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Baroness Howells of St Davids: My Lords, I feel compelled to speak in this debate. I am sure that noble Lords will not doubt me when I say that the one place in which the black community has excelled is in support of the profession that we are discussing. They have given unstinted help from the 1960s to now and have reaped the rewards. Nevertheless, I felt that it was important to find out from them what was really going on. They are in full support of the Royal College of Midwives, the Royal College of Nursing and the Community Practitioners and Health Visitors Association in welcoming the order.
All these organisations would have liked far more for themselves, but they all recognise that a fully comprehensive consultative process has taken place and the best possible formula has been found to accommodate all parties. They all say that this has been a long drawn out process that has found an
acceptable solution to a very complex situation. The solution has been reached only with the dedication and commitment of the organisation involved, as well as the Department of Health, which has handled this matter in a very efficient manner.As has already been said, there has been extensive lobbying within Parliament by a small minority of health visitors who want a disproportionate level of representation on the nursing and midwifery council. The whole idea of the council is for the RCM, the RCN and the health visitors to work together in partnership, a word that is often used in this Chamber. Working in partnership is not for their benefit but for the benefit of the public. That will be a very tall order with these rebels creating tension within the three bodies. They oppose the setting up of the council unless they achieve all their demands. That is not democracy at its best and I suggest that noble Lords will recognise it as such.
If we allow this vocal minority of rebel health visitors to succeed, and we halt these orders, we shall see a situation where the public have less protection from practitioners. I am sure that no Member of this House would vote for members of the public to be left unprotected and open to the practices of unqualified medical practitioners.
There is another reason why we should support these orders. Should they fall, the professions will remain under the auspices of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. This body is preparing to be wound up. We know that it wants to wind itself up, because one senior officer has already announced her resignation and I am sure that others will follow. We shall be entrusting the welfare of the public to a body that has accepted that it is now time for a more modern body to come into being.
The organisations concerned with the NMC order are quite clear that they will want a full review of this legislation if there is further opportunity. They estimate that the process may take a further two years and will be an exhaustive affair. Two years of the public—the very public that we want to serve—being left without full protection; two years with the UKCC left in uncertainty; and two years of further wrangling between these august bodies.
We need to think about the welfare of the general public. We also need to take into account the views of the royal colleges of midwives and nursing, as well as the Community Practitioners and Health Visitors Association, which have all found agreement through this legislation. Voting against this order will be a retrograde step for Parliament and the health service and may have detrimental health implications for the general public.
Baroness Cumberlege: My Lords, before I make my contribution, I declare an interest as vice-president of the Royal College of Nursing and of the Royal College of Midwives and I hope a friend of the Health Visitors' Association.
The other day the Minister reminded me that it was I who conceived this difficult debate. When I was a Minister I commissioned JM Consulting Group Inc to
review the regulation of nurses, midwives and health visitors. I did so because, prior to becoming a Minister in 1992, I was a lay member of the UKCC. I served under the very inspiring leadership and skilful chairmanship of the noble Baroness, Lady Emerton. I was very conscious when I was serving on the UKCC that the noble Baroness was determined that the issue that was most important was the protection of the public, as well as keeping these professions together in the nursing family.That was not explicit in the regulations, it was implicit, and the noble Baroness consistently and continually reminded us of our role. Having served on that body, I understood that the UKCC was cumbersome, rigid, slow, bureaucratic and very demanding of members' time. I should like to pay tribute to all the members of that body, particularly the professional members. But the costs to the National Health Service were high, because those people when they were in committee, on the professional conduct hearings and all the mechanisms involved in that, were not looking after patients or clients in the community.
Like my noble friend Lady Noakes, I do not subscribe to the conspiracy theory. I understand the health visitors' fear about their professional status being eroded and also that the public is not being fully protected. But their fears are being exaggerated. As I understand the matter, the health visiting profession will be separately identified through the dedicated part of the new register; only a registered health visitor will be entitled to use the title that has been designated from that part of their new register; and under transitional provisions the health visiting profession will have separate representation on the new council and parity with the other professions. That is a huge step forward.
When I reviewed community nursing 15 years ago, I remember the publicity in the press. There were headings such as, XWhat do Health Visitors do?", XWhy are health visitors there?", XWhat is their role?". There was tremendous ambivalence. There was pressure on my team to try to erode the role of health visitors. Trevor Clay, who was the general secretary of the Royal College of Nursing, asked me, XAre you going to do away with health visiting?" We did not because it has such an important role.
In the intervening 15 years we have seen its role expand enormously. They really are the praetorian guard. They are the people there to promote health. I have seen the cycle of deprivation broken very impressively, not by social workers but by health visitors. So of course I have great feeling for their concerns. But those involved in health visiting see the future. It is interesting that they have even changed the name of their organisation to the Community Practitioners and Health Visitors Association. That is visionary, and I hope that in future they will go on to break new frontiers to improve the health of our nation.
