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Lord Hunt of Kings Heath: My Lords, a common theme has been the importance of the 12 professions that will be regulated under the new council and the hope that other professions will be regulated in future. Considering the challenges facing the National Health Service, there is no doubt that the professions covered by the proposed Health Professions Council will have an important role.

I was somewhat amused when the noble Earl, Lord Howe, said that the process by which the order was brought to your Lordships' House involved Xrush"; that is not the word that I should choose. It has been a very long process—too long, in many ways.

As with the NMC, extensive work has been undertaken with the professions, groups that represent the public interest and the department to try to get the matter right, and I believe that we have done so. My noble friend Lady Dean raised an important point when she discussed partnership with the profession. One criticism that I should make of the CPSM's record is that in many cases it had lost the confidence of the professional organisations. I believe that the HPC will work effectively only if, in serving the public interest, it develops a strong partnership with each of the 12 professions.

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We have appointed a very good shadow council and I am confident that the right leadership is being provided. I say to my noble friend that I am convinced that the HPC will seek to work in partnership with those professions. Unless the HPC, in protecting the public interest, also allows those professions to feel real ownership in relation to the its work, it will not work effectively.

We seek to ensure that we do not have an over-sized council. Twelve professions are involved and inevitably there will be a limited number of places. Essentially, each profession will have one representative. In that context, my noble friend Lord Prys-Davies raised a concern about the shape and status of the professional advisory committees, which are provided for in the order. It is important that the HPC is left to advance its own proposals about how it will organise its work within the general parameters that are laid down in the order. Setting up PACs is a matter for the HPC.

Following discussions with noble Lords over the past two weeks, I have satisfied myself that the shadow HPC is working in partnership with the professional bodies to ensure that they have confidence in the arrangements relating to PACs. I understand that the HPC will produce proposals that will give wider representation than at present. That would involve more professionals with targeted expertise who would ensure high-quality, speedy and appropriate expert professional input to the functions of the HPC. That would be backed up with full training in those functions.

The shadow HPC welcomes the positive contribution of professional bodies. I should expect the HPC to work through its registrant members to develop a range of appropriate mechanisms to enable the professions to contribute to the successful implementation of the order.

The HPC will need arrangements that take account of the needs of the different professions. That may include regular standing advisory committees and making use of existing networks. The HPC should consult widely among registrants and the professions on its proposal to obtain professional advice before it finalises its arrangements. It will be required to report to the Privy Council each year on how it has carried out its functions. It is envisaged that the HPC will hold frequent PAC meetings, particularly in the early stages while setting up its new procedures.

The order also permits the council to delegate some of its functions to the bodies that it sets up. But the HPC can accommodate all this with a fresh approach. I am sure that the shadow HPC will continue as it has done, working in partnership with the professions to ensure that it has the professional advice and input that it needs.

A very relevant point was raised by, I believe, the noble Earl, Lord Howe, about the concern of state-registered chiropodists in relation to professional representation from all four UK countries in a smaller, more strategic council. One way in which we shall ensure that is through the supplementation of the work

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of the council by statutory committees plus other networks and committees which can draw on other professionals from each country. Again, in that way, with a flexible, inclusive approach, the HPC will be able to cover the four-country angle. It will also do so by encouraging professions fully to brief council members.

Much of the detailed work involving professional difference will not be handled by the council but by its committees. Again, they may draw on a wide range of professionals from all four countries. But a profession which does not have council representation in a country can always ensure that its concerns are raised both by its own professional representatives and also by its own country members. I am confident that the HPC will be able to handle the four-country issue.

I turn to the question of chiropodists. In doing so, perhaps I may pick up some of the points that were raised by the noble Lord, Lord Hodgson, and others. First, I fully accept the point that the noble Baroness, Lady Masham, made. Chiropodists are very important. I believe that their role, in particular in relation to the mobility of older people, is crucial. The National Service Framework for Older People is the way in which we wish to develop services for older people. Within that, I would expect the role and number of chiropodists to be given full attention.

As the noble Earl, Lord Howe, said, the profession is split into two. In essence, in relation to the grandfathering provisions there is a very important debate as to how long the HPC register should be kept open to allow those who have not been trained on an approved course time either to undertake extra training or to demonstrate experience in safe practice so that they may register before the register is closed to all but those who are trained in the approved way. As the noble Lord, Lord Hodgson, suggested, that method of registering people who do not have approved training is called Xgrandparenting".

Article 13 of the order provides a transitional pathway to registration which is 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. In that context, perhaps I may make it clear that in either case the HPC may, but need not, require them to pass a test of competence.

I want to repeat a point that I made in my introductory remarks. Both sectors are meeting regularly under the facilitation of the Department of Health and the shadow HPC with a view to reaching an agreed position on the requirements for registration before the new council is established next April. The noble Earl, Lord Howe, chided me because he believed that those discussions should have been completed by now. The Department of Health made strenuous efforts to ensure that the discussions took place, but, in this case, it takes three to tango. Representatives of the non-state-registered sector have proven rather reluctant to engage in the discussions. Having said

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that, meetings are now taking place regularly. As a Minister, I am very keen to ensure that they come to a successful conclusion.

