§ 8.—(1) In this section the expression "Joint Committee" shall mean the Statutory Health Visiting Joint Committee hereinafter referred to.
§ (2)The Secretary of State shall by order constitute a Joint Committee of the Central Council and the National Boards, to be called the Statutory Health Visiting Joint Committee.
§ (3)Of the members of the Joint Committee the majority shall be practising Health Visitors.
§ (4)(A) The Council and each of the Boards shall consult the Joint Committee on all matters relating to health visiting; and the Health Committee shall, on behalf of the Council or of any Board, discharge such of the functions of the Council or the Board as are assigned to it by the body otherwise charged with those functions or by the Secretary of State by order.
§ (B) Such functions shall include those more particularly specified in paragraphs (a) to (d) of subsection (5) of this section.
§ (5) The Council and the National Boards shall make provision for the matters relating to Health Visiting set out in paragraphs (a) to (d) of this subsection, upon the recommendation or recommendations to that effect of the Joint Committee but not further or otherwise, namely:—
- (a) the education and training of Health Visitors
- (b) the further education and training of Health Visitors
- (c) the approval of courses for the education and training and further education and training of Health Visitors and of the Institutions providing such courses
- (d)the conduct and content of examinations for the qualification of Health Visitors.'.—[Mr. Thorne.]
§ Brought up, and read the First time.
§ 4.10 p.m.
§ Mr. Speaker
With this, we may take the following amendments: No. 22, in page 6, line 12, leave out Clause 8.
414 No. 27, in clause 8, page 6, line 22 at end insert—such functions may include any or all of those referred to in subsection (4A)(a) to (d) below.'.No. 28, in clause 8, page 6, line 31, at end insert—(4A) Neither the Council nor the National Boards shall act on any of the following matters relating to Health Visiting except on a recommendation of the Health Visiting Joint Committee and shall not unreasonably fail to act on a recommendation of the Health Visiting Joint Committee in respect ofGovernment amendments Nos. 29 and 30.
- (a) the education and training of health visitors;
- (b) the further education and training of health visitors;
- (c) the approval of courses for the education and training and further education and training of health visitors and of the institutions providing these courses; and
- (d) the conduct and content of examinations for the qualification of health visitors.'.
§ The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)
On a point of order, Mr. Speaker. I think that it would also be for the convenience of the House if we took amendment No. 25 with this group.
§ Dr. Gerard Vaughan (Reading, South)
Further to that point of order, Mr. Speaker. If the House is agreeable to the Minister's suggestion, we shall certainly support it.
§ Mr. Speaker
If the House agrees, we shall also include in this group amendment No. 25, in clause 8, page 6, line 18, leave out from 'visiting' to end of line 22, and insert:and the Committee shall, on behalf of each of the Boards, discharge the functions of the Boards in relation to health visitors.'.
§ Mr. Thorne
It is with some regret that we find it necessary to propose the new clause. There were a number of debates in Committee hingeing on some of the matters raised in the new clause and it would have been helpful if the Minister had accepted some of our suggestions.
To some degree, the new clause is the product of the Council for the Education and Training of Health Visitors following its discussions with the Royal College of Nursing. There is a similarity between 415 new clause 1(5) and amendment No. 28 and, if they are taken together, I hope that hon. Members will understand their aim.
The Health Visitors Association, which is a trade union, supports the intention behind the new clause, as, I understand, does the Central Midwives Board. Even though there have been discussions at various levels, it has been difficult, if not impossible, to get the complete agreement of all those concerned on the matters raised in the new clause. Nevertheless, there seems to be a substantial area of agreement sufficient, at any rate, to justify the Minister making some new assessment of the position.
The new clause attempts to put right the deficiencies to which I have referred already, resulting from our deliberations in the Standing Committee. Originally, some of us sought unsuccessfully to amend clause 7. Now we have clause 8, which leaves the future education and training of health visitors at the mercy of the main groups of hospital nurses who are trained in hospitals under a totally different system from that which affects health visitors.
On Second Reading, a number of hon. Members pointed out that there were special circumstances attending the education and training of health visitors. Many of them complete courses in polytechnics, institutes of technology, colleges of further education and so on, which embrace social and economic history, sociology and social psychology and which, in an inter-disciplinary context, give them an understanding of the environments in which they are to work. On these courses they benefit from contact with other disciplines involved in the study of communities where a multiplicity of behavioural patterns are to be found.
It is because of the special experiences and activities of health visitors, which have been largely ignored both in the co-ordinating committee referred to in the Briggs report and in the Standing Committee, that pressure has come from health visitors throughout the country for some recognition in the Bill. There can be few hon. Members who have not had letters about the need to recognise the special position of health visitors, even though they represent a minority.
416 The Council for the Education and Training of Health Visitors has attempted to pursue a policy of co-operation with the nurses and midwives. At the same time, it needed some assurance that the future of the education and training of health visitors would be safeguarded as a result of this Bill. At no stage was the CETHV required to give an account of its work, although this material was asked for from the General Nursing Council. No opportunity was given to look at an alternative method of co-operation by means, for example, of a federation, as was suggested by the CETHV.
Many right hon. and hon. Members will recall the Government document "Prevention and Health: Everybody's Business" in which support was given to the important role of hospital visitors. In fact, the emphasis of the document was on preventive medicine. Given the passing of the Bill as it is drafted at present, there is a real danger that more and more resources could be drawn away from the health visitors and absorbed into the curative service.
When we talk about these matters in terms of our present National Health Service, most of us want to see an extension of resources across the board. However, some Opposition hon. Members are perturbed about the public expenditure implications of that, whereas some Government supporters are anxious to oppose cuts in public expenditure in order to protect resources in the National Health Service. Recognising the diminution which has occurred, in our view it is not desirable, with scarce resources, to concentrate them more and more in the curative sector at the expense of those involved in preventive medicine.
Regrettably, the preventive services are not seen as a priority by some of the hierarchy in general nursing, and a minority group such as the health visitors will be unable to prevent the withering away of their role unless their position is eventually written into legislation—hence, the new clause.
In my view, it is necessary for the health visiting joint committee to be seen to be speaking with an authoritative voice in making arrangements with universities and colleges as has been done so happily in the past. It has the right sort of understanding with those institutions, and in my view that should be maintained. 417 If information and guidance are seen to come from a variety of sources, some informed and some uninformed, it will be impossible to keep up the standards existing in the United Kingdom which stem largely from the activities of the CETHV in co-operation with the educational institutions to which I have referred.
In the setting of standards, advice is not enough. The Royal College of Nursing amendment, which is mirrored in amendment No. 28, goes a long way towards giving a positive indication that the health visiting joint committee should be taken as the authority on health visitor education and training matters. Unhappily, the amendment contains a set of words which can only create problems. Those words are "unreasonably fair". Clearly, the definition of "unreasonably" would finish up in an argument in the courts.
§ Dr. Vaughan
Probably all of us want to safeguard the position of the health visitors. It is obvious that the hon. Member has given a great deal of thought to this new clause. Is the implication of the clause that the health visitors will function as a completely separate committee and break their relationship with the Central Nursing Council? I am sure that we do not want to undermine the Central Nursing Council to an extent which will undermine the whole Bill.
§ Mr. Thorne
I am sure that health visitors generally accept the passing away of the Council for the Education and Training of Health Visitors. They intend to co-operate with the nurses and midwives following the passing of the Bill. However, they are anxious about the prospect of their position becoming eroded unless the protections which we are discussing at the moment are built into the Bill. None of them seeks to say that they should be entirely separate from the main stream of those covered by the Bill. They are anxious to co-operate, but they are rightly determined to protect the CETHV's specialist education and training function.
