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Lord Clement-Jones: My Lords, attracting professionals back from the private sector is often a matter of attracting them after they have brought up a family. How successful has the Government's campaign, launched in January 2001, been in bringing more midwives back to the NHS?

Lord Hunt of Kings Heath: My Lords, midwives are a very important group, and we certainly expect them to benefit from the initiatives we have introduced to encourage a return to practice. Those initiatives

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include flexible working practices, family-friendly working policies, and access to further continuing professional development—an important component in ensuring that midwives feel that the NHS is a place where they want to work.

The Lord Bishop of Hereford: My Lords, can the Minister confirm that one of the areas of difficulty is over agency nurses? Many nurses are attracted away from the NHS to work for agencies where pay is higher. Does he agree that the reason for that is very often the mismatch between the NHS nursing establishment and the actual need for nurses in a given hospital? For example, if the nursing establishment is calculated on the basis of 85 per cent bed occupancy, but the hospital is actually experiencing 98 per cent bed occupancy, there is immediately created a market for agency nurses. Is it possible that the bed occupancy rate can be recalculated so that the NHS nursing establishment is adequate for what is needed in a particular hospital?

Lord Hunt of Kings Heath: My Lords, there is no doubt about it: one of the key challenges facing us is to increase our capacity to deal with the patients whom we need to treat, and recruiting more staff is a very important part of that process. It is worth pointing out that, from 1997 to 2002, we increased the number of nurses working in the health service by nearly 40,000, a very important achievement. However, I agree with the right reverend Prelate that we need to reduce our dependence on agency nurses. That is why we have launched a new scheme called NHS Professionals in which we offer NHS employment conditions to staff wishing to be employed flexibly. The scheme is starting to get a grip on the issue within the health service, and I hope that, as it develops, we will indeed reduce our dependence on agency nurses and the costs accruing from that dependence.

Baroness Pitkeathley: My Lords, on the matter of flexible working practices, is consideration being given to encouraging nurses, for example, to work in both the secondary and the primary care settings and in community-based activities?

Lord Hunt of Kings Heath: Yes, my Lords. As the role of nurses in the community has developed over the years, evidence has shown that a number of experienced nurses from the hospital sector have gone into nursing in the community, and vice versa. We should certainly encourage that. I also believe that the development of nurse consultant posts, which reward nurses for staying in clinical leadership and practice, is another way of enhancing the profession and making it attractive to nurses with a lot to give but who do not wish to go into management.

Baroness Masham of Ilton: My Lords, does the Minister agree that, sometimes, especially at night, very young qualified nurses are put in a position of great responsibility although they feel that that is too much for them and that, subsequently, some of them

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throw in their hand? Will he also tell us what has happened about the sisters and the matrons he promised?

Lord Hunt of Kings Heath: My Lords, the noble Baroness is right to point out that we depend very much on nurses, often on newly trained nurses, and that they face many pressures. I do not think that there is any doubt about that. The long-term answer is to increase the number of nurses employed within the National Health Service. That would result in more nurses on the wards. Student and newly qualified nurses could then look to more experienced nurses for advice, management and skilled leadership to make them less vulnerable. In the mean time, we are redoubling our efforts to ensure that newly qualified nurses in particular are given appropriate supervision. We are keen to see the development of the concept of modern matrons, which involves giving nurses back the authority that they have lost over the past 20 years. The more authority a nurse has on a ward, the better that ward will be run.

Lord Skelmersdale: My Lords, when will the Government start to look at health provision in the round? Does it really matter whether health provision comes from the private sector or the public sector? The Minister has been talking about attracting nurses and, to an extent, consultants back into the National Health Service from the private sector.

Lord Hunt of Kings Heath: My Lords, we have set up workforce development confederations at local level to consider the needs of the health service in terms of how many people need to be trained to meet future requirements. The workforce confederations also take into account the likely demand from the private sector. I agree with the substance of the point that the noble Lord raises; namely, that if you consider a local healthcare system in the round, you need to consider the contribution that the private sector makes bearing in mind that the NHS purchases about 7.5 per cent of all the work undertaken in the private healthcare acute sector at the moment and that, in the area of long-term care, nursing homes and residential homes have a critical bearing on our ability to discharge patients from hospital when they no longer need treatment.

Baroness Finlay of Llandaff: My Lords, what is being done to clear the backlog of medical trainees who apply for flexible training posts but are currently told that there is no funding for flexible training and that therefore they either have to work full time or take a career break and in so doing are lost to the service?

Lord Hunt of Kings Heath: My Lords, our aim is to have up to 1,000 doctors on a flexible career scheme by 2004. I was not aware of the problems raised by the noble Baroness but I should be happy to look into the matter.

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Overseas Hauliers: Charges

2.53 p.m.

Lord Bradshaw asked Her Majesty's Government:

    What progress has been made on the introduction of a carnet system for foreign hauliers.

Lord McIntosh of Haringey: My Lords, the 2001 Labour Manifesto made a commitment to,

    "ensure that hauliers from overseas pay their fair share towards the cost of our roads".

In the 2001 Pre-Budget Report, the Chancellor gave a commitment that the UK haulage industry would not pay any more as a result of the introduction of a charge and consulted on options to deliver that commitment.

In Budget 2002 the Chancellor announced that the Government aimed to introduce a distance-based lorry road user charge in 2005 or 2006. Since the Budget, detailed work has been undertaken on how to administer and procure the charging systems. The recent Pre-Budget Report announced that the Government will publish a second progress report early next year.

Lord Bradshaw: My Lords, I thank the noble Lord for that reply. Will he indicate whether the charge to be paid by foreign hauliers will correspond to the road user charge and the environmental charge that should be levied on a typical five-wheeled vehicle? If that is not the case, why will they be charged less?

Lord McIntosh of Haringey: My Lords, I do not believe that the amount to be charged is the most urgent priority. In consultation with the industry we have chosen probably the most technically advanced but the best scheme which comprises a distance-based charging scheme rather than a time-based charging scheme. It requires satellite technology. The technological aspects of the scheme are being studied and will be reported on again soon. Questions regarding the amount of the charge will properly follow from that.

Lord Clinton-Davis: My Lords, will my noble friend indicate whether any discussions have taken place on the issue with the European Commission and, if not, why not?

Lord McIntosh of Haringey: My Lords, discussions certainly have taken place with the European Commission. As the noble Lord, Lord Clinton-Davis, knows, the European Commission has issued a directive on the Euro vignette system but at the moment that applies only to motorways. We are keen for a charging scheme to be extended. Germany and Austria are already working on that and we are in close contact with them on the matter.

Lord Berkeley: My Lords, the House should welcome the fact that the new carnet system for foreign lorries will be based on distance travelled. But how will it promote fair competition vis-a-vis British hauliers

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whose payment through tax, vehicle excise duty, fuel duty or whatever is based not on distance travelled but largely on a lump sum per annum?

Lord McIntosh of Haringey: My Lords, fuel duties are based on distance: the more you travel, the more fuel you use. In that sense, the new system will be directly comparable. What we said, and what we shall stick to, is that there will not be any additional charge for the UK haulage industry. I am not saying that it is certain that the rebates, in effect, to the UK haulage industry will take the form of reduced fuel duty but that certainly seems the most likely possibility.

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