposals for services. Inevitably we shall be looking at pathology developments within that.

Baroness Sharples: My Lords, the noble Lord did not answer me when I asked him about the shortfall.

Lord Hunt of Kings Heath: My Lords, I do not have specific figures for a shortfall. Those are issues which fall to be dealt with locally. But I have said that I believe that the increase in the number of specialist registrar training places will enable us to overcome many of the problems that undoubtedly are occurring at the moment.

Agency Nurses: Percentages

2.51 p.m.

Baroness Masham of Ilton asked Her Majesty's Government:

    What percentage of nurses employed in London hospitals are agency nurses.

Lord Hunt of Kings Heath: My Lords, no data are collected on the number of agency staff working in London at any one time. But the Government have already indicated in their response to the Health Select Committee that the NHS needs to reduce its dependency on temporary staffing. We are ensuring that it takes action to do so.

Baroness Masham of Ilton: My Lords, I thank the Minister for that rather inadequate reply. Does he agree with me that sometimes agency nurses with inadequate training are placed on highly specialised wards? Does he further agree with me that this puts patients in a vulnerable position? The nurses feel inadequate. When will sisters come back to work on the wards to give this much needed instruction?

Lord Hunt of Kings Heath: My Lords, sisters play a vital role in leadership in wards. The Government are determined to give as much support as they possibly can to their work. I fully accept the noble Baroness's point. We must ensure that when agency nurses are placed in ward situations they are suitably qualified and are able to accept the responsibility placed on them. Part of the work that we are undertaking, both at national level and in London, is to ensure that we develop good practice so that trusts use agency nurses appropriately where they have to be used, and to ensure that we have other mechanisms by which trusts--perhaps through nurse banks, sharing services between different trusts--can reduce the need for agency nurses.

Lord Campbell of Alloway: My Lords, may I respectfully direct the Minister to the Question and ask him whether he would be good enough to answer it and refrain from bamboozling this House with verbiage?

Lord Hunt of Kings Heath: My Lords, I think that I did answer the Question. I said that no data have been

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collected on the number of agency staff working in London at any time. The issue is a serious one. An analysis of the amount of money spent by NHS trusts on agency staff indicates that in London it varies as a percentage of employee costs from between 2 per cent and 15 per cent, with an average of around 9 per cent. It is the Government's contention that while there will always be a need for agency nurses, that figure is too high and we need to reduce our dependency; hence the work both in London and nationally to deal with the problem.

Lord Morris of Castle Morris: My Lords, can my noble friend kindly explain why an efficiently run National Health Service needs to use any agency nurses except in cases of dire emergency? Could it be the result of bad planning in the past?

Lord Hunt of Kings Heath: My Lords, the party opposite has a good deal to answer for. It has a good deal to answer for as regards its decision in the 1990s to reduce the number of nurse training places. Noble Lords will know that we have reversed that trend and increased dramatically the number of nurse training places. In answer to my noble friend I would say that there will always be a need for some agency staff--to cover increased demand for staff when it is uncertain how many staff one needs, periods of high activity and to cover holiday periods and sickness. I would say also that when nurses return to work as nurses, which we want to encourage, there is some evidence that many of them prefer to return through agency nursing programmes. The way to tackle this issue is: first, to increase our efforts to recruit more nurses--and that is happening--secondly, to increase the number of nurse-training places--and that is happening--and, thirdly, to increase the use of nurse banks--and that is happening. In combination, I think that we can reduce the number of agency nurses.

Lord Clement-Jones: My Lords, the Minister referred to the success of the nursing recruitment drives. The fact is that in the past year the cost of agency nurses has increased on a national basis from £264 million to £344 million. It was recently reported that we are recruiting nurses from as far afield as China. Surely the Minister cannot claim that that is a success.

Lord Hunt of Kings Heath: My Lords, the national nurse recruitment campaign has been successful. For instance, nearly 14,000 qualified nurses and midwives have approached their local education consortia for information about either becoming nurses or returning to nursing and 3,845 nurses and midwives have already returned to employment in the NHS in England. A further 2,000 are preparing to join them after completing refresher training. With regard to the recruitment of overseas nurses, the health service has always recruited nurses from overseas. That has been beneficial both to the UK and to those countries. It has

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enabled links to be maintained. It helps our health exports. It is done on an ethical basis. I see no problem with that.

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