Nurse Prescribing (Hansard, 30 January 1991)

§ Mr. Dudley Fishburn (Kensington)

I beg to move, That leave be given to bring in a Bill to amend the Medicines Act 1968, the National Health Service Act 1977 and the National Health Service (Scotland) Act 1978 in respect of pharmaceutical services; to make provision for registered nurses to prescribe medicinal products in certain circumstances; and for connected purposes. The purpose of my Bill is straightforward. It is to give nurses the authority to write prescriptions for a limited number of medicines. Although hundreds of thousands of patients receive care at home from Britain's 28,000 community nurses, and although it is those nurses who determine what medicines or medications are needed for re-supply, only a doctor can sign the necessary prescription form. This is a bureaucratic bottleneck that needs breaking. The object of my Bill is not to involve nurses in the diagnosis of a disease or its treatment—none want that—but to allow them more responsibility in the long-term, continuing management of a patient's care.

This is a liberalising Bill. It costs nothing. It increases efficiency and diminishes suffering. Imagine someone with a disability or a chronic disease or whom age has made infirm. A routine medication that he needs, often something ordinary such as a dressing or a lotion, runs out. The community nurse who visits regularly can do nothing, so the patient has to lug himself down to the nearest surgery—often long distances in the country—or through heavy London traffic, and wait in a queue for the doctor to fill in a form. Such madness imposes suffering and strain on hundreds of thousands. It causes frustration in the nursing profession and unnecessary inefficiency in the medical one.

The Bill would do away with the need for doctors to waste their time writing out prescriptions for such things as bandages or repeat dosages of pain killers. Nurses who had had training to the highest standards would be able to write them instead, but only from an agreed list of products—a nurses formulary, as it would be called.

This decent liberalising measure is already in place in countries such as Canada and the United States, but in Britain there has been unpardonable delay. Report after report has looked into the suggestion that nurses should be given the power to prescribe, and report after report has said that we should go ahead with it because it is a good idea which will streamline procedures.

First, a committee headed by my noble friend Lady Cumberlege reported in 1986. A year later, the Select Committee on Social Services recommended that the Government get a move on. The Department of Health decided to go over the ground itself once again and its report was even more emphatic. It said, "Let nurses prescribe," and set a deadline of this year for making the legislative changes. Those changes constitute my Bill.

Section 52 of the Medicines Act 1968 needs amendment so that pharmacists can recognise prescriptions written by nurses. Likewise, section 27 of the National Health Service Act 1977 needs amendment so that prescriptions written by nurses can be dispensed.

The whole thrust of health care, not just in Britain but throughout the west, is to allow those who are elderly, disabled or chronically ill to get as much treatment at home as possible. It is cheaper and it is better that way. A 945 successful system of health care is one that keeps as many people as possible away from the queue at the doctor's surgery or the hospital clinic.

That is why the British Medical Association wants to see the legislation passed. It knows that nurses already write out prescriptions unofficially for the overworked doctor to scrawl his incomprehensible signature on. But it knows, too, that that is not good practice.

Britain's nurses want the change and the responsibility and training that would go with it because they want the best, fastest, most uncluttered service for their patients. They can see the absurdity of cancer patients suffering great pain at home who cannot have the dosage of their painkiller altered by the nurse who looks after them. They know the inconvenience facing an incontinent elderly person who cannot even get something as simple as a bedpad without a visit to the doctor.

But most of all, it is the public who need the change. The extension of limited prescribing rights to nurses is supported by groups such as Age Concern and the Spastics Society, by those trying to help the homeless, who generally do not have resort to a general practitioner, and by those helping the terminally ill to live out their last days without disruption.

But the net goes far further than that. Just to give one example, thousands of diabetics who regularly have to inject themselves with insulin would be able to get their supplies of syringes from their community nurses.

The Bill appeals to me as a Conservative, as I know it appeals to those on the Opposition side who have supported me, because it liberalises, because it strips back a layer of form filling, because it costs nothing. It reflects the times by allowing the best modern practice and it reflects a need—the need to deliver our health services with the maximum of efficiency and a minimum of fuss. I commend it to the House.