FAMILY PRACTITIONER COMMITTEES (Hansard, 23 July 1984)

§ Mr. Kenneth Clarke
I beg to move, That this House doth agree with the Lords in the said amendment.
We have been persuaded by their Lordships to put on the face of the Bill an undertaking given by the Government which always met with the approval of the Opposition in both Houses.
It has been argued strongly ever since we proposed our new arrangements for the independent status of family practitioner committees that one of the members of a new committee should be a nurse with community experience.
When we debated the Bill in this House, I kept giving undertakings on behalf of the Government that we would ensure that that was the case when we appointed the FPCs. I regret that, even in another place, there were unworthy suspicions that that undertaking might not be honoured —not by present Ministers but by our successors. In answer to that, someone succeeded in finding a way of putting the necessary provision on the face of the Bill. I do not recall that either House at any stage argued that there should not be a nurse with community experience included as a member of a family practitioner committee.
I suggest that at this stage we congratulate the other place on getting it put into the Bill and that we agree with the amendment.

§ Mr. Dobson
As the Minister said, this amendment meets an undertaking given by the Government. It appears 728 that, following certain salutary events in the other place, the Government now take more notice of expressions of cynicism by their Lordships about the Government's good intentions than they do of similar expressions in this House. A good deal of cynicism was expressed about whether even present Ministers—and certainly future ones—would honour undertakings given in the House that did not appear on the face of the Bill. Now that those expressions of cynical amusement have apparently been expressed in the other place as well, the Government have decided that they had better still the discontent by accepting what other people have been proposing all along should be included in the primary legislation.
We welcome the provision that each family practitioner committee will now include a nurse, a midwife or a health visitor who has some record of that type of work in the community. This may be my last opportunity to mention to the Minister my experience as a member of one of the formerly constituted family practitioner committees. Whenever we wanted to discuss any community nursing matter, the person who shuffled in was the gaffer of a group of nurses working in a hospital whose experience was not necessarily all that relevant to what we wanted to discuss.
We congratulate the other place on pressing more effectively than we did for an amendment along these lines.

§ Mr. Kennedy
The alliance welcome this amendment. However, when thanking their Lordships, we should not ignore the fact that it was not just the official Opposition who supported the change. My noble Friend Lord Kilmarnock was also extremely supportive of the idea that some kind of nursing representative should be a member of each FPC. I am sure that the Minister will be the first to acknowledge that.
We have been through the arguments about whether the greater independence of FPCs will allay the fears of the National Association of Health Authorities, but it is a pity that the Government did not take advantage of the opportunity presented to them to dilute the powers of the Secretary of State to control the composition of FPCs. We on the alliance Bench would argue that they would have been well advised to inject an element of direct election into the composition of the committees, in much the same way as we would like to see it on health authorities generally. It is a pity that that element is lacking, but perhaps the Minister will take advantage of a future Bill to introduce a provision along those lines.

§ Mr. Pavitt
I can understand the Minister's evident exasperation. On one of the few occasions when he is doing all the right things and we are praising him and thanking him, just like Oliver Twist we immediately ask for more. That is certainly true of this Lords amendment.
It is right that district nurses, health visitors and nurses with community experience should serve on FPCs. Their presence has been lacking for a long time. The problem now is to deliver. The additional qualifications required will present a problem in the coming months. The Government have cut £2 million from the funds available for the education and training of nurses. One of the scandals affecting district nurses and health visitors is that nursing is probably the only profession where a state registered nurse wishing to acquire additional qualifications has to pay her own fees and then, when she has 729 passed her examinations and qualified, gets no additional increment. She is paid precisely the same as she was before.
I am glad that the Government have seen the light and that the Lords have put this provision on the face of the Bill. However, the problem remains that, unless there is a change of policy about nursing education, in future the family practitioner committees will have a smaller and smaller pool of district nurses and health visitors on which to draw. They are very busy people. They do a full-time job. The additional responsibility of attending committee meetings will make further inroads on their time—for which they will get no additional remuneration.
I apologise to the Minister, because he has been extremely good to me today. Even when he is being good, I twist his arm to look at the problems which arise when he comes to implement the good that he has done. It is no good having a provision on the statute book if, when it comes to implementing it in two or three years, people are not available for a number of reasons, one of the most important being the £2 million cut in nursing education.

§ Mr Kenneth Clarke
It would be wise of me to resist being drawn into an argument about a new feature of our alleged cuts in the Health Service—a feature with which I am not instantly familar. We are trying to increase the emphasis on community nursing and community services in general throughout the NHS. That applies to the hospitals and to general practice. I am glad to say that there is a welcome and continuing increase in the number of nurses both being trained and engaged in community nursing. Without being drawn into a discussion of the hon. Gentleman's ideas about training problems, I can assure him that we will continue to give a high priority to increasing the quality of training in this field and the numbers of nurses who specialise in it.
The hon. Gentleman has suggested that I must be feeling exasperated. That is not so. We have at last reached a stage in our discussion of the Bill when all four hon. Members who persist in discussing it—including myself —are in complete agreement about the amendments that have been made in another place and the policies which underlie them. Our proceedings will end on a happy note of unanimity.