NURSES, MIDWIVES AND HEALTH VISITORS BILL

HL Deb 19 February 1979 vol 398 cc1643-81

8.49 p.m.

The PARLIAMENTARY UNDERSECRETARY of STATE, DEPARTMENT of HEALTH and SOCIAL SECURITY (Lord Wells-Pestell)

My Lords, I beg to move that the Bill be now read a second time. This Bill is a modest one. It is concerned with the reorganisation of a number of bodies—six statutory and three non-statutory—currently responsible for the training and the governance of the nursing professions into a new unified structure which can look at training needs across the board, assess priorities and consider not only the training for entry into nursing, midwifery and health visiting, but also further training in all three fields. In short, it establishes a new framework for formulating the policy on education and training for these professions for the future. The Bill itself does not say what that future education and training should be, nor indeed whether any change from the present arrangements is necessary. It is limited to the creation of the framework within which those decisions will be made; and, as I have said, it is a very modest measure.

I think that it is important to emphasise this last point about changes in training, because I believe that many of the anxieties and reservations felt by certain groups within the professions, notably midwives and health visitors, spring not from what is actually in the Bill, but from what they fear it may contain, or perhaps, to be more accurate, what it may lead to. I shall want to speak more fully about their worries later, but I cannot stress enough that the Bill is concerned with organisation and structure, and not with the content of training.

Some of the misunderstanding comes from the fact that the provisions of the Bill derive from recommendations of the report of the Committee on Nursing, published in 1972, which was under the chairmanship of the noble Lord, Lord Briggs, a report which was much preoccupied with changes in the pattern of education and training for the nursing professions. It may therefore be convenient to look briefly at some of the key proposals of that report, and at the way in which they have influenced the provisions of the Bill before us today. I am sure that I speak not only for myself but for all of your Lordships in saying that we are delighted to see the noble Lord, Lord Briggs, here tonight. We look forward with pleasant anticipation to the maiden speech which he is due to make later.

The Briggs Committee on Nursing was set up in March 1970 by the late Richard Crossman with a broad remit: To review the role of the nurse and the midwife in the hospital and the community and the education and training required for that role, so that the best use is made of available manpower to meet present needs and those of an integrated health service". I am sure that the last phrase is the crucial one. There have been many reports before on aspects of nursing and nurse training, but never before had there been an attempt to look at the role of the nursing professions in the context of an integrated Health Service; that is, within a Health Service that comprised not only the hospital sector, but also the community and the important preventive aspects of health care. An integration is in many senses the keynote of the report which was published in October 1972; integration not only between hospital and community care, but integration between the various kinds and levels of nurse.

The report recommended an entirely new approach to nurse training. In future, it suggested, there should be a common point of entry into training for all nurses and midwives. For the first 18 months, there would be one basic course for all entrants, comprising a number of separate modules of training in different fields, which should include some experience in psychiatric nursing and work in the community. The course would lead to a common "certificate of nursing practice" which would then become the basic, first-level, qualification. At that stage, the individual could choose whether to start work or whether to continue in training to a more advanced level. Or perhaps an individual nurse would choose to work for a number of years and then, later in her career, choose to pursue her professional training further. After the first common course, there would be a further 18-month course, leading to a level comparable to the present registration level in nursing. During this period, the individual would specialise in a particular area of nursing care—for example, mental illness nursing—and this would become her "preferred field" for work on completion of training. For the more highly specialised fields of care—for example, theatre nursing—there would be specialist courses leading to what were to be known as "higher certificates", which could be taken either concurrently with the second 18-month period of training or as separate six-month courses thereafter.

The idea was to create a continuum of education, where the individuals could progress at their own pace and pursue their own particular interests. Because everyone would have undergone the same common core of training, if later in their career they wished to change direction and enter into a very different sphere of specialisation, they would have received the necessary basic grounding and all that would be needed would be to build on that existing core of knowledge. Thus, the nurse whose preferred field was in general medicine could change relatively easily to work in the mental illness field, because her basic training had included a grounding in psychiatric nursing. This would seem a more flexible structure and one which would allow the individual nurse to adapt to the changing needs of the service, and also to develop her own interests rather more easily than the present arrangements allow.

I have gone into some detail about the plan of education and training which was recommended, because I feel that it is important to see what is in the Bill against that background. It was in the context of this integrated approach to training—and, as I have said, integrated not only in terms of areas to be covered but also in terms of the continuum of education and training—that the Committee considered the arrangements for control of training; that is, the setting and maintaining of standards. And here they found the present arrangements the very opposite of integrated. Although one can have nothing but praise for the work which the present six statutory and three non-statutory training bodies do, it cannot be denied that by compartmentalising training into separate areas there is a fragmentation of the whole approach to the general issues which underlie training in a specific field. As the report itself put it: At present there is a wide range of bodies concerned with nursing and midwifery education and directly or indirectly, therefore, with the future of the professions. … We have been impressed by the quality of the evidence each one of them has presented to us and with the care and sense of public responsibility with which the evidence was compiled, in some cases after a comprehensive review. It is in no sense because we fail to recognise the achievements of these bodies that we recommend that in the interests of the profession there should be one single central statutory organisation to supervise training and education and to safeguard and, when possible, to raise professional standards". The report went on to recommend the creation of a central council, responsible for the formulation of the broad lines of education policy and for the registration and discipline of the professions, and of four national boards, one for each country of the United Kingdom, to be responsible for the administration of training within that country.

The concept of an integrated statutory framework flows logically from the concept of integrated training. However, when one comes to making changes, it is necessary to have the structural changes first. That is what this Bill is all about. It makes those structural changes and establishes the central council and the national boards which the Briggs Report recommended. It does not tackle the question of the detailed changes in training recommended by the report; these are for the new bodies, once they are established. And this, I think, would seem to be perfectly right. It is now some years since the Briggs recommendations were formulated and I am sure that the noble Lord, Lord Briggs, would be the first to admit that things have changed since then. We have a reorganised and integrated Health Service. We are members of the European Economic Community, and the whole climate within the nursing professions has changed radically.

I am sure the new bodies, when they get down to looking at education and training needs and the question of changes, will consider very carefully what was said in the Briggs Report; it was, and is, a very impressive document. But I think they will wish to look again at some of the detailed proposals and to look at their feasibility in a somewhat changed Health Service. However, the point is that the Bill of itself does not mean that there will be changes in training, and it certainly does not mean that the pattern of training proposed by the Briggs Report will be introduced overnight.

