HC Deb 07 February 1979 vol 962 cc458-67
Mr. Hodgson

I beg to move amendment No. 9, in line 8, at end, insert: 'and there shall also be two members of the general public at least one of whom must be a woman'.

Mr. Deputy Speaker

With this we are to take amendment No. 17, in clause 7, page 5, line 34, after first 'committee', insert: '(which shall include two members of the general public one of whom must be a woman)'.

Mr. Hodgson

These two amendments concern the general interest of the Opposition to ensure that the public are adequately represented on the individual boards which are to be set up following the recommendation of the Briggs committee.

In Committee, we considered the place of the general public on the Central Council. Government amendments Nos. 12 and 13, to which we shall be coming in a moment, concern the representation of the general public on the national boards. This amendment concerns the representation of the general public on the midwifery committees, both the central midwifery committee and the midwifery committee of each of the national boards. These two amendments are different from those which we considered in Committee in that, instead of concerning ourselves merely with two members of the general public, we specify here that one must be a woman.

The reason why we want to include one woman is fairly obvious. Women have a special interest in the operations of a midwifery committee. But one further argument worth making concerns the pressure from the medical profession and possibly from the DHHS for women to have their children in hospital rather than at home.

A measure of unease about this proposal was circulating fairly widely amongst hon. Members who served on the Committee. Certain sections of the midwifery profession feel that the powers-that-be, as they see it, are putting unnecessary pressure on women to have all their children in hospital rather than at home, bearing in mind that certain European countries — Holland especially — has adopted the reverse policy with very satisfactory results from the point of view of natal mortality and natal care.

The sections of the midwifery profession which are concerned about this feel that the representation of the general public, especially by one woman who is from outside the profession, on each of the committees will have a balancing effect and will ensure that more general views can at least be heard, understood and argued about on the midwifery committees.

I move this amendment, therefore, for two reasons. The first is that we are discussing the general public, and this is a Bill concerned with the nursing profession which seeks to serve the general public. In view of that, the interest of the general public and the consumer interest must be represented properly.

Secondly, a woman from outside the nursing and medical profession, perhaps an ordinary housewife, would bring a new dimension and a new perspective to the deliberations of the midwifery committee. For those reasons, I ask the House to accept the amendment.

Mr. Powell

I hope that the Minister will not smile upon this amendment, at any rate in its present form, because of the intolerable obscurity, in this context, of the concept of "a member of the general public".

I invite the House to recall the constitution of the Central Council of which the midwifery committee is to be a committee. Clause 1 (3) (a) sets out that the majority shall be members of the national boards, nominated or elected in a particular way, with the remainder appointed by the Secretary of State from among persons described in clause 1(4). It appears to me that none of those persons constituting the Council under clause 1 is a member of the general public in any natural sense of the term.

There are two views of the meaning of this expression. We are all members of the general public when we are not doing our own thing. The most highly qualified consultant surgeon is sometimes only too obviously a member of the general public immediately he ceases to practise as a consultant surgeon. In one sense, all the members of the Council, except in one particular aspect, are members of the general public. I do not know whether the hon. Member for Walsall, North (Mr. Hodgson) wants to interrupt.

Mr. Hodgson

I accept the point of the right hon. Member for Down, South (Mr. Powell) about clause 1. He will understand that we have tabled an amendment. I hope I have made clear that it is not in the Bill as presently constituted. We have sought to move an amendment to it.

Mr. Powell

Even if it is intended that these persons who are to be members of the midwifery committee are not to be members of the Council, of which it is a committee, which may have been vaguely hinted at by the word "also" in the amendment, there still remains the difficulty, which I was in the middle of dissecting, of this concept of "member of the general public".

One alternative—I shall endeavour not to repeat myself—is anybody when he is not in his professional capacity. The alternative is "a layman" or "a laywoman", that is to say, a person who has none of the qualifications for being a member of the Council or of the national boards, which are set out in different parts of the Bill. Clearly, if the amendment were interpreted in that light, the first meaning would be nugatory. If we take the second meaning, I cannot believe that it is a good idea for us to place on the midwifery committee persons who have no qualifications or experience in education, medicine or other fields which would be of value in the performance of its functions. Surely, under the second category of meaning, they are not members of the general public.

We therefore appear to be asking that the Secretary of State should ensure that there are people on the midwifery committee who have no possible reason for being there except that they have no reason for being there. That does not seem a satisfactory method for afforcing the committee. Unless the Minister can discover more meaning in the amendment than I have been able to do, I hope he will not give it a fair wind.

