Draft Nursing and Midwifery Order and Draft Health Professions Order 2001

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Sandra Gidley (Romsey): On the whole, the Liberal Democrats welcome the thrust of the order, but we have concerns about the role of health visiting professionals. It is a mystery why health visitors, who are professionals in their own right and front-line troops in the delivery of primary health care services, seem to have been—to their minds—downgraded by the wording of the order.

Health visitors must have a nursing qualification, so I understand the justification for keeping only nursing and midwifery in the title. However, health visitors play a much wider role than that of nurses. They have a distinct public health agenda but also incorporate education and social services aspects: there is a greater emphasis on multi-agency working. A particularly relevant example is the child at risk. A nurse has no authority to investigate concerns and would focus primarily on health, whereas the health visitor would develop a long-term relationship and assess social, emotional and environmental factors in addition to medical factors. She or he liaises with other agencies and often fulfils an advocacy role on behalf of the patient. Health visitors must gain an extra qualification to perform their very different role.

On that basis, the points raised by the hon. Member for North-East Hertfordshire (Mr. Heald) were valid. I, too, have read the briefing from the grassroots network, but I will not repeat what has already been said. I am trying to start a new trend in this place, so the Committee should take his comments as read, as I have no intention of repeating them simply to put them on the record again.

Health visitors have concerns about several parts of the order. As has already been mentioned, the designation ``health visitors'' should be included, because that would give them the recognition that they deserve. At present, they feel that they are treated as just another branch of nursing and midwifery and have no special status, especially as article 5 states that the order shall establish

    ``a register of qualified nurses and midwives.''

    Some health visitors are concerned that there will be a lack of protection against inadequate standards in health visiting. I would like the Minister to clarify his comments about the regulation of the health visiting profession under the order. I am not sure why he thinks that standards will slip, apart from the historical evidence that it has happened in the past. Can he assure the public that all aspects of the health visitor role will be regulated?

    There is also a concern that we have no guarantee that a hostile coalition of nurses and midwives would not vote to remove health visitors from the register. On the face of it, it appears that separate parties would be set up. However, there is no provision in the order that gives long-term protection. One day, the role of health visitor may go and health visitors will be just included with nurses. I say ``just included'' not to decry the nursing profession, but it should be recognised that the bodies are different.

    Article 9(2)(b) refers to the ``safe and effective practice'' of a nurse or midwife. However, health visitors would contend that competency as a nurse or midwife does not guarantee the competency of a health visitor, although it may be taken as read. Will the Minister clarify that?

    We are minded to vote against the order because we do not feel that the role of the health visitor is recognised and, from the public protection angle, there are no adequate safeguards to ensure regulation of health visitors, and not because we do not agree that we should have adequate registration and public protection.

5.17 pm

Ms Walley: I broadly welcome the changes that are proposed, but I would not be true to worries that I have mentioned in the past, for instance during Health questions in the past Session, if I did not raise a couple of worries, as other hon. Members did.

I am concerned about midwives and fines. The order proposes an increase in fines for people who impersonate midwives from level 4, which is currently £2,500, to level 5, which is £5,000. That is right and proper because the offence is serious, and the Government are correct to increase the fine. However, if I have interpreted the order correctly, the Government intend to increase the fine similarly for people attending births. Such people could be husbands or family members who attend at home because a midwife is unavailable. At present, resources are not available and we do not do as much as we could to ensure that a woman who wishes to have a home delivery is able to do so, provided that it is safe. I agree with the Minister that safety must be paramount. I have figures that suggest that 98,000 midwives are trained, qualified and registered, but only 36,000 are employed. Parts of the country are under pressures that mean that it is not always possible for a midwife to attend at home, which people who wish to have a home birth would want.

Mr. Heald: I share the hon. Lady's concern that people who genuinely impersonate midwives should be caught. However, is there protection for an innocent taxi driver?