I should like now to turn to what is contained in the Bill. Its main purpose is to establish a United Kingdom Central Council for Nursing, Midwifery and Health Visiting, and four national boards. The central council is to prepare and maintain a central register of qualified nurses, midwives and health visitors; and to determine by means of rules, education and training requirements and other conditions for admission to the register. The new bodies will, as I have explained, replace all the existing statutory bodies; namely, the General Nursing Council for England and Wales, the General Nursing Council for Scotland and the Northern Ireland Council for Nursing and Midwifery, the Central Midwives Board for England and Wales, the Central Midwives Board for Scotland and the Council for the Education and Training of Health Visitors. They will also take over the functions of the three non-statutory bodies; namely, the Joint Board for Clinical Nursing Studies, the Committee for Clinical Nursing Studies (its Scottish equivalent) and the Panel of Assessors for District Nurse Training. All those concerned with education and training for nurses, mid-wives and health visitors will be brought together so that the full range of education and training issues can be looked at together and the concept of education as a continuum throughout the individual's career can be fostered.

There is also another important aspect to the Bill; it is fundamentally concerned with the governance of the professions, through the requirement that nurses, midwives and health visitors shall be registered for practice in their profession, and by the enforcement of standards of professional conduct through the disciplinary process. These provisions, vital as part of the protection of the public, ensure that those who care for us are in all respects well qualified to do so.

I now turn to the detailed provisions of the Bill. Clause 1 establishes a new United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Its detailed membership will be prescribed by Ministers, but the crucial feature is the high degree of cross-membership with the four national boards, each of which will nominate, in equal numbers, members to the council. Those nominated by national boards will form the majority on the council, and that majority will comprise nurses, midwives and health visitors. Though it is right that the professions themselves have the major say in governing their own affairs and in setting standards of education and training, others have an important contribution to make. For example, there is a close relationship, as we all know, between the nursing professions and medicine. Also, those skilled in the field of education have an important part to play in formulating the way in which the professions' kind and standard of training are determined. There will therefore be members representing both fields on the council.

Clause 2 deals with the council's functions. As a new governing body for the professions, responsible for registration and discipline as well as setting standards of education and training, it will have the power to formulate rules on these subjects. Clause 3 deals with specialist standing committees of the Council. These will be established by order. In particular, there is a requirement to constitute a Midwifery Committee and a Finance Committee. There is power to establish other specialist committees, including committees for district and mental nursing, for clinical nursing studies—which may cover the whole range of post-basic specialties such as intensive care, renal nursing, theatre nursing—and occupational health nursing. And in time there may well be others.

Clause 4 deals with the council's Midwifery Committee in some detail. The majority of members of the committee are required to be practising midwives, and the council is to consult the committee on all matters relating to midwifery and may assign functions to that committee which, if the council so authorises, the committee can deal with finally without further reference to the council. In recognition of the special position of midwives, the only group whose practice is controlled by rules, there is a special provision requiring the council to assign to the committee all matters relating to the preparation and the making of rules on practice. Because this is very much an area for experts, rules on practice may not be approved unless they are framed in accordance with the recommendations of the committee. This is a very important recognition of the need for expert advice in this area, which is so vital to the protection of the vulnerable mother and child.

Clause 5 establishes the national boards, one each for England, Wales, Scotland and Northern Ireland. As with the central council, detailed membership is to be prescribed by order. The majority will be members of the professions and, after the initial term, will be directly elected by the professions themselves. This will enable the professions to have a greater say in the control of their own affairs. Though there are elections at present to the General Nursing Councils, this will be the first time that midwives and health visitors have been able to have a direct involvement in the governance of their own professions.

Clause 6 deals with the functions of the national boards. Each board is charged with providing, or arranging for others to provide, courses of training for those seeking registration and courses of further training for those already registered. The boards are required to ensure that the content and standard of the courses meets the requirements of the Central Council. Indeed, the national boards are specifically charged with collaborating with the council in promoting improvements in education and training. They will also have a responsibility for investigating cases of alleged misconduct. Clause 7 deals with the standing committees of the national boards. Clause 8 deals with joint standing committees—that is, committees serving both the council and the boards. There is a requirement to establish a health visiting joint committee which the council and boards are to consult on all matters relating to health visiting and which will discharge functions assigned to it. Clause 9 deals with local training committees. This enables Ministers to establish training committees of the national boards which will assist boards in carrying out their training functions.

Clause 10 is in a sense the practical kernel of the Bill. This clause requires the council to prepare and maintain a professional register of qualified nurses, midwives and health visitors. In order to distinguish different qualifications and different kinds and standards of training, the register is to be divided into parts which Ministers will prescribe by order after consulting the council. Clause 11 deals with admission to the register and Clause 12 deals with the circumstances in which and the means by which a person may be removed from the register. Clause 13 deals with the procedures for appeals for anybody aggrieved by decisions of the council to remove them from the register. Clause 14 provides for offences and penalties for falsely claiming to be qualified as a nurse, midwife or health visitor. Clauses 15–17 restate in relation to the council and boards provisions from existing legislation concerning the practice of midwifery. In particular they require the council to make rules covering midwifery practice and restate the provisions establishing local supervising authorities. The presence of this group of clauses is again a recognition of the separate characteristics of midwifery and the need in order to protect the public to have adequate control over the way in which midwives operate. Clause 18 is also a restatement of existing provisions in the Midwives (Scotland) Act 1951 which exempts midwives from jury service. Similar provisions for midwives in other parts of the United Kingdom already exist in other legislation. Clause 19 deals with the finances of the council and boards, and Clause 20 deals with the accounts of the council and boards. The remaining clauses are all of a technical nature.

The Bill has eight Schedules. Schedules 1 and 2 are concerned with the constitution of council and boards respectively, setting out in some detail their procedures and methods of working. Schedule 3 deals with disciplinary proceedings before council and boards. Schedule 4 deals with the qualifications of auditors. Schedule 5 contains transitional provisions relating to the transfer of staff, property, et cetera, from the existing to the new bodies. Schedule 6 contains the adaptations required for Northern Ireland and its national board. The constitutional position in Northern Ireland is different from that elsewhere in the United Kingdom and it is therefore necessary to adapt United Kingdom legislation to take account of this. Schedule 7 contains Amendments to other Acts. Schedule 8 deals with Acts to be repealed.

