Draft Nursing and Midwifery Order and Draft Health Professions Order 2001

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Mr. John Lyons (Strathkelvin and Bearsden): I welcome the proposals. Modernisation of the councils, which is long overdue, will provide a positive benefit and is largely welcomed in the various areas that are represented.

I draw the Minister's attention to a couple of points that have been raised in my constituency. It is fair to say that there are tensions between the state and non-state sectors. We all have a responsibility to try to overcome those tensions and to include both sectors in the new council as smoothly as possible. Those sectors have developed in different ways historically but their future lies together in the new council rather than as two separate bodies that are continually bickering and creating tensions between each other. We must recognise that the non-state sector is substantial, consisting of 8,000 people. If we are to ensure the smooth transition to the new council, we must give it full recognition in terms of size, knowledge and understanding of the sector.

Another important matter, to which the Minister referred, concerns training and competence. We must ensure that there is parity of qualification, experience and professional development between the state and non-state sectors when assessing someone's request to be put on the new register. We want to protect patients by ensuring that there is parity of qualification and experience. However, some features do not lend themselves to or complement that objective. Someone who left the profession for a substantial period could be put back on the register by paying a fee. That person would automatically be on the new register during the two-year relevant period. We must be cautious about that and ensure that proper protection exists for patients.

A key question concerns continual professional development. Again, someone might go on to the register without having had continual professional development. We must ensure that such development is the norm for everyone, whether in the state or non-state sector, and that being together means that there will be continual professional development for everyone.

The non-state sector has been overlooked and was not originally asked for nominations to the new council. It feels that it was excluded. It would be illogical and impractical to have a seven-year transition period in which to bring people on to the new register. That would never work, but we do not want to cut the period too fine and struggle to meet the two-year deadline, so we must be flexible.

I have received representations from people who simply want proper consideration to ensure that they are not overlooked and forgotten. They provide a good service alongside the state sector and they must be recognised.

6.4 pm

Dr. Evan Harris: I want to restate briefly the support for the principle of the order, which is based on the 1999 Act, which the Liberal Democrats supported. I should like the Minister to respond to a couple of questions in the short time left.

First, he talks in the consultation response about some people calling for the council to be responsible for registering psychotherapists and, indeed, practitioners of complementary medicine. Does the Minister think that that would be appropriate or, as I suspect, that a different approach may need to be taken in those sectors?

Secondly, there is the question of chiropodists and podiatrists. I agree with the Minister that protection of title is critical. Those professionals administer what can be quite invasive treatment with surgical skills, as I saw when I worked in the field of diabetes, and they make an important contribution. There needs to be an assurance of quality that goes along with the title. That said, one must pay tribute to the valuable work done in the state-registered sector and the unregistered sector by chiropodists and podiatrists.

As the hon. Member for North-East Hertfordshire said, there is a shortage. He was a little too charitable in saying that the rationing of chiropody and podiatry was due only to a shortage of staff. In my area in Oxfordshire, the health service is clear that a shortage of cash has led to drastic changes in the eligibility criteria. There is now a crisis in accessing treatment for feet, just as there is in accessing orthodontic treatment—people in Oxfordshire have called that a new sort of foot and mouth problem. As with dentistry, those services are sliding out of the NHS, which is a major problem. That is why the Government must be careful about how they handle this matter.

I have sympathy for the Minister, because we are dealing with a split profession. I have had effective lobbying from both sides. I pay tribute to both the Society of Chiropodists and Podiatrists and the British Chiropody and Podiatry Association for the clear way in which they have put their views to me and, I suspect, other members of the Committee.

It is difficult to take sides. On the question of entry to the register, the hon. Member for North-East Hertfordshire made representations for the currently unregistered sector. He then repaired the damage, as he might see it, by making a valid point about the professional advisory committees, put to him by Hilary De Lyon and others from the registered sector.