Much consultation has taken place over a long time, which should not be rubbished. The association has been extremely diligent in trying to obtain the views of
its members. The view of the minority, and all the rest of it, has already been debated, so I shall not go into that. But the potential of the new council should be realised and the building blocks are there. It is with huge embarrassment that I find myself totally in support of the Government on this occasion.I shall refer briefly to midwifery. A concern has been expressed about Article 45. I know that the Minister shares my view that women should have a choice about where they give birth. A lot of pressure is being put on women to give birth in hospital rather than at home when they would prefer to be at home. There is concern that where husbands, partners or friends take part in a birth and a midwife is not present, they may be prosecuted under the order.
I should like an assurance from the Minister that that choice will still be open. I hope that he will promote it in any way that he can. I also hope that he will assure us that no prosecutions will take place in such circumstances.
9 p.m.
Lord MacKenzie of Culkein: My Lords, I also rise to support the order and to oppose the amendment in the name of the noble Lord, Lord Clement-Jones. In doing so, I declare an interest as a current registrant in the register held by the United Kingdom Central Council and, latterly, as an associate general-secretary of Unison—although I have not been briefed by Unison for this debate.
There has been every opportunity for the organisations representing the professions to have their say during the long consultation period. Indeed, the outcomes have been very much influenced by the nursing and midwifery organisations. The royal colleges of nursing and midwifery, Unison and the Community Practitioners and Health Visitors Association have all been active in consulting and representing their members.
As someone who gave evidence and made representations to the Labour government in the run-up to the 1979 legislation, which gave effect to the UKCC and the four national boards, I know just how seriously nursing organisations take the issue of registration, professional regulation and discipline. The noble Lord, Lord Hodgson of Astley Abbotts, referred to that legislation and its run-up. It was the last Act carried by that Labour government before it fell in 1979, and I know that many concessions were made. I cannot remember whether the inclusion of health visitors was one of those, but many concessions were certainly made in the wash-up period before the Act was passed.
I also know, unless the world has changed since my day of representing nurses, that none of the organisations will have got everything that it wanted during discussions with the Government. That is the nature of the real world. The order represents an acceptable compromise agreed between the Department of Health and the professions of nursing, midwifery and health visiting. Lest any noble Lord be
in any doubt, the unions to which I referred represent the vast majority of nurses and midwives on the register. None of those organisations will regard it as helpful if the amendment is carried.When I was general-secretary of the Confederation of Health Service Employees—an organisation with about 70 per cent nurse membership, together with some midwives and health visitors—I was familiar with groups of members being unhappy with the outcomes of negotiations, consultations or democratic decision-making. Their cry was, as the noble Baroness, Lady Cumberlege, said, XWe've been sold down the river by the leadership". They sought to engage every avenue to pursue their cause—including, of course making representations to Opposition politicians. I know nothing of the current internal business of the CPHVA, but sometimes such causes have as much to do with trying to usurp the leadership or preparing for a round of elections as with the issue.
What we have here is a great deal of compromise to reach middle ground with which everyone can live in the interests of the greater good. A group of health visitors believe that they have been sold down the river. They do not appear to see the wider picture. They do not see what others have given up in the course of reaching that compromise that meets the wider interest.
Let me give one example of such a compromise. If memory serves me correctly, the present statutory body, the UKCC, contains 28 elected nurses, four health visitors and four midwives among its membership. The order tonight provides for four nurses, four health visitors and four midwives. I know many nurses who think that that change in the ratio between the professions from 7:1 to 1:1 with health visitors may be a compromise too far, but the majority of them accept the need for a streamlined, efficient and flexible organisation. Nurses have not become a dissenting voice, notwithstanding what they have given up—some would say, given away.
To carry the amendment would be manifestly unfair to nurses, not least because many nurses—I am among them—accept that health visiting is part of the greater family of nursing. One cannot be a health visitor unless one is a nurse. Nursing is a family with several branches and, within those branches, many specialisms. Of course health visitors do a great job and tribute has rightly been paid to them today. We shall continue to do so. But many others do a great job: practice nurses, palliative nurses, district nurses, community psychiatric nurses and others in community teams who are not nurses, such as physiotherapists and occupational therapists. The boundaries between all of them are becoming increasingly blurred. Which would be in, and which out, in the definitions proposed by the noble Lord, Lord Clement-Jones?
If I can for a moment be critical of my profession, it has a propensity for elitism. All nurses are special, perhaps none more so than nurses registered in the specialty of caring for people with learning difficulties. They are special, but they are not elitist. They have not
been lobbying for their own part of the register to be guaranteed. That may well happen—I have no doubt that it will—but they have not been lobbying for it.Most of my clinical practice was in operating theatres and in trauma intensive care. We were a scarce commodity, but we were not, I hope, an elitist group. How could we be when so many of our colleagues used to suggest that we were really technicians?
In a profession as disparate as nursing, there is no room for elitism. There has to be room for change, development and continuing learning to keep pace with all the changes in society. As the noble Baroness, Lady Cumberlege, properly pointed out, in recent years health visitors have played a tremendous part in that change. I have no doubt that they will continue to do so.
There is no need for the amendment. There is already provision in the order for setting up a part or parts of the register for community and public health specialists. And with one health visitor to every nurse, to every midwife, I have not the slightest doubt that health visitors are well provided for; and I believe that a part of the register will include health visitors. However, the amendment would create uncertainty and would be a distraction from the real business of bringing regulation up to date and, most importantly, of protecting the public.
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