My Lords, I do not want to spend much more time this evening on aspects of the Bill, because we are not unmindful of some of the difficulties that certain people are experiencing. But may I just say this about the problems. There has been a great deal of debate about the position within the Bill of minority groups, especially midwives and health visitors. Obviously, your Lordships will want to deal with this matter when we reach the Committee stage, probably in some detail.

The main concern has been that their separate indentity and distinctive training will be lost because their interests will be given scant regard by bodies dominated by the numerically stronger nurses. For this reason, there has been a desire to build in greater protection and safeguards by giving definite responsibilities to the specialist standing committees for both the midwives and health visitors. Indeed, Clause 4, introduced during Committee in another place, was designed for just this purpose: to indicate clearly and put beyond doubt the remit of the experts on the midwifery Committee in relation to the rules of midwifery practice. We believe this has gone a long way to removing the midwives' fears.

There remains, however, a difficulty over health visitors. The problem in essence is quite simple; it is, if I may say so, a matter of balance. On the one hand, there is a need to reassure health visitors that their committee will have a real say in matters wholly or mainly affecting health visitors, and, on the other, there is the need to preserve the position of the council, and boards, and their ability to take the broad view and make decisions on all aspects of training for the professions. The crux of the problem has been to find a middle way between these two laudable objectives. So far I have to confess no middle position has been found. A number of proposals have been put forward, but all have involved a degree of delegation—in some cases amounting to virtual autonomy—to the health visiting joint committee which would, if carried through, vitiate the whole purpose of the Bill.

We are, however, still trying to find that middle road. My right honourable friend, the Minister of State for Health, has given an undertaking that if the various groups involved come forward with a better agreed solution the Government will write it into the Bill. A meeting has been arranged with the various groups to be held very soon, to see whether anything has been or indeed can be agreed. If agreement is forthcoming, I would move Amendments either at Committee, or, if necessary, at Report. I think this is a fair undertaking and one which the various groups representing the professions should take very seriously.

We believe that there is a good deal of unanimity about the ends to be attained. The dispute is wholly about the means to attain them. We want nurses, midwives and health visitors to work together in the new structure, and we believe that by doing so they will be promoting the best interests of their professions. Their ability to move forward and introduce changes in training will be severely restricted if there are people within the professions who are unhappy about the way decisions are made. That is why we are anxious to see an agreed solution to which everybody can put their name.

My Lords, I started out by saying that I think this Bill could be described as a modest one; it is, but it is also a worthwhile and useful measure. Over one-third of all National Health Service revenue is spent on nursing. I think that we have a duty to ensure that that money is being wisely spent for the benefit of the patient. Patients will benefit most from a well-trained workforce of nurses, mid-wives and health visitors who are well prepared for their roles. It is my belief that the new bodies to be established by the Bill present a tremendous opportunity for a review of training so that we can do what is best for the Service and, of course, for our nurses, midwives and health visitors. My Lords, I beg to move.

Moved, That the Bill be now read 2^a—(Lord Wells-Pestell)

9.20 p.m.

Baroness YOUNG

My Lords, I should like to begin by thanking the noble Lord, Lord Wells-Pestell for introducing the Bill this evening and for explaining it all so clearly and carefully. May I say at the outset how delighted we are on this side of the House that the noble Lord, Lord Briggs, is making his Maiden speech on the Bill. We shall all look forward to hearing what he has to say. One of the great benefits in the House of Lords is that we make it possible for the chairmen of such important committees to be able to speak to their report and for us to hear at first hand their views upon it.

The Bill was introduced in another place as a non-controversial measure, and so it might well appear from its title. We can all agree on thanking the nursing profession not only for what they do in the ordinary course of their duties, but particularly for all the extra work that they have taken on during these past weeks of industrial unrest in the Hospital Service. What is non-controversial is that we must all look after the nursing profession to which we all owe so much. In saying that, we must also look after the other professions—the midwives and the health visitors—with whom we are concerned in the Bill. There is, I think, a particular reason for that. Not only are we grateful for what they do, but the trend in medicine today is towards community care and that means an ever-greater dependence upon midwives and particularly upon health visitors. We have an ageing population and health visitors play an increasingly important role in the care of the aged. That role and that of midwives is also extremely important in the world of preventive medicine to which we are all increasingly turning.

However, that said, to describe the Bill as a non-controversial measure would, I think, be not quite correct. From the moment of its Second Reading in another place it has, in fact, proved to be controversial, not particularly in a party political sense, but, judging from the number of letters that I have received, it is difficult to see that it is anything but still controversial and that the controversies will not easily be resolved.

If the main principle of the Bill is right—namely, the establishment of a United Kingdom Central Council for Nursing, Midwifery and Health Visitors—then what I may describe as the "minority professions" are bound to fear that their views will be overruled by those of the majority. If, on the other hand, too much is given to the minority professions, then the majority will feel that their needs are being watered down. I cannot help wondering, in view of all the discussions and letters that I have had, whether enough preparatory work to see if it was not possible to reach agreement between the different professions was done before the Bill was ever introduced.

I feel sure from looking at the list of speakers this evening that other noble Lords and Baronesses will refer in particular to the question of the health visitors. I have considerable sympathy with their fears that, as the smallest profession, they will lose out in the new arrangements and that their particular needs in education will not be catered for. That is something to which we shall certainly return in Committee. I was, therefore, particularly glad to note what the noble Lord, Lord Wells-Pestell, said on that very point and may I say that, if it is possible to reach an agreement between all the professions, we on this side of the House would be very glad to support it. My understanding at present is that there is no agreement and I think that that is something to which we need to turn our attention during the Committee stage.

I believe that there is a more general criticism. As I understand it, the Bill was originally based on the report of the noble Lord, Lord Briggs. Of course, we greatly look forward to hearing what he has to say. However, having read his very interesting report, the essence of it is really education, manpower in the nursing professions, the career structure for nurses as well as the conditions of work for the nursing professions. The actual statutory framework is, in fact, the smallest part of the report. I would suggest that this Bill can only be a beginning.

