Draft Nursing and Midwifery Order and Draft Health Professions Order 2001

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Mr. Hutton: I congratulate all those who have spoken. We all share a concern to get the new regulatory arrangements right. It is not giving away too many ministerial secrets—I do not have many, Mr. O'Brien—to say when I took on this responsibility within the Department, I asked my officials exactly the same questions: for example, I asked them why health visiting was not in the title of the new NMC. Rather than relay the history of the process, it is important to tell the Committee that my view—take it or leave it—is that the arrangements in the order are the best way to deal with such issues.

We are not in the business—nor should we be—of downgrading the status of health visitors or of reducing the standards of training set by regulatory bodies for health visiting. My hon. Friends have expressed concerns about the training module, but we should not lose sight of the fact that those arrangements have been approved by UKCC. We have not acted to reduce the training input by diktat or ministerial intervention, as those issues are properly the responsibility of the regulatory authorities. The intention is not to downgrade the importance of health visiting—far from it. Our measures, including equal representation on the NMC of health visitors alongside nurses and midwives, are signals of the importance that we attach to health visiting.

Ms Walley: Despite what the Minister just said about changes that have already been made, health visitors have told me that they believe that health visiting has not benefited at all from the new curriculum, which was introduced by the out-going council. That makes it doubly important that Parliament should put safeguards into legislation to ensure that health visiting is not further downgraded.

Mr. Hutton: I accept my hon. Friend's point, but I cannot see how putting health visiting into the title of the order will give her and those about whom she is concerned the assurances they seek. Health visiting is already referred to in the title of the UKCC—we must not lose sight of that. The issue is important and I accept the arguments advanced by members of the Committee, but I genuinely do not believe that such a move would signify that standards were improving or could be strengthened in the future. What matters is the arrangements that we put in place under the order to ensure that health visitors are properly represented, so that their views can be ascertained properly and brought to bear on the issues. The NMC will certainly do that. It is important to have the opportunities to set up the register and for the issues to be explored fully within the council when it considers education and training standards.

Mr. Heald: Is it true that the Royal College of Midwives does not believe that there should be a separate part of the register for health visitors, whom the Minister describes as specialists in the community? Is the Royal College of Nursing of the same view? Given that the House believes that health visitors should be a separate profession, is not it doubly important that we protect them as far we can under the order?

Mr. Hutton: The hon. Gentleman makes my case for me. That is precisely what we are doing. He is right. Other organisations have expressed concern and the Government have taken action to deal with that concern and to respond to the worry expressed by health visitors about the need for such measures to be reflected in the order. It is a genuinely difficult area. I accept that there is a temptation to split the difference between the two arguments, but I do not think that that can be done in the circumstances. It is important that we make the right decisions about the future of the profession and ensure that the right standards are in place under the new arrangements. We are taking the correct action.

I suspect that some members of the Committee will not be entirely reassured by my response, but the measures that we have taken are designed to strengthen the role of health visiting, not weaken it. Education and training will probably be matters for the NMC as the organisation that sets standards. Health visitors will be equally represented with nurses and midwives on that council, which is the right way in which to proceed.

Sandra Gidley: The Minister has just said that health visitors are represented, but they are in the minority. If health visitors on the council consider that stronger measures need to be in place for their profession that do not relate to nursing or midwifery, how will they be able to get such measures accepted?

Mr. Hutton: In the same way as proponents for change in any organisation get matters through, which is by argument and persuasion. That is how the matter should proceed and that is what the order will ensure happens. We could go on debating the issue for some time, but I have tried to reassure members of the Committee that nothing in the order could be reasonably interpreted as downgrading the importance of health visiting. To say otherwise is not fair criticism.

The hon. Member for North-East Hertfordshire referred to schedule 4, and rule 27 of the UKCC rules, arguing that they were not fully replicated under the order. That is not so. The powers under which the UKCC makes the midwifery rules are the same—and will be—for the NMC. The UKCC rules have been replicated fully in the order. There is no deviation.

Mr. Heald: Does the Minister agree that rule 27 under the UKCC midwives rules and code of practice has exactly the same effect as schedule 4?

