Nursing, Midwifery and Health Visiting

HC Deb 27 July 1982 vol 28 cc1019-31 10.26 pm

The Minister for Health (Mr. Kenneth Clarke)

I beg to move, That the draft United Kingdom Central Council for Nursing, Midwifery and Health Visiting (Electoral Scheme) Order 1982, which was laid before this House on 8th July, be approved. This order is important to the professions of nursing, midwifery and health visiting. It is one part of the process of devising new arrangements for the education, training and discipline of those professions. The whole subject matter of reforming the structure of the professions is taken very seriously by the Government. The order follows directly from the setting up of the United Kingdom central council and the four national boards for nursing, midwifery and health visiting under the Nurses, Midwives and Health Visitors Act 1979. I shall briefly give the background to that Act and bring hon. Members up to date on what has happened since the Act received the Royal Assent in April 1979, and how the election scheme now before us fits into the process.

As the House will recall, the Act arose originally from the report in 1972 of the committee on nursing, chaired by Professor Asa Briggs, now Lord Briggs, which recommended a unified statutory structure for nurses, midwives and health visitors as a prerequisite for the reappraisal of the future education and training needs of the profession. The bringing together of all special interests into one structure should make it possible to identify needs across the board and to examine the interrelationship between basic and post-basic training in such a way as to produce more effective patterns of education and training.

The Nurses, Midwives and Health Visitors Act 1979 arose out of the Briggs report of 1972. It provided for the education, training, regulation and discipline of nurses, midwives, health visitors and the maintenance of a single professional register. The Act and the order do not implement any of the detailed Briggs recommendations on nurses' education and training, but they establish the framework on which future changes can be made. That framework is provided by the establishment of new bodies—the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, and also four national boards for nursing, midwifery and health visiting, one for each country in the United Kingdom. Those new bodies will replace the nine existing statutory and other training bodies which will be dissolved eventually under the Act.

The present Government continued the policy of moving towards the new structure for nursing that has been developed by our two predecessors—the last Conservative Government and the last Labour Government.

We see the setting up of the five new bodies as the means of developing the education and training of nurses, midwives and health visitors throughout the four countries of the United Kingdom. We place a great priority on the development of the professions and we recognise the vital part that that will play in maintaining a high standard of patient care in the future. We see the whole process as a great opportunity for the profession as a whole, and I am confident that that opportunity will be taken.

Most of the Act has not yet come into force, but the United Kingdom central council and the four national boards—one for each country—were set up in November and September 1980 respectively to prepare themselves for taking over the functions of the nine existing nurse training bodies. The old existing bodies continue to carry out all registration and training functions until the new bodies are ready to assume that responsibility. All the present members of the new bodies were appointed by Ministers from the four United Kingdom Departments responsible.

With effect from 15 September 1983 each of the national boards will consist partly of members directly appointed by Ministers and partly of elected members. The elected members will be elected under an electoral scheme proposed by the central council and approved by my right hon. Friend the Secretary of State for Social Services. In accordance with the Act, elected members will form the majority of each national board.

Each newly constituted national board must then nominate members to the central council in equal numbers, and the majority of the central council must consist of national board members with the remainder being directly appointed by my right hon. Friend the Secretary of State.

The details of the scheme are very much a matter for the profession. I should like to acknowledge the detailed work that the present members and staff of the central council have undertaken in its preparation. Together with my colleagues, the health Ministers with responsibility for health from other United Kingdom Departments, I have met members of the council and have gone through the details of the scheme that they propose with them.

The Act provides that Ministers and the House have to take a view of this scheme. I have taken a broad view that this matter is, in the first place, very much a matter for the profession to resolve and for the profession to carry its own members with it. The role of the Ministers and the House is to intervene if things look as if they are going sadly awry. I hope that it is apparent to the House that the fact that we are promoting this order this evening means that we do not believe that the council has got it wrong.