Ms Walley: Far be it from me to interpret the legislation, with which I am not as familiar as the Minister, but I understand that there are exceptions for a person in an emergency. It is not intended that such a person should be fined or suffer the increase in fines. It is of concern when a woman cannot receive the home service that she requests. The point is that she should feel safe delivering her baby in her own home, possibly with the help of her husband, rather than having to have a hospital delivery. Some lay midwives fear that a husband, rather than risk a fine of £5,000, would choose not to be present at the birth, which would mean that women could deliver at home unattended. I would not want that to happen. Will the Minister clarify the matter, either during the debate or later, and reconsider whether the fine should be increased to £5,000 in cases in which people have been unable to have home deliveries as they had wanted?

I also want to raise the issue of health visitors, although I do not want to labour the point made by both Opposition spokesmen and Labour Members. The Minister is right to introduce a generic committee of practitioners, but I would like some further clarification. What provision is made under the title and substance of the order for community practitioners, such that there is a statutory body responsible for education and training? In the brief time that I had for discussion with health visitors, I found that there was a genuine fear that the order could—I emphasise the word ``could''—pave the way to closing the health visitors register.

Safeguards are needed in this area. In my constituency, health visitors have done some sterling work in terms of Government objectives for reducing inequalities. Health visitors are vital, in primary care trusts and elsewhere, in reducing those health inequalities. I worry that, because of the new arrangements that are being introduced, midwives or nurses could prevent health visitors, either intentionally or otherwise, from having the same distinction and specialist education and training as they have at present. We do not want health visitors to receive the message that they are unimportant. We want them to take a key role in the new primary care trusts and for their specialist knowledge to be available at the heart of the community, where we are reducing inequalities.

Opposition Members referred to education and training. One of the issues raised was that already, with the new proposals from the outgoing committee, health visitors' training has been reduced from a module of more than 50 weeks to 30-odd weeks. In some cases, it is possible to leave out extra training on child protection. We have all seen the headlines in the press when something goes desperately wrong. We must take the precautionary approach and ensure that education and training equips health visitors to do the work that we expect them to do.

Will the Minister give some assurances on those matters and pay particular attention to the issue of fines for those attending someone in labour?

5.23 pm

Dr. Evan Harris (Oxford, West and Abingdon): I will speak briefly, as I do not want to repeat the hon. Member for North-East Hertfordshire, my hon. Friend the Member for Romsey (Sandra Gidley), or the hon. Member for Stoke-on-Trent, North, who spoke about health visitors. It is unfortunate that that significant problem remains, as the order is otherwise one that the Liberal Democrats would like to support.

I hope that the Government will consider relaying the order with an amendment before or after it is introduced in another place, and that they will not discount the possibility of redrafting the order so that the matter can be debated as a single issue. One of the problems of that arrangement for making changes is that the option is take it or leave it, which puts hon. Members on both sides of the Committee in a difficult position.

None the less, I applaud the Government for their general approach of trying to rationalise the regulation of the health professions. I remember discussing the issue during the passage of the Health Act 1999 and describing it as a welcome move by the Government. Powers were taken to make such changes by order, but I stick to my caveat that there should be separate orders for contentious issues. I am especially pleased that the Government intend to ensure that a range of penalties are available to the statutory disciplinary committees of the councils, because without that flexibility regulators are put in a difficult position, which often leads to public concern about whether they are doing an adequate job. My professional experience is that patients, nurses and doctors were all mystified by the different degree of regulation and discipline meted out to different health profession for doing similar things that should not have been done, whether through error, recklessness, negligence or misconduct. It would be helpful to have such an arrangement when the final picture is produced.

My final point relates to the proposed legislation to provide an overriding council to identify best practice. I am not sure when different matters emerged, but that proposal seems to have emerged since the order was initially drafted. That council is welcome because it can identify and promote best practice. Will the Minister say what implications that new structure has for both orders, so that we know how that process will be introduced? Concerns will be expressed about extent of the proposed council's powers of direction for regulation of health care professionals, but I do not propose to discuss that now. Generally, however, Liberal Democrats support that approach. Will the Minister explain how he expects the two to mesh in legislative terms when the final picture of the council is produced, assuming that the Government's other business is passed?

5.27 pm

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