Mr. Pavitt

I understood the argument of the right hon. Member for Down, South (Mr. Powell), but I also understand clearly what the hon. Member for Walsall, North (Mr. Hodgson) is seeking to achieve. He is seeking some participation by the customers in the Health Service. We are setting up an educational body.

I doubt whether the hon. Gentleman's intentions would serve a useful purpose. He is reaching for an objective that many of us would like to see in other sectors of the Health Service. We would like some participation by patients. The description by the right hon. Member for Down, South of "the general public" applies equally to the patients. We are patients at some time in our lives. For most of the time, we are not. It is a weakness of the Health Service that there is no meaningful participation by people at the receiving end of the Service.

I should be prepared to support the contention of the hon. Member for Walsall, North in other sectors of the Health Service, but I can see no way in which practical expression can be given to the principle he is putting forward in this amendment.

6.45 p.m.

Mr. Moyle

We ran over the course of this amendment and its principles in Committee. I reassure the right hon. Member for Down, South (Mr. Powell) that I agree wholeheartedly with all the strictures he has passed on the phrase "general public". He spoke of "intolerable obscurity" about the phrase. I heartily agree with him.

There are other technical defects in the amendment. As my hon. Friend for Brent, South (Mr. Pavitt) said, this is an attempt to get some consumer representation into the midwifery committee. The essence of consumer representation would be a woman on the committee who was a mother. The amendment does not specify that the woman should be a mother. It is vague in that respect.

I also pointed out in Committee that, given the make-up of the midwifery profession, it was highly unlikely at this stage that the midwifery committee would be devoid of women and devoid of women who were mothers. I would have thought it almost inevitable that at least one member of the committee would have experienced childbirth, even on the most random process of selection.

The hon. Member for Walsall, North (Mr. Hodgson) was confusing matters a little. He seemed to think that the Central Council would be part of the Health Service. The body will contain people who are involved in the Health Service, but it will not be part of the Service. It will not be concerned with the provision of health services. It will be concerned with the control of an important profession.

The question whether babies are delivered in hospital or at home—a very important question—is not a matter that this body can settle. The whole argument about whether babies should be delivered at home or in hospital is almost totally irrelevant to the matters we are now considering in this Bill. It is a matter of departmental and Health Service policy. We try to encourage mothers to have their babies in hospital because of the full range of back-up services if things go wrong. If, despite all the best advice that we tender mothers, they still want to have babies at home, we will make provision for that. But this is not a matter for the Central Council or for the midwifery committee to consider. It is a matter for the Health Service and for Ministers. If members of the public quarrel with the policy, their quarrel is with the Secretary of State and myself and the medical profession, and not with the Central Council and the midwives.

Mr. Hodgson

I find the Minister's remarks less than persuasive. Clause 4 deals with midwifery practice. There is no doubt that his Department will receive representations from the Central Council and the midwifery committee about midwifery practice in the broadest sense. People who wish to contribute to the way midwifery practice is carried out will do a great deal better if they proceed through the midwifery committee rather than write directly to the Minister, because the established profession will be behind them.

The amendment is therefore concerned with giving other views fair exposure in the councils of the DHSS. It is a question not of involvement in the Department but of putting pressure on it. The Minister says that it is unlikely that the committee will exclude mothers and

members of the general public. I accept that, but there is no certainty. Therefore, I press the amendment to a Division.

Question put, That the amendment be made:—

The House divided: Ayes 149, Noes 121.

