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Earl Howe: I too wish to support these amendments. With the prospect of the repeal of the Nurses, Midwives and Health Visitors Act 1997, I think it is terribly important that safeguards are put in place to protect the essential features of the regulatory regime for midwives. This Bill provides an ideal opportunity to do so. Midwives are the third largest professional group in medicine. They can diagnose, prescribe for, and treat a number of specific conditions without reference to a GP, and as a result they are a profession which lays particular emphasis on training and continuous professional development. It would be most unsatisfactory if there were ever any confusion or uncertainty over which education and practice issues were relevant to midwifery.

There is absolute unanimity in the profession about wanting to see acknowledgement of midwifery having control over its own professional destiny and in particular its own education and practice. That can really only be done by strengthening the representation of midwifery on the central council. Whether you achieve that by having a separate midwifery committee, or by having equal representation of nurses and midwives on the council, is open to legitimate debate. I hope that the Minister will at least be receptive to the thrust of these amendments.

Baroness McFarlane of Llandaff: I too wish to speak to the two amendments which bear my name. I regard them as probing amendments because I believe they may well be overtaken when we arrive at a firmer resolution of what is envisaged for the successor body to the UKCC. I have tried to do the arithmetic with regard to the successor body with perhaps 24 members, a third of whom will be lay members, with representatives from four countries. I do not know whether the Minister is prepared to do the arithmetic and divide up the successor council, rather like Solomon wanting to divide the baby between the two ladies. She will need the wisdom of Solomon in this regard. We need to be careful that the particular professional expertise of midwives is guarded. We have already heard that they undertake considerable independent clinical decision-making.

Baroness Hayman: Our brief debate on this issue is analogous to the debate we had on chiropody and

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podiatry. We are debating the contribution of important professional groups. In this Bill we establish an enabling structure to allow successor bodies to be put in place. I cannot give the Committee chapter and verse on every detail of that successor body. However, the Government fully understand and share the aims that have been expressed of preserving the strong identity of midwifery as a separate profession within a joint regulatory structure. Midwives have been at the forefront of developing services which are more focused on what patients want and need. They rightly expect to have a strong and decisive voice in the regulation of their own profession. That is why we made clear in our response to the recent review of the Nurses, Midwives and Health Visitors Act that any proposals we put forward for legislation to replace that Act will provide for the separate registration of midwives. The new council will have a duty to make rules on midwifery practices. There will be equality of elected membership of the council between the professions. However, I shall not follow the noble Baroness, Lady McFarlane, into the judgment of Solomon which, as she rightly says, we may need as regards the allocation of places on the council. Perhaps most importantly, the structure and rules for the committees should ensure that midwives cannot be outvoted by the other professions on matters solely affecting midwifery. That is an extremely important point, as indeed is the recommendation, which we support, that the council should create a post of director of midwifery regulation.

As I have said many times today, it is our intention to repeal the whole of the 1997 Act and abolish the UKCC. We shall bring forward an amendment to enable this. We intend to consult fully on the detailed proposals for the replacement legislation. As the noble Lord, Lord Clement-Jones, recognised, that process has started. It would be wrong, through this amendment or through any comments I make on further detail, to pre-empt that consultation. However, I am happy to repeat the commitment that we shall not bring the repeal of the Nurses, Midwives and Health Visitors Act into effect until we are ready to put in place a new scheme that commands public and professional confidence. We shall consult with each of the professional groups involved to ensure that we strike the right balance between the multi-professional overall body and the representation of individual professions, particularly the midwives, in areas relating to their own practice. I hope this provides some reassurance to the noble Lord.

Lord Monkswell: I thank everyone who has taken part in the debate on this amendment. I thank particularly my noble friend the Minister. I think we are all reassured by the specific assurances she has given from the Front Bench. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 206 to 213 not moved.]

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Baroness Wilcox moved Amendment No. 214:

Page 52, line 20, at end insert (", and
(c) consult patients and carers.").

The noble Baroness said: In moving the amendment I must declare an interest. I am the president of the National Federation of Consumer Groups. Having been involved in the consumer representation world over a number of years, I have taken a considerable interest in the way the professions organise themselves. In this House I raised the issue of professional rules during the passage of the Competition Bill in the previous Session. Professions perform important services for us all. This is particularly so in the field of healthcare where the professions try to keep us healthy, look after us and treat us when we are ill. But by their very nature professions can have considerable power over those to whom they provide a service. And we all know that things can go wrong, sometimes disastrously so.

