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Lord Clement-Jones: Without wishing to pre-empt the reply of the noble Lord, Lord Morris of Manchester, I hope that I may express a view to the Minister. I believe there will be considerable disappointment at her comments, but on the other hand strands of what she said may well be helpful. The Minister talked about the issue of safeguards and fitness to practise being kept firmly within a profession's ambit. Can she say a little more about the advisory boards as they are a considerable bone of contention, as she knows? In the J.M. Consulting report they were regarded as an optional extra. However, many professions, not just chiropodists and podiatrists, would regard them as being an important part of the new framework. Will the Minister elucidate further on that?

Baroness Hayman: I am not sure that I can because we do not have proposals to put forward at this time for an order to replace the current legislation. It has been said often during the course of our debates that we should listen to the professions on these issues. If I were to pre-empt that discussion by saying now what the rules of the advisory committees will be, I suggest that that would not be in the spirit of the consultation we are trying to take forward. We must ensure that the overall board--which is multi-professional, and can gain strength from that--recognises that there are some issues where the distinctive voice of an individual profession must be heard. We shall try to take that into account when framing proposals. However, I cannot tell the noble Lord what the proposals are because we have not framed them.

Lord Skelmersdale: In that case why does the Bill get rid of the 1960 Act at this moment? Why not make provisions by order so that we all know what is going on?

Baroness Hayman: One of the safeguards is that we cannot abolish a regulatory body except by primary legislation. That is one of the safeguards written into the Bill. We are in something of a Catch-22 situation here. If we did not take the relevant powers in this piece of primary legislation, we would leave professions supplementary to medicine in exactly the same difficulty as they are in now of having to queue up for primary legislation before any change can be made to them. Because the defects of the system are so well established the Government know that they want to repeal that piece of legislation. A review was published in 1996 along with the then government's response to it. Therefore we thought it appropriate to state on the face of the Bill that we intended to do that so that everyone was aware that that was the way we were going forward. However, that shall not be effective until replacement legislation--in this case, secondary legislation--has been brought forward. Therefore we ensure that we do not set the

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position in tablets of stone for those who are furthest advanced in needing change, and not allow them the benefit of the order-making power.

Lord Clement-Jones: I hope I may probe a little further. I fully understand that consultations are taking place. However, I had understood that consultations were taking place on the basis of the Government's view of the J.M. Consulting report of 1996. I had assumed that the Government had said they liked its broad outlines. Surely the consultations concern precisely that framework. My questions to the Minister were set in the context of that framework. I asked whether or not there was the possibility of the Government moving further in the light of representations which have been made on the Bill, and those made before the Bill was published.

Baroness Hayman: The previous government responded to the J.M. Consulting report. What I have tried to say this afternoon is that in framing any proposals that this Government bring forward for the content of a new order to replace the Act, I personally shall ensure that the comments of the Committee this afternoon and the issues that it has highlighted, particularly concerning individual professions, will be taken on board. However, this is a sequential issue. First, there is the repeal of the Act, and there is the order-making power. Then there will be proposals to be consulted on with the regulatory body, the individual professions and with the wider public. Then we have to have a draft order that is consulted on. We are not at the stage of having definitive proposals to put before the Committee.

Lord Morris of Manchester: As I indicated in moving the amendment my purpose today was to secure total clarity as to the Government's intentions in regard both to protection of title and definition of the future regulatory regime they envisage. Certainly what my noble friend has said about protection of title will be welcomed. I also sought firm assurances that would satisfy the Society of Chiropodists and Podiatrists that any change to current arrangements for self-regulation would be to strengthen rather than to weaken them. I shall be consulting the society urgently about the outcome of today's debate so that it can consider what further action it may wish to take in the interests both of its members and the public interest. It is on that basis that I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 196 and 197 not moved.]

4.30 p.m.

Lord Clement-Jones moved Amendment No. 198:

Page 38, line 28, at end insert ("including specifically nursing auxiliaries as defined in subsection (6)").

The noble Lord said: This is a probing amendment. The amendment seeks to include within those professions related to health and medicine healthcare assistants and nursing auxiliaries. The amendment is a response to the fact that much of healthcare at ward level is in the hands of healthcare assistants or nursing

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auxiliaries. At present the profession is completely unregulated. Although it is very difficult to make comparisons between now and 10 years ago, it seems from the figures that in some regions there has been some growth in the use of nursing auxiliaries. There have been abuses and problems as a result of that profession being unregulated.

A recent J.M. Consulting report on the regulation of nurses, midwives and health visitors took a good deal of evidence on the issue of nursing and midwife discipline and also responded to the concerns being expressed about the lack of regulation of healthcare assistants. The report states:

    "Those who responded to our consultation have expressed a deep concern about the threat to public protection posed by some unregulated support workers who, for example: obtain posts by deception or without adequate check on their suitability; or work unsupervised with vulnerable patient groups; or work in high-risk situations with no training".
It continues:

    "We recommend that the government establishes a short review of this area with the aim of introducing a practical scheme of regulation".
In a recent Starred Question the Minister assured me that the matter was under review but the second half was, in a sense, missing. There was no undertaking that at the end of the process the idea was to introduce a practical scheme of regulation. It would be very helpful if the Minister could indicate her intentions at this stage.

The RCN has called over a number of years for the regulation of healthcare assistants and certainly did so in its response to that review of nurse and midwife discipline. A recent survey of nurses showed 94 per cent. of respondents calling for regulation. The most notorious case involving healthcare assistants was that of Yuen How Choy, which was reported in 1996. In that case a former mental health nurse and former rapist was struck off the nursing register but could still be employed as a care assistant in a hospital. That may be a hard case but it seems to demonstrate precisely why regulation is needed in these circumstances. I beg to move.

Earl Howe: I rise to support the noble Lord, Lord Clement-Jones, in his amendment. The points he has made are very persuasive and ones with which I completely agree. He is right to draw attention to the issue, which is of considerable importance. If I have a small criticism it is of the wording of the amendment. I would have preferred to see specified "healthcare assistants" and not "nursing auxiliaries", but the substantive point is exactly the same.

As the noble Lord said, healthcare assistants or nursing auxiliaries play an increasingly important role in the delivery of patient care, both in hospitals and in the wider community. The registration of healthcare assistants would achieve two main purposes. It would offer a means of sifting out bad apples who presently move from one part of the country to another and repeat their misdemeanours undetected and often with impunity. It would also lift the standing of the profession by providing a means of self-advancement through a recognised system of professional

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qualifications. In addition, the Royal College of Nursing has referred to the desirability of matching the regulatory framework with the lines of accountability that operate in practice. Healthcare assistants are very often supervised by nurses and there is a good argument for shared and complementary codes of conduct and disciplinary systems.

There is an urgent need to address this matter quickly. I wonder how many members of the public are aware that healthcare assistants, in hospitals or the uniformed carers in an old people's home, are subject to no statutory regulation or minimum standard of proficiency. The increasing dependence of hospitals on their auxiliary staff and public concern over cases of abuse in homes make it all the more essential that we provide a means of raising standards of care across the board. It is part of the quality agenda and I hope that the Minister will be sympathetic, if not to the amendment then to the central point at issue.

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