Therefore, it is disappointing that, as the Financial Memorandum makes clear, there cannot be any changes in education and training in the nursing professions until more funds are available nationally. In that way, those bodies that were so keen to see this Bill on the Statute Book may well be disappointed. I should not like to be taking part in yet another Bill on which we all labour and which we all think is, in principle, a good Bill, but find at the end of the day that because there is no money to support it, the Bill is in fact a dead letter.

As recently as 10 days ago we debated the International Year of the Child. It is, indeed, most disappointing that four years on we have still not been able fully to implement the Children Act 1975 because funds have not been available. I make this point now because nothing brings Parliament into disrepute more than passing legislation for which there is not adequate money, because hopes are raised which, in fact, are not fulfilled.

Under this Bill we have the structure, the framework, as the Briggs Report makes out, but we are without the money to carry out its purpose. Without wishing to be in any way unfair, we have a Bill which does nothing about education and training and nothing about conditions of work. It is a Bill that will not produce more nurses or midwives or health visitors.

At no point in the Bill are the interests of consumers—or should we in this case say patients—mentioned at all, except in Clause 4(1), where I assume that the two members of the midwifery committee who are to be members of the public are representing patients' interests. If in fact that is not the case, I should be glad if the noble Lord, Lord Wells-Pestell, would say so. But if it is the case, I should like to ask two questions.

If it is thought desirable to have patients' interests represented on this committee, why are they not represented on every committee? Secondly, how will these two representatives be chosen? Will they come from organisations representing patients' interests? Will they come from among women who have had their babies brought into the world by midwives? How will they be chosen? Again, this is a matter to which we can return at the Committee stage.

Another cause for concern arises under Clause 12. It has been expressed to me by the Royal College of Midwives. This is a matter to which others may well refer in the course of the debate. I believe that there is a fear on the part of midwives—and it should be an equal fear on the part of nurses and health visitors—about what will happen if mistakes are made by one of them as a consequence of an industrial dispute when they are short-staffed, short-handed or having to work long hours. I understand that midwives have a "no strike" agreement. Therefore, they are put at risk by strike actions on the part of others. Under Clause 12, what happens to them if they make a mistake?

Furthermore, it is just worth considering whether, should one of the members of these professions be brought before the disciplinary committee, it is right that the proceedings should be heard in public. It has been said to me—and there seems to be some force in the argument—that when members of other professions are brought before their disciplinary committees, the proceedings are not held in public. I can understand the arguments for holding the proceedings in public, but, on the other hand, from the point of view of the person who is accused, there is always the danger that, at the end of the day when they are proved to be not guilty but completely innocent, someone will say, "There's no smoke without a fire", and their professional reputation will inevitably be damaged by prejudiced people. I think that this is a point one should look at in the course of our Committee proceedings.

The Bill gives enormous powers to the Secretary of State. Initially, he will appoint the chairman of the Council itself. He will constitute the standing committees of the council, and the midwifery and finance committees. He has further powers under Clauses 7, 8 and 10, and under these he will constitute by order the committees of the boards and the joint committees serving both the councils and the boards. All this would appear to be an enormously weighty structure.

As I understand the situation, those in the nursing profession who were most keen to have this Bill, as they wanted action on the report of the noble Lord, Lord Briggs, may well prove to be disappointed. It is, after all, six years since the publication of that report, and now, inevitably, they are not getting a Bill which deals with the substance of that report but only with its framework. It is a structure without any provision for the real bones of the report that support the structure.

Before concluding, may I raise one other concern of my own. It does not arise directly from the Bill, although the noble Lord, Lord Wells-Pestell, in intro- ducing the Bill commented at length about the proposals on education: that is, the proposal that there should be one basic 18-month course for all three professions. This may well be right. But does it mean that we are about to establish a new figure—the generic nurse? The concept of the generic social worker has in fact been a disaster in the social work world, and I very much hope that we shall not repeat it in the nursing world. I myself am a believer in specialisation, for we live in a specialist world, and I would not wish to see expertise neglected or denigrated. I am of course pleased to read Clause 3(3), which makes provision for consultation with the specialisms within nursing. However, I note that it is not a mandatory consultation as in subsection (1) but is permissive. Above all, let us learn the lessons of the reforms which led to social service committees and the training of social workers, and, where there have been mistakes, let us not repeat them in the nursing profession.

This is a Bill that we shall want thoroughly to examine in Committee. I cannot pretend that it is one that we on this side of the House are particularly enthusiastic about, and I certainly cannot accept that it is at present a non-controversial measure. One of the many advantages of your Lordships' House is that we have time fully to consider all the many problems that still arise upon it. We on this side of the House shall not oppose it at Second Reading, but we shall want time thoroughly to examine it as it proceeds through your Lordships' House.

9.33 p.m.

Baroness ROBSON of KIDDINGTON

My Lords, may I join the noble Baroness, Lady Young, in thanking the noble Lord, Lord Wells-Pestell, for his introduction of the Bill in front of us. I shall be short in my remarks because, like all noble Lords present in the House at the moment, I am looking forward to hearing the noble Lord, Lord Briggs, and his understanding of the Bill and his views on the changed situation that now exists in a unified National Health Service since his report was originally published.

The noble Lord, Lord Wells-Pestell, said that this Bill is about organisation and structure. He expressed the view that the fears of the various sections of the profession that have been voiced are perhaps unnecessary fears when it comes to this Bill; that they are fears of a changing educational and training pattern and not exactly fears of the organisation itself. I believe there is a bit of both in the problems that the Bill has come up against. I personally welcome the Bill in the way that it sets out a framework for establishing a central council and national boards. It will obviate much of the fragmentation that has taken place in the past and I believe it will help some of the funding arrangements as they presently stand.

This fragmentation in nurse and midwife training and education, it is not realised, has created enormous problems for nurse managers and educationists in the Health Service over the years, and for that reason I welcome the establishment of a proper structure for the profession. However, like the noble Baroness, Lady Young, I regret that there is no money available for implementing a real restructuring of the education of nurses, midwives and health visitors in the Health Service.