The CETHV has a sound legislative position. The health visitors would he conceding more than any other group in the interests of co-operation if this Bill were passed, because they are the only group to have established the sort of education and training structure which 418 the council represents. It is surely no more than common justice that they should be allowed to ensure proper provision for the future for their own education and training.
I hope that the House will seriously consider the points I have made and will give its support to the new clause.
§ 4.30 p.m.
§ Mr. Robert Boscawen (Wells)
The hon. Member for Preston, South (Mr. Thorne) has done well to make maximum use of the parliamentary procedure to obtain a debate on this crucial central issue that remains outstanding from the Committee stage of the Bill. It concerns the protection of the minority group of health visitors in the new Central Council.
I want to clear up the question of any difference between new clause 1 as it has been tabled by the hon. Member for Preston, South and amendments Nos. 27 and 28, tabled by my hon. Friends and myself. The difference is an important one of emphasis. The difference is not important in relation to the central thrust and purpose behind both the new clause and the amendments. They are designed to ensure that the health visiting profession exerts considerable influence over the treatment of the profession by the Central Council in relation to education and training courses. It is to the credit of that small profession that it should have forced the hon. Member for Preston, South and hon. Members on this side of the House into taking the same view. Few other professions could have achieved that.
Let me get the differences between the new clause and these amendments out of the way. They are not too great. New clause 1, as far as subsection (5), is virtually the same as clause 8 of the Bill. We do not seek to amend the first three subsections of clause 8. Our proposal is perhaps neater and more logical. It makes alterations to clause 8(4) in the same way as new clause 1 makes considerable alterations in clause 8(5).
Our amendments are perhaps stronger. We give negative powers to the health visitors in relation to education and training, whereas the new clause gives more positive powers to the health visitors in restraining the Central Council should 419 the Council not accept their recommendations over training and education. There is not a great deal of difference between the two approaches. Our amendments were recommended by the Royal College of Nursing, backed by the Health Visitors Association, and were agreed by the Council for the Education and Training of Health Visitors.
As the drafting was proposed by the Royal College of Nursing, we considered it best to try to stick to the views of the majority profession. There would be less likelihood of individuals in that majority profession saying that we were seeking to undermine the central purpose of the Bill and the setting up of the Central Council by removing too much power from the Council.
Both new clause 1 and our amendments seek to strengthen the position of health visitors in the Bill. We are surprised that the Government have not come forward at this late stage with a similar measure. They must have been aware that members of that profession are nervous about their possible treatment under the Bill. Their fears have been expressed a number of times to hon. Members on the Standing, Committee, to the Minister of State and to the Secretary of State, both in the co-ordinating committee and throughout the progress of the Bill. On Second Reading the Secretary of State stated clearly:To these and other organisations"—which includes the health visitors—who are uncertain of the future, I say that they must seize the opportunity to make their voice heard. They should not let the opportunity pass. No one ever influenced an organisation by refusing to participate in its deliberations."—[Official Report, 13 November 1978; Vol. 958, c. 48.]This minority has sought to make its views known to the Department. I am therefore surprised that the Government have not come forward at this late stage of the Bill with some amendment to clause 8 to reassure that profession. Why do we regard it as so important that the health visitors should be given this added say over their training and educational courses under the aegis of the Central Council? They are a very small minority. I understand that there are about 10,000 health visitors working at the present time. Some of those are only working part-time 420 We are therefore talking about a very small number.
There is a substantial difference between the job the health visitors carry out and the work of general nurses and midwives. The hon. Member for Preston, South rightly summarised the primary concern of health visitors as preventive care whereas the others are concerned with curative care and curative medicine. A condition of entry into the health visiting profession is that its members should be qualified SRNs. They must have gone through the whole programme. Health visitors want to play their part with the General Nursing Council in working towards the central purpose of the Bill. That purpose is to establish uniform standards of professional competence for the nursing profession throughout the United Kingdom. There is no quarrel about that aim. The first part of health visitors' training is in general nursing. They want to play their part as equal members of the Council.
It is of course the preventive side of their training about which they are concerned. Having already created for themselves under the Health Visiting and Social Work (Training) Act 1962 their own set of national rules—introduced in 1965 and updated in 1972 with the full approval of the Secretary of State of the day—they want to be sure that those rules are perpetuated by the new body. They have governed their own affairs adequately and effectively for a considerable time and they want the rules under which they have worked to continue. That is natural, and we believe that they should be given that opportunity.
The next reason for strengthening the clause as we have proposed is that the whole emphasis in the country and in the National Health Service is on curative medicine and far less on prevention. The enormous investment of resources in curative medicine—manpower, skill, equipment, buildings and materials—attracts so much attention, as it has to do, from Governments and the public that the relatively small commitment of public resources to prevention never gets anything like the support that it should have.
Giving health visitors more support is of great importance outside the immediate profession, in order to further pre- 421 ventive medicine generally. In its first report of 1978, the Social Services Sub-Committee of the Expenditure Committee said, in paragraph 109:In 1974 the United Kingdom ratio of health visitors to population was 1–5,822. We view this with concern and recommend that strenuous efforts should be made to improve it.I am sure that the Government and the whole House will agree with that. We need to improve the ratio and give the profession a boost.
The Select Committee on violence in the family, 1976–79, said in paragraph 133:What is … important … is that there should be an adequate number of health visitors to cover the needs of the community whether old or young.How important in dealing with violence in the family are the visits of health visitors and their competence and training. We have seen so many sad cases in which insufficient attention has been paid to those unfortunate families.
The House also expresses frequent concern about the high level of infant mortality in this country, which has not improved, alas, as fast as in other countries in recent years. The health visitor has an enormous part to play here. I believe that health visitors take over the matter of advice to and counsel of the families when a baby reaches the age of 10 days. That is a crucial period, according to the evidence, in potential infant mortality. The House should be most concerned that this profession gets the greatest possible support for its desire to have some control of the specialised training of its members.
Another important aspect of the profession's work has been mentioned this very week in the House in a powerful appeal by the hon. Member for Stoke-on-Trent, South (Mr. Ashley) about vaccine damage. It would be better to reduce the number of children or adults damaged by inoculations than pay compensation after the event. That is an obvious comment, but it was put very well by the hon. Member. The health visitors have a great responsibility for inoculations, particularly of children, against whooping cough and other disease.
When the health visitors see that the Central Council and the national boards 422 will be overwhelmingly in the hands of those who are involved in curative medicine, they are naturally concerned. Only a small minority will be involved in prevention. The members of this profession do not see that health visitor training can be better done under the Bill than it was when they had a much smaller body without statutory powers. When we ask them to join the Council, we must ensure that their voices are heard.
The argument against giving the health visitors powers over their own education and training—of which the Central Council would have to take note—was made in Committee and by the Minister. It is that there is a danger that the fundamental principle of the Bill would be breached if by law such recommendations on training were made obligatory on the Council and the boards.
We have had representations from the Scottish Royal College of Nursing that it is concerned about independence. It does not want to be bound by obligations to a central joint committee of health visitors. Nevertheless, we do not believe that the new clause and the amendments will undermine the Central Council as the recognised authority with overall control of the registration, education and training of all the professions concerned by allowing one of the minority constituent bodies this extra safeguard over training and education and the allocation of expenditure. Expenditure is much in the hands of the large battalions whose members are interested in and dedicated to curative medicine. We want to be sure that the small minority that is dedicated to preventive medicine receives a fair share.
