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Public Bill Committee Debates

Draft Nursing and Midwifery (Amendment) Order 2008

The Committee consisted of the following Members:

Chairman: Mrs. Janet Dean
Armstrong, Hilary (North-West Durham) (Lab)
Bradshaw, Mr. Ben (Minister for the South West)
Burt, Lorely (Solihull) (LD)
Butler, Ms Dawn (Brent, South) (Lab)
Cooper, Rosie (West Lancashire) (Lab)
Johnson, Ms Diana R. (Kingston upon Hull, North) (Lab)
Kawczynski, Daniel (Shrewsbury and Atcham) (Con)
Key, Robert (Salisbury) (Con)
Lilley, Mr. Peter (Hitchin and Harpenden) (Con)
Milton, Anne (Guildford) (Con)
Mulholland, Greg (Leeds, North-West) (LD)
Osborne, Sandra (Ayr, Carrick and Cumnock) (Lab)
Prosser, Gwyn (Dover) (Lab)
Ryan, Joan (Enfield, North) (Lab)
Stuart, Ms Gisela (Birmingham, Edgbaston) (Lab)
Williams, Mrs. Betty (Conwy) (Lab)
Wright, Jeremy (Rugby and Kenilworth) (Con)
Mark Oxborough, Committee Clerk
† attended the Committee

First Delegated Legislation Committee

Monday 19 May 2008

[Mrs. Janet Dean in the Chair]

