§ 3.6 p.m.
§ BARONESS MASHAM OF ILTONMy Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
§ The Question was as follows:
§ To ask Her Majesty's Government what proportion of National Health Service hospitals employ nurses obtained through private agencies; and whether they consider that the payment of agency fees is a good use of public money.
§ LORD WELLS-PESTELLMy Lords, at September 30 last year agency nurses and midwives were employed in 14 per cent. of the National Health Service hospitals in England and Wales and formed 3 per cent. of the total employed. Agency nurses are brought in only when this is necessary to avoid serious adverse effects on services to patients in the National Health Service hospitals. A comparison of the total cost to the National Health Service of agency nurses with the cost that would have been incurred if nurses had been directly employed is not possible because agency charges vary and directly employed nurses are paid on a scale and not on a flat rate. But in some cases your Lordships will be interested to know that there is little difference when account is taken of paid sick leave, holiday and superannuation provisions for the directly employed nurses.
§ BARONESS MASHAM OF ILTONMy Lords, while thanking the noble Lord for his Answer may I ask him now how 812 many private agencies there are, and whether someone with nursing qualifications is always involved in the licensing and inspecting of the existing agencies? Also because the number of agencies is increasing, does he consider that it might be beneficial if the National Health Service ran their own?
§ LORD WELLS-PESTELLMy Lords, I am sorry that I cannot give your Lordships the actual number of agencies, but I will undertake to ascertain that number and, if the noble Baroness wishes me to do so, I will of course let her have it.
The nursing agencies are required by the Nurses Agency Act 1957 to be licensed, and all I can say in reply to that part of the question is that from April 1 1974, yesterday, the licensing authorities are the councils of the non-metropolitan counties, the London boroughs and metropolitan districts and the Common Council of the City of London. They have power to control the rate of commission that agencies take and from which they meet their overhead expenses and derive their profits. It is normal practice for licensing authorities to use that power.
§ LORD REIGATEMy Lords, would not the noble Lord agree that agency nursing is a very useful channel for the employment of those who may be temporarily in this country, particularly nurses from Australia, and so on; and that it is of the greatest help in the maintenance of hospitals in the centre of big cities, where living conditions are so difficult and so expensive? Arising out of the last supplementary question, is the noble Lord aware that certain hospitals in London are endeavouring to start their own co-operative agency for this purpose?
§ LORD WELLS-PESTELLMy Lords, I am much obliged to the noble Lord. It is perfectly true that we are dependent upon these agencies and that the teaching hospitals have set up a form of agency from which they hope to recruit qualified nurses.
§ LORD CROOKMy Lords, can the noble Lord confirm that if nurses were better paid, and therefore more were recruited, we should not need agencies at all?
§ LORD WELLS-PESTELLMy Lords, I am sorry to disillusion my noble friend, but this just is not so. It has been found by the Department that whenever the salaries of nurses have gone up, so have the payments to nurses by agencies. Consequently, if we judge from past experience, an increase in the wages to the directly employed nurses would not affect the situation.
§ BARONESS BROOKE OF YSTRADFELLTEMy Lords, can the noble Lord give us any idea of how many hospitals or wards have had to be closed as a result of the shortage of both agency nurses and National Health Service nurses?
§ LORD WELLS-PESTELLMy Lords, I have no information in that regard, but I will find out and let the noble Baroness know.
§ BARONESS SUMMERSKILLMy Lords, is my noble friend satisfied that the Royal College of Nurses agree with him when he says that the fact that nurses are under-paid is not the reason for the demand for agency nurses?
§ LORD WELLS-PESTELLMy Lords, I am not aware that the Royal College of Nurses think otherwise. I would refer my noble friend Lady Summerskill to a comment I made a short time ago, that, taking into account superannuation, paid holidays and sick leave, the real income of the directly employed nurse does not vary a great deal from that of the agency nurse.
§ LORD ABERDAREMy Lords, would it not be more appropriate if the agencies were licensed by the Area Health Authority rather than by the local authority? If licensing is the responsibility of the local authority, will the local authorities be instructed to have the closest possible liaison with the Area Health Authorities on the matter?
§ LORD WELLS-PESTELLMy Lords, this is a matter we could look into, but I would remind the noble Lord, Lord Aberdare, that the regulations which came into force yesterday, April 1, 1974, concern matters that could have been dealt with by the last Government.
§ LORD CAMOYSMy Lords, I should like to emphasise what was said by the noble Lord—
§ LORD CAMOYSMy Lords, can the Minister tell us what are the basic pay and conditions of the younger nurses as compared with similar persons who come through an agency? I have an idea that we do not pay our young nurses a sufficient amount.
§ LORD WELLS-PESTELLMy Lords, I cannot give the actual figures to the noble Lord, Lord Camoys, but if he is interested perhaps he will put down a Question to this effect, which I shall be very ready to answer.
§ LORD SEGALMy Lords, can my noble friend say what percentage of these private agency nurses are employed exclusively on night duty, when their responsibilities are likely to be less onerous?
§ LORD WELLS-PESTELLMy Lords, my understanding is that a high percentage of the agency nurses are in fact employed on night duty. I believe I am right in saying that comparatively few are employed in the ordinary day-to-day routine.
§ BARONESS STOCKSMy Lords, would the noble Lord agree that one disadvantage of this large proportion of agency nurses as compared with the regular hospital staffs is that one loses personal contact with the patient and in the ward?
§ LORD WELLS-PESTELLMy Lords, this is perfectly true. I think one has to bear in mind that with the nursing shortage there are coming back into the sphere of nursing a good many trained nurses who want to work for one or two days a week, and then not regularly every week. In that respect, agency nurses are fulfilling a very real need.
§ LORD ARDWICKMy Lords, can the noble Lord say what proportion of agency nurses are engaged in the London teaching hospitals?
§ LORD WELLS-PESTELLMy Lords, in reply to the noble Baroness, Lady Masham of Ilton, a moment ago, I said 14 per cent. of the National Health Service hospitals in England and Wales are served by agency nurses. I cannot give the actual percentage within the London area other than to say there are more employed in the London and metropolitan areas than in the rest of the country.
§ LORD SHEPHERDMy Lords, may I again suggest that we now proceed to the next business?