We believe it essential that the marriage between health visitors and the General Nursing Council should not be a shotgun affair. As the Bill stands, I believe that that tends to be the nature of the marriage. If the Bill is not amended in one of the ways that has been proposed, there could be considerable bitterness among members of the minority profession. That would be a tragedy for the future of preventive medicine.
I hope that the House will give serious consideration to voting in favour of the new clause. If the new clause falls, I hope that the House will support the amendments.
§ Mr. Laurie Pavitt (Brent, South)
The Bill is one of the most paradoxical of those that I have had the privilege of considering in Committee. The debate on the new clause and amendments illustrates the position in which we found ourselves throughout consideration of the Bill in Committee. There is a wider measure of agreement among all political parties on the purposes of the Bill than there has been on any Bill with which I have been connected. There is a wider measure of agreement among the various sectors within the various parties than I have known previously. There is a wider measure of agreement among the many organisations forming the Briggs co-ordinating committee that has been informing hon. Members on these matters than is usual when a number of organisations come together. However, we are having to try to find solutions all the time to satisfy those who will be involved in the ends that we are trying to serve by the means that we are putting into the Bill.
I agree with practically every word that the hon. Member for Wells (Mr. Boscawen) said about the problem that we face. I differ with him in only one respect. The hon. Gentleman hazarded the thought that, unless we solve the problem, the health visitors will remain outside the structure that we propose to establish and their education would be superior in that event than if they became a part of it. The health visitors have had a solid background of knowledge and experience since 1962 and as an integral part of the new machinery they have a part to play for not only their members but for the Central Council and the boards. It is to be a structure that will be of mutual benefit. It will not consist merely of individual sectors. We are seeking to safeguard the best elements.
On Second Reading I made a pledge to the health visitors that in Committee I should seek to safeguard what I felt were their real fears. Together with my hon. Friend the Member for Preston, South (Mr. Thorne), I tabled amendments that were debated in Committee. The fears of the health visitors are real. The health visitors have a body of experience behind them based on practical application in circumstances different from those that obtain in hospitals. They are 424 naturally scared to lose that background. The purpose of the new clause is precisely to preserve that entity, individuality and, if I may say so, personality as part of the broad spectrum that we are discussing.
On Report it is the job of the House to resolve the fears of the health visitors. If the Bill goes on to the statute book without their fears being satisfactorily resolved, that will be bad for the whole of the nursing profession and not merely for the health visitors. However, we face problems when we come to consider the new clause. The last few sentences of my hon. Friend's drafting could have the effect mentioned by the hon. Member for Wells. It is difficult to envisage how paragraphs (a), (b), (c) and (d) of subsection (5) could be put into operation without damaging to some extent the unified structure that the Bill is all about. That may be a defect of wording rather than intention. It should be put right, and I believe that it can be put right.
In Committee my hon. Friend the Member for Preston, South and I moved and, on agreement, withdrew two separate amendments on the assurance given by my right hon. Friend the Minister of State that at some stage he would meet the arguments that we were advancing. His assurance was qualified. He said that it should be possible for him to be able to meet the fears of health visitors and those of other sectors if the various organisations and sectors were themselves able to reach agreement. I pay tribute to the way in which over the Christmas Recess the various organisations and sectors got together immediately to seek to resolve their differences. I think especially of Mr. David Rye of the Royal College and Catherine Hall and Miss Norma Batley of the health visitors. There have been regular meetings ever since.
My right hon. Friend's problem is that he has to satisfy not only the 300,000 nurses of the Royal College and the health visitors but about 12 separate organisations and 12 separate pressure groups, including three important trade unions. I do not have to declare an interest because I am not a sponsored Member. I am a member of NUPE and proud of it, in spite of all the newspaper headlines that try to give the impression that Alan Fisher is the devil incarnate, He is one of the most gentle persons I 425 have ever met. NUPE, COHSE and NALGO have grave reservations. The district nurses have made representations, as have the psychiatric nurses. In discussing the new clause we must bear in mind the repercussions elsewhere.
If we can find the right solutions, which are very much contained in the new clause, with a satisfactory agreement on the basis of a compromise reached by the various organisations, and if we use the time that will be available to us before the Bill returns from another place to formulate and offer the right sort of assurances so that we may establish the right structure and provide the guarantees that are required by those who will be involved in the education system envisaged by the Briggs report, we shall be taking a great step forward for the whole of the nursing profession, both internally in the hospitals and outside. If we do that successfully, and successfully hold back the smaller claims that might arise, and give the health visitors the assurances that they require and the necessary safeguards, retaining the main structure that is set out in the Briggs report, the House will have acted properly and correctly.
I shall be listening with more than usual interest to my right hon. Friend the Minister of State. I believe that it is possible to achieve a solution. We have not reached an impasse where we are about to start pulling everything apart. I believe that, with the co-operation of the Department and the outside bodies, we shall be able to adopt a unifying approach that will give the Central Council and the national boards the right start. In that way we shall avoid a start being made against a background of acrimony and dissidence. If that can be achieved today —in my view it is the crux of the debate —we shall have done well.
§ 5 p.m.
§ Mr. F. A. Burden (Gillingham)
I agree with hon. Members on both sides on the intention behind the new clause. I did not have the pleasure of going through the Bill in Committee. However, it is obvious that in Committee there grew up unanimity on the need for giving health visitors the security which they require and for which they ask. I intervene as I have received representations from my constituents. As this Bill concerns nurses, midwives and health visitors, the Minister should turn over backwards, 426 if necessary, to ensure that they are treated fairly, so that they accept the final position in the statute.
In these days it is unusual to find agreement on both sides. I have been in the House for a good few years. On those occasions when there is near-unanimity, it is difficult for a Minister to reject the ideas advanced from both sides and extremely dangerous for him so to do.
Cogent arguments have been advanced from both sides in favour of giving health visitors the power that they require. There are comparatively few health visitors. There are but 10,000 of them. They are all highly trained people. They play an important part in the National Health Service. If not, they would have been ignored and not provided for under the Bill. They are a highly professional body. Their training has been standardised throughout the United Kingdom since 1962. They are highly efficient, well organised and well disciplined. They play an important part in the care of those in need.
Here is an occasion when the differences between the two sides of the House are marginal. The intention is clear. Perhaps the Government foresaw that there would be this agreement and that possibly a new clause might be moved by Government supporters. The Government will have been left in no doubt that the Opposition wish to amend clause 7 to ensure that the health visitors are given the protection for which they asked.
There may be problems in the drafting of new clause 1 from the Government side, and perhaps some problems created by amendment No. 28, which was proposed by the Royal College of Nursing. There may be difficulty in accepting either the new clause or the amendments as they stand. But the Government will be unwise—I have no doubt that the new clause will be pressed strongly from both sides—if they do not say that they are fully seized of the desires and intentions of the House and give an undertaking that, before the Bill goes to another place, they will insert a clause to put into effect the wishes of the House as expressed this afternoon.
§ Mr. John Ovenden (Gravesend)
I do not often agree with the hon. Member for Gillingham (Mr. Burden). This is 427 probably the strangest event that has occurred in Kent for a long time. The House is in unanimity on this occasion. Although I prefer more controversy and excitement, perhaps today's mood on this issue is more constructive.
