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Baroness Noakes: My Lords, I thank the noble Lord for giving way. When he referred to what the members were balloted on, can he confirm that they were asked specifically—I believe that this is what he said—whether or not they were happy with the draft order?

Lord Hoyle: My Lords, I said that they were happy with the way that matters had progressed in relation to this matter. I also said that 81 per cent had gone further than that. Independent surveys were carried out in which 5,000 people were canvassed—that is, 82 per cent of the total. Only recently—that is, this year when the matter came before us—3,700 people were contacted. Again, 81 per cent of those balloted were in favour. Therefore, I say to the noble Lord and to the noble Baroness, who have spoken from the Opposition Front Benches, that they are speaking for a minority—a vociferous minority, I accept. However, that is the group for whom they are speaking.

This order is not about titles; it is about what will happen in the future. In the future the order will not only bring together the professions; it will also involve the public far more. It is about protecting the public as well as the professions. Professions are important but we must not be hidebound by them or by their names. We must see what is being done.

There are more health visitors on the new council than there were on the old one. In addition, they will have equality. This issue has not arisen out of nothing. Not only has consultation taken place among the members of that profession; there has been consultation with Ministers and officials. It has taken six-and-a-half years to arrive at the point that we have reached this evening. I say to anyone who wishes to

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destroy what has been built up over six-and-a-half years that there is a pointer to the profession being better and more professional. Health visitors will become involved. Their profession is a very proud one. In addition, as has been said, the public will be protected in relation to community and public health, too. We are moving forward.

I do not want to see this matter unravel because of amendments, however well meaning. I hope that, on reflection, the noble Lord, Lord Clement-Jones—he says that a member of his family belongs to this profession—will take into account what has been said by those of us who speak not only for one person but for the vast majority of health visitors and other professionals, such as those who work in community and public health. I hope that the order will not be held up or even destroyed because of a good intention upon which the amendment is based. I believe that we have moved on and that the noble Lord speaks for a tiny minority.

Baroness Emerton: My Lords, I declare an interest having had 48 years experience as a nurse and 23 years of being involved in the professional regulatory system. I was chairman of the UKCC until 1993. It is true that a need for change in the nurse regulatory system and nurse education was identified in 1948 and it took until 1979 for legislation to be passed. From 1983 until now there have been great movements forward in bringing nurse education into further education and universities. There has been movement in terms of the profession coming closer together. However, there is no doubt that large bodies are not effective and efficient at working speedily. It has been apparent that professional conduct work has been slowed down by procedure.

After the review of the present structure by JM Consulting recommendations were taken on board. We know that primary legislation was urged by the profession. However, we were persuaded by Ministers at the time, because consultation would take place, to go for an affirmative order. The profession, which includes nursing, midwifery and health visiting, were resistant at that stage. However, it was finally persuaded and consultation took place. As stated by the noble Lord, Lord Hoyle, that took place over a period of six years.

I am mindful of the words used by the noble Lord, Lord Clement-Jones, in terms of the minority group. The noble Baroness, Lady Noakes, referred to the minority of health visitors—which is a small minority—who wish to contest the title of the order and the fact that they do not have a separate register. We live in a fast moving world of change in the health professions. I support the order. I would ask that the amendment before us tonight be revisited in the light of the fact that the draft order states that the council may set up a register and that there is representation on the council of an equal number of nurses, midwives and health visitors, as the Minister stated, with a majority of one professional.

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I therefore support the draft order. I take into account the views of health visitors, who play an important part in the future of community and public health nursing. They have a proud profession on which to reflect. However, we have to look to the future in the provision of health care, both within hospitals and the community, which is fast moving. The delivery of the health professionals is extremely important. The draft order provides a facility in which there can be flexibility and whereby a register can be set up which could embrace all those that work in the community. I am sure that any council which well and truly reflects public and patients' interests will ensure that there is equal representation in terms of a need to set up a register.

8.45 p.m.

Baroness Turner of Camden: My Lords, I, too, declare an interest. The noble Lord, Lord Clement-Jones, said that his sister is a health visitor. My step-daughter is a health visitor and a member of the HVA. I was an official of MSF, which is the overall organisation to which the Health Visitors Association is affiliated. The HVA is a democratic organisation. It had its own elected executive and annual conference. The group that has been lobbying in favour of the amendment or against the order seems to be a tiny, maverick group. When consultation takes place, that must be with the elected leadership of those organisations. Who else should consultations proceed with?

The HVA is keen to have this order after six years. It thinks that it will help its members to move forward. It is anxious that the order should pass unamended tonight. It has pointed out to me that this will give the HVA stronger representation on the council than it has ever had before. It believes that the order will be helpful, and that it speaks for its membership except for a tiny minority. We do not have to take note of tiny minorities, no matter how articulate. What really matters are the elected senior representatives of the organisation. They are both elected and supported by the membership. I therefore hope that we shall vote tonight for the order unamended.

Lord Hodgson of Astley Abbotts: My Lords, the noble Lord, Lord Hoyle, had his finger on the button when he spoke of the key criteria being patient care and patient safety. Therefore, I understand the thrust behind the order which the Minister clearly explained. That having been said, I believe that the noble Lord, Lord Clement-Jones, has made a good point. I do not want to re-run the arguments put before your Lordships' House; they are clear.

Twenty years ago, as a Member of another place, I served on the Standing Committee which dealt with the Nurses, Midwives and Health Visitors Bill, which became an Act in 1997. Some of the issues that we are debating tonight are echoes down the years of the tensions that exist between the different professions—or different branches of the same profession, depending on how one looks at it—that we then had.

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As I recall, there was a long discussion within the then Labour Government about the short title of the Bill. As a result of that, it was concluded that Xhealth visitors" should appear in the short title, as eventually happened. The reason given by the then Labour Government was that health visitors had a distinctive role in healthcare. More than any other, they operated in the community not within the structures of the NHS or the educational system. Theirs was an important and distinctive role, albeit a preventive one, but none the less important for that, as opposed to the curative role with which the other professions were concerned.

In the eyes of the Minister's predecessor at the time, Roland Moyle, it entitled them to a specific mention in the title of the Bill. There is a danger that if one is trained as a health visitor and called a health visitor one does not feel as committed to an order entitled XThe Nursing and Midwifery Order" as a nurse or a midwife, or even a factory nurse or school nurse. I understand from official correspondence which I along with other Members of your Lordships' House have received that all parties, at least at an official level, are happy with the title of the order and what is contained therein. However, as the noble Lord pointed out, Clause 6(3) states Xmay provide". It does not require the register to be set up.

It is easy to talk of 19 or 20 per cent as being a vociferous minority. However, if we were to find a way to move from Xmay" to Xshall", surely that would have the effect of calming the concerns of those health visitors who feel that their profession may be overwhelmed under the new structure and those who feel their distinctive contribution may be overlooked.

I hope that the Government will think about the noble Lord's amendment as a way of bridging the gap and ensuring that we move forward with the thoroughly praiseworthy reasons behind the order but that at the same time we carry not just 80 or 70 per cent of the health visiting profession with us but all of it, because it carries out such an important preventive role for the health of our society.

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