Draft Nursing and Midwifery Order and Draft Health Professions Order 2001

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Mr. Heald: On a point of order, Mr. O'Brien. As we are having a separate debate on the Health Professions Council Order, would it not be more appropriate to deal with that matter then?

The Chairman: I do not know how far the Minister intends to go on that issue, but it would be in the Committee's best interests if those remarks were reserved to the next debate.

Mr. Hutton: I am happy to leave my remarks on chiropodists to the next debate, Mr. O'Brien.

It is probably time for me to wind up. I pay tribute to the existing councils and boards for their achievements. They have striven hard to balance independent professional standards and to engage more openly with a wider public, but as CPSM chairman Brian Edwards said in the last annual report:

    ``We have struggled within an archaic statutory structure''.

The UKCC and CPSM have frankly acknowledged the need for greater alignment between the policies and procedures of all the regulatory bodies and for a less prescriptive legal framework. The experience of both councils and the boards means that their successors start with a good deal more than a clean sheet, but a good deal less than a blueprint. I wish them every success. We have a rare opportunity to overhaul radically a regulatory system that is crucial to safeguarding the quality of professional practice and the provision of patient care. I commend the order to the Committee.

4.56 pm

Mr. Heald: I start by welcoming you to the Chair, Mr. O'Brien, as the Minister did. I thank him for arranging for me to have a briefing with officials this morning. That was helpful and kind.

I welcome the thrust of the orders. We accept the need for regulatory bodies to be smaller, more streamlined and able to act swiftly and transparently with those who require regulation. We also accept that the principles outlined in the review by JM Consulting are correct on the creation of a new and stronger council for the health professions to replace the CPSM. We believe that similar principles apply in the order.

The multi-professional approach to developing procedures and the broader membership base should reduce bureaucracy and improve standards. We are, however, concerned that it has not been possible to resolve some of the thorny issues that arose during consultation. Draft orders cannot be amended, so we must consider, in the light of the Minister's comments, whether these orders are satisfactory as they stand.

As the Minister has said, the controversy about the first order relates to the absence of health visitors from it, its title, its committee structure and its mandatory register. The Government's response in correspondence and today has been that health visitors will have parity of representation with nurses and midwives on the new council and that legislation will provide for the separate registration of public and community health specialists.

There is a difference between public and community health specialists, which is how health visitors and others are described in article 6, and plain health visitors. That has caused much concern, because of the wider definition and the ability, under article 6, for the council to refer to the Privy Council a proposal for an order that could abolish that category or change its definition to exclude health visitors. As the Minister knows, the Royal College of Midwives—perhaps he will tell us whether this is also true for the Royal College of Nursing—does not accept that there should be any third category. In its view, there should be a register for nurses and midwives, with health visitors and other public and community health specialists who are also nurses or midwives having their additional qualifications marked in some way, but not as a separate category on the register.

The category that the Minister is talking about could include health visitors, but it makes a profession vulnerable if it could, at any time, be outvoted by two other professions that do not believe that it is a separate profession. If that happened, there would be a proposal to the Privy Council to change that category of the order.

The grassroots network and individual health visitors state that health visiting is a discrete profession with a long history of being flexible and providing something that the public want, and that the Government and the Opposition value. There has been a register of health visitors since 1925, but the profession dates back to 1860. It has huge achievements as a distinct profession: for example, up to the 1920s, health visitors were one of the main forces imposing sanitary hygiene in households by inspecting and advising, and since the 1920s they have been closely involved in advising on and inspecting children's physical environment and health. Health visitors have strong links to nursing, but they see themselves as a separate profession. I accept that to enter the profession a person needs to be a nurse or a midwife, but the profession's concern is that

    ``as soon as health visiting is treated as part of nursing, standards fall''.

