asked Her Majesty’s Government:

Whether they will take steps to ensure that the number of specialist nurses for long-term conditions such as Parkinson’s disease and multiple sclerosis will not be reduced within the National Health Service.

My Lords, the Government continue to support the development of a range of specialist roles within nursing. However, it is for local trusts to deploy specialist nurses in accordance with their local needs. There are more than 400,000 nurses working in the NHS, an increase of more than 85,000 since 1997. We recognise that there is now a much closer match between affordable demand for nurses and their supply. That is why we launched on 30 October a new framework for NHS employers for the NHS and social care to work in partnership for the benefit of displaced staff and new qualifiers leaving training.

My Lords, I thank the noble Lord for his reply, but it is rather worrying. Is he aware that, before my husband died, we had the expertise of a special diabetic nurse, a Parkinson’s nurse and a stoma-care nurse, who gave vital help to the family and to the ordinary nurses? Specialist nurses are the vital link between the specialist units within the hospital and the community. If their numbers are cut—this is a serious situation, because PCTs are running out of money—it will be a disaster.

My Lords, I am very pleased that the noble Baroness and her family had that level of support, which is testimony to the vital services that specialist nurses bring to people when they need them. More generally, we recognise the contribution that specialist nurses make, but we have to leave it to people at the local level to make decisions about priorities. It is right that they should continue to look at nursing establishments and how nurses are deployed and ensure that that represents the best way locally of using those skills.

My Lords, we all accept that local NHS organisations have to make decisions about how resources are allocated. Will not the Government nevertheless give a lead—particularly given that Brian Jarman’s research shows that specialist Parkinson’s nurses are cost-neutral to health services—so that we can ensure that the 11 quality requirements of the National Service Framework for Long-Term Conditions are met? I cannot see otherwise how we will be able to do it.

My Lords, the fact that we issued a national service framework indicates that we gave a lead. We set out very clearly what the expectations were around the pattern of services for people with those particular conditions. We continue, as part of the standards for the Healthcare Commission to inspect against, to require people to work in accordance with both NICE guidance and the national service framework. So we have not resiled in any way from giving a lead in this area, but it is down to people locally to make the decisions on the detailed deployment of personnel.

My Lords, is the Minister aware that, with multiple sclerosis, the biggest improvement in the last 10 years is due not to any tablets or treatment but to the access that patients have had to specialist nurses? I understand that the various charities, such as the Multiple Sclerosis Society, make quite a financial contribution to the funding of these nurses. Is that money earmarked for multiple sclerosis patients?

My Lords, it is true that the Multiple Sclerosis Society makes a valuable contribution in this area and indeed funds specialist nurses. The expectation in those cases usually is that the NHS will pick up the tab at the end of two to three years of funding from the charity. The overwhelming majority of those specialist nurses—and there are over 200 of them—are funded by the NHS as part of its services for people with multiple sclerosis.

My Lords, perhaps I may look at another illness—epilepsy. I declare an interest as chair of the All-Party Parliamentary Group on Epilepsy. Epilepsy specialist nurses are being made redundant or are allowed to spend only 10 per cent of their time doing epilepsy work, with the rest on general work. That is in complete contradiction to the NICE guidance, which states:

“Epilepsy … nurses should be an integral part of the network of care of individuals with epilepsy”.

I appreciate that decisions have to be made locally, but what advice and specific guidance are being given to ensure that the NICE guidelines are implemented?

My Lords, I say to my noble friend what I said to the noble Baroness, Lady Neuberger: the national standards, against which all trusts are inspected, require PCTs, acute trusts and other trusts to adhere to national service framework advice and NICE guidance. It is no good the noble Baroness, Lady Neuberger, shaking her head. That is the Government’s policy; it is integrated into the standards and that is the system that operates. We cannot micromanage the NHS from the centre of London. We have to leave people to make their judgments and take the consequences if the quality of their services is found to be inadequate by the Healthcare Commission.

My Lords, does the Government's advice include pointing out locally that, when a vacancy occurs in the NHS, all we have to do is to ask whether, if the vacancy is not filled, any patient or student will suffer?

My Lords, we are consistent in saying that it is for clinicians locally to decide what is the most appropriate care for their patients. It is down to the NHS locally to take into account the needs and safety of patients when decisions on resource allocations are made. I draw the noble Lord’s attention to the report produced by the Healthcare Commission, which showed that there was no evidence whatsoever that you cannot combine good-quality management and good-quality services with financial health.

My Lords, are there sufficient training programmes and places for specialist nurses to meet foreseeable future staffing needs?

My Lords, I am aware that there is a diversity of training programmes for specialist nurses. It is important to emphasise that those training programmes continue to be applied for and filled and we continue to produce newly trained nurses across the board to take up employment in the NHS.