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Lord Razzall: My Lords, does the Minister agree that this is a moment for proactivity on behalf of his department? It is not for your Lordships' House to come up with ideas following the Question of the noble Lord, Lord Faulkner, but, for example, would not this be a perfect avenue for use by the retail distribution trade within London? Alternatively, what possibilities does it offer for CrossRail?
Lord Sainsbury of Turville: My Lords, it is not for the House or the Government to look for opportunities. The situation requires the Royal Mail to take a commercial decision. A consortium called Metrofreight was established to look at a proposal for using MailRail tunnels to deliver goods underground to retailers in Oxford Street. It became clear that this would cost in the region of £100 million, without a proper commercial return. It looks unlikely therefore that that scheme will go ahead. But there are other commercial possibilities and it is for the Royal Mail, which is seized of the issue, to consider them.
Baroness Andrews: My Lords, as the noble Lord will understand, for many reasons I wish that my noble friend Lord Hunt were here to answer the Question this afternoon. In my view, he was an outstanding Minister.
Health visitors will continue to play an important part in our measures to improve the nation's health and to tackle health inequalities. They have a crucial role in helping to deliver the Government's health priorities, including cancer and coronary heart disease prevention, improving older people's health and, of course, promoting the health of children and families.
Lord Clement-Jones: My Lords, I join the Minister in her reference to the noble Lord, Lord Hunt. I should like to express the sadness on these Benches at the very principled resignation of the noble Lord. He is held in universal high regard in this House and we will miss him greatly, even at starred Question Time.
Health visitors feel that they have been led up the garden path by the Government. When the nursing and midwives order was put through this House and another place, successive Ministers assured health visitors that their profession would be able to develop and expand. But is it not the case that despite massive support from the public consultation, the NMC has not been able to choose the name of the third register or the educational qualifications that it would wish to choose? In the light of the importance of family support and child development, is it not time that the Government had a rethink?
Baroness Andrews: My Lords, the noble Lord will want me to make a robust response in place of my noble friend Lord Hunt. I cannot agree with him. We took the line that we did on the order to ensure that rather than have health visitors in the title of the third part of the register there should be a broader commitment to developing the public health nursing profession. As the noble Lord in particular will know, entry into the profession is a matter for the Nursing and Midwifery Council, and another element of consultation will start very shortly.
Lord Laming: My Lords, during this period of change and uncertainty for health visitors, will the Minister do as much as she can to ensure that the liaison role that health visitors fulfil between hospitals and general practice is given proper priority by primary care trusts?
Lord Northbourne: My Lords, am I right in believing that it is the Government's policy to build on the confidence that parents have in health visitors and extend their role to give parenting and family support? How can this possibly tie in with requiring health visitors to spend four years qualifying if and when a suitable three-year course can be designed by them?
Baroness Andrews: My Lords, the noble Lord is quite right. In programmes such as Sure Start and in the development of the national service framework for children, the role of health visitors will be crucial, and we have every intention of giving them support and encouragement to enable them to play as full a role as possible.
Baroness Greengross: My Lords, because of the huge caseload that health visitors have, does the Minister agree that they largely have to ignore the promotion of the health of vulnerable elderly people in their area, as priorityrightly, in many waysis given to children? Does she agree that health visitors can only undertake certain work for which, in many cases, they are overqualified and undervalued?
Baroness Andrews: My Lords, the provision of health services is a matter for the primary care trust and the Workforce Development Confederations. I hope that any clash of priorities would be managed properly at local level. We would not want the health of elderly people to be sacrificed to any other part of the population, and I am sure that good management would prevent that happening.
The Earl of Listowel: My Lords, how many health visitors are currently in practice? With the rolling out of Sure Start and the implementation of the national service framework, can the Minister indicate how many more health visitors will be required and how she intends to meet the shortfall?
Baroness Andrews: My Lords, I may be wrong, but I understand there are between 10,000 and 13,000 health visitors in post. In terms of what we are doing to increase that number, which is I think the crucial question, we are delighted that we have been able to recruit an additional 40,000 nurses since 1997. That will give us scope to develop the profession. The increase in the headcount among health visitors is 5.2 per cent since 1997, and there is a planned increase in health visitors in training for the next two years. We are optimistic that by giving them a higher profile, we will be able to recruit the numbers we need.
Earl Howe: My Lords, I echo the comments of the noble Baroness and the noble Lord, Lord Clement-Jones, regarding the departure of the noble Lord, Lord Hunt, from the Government, and express the high regard in which he is held on these Benches.
Is the Minister aware that the health visiting profession, despite its growing importance, as she has rightly emphasised, is finding it increasingly difficult to recruit new members? Does she accept that the one way to inhibit recruitment is to insist that anyone wanting to be a health visitor has to have a nursing qualification as well?
Baroness Andrews: Yes, my Lords, which is precisely why we are not very happy with the concept of direct recruitment. We are keen to keep the nursing element in the health visiting profession because it is so important for the range of work that health visitors so.
Lord Clement-Jones: My Lords, were the Government aware that there would be no possibility of direct entry into health visiting at the time the order was put through? If so, why did they not inform health visitors? Are they now saying that it is impossible to qualify as a community practitioner by any route other than that of nursing?
Baroness Andrews: My Lords, as I have said, it is for the NMC to decide how best to regulate the profession. It can only regulate nurses and midwives with appropriate qualifications. Direct entry would mean that health visitors would not have to hold a nursing or midwifery qualification. In terms of other routes that might lead to the Health Professions Council at some point, we will have to see how the profession develops.
The Parliamentary Under-Secretary of State, Foreign and Commonwealth Office (Baroness Amos): My Lords, British pensioners in Zimbabwe, of whom there are 4,036, are not paid through the banks at the official rate of exchange. The Department for Work and Pensions pays British state pensioners in Zimbabwe in one of three ways, either through direct payments into a UK bank account, into an overseas bank in a country other than Zimbabwe or by payable orderin effect, a sterling cheque sent to the pensioner's home address. Pensioners are responsible for how pension payments made in sterling are converted into Zimbabwe dollars. Zimbabwe's independence constitution, agreed during the Lancaster House negotiations, made it clear that the UK Government would not protect Zimbabwe pension payments against the effects of fluctuating exchange rates.
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