Following the description that I gave a few moments ago of the constitution of the four national boards and eventually the central council, we have before us this evening the electoral scheme for the national boards. If the House approves the order before it tonight, that electoral scheme will be put into force.

Mr. Mike Thomas (Newcastle upon Tyne, East)

Will the Minister explain why he finds that there is no problem in this instance with the use of the single transferable vote?

Mr. Clarke

I shall come to that when I deal with the three components. It is true that with the assistance and advice of the Electoral Reform Society, the single transferable vote is the method chosen by the profession. I have already said that I took the view that the role of Government Ministers and the House was, first, to put the profession in the driving seat and for it to devise its own mechanisms. We shall intervene only if we think that what they devise is drastically wrong.

In devising the scheme, I am glad to say that the council has consulted widely within its professions. The proposals that it has put forward to Ministers, which we are endorsing in the order this evening, take account of the wide-ranging and sometimes conflicting views of the professional bodies that it consulted.

I and my colleagues, the Ministers with responsibility for health from the other United Kingdom Departments, are satisfied that the scheme largely reflects the wishes of most of the profession, although we are fully aware of the concerns of certain minority groups. However, I believe that in spite of the concern of minority groups, the scheme that we are putting forward will cover their interests too.

The council had six general principles in mind when drawing up the electoral scheme. First, it decided that the election must be fair and seen to be fair. Secondly, it must result in representative assemblies. Thirdly, the method used must be easily understood so that it elicits a response. Fourthly, the method must be practicable. Fifthly, the scheme must represent value for money. Sixthly, although of necessity based on present qualifications, the scheme must be sufficiently flexible to take account of future educational changes which may alter qualifications. The scheme had to satisfy all those criteria. Unlike the criterion of the hon. Member for Newcastle upon Tyne, East (Mr. Thomas), it did not have to accommodate the position of the Social Democratic Party in the results that it produced. The idea was to produce a broad, representative assembly to represent all interests within the nursing, midwifery and health visiting professions.

Mr. Mike Thomas

rose—

Mr. Clarke

I shall be dealing with proportional representation in a moment and I shall give way to the hon. Gentleman when I do so. In the council's opinion, which received the Government's approval, the scheme had to meet the six general principles to which I have referred. There is a great deal of detail, but there are three main elements to which the House will wish to pay attention. They are as follows: first, the creation of an electoral roll; secondly, the securing of the candidates; and, thirdly, the voting method.

The electoral roll has been created on the basis that nurses, midwives and health visitors will be invited to opt into the election scheme. That means that following a publicity exercise all nurses, midwives and health visitors will be invited to take part in the election, and eligibilitiy to do so will be confirmed from existing records. Once that eligibility to take part has been verified, each nurse, midwife and health visitor will be entered on to the electoral roll and subsequently will be sent the appropriate ballot form. I am sure that the decision to create a live electoral roll is the correct choice. The alternative of inviting all the nurses listed on the register or roll would in practice prove to be inordinately expensive and wasteful.

For the securing of candidates the scheme proposes that there should be three categories of candidate. These will be as follows: first, practising nurses both registered and enrolled; secondly, practising midwives; and, thirdly, practising health visitors. The proposal is that the proportion between these three categories should be four practising nurses to one practising midwife and one practising health visitor. By "practising" the order will mean that the person must be working in some capacity by virtue of a qualification in nursing, midwifery or health visiting. In reaching that view about the securing of candidates, the central council was influenced by the general support that had been given to the idea of three categories of candidate by professional bodies and trade unions in response to the consultation paper.

Mr. Ronald W. Brown (Hackney, South and Shoreditch)

Do those categories include part-time agency nurses and agency health visitors, for example? They are practising even though they are not full-time Health Service workers.

Mr. Clarke

Yes, the part-time will be included. As I have said, anyone working in some capacity by virtue of his or her qualification will be included. An agency nurse needs to be qualified in one of the appropriate ways if she is to be able to practise, and such a candidate will be able to opt on to the electoral roll and take part in the electoral process. It will include the whole practising profession which is covered by the proposals.