The Bill has had several Amendments made to it in another place and we should pay tribute to what has been done there. To a great extent the Bill has been improved, but some points still worry me. As has been said that it is difficult to get the various arms of the professions to meet, and I was therefore greatly reassured when the noble Lord, Lord Wells-Pestell, said that if agreement could be obtained from the three arms of the Service he would introduce the relevant provision either in Committee or on Report. We on this side of the House will be happy to support it. An example of what happens in the desire to safeguard their position may be mentioned here in relation to Amendments being made to the Bill in another place. Noble Lords will remember that an Amendment was introduced in Committee to enable the midwifery committees of the national board to communicate direct with the midwifery committee of the national council. That was, to me, a dangerous move because it could take away from the statutory board its proper relationship with its subordinate committees, and I was therefore concerned about that. Later, on Report, that position was reversed, and now I believe the structure is better. Nevertheless, the midwives are concerned about their voice being properly heard through their national boards, and they have put it to me that they would like something put in the Bill to obligate the national boards to forward the views of the national midwifery committees. I do not know whether that is possible, but it is something we in this House should consider.

The other problem that worries me is that to which the noble Baroness, Lady Young, referred; namely the Amendment introduced to the effect that there shall be two members of the general public, at least one of whom must be a woman, on the midwifery committee. As a woman, I am absolutely against the "statutory woman". I do not believe it is correct that we should always be harping about one person being a woman. Other noble Lords will speak about the composition and membership of these committee sand I agree it is desperately important that members of the medical profession should be on these committees, but I do not think it is necessary for there to be a woman as such representing the consumer. This provision has crept in because people have misunderstood the purpose of the midwifery committee. They feel that it governs, for instance, the provisions of facilities for home confinement; it does not. I personally should prefer not to see the statutory woman as such on the midwifery committee.

Like all of us in the House, I am fully aware of the difficult position in which the health visitors find themselves, being by far the smallest body, and anything that we can do to reassure them that under the new structure their case will be heard will be welcome. Another point that concerns me about the debate as it took place in the other House is that it seems that we are going too far in many ways in establishing committees at the national board level. We have agreed that there are certain committees that must be set up at central council level, but I am concerned about what appears to be the desire to set up statutory committees at national board level, because the national boards must vary, depending on the structure as it is at the moment. In Northern Ireland, for instance, there is currently a joint statutory body, and specialist separate committees are not wanted. The national boards should be left with freedom to set up the committees that they themselves consider necessary in the particular context of the country in which they function. I believe this to be desperately important.

I also want to refer to the disciplinary action. Here again, I am afraid that I am very much on the same lines as the noble Baroness, Lady Young. I am tremendously concerned about what happens to midwives, nurses or health visitors (who will also come under the umbrella by the time they are part of the statutory body) if, through no fault of their own, they make a mistake because there is a shortage of staff due to industrial action. Perhaps this is such a big subject that it cannot be dealt with only under the Bill. It is a problem which, in our present industrial situation, exists in many walks of life; but in this particular case, because there is a disciplinary committee set up under the central council, these people will be very vulnerable. I believe that we would do well in this House to devote quite a bit of our time to seeing that they are safeguarded, as they are among those who have agreed not to take industrial action because they are interested in the life of the patient. I hope that we shall be able to spend some time discussing that point in Committee.

9.44 p.m.

Lord BRIGGS

My Lords, may I crave the indulgence of your Lordships for talking at this stage in the discussion of a Bill which to me has a very long pre-history. It was on a grey afternoon in December 1969 that the then Secretary of State asked me, as a matter of urgency, whether I would chair a committee to look into the role of the nurse, the education, training, and conditions of work of nurses, and the most effective use in the future of manpower within an integrated National Health Service. When I accepted the invitation to chair the committee I did so because I believed that there was an urgent need for action. The committee was duly appointed in March, 1970, and we completed our report within the time which was scheduled for us, by the summer of 1972. Those of us who were concerned with the committee and who felt the sense of urgency at that time have since been most disappointed at the very slow rate of progress in dealing with what seemed to us at the time, and what still seems to me at this time, to be urgent matters.

There are in fact six aspects of the report which still seem to me to retain their basic importance. First, there was the attempt to set out clearer rules and understandings about recruitment into the nursing profession. Conditions of recruitment vary very much from one place to another. It seemed to us at the time that all kinds of obstacles were being placed in the way of nurse recruitment, and we attached the utmost importance to the whole of that range of issues. Secondly, we looked at the nature of the training and educational system in relation to nursing, and we noted again that there was in fact no system. There was a great variety of different forms of education, some very good, some not at all good; and we attached a great deal of importance to an urgent action programme to increase and improve the supply of nurse tutors. That was one of the most important points in the educational proposals.

But, my Lords, we also envisaged the nursing profession in terms of continuing nurse education to develop the best opportunities for each individual nurse and to give the nurse within the profession choice of the various kinds of specialisation which the nurse in question could most effectively develop. There was no suggestion whatsoever—I say this in reply to the noble Baroness, Lady Young—of a generic nurse. We believed that it was essential to give the right kind of basic nursing education, so that the specialised forms of nursing education could be developed on the basis of that initial education. We also wanted some of the ideas which were at work in the educational world as a whole about methods of learning to be taken into the nursing profession.

The third point in the report was a study of the conditions of work. We felt, as indeed I still feel, that the conditions of work in relation to the nursing profession required, and continue to require, regular scrutiny. When we consider the difficulties that the National Health Service has faced during the course of these last few weeks or months, I yield to none in my admiration for the work of nurses at this difficult time—and they are working in extremely difficult conditions. In our report we tried to lay down some of what seemed to us to be the essential conditions if one was going to have a nursing pro- fession consisting, not only of people who cared but of people who were cared for by the community.

Fourthly, in the report we attached a great deal of importance to community nursing. At the beginning of the day, when the report was being discussed, I regretted that some suspicion was then expressed by health visitors about features of the report. It was the only suspicion, I think, which was registered at that particular time. There were midwives on my committee, and they played a most important part. I heard no suspicions registered by midwives at that particular stage in the story, but there were some suspicions which were expressed by health visitors. I did my best at the time to allay them, because if one bothers to read the report with care one finds that it lays a tremendous amount of importance on community care, on primary care, on trying to ensure that everyone within the nursing profession who is concerned with hospitals understands the relationship between hospital care and community care. It was that notion of integration, the integration between community care and hospital care, which seemed to me to be the point to bring out in our report.

