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Lord Clement-Jones: My Lords, I agree with the Minister that this has been an extremely useful debate. I very much welcome the support from the noble Baronesses, Lady Noakes and Lady Emerson, and from the noble Lord, Lord Hodgson for the Motion to amend the order.
I admit, however, that I am totally unrepentant in the face of the speeches of the noble Lord, Lord Hoyle, the noble Baronesses, Lady Turner, Lady Gibson of Market Rasen and Lady Howells, and the noble Lord, Lord MacKenzie—whose view seemed to be that I was entering into the trade union politics of the matter rather than debating the merits of the order.
Whether or not they are a Xvocal minority" or Xrebel" health visitors—and the noble Baroness, Lady Turner, suggested that we do not have to take any notice of tiny minorities, just of the Xsenior people"—the fact is—
Baroness Turner of Camden: My Lords, will the noble Lord give way? My point was that the people who were consulted were not just senior people; they were elected through the democratic process within the union.
Lord Clement-Jones: My Lords, I and others on these Benches have always taken one of the functions of this House to be the protection of minorities. It is an extremely important function. It is precisely why this Motion was tabled.
That minority has done a great service. It has elicited considerable assurance from the Minister. He elicited the letter from the shadow president of the new body giving the assurances on each of the three areas about which I asked him. That demonstrates that the minority was right in asking for such assurance. It was right to articulate its concerns to Members of this House.
I shall repeat those assurances because I believe that, effectively, the Minister has answered them. The first is that the register will be set up: I believe that the Minister has given us that assurance, and that it will include health visitors. It will not just be on a transitional basis, but it will be permanent. Secondly, there is the assurance about name protection for health visitors. Lastly, I believe that the Minister has also given an assurance about health visitors' qualification standards and that the new order can deal with and enhance those standards as part of the new registration process.
I am pleased that the Minister has given us those cast-iron assurances for which I asked. I believe that all health visitors will be able to unite behind the order. We have had an effective demonstration of how it is possible for Ministers to give such assurances. Although at the first hurdle they did not succeed, at the
second hurdle—namely, in this House—we have had a satisfactory debate. I beg leave to withdraw the amendment.Amendment, by leave, withdrawn.
Lord Hunt of Kings Heath: My Lords, I commend the order to the House .
On Question, Motion agreed to.
Health Professions Order 2001
9.31 p.m.
Lord Hunt of Kings Heath rose to move, That the draft order laid before the House on 15th November be approved [10th Report from the Joint Committee].
The noble Lord said: My Lords, some of the remarks that I made in introducing the previous order are applicable to this one so my speech will be briefer.
This order is consistent with the order that we have just discussed. It will replace the Council for Professions Supplementary to Medicine (CPSM) and its 12 uniprofessional boards. It makes the same provision and gives the same benefits for the allied health professions and the patients who use their services, as the previous order does for nurses, midwives and health visitors.
Importantly, the HPC will be able to initiate proposals for the extension of regulation to new groups. This is a big step forward. The CPSM was restricted by law to covering only 12 professions, but the HPC has no such restriction. I pay particular tribute to the patience of such groups as the Association of Operating Department Practitioners and Perfusionists who did not secure the limited slots available with the CPSM. I know that they and other professional groups will look forward to the new HPC taking that work forward.
The HPC will have an option to have 25 members, 13 professional and 12 lay, where the president is a professional, as is the case with the appointments made to the shadow council. Of the 13, one will be the president and the rest will each represent one of the professions regulated by the council. We would not expect those members to do the work by themselves. The council must also have four statutory committees to cover the main functions of a regulatory body. Those committees will be multi-professional too, but there is no limit on their membership.
The council will have wider powers to deal with individuals who present unacceptable risks to patients set out at Articles 22 to 33 of each order. It will have powers to deal with registrants whose fitness to practise is impaired, whether through ill health, lack of competence, or misconduct. That will be a big improvement on the current limited powers of the CPSM, which is able to deal only with infamous conduct in a professional respect and has only one option for action which is striking off.