The third aspect of the election—

Mr. Mike Thomas

What will be the position of the nurses of the mentally ill and mentally handicapped? The hon. and learned Gentleman will know that the Royal College of Nursing has written to a number of those who considered the Mental Health (Amendment) Bill in Committee about the position of these nurses. They are not a minority group as they form a substantial group. Is he concerned that no provision has been made for their representation? They might accidentally end up unrepresented.

Mr. Clarke

This is an issue to which we all had to address ourselves. There are minority interests—I accept that some of them are quite substantial—within the nursing profession that are not sure whether their interests will be represented by the three broad categories of nurses, midwives and health visitors. We have addressed ourselves to the problem. The difficulty is that there are so many specialist groups within the nursing profession. There are those working in mental hospitals and there are psychiatric nurses. There are also district nurses and nurses specialising in the care of sick children. Once we start considering specialist groups that might want to have reserved categories of candidates and places, there will be so many potentially that it will be difficult to secure their representation. That is one of the reasons that led the council and the Government to go for the three broad categories. One reason for choosing a ballot was that the central council believed that the specialist groups which express anxiety could, if they organise and concert their efforts and choices, secure the representation that they require.

Mr. Thomas

I accept that and I see the difficulty, but the Royal College of Nursing made special representations on behalf of mental handicap and mental illness nurses because of the manning of the mental nurses committee. The Secretary of State said that the Government will redress any imbalance by appointment, if necessary, but, as the Royal College of Nursing said that it would prefer us to deal with the problem by election, would it not be better to do so?

Mr. Clarke

One problem that will arise is the manning of the various committees that will be set up by the national boards to ensure that we have a pool of specialist nurses upon which we can draw The composition of the committees is still being discussed by the central council. I suspect that the elected central council will take the final decision as to whether the committees are statutory or non-statutory. I assure the hon. Gentleman that the central council fully accepts the need for a pool of specialist staff but believes that it is not necessary to reserve a category of candidates for mental nurses. I singled out the largest argument about putting aside a separate category of mental nurses for the purpose of securing candidates, which is that, although we are being pressed by the Royal College of Nursing, other groups with a distinct interest will feel that they are entitled to put forward an equally strong case. We may end up with a fragmented list of candidates that will be unmanageable in practice.

The intention is that the voting method will sort out some of those problems and enable the professional groups to achieve adequate representation. The single transferable vote was chosen by the central council because it believed that it was most likely to secure a broad representation. The experience of the Electoral Reform Society, which has been advising the central council, led it to advise that considerable support for the scheme was demonstrated. The minority groups must concentrate their votes on those who represent their interests if they feel that they need specialist representation. As the hon. Member for Newcastle upon Tyne, East said, if the minority groups fail to secure adequate representation, Ministers will examine the experience of the elected members in considering the appointments that they must make. The result is that Ministers can fill any gaps in the representation of minority groups.

The central council proposes to adopt that process for the first election only, which it expects to take place in March 1983. The election will be evaluated thoroughly by the central council, the Government and the Electoral Reform Society to assess the extent to which fully representative assemblies are achieved. The evaluation will consider, in time for future elections, whether we have adopted the most appropriate arrangements.

The order sets out the arrangements for the first election. If it does not produce the results that we anticipate or desire, it will be reviewed in due course— [Laughter.] I assure the hon. Member for Newcastle upon Tyne, East that by "results" I do not mean the candidates who are elected but the broad representation that we can achieve. Only the SDP wish to revise electoral systems because they produce the wrong winners in the end. We are interested in ensuring that a broadly representative assembly is achieved. That is certainly the only interest of the central council and the Electoral Reform Society.

What we have before us is the result of careful consideration by members of the professions. They have consulted widely. It would be wrong for the Government or the House to overrule them unless we were convinced that they are wrong. Therefore, I commend the order to the House.