The next point in the report was an emphasis upon the need for continuing research to identify nursing needs, and an attempt to ensure that these would be met with the proper degrees of priority within the National Health Service. Lastly, we emphasised the importance of a unified profession and of the development of what the noble Baroness, Lady Young, called a framework which would enable that unified profession itself to make some of the key decisions about the future of nursing.

My Lords, in all the work I have done in my life I have never found any committee more rewarding than the nursing committee which was composed of a majority of nurses. The ideas which were discussed in that committee were ideas which had been discussed for years previously within the nursing profession. They were not new ideas. What the report did was to try to bring the ideas together and put them in some kind of logical, coherent form and to take account of the relationship between nurses and the medical profession, a key relationship; but to take account also of the relationship between the nurses and paramedicals and the ancillaries in the National Health Service. The importance of those groups has grown considerably since the report was published.

My committee had a very broad remit, but the measure which we are considering is, as my noble friend Lord Wells-Pestell has said, a modest Bill. It deals entirely with machinery; and to those who like me are concerned with objectives there is an element of disappointment in this. Machinery, however important, is merely instrumental. A great deal depends not only on the structures which have been devised but on the goodwill which is applied to the application of the structures when they come into existence.

I welcome very much the notion of a common council which will deal with the problems of the nursing profession as a whole. I believe that the creation of such a council is in the interests of the nursing profession and that it will give the profession a chance to work out its own destiny more effectively than it has ever been able to do in the past. I welcome very much the possibility of further discussions, as my noble friend Lord Wells-Pestell has said, between the health visitors, who remain deeply concerned about aspects of the measure, and the nursing profession. I sincerely hope that those discussions will be fruitful.

In my view, it would be a tragedy if we were to fail to make progress after 10 years in this field because we cannot at the moment get the feeling that behind the necessary measures we have a united profession. I can understand the reasons for some of the worries. I hope that at the Committee stage it will be possible to hammer out some of the problems. I agree with noble Lords who have spoken that there are aspects of some of the Amendments which I do not like. I hope that we shall have an opportunity to discuss these very fully indeed at a later stage. But if it were possible for agreement to be reached between the health visitors and the nursing profession as a whole before that stage it would be a great encouragement to us all.

My Lords, in conclusion, may I say that while I regard machinery as being instrumental—and the sections on the framework in the report are, as the noble Baroness, Lady Young, has said, brief in relation to the content of the report—nevertheless the framework is important and it is essential that we get it right. I hope that it will be possible for an atmosphere of trust to be built up if we are going to make the new machinery work right from the start. But unless we make a start with the machinery, we will never be able to get any further in relation to securing the objects which, I think, are shared by most people in the nursing profession.

Those objects are objects which are all bound up with the ideas which are set out in the report. Times have changed; there is a different social situation and a different situation in the National Health Service itself as compared with 1972. Yet that report was seeking to look to the future of nursing towards the end of this century. If one misses an opportunity in relation to the future of a profession for whatever reasons, it may be very difficult indeed to find another moment when it will be possible to have the same opportunity.

9.55 p.m.

Baroness WARD of NORTH TYNESIDE

My Lords, it is a great pleasure for me to congratulate the noble Lord, Lord Briggs, on his maiden speech. It must really be wonderful to be able to make a maiden speech which carries with it such knowledge and concern for the service in which the noble Lord has been so interested, so far as I know, all his life. Today our House is very lucky to have had a maiden speech from the noble Lord on this subject. Making maiden speeches is always a problem and always rather difficult. I do not think that we often get a maiden speech on a topic which over the years we have all learned to acknowledge, covering aspects which we try to put into operation. We know how able the noble Lord is and how much study he has given to the profession which he more than adequately, and indeed wonderfully, represents. In congratulating him we know that the noble Lord, Lord Wells-Pestell, who moved the Second Reading, will be able to get in touch with the noble Lord, Lord Briggs, and gain the benefit of his experience and knowledge. We have been delighted to have been here tonight to hear the maiden speech of Lord Briggs and we sincerely hope that he will often attend this House and contribute on a matter about which we are all, whatever our Party, very anxious. I should like to thank the noble Lord very much indeed and I am delighted to have had the honour of congratulating him on a wonderful maiden speech.

May I now turn to one or two points that I should like to make, having listened with very great interest and respect to the noble Lord, Lord Wells-Pestell. For many years now I have been a vice-president of the Royal College of Nursing. I have always enjoyed this very much indeed and it has helped me to do the very little that I have been able to do for the nursing profession. I am very pleased with the contribution made by the noble Lord, Lord Wells-Pestell, this evening. It starts us off on something quite new which ought to be of great benefit to the nursing profession, the midwives and the health visitors.

I was not quite so pleased with the speech made by my noble friend Lady Young. I do not know how much knowledge she has of the nursing profession and how it works; but I know from the Royal College of Nursing that, as they have already indicated to me, they want one small amendment to be made to the Bill. They have forwarded this amendment to me and when we come to discuss the Bill in Committee I hope that the noble Lord, Lord Wells-Pestell, will be able to accept it. That indicates to me that, although there is a lot of worries, I understand, among certain sections which are covered by this Bill, there are not quite so many worries as my noble friend Lady Young seeks to point out.

There is one point in particular I should like to make because, as I say, the Royal College of Nursing has played a very important part in the nursing profession and I have always been very proud to be associated with them. I should like to read to your Lordships a passage from a letter I have received from Mr. D. H. Rye, Director of Professional Activities in the Royal College of Nursing. I think this will indicate to the noble Baroness, Lady Young, the feeling of the Royal College: I would just make one point: that the Royal College of Nursing sees this"— that is, the new Bill we are now discussing— as enabling the creation of a new statutory framework to develop the training and education of the nurses, midwives and health visitors, and it must be seen as a means to an end, not as an end in itself. Much more work will have to be done by the new statutory body to implement the educational recommendations made in the report of the Briggs Committee. I hope that this information will be sufficient for your purposes". That is really a very important letter I have from the Royal College of Nursing. Of course, a lot of people may not necessarily support the Royal College of Nursing. We in this country like all sorts of things that we do not always support in detail, but the Royal College of Nursing has done an immense amount in helping the nurses, the midwives and the health visitors. Therefore, I was very pleased to get this note from Mr. Rye. As he says, the Bill enables the creation of a new statutory framework to develop the training of nurses, midwives and health visitors and it is something that "must be seen as a means to an end, not as an end in itself".

