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 Governments 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 patientsfor 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 midwivesthe Nursing and Midwifery Order
2001and 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 Smiths 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
councils committee structure, to give it more freedom. The
order implements a number of other smaller changesfor 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 NMCs work. The Bill
introduces the civil standard of proof into the fitness-to-practise
cases dealt with by all the health regulatory bodiesanother of
Dame Janets 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 consultations 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 orders 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.
Most
respondents supported a move toward setting out the constitutions of
the regulatory bodies, including the NMC, in a separate constitution
order. However,
some concerns were expressed about the balance between lay and
professional members and the number of nurses, midwives and health
visitors on the new council. I would like to draw further attention to
that, and to leave the Minister and his officials with some problems to
resolve.
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
NMCs 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,
wouldnt 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 Ministers
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 Healths 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 NMCs
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 peoples 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
Ministers 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 processevery
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 committeeit will be
all-appointedis 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 messI am afraid that that is the only
word for itover 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
registrants
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 Ministers opening comments, those are precisely the
questions that we are trying to deal with in the order.
I accept the Ministers
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 Smiths inquiry. Dame
Janets 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 Janets
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 anybodys 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 Unites 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.
Resolved,
That
the Committee has considered the draft Nursing and Midwifery
(Amendment) order
2008.
Committee
rose at nine minutes to Five
oclock.