10.45 pm

Mrs. Gwyneth Dunwoody (Crewe)

I am grateful to the Minister for his careful explanation of the order, because it is extremely important. As he says, it came about because of the Nurses, Midwives and Health Visitors Act 1979. Because of the contents of that Act, it is important that the order should be correct. It is not just a question of an electoral process being set up to represent professionals with regard to one aspect of their work; the 1979 Act gives the central council extremely wide duties. Section 2(6) of the Act states: In the discharge of its functions the Council shall have proper regard for the interests of all groups within the professions, including those with minority representation. Section 3(3) states: The Secretary of State may by order constitute other standing committees of the Council and…require the Council to consult them on, or empower them to discharge functions of the Council with respect to, other matters including in particular—

1. (a) training;
2. (b) clinical nursing studies;
3. (c) mental nursing; and
4. (d) occupational health nursing."

The Minister said that it was wrong for the Government to seek to impose upon the professions a system of election that they might not want, so they have been guided by the wishes of the groups concerned. He also said that there had been wide consultations and that the Government had taken a broad view. He said that he had to make it clear that the Government did not believe that the council had got it wrong. In view of that and in view of the clear terms of the Nurses, Midwives and Health Visitors Act, I shall ask the Minister some questions that much concern me.

The categories set out in the order are general. The Minister said specifically that any attempt to narrow those categories might cause fragmentation and would not do the job of representation that the council desperately needs to do. I ask the Minister whether not only the Royal College of Nursing but the Confederation of Health Service Employees has made direct representations to him on the fact that the general category for nurses may not be the best way of dealing with the problem. The specific difficulty that will arise in relation to psychiatric nurses is one reason why I have strong reservations. There might be a better way of dealing with the matter. Would it not be possible to have four smaller categories—general nursing, children's nursing, mental illness and mental handicap? I suggest that because I am concerned that the specialties should not be swamped by general nursing categories, particularly in view of the special responsibilities that the central council will have.

The Secretary of State has said that as one-third of the members will be appointed, if there is any danger of the specialties being swamped, it will be his intention after the first election to look at the general representation and see where, if need be, other appointments should be made by direct patronage.

In principle I do not approve of setting up an electoral procedure with which one has to tinker after the result is known. That is a dangerous precedent. It would be better, before one reaches that stage, to work out how one can get representation by giving the categories a proper number of members in the first instance. I also believe that appointed members in a system of this kind will feel at a disadvantage in relation to elected members. It is very easy to make the charge, "I put myself forward for election and was accepted by the profession as a whole while you have to rely for your appointment on the patronage of the Minister". Will the Minister therefore tell us why the advice of both the Royal College of Nursing and COHSE was so lightly ignored? It does not seem a sensible decision.

Mr. Mike Thomas

I very much support the hon. Lady's comments about the categories and about patronage and appointments. I, too, find that unsatisfactory. Given that there are to be elections, however, will she say clearly, either now or later in her speech, whether she supports the use of the single transferable vote system for the elections?

Mrs. Dunwoody

If the hon. Gentleman had observed the elementary courtesy of waiting instead of interrupting other people all the time, I should have come to that.

Mr. Thomas

I apologise.

Mrs. Dunwoody

I accept the hon. Gentleman's apology.

Personally, I am sorry that the single transferable vote system has been chosen by the college because I believe that it will be extremely expensive. The Minister said that alternatives would be wasteful and expensive. In my experience, anything run by the Electoral Reform Society is certainly well organised and very fair, but it is also quite expensive. Has that been taken into account? I should have thought that a simpler method of election might have benefited from also being cheaper.

The hon. Member for Newcastle upon Tyne, East (Mr. Thomas), who speaks for the Social Democratic Party, asks what I think about the single transferable vote system. I will tell him a little story. A dearly loved friend of mine who was in the Dail once explained to me how the single transferable vote system worked. He said that in Ireland it was very simple—there was one candidate whom one loved, one whom one hated, and one in the middle whom no one had heard of and who was no bloody good but who was elected. My view of the single transferable vote system is, therefore, that almost anything else would be preferable. I hope that I make myself clear.