When we come to the Committee stage of the Bill I think that everybody will be able to make a contribution from their own knowledge. That is tremendously important; I am a great believer in experience. I sometimes think that the nursing profession, with the midwives and the health visitors, have never really had all the support and help they needed from either Government—going back a long way. Here is a new opportunity and I shall look forward to the Committee stage. At the same time, I should like to thank the noble Lord, Lord Wells-Pestell, for thinking out this new idea which he has put forward in this Bill today. I am sure he will be wanting to congratulate my noble friend on his maiden speech: it was a wonderful speech that he made. Of course, if there are certain points I do not agree with, when the Committee stage comes along I shall try to make him alter his mind. But, in the meantime, it is quite right that he should be congratulated on coming forward with this great scheme, which I hope will do all that he hopes for those people we want to serve, and serve well.

I shall not take up any more of your Lordships' time but I should just like to say again, "Thank you for the Bill". I think it was wonderfully developed and I hope that my Party, together with the Liberal Party, will be able to do whatever is possible to make absolutely certain that everybody benefits from this proposal. I think it is a very good one and I again congratulate the noble Lord on bringing forward this Bill.

I have nothing further to say, except that I have always been proud of the nursing profession, and of the midwives and health visitors, as have we all. We have a wonderful number of them in this country, and when we are discussing what I call the political terms of this Bill we also have to remember what they would like and what will help them. So I am delighted to be here tonight and to pay my tribute. I hope that the Bill which the noble Lord has introduced, and which is supported by so many people in the country, will have a profound effect upon our services to nurses, to midwives and to health visitors. So thank you very much indeed.

10.6 p.m.

Lord SMITH

My Lords, may I first be allowed to apologise to the House for the fact that, due to the arrival in London this evening of a distinguished American surgeon, long arranged, for whom I have some responsibilities, I shall not be able to stay, as I should like, to the end of the debate. I should also like to say how very much I enjoyed the most elegant and informative maiden speech of the noble Lord, Lord Briggs. I am sure that we have all benefited greatly from hearing his description of the history behind the report of his committee.

As the noble Lord, Lord Wells-Pestell, has said, behind the Bill lies the setting and the maintaining of standards. How good it is to be able to support the pursuit of excellence at a time when it is so widely assumed that in health matters the only moral objective is equality! As has already been said, there are certain anxieties that were aroused by the report of the committee chaired by the noble Lord, Lord Briggs; but of course these anxieties do not stem from the Bill itself, and whether they turn out to be justified will be dependent on the way in which these new bodies do their jobs. That, in turn, will depend to a certain degree upon their constitution, and it is about one aspect of the constitution that I want to speak very briefly this evening.

In regard to the constitution of both the central council and the national boards, there is one anxiety that I have. As a consultant in a large hospital, I have myself taken part in teaching nurses for over 30 years in the lecture room, in the operating theatre and at the bedside. Indeed, I have always regarded it as a duty of doctors in hospital to assist directly in training nurses, but also, at times, to give advice as to how the curriculum might best contribute to the total care of the sick. As the noble Lord, Lord Briggs, has said, this is a key relationship of the two professions.

It seemed to me that this was so self-evident that, when I received the text of this Bill, I looked to see how it was suggested that the help of doctors could be used to best advantage on these important bodies, the council and the boards in particular. It was with some surprise that I saw that the statutory representation of the medical profession was to be nil, and that, as has already been mentioned this evening, an Amendment had been passed in another place which, by Statute, put two members of the general public on to the midwifery committee, but not, by Statute, an obstetrician. The Secretary of State has the power, if he should so wish—and I am sure that he will—to use the services of doctors on these bodies. Indeed, it is stated that the Secretary of State's appointments: shall be made from among persons who are either nurses, midwives or health visitors or have such qualifications and experience in education, medicine or other fields as in the Secretary of State's opinion will be of value to the Council in the performance of its functions". The same is true of the boards. However, the power to include must imply the power not to include.

Although the present Secretary of State may very well feel just as convinced as I am of the necessity to have the proper amount of advice and help from the medical profession, I think it is reasonable to ask whether this Bill should leave it to the discretion of all future Secretaries of State to decide whether or not there shall be any medical representation upon these important bodies.

I am quite sure that no doctors would want to make a kind of take-over bid to look after the affairs of the nursing and other professions, but surely all doctors will want the objectives of this Bill to succeed. They will want the work of the council and of the boards to succeed. They will also want the traditional help which the medical profession has always given in the training of nurses to continue.

Surely the nursing of patients cannot be organised in isolation but only as a part of total medical care. By adding a few words, this House can amend the Bill so that adequate medical representation is provided for by Statute. I hope very much indeed that, when the time comes, the House will decide to do so.

10.13 p.m.

Baroness VICKERS

My Lords, it is rather embarrassing to have to speak after two such distinguished contributors to our debate. I should like to add my congratulations to the noble Lord, Lord Briggs, on his maiden speech. May I also say that we are very glad to hear again the noble Lord, Lord Smith, who made his maiden speech only a short while ago. I am sure that he will be very helpful on this Bill.

As their vice-president, I must declare my interest in health visitors. I noticed with interest that the noble Lord, Lord Briggs, was a little worried about their future. As he will know, since 1962 the training of health visitors has been of a special type. Furthermore, the same kind of training is given in every part of the United Kingdom. Consequently, health visitors are a little in advance of certain other professions. They have to be able to assess the health and the health needs of people, provide information on health matters and give such service to families and individuals as they may need. I think that it will be agreed that this is rather different from the training that is given to nurses.

It appears that general nursing courses do not emphasise the importance of communication with patients and others, nor do they emphasise the knowledge of social and emotional factors which affect health and illness. Such knowledge and skills, I suggest, are becoming increasingly important, in view of the following changes: the change in the pattern of disease from short-term acute to long-term, chronic and handicapping conditions; the emphasis on the promotion of health and preventive medicine as well as curative medicine, with the need for public knowledge and involvement if health habits are to be changed—and health habits still need to be changed—and also the increasing awareness of emotional and psychological factors in illness. The Court Report paid particular tribute to the health visitors and the committee thought there should be a distinct group of these nurses. At one time it suggested that they might just be called "health nurses". The Snowdon Committee also reported how helpful they were with the disabled, and the Hearing Impaired Persons Committee also recommended that they keep their same standards. Then there was the Select Committee on Violence in the Family in 1976–77, which underlined the need for health visitors because of their special training.

