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Lord Hodgson of Astley Abbotts: My Lords, I must begin by apologising to the Minister because I was unable to attend the briefing he kindly held on this order the other day. Therefore if he tells me that the points I make were covered there, I accept that reprimand and pray his indulgence this evening.
I support the broad principles behind the order and its purpose. As more and more consult what is rather inelegantly called in this order the Xrelevant" professions, those professions are making an increasingly valuable and widespread contribution to our health and welfare. Therefore, conversely, the
general public are ever more entitled to seek some form of imprimatur of their conduct, behaviour and competence.I should like to ask for the Minister's reassurance on three points. The first concerns the grandfathering, which takes place in paragraph 6(3)(c) on page 11. I pray in aid here the fact that I was a board member in the City of one of the first regulatory authorities which required us to bring together individual registers and combine them. When we began to do this under the Financial Services Act in the late 1980s, early 1990s, we found that there was considerable difficulty in ensuring that the right standards of competence were held by all participants. It presented us with many practical problems. The grandfathering proposal in this order, while obviously attractive in theory, is not always as attractive in practice.
The proposal before us is designed to raise standards, to impose common levels of competence and so increase public confidence. The reassurance I seek from the Minister is that he is really convinced that this wholesale grandfathering from the 1960 Act will not undermine the authority and reputation of the new body. Clearly, some difficulties in the early days of the new body would severely damage its public reputation.
The second point concerns continuing professional education. It is a commonplace that we live in an age of rapid change, and the healthcare world is not immune. That is not just as regards the practise of professional skills, although that is obviously very important; it also covers the whole area of professional relationships. We no longer live in a deferential age but in a questioning age. Professional relationships have shifted and are continuing to shift.
I seek the Minister's reassurance that as regards Article 15(1)(b) on page 19 he believes that there is imposed a sufficiently clear duty for there to be a proper programme of continuing professional education. As a layman I did not find the wording of that clause particularly clear or compelling.
The last point concerns the discipline of the incompetent or errant. Until last summer I was the deputy chairman of a private hospital group. It was a for profit acute hospital group. In such companies one does not employ doctors, consultants or surgeons; one provides a facility within which they practise. But although one has no authority over their professional conduct, one has an interest in their competence because of the impact on the reputation of the hospital.
We found that complaints against doctors took a very long time to be heard by the GMC. They took many months and often one to two years. That was in no one's interest. It certainly was not in the interests of our company. It was not in the interests of the doctor, who had a cloud hanging over him the whole time. Above all, referring to our primary duty mentioned in the last debate, it was not in the interests of the patient, whose safety might be compromised.
I do not see in this order any requirement for urgency in the disciplinary procedures. I believe that the new body should have some duty imposed on it to
act with sufficient celerity. If we are seeking to build public confidence we need to ensure that complaints are addressed promptly. I would therefore like to hear the Minister's views on that issue as well.As I have said, I believe that this is a welcome order and I am pleased to see the emphasis that we are giving to the relevant professions. But I would like to hear the Minister's views on those three points.
Baroness Masham of Ilton: My Lords, can the Minister give an assurance to the House that in the interim period of state registration of chiropodists, there will be enough of them to deal with the ever-growing elderly population and the increase in the number of people with diabetes? Can the Minister say how a non-state registered chiropodist obtains full state registration?
Lord Prys-Davies: My Lords, it is rather late and I shall be brief. I support the order. I am very sorry that my noble friend Lord Morris of Manchester is unable to take part in the debate. He is president of the Society of Chiropodists, but he has had to keep a hospital appointment.
I am aware of the concerns, particularly among chiropodists, about some of the provisions of this order. I believe that the most important concern of the state registered chiropodists is that in their view the order fails to ensure that a strong, professional advisory committee will be established for each of the professions. Article 3 empowers the Health Professions Council to establish a PAC and that is obviously an advance. But it must also be said that the Health Professions Council is not under a duty to execute that power. Moreover, although the HPC has established a professional advisory committee, it can also abolish that committee.