How does the Secretary of State envisage the second election being carried out? Is he assuming that his tinkering after the election will produce another order to be brought before the House, or that it is only in the first instance that he may have to appoint specific representatives from the categories not offering themselves for election and that this will be sufficient to deal with all the problems that are likely to arise?

I found certain aspects of the system a little difficult to follow. As it is so important that we get the system right, I hope that the Minister will give a little time before putting it into operation. I appreciate that as it has been on the statute book for a number of years he feels that we should reach some conclusion. Nevertheless, as there are such strong reservations in the professions, should he not take account of the views, for instance, of the psychiatric nurses, the occupational health nurses and certainly the district nurses? It would be most unhelpful for relationships within the profession if the idea grew up that only the category of general nursing would have a strong say in the working of the statutory instrument. I know that that is not, intended, that the consultation was deliberately meant to reach a consensus and that the Royal College of Midwives is happy to accept the existing machinery. Some real difficulties still exist, and I hope that the Minister will confirm that he is prepared to take account of them before he puts the machinery into operation.

I was tickled by the contents of the nomination form. It firmly states: Election of National Board Members", and adds: Date of Birth (optional)". I take it that that is not a sexist assessment of the expected response from members offering themselves for election, but in an attempt not to upset anyone, I hope that the Minister will give an undertaking tonight that he will look again at the contents of the statutory instrument.

10.56 pm

Mr. Ronald W. Brown (Hackney, South and Shoreditch)

There are several points on which I hope the Minister will comment.

When I intervened in his speech, I talked about practices. Paragraph 5 purports to outline the grounds for being added to the electoral roll. Sub-paragraph (d) states: Any person who can establish an eligibility to be on the Electoral Roll may be on the Roll whether that person is or is not living in the United Kingdom, whether that person is or is, not retired, and whether or not that person is unemployed or no longer practising as a nurse, midwife or health visitor. The Minister says that such people must be practising. In that case, why does sub-paragraph (d) say that that is not necessarily so? Perhaps he will explain what on the face of it appears to be a paradox.

Sub-paragraph (e) states: Each person who requests his name to be included in the Electoral Roll and has established an eligibility to be on the Electoral Roll will be allocated to that part of the Electoral Roll which relates to the National Board for which he is qualified". The Minister said that if there were vacancies there could be some topping up. Is that because there may well be insufficient voters? I may not have understood this correctly, but sub-paragraphs (d) and (e) seem to run counter to what the hon. and learned Gentleman said.

Sub-paragraphs (f) and (g) also cause me some difficulty. Sub-paragraph (f) states: Subject to the provisions relating to persons not living in the United Kingdom, each nurse, midwife and health visitor will be able to take part only in the National Board election in the country in which they live or work. Are we talking about the four countries of the United Kingdom? The instrument does not say that. It merely refers to the country in which they live or work". That could imply any EEC country. Perhaps the Minister will look at this provision and make sure that people practising in other parts of the EEC will be eligible to lake part in the voting.

I also referred in my intervention to agency nursing, which has been a bone of contention for a long time. Some of us who have worked in the Health Service do not accept the argument for agency nursing, not least because of the doubt that is often entertained about qualifications. It is difficult to be satisfied that agency nurses have adequate qualifications.

I have always opposed the use of agency nurses because I do not think it right for a variety of reasons, principally because one could never be satisfied that they were adequately qualified. What criteria will be used to determine standards of qualification for agency nurses, midwives or health visitors?

In Hackney, which the Minister knows well, we have insufficient health visitors. While we have vacancies and know that there are health visitors looking for jobs, they cannot be employed because the health authority cannot afford to pay them. There have been five or six vacancies in my area for some years.

Mr. Deputy Speaker (Mr. Bernard Weatherill)

Order. I think that the hon. Gentleman is going a little wide of the order. I do not think that it covers that particular subject.