I want to hear what the Minister says in reply to the strong case that was put to him today. I congratulate my hon. Friend the Member for Preston, South (Mr. Thorne) on tabling the new clause and on the fight that he put up in Committee on behalf of health visitors. I was not a member of that Standing Committee. However, I followed the debates from afar and read the records of them. I do not read closely the reports of Committee debates on all our legislation. Like most hon. Members, I was approached and received representations from health visitors about their views upon the Bill, which prompted me, along with many other hon. Members, to take a much closer interest in what happened in the Committee than perhaps might otherwise have been the case.
The health visitors expressed to me their fears about what control and influence they would have over training and education within their profession if the Bill went through unamended. They have a fear that they would be outvoted and overwhelmed by the larger numbers in the professions with which they are now in liaison. We must take those fears seriously. I was impressed by the case they put to me for the safeguards that are necessary to protect their position, their explanations of what their job is about and how different they are from the other professions within the Central Council and the national boards.
Health visitors play a valuable and unique role in our health services. Their role is mainly in the area of preventive rather than curative medicine. That is true to a great extent although I find that the line between those two is not as clear cut as some people pretend. The job they do is different in many other ways. They work in different environments, with people in their own homes, in a situation which requires co-operation between the health visitor and the patient. That is a different atmosphere from that in which the hospital nurse works. Without wishing to be unkind to those who work in hospitals, I must say the atmos- 428 phere in hospital is basically authoritarian. It is an authoritarian regime. However, when we take away a person's clothes and put him in a hospital bed, he has not much choice about whether to do what he is told. The people with whom health visitors deal have a different attitude. They can choose whether to do as they are told.
Recently I was told a story by one of my constituency health visitors, who some weeks ago was accompanied on her rounds by a hospital nurse. The health visitor spent a long period trying to persuade a mother with young children exactly what she should do to protect and improve the health of the family. This took a great deal of persuasion. When they left, the hospital nurse said "Why did you waste all that time? Why did you not tell her what to do?" This illustrates the difference between the attitudes of the two professions.
We are dealing with people who work in an atmosphere of voluntary cooperation, among deprived sections of our community. Those people are not just nurses but have a range of other skills. They are also social workers. That sets them slightly apart from the other people within the nursing profession. I admit that the basic training is the same. That is why we need co-operation and a joint body to oversee the general training. We must recognise the differences in the rôle, training and education necessary for the health visitor to do her job. As the health visitors have a special role they feel that they need to retain control over decisions affecting their profession.
I welcome the concessions made by the Minister. We are pleased at the action taken in Committee to make sure that there is a majority of practising health visitors on the health visiting joint committee. The health visitors very much appreciated that gesture.
I also welcome the commitment in the Bill to allow the health visiting joint committee to exercise certain functions of the Central Council and of the national boards which are delegated to it either by those bodies or by the Secretary of State. That goes a long way towards restoring the rights of health visitors—who will have a majority on the joint committee —to exercise proper control over education and training within their profession.
429 What clause 8 does not spell out is precisely what those functions will be. It does not contain any commitment that any function at all will be delegated to the joint committee. This is what my hon. Friend the Member for Preston, South is seeking to correct in the clause. He makes it quite clear that the national boards and the Central Council will have the power to act only within certain spheres affecting training and education and the further education of health visitors, and will have power to act in those spheres only on the recommendations of the joint committee. That makes the relationship just about right. It maintains the centralised structure, but it ensures that that centralised structure cannot overrule the very special and unique interest of this very small profession.
I realise the problems that my right hon. Friend the Minister has had with the Bill and how difficult it is to try to resolve the conflicting interests and the conflicting views of a large number of bodies. He has had to deal with a very large number of bodies. But politics is often about that sort of thing. If we could leave it to others to decide among themselves precisely what they wanted and just come to us to rubber-stamp it, there would be little need for our existence. It is very often the case that the conflicting interests cannot agree among themselves and Parliament has to make a decision.
Although I should like to see this matter resolved purely by agreement, if that cannot be done it would be an abdication of our responsibility for us to run away from it. We must look at the case on its merits. Whatever the difficulties of reconciling the different groups, the health visitors have an unanswerable case for the sort of treatment that is spelt out in the new clause. We should stand by them in that fight.
§ Mr. David Penhaligon (Truro)
I should like to know from the Minister how important the Government believe health visitors to be. Any health visitors who may be listening to the debate today will be having one of their best days ever, for Member after Member has said how much we value health visitors and how important it is for them to maintain their standards. I agree with everything that has been said in that respect but point out that, although 10,000 seems to 430 be quite a large number, it works out at only 15 health visitors per constituency. As has been pointed out, some of those health visitors are not working full-time.
What, therefore, is the Government's attitude towards health visitors? Are they regarded as being a vital and important part of the National Health Service? Would the Government—provided there is the money—like to see their function expanded? Or is the fact that, after Second Reading and our deliberations in Committee, the Government have come up with no solution whatever to the dilemma an indication that in reality they do not value the health visitors very highly? If that is the Government's view, they will have some difficulty—judging by the mood of the House this afternoon—in getting the measure through.
I draw attention to amendment No. 25, in my name and the names of my hon. Friends. I could vote for that or for any other amendments, quite frankly, as they would all do a great deal to allay the anxieties of the health visitors and a great deal to protect them against the fears they have expressed. These fears are by no means unjustified.
I am by training an engineer. That is a long way from being a health visitor, but I am well aware of what has happened in engineering to the skilled craftsmen's unions over the years as they have been absorbed by the larger numbers of non-skilled people. The analogy with the health visitors is not precise, but it is relevant to the extent that the majority will is overwhelmed. The original concept of some of the craft unions has been pushed to one side by the majority of the membership. That is exactly the sort of fear that the health visitors have and are expressing. They are also worried that they will be pushed into a large sea of numbers in which their own number is seen to be rather small. They fear that their interests will be pushed to one side because of their sheer lack of numbers.
I do not accuse the health visitors and their centralised committee of trying—as is sometimes the case in other professions—to preserve particular professional standards. There is sometimes in some professions an inclination to push standards up and up, for no apparent reason other than to justify the existence 431 of the profession concerned. Although that tendency is evident in many professions, I do not think that the health visitors can be accused of it. They seem to have evolved for themselves a reasonable and sensible standard of education that is specific to the profession to which they apply themselves and reasonable in general. If this House were to do anything today to make that development falter or to make it less effective than it is now, it would be extremely foolish.
What, then, is the Government's view of health visitors? Why has the Minister not been able to produce a compromise? My hon. Friends and I will be prepared tonight to vote for any of the amendments on the Amendment Paper because we believe that any of them would be an improvement on the existing position.
§ Mr. George Rodgers (Chorley)
I did not serve on the Standing Committee. Therefore, I have not the same detailed knowledge as my colleagues who have examined the legislative proposals in considerable detail. The House will be gratified to know that my contribution will, accordingly, be restricted.
My interest has been aroused—as has that of many hon. Members—because concerned constituents have contacted me about it. It is to the credit of the organisations and individuals involved that they have conducted a campaign which has made many Members aware of problems that many of us had not appreciated. I understand that every Member of the House has been approached and is now aware of the enormous interest, concern and anxiety provoked by the Bill. It is true that many of the anticipated problems have, happily, been resolved by consent and by compromise. Even so, certain aspects continue to cause grave disquiet.