Health visitor training has been reduced from 51 to 32 weeks after the abolition of the health visiting committee of the UKCC. No doubt the idea was to equate health visiting more with community nursing, but the view of those who wrote to me is that standards have been adversely affected. If the Government continue to reject the proposal that health visiting should cease to be a separate profession and should be considered merely a further branch of nursing, it is hard to see how the order came to be drafted, as there is little future protection for the profession. Health visitors say that they should retain their register and their status of equality with nursing and midwifery. If health visiting is enshrined in the order, as the Minister said almost in an aside, there will be an inflexibility and a fresh order would be needed if there were continuing developments that expanded the role of health visiting.

The justification when section 60 was added to the Health Act 1999 was that it was a simple procedure, allowing the orders to be changed relatively easily. The burden is on the Government to say why they do not want to reflect the existing arrangements for regulating the three separate professions. If there are further developments that lead to health visiting becoming part of a wider community practice, including anti-smoking and other therapies, so be it—we shall come back in three or four years' time when that has happened and debate another order—but it is not right to say, ``Well, that may happen in future, so article 6 should reflect a profession that does not exist.''

The Minister, with the best of intentions, has looked ahead and tried to do something that reconciles the various concerns, but a proud profession, with great achievements behind it and a future that the Government fully acknowledge, is being treated in a way that does not reflect its status and importance.

If I may, I shall read briefly some comments from a consultant obstetrician who wrote to the Secretary of State and sent me a copy. He said:

    ``For the last four years Health Visitors have been battling for survival against financially pressed Health Authorities and Trusts. They have also been fighting a rearguard action against their regular nursing colleagues who want to bring them under the umbrella of ``Nursing'' rather than having their own speciality.''

He continued:

    ``This is of course ridiculous especially in view of the fact that at a local University, it is felt pertinent to train midwives and nurses in town country planning as part of their courses.''

He concluded:

    ``I am aware that the overwhelming majority of health visitors are very unhappy with the new legislation and I would urge you to consider this matter personally and revalue Health Visitors as they should be.''

Given that such an important profession is clearly unhappy with the contents of the order, cannot the Minister continue the basic structure of the status quo—in other words, each profession being regulated—until circumstances come along that require different disposal? At that stage, by all means introduce another nursing and midwifery order, but for the moment let us not deny an important profession its place at the table.

The Minister will be aware that the Royal College of Midwives has written to hon. Members. It opposes having a new part of the register for public and community health specialists and has some comments on the definition of practising. It is concerned that the definition in rule 27 of the UKCC rules has not been replicated in schedule 4 because there is no requirement for up-to-date midwifery knowledge or to notify an intention to practise. It believes that the old definition is better than the new. Can he comment on that, too?

5.7 pm

Ms Drown: I should like to pursue a point that I raised in an intervention, but first I should like to say that I welcome the general thrust of the orders. It is important to update the regulations for these professions and I appreciate what the Government have done in consultation with the organisations concerned. As chair of the all-party group on maternity services, I get letters from women who are pleading to be able to give birth at home but who do not receive the necessary midwifery support from their health authorities or local trusts. Sometimes there is good reason, as no midwives are available, but at other times it just seems that their views are not being appreciated.

My real concern, which I have written to the Department about, relates to those women who simply will not go into hospital and will give birth at home whatever happens. The Minister said in response to my intervention that it is not for us to decide who should or should not be prosecuted, but it is for us as parliamentarians to decide what the law should be. My view, which I think would be shared by Parliament as a whole, is that we do not want women who are determined to give birth at home to give birth alone for fear of their husband or partner being prosecuted. It is important to state that. We would not want the professional organisations that are entrusted with managing the regulations to prosecute people in those circumstances.

The issue here may be the definition of the phrase

    ``attend a woman in childbirth''

in article 45. If attending a woman in childbirth means someone attending and pretending to be a midwife or a registered medical practitioner, and it is the pretence that is at issue, we are all probably comfortable with the provision, because husbands or partners would not be pretending to be midwives or registered medical practitioners. Undoubtedly, they would be present at the birth, and I am sure that we would not want to prevent that.

I ask the Minister to ensure that these important and improving provisions do not allow even the possibility of prosecution. The point is not whether someone is prosecuted but whether they feel threatened by the £5,000 fine. A person who fears prosecution might abandon their partner and child, which would be a riskier situation than if they were present.

5.10 pm

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