Mr. Heald: The hon. Gentleman may be twitting me but he would accept that it is the Opposition's job to put the concerns of people with different views. Does he agree that it is important to have enough podiatrists, because evidence shows that they reduce the number of amputations as a result of diabetes by about 40 per cent? Podiatrists are doing a job that not only saves a huge amount of money for the patient, but is important for patients' health.

Dr. Harris: I wholly agree about the importance of those professionals in the care of patients not only with diabetes, but with peripheral vascular disease. Those are common conditions, particularly in the elderly, and the increasing work load is also a result of demographic changes.

However, the threat of a shortage should not be an excuse for saying that we shall be less than strict about the quality standards that we require. I am not saying that the hon. Member for North-East Hertfordshire or the unregistered sector is suggesting that. The duty to ensure that there is not a shortage of health care professionals lies with the Government—not necessarily this Government but perhaps the Governments of three, four, seven or eight years ago. I do not want to rehearse that debate, but we cannot use the shortage as an excuse not to deal with the issues. I think that the Minister recognises that.

I support the Minister's view that competence must be established; that registration and protection of title are important; and that that is the basis on which we go forward. However, it is fair to say—I should like the Minister to address this point—that the concerns of non-state-registered chiropodists and podiatrists are not simply that they face a barrier to entry on to the register, but that the register's mediation will be controlled by the HPC, on which, by definition, they have little representation. The places for podiatrists are likely to go to the already registered group—the electorate voting people on to the council.

Will the Minister give an assurance that fairness and care will be applied to allow chiropodists and podiatrists access to the state register where they do not feel that decisions about their qualifications or level of competence in the non-NHS sector of their work are justified? If the Minister can provide such reassurance, there may be a way forward and I would certainly support the regulations on that basis. This group is clearly split. There may be a suspicion—if not paranoia—that entry to the register will be made more difficult to ensure safety and appropriate protection of title.

Finally, I shall deal with the professional advisory committees. I recall the passage of the 1999 Health Act when considerable concern—effective lobbying was based on it—was expressed by the Society of Chiropodists and Podiatrists about uni-professional input about matters that worried them on a standing, if not a statutory, basis. Representations from the society imply that it has been reassured that the Government

    ``has now allowed for the establishment of Professional Advisory Committees for each individual profession''.

It is concerned, however, that it will not be standing, but ad hoc, committees with working panels. This group again feels misled about the ministerial assurance on uni-professional input on a standing basis into the procedures of the council. I am sure that the Minister will want to clarify what he said, so that he will not stand accused of reneging on a commitment and the shadow HPC will not be seen as deliberately reneging on an agreement that the society thought that it had reached. If the Minister can provide the reassurance—I am trying to be constructive—we can unreservedly support the order.

6.12 pm

Mr. Hutton: I thank hon. Members for their contributions this afternoon. I should like to re-emphasise some of my opening points about the motivation and rationale behind the orders. We are not ganging up on the non-state-registered chiropodists and podiatrists. That would be to ascribe to us a petulant and juvenile intent, which we simply do not have. As the hon. Member for Oxford, West and Abingdon (Dr. Harris) rightly said, we are attempting to take the debate forward. It has been rumbling for a long time and current regulatory arrangements do not serve the profession or the public well. It is incumbent on us to resolve those problems in the most consensual way possible. It is a difficult issue, which we have tried hard to resolve. Thus far, we have been unable to achieve 100 per cent. agreement from the non-state-registered chiropodists, which is unfortunate.

Today we are trying to introduce a sensible, worked-out set of proposals. That will not, as the hon. Member for North-East Hertfordshire implied, require every non-state-registered chiropodist to attend a three-year undergraduate degree programme in order to gain access to the new state register.

I want to make it clear that unregulated chiropodists will have to demonstrate safe practice during the recent past or competence against required standards. Some in the unregulated sector train via a two-year diploma and then clinical practice. They may not need much, if any, extra training to meet the HPC's future standards. The first important step is for the unregulated sector to make its training available for assessment by the HPC, and I hope that it will be pleasantly surprised. The sooner it does, the longer the amount of time that there will be for any necessary extra training.

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