It is right that particular attention should be directed towards the education and training of health visitors and that this should extend to the conduct and content of examinations for the qualifications of health visitors. I believe that the new clause recognises this overwhelming requirement of precise legislation to meet the need for training in the future. It largely embraces the views of the Council for the Education and Training of Health Visitors and the Royal College of 432 Nursing. It also supports the approach of the panel of assessors of the Central Midwifery Board. It is surely essential that the high standards—
§ Mr. Robin Hodgson (Walsall, North)
I am grateful to the hon. Gentleman for giving way. He will be aware that the new clause, as drafted, excludes the possibility of there subsequently being other joint committees of the Council and boards. If the new clause is passed in its present form, other minority professions, such as the district nurses, will be excluded and will consequently feel even more aggrieved about their position within the new framework of the nursing profession. I hope that the hon. Gentleman will bear that in mind.
§ Mr. Rodgers
I do not deny the fact that many organisations would feel aggrieved if the new clause were put into effect. It may be—I accept this entirely—that the Minister will have to review the broad position in order to accommodate the provisions of the new clause, but that is quite feasible and quite within the capacity of the Minister.
I believe that the essential high standards which have already been established must be maintained in the future. The new clause points to one of the ways in which this objective can be attained. The case for delegated powers being allocated to the joint committee in the area of training and education is fairly obvious. I believe that it can be accommodated by the acceptance of the new clause, even if there has to be some subsequent rethinking, variation and modification.
I believe that it is of prime importance that the House should demonstrate that it is prepared to listen to the guidance given by those who have a deep knowledge of the service. I think that we should be prepared not merely to listen but to act on this advice, particularly when the issues are of such wide-ranging importance and have a direct effect on the lives of so many people.
When I looked at the reports of the Committee proceedings, I observed, with some alarm, that the Minister of State made reference, when examining clause 8, to the fact—some of us think a melancholy fact—that we are now members of the Common Market. He remarked on the 433 impact that this would have on training and education in a number of professions, including nursing, and added that we must take these considerations into account. As one who does not assume that we shall remain in the Common Market in perpetuity and who also thinks that in the meantime we should concentrate our minds on reforming that body—preferably out of existence—I hope that the Minister will not be unduly swayed by these Common Market considerations. Rather than adapting our standards of training and education to EEC levels, we should insist that our Common Market partners adjust their standards to our own, which are very high indeed.
I do not pretend that the Common Market aspect is a major issue in this debate, but it certainly was a point raised by the Minister. I have been very much impressed by the accord throughout this Chamber and the desire to remedy that particular defect. I appreciate that the purpose and motive behind the Bill are sound and that it has general support. But I give my wholehearted support to clause 8, which I think reaches to the essence of the problem. I hope that the Minister will be able to offer some token of that acceptance.
§ Mr. Alec Woodall (Hemsworth)
I read at the weekend that speeches in this Chamber were getting longer and more boring. I cannot guarantee that I shall not be boring, but I can say that I shall be brief and to the point.
Last weekend I had the pleasure of meeting health visitors in my area. A more professional and dedicated body of people I have never met, and I pay tribute to their professionalism. However, they are very concerned about that professionalism. One of them said, with the utmost sincerity, that she had been trained to be a nurse, as all health visitors had to be trained. Their training for health visiting—a much more complex affair—is undertaken not in a hospital environment but in a university or a polytechnic. She said that not until she had completed her training as a health visitor did she think that she was a complete person. Those are sincere but dramatic words.
Health visitors are concerned that, within this Bill, the specialised training which they have received up to now, 434 through the Council for the Education and Training of Health Visitors, is to be abandoned after only 17 years. I know that my right hon. Friend the Minister will agree that a marvellous job has been done in training health visitors to date. But—this is the crux of the matter—the health visitors emphasise that their training is different from that of nurses because it is given within the professional atmosphere of universities and polytechnics. No matter what my right hon. Friend may say about his intentions for the unification of training for nurses, midwives and health visitors, the health visitors fear that under this Bill there will be a diminution of their professionalism.
Without going into the matter any further, because the point has already been made by many hon. Members, my plea to my right hon. Friend is to think again before pushing this Bill through, because the health visitors are very disturbed. They wish to carry on giving to people their specialised advice and treatment which is different from medical and nursing advice. I ask my right hon. Friend to think again and to take into consideration the views of this very professional and dedicated body.
§ Mr. William Molloy (Ealing, North)
I ask the House to acknowledge that the one great thing that has come out of this debate is that the Government need not fear further criticism of public expenditure from the Conservative or Liberal Parties when we try to improve the National Health Service. That is one of the most gratifying remarks I have heard in this House for very many years, and I welcome it.
This has been a very useful debate. In Committee, when we examined these proposals—bearing in mind that they were based on the Briggs recommendations—we eliminated many of the points that might have become difficult to reconcile. That does credit to all, including myself, who served on that Committee.
We should recognise that many of the organisations which contributed to Briggs have, over the last 30 years, made massive contributions to improving the status, training, salaries and wage scales of those dedicated men and women who work in the National Health Service. We should also recognise the representations and contributions which have been made by 435 trade union organisations to improve our health services. It is proper that, having paid due acknowledgment to the Health Visitors Association, we should acknowledge that, long before Briggs or this debate, the Confederation of Health Service Employees, with which I am associated, and the National Union of Public Employees made valuable contributions to the betterment of the National Health Service.
As I see it, the problem which my right hon. Friend must try to resolve is that the Bill should not cause conflict or apprehension in any sector of the Health Service—whether it be State registered nurses, State certified midwives or psychiatric nurses—which believes that it is a special case.
My hon. Friend the Member for Gravesend (Mr. Ovenden) said that when one went into hospital one simply had to do as one was told. I suggest that in psychiatric nursing the last thing many patients do is what they are told. Psychiatric nursing is a very difficult job. It requires as much patience, expertise and a desire to help as is needed in any other sector of the National Health Service. One of the most poignant features of our Health Service is the work being done by psychiatric nurses.
I want to make certain that we find in this House today, if we possibly can—it ought not to be beyond our endeavour—a reform which will not exacerbate the conflict but will, instead, achieve better understanding. We can do that only if we include words which will not necessarily mean that Health Service visitors have to make massive public endeavour to draw to our attention what they consider to be their apprehensions. If one acknowledges that, it must follow that there is something in the Bill which is not perfect but which, perhaps, we can make perfect.
At the same time, we must beware of being too rash in attempting to meet all the points of one sector and, by so doing, sowing the seed of discontent amongst members of NUPE, the psychiatric nurses and all other sectors of the Health Service. That is very important, and I ask my right hon. Friend to understand and consider it. I wish that I could give him 436 some advice about how to do it. I would help if I could.
What might seem an impossible task frequently proves to be the opposite. One of the beauties of our democratic process—though we are laughed at for it—is that we talk and talk, as we did in Committee on this Bill, and sometimes, after hours of talking, suddenly we hit on a solution. This is what one does not find in authoritarian regimes. The law is firmly laid down. We argue, and we debate. Occasionally we are on the verge of losing our tempers and are savagely criticised for that. Every other organisation could debate for hours and weeks without getting excited, but not we in this House, sent here on the votes of hundreds of thousands of ordinary people.
I regret that on a number of occasions I was not able to be present in Committee—for a very good reason; I was out of the country—but I believe that the Committee had most useful and intelligent debates on various subjects. Many Members of both major parties found, at one time, that they were not in full agreement with either Front Bench. That was remarkable.
I ask my right hon. Friend to try to reach a decision via discussion and examination with health visitors as a vital element—which I acknowledge they most certainly are—and with COHSE, NUPE and NALGO. That should not be impossible. Surely we can find a formula—perhaps we ought to have done it before—which will remove the apprehensions of health visitors. In finding that formula, not only will we get the approval of the Health Visitors Association but the result produced will also receive the applause of all other organisations in the National Health Service.