Division No.73] AYES [6.50 p.m.
Arnold, Tom Hamilton, Archibald (Epsom & Ewell) Overden, John
Atkinson, David (B'mouth, East) Hamilton, Michael (Salisbury) Page, Rt Hon R. Graham (Crosby)
Awdry, Daniel Hampson, Dr Keith Page, Richard (Workington)
Bain, Mrs Margaret Hannam, John Penhaligon, David
Banks, Robert Hawkins, Paul Price, David (Eastleigh)
Beith, A. J. Hayhoe, Barney Raison, Timothy
Bell, Ronald Hayman, Mrs Helene Reid, George
Bendall, Vivian Hicks, Robert Renton, Rt Hon Sir D. (Hunts)
Berry, Hon Anthony Hodgson, Robin Renton, Tim (Mid-Sussex)
Biffen, John Holland, Philip Rhodes James, R.
Blaker, Peter Hooson, Emlyn Ridsdale, Julian
Body, Richard Howell, David (Guildford) Roberts, Michael (Cardiff NW)
Boscawen, Hon Robert Howells, Geraint (Cardigan) Roberts, Wyn (Conway)
Brotherton, Michael Hunt, David (Wirral) Ross, Stephen (Isle of Wight)
Buchanan-Smith, Alick Hunt, John (Ravensbourne) Sainsbury, Tim
Buck, Antony Hurd, Douglas Shaw, Giles (Pudsey)
Bulmer, Esmond Jenkin, Rt Hon P. (Wanst'd&W'df'd) Shelton, William (Streatham)
Burden, F. A. Jessel, Toby Shepherd, Colin
Canavan, Dennis Kaberry, Sir Donald Sims, Roger
Carlisle, Mark Kimball, Marcus Smith, Cyril (Rochdale)
Chalker, Mrs Lynda King, Tom (Bridgwater) Smith, Timothy John (Ashfield)
Channon, Paul Knight, Mrs Jill Spicer, Jim (W Dorset)
Clark, William (Croydon S) Latham, Arthur (Paddington) Sproat, Iain
Clegg, Walter Lawrence, Ivan Stainton, Keith
Colquhoun, Ms Maureen Lawson, Nigel Steel, Rt Hon David
Cook, Robin F. (Edin C) Le Marchant, Spencer Stewart, Rt Hon Donald
Cooke, Robert (Bristol W) Litterick, Tom Stewart, lan (Hitchin)
Cope, John Lloyd, Ian Stradling Thomas, J.
Corbett, Robin Luce, Richard Taylor, Teddy (Cathcart)
Costain, A. P. Macfarlane, Neil Temple-Morris, Peter
Dodsworth, Geoffrey MacGregor, John Thatcher, Rt Hon Margaret
Douglas-Mann, Bruce MacKay, Andrew (Stechford) Thomas, Rt Hon P. (Hendon S)
Dykes, Hugh McNair-Wilson, M. (Newbury) Thomas, Ron (Bristol NW)
Elliott, Sir William Marshall, Michael (Arundel) Thompson, George
Emery, Peter Marten, Neil Thorpe, Rt Hon Jeremy (N Devon)
Evans, Gwynfor (Carmarthen) Mather, Carol Townsend, Cyril D.
Fairgrieve, Russell Mawby, Ray Vaughan, Dr Gerard
Farr, John Maxwell-Hyslop, Robin Viggers, Peter
Fisher, Sir Nigel Meyer, Sir Anthony Wainwright, Richard (Colne V)
Flannery, Martin Miller, Hal (Bromsgrove) Walters, Dennis
Fletcher, Alex (Edinburgh N) Mills, Peter Warren, Kenneth
Fletcher, Ted (Darlington) Mitchell, Austin (Grimsby) Weatherill, Bernard
Fookes, Miss Janet Montgomery, Fergus Welsh, Andrew
Freud, Clement More, Jasper (Ludlow) Wigley, Dafydd
Goodhart, Philip Morgan-Giles, Rear-Admiral Wilson, Gordon (Dundee E)
Gorst, John Morris, Michael (Northampton S) Wood, Rt Hon Richard
Gow, Ian (Eastbourne) Morrison, Hon Peter (Chester) Younger, Hon George
Grey, Hamish Neubert, Michael
Griffiths, Eldon Newton, Tony TELLERS FOR THE AYES:
Grimond, Rt Hon J. Nott, John Sir George Young and
Grist, Ian Onslow, Cranley Lord James Douglas-Hamilton.
Armstrong, Ernest Cocks, Rt Hon Michael (Bristol S) Eadie, Alex
Atkinson, Norman (H'gey, Tott'ham) Cowans, Harry Edge, Geoff
Bates, Alf Cox, Thomas (Tooting) Evans, Ioan (Aberdare)
Benn, Rt Hon Anthony Wedgwood Craigen, Jim(Maryhill) Evans, John (Newton)
Bennett, Andrew (Stockport N) Cronin, John Ewing, Harry (Stirling)
Bidwell, Sydney Cryer, Bob Fernyhough, Rt Hon E.
Bishop, Rt Hon Edward Cunningham, Dr J. (Whlteh) Forrester, John
Blenkinsop, Arthur Davies, Bryan (Enfield N) Fraser, John (Lambeth, N'w'd)
Boardman, H. Davies, Ifor (Gower) Garrett, W. E. (Wallsend)
Booth, Rt Hon Albert Davis, Clinton (Hackney C) George, Bruce
Boothroyd, Miss Betty Deakins, Eric Ginsburg, David
Brown, Hugh D. (Provan) Dell, Rt Hon Edmund Golding, John
Buchanan, Richard Dempsey, James Gould, Bryan
Carter-Jones, Lewis Doig, Peter Gourlay, Harry
Cartwright, John Dormand, J. D. Graham, Ted
Clemitson, Ivor Dunn, James A. Hardy, Peter
Harrison, Rt Hon Walter Madden, Max Silkln, Rt Hon John (Deptford)
Heffer, Eric S. Marshall, Dr Edmund (Goole) Silverman, Julius
Home Robertson, John Marshall, Jim (Leicester S) Skinner, Dennis
Horam, John Mikardo, Ian Snape, Peter
Hughes, Rt Hon C. (Anglesey) Millan, Rt Hon Bruce Spriggs, Leslie
Hughes, Roy (Newport) Molloy, William Stewart, Rt Hon M. (Fulham)
Hunter, Adam Morris, Rt Hon Charles R. Stoddart, David
Irving, Rt Hon S. (Dartford) Morton, George Strang, Gavin
Janner, Greville Moyle, Rt Hon Roland Summerskill, Hon Dr Shirley
Jay, Rt Hon Douglas Newens, Stanley Tierney, Sydney
John, Brynmor Oakes, Gordon Urwin, T. W.
Johnson, Walter (Derby S) Ogden, Eric Walker, Terry (Kingswood)
Jones, Alec (Rhondda) Palmer, Arthur Watkinson, John
Jones, Dan (Burnley) Parker, John White, Frank R. (Bury)
Judd, Frank Parry, Robert White, James (Pollok)
Kerr, Russell Pavitt, Laurie Whitlock, William
Lamond, James Phipps, Dr Colin Willey, Rt Hon Frederick
Lestor, Miss Joan (Eton & Slough) Powell, Rt Hon J. Enoch Williams, Sir Thomas (Warrington)
Lewis, Ron (Carlisle) Radice, Giles Wilson, William (Coventry SE)
Lyons, Edward (Bradford W) Rees, Rt Hon Merlyn (Leeds S) Woof Robert
McElhone, Frank Robertson, George (Hamilton) Young, David (Bolton E)
MacFarquhar, Roderick Roderick, Caerwyn
McGuire, Michael (Ince) Rodgers, Rt Hon William (Stockton) TELLERS FOR THE NOES:
MacKenzie, Rt Hon Gregor Sedgemore, Brian Mr. James Hamilton and
Maclennan, Robert Sever, John Mr. James Tinn.
McMillan, Tom (Glasgow C) Short, Mrs Renée (Wolv NE)