Baroness Masham of Ilton: My Lords, before the Minister leaves that point, perhaps I may ask him whether he believes that there will be enough people to assess the non-registered chiropodists and how long that process will take.

10.15 p.m.

Lord Hunt of Kings Heath: My Lords, I shall come to that. I believe that this will be a challenge to the HPC but, as I have explained, this matter does not rest with the individual members of the HPC. It is able to use professional people from the field. I am sure that it would be able to find a way to do as the noble Baroness suggests. That is the whole point of facilitating discussions between the two sectors; that is, to ensure that this is carried out as smoothly as possible.

There is a balance to be struck. It is unsatisfactory that we have a situation at present in which people who have not gone through state registration can call themselves chiropodists. We have to protect the public interest. That is the paramount consideration. The noble Lord, Lord Neill of Bladen, raised the issue of human rights in relation to this specific question. The view of the Government is that the order is compliant with the Human Rights Act. Article 12 is applicable. The council must consult those affected on criteria for grandparenting. There is a choice of routes, either through qualifications or experience. Reasoned decisions must be given. Applicants have a right of appeal, first, to council and to the courts. It has to be a careful process. We must uphold the public interest. However, equally we must ensure that those people who do have the relevant qualifications, or can obtain them, or have the relevant experience, are given as much opportunity as possible to enable them to be registered by the council.

The noble Baroness, Lady Masham, asked about timing, which is important. We have received representation from the unregulated sector, which wanted the transitional period for meeting the standards before the new register is closed to all but those with the approved training extended to seven years. The order proposes two years. It is the view of the Government that, given that full training is up to three years at most, the call for a transitional period of seven years seems excessive. It may be designed to allow those who are currently practising to reach retirement before they need to comply with the new standards. There is a difficult balance between public interest and being fair to the unregulated sector. But I believe that that sort of extension is unacceptable.

However, the timetable allows flexibility. If your Lordships approve the order today, the health professions council will be set up on 1st April 2002. It will inherit the register, rules and procedures of the CPSM to begin with, so that there is no break in the regulatory function. During its first year, the HPC will have to propose the parts, protected titles, associated qualifications and standards of proficiency which its

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new register will encompass. It must consult registrants and prospective registrants on those proposals. It will then propose to the Privy Council, which will ultimately determine the parts, titles and qualifications relating to each profession in the register, which it will then be able to open.

Even if we rush in an unseemly way, I do not believe that that process could be undertaken in less than one year. The expectation is that the process might take up to April 2003. Once the register is open, it will remain open for a transitional period of up to two years before it is closed to all except those who achieve registration by reaching the standard of practice and training the HPC requires. That is likely to happen by April 2005. From now until 2005, a period of about three-and-a-quarter years is likely to be available for those in the unregulated sector who wish to become registered with the HPC and to carry on practising as chiropodists or podiatrists, using whatever title is protected under this order to demonstrate to the HPC that they meet its standards. That is a reasonable period of time.

I also point out—the noble Baroness, Lady Cumberlege, is no longer here—that the JM report was published in 1996. It is apparent that that has been the aim of both the previous and of this Government. The unregulated profession has had time to think through some of these issues. We are essentially saying that it has three and-a-quarter years from today before the likely end of the grandfathering provision.

Perhaps I may take up two points raised by the noble Lord, Lord Hodgson. Both were extremely interesting. He asked about continuing professional development. I refer the noble Lord to Article 19 on page 24. That relates to post-registration training. Paragraph 19(1) states:


    XThe Council may make rules requiring registrants to undertake such continuing professional development as it shall specify in standards.

Continuing professional development is vitally important. The order clearly gives the HPC the power to do it. I am sure that, consistent with what is happening in the other professions, continuing professional development will be a very important factor.

The noble Lord asked another important question: how will the new body enhance and speed up the disciplinary procedure? I agree with the noble Lord that speed is of the essence. The smaller dynamic councils that we hope to establish will lead to swifter and more transparent decision making in addressing public protection issues. The establishment of statutory committees linked to the core regulatory function, including the main areas of fitness to practise work, the investigation committee, the conduct and competence committee and the health committee, give an ability to the HPC to ensure that it has effective procedures.

It is also worth bearing in mind, and as a trailer to the NHS modernisation Bill, which is proceeding rapidly through the other place, that within that Bill is a provision to establish a UK council of health

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regulators. That council will have an important role to play in ensuring that the different regulatory bodies are working as effectively as possible.

I am grateful to noble Lords for the issues that they have raised. I understand the concerns of the chiropody profession. I reiterate that we shall work as hard as we possibly can with representatives of both sectors to enable the matter to be dealt with fairly and effectively but crucially in the public interest. I am grateful to noble Lords for their attention.


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