§ Mr. John Wells (Maidstone)
All I wish to say, Mr. Deputy Speaker, is that I have had more sensible letters on this topic than I have had from my entire constituency in almost 20 years as a Member of this House
§ Mr. Tom Litterick (Birmingham, Selly Oak)
In deference to my hon. Friend the Member for Ealing, North (Mr. Molloy), I shall try not to get excited.
The reason why I rise to speak on behalf of the new clause is that the Bill, 437 which was originally conceived to set up a rather monolithic structure to control education and training for the nursing professions, has been significantly amended already in respect of midwives. In the case of midwives, the principle has been conceded that there are significant subsections of the profession which can be sensibly distinguished from one another in terms of their functions, the activities involved and the skills required by the various people who carry out those sub-professions of the general nursing profession.
The Bill makes that very clear. Clause 4(4) states:The Secretary of State shall not approve rules relating to midwifery practice unless satisfied that they are framed in accordance with recommendations of the Council's Midwifery Committee.In other words, clause 4(4) ensures that midwives will be mistresses of their own house. I think that that must have given great satisfaction to midwives when it emerged from Committee.
When we come to health visitors, we discover, in clause 8, that no such autonomy, no such authority, is allowed to them.
It is our contention—and, I think, that of many hon. Members on both sides of the House—that the activities, functions and required skills of health visitors are so easily distinguishable from those of midwives and from those of what, for want of a better term, we might call general nurses—though that begs many questions—that they should also be constituted separately for this purpose and be, if not wholly autonomous, as autonomous as the midwives.
Having said that, I must say to Opposition Members that I prefer the wording of the new clause to their wording in amendment No. 28. I do not think that this is simply a matter of playing with words. I draw their attention to the provision thaton a recommendation of the Health Visiting Joint Committee and shall not unreasonably fail to act on a recommendation of the Health Visiting Joint Committee".That is in respect of the national boards. The national boardsshall not unreasonably fail to act on a recommendation of the Health Visiting Joint Committee.438 With respect to Opposition hon. Members, that, quite clearly, leaves ultimate residual power in the Central Council in a way which does not happen with midwives. I cannot see the logic in conceding that degree of autonomy to midwives but not to health visitors. If the reason for arguing for either new clause 1 or, indeed, amendment No. 28—
§ Dr. Vaughan
It might be helpful to the hon. Gentleman if I tell him that it is not our wording, but wording which was agreed between the Royal College of Nursing and the health visitors. It was only afterwards that the health visitors began to have doubts.
§ Mr. Litterick
I am most grateful for that intervention. However, I must say that the Royal College of Nursing is mistaken. It has introduced an inconsistency. The principle that we must adopt in logic if we are seeking to amend the Bill in a way about which, in essence, I believe we all agree is precisely the principle that has been explicated in clause 4(4) in relation to midwives. I cannot see any sense in doing otherwise.
With respect to the hon. Member for Reading, South (Dr. Vaughan), amendment No. 28 would not do that, because it explicitly leaves a residual power in the hands of the Central Council. Therefore, it would detract from the autonomy of the health visiting joint committee. I prefer the wording of new clause 1 because it says that the national boards, and the Council itself, shall make recommendations, provisions, and so forth, on matters of education and training with respect to health visitors only upon the recommendation made by the health visiting joint committee, but not further or otherwise. I think that that makes it very clear.
Having said that, I shall refer to what I believe my hon. Friend the Member for Gravesend (Mr. Ovenden) said, which is that having conceded the principle once—in fact, and I think that we are about to do so for a second time this evening—there is no sensible reason why we should not anticipate that this will not happen again. We know that there are arguments, if not tensions, within the nursing profession about various groups of nurses, who have a particular set of special skills and a particular type of working experience, and who argue, and will continue to 439 do so—and probably in the future with greater force—that they are as distinguishable from the general body of nurses as are the midwives and, as I think we are agreeing tonight, the health visitors.
We can expect a further proliferation of committees such as those that we are looking at in the context of new clause 1. I do not see that we should be worried about this in any way. I believe that it is an inevitable consequence of the growth of the profession and its growing sophistication that people will become more specialised and therefore will want to distinguish parts of training and education for the different specialisms.
So far in this debate we have talked of three groups of people whose basic training is now generally agreed to be in general nursing. However, we do not know whether that will continue to be the case among all the various groups that are subsumed within the general word "nurse" into the indefinite future. I suspect that with some of the sub-groups the position will change within a few years and that nursing will cease to be the basic relevant training for such people. Therefore, I see no reason why we should be anxious that the Bill will lead to a proliferation of committees and subcommittees. That would be only a logical institutional response to the development of the profession.
In common with other hon. Members, I have received representations from the health visitors and I have been impressed by the quality of their arguments. The Minister should beware of being over-impressed by numbers. It is true that there are many nurses—350,000, I am told—and a large number of midwives, totalling 40,000, I understand. Therefore, there are relatively only a small number of health visitors. Although 350,000 nurses may have a loud voice, that does not necessarily signify the quality or cogency of their arguments. The only criteria we can use in deciding whether subgroups should have the kind of autonomy that is already conferred on midwives are the character of their activities, their function and the nature of the skills which they have to acquire to carry out those functions. If they are significantly distinguishable from other groups within the 440 nursing profession, it is logical and justifiable for the House to create a separate autonomous institution to govern the training and education of that group.
§ Mr. John Cronin (Loughborough)
I am a Member sponsored by the Confederation of Health Service Employees. Indeed, I am chairman of the group of sponsored Members, and some of what I say may reflect their views. However, what chiefly moves me to speak today is my admiration for this excellent Bill and my concern that its effect should not be impaired. Having practised as a consultant surgeon for 30 years, I am not entirely ignorant of the issues involved. Therefore I wish to apply myself to the argument to ensure that the Bill retains its excellence.
I was impressed by the importance attributed to health visitors by my hon. Friend the Member for Preston, South (Mr. Thorne) in his excellent speech moving the new clause. Furthermore, the hon. Member for Wells (Mr. Boscawen) paid a powerful tribute to the health visitors. They are fairly important people and their work is particularly useful.
At the same time, we must bear in mind that our most important purpose here is to see that the nursing profession is controlled by a completely authoritative organisation. The clause and the amendments taken with it go against the whole concept of the original Briggs report, namely, the concept of unity. If we make special arrangements for special sections of the nursing profession, we shall be perpetuating the old system under a different name.
The hon. Member for Wells stressed that health visitors are most concerned with preventive medicine. I agree that that is very much in their favour, but I do not see why that aspect of their work should be so important that they must have separate representation. We must remember that there are only 10,000 health visitors, and this, surely, is a question of the tail wagging the dog.
§ 5.45 p.m.
§ Mr. Boscawen
The hon. Gentleman suggests that the tail is wagging the dog, but it will wag the dog only in a narrow respect specific to the health visitor. It will not wag the dog in relation to the 441 rest of the general nursing profession involving midwifery and the other minorities.
§ Mr. Cronin
The same argument could be applied to any other section of the nursing profession. When the Briggs committee met to discuss this matter, very little support was given to the idea of according health visitors special treatment. Therefore, I am surprised that that suggestion should arise now. The Briggs committee agreed to bury differences and to work together. Now these differences appear to be re-emerging to the detriment of the Bill. If this special treatment is given to health visitors, it will discriminate against other sections of nurses such as district nurses, psychiatric nurses, occupational health nurses and other groups of nurses who could equally demand the same treatment.