Mr. Hutton: Yes. The debate, although important, has lasted longer than I anticipated. I have tried to respond to some of the issues raised.

Ms Walley: I had hoped that my right hon. Friend the Minister would refer to the increased fine in respect of midwives.

Mr. Hutton: I thought that I had dealt with that when responding to my hon. Friend's intervention. We are not setting an automatic fine because that is not how the system works. The fine is discretionary, up to the maximum band. My officials cannot remember when the last prosecution was: there might have been one a while ago, but I am advised that there were no prosecutions last year.

The issue is a fine one and I understand the arguments about choice, but I also understand the arguments about safety, which is the paramount consideration. In any prosecution, the public interest has to be served, so I hope that no prosecution will brought unless there are compelling reasons for doing so. I certainly would not regard prosecution for a trivial matter as a justifiable exercise of the power to prosecute a member of the public. However, I must say to my hon. Friends the Members for Stoke-on-Trent, North and for South Swindon that such issues are properly left to the prosecuting authorities. The proposed legislation is exactly the same as the existing provisions. We are not changing them, nor are we sending out a different signal or trying to move the legal goalposts. The provisions are the same as those that currently exist.

Perhaps on this occasion I have not persuaded certain members of the Committee, but I am certainly happy to continue to look at the issue and to correspond with anyone who remains concerned.

5.36 pm

Mr. Heald: On the point that was raised by the hon. Members for South Swindon and for Stoke-on-Trent, North, the Minister's comment that prosecuting authorities should be allowed to exercise discretion is cause for concern. What we really want is to avoid prosecuting the husbands of women who hold a particular view as a matter of conscience. Surely it is for the Committee to decide whether we consider such actions a crime? I am not sure that I like the idea of giving that responsibility to somebody else.

Mr. Hutton: With great respect, that is not the argument that I am making. It is clearly our responsibility to set the legislation's parameters, and that is what I am proposing we do by carrying forward existing legislation that the House has approved on many previous occasions. However, it is also clear that a decision to prosecute on the basis of the facts is an appropriate exercise of discretion on the part of the prosecuting authorities.

Mr. Heald: Can it be right to regard as a crime a situation in which a woman desperately wants to go ahead with a home birth and her husband wants to ensure her safety by being there and perhaps helping? According to the Minister, we should say that that is a crime, albeit in the knowledge that the prosecuting authorities probably will not prosecute. That is unsatisfactory.

Sir Paul Beresford: I thank Government Members for raising a matter of which I was unaware. The Minister says that the legislation has not changed, but this is a chance to improve it and he is turning his back on that chance.

Mr. Heald: I am grateful to my hon. Friend for that intervention. This is not the main issue about which I intended to argue, but it strikes me as rather odd to make such an action a crime and leave the decision to the prosecuting authorities.

I remain unhappy about the issue of health visitors. The hon. Member for Stoke-on-Trent, North mentioned training. The consultant obstetrician who wrote to the Secretary of State also raised that subject, saying that:

    ``the specialist training of health visitors has . . . been cut from 51 to 32 weeks with child protection, nutrition and mental health, once an essential part of training barely covered on some training courses.''

Those are all important issues. The Government are strongly committed to early interventions in mental health, so it seems wrong that health visitors are not getting the training they need.

Although the Minister has tried, he has not satisfied me. We shall not support the order in its current form; in fact, we shall vote against it. I should like to make it clear to him that we are not against the principle of the order. We would be happy to vote for it if addressed those two issues. If he loses, we invite him to return with a different order. If he wins, no doubt the Lords will have something to say.

Question put:—

The Committee divided: Ayes 9, Noes 6.

Division No. 1]

Begg, Miss Anne Betts, Mr. Clive Fitzpatrick, Jim Hutton, Mr. John Joyce, Mr. Eric
Purnell, James Rapson, Syd Walley, Joan Ward, Ms Clair

Beresford, Sir Paul Cameron, Mr. David Gidley, Sandra
Harris, Dr. Evan Heald, Mr. Oliver Wilshire, Mr. David

Question accordingly agreed to.

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