Mr. Brown

I was referring to the fact, Mr. Deputy Speaker, that the voting procedure allows for four nurses to one midwife and one health visitor. The Minister said that if there were insufficient numbers in any of those categories he would have to top them up at the end. I believe that one of the categories that he will have to top up will be that of the health visitors. If there are insufficient health visitors practising, they are prejudiced in the final vote.

I am worried that if the Minister for Health's Department and the Department of the Environment, through lack of funds, cannot employ health visitors there will be insufficient to go on the board. The Minister talked about topping up, from which I do not dissent—it is an experiment that we have to make, and we have to be able to put it right if it does not work the first time—but he has already prejudiced the topping up. We have had the example recently of the chairmen of the DHAs, and I do not want to enter into an argument about that. The selection of the chairmen was based on whether they agreed with the Government. Those that did not were sacked. The principle that has been maintained by all parties over the years has been that appointments should not be made on a political basis. The person was appointed who was thought best fitted to carry out the task. I support the proposal, but appointments will have to be made on a non-political basis. It will not be fair if the Minister judges a person's suitability on whether he supports Government policy. If there has to be topping up, and there are people available, everyone's name must go in the hat and not just blue-eyed girls or boys who can persuade the Minister that they support him.

There is a great deal in the order about which I am not happy. Of the three categories of specialty we are talking about, the nursing council is more organised and likely to be more overbearing. The danger is that the other two categories will not have the same opportunities as the nurses. I shall watch the outcome with interest. I hope that the measure will work, because it is a major step forward towards organising these professions. I believe that there are some dangers, and I hope that the Minister can answer the points I raised about sub-paras (d), (c), (f) and (g) para 5.

11.3 pm

Mr. Mike Thomas (Newcastle upon Tyne, East)

I raise two issues briefly. In view of events earlier I should point out that, apart from the hon. Member for Crewe (Mrs. Dunwoody), the Front Bench spokesman for the Labour Party, there is no other Labour interest and no doubt the nursing profession will draw its own conclusions.

Mr. Dennis Skinner (Bolsover)

What does the hon. Gentleman think we are doing here?

Mr. Thomas

The hon. Gentleman is going to make a speech, is he?

I support the points made by my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Brown), and I hope that the Minister can answer them satisfactorily. I want to amplify the point that I made earlier about the representations by the Royal College of Nursing regarding psychiatric nurses and nurses of the mentally handicapped and mentally ill. I support the remarks made by the hon. Member for Crewe.

In its letter to me, the Royal College of Nursing made specific proposals for dealing with the difficulty. It suggests: consideration might be given to a reduction to 10 of the ministerial appointments, with the 5 places which would be removed from patronage being offered for election—3 for mental illness nursing and 2 for mental handicap nursing. I am not sure—like the hon. Member for Crewe—that that is necessarily the perfect solution, but I hope that the Minister will agree to look at the matter again. After all, that is the profession's view.

It was heartwarming to hear the Minister advocating the single transferable vote as a method, as he said, of producing a representative assembly. That is a good description of the virtues of the system. However, the Under-Secretary of State for Scotland with responsibility for health is in the Chamber tonight. I understand that he once adhered to the Liberal Party. I believe that he was a Liberal candidate and presumably he then advocated the single transferable vote. After all, that is Liberal Party policy. I was interested to hear the hon. Gentleman agree, from a sedentary position, with the hon. Member for Crewe. He implied that he had no time now for the single transferable vote.

Under the Order, Scottish nurses are to participate in elections on the basis of a single transferable vote. Therefore, we are entitled to know the view of the Under-Secretary of State for Scotland. He should tell us what it is. Is there a division of view between him and the Minister? That would be a serious matter. As the Minister pointed out, the responsible professional body has made a recommendation and he has—as we would expect from one who is an electoral reformer at heart—wisely and sagely accepted its recommendation. However, it is clearly and openly disputed by the Under-Secretary of State for Scotland. We should know the position. [Interruption.] I always thought that the hon. Member for Crewe considered it important for people to agree with her, because it happens so rarely. Therefore, if the Under-Secretary agrees with the hon. Lady, we should know.