The council will also have a critical role in positively guiding and supporting the vast majority of practitioners whose fitness to practise is never in doubt. In addition, the council may set up any other committees and panels that it needs. It will have extensive opportunities to co-opt non-members to advise on professional matters or on national policy or to carry out detailed casework within the strategic framework that they set.
I understand that one issue that will be discussed in the debate on this order is the matter of chiropodists, particularly unregulated chiropodists. The profession is split into those currently regulated, who have a full three-year degree training to cover footcare across the whole ill and well population, and the unregulated, who, I believe, train chiefly to carry out basic footcare on otherwise healthy people.
The order provides a transitional pathway to registration, open to those who can demonstrate that they have been practising safely and effectively or that their qualifications and experience are comparable to the current requirements for registration. I know that there are some concerns about how that will operate. I assure the House that both sectors are meeting regularly under the facilitation of the Department of Health and the shadow Health Professions Council with a view to reaching an agreed position on the requirements for registration before the new council is established next April.
In the order we have sought to tackle gaps in existing legislation. We have also taken on board the concerns raised by the professions and by consumer and patient organisations. They are unanimously in support of the order being passed. I understand that there are concerns, particularly about chiropodists, but I believe that the order is the best way forward. I commend it to the House.
Moved, That the draft order laid before the House on 15th November be approved [10th Report from the Joint Committee.]—(Lord Hunt of Kings Heath.)
Earl Howe rose to move, as an amendment to the above Motion, at end to insert Xbut that Her Majesty's Government should also lay an amended order containing a provision for a practicable transitional period for entry of unregistered members of the chiropody profession to the register of the Health Professions Council and for wider representation on professional advisory committees".
The noble Earl said: My Lords, I thank the Minister for his comments on the order, which is very welcome in principle. We all recognise the importance of protecting professional titles and ensuring proper standards of training and competence on the part of those who administer treatment to patients. As a concept, the establishment of a Health Professions Council with enhanced powers compared with those of the CPSM is also a positive step forward.
However, as the Minister said, one group of professionals—the large group of non-state registered practitioners of chiropody and podiatry—are far from happy with the order. Chiropody is unique among the
12 or so professions covered by the HPC in that it is the only one split almost 50:50 between state registered and non-state registered practitioners. Both sections account for about 8,000 members, although the non-state registered sector is slightly larger.The split goes back to 1945 when five British chiropody organisations amalgamated and began offering their members to serve the needs of the newly formed National Health Service. They subsequently became the examining body for the purposes of state registration under the Professions Supplementary to Medicine Act 1960. At that time there was no compulsion and little incentive to be registered, unless one wished to work for the NHS. For that reason, the other half of the profession, represented by the British Chiropodists and Podiatrists Association and the SMAE Institute, which had not amalgamated, opted to remain unchanged.
The issue for non-state registered chiropodists is that, upon approval of the order, to be able to work as a chiropodist or podiatrist in the community they will need a three-year honours degree. The existing qualifications of those 8,000 practitioners will officially count for nothing, no matter how long, how safely or how successfully they have been practising.
Nobody, least of all the BCPA, has an interest in allowing sub-standard chiropodists to treat patients. Everyone wants proper regulation. However, the way in which the order will impact on the chiropody profession flies in the face of common sense. All of a sudden we shall be faced with the prospect that a substantial number of chiropodists and podiatrists who are doing important and valuable work will no longer be available to look after their patients. A large decrease in chiropodist numbers will put added pressure on an area of the NHS that is already over-burdened.
The HPC may or may not take a sensible, pragmatic view of this issue. However, the HPC will be dominated by the state-registered sector; the independent sector will have no representation on it whatsoever. I am quite certain that the state-registered sector is approaching these concerns responsibly and will want to avoid a large fallout of numbers, but the matter is largely not within their hands. A two-year transitional period has been allowed for to enable independent practitioners to transfer to the new registry. That period is totally impracticable bearing in mind not only the 8,000 applications that will need to be considered and processed, but independent-sector students who are due to qualify after the critical period.
