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Baroness Gibson of Market Rasen: My Lords, I rise to support the Nursing and Midwifery Order and to support the CPHVA, whose leadership may have been a little maligned on occasions today. I here declare an interest. Before entering your Lordships' House, I worked for the Manufacturing, Science and Finance Union of which the CPHVA is a valid part. I worked there for 13 years with and for the CPHVA, so I am very familiar with the debate which is taking place in the Chamber today.
I also had the honour—and it was an honour—during that time to attend the annual conferences of the CPHVA. There has perhaps been a suggestion that the CPHVA is not a democratic organisation. Every year it holds a large conference attended by many representatives who represent the 18,000 members. Every year the director of the CPHVA addresses the conference.
I want to read a short extract from a report of the director's address to the 1999 conference because it has been suggested that the CPHVA did not mention to its members what was taking place. The article states:
- XIn her opening address she"—
- Xsaid that the CPHVA's developing role in the arena of primary and community health care had meant letting go of some of the things held dear in the past, such as the name 'health visitor' in the title of the new Nursing and Midwifery Council.
- XSome feel that this is a disaster for the future of health visiting. My message to all of you who feel this way is that you are wrong".
- XCPHVA members should have the confidence to know that health visitors were still leading the agenda from their place on the new council, so professional differences should be left behind. 'They weaken us and detract from the main agenda—an agenda to secure the right and appropriately regulated workforce for the future'".
Jackie Carnell was not howled down. There were no shouts of Xhorror" from the floor. There were no riots at that conference. Instead, she was received with acclaim and a standing ovation at the conference for what she and the executive behind her had done for CPHVA members in relation to this order.
Finally, the CPHVA is not an organisation which is irresponsible. It obviously wanted to look after its members, so it took legal advice. It was firmly advised that the order as it is written fully covers the HVA and what it requests from the order.
9.15 p.m.
Lord Hunt of Kings Heath: My Lords, this has been a high-quality debate. That is not surprising because the issues we are debating are extremely important in relation to the future of these professions. All noble Lords have spoken from a great degree of experience in these areas. The noble Baroness, Lady Emerton, set the context of self-regulation. The enormous strides which have been taken over the past 40 years have been partly as a result of her profound leadership of the profession and her stewardship at the UKCC. While I firmly believe that the current rules surrounding the UKCC are not up to what we need for the modern professions and their regulation, I pay tribute to all UKCC members who have put in an enormous amount of hard work.
My noble friend Lady Howells of St Davids made a telling point about the community interest to black minority ethnic nurses, health visitors and midwives. She pointed out that they, along with most of the professions, which are so dedicated, welcome what is contained in the order.
The most striking point that I should like to make to noble Lords tonight is that the health professions are often accused of tribalism. Sometimes that accusation has been correct, but those professions—I include the 12 professions that we are to debate shortly—within the Health Professions Council have ridden above that tribalism. Surely it is unique that the Government stand before noble Lords with the backing of the 15 professional organisations, together with Unison, in support of the order. It is an order that will enormously enhance the public interest and public involvement in those regulatory councils. I repeat, surely that is unique.
My noble friend Lord MacKenzie spoke of the compromises that enabled this development to take place. Yes, there have been many compromises, but I believe that they have come about through a measured process of consultation. The noble Baroness, Lady Cumberlege, has already referred to her starring role in commissioning JM Consulting. When she welcomed its first report, concerning the professions supplementary to medicine, she said that she
welcomed the report and supported its conclusions, but that completely new legislation would be required to streamline the existing arrangements. How right she was. Considerable consultation has taken place since 1996 in relation to the health professions, and since 1997 in relation to nurses, midwives and health visitors.It is also worth making the point that we published our original proposals for a three-month public consultation on 1st August 2000, and completed those by 1st November 2000. Having considered those responses and having been involved in many discussions between the professions and those organisations which reflect the public interest, as well as the Department of Health, a draft order was then published for consultation. The comments we received as a result of that consultation very much reflected support and a recognition of the fact that the Government had listened.
I come to the issue of health visiting. We have had a long and passionate debate. I am aware of those health visitors who are concerned about the position of the health visiting profession, but I have to say that the professional body for most health visitors has campaigned long and hard for this very change. As my noble friend Lady Gibson pointed out, my experience of the CPHVA confirms that it is an extremely professional organisation that is well able to speak on behalf of its membership. Any government must rely on the basis of discussions held with the recognised professional organisations. That is what we have done.
In the light of all the discussions that have been held over the past few weeks since the order was debated in another place, I have talked to Mr Jonathan Ashbridge, the president of the shadow Nursing and Midwifery Council. I felt that noble Lords would find it helpful if I were able to give the assurances which he has given to me and to place them on the record tonight. In a letter which I received yesterday, Mr Ashbridge states that:
- XI can confirm that the Council is committed to ensuring that there is a part of the register for health visiting. Indeed, at its meeting next Thursday, the Council will be asked to approve its response to the competence framework required for entry onto this part of the register.
- The NMC's prime function is public protection. The full range of public health and community practice that health visiting embodies is seen by the Council as a vital component of the provision of healthcare in this country. It is therefore essential that the existing high standards of regulation must continue and be enhanced. It is inconceivable that health visitors would not play a significant role in the conduct and work of the Council as the majority of care provided in this country is and remains in the community.