On behalf of my party I welcome the order in principle. It is good that we should move towards that electoral arrangement and that we should use the single transferable vote. I look forward to hearing the Minister advocate the advantages of the single transferable vote in the eloquent language that he used earlier.

11.7 pm

Mr. Kenneth Clarke

The hon. Member for Crewe (Mrs. Dunwoody) pointed out that the RCN and COHSE have both made representations about the categories of candidate that have been chosen and have expressed doubts about whether the psychiatric nursing profession, in particular, should not be more distinctly represented. The hon. Member for Newcastle upon Tyne, East (Mr. Thomas) also touched on that point.

The United Kingdom central council consulted widely and I accept that it found dissenting views from the RCN and COHSE. All hon. Members are aware of that. However, they were not the only bodies consulted. A broad body of professional opinion takes the opposite view and thinks that the broad division of candidates into the three categories proposed—nurses, midwives and health visitors—is right. I am sorry to return to my argument, but it is difficult to decide where to draw the line between the various specialist groups that might claim that they had a case to have a distinct list of candidates, as the psychiatric nurses would wish.

However, I concede that psychiatric nurses probably have the strongest case because there are so many of them, specialising in mental illness or handicap of one type or another. However, specialist groups include occupational health nurses, sick children nurses, district nurses and so on. They could all make similar claims, albeit backed by slightly smaller numbers. There are so many distinct interests and specialties to be covered—between, for example, hospital and community nursing, teaching nurses and service nurses, clinical nurses and those involved in management—that to try to guarantee places for one specialist group, although a large and important group such as psychiatric nurses, could be seen as unfair to the others or, conversely, could give rise to claims from the others.

I hope that I have said enough to show that these representations were not brushed aside. The United Kingdom central council, like the Government, has examined carefully the case of the psychiatric nurses. After considering a whole range of opinions it was decided that it would be impossible to reserve a category of candidates for them without creating other anomalies.

Mrs. Dunwoody

I did not make the case simply for psychiatric nurses, an important group who must be given proper consideration. I agreed that other groups had to be included in order to achieve fair representation. There is little to be said for the single transferable vote except that it gives wide representation. To narrow the categories does not make sense.

Mr. Clarke

I am not sure about that. This is for the first election only. We should see what happens. The United Kingdom central council and the Government have decided that to reserve particular lists of candidates is not a suitable means of achieving broad representation. It is believed that the electoral system will achieve that aim. If it does not, it will be reveiwed.

It is inconsistent, I believe, to argue that one should take the opposite course and narrow the bands of candidates while retaining the single transferable vote. Narrow bands of candidates would make the single transferable vote system difficult to operate.

I do not mind political leg pulling in the Chamber, but the broader points that the hon. Member for Newcastle upon Tyne, East tried to draw about electoral systems as applied to Parliament are slightly irrelevant when the House is debating a serious order that relates to the nursing profession. I believe personally that the single transferable vote, or anything like it, is a totally irrelevant method of electing the Parliament of this country.

I also listened to the arguments of the hon. Member for Crewe about the effects of STV on elections to the United Kingdom central council. I hope I have made it clear that it is the belief of the central council that STV will produce this broad representation. Whether it does depends on how the individual voting members choose to transfer their votes and elect their preferences. The choice made by the central council was not one that Ministers, on behalf of the Government, felt inclined to ask the House to overrule. We shall watch to see what happens. It may prove expensive. I am not party to the direct arrangements between the council and the Electoral Reform Society.

The system is however, operable. No one claims that it is not a feasible system in practice. The whole purpose, according to the UKCC, is to try to make sure that the specialist interests have the opportunity so to transfer their votes as to carry through a sufficient block vote to ensure adequate representation on the resulting council. If that fails, we propose to nominate members to top up any specialty that proves to be under-represented.