Regulation of the professions is therefore important for the consumers of their services. In healthcare, bodies such as the General Medical Council, the General Dental Council and the General Osteopathic Council provide statutory self-regulation, as we have heard so well expressed today. Those who use the services of the professionals need to be confident that they are adequately trained; that they operate to minimal standards of competence; that clients have somewhere to go if things go wrong; and that appropriate disciplinary action is taken if a member of the profession is found guilty of misconduct.

Each profession is regulated under a law specific to it. This has led to anomalies developing between different professions, which everyone acknowledges need rectifying. For example, the General Medical Council has powers to act where doctors' performance is not up to standard, while the General Dental Council does not have such powers. Some councils have powers to act where the health of a professional is causing poor performance; others do not. And, worryingly, many professions--psychologists, counsellors, psycho- therapists and many working in complementary therapies--have no statutory regulation at all.

Changes to these schemes currently require primary legislation. As we all know, relying on spaces in the legislative timetable is a somewhat precarious and inflexible process. The provisions in the Bill to enable these changes to be made through an order rather than primary legislation are very welcome.

My amendment, which is supported by the National Consumer Council and other organisations within the Patients' Forum, relates to the process of making the order. Paragraph 9 of Schedule 3 requires the Secretary of State for Health to lay a draft order before Parliament. He is required to publish the draft order and consult professional bodies about the draft. The purpose of my amendment is to require the Secretary of State to consult also with users and carers as well as the professions. The regulation of professionals has implications for the users of their services and any changes must command their confidence.

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In support of my case, perhaps I may quote what the Government said in the White Paper, The new NHS Modern · Dependable:

    "The Government will continue to work with the professions, the regulatory bodies, the NHS and patient representative groups to strengthen the existing systems of ... self-regulation by ensuring that they are open, responsive and publicly accountable".
I believe that my amendment is in the spirit of that very welcome statement. Professional self-regulation is not just about the professions but about the experiences and needs of patients and carers too. They have an important view. Statutory provision for consultation should include them on the same basis as the professionals. I beg to move.

Baroness Pitkeathley: I rise to support the spirit of the amendment. It is in accord with the huge amount of progress that has been made in recent years in making the patient, the user and the carer infinitely more central to healthcare provision than has hitherto been the case. The amendment is very much in that spirit in recognising that the experience of the patient and the carer should be important to all the professional deliverers of that service.

6.45 p.m.

Baroness Hayman: I am grateful to both noble Baronesses who have spoken for allowing me the opportunity to say that, in a sense, this is the counterweight to some of the discussions we had earlier and a recognition that we should not underestimate the importance of the views of those who are at the receiving end of professional services. Opening up government and public services and making them more responsive to the public and public service users' views is a key theme for the Government. We have made our commitment clear in the White Paper, as the noble Baroness, Lady Wilcox, pointed out. The Government are working to attain more effective public and user input into the development of policies. For instance, they have developed with the help of some national patient organisations a set of principles to follow involving user organisations in the development of health service policies. They have also established a standing advisory group for consumer involvement in research and development which includes user-group representatives to advise on the best way to involve consumers more fully in the department's research programmes. In the White Paper and in our discussion document A First Class Service we made it clear that we expected the statutory regulatory bodies to work in partnership with the Government, the NHS and patient representative groups to strengthen the existing systems of professional self-regulation by ensuring that they are open, responsive and publicly accountable.

As we have said many times this afternoon, protection of patients is at the heart of professional self-regulation. It is important that we consult with patient representative bodies on draft orders and it is certainly our intention so to do. There are, of course, a number of interested bodies and parties which should be

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consulted on a draft order. We will work closely with them in developing those orders and consult fully according to the processes I described earlier today.

As ever, we have returned to a recurring theme of some of the Committee's debates--how we avoid listing the people to be consulted in any set of circumstances and the dangers of making that list exclusive. However, I suspect that we have been too paring in the provisions in this regard. We have made it clear that there is a responsibility to consult the professions. Equally, we should make the necessity of consulting patient representatives clear on the face of the Bill. If it is possible to draw up something suitable, and if the noble Baroness would be content, I should like to give some further thought to this matter and see whether at some stage in the further progress of the Bill we can bring forward a suitable amendment.

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