The role of an advisory committee is usually to advise on any matter affecting its interests, including reporting on present conditions and making recommendations for future changes. What will be the role of an advisory committee established under Article 3? We have read what the president of the shadow Health Professions Council has had to say. She is in a key position. But the concept which she advanced has come in for criticism. I should be grateful if my noble friend the Minister could say how the department considers that a professional advisory committee should operate under this order.
I refer to an aspect of devolution. As far as I can see, the order contains at least three provisions which relate exclusively to Wales; namely, Article 6(3)(g), Article 20 and Article 45. There may be others which I have missed. Yet nowhere in the explanatory note is there a reference to those provisions. They are nowhere mentioned. I envisage that there will be more such provisions in the future as the Welsh Assembly develops policies to meet Welsh needs. Therefore, it would be helpful to the practitioner in Wales if the explanatory note were to draw his or her attention to
the existence of such provisions within the order. That would be a simple improvement which should be built into the explanatory note in the future.
Lord Neill of Bladen: My Lords, I understand that the noble Earl, Lord Howe, raised a concern which I hope the Minister will address. The thrust of the argument seemed to be that a category of chiropodists, for example, would have to acquire a professional qualification over a set period to be able to go on the register, but the timing was such that they could not acquire that within the time limits imposed by the order. The practical effect of that appears to be that, for a period at least, certain people will be driven from their professional activity.
If that is the case, have the Human Rights Act implications of that been thought of? If one passes legislation which has the effect of depriving a person of a profession, normally, as the noble Lord, Lord Hodgson, said, one has efficient grandfather clauses which ensure that all competent people who have practised a profession are carried on into the new system. There is no guillotine and one does not put people out of business. It may be that the legal premise for that is wrong. However, if a category of professionals could be put out of business by the order as they could not comply with its terms, that would be a grave matter. I hope that the Minister will address it.
10 p.m.
Baroness Dean of Thornton-le-Fylde: My Lords, in welcoming the order I declare an interest as president of the College of Occupational Therapists which greatly welcomes the order which has taken many years to reach the House. I have been president of the college for approximately seven years. I assure noble Lords that in that time, and before, the professions allied to medicine have pressed hard for the kind of order that we have before us. This is not a new idea. It has not been rushed through and it is greatly welcomed by the profession. Certainly, the provisions within the order for closure of title—as a lay person would express it—will prevent those without appropriate qualifications parading as titled practitioners. That measure is extremely welcome from the consumer protection angle.
Both that measure and the proposal to require the regulated professions to provide evidence of their continuing professional development and fitness to practise are welcome and are supported not only by the College of Occupational Therapists but also by the bodies that form the 12 professions which are covered by the order. College members work both in the state sector and private practice but there has been a relationship for many years between the college and universities for validation of degree courses—for which students receive no state aid, unlike nurses who can receive bursaries. That issue should be addressed but it is not before us this evening.
The college, together with allied health professionals, supports the order's provision for a robust system of self-regulation that puts public protection at the forefront. That does not exist at
present. Persons are practising in professions allied to medicine who do not have a recognised qualification. The order provides for qualifications to be withdrawn but they must be held in the first instance. That provision is similar to one in the nursing profession where the regulatory body can withdraw a nurse's licence to practise. The order will introduce a similar measure to all the professions that it covers.I hope that the noble Earl, whose views I much respect, does not press his amendment. The order has been a long time coming. There has been plenty of time for people without qualifications to improve, to ensure that registration is within their grasp. The transitional arrangements should provide for that to happen. If your Lordships insist on specifying who will sit on the new body, what committees it will form and how it will operate, that would tie the council's hands. The new body will not be a closed shop but will have lay representation, which the professions also welcome.
Does the Minister agree that the new Health Professions Council must work in partnership with the College of Occupational Therapists and the 11 other professions? Also, will the Government ensure that the regulated professions play a full and equal part in maintaining high standards of professional practice—if for no other reason than the protection of the public?
The majority of professions allied to medicine welcome the order. They pressed the previous government for such a measure but did not get far. They have been pressing the present Government since the 1997 general election. The order will underpin the quality of services provided. It will ensure that when individuals do not practise to high standards, their professional body will have the authority to withdraw their title. I welcome the order and hope that the House will support it.
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