It should be possible to find a way forward. There are already provisions to enable state-registered practitioners to be registered automatically even if they have no academic degree. So far, however, the picture looks exceedingly unclear. I am sorry to say this, but the Government give the impression that they have rushed the matter along without sufficient thought or discussion. They now seem to be throwing up their hands and saying, XIt's all too difficult; the profession itself must sort out the problems". I believe
that that is not a responsible position for Ministers to adopt. We are not talking about some small minority of under-qualified or unsuitable people from whom the public need to be protected; on the contrary, it is a very large number of skilled practitioners who to a greater or lesser extent have relieved the pressure on the NHS for very many years and do not feel that the Government have done them justice.The order will enable the Government to wash their hands of the problem in the knowledge that the chiropody profession will now be fully regulated. It is deeply regrettable if that is all that matters to the Government. The Government should have felt that they had a responsibility to resolve these difficulties.
Perhaps I may turn to other matters of concern as reflected in my amendment. The Society of Chiropodists and Podiatrists, which represents the state-registered sector, is worried that there will not be adequate representation for each profession on the HPC. Without that, the society fears that the HPC's main aim will not be achieved—the effective protection of the public. I am aware of the proposals to establish professional advisory committees, but the PACs will only be ad hoc working panels to advise on specific projects; as I understand it, they will not be standing committees. Unless sufficient representatives of each profession have a real input into the HPC, it is hard to see how the public are to be reassured by what is now proposed. I wonder whether the Minister could comment on that.
Additionally, the society wants to see a role for the professional advisory committees in ensuring that the four United Kingdom countries are effectively represented in the deliberations of the HPC. There is currently no guarantee that each profession from each of the devolved countries will have a voice on the HPC, although that is apparently what the Government want to see. All that the Government have provided for is for at least one of the professional members and alternates to come from each UK country. As the society has stated, that could mean that a biomedical scientist from Scotland could end up representing all the Scottish professions on the HPC. How practical and how fair do the Government think that that would be?
As I said, we on these Benches have no quarrel with the principle of this order. Our complaint is that the Government should have taken a little more time and trouble to ensure that the concerns that I have outlined were eliminated. That should not have been beyond the wit of man. Regrettably, however, they have taken the decision that it is more important for the order to be rushed through, loose ends and all. I hope that the Minister can provide us with some real reassurances on those important matters. I beg to move.
Moved, as an amendment to the Motion, at end to insert Xbut that Her Majesty's Government should also lay an amended order containing a provision for a practicable transitional period for entry of unregistered members of the chiropody profession to the register of the Health Professions Council and for wider representation on professional advisory committees".—(Earl Howe.)
9.45 p.m.
Lord Clement-Jones: My Lords, I join the noble Earl, Lord Howe, in thanking the Minister for his exposition of the effect and benefits of the new Health Professions Order. In some ways, clearly, putting together the order for the new Health Professions Council to replace the CPSM has been even more difficult than the previous order. But it is clear that most of the professions involved are broadly supportive of the order, believing that it offers a better regulatory system than the current one. I particularly welcome the common registration for independent and state sector practitioners and the type of protection that that will give.
Yet as the noble Earl, Lord Howe, said, there are still strong concerns and problems. In the jargon of the trade, many of them are uni-professional concerns; that is, concerns that relate to individual professions and not necessarily to the scheme as a whole. One of those concerns relates to the practice advisory committees.
Under the previous 1960 Act there was a scheme of boards for each profession which was set up to regulate education and training for each of the 12 professions. Under the order there will be no statutory uni-professional arrangement. However, there will be professional advisory committees which can be set up by the council under paragraph 3(12)(b) of the order.
There is no compulsion for those professional advisory committees to be set up, nor is there any clear ambit for their responsibilities. Those committees should be standing committees with a clear remit.
In addition, as the noble Earl, Lord Howe, said, there is concern among some of the professions about the representation by each of them from the different nations in the UK on the slimmed-down council. The Minister and the council need to ensure that, as far as possible, the interests of the four countries are represented on the council. Perhaps the Minister can explain how that will be achieved under the order as it now stands.
Finally, there is unhappiness at the level of representation on the council among those professional bodies which reflect effectively two or three disciplines, such as the prosthesists and orthotists, or the arts, music and drama therapists. What comfort can the Minister give to those professions who feel that the size of the new body will cause problems to those individual disciplines?
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