Draft Nursing and Midwifery (Amendment) Order 2008

4.30 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ben Bradshaw): I beg to move,
That the Committee has considered the draft Nursing and Midwifery (Amendment) Order 2008.
The order is part of the Government’s widespread reform and modernisation of the regulation of the health care professions. The aim of the reforms is to ensure that the public have greater confidence in the ability of the health regulatory bodies to protect the public interest and deal with poor professional standards. Public concern has been highlighted in a number of high-profile cases in the past few years in which harm has come to patients—for example, the cases of the nurse Beverley Allitt and of the GP Harold Shipman. Those cases led to a number of detailed inquiries, including that led by Dame Janet Smith. The inquiries made many far-reaching recommendations, which we are in the process of implementing.
The order makes various amendments to the framework legislation for regulating nurses and midwives—the Nursing and Midwifery Order 2001—and contains consequential changes. Many of the amendments relate to the governance arrangements for the Nursing and Midwifery Council. We are moving the NMC from an elected to an appointed council, because of Dame Janet Smith’s recommendation that particular professional interests should not unduly influence council members. The appointment of council members by the independent Appointments Commission will mean that members are appointed because of their skills and expertise, rather than to represent sectional interests. It will also make it easier to remove council members who do not come up to the standards that we would reasonably expect of professional regulators.
The order will be accompanied by a constitution order that will reduce the size of the council from 23 to 14 members. That will make the council more board-like and strategic; again, that is in line with recommendations. The 14-member council will have seven registrant and seven lay members. We are also being less prescriptive about the council’s committee structure, to give it more freedom. The order implements a number of other smaller changes—for example, in the annual reporting requirements.
Parallel to this process, the Health and Social Care Bill is going through Parliament. That, too, will impact on the NMC’s work. The Bill introduces the civil standard of proof into the fitness-to-practise cases dealt with by all the health regulatory bodies—another of Dame Janet’s recommendations. The Bill will also ensure at least lay parity and allow for lay majorities on all the health professionals councils, including the NMC. The NMC has already said that it is moving toward lay parity anyway.
The order cancels the elections that were due to take place for the English registrant members of the NMC next month. That may sound like an odd move, but it is happening at the request of the council itself, and the Government have previously responded positively to similar requests from the General Medical Council and the General Dental Council. We recognise that the cost and disruption of holding elections for council members who will serve at most only a year, and more likely eight months, of a four-year term when a system of all-appointed members will be in place next year is not sensible. The reforms should improve public confidence in the independence and professionalism of the NMC.
The order makes a number of miscellaneous amendments that deal with notable matters such as enabling the NMC to give enhanced prescribing rights to more of its registrants in an emergency, such as a pandemic flu outbreak, and enabling the NMC to strike off registrants who are barred from working with children or vulnerable adults when the new independent barring board is established.
All these measures are supported by the NMC. I commend the order to the Committee.
4.34 pm
Anne Milton (Guildford) (Con): It is a pleasure to serve under your chairmanship, Mrs. Dean. I do not want to detain the Committee any longer than is necessary, but I should raise a few points. The amendments made by the order were originally set out in the Health Care and Associated Professions (Miscellaneous Amendments) Order 2008, which was published in draft for public consultation in November 2007. The consultation closed in 2008. I gather that, as a result of representations made by the NMC during the consultation, it was decided to introduce the amendments to the 2001 order earlier, in a separate order. The Nursing and Midwifery (Amendment) Order 2008 reflects comments received during that consultation.
It is worth mentioning some of the consultation’s key findings. Some 57 per cent. of respondents agreed that Parliament should play an enhanced role in the monitoring of regulatory bodies. However, the number who agreed among the respondents identified as having an interest in nursing or midwifery was much lower, at 27 per cent. I ask the Minister to take note of that: most nurses were clearly unsure about the draft order’s benefits. It might simply be an issue of communication, but it is important that nurses understand what the Government are trying to achieve in the order.
Most respondents supported a proposal to give the NMC reserved powers to annotate the register so that suitably qualified and experienced people without the relevant qualifications would be able to act as prescriber during an emergency, although some concern was expressed about the exact meaning of the phrase “suitably experienced”. I understand that officials have noted those concerns, but it is important that the phrase should be clarified.
I know that the Government are working with the NMC to develop the proposals, but it is important that a balance be found among the professional groups at the right stage. One of the problems is that the bodies do not all agree. The NMC is particularly concerned about its elections and what will happen in the interim. The new legislation includes a provision to cancel any further elections, but it is not expected to complete its passage until 25 June. However, the legislation coincides with the NMC’s schedule for the election of six new members. The timing has resulted in a dilemma for the NMC and any nurse, midwife or specialist community public health nurse who decides to stand in the England election. Prospective candidates will face a very short term of office, from 1 August this year to 31 March next year. After a rigorous election and induction process, such a short term would be disappointing for many potential candidates.
The timetable for the England election is as follows: notice of election will be on 14 May, and the closing date for nomination forms is 5 June. I understand that the NMC has considered a number of options, including removing the requirement to hold the election. The council would prefer to cancel the England election, as the Minister said he would, and extend the term of office for current elected members until 31 March 2009. However, the NMC has concluded that a decision to halt the election can be taken only after the legislation has received parliamentary approval. I do not know what flexibility there is; perhaps there is none, but it would be useful if the Minister heard that message loud and clear and worked with the NMC to achieve it. The NMC will proceed with the initial stages of the election process as normal, but it will take steps to cancel the election if the legislation comes into effect by 25 June, so it wants some clarity and absolute assurance that that will take place.
The Royal College of Midwives raised a number of issues. It believes that the elections should be held and not cancelled, so it is with a smile on my face that I leave the Minister to resolve the issue. The RCM believes that the rights and privileges enjoyed by nurses and midwives should be maintained until the new, all-appointed council is created, and that the right to vote should not be swept away easily or for the sake of bureaucratic convenience.
The RCM would also like the NMC to indicate clearly how it would consult the midwifery profession on the proposed constitution of the midwifery committee, and it has some concerns about the committees. A number of professions will be involved and, as I said earlier, there are sensitivities that I hope the Minister will observe when taking the next steps. The RCM believes that midwives should also make up a significant proportion of the registrant membership of the new, all-appointed council. One might say, “They would say that, wouldn’t they?”, but of the seven registrant members on the new all-appointed council mentioned in reports on the NMC website, the RCM would like at least three to be midwives.
Unite has raised a number of concerns to which I should like to draw the Minister’s attention. Proposed new article 3(5) uses the phrase “proper regard for”. I have some sympathy with Unite, which has asked for clarification of that phrase. In this instance, it refers to
“the interests of persons using or needing the services of registrants in the United Kingdom, and... any differing interests of different categories of registrants”.