Mrs. Dunwoody

It is clear from the original Act that any change in the electoral system must come back to the House in the form of a statutory instrument. If the first election is unsatisfactory and if dissatisfaction among the nurses in general becomes much more manifest, the Minister has not given an undertaking that he will come back to the House. Will he now say that?

Mr. Clarke

I have already mentioned the Secretary of State nominating members to top up the numbers of any specialist group that turned out to be under—represented following the election. That is only a fall-back position. We hope and anticipate, like the central council, that there will be a broadly representative range of elected members. It is only if we are wrong and that fails to be produced that we shall nominate members to top up specialities.

I assure the hon. Member for Hackney, South and Shoreditch (Mr. Brown) that, even if we have to do so, we shall try to ensure that we get the right candidates and I do not exercise political judgments in nominating members to a body such as the United Kingdom central council. If things go wrong and we have to use the Secretary of State's powers to give adequate representation to a specialist group, the electoral system will he called into question.

The central council will review this matter, and will have the assistance of the Electoral Reform Society in reviewing it. The Government will review it and if it turns out to be unsatisfactory, we shall return to the House with a fresh order for a fresh electoral system to get it right next time.

We shall be guided in that, as we have on this occasion, largely by the views of the professions. The whole point of the Briggs structure is that the professions are to be self-regulating and to have control over their training, discipline and development. If the professions, particularly the council, say that they are dissatisfied with the order, the Government will review the matter and decide whether to come to the House with a fresh order, as we should if there was widespread dissatisfaction.

The hon. Member for Hackney, South and Shoreditch raised some other specific points and asked about the qualification that candidates should be practising members of the various professions. That is the case. To be a candidate, one has to be a practising nurse, midwife or health visitor. That does not apply to the electorate. As the hon. Member has discovered on reading through the order, in paragraph 5 the electoral roll—those who cast the votes— may include people who have retired, as long as they fulfil the qualifications set out in the paragraph about the electoral roll. There may have been a slight confusion about what I said on the matter.

The hon, Member for Hackney, South and Shoreditch also raised an astute question about what happened in the case of electors who do not live in the United Kingdom when it came to voting for a national board. That is specifically covered in the small print of paragraph 5(g) which provides: Individuals who are placed on the Electorall Roll, and who do not live in the United Kingdom, will be allocated to an appropriate National Board according to the home/work address in the United Kingdom from which they departed or to which they intend to return. The hon. Member then tried to go on to a broader issue about the insufficient number of health visitors in places in his constituency, which is a matter that I should be delighted to debate with him on a more appropriate occasion, or to correspond with him about. In case he was concerned about the adequate representation of health visitors, which is what the debate is about, the ratio that we have chosen between nurses, midwives and health visitors—the four, one, one ratio—slightly over-represents the smaller professions of the midwives and the health visitors vis-a-vis the nursing profession. That is essential to make sure that their voice is heard and they have their specialist committees adequately staffed. The hon. Gentleman need have no fear that the role of health visitors was understated or overlooked in drawing up the order.

Those are the detailed questions that have been raised. This has not been a long or detailed debate. That reflects the broad view of all three parties represented in the House that this should be a successful scheme. There has been considerable continuity of policy since the Briggs proposals came out, leading up to this setting up of the new arrangements for the new United Kingdom central council and the four national boards.

We appreciate the importance of this to the nursing profession and we hope that the elected national boards and the United Kingdom central council results will be effective in instituting the new arrangements for the development of training and education in the professions that Briggs was meant to prepare for. This is an important order and I hope that, on the basis on which I have described it, these arrangements for the first elections, subject to review, will have the unanimous approval of the House.

Question put and agreed to.

Resolved,

That the draft United Kingdom Central Council for Nursing, Midwifery and Health Visiting (Electoral Scheme) Order 1982, which was laid before this House on 8th July, be approved.