Many hon. Members have referred to the fears of the health visitors. Nobody has said what those fears are. What are they afraid of?
§ Mr. Thorne
I thought that my hon. Friend listened to my speech. Their fears are based on the prospect that the education and training which they now receive in certain types of institution will in time be so eroded that they end up by getting a form of education in hospitals away from the environment on which they have built over a long period of time and which gives them the specialist training about which we have been talking.
§ Mr. Cronin
I assure my hon. Friend that I listened to his remarks most carefully and I took that point, but I cannot see why the nurses have these fears about their future. It is no compliment to the future Central Council if we in this House feel that that body will not be sufficiently well established to understand the importance of education.
§ Dr. Alan Glyn (Windsor and Maidenhead)
The point is that there is a genuine fear among health visitors that their own views may be overridden in two or three years' time and that their system of education may be altered by the Central Council. That is the basis of their concern.
§ Mr. Cronin
My suggestion is that those fears are unjustified. I do not see why the Bill should be radically changed 442 because of the fears of a relatively small group.
Some other members of the nursing profession have an equal entitlement to special consideration. Let us consider the case of mental nurses in mental hospitals, who have great responsibilities quite different from those in general nursing. They have onerous decisions and responsibilities under the Mental Health Act 1959. They have the responsibility for taking away the freedom of patients, giving treatments that are not accepted by some patients and restraining patients physically. These responsibilities are unique. If a small group such as the health visitors are given special treatment, why should the mental nurses not have the same treatment?
§ Mr. Burden
I understand what the hon. Gentleman says, but he might like to retract his remark that we should not pay too much attention to the requirements of a small group. They are the people whom Parliament should always take great care to protect.
§ Mr. Cronin
If any difficulty arises, they are fully protected under clause 3(3). The Minister has powers to take steps to see that they are protected. There is no need for these fears.
§ Mr. Litterick
In the last few minutes my hon. Friend has frequently used the word "responsibility", which indicates that he is confusing responsibility with skill. We are talking of skills and the necessary training for skills. Responsibility is quite different.
§ Mr. Cronin
Responsibility in the nursing and medical professions involves a high degree of skill. They go together.
§ Mr. Cronin
I hope that my hon. Friend will accept from me that consultant surgeons are responsible people because they have the skill to accept the responsibility. I cannot accept his argument that skill and responsibility are altogether separate.
The Confederation of Health Service Employees accepted the Bill because it involved unification of the profession, which it thought desirable. COHSE represents 230,000 Health Service employees. Even in these troubled times we should pay attention to the unions 443 involved. COHSE is not happy about the new clause and the amendments. It accepted the special treatment of midwives. Some people believe that the Minister's acceptance of the amendments that led to the midwifery committee did not help the Bill. It is asking a lot of a trade union which has accepted with some misgivings one amendment to accept a further proposal that puts a large number of its members at a relative disadvantage.
The Bill is excellent. I was not a member of the Standing Committee, but I pay tribute to the splendid work that it did. As a result, we have an excellent Bill that will transform the nursing profession. I hope that no amendment will be accepted which will disfigure the excellence of this most satisfactory Bill.
§ Mr. Moyle
We have had a lengthy and interesting debate. The Bill not only surveys the problems of the nursing profession, the National Health Service and the internal politics of the nursing profession but, as I was reminded by my hon. Friend the Member for Chorley (Mr. Rodgers), reveals the problems of British membership of the Common Market, devolution, Government policy on Northern Ireland, the British constitution and parliamentary practice. In spite of these multifarious problems, we had a good Committee stage. Most of the problems have been resolved in an acceptable way, apart from the remaining problem that we are faced with this afternoon.
I associate myself with all the statements of principle that have been made in the debate on both sides of the House. I was asked by the hon. Member for Truro (Mr. Penhaligon) and others what the Government's attitude was to health visitors. We believe that prevention must be treated as being of paramount importance in the development of the Health Service. I was pleased to see that the hon. Member for Wells (Mr. Boscawen) supports that view. So that even in the untoward event of a change of Government the policy developing prevention will continue with enthusiasm.
Essential to that policy is a good health visiting service, and the Government are committed to developing that. The Council for the Education and Training of Health Visitors has blazed a trail in the 444 organisation of the training of health professionals. In its relatively short existence it has adopted a businesslike approach and provided an excellent system. Not only has that system been good, but when the Bill is on the statute book the system will continue to be good. There will be modifications as conditions change, but it will essentially remain unchanged.
We are faced with three proposals. My hon. Friend's new clause 1 and the Opposition's amendments Nos. 27 and 28 suffer from technical defects which should give the House pause before putting them into the Bill. They are substantial technical defects.
Turning to new clause 1, amendment No. 22 removes existing clause 8 in order to substitute the new clause. Clause 8 (4) says:The Secretary of State may by order constitute other joint committees"—that is, other than the joint health visiting committee. In Committee I said that if the district nurses would like a joint committee they could come to me and I would institute it. Hon. Members have a group of amendments down that would make legal provision for that.
If I accept my hon. Friend's new clause 1, that removes from me any opportunity to povide a joint committee for district nurses, psychiatric nurses, mental nurses, occupational nurses and midwives. That is a massive obstacle to my accepting new clause 1, and also to the House accepting it, even those hon. Members who would like to see for the health visitors a more developed solution than there is at present in the Bill.
Opposition amendments Nos. 27 and 28 have developed a solution which tries to recognise that under the Bill there must be overall control by the Central Council as well as a substantial responsibility for the education and training of health visitors by the health visiting joint committee. The technique that has been recommended by the Royal College of Nursing and the Health Visitors Association is to say that in any disagreement between the Central Council and the health visiting joint committee, the Central Councilshall not unreasonably fail to act on a recommendation of the Health Visiting Joint Committee.445 6 p.m.
What is reasonable, what is unreasonable, and who decides? We have a definition of a reasonable man by one of our learned judges who said many years ago that the reasonable man was the man on the Clapham omnibus. But it is sinister in this context if, to find out what is reasonable, I have to quote a judge. The moment one puts the term "reasonable" into a statute, one is flagging to all and sundry that a correct solution to the problem will have to be sought through the courts.
If we accept amendments Nos. 27 and 28 as they are, even if we agree with the principle, we envisage the possibility that relations between an overall Central Council and one of its committees will have to be decided upon in courts of law. We are suggesting that there will be litigation to settle the boundary between two bodies which are supposed to be closely related. Therefore, I could not accept the burden of the amendments, even if I agreed with the principle.
However, the Opposition have been moving in the right direction, because their two amendments have some measure of agreement on the Briggs co-ordinating committee. The Royal College of Nursing, the Health Visitors Association, the Council for the Education and Training of Health Visitors, the panel of assessors and the Joint Board for Clinical Nursing Studies have agreed to the amendments going forward. That is an advance. On the other hand, the Royal College of Midwives, the General Nursing Council of England and Wales, the General Nursing Council of Scotland, the Central Midwives Board for England and Wales, the Central Midwives Board for Scotland, the regional nursing officers who speak for NHS nursing management, the Clinical Nursing Studies Committee for Scotland, the Association of Nursing Administrators, the Northern Ireland Council which encompasses all those bodies for Northern Ireland, the National Union of Public Employees, the National and Local Government Officers Association and the Confederation of Health Service Employees all believe that this is not a proper solution. Therefore, the bodies that support the amendments must get the wording changed if they want them to go forward. They must remove this 446 concept of "reasonableness", and they must persuade their colleagues.