Unite is concerned about specialist community public health nurses and visitors. Since the launch of the new council in 2004, health visiting, a profession previously in statute for almost 100 years, has seen its numbers drop by more than 10 per cent and very little reference is made to health visiting in the Department of Health’s nursing profession policy.
Again, the different professions represented by the NMC have extreme sensitivities to which I hope the Minister has due regard. For example, the NMC’s literature refers to nurses and midwives but not to specialist community public health nurses. However, public health in the community could not be more important at the moment, not least because of how it affects people’s health outcomes. Lack of reference to specialist community public health nurses sends a poor message. Will the Minister insist that there be three equal committees, one for each part of the register, with each being responsible for advising the council?
There are few other points to make on the measure. I reiterate that the interim arrangements will be extremely important to the NMC, and so that we do not further disfranchise nurses, midwives, public health nurses, health visitors and all those represented by the NMC, I hope that the Minister maintains an open dialogue with the council. I also hope that he maintains an open dialogue with professions such as health visitors, public health nurses and midwives, who feel that the order will introduce changes that will further push them to the back of the line when it comes to having their voices heard.
4.43 pm
Greg Mulholland (Leeds, North-West) (LD): Given the busy evening that we have ahead of us, I shall keep my comments brief, but there are some important points to make.
I agree with the Minister’s opening statement on the need to deal with the shortcomings in the regulatory system. Unfortunately, I simply do not believe that the move to cease having elected members on the Nursing and Midwifery Council is necessary. It also sends out a strange message because, clearly, it further centralises the appointments process to members of the committee as opposed to lay members. My first and main question to the Minister is this: is there another way to deal with those shortcomings without abolishing elections altogether? For example, we could have a system by which everyone who wished to stand for election must in the first place go through a rigorous process of approval. That way, everyone would have a clear person specification and would be subject to some kind of vetting process—every single candidate who went forward would be deemed suitable, which would avoid many the problems that the Minister identified as the reasons for the measure. I do not accept his conclusion, and the Liberal Democrats do not and cannot support the measure.
The composition of the new committee—it will be all-appointed—is strangely not defined. Will the Minister say why? As we have heard from the hon. Member for Guildford, the RCM has called for midwives to make up a significant proportion of the committee, and I wholeheartedly agree with that common-sense view. It is strange that the Government have suggested a new composition without saying what it will be, and I ask the Minister to say why the Government have done that.
My next point, which also follows on from the comments of the hon. Member for Guildford, relates to the mess—I am afraid that that is the only word for it—over whether there should or should not be elections. Why should registrants based in England be discriminated against in that they will be the only ones not to have elections?
The argument with which I have a particular problem is that it would not be fair to allow elections to take place because people would have only a short term in office. When I stood for election to Leeds city council in 2003, I knew full well that its boundaries would be redrawn and that my term would be one year instead of four. Nevertheless, I chose to take part in the election on that basis. The people we are talking about will be in exactly the same position. The idea that we should extend the term of any elected position simply for the sake of bureaucratic convenience is not an acceptable way to run any public body.
My final point relates to the new powers that are being given to the NMC. The temporary annotations to its register would enable
“fit, proper and suitably experienced”
“to order drugs, medicines and appliances”
that they would not normally be able to order. That sounds perfectly sensible, but should such powers be left to the discretion of the registrar? Are there sufficient safeguards governing the use of such powers? To return to the Minister’s opening comments, those are precisely the questions that we are trying to deal with in the order.
I accept the Minister’s reasons for introducing the proposals, but I simply cannot accept the conclusion that the only way to deal with this issue is to abolish elections and go to an all-appointed body, and my party opposes that.
4.47 pm
Mr. Bradshaw: I was slightly surprised by the comments of the hon. Member for Leeds, North-West, who spoke on behalf of the Liberal Democrats. During the passage of the Health and Social Care Bill, we had some quite long discussions about the idea of having appointments rather than elections to regulatory bodies, but the hon. Member for Romsey (Sandra Gidley), who usually speaks on behalf of the Liberal Democrats on these issues, did not make the points that the hon. Gentleman has just made. That is because the idea was part of the fundamental recommendations by Dame Janet Smith’s inquiry. Dame Janet’s concern was that elections to such large bodies could allow special interest groups in the professions to fight certain agendas and that they were not the best way to secure public or parliamentary confidence in the real independence of regulatory bodies or their ability to deal with professional misconduct in the professions.
The hon. Gentleman says that we are centralising the system, and we are handing over responsibility for appointments to the Independent Appointments Commission, but it is independent. The Standing Committee that dealt with the Health and Social Care Bill, along with Dame Janet’s inquiry and the other inquiries into the medial professions, felt strongly that that was the right way to secure the ends that we wanted to secure.
On the cancellation of the elections, let me say that the elections would be cancelled as long as the order goes through, and that there should be no problem with the timing vis-A -vis June. I imagine that the NMC would have to go through certain processes if the order were to be voted down, but I hope that that will not happen and that the council will be able to do what it wants to do. That aside, the proposals are not about curtailing anybody’s freedom; they are the result of the strong representations that have been made to us by the NMC, the GMC and the corresponding dentistry body. The NMC said that it would cost about £300,000 to conduct elections for people who would be in office for only eight months and who might not be terribly motivated to stand for election for such a short time. The council rightly felt that it would be difficult to justify that. As hon. Members may know, the NMC is going through some convulsions in terms of its internal dynamics, and it has said that it would not find it easy to justify such huge expense, given that those who would be elected would serve for only a short period.
On the issues raised by the hon. Member for Guildford, who spoke on behalf of the Conservatives, I understand Unite’s concerns; indeed, its representatives came to see me and we had a meeting about the issue. She might have noticed that the terminology in the order has been changed to reflect their concerns. She will forgive me for not being able to point to the exact part of the order, because I cannot find it, but the terminology has been changed to use the term “registrants” to address those concerns.
The hon. Lady also asked about the make-up of the council and why that had not been laid down. We have said that the proposals are to have lay parity, with seven lay members and seven professional members. The lay members should include one from each of the four UK countries and the professional members should include one from each of the four countries and one from each of the three parts of the NMC register. Beyond that, we are trying not to be prescriptive, because these are independent bodies. As was the case when the Health and Social Care Bill was in Committee, there is a constant tension when setting up such independent bodies between the desire to be more prescriptive with regard to what they can do, including how they set up their committees, and the desire, often on the part of the same Members, for those bodies to be independent. I think that we have struck the right balance here and commend the order to the Committee.
Question put and agreed to.
That the Committee has considered the draft Nursing and Midwifery (Amendment) order 2008.
Committee rose at nine minutes to Five o’clock.

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