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Earl Howe: My Lords, I have little to add to what other noble Lords have said. The amendments represent a very satisfactory resolution of the difficulties highlighted at Second Reading and in Committee. The Minister deserves our thanks for all that she has done. I beg to differ slightly from my noble friend Lord Skelmersdale because I do not believe that any apology from the Minister is called for after all the hard work that she has done.
My only question relates to Amendment No. 79C. I have been asked by the Association of Optometrists to obtain an assurance from the Minister. As the Government say in their Explanatory Notes to the Bill, the purpose of professional regulation is to set a standard of conduct and competence for each profession
which protects the public. By implication, the purpose of the order-making power in Clause 47, as amended, is not only to keep the legislative framework surrounding the professions up to date but also to strengthen that legislative framework. That was a point which the Minister made this evening.Therefore, will the Minister respond to the concern expressed to me by the Association of Optometrists that the order-making power in Clause 47 and Schedule 3 will be used essentially to preserve and develop the statutory regulation of health professions and that, in particular, it will not be used to reduce the responsibility of the profession for a particular reserved activity such as the testing of eyesight?
9.45 p.m.
Lord Rowallan: My Lords, my noble friend Lord Skelmersdale mentioned alternative medicine, which I use very readily. I felt that he cast aspersions--twice in fact. He said that often people, having been to alternative medicine therapists, then needed "proper" help from the NHS. I believe that that needs to be looked at.
Lord Skelmersdale: My Lords, I must interrupt my noble friend on that. I said that intervention by alternative therapists could--and I stress "could"--result in hospitalisation. I gave three examples of which I had personal knowledge where that was the result. That is most certainly not to say anything damning about alternative medicine therapies. Not only have I used many of them myself, but I was also the Minister responsible for them when I was at that department at the relevant time.
Lord Rowallan: My Lords, I am delighted to accept my noble friend's assurance on that. I have certainly come across many cases where the opposite was the case. People have found great help from one of those alternative medicine therapies.
Further to that, such therapies have existed for a very long time indeed. I have spoken to therapists although only in Scotland, because that is where I live. However, they have led me to believe that they would all be more than happy to welcome self-regulation, compulsory if necessary. There would be little argument from them on that. I believe that it is an extremely good idea. I certainly welcome the amendments which the Minister has brought forward.
Baroness Hayman: My Lords, I am grateful to noble Lords for their generous acceptance of the fact that we have tried hard with these amendments. I say first to the noble Baroness, Lady Fookes, that I accept her point absolutely. There are still considerable powers given to the Secretary of State under secondary legislation. The Delegated Powers and Deregulation Committee and those who have participated in the debates have recognised that if the order-making power were to be effective to do that which the profession wants it to do--for example, to provide a successor body for the CPSM
and the Nurses, Midwives and Health Visitors Act and to allow sensible and flexible changes in the regulation of the professions--it had to be a substantive power.The argument has always been to make sure that that power was not untrammelled and that the appropriate safeguards were built in. Our concern has been to ensure that we strike what I think the noble Baroness referred to as the balance between flexibility and the safeguards. The reaction of the professions indicates that we have managed to do that in the numerous changes which have laid me open to the strictures of the noble Lord, Lord Skelmersdale, of having too many amendments at one time. I understand that that makes it difficult for noble Lords.
Perhaps I may deal with one or two specific points raised in the course of the debate. I should say to the noble Baroness, Lady Emerton, as I tried to make clear in Committee, that I share her concern about the word "administering" not seeming to be particularly clear. It is simply a matter of drafting and covers the issues upon which she had concerns.
In dealing with nurses, midwives and health visitors, perhaps I can answer the questions about the transitional nature--if I can put it that way--of some of the amendments relating to UKCC and CPSM, particularly concerning Amendments Nos. 96 and 97.
In drafting the government amendments on this issue, we have had to balance the need to protect the fundamental functions in respect of the professions supplementary to medicine and the nurses, midwives and health visitors with a need to replace the current bodies. It has not proved possible to draft provisions which would both secure these functions to the CPSM and UKCC and allow us to transfer them to successor bodies, but although in theory we could, therefore, transfer the four core functions to another body--I make it absolutely clear that the Government have no intention so to do--I would like to give the clearest of undertakings on this point. We framed the amendment in order to allow for the transition from the current to the successor bodies which will, of course, have those core functions protected. We shall not remove the four core functions from the CPSM or the UKCC, except to transfer them to the successor bodies when the orders creating those successors come into effect.
On the issues relating to midwifery, perhaps I could reassure my noble friend on the absolutely basic point that it is, and will remain, an offence for anyone who is not a midwife or a doctor to attend a woman in childbirth other than in an emergency. I would also like to reassure him that we value the independent practice of midwives and have no intention of diluting it. In consulting on our proposals for replacing the current Act, we have made it clear that the new council will have a duty to make rules on the midwifery practice and will have a continuing responsibility for the statutory supervision of midwives.
Midwives will have a decisive voice in these arrangements because we intend to provide that matters solely affecting their profession cannot be determined
on the votes of other professions or lay members. I hope that the noble Lord, Lord Clement-Jones, will find that reassuring, bearing in mind the questions that he asked.As regards the question from the noble Earl, Lord Howe, on optometrists, we intend to use the power to strengthen professional self-regulation. It is not our aim to preserve the roles of the existing professions which, quite rightly, develop over time. Our aim must be to ensure that any professional is properly trained to carry out procedures and that they maintain their competence. That is very much the purpose behind these provisions.
Perhaps I can also reiterate to the noble Lord, Lord Clement-Jones, that I believe that I made clear the position with the Privy Council and the CPSM and the reserve nature of the professions supplementary to medicine and nurses, midwives and health visitors.
That brings us to the Scottish issues to which reference has been made. All professions regulated under statute as at 1st July 1999 are considered to be reserved to the UK Parliament. Professions seeking statutory regulation after that date will need the approval of the Scottish Parliament to come into a UK-wide scheme, but it is not possible to change the UK-wide powers and the reserved nature of the powers for the existing professions.
Lord Skelmersdale: My Lords, I am grateful to the Minister. Perhaps I may take the purely hypothetical example of the reflexologists. If a UK-wide scheme is proposed from Whitehall, that is fine. The Scots can either accept it or reject it. If, however, the idea comes from Scotland, are the Scots then allowed to do their own thing? Equally, if it comes from Whitehall, are they allowed to say no?
Baroness Hayman: My Lords, perhaps I may deal with the regulation of new professions, which was the main issue to which the noble Lord, Lord Skelmersdale, referred. I was not quite sure whether the noble Lord was concerned that a new profession could be regulated by order only as part of the successor body to Professions Supplementary to Medicine or whether he was concerned with what is in fact the case, which is that a separate, free-standing regulatory scheme can be provided for by order which will include the four main functions.
Perhaps I may clarify the position. Both situations are possible under the order-making power. There is a precedent for one in that it has been possible by secondary legislation to add professions to the Professions Supplementary to Medicine. It will be an innovation to be able to regulate a new profession by an order-making power.
We believe--the noble Lord, Lord Walton, confirmed that it was also his belief--that, given the very detailed nature of the consultation that would take place, the laying of the draft orders and the consultation upon them, that is an appropriate way to deal with those groups. The noble Lord, Lord Skelmersdale, referred to alternative therapists. Psychologists spring to mind as a group that might seek professional regulation. We
believe that there are sufficient safeguards to make this an appropriate way forward, but the noble Lord may not share that view.
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