- Health visitor registrant members are already making a vital contribution to the work of the Shadow NMC. This reflects their comprehensive preparation in terms of education and training, but also their unique ability to articulate the wider health needs of the public. The proactive approach epitomises the modern face of regulation which is encapsulated in the draft order and is a valuable base which will underpin the Council's work".
I want to make it clear that we need to be able to protect the public by registering the whole range of health visitors and community and public health
specialists. This protection does not come from having a profession named either in the order or in the name of the council itself. The protection comes from being included in the register held by the council. This means having the power to create a part of the NMC register for that whole group of practitioners, with a designated title and appropriate qualifications to match. The order contains a provision to do just that.As noble Lords have remarked, we have provided for a part of the register for specialists in community and public health and for their four places on the council. In practice, this might change only if they themselves wanted it to happen, by extending their role to cover a wider group of specialists in community and public health. Before any change could occur, the council would have to consult health visitors and must have proper regard to their differing considerations as a group. This would extend their protected title and protected specialist training into a wider group.
The part of the new register will carry with it a protected designated title, which means that only those with the specialist approved training, such as in health visiting, which leads to registration in that part of the register may call themselves by that title. The title and part itself is for the council to propose and the Privy Council to determine. To make a far-fetched suggestion, even if the council tried to overrule the health visitor members by not proposing such a part—which is most unlikely—the Privy Council would still be able to overrule the council.
The title might be XRegistered Health Visitor"; it might be XRegistered Community Practitioner (Health Visitor), XRegistered Community Practitioner (Public Health Practitioner)" or XRegistered Community Practitioner (Family Health Practitioner)". The additional identifier in the parenthesis could be whatever health visitors choose, the NMC proposes and the Privy Council decides on to reflect their changing wider role. But, whatever it is, only practitioners with that special training may call themselves by that title. In future, the part of the register may be for XRegistered Community Practitioner" with additional identification of the branch of specialist qualification in parenthesis—for example, X(Health Visitor)". There is an exact parallel to this on the Health Professions Council, which we shall come to debate shortly.
As to membership, the election scheme in Schedule 1 Article 2(2)(b) must be devised by the Nursing and Midwifery Council itself. Again, the health visitors on the council will be there to see that the election scheme provides for their part of the register to have members to represent it. Given that there must be health visitors on the council, it is inconceivable that they will not propose to have their own part on the register. From my discussion with Mr Ashbridge yesterday, I can assure the House that there are four very able and assertive health visitors already playing a full part in pursuing their professional interests.
My noble friend Lord MacKenzie made a telling point about membership. At the moment, on the UKCC there are 40 elected professionals. They
comprise 28 nurses, eight midwives and four health visitors. The new shadow council, the transitional council, enables there to be four health visitors, four nurses and four midwives. What better protection can there be for health visitors than that change?Like every noble Lord, I believe that the health visitor profession is a noble one. It has, as the noble Baroness, Lady Cumberlege, said, played an enormous role in developing public health in this country. I believe that the way in which the order has been constructed enables the profession to go forward and to enhance its responsibilities and role. I am convinced that there are sufficient safeguards in the order to enable that to happen.
I turn to the question raised by the noble Baroness, Lady Cumberlege, concerning midwives, and particularly to the proposal to increase the fine applicable to those who commit the offence of attending a woman in childbirth as a provider of care without an appropriate qualification as either a midwife or a medical practitioner. By Xattend" we mean Xassume responsibility for care".
The proposal is not intended to outlaw husbands, partners and relatives whose presence and general support for women in childbirth is extremely important. The point of the offence is to protect the function of midwifery in the interests of public safety. This has been an offence since the Midwives Act 1902. The fine incurred by the offence was #10 at that time. We received advice from JM Consulting, which thought that the level of the fine should reflect the seriousness of the offence. The Royal College of Midwives and some consumer groups supported that.
I am aware that the Association for Improvement in Maternity Services feels strongly that a fine for this offence should be dropped altogether. I understand why. The association wants this so that, in the case where a woman wants to give birth at home but there are no qualified midwives available to attend her, she may at least have the attendance of a partner or relative on the grounds that having someone unqualified is better than having no one in attendance at all.
The noble Baroness, Lady Cumberlege, knows that I am sympathetic to matters relating to childbirth as two of my own children were born at home. However, I also believe that the safety of both mother and baby is paramount. I accept the challenge that the noble Baroness lays down. But the best way to tackle this is to increase the number of practising qualified midwives to enable the health service to offer the home birth service which I believe it should be offering. I say unequivocally that that is our intention. I point out that there have been hardly any prosecutions for this offence. We have come across only one, which took place nearly 20 years ago.
Again, the quality of the debate has been outstanding. We are all agreed that we want to see enhanced professional self-regulation to enhance the public interest. No one disagrees with the noble Lord, Lord Clement-Jones, as to the importance of health visitors. I hope, however, that I have reassured the
noble Lord that the intent in this order is to enhance the profession, to safeguard it, but to create the conditions in which it can expand and develop the services that it offers to the public.
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