§ Mr. Roderick Macfarquhar (Belper)
Is my right hon. Friend saying that the objection by that long list of bodies is to the one word "reasonable", or are there other objections?
§ Mr. Moyle
There are other objections, and I am coming to them now. From the drafting point of view, and from the point of view of trying to administer the Act, the insertion of the concept of reasonableness is a severe blow to the wording of amendment No. 28.
The trouble is that both amendments destroy the overall control by the Central Council of the education and training of health visitors. It is an essential element of the whole of the Bill that, despite the fact that we make arrangements for minorities, there should be eventual control, as far as the profession is concerned, in the Council. Several hon. Members have recognised that there is this tension in our efforts to solve the problem.
If we cannot get agreement, it will be difficult. If we can, everything becomes possible. But both amendments involve the handing over of all responsibility for the education and training of health visitors to the health visiting joint committee, except in so far as this dangerous element of reasonableness comes into them.
If a move is made to remove the total control of health visitors' education and training from the Central Council to some standing committee and it is blessed by this House, we shall land ourselves in difficulty. There are various groups that we are trying to bring together—midwives, health visitors, district nurses, psychiatric nurses, occupational nurses and general nurses. The general approach has been that all of them must pool their particular interests and give up something in order to get this precious concept of unity. The moment one group breaks ranks, all the others will wish to follow. My hon. Friend the Member for Ealing, North (Mr. Molloy) made a particularly passionate indication of the sort of case that one might get with psychiatric nurses if this occurred in respect of health visitors. If the psychiatric and mental nurses can agree on the sort of solution that we might apply to the health visitors, we can all go forward together.
447 The health visitors have a tremendous self-interest in associating themselves with the general nursing profession because they make use of general nursing training at the initial stage. Therefore, they have a tremendous interest in making sure that general nurse training develops along lines that will be useful to them. Health visitors also must have some knowledge of obstetrics. Therefore they also have an interest in midwifery training. It is important that health visitors should stay in with the general nursing profession on terms that will allow them to influence the general nursing and midwifery training. At the same time, they must not cut themselves off completely from their own health visiting training.
What is the position of health visitors as a result of the amendments and modifications made in Committee? I recognise that they are still suffering from a sense of unease. They are worried, and I am prepared to continue to look at the problems. We have Government amendments Nos. 5 and 16 on the Amendment Paper, which I hope that the House will adopt. Those amendments lay a legal obligation on the Central Council and the joint boards to have regard to minority interests in their administration of the profession. That writes in a legal obligation for the protection of health visitors, district nurses, midwives and other similar bodies.
§ Mr. Robert Hughes (Aberdeen, North)
I appreciate that the unease of health visitors is at the core of the problem. If we listen to the other objections which my right hon. Friend put and do not build in proper safeguards, this unease will be reinforced. My right hon. Friend said that the insertion of "reasonable" is very difficult because one cannot say what is reasonable. By the same token, what is "proper", which appears in his amendment?
§ Mr. Hughes
My right hon. Friend mentioned amendment No. 5 and said that in the discharge of functions "proper regard" shall be had. What is proper regard?
§ Mr. Moyle
That is a point, but this is a new development which lays a burden 448 on the various bodies to have regard to the proper professional interests of the minorities covered here. This is just the first, and by no means the most important, of the defences that health visitors will have under the Bill. We have made sure that there will be a health visiting joint committee of the Central Council. All matters relating to health visitors will be referred to that committee by the Central Council.
I believe that once a health visiting joint committee is set up it will be inconceivable for the Central Council to proceed on a matter relating to health visitors without first referring it to the committee. However, if by some mischance it proceeded without reference to the committee, there are other protections for health visitors. For example, the majority on that health visiting joint committee will be practising health visitors, who will be able to make recommendations to the Central Council. I believe that in 99 cases out of 100 the Central Council will accept the recommendations of the committee.
It was made clear in Committee that the Central Council will be able to operate, once it has decided what to do, only by seeking the authority of a statutory instrument of the House. Therefore, the Central Council will have to draft a statutory instrument and put it before my right hon. Friend the Secretary of State for Social Services for his agreement. It is said that at some time in the future there might be a Secretary of State who will not bother to ask the Central Council whether the health visiting joint committee had considered the matter before it was put to him. I believe that to be highly unlikely. No Secretary of State would lay those rules before the House for debate and approval in the face of opposition from the health visiting joint committee. However, if he did, the order would still have to be laid before the House for debate.
Some relatively caustic remarks were made in Committee by my hon. Friend the Member for Preston, South (Mr. Thorne). He said that provisions relating to statutory committees, particularly if they were subject to the negative procedure, were often laid before the House and never seen. In this case, I do not believe that to be possible. After all, the scenario that we are setting is one 449 where the health visiting joint committee is outraged because it feels that the Central Council has not observed its wishes on the training and education of health visitors. After what has occurred in the past two months, no hon. Member could believe that that situation would slip by unnoticed. Shoals of letters have been descending upon us in recent weeks. They would be reinforced—and doubled in many cases—rather than die off if the Central Council ignored the joint committee. The consequent debate and vote upon the rules would provide more protection for health visitors.
§ Mr. Ovenden
Does my right hon. Friend accept that one of the problems of the negative procedure is that, despite the feelings of hon. Members who may be annoyed about the issue, it is up to the Government to provide time for a debate? Will my right hon. Friend cast his mind back to the arguments raised over the past two months about non-contributory invalidity pension, when prayers were tabled but the Government refused to allow time for a debate?
§ 6.15 p.m.
§ Mr. Moyle
In a contentious case involving health visitors, I do not believe that the Government would refuse to allow time for a debate. The House agrees that if the wishes of health visitors about their education and training are not met, a contentious issue evolves. Therefore, there is no prospect of the matter sliding by. I have demonstrated that even if there are no further amendments to the Bill, other than amendments Nos. 5 and 16, substantial protection still exists for health visitors.
However, in spite of all the protection, there is still a sense of unease. Following the extensive discussions of the Briggs co-ordinating committee, the Government felt that clause 7 of the original Bill—the present clause 8—was as satisfactory as could be achieved. We believed that it would provide an adequate safeguard for the health visitors and would not undermine the Central Council. However, it is clear from representations that many hon. Members have received that some sections of the health professions are still unhappy.
We accept that the training of health visitors is specialised. I undertake that if the various groups involved come for- 450 ward with a better agreed solution the Government will write it into the Bill in another place. That is further than I have gone before. With that assurance, I ask hon. Members not to press for any change in the principles of clause 8 at this stage.
§ Dr. Vaughan
I am grateful to the Minister for that important concession. I believe that it will go a long way towards settling the anxieties of health visitors. However, will the right hon. Gentleman bear in mind that in Committee the amendments to the former clause 7 were withdrawn on the understanding that the clause would be improved?
§ Mr. Pavitt
The Government have made an important concession. Will my right hon. Friend confirm that he is not seeking to achieve 100 per cent. agreement of all the organisations concerned, and that if he gets maximum agreement the concession will be written into the Bill?
§ Mr. Moyle
I am not sure what my hon. Friend means by "maximum agreement". However, I am not seeking a 100 per cent. consensus.
I turn now to amendments Nos. 29 and 30. I have accepted, in principle, the idea that the majority of members on the health visiting joint committee should be persons with experience in the profession. I raised a query concerning the wording of the amendments proposed in Committee, and amendments Nos. 29 and 30 include the wording that my legal advisers regard as appropriate to apply the concept. I hope that the House will accept the amendments.
§ Motion and clause, by leave, withdrawn.