Question accordingly agreed to.

7 p.m.

Mr. Moyle

I beg to move amendment No. 10 in page 3, line 14, leave out subsection (3) and insert: '(3) The Council shall assign to the Committee any matter involving a proposal to make, amend or revoke rules under section 15 (regulation of midwifery practice); and—

  1. (a) the Committee shall consider the proposal and report on it to the Council;
  2. (b) the Council shall take no action on the report until they have consulted the National Boards with respect to the matters dealt with in it.'.
The amendment has been tabled to clarify new clause 1 as it applies to the midwifery committee. At the same time, I shall refer to Government amendment No. 18. The orginal new clause 1 that was considered in Committee—it is now clause 4—referred to the assignment to the midwifery committee of midwifery practice. I assumed that it would be generally understood that midwifery practice referred to the rules of midwifery practice that are now mentioned in clause 15. The hon. Member for Reading, South (Dr. Vaughan) said that that was not clear in the wording that we had adopted.

The object of the amendment is to make it crystal clear that when we talk about the assignment of midwifery practice to the midwifery committee we are talking about the midwifery practice rules in clause 15. The amendment is designed to meet the arguments of the hon. Gentleman, and I hope that the House will give it its support.

Dr. Vaughan

I am glad that the Minister, having considered the argument put to him in Committee, came to the conclusion that it was necessary to make some changes. We support the words that are before us. When we discussed the matter with the Royal College of Nursing to seek the view of the nursing profession, it felt that the wording was satisfactory.

Amendment agreed to.

Mr. Moyle

I beg to move amendment No. 11, in page 4, line 4 leave out "30" and insert "35".

In Committee we discussed the number that should compose the Northern Ireland national board. We discussed whether it should be increased from 30 to 35. I undertook to consult the Northern Ireland profession to ascertain what it thought to be the best number. It has said that it would prefer 35. Therefore, we are writing that into the Bill.

Dr. Vaughan

This is a much more important change than appears from the brief wording in the amendment. It will give much more flexibility to the working of the board and in enabling those concerned to represent the different professional groups in Northern Ireland. Whenever we discuss Northern Ireland and the importance of the Northern Ireland nursing groups, we must remember that some of their numbers are small. At the beginning of our deliberations in Committee we spent some time considering whether they would be able adequately to fill all the committees and to undertake the responsibilities that the Bill would require of them. We are pleased that the Minister has accepted the argument and has increased the number.

Amendment agreed to.

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