Those important reports seem to support the fact that the health visitors should have a better role under this Bill. We expect to have an increase in the number of elderly people in the population and we are all agreed that there should be more care in the community instead of people going into institutions. Like others, health visitors are aware that improvements are needed, but they feel that what is contained in this Bill at the moment will not satisfy their wants.

The United Kingdom National Standing Conference of Health Visitor Tutors is—and I think the noble Lord, Lord Briggs, would understand this, too—understandably anxious that whatever educational standards have been achieved at the present time should be safeguarded and their anxiety arises because, while there are other post-basic nursing training specialisms, only health visiting, together with midwifery, has existing statutory autonomy and a well-developed educational syllabus. Health visiting has evolved a different pattern of education, better fitted to its work in the community, as the different scope requires different methods. What the health visitors consider to be the danger is a fragmenting of the existing United Kingdom education—as I mentioned previously they have the same syllabus throughout the United Kingdom—and they feel there is a danger that health education may become less uniform throughout the United Kingdom than it is at present. This would be ironic since the Bill is supposed to ensure United Kingdom uniformity for nurse education. Health visiting is the only existing training that is uniform throughout the United Kingdom. Of all the professions, this is the only one that has this training; it does not apply to the nursing or midwifery.

The health visitors consider that the danger also arises because the national boards will have the function of initiating and approving courses and institutions and holding qualifying examinations. They will have to ensure that the courses meet the central council requirements as to content and standard. This would appear to ensure United Kingdom uniformity. However, this depends on the relative powers as between the central council and the national boards. Prior to this Bill, the stated intention was to give the finance for the nursing education directly to the national boards, but Mr. Moyle, the Minister in the other place, referred during the Committee stage to the central council as the co-ordinating body, though, despite his subsequent points about the quality of leadership required for successful coordination, it is far from clear that the central council will be the authority and the power in practice.

Given the inbuilt majority on the central council and the national boards of those whose experience has been of basic nursing training or training in hospital nursing only, there is a danger that this will be seen as the only pattern. That is one of the fears of the health visitors. Basic nursing training and much of other post-basic nursing education has always taken place in schools of nursing, away from the mainstream of general further education, although I think there are exceptions within the basic nursing training—there have been schemes which involved state registration and district nursing or health visiting which have been established in some educational establishments.

In many cases health visitor courses have pioneered the way for nursing courses in further education. There is a danger that health visiting education, which is the only one totally within further and higher education, may be removed and taken into colleges of nursing, which as monotechnic institutions would not be able to provide the depth of education needed. I think this would be a retrograde step for health visitor education and for prospects of a nurse's education more suited than the present one to future needs.

Health visitors are a very small group compared to the hospital nurses, and they fear that they will be outvoted unless they are given a major say at least in organising their own very different form of education and training. This fear has been amply justified by experience gained while the co-ordinating committee was meeting, when the council's representatives made the following points. They said an alternative plan for federation should be examined, and this is in line with the council's original response to the Briggs report. Before such radical changes take place, a feasibility study should be undertaken. A White Paper should have been issued for all interested parties to see in advance of the Bill, and this regrettably did not happen. The council made it clear in February 1978, and repeated in November 1978, that it could not support proposals for this legislation as they stood.

Whether this is accurate or not I do not know, but I have been told that in the case of points put forward by this minority group every one has been overruled. So I hope that if this Bill becomes law the health visitors will be conceded more than any other group in the interests of the whole. It is the responsibility of this council, and surely no more than common justice, to ensure proper provision for the future health visitor's education and training. So I shall be submitting to the noble Lord, Lord Wells-Pestell, some Amendments which I hope may do away with the fears of the health visitors, which he will perhaps be able to accept. In any case, he has been gracious enough to say that he was looking forward to discussing this Bill thoroughly, and I hope it will turn out satisfactorily in the end.

10.22 p.m.

Baroness ELLIOT of HARWOOD

My Lords, it is late and I do not intend to keep your Lordships very long. I must say that it is unfortunate—and I am sure this is not the fault of the noble Lord, Lord Wells-Pestell, who is as enthusiastic about this subject as anyone in your Lordships' House—that this Bill has been put on so late in the day. This is one of the most important subjects we could discuss. I am sure both noble Lords opposite feel the same. It is unfortunate that we should be speaking to totally empty Benches when we have just had the most marvellous maiden speech from Lord Briggs. This report has been in the hands of Governments—not only this one, but others—since 1972, and this debate should have been a great occasion upon which we should have been able to get everybody to join in. I know that time is a difficulty, but it is a pity that we could not have had this debate when more Members of your Lordships' House were here to listen, anyway, if to nobody else, to the noble Lord, Lord Briggs.

I yield to no one in my enthusiasm for this profession. Like the noble Baroness, Lady Ward, I am also a vice-president of the Royal College of Nursing; and having been married to a doctor, I know what the nursing profession means in the life of professionals. I would like to support the noble Lord, Lord Smith, in his suggestion that some of the medical profession should at least be involved in the setting up of these new committees. I hope very much that these committees will be a success; but I have had a lot of experience recently of reorganisation and I have become a little sceptical about it.

I was involved in reorganisation of local government, and I cannot honestly say I think our efforts, although they were quite genuine, have been as successful as some of us thought they would be. I feel a little nervous when people talk about reorganisation rather than about putting in a new framework, or of sticking to the old framework and simply having some small alterations. Local government was certainly one example; so also, to some extent, was the Health Service, although again no one Party was responsible for that. My Party was as responsible as anyone else. I cannot say that I think that all the reorganisation of the Health Service has been as successful as we anticipated. I do not want to be a Jonah and say that no reorganisation is a success, because I hope that this reorganisation will be successful. However, I am a little sceptical because I have seen so much reorganisation that has not resulted in improvement.

If the Bill follows—as I believe it does—some of the recommendations of the Briggs Report, then I feel sure that we shall be able to carry out some of these provisions. I wish that, instead of just reorganisation, it had been possible to adopt some of the proposals of the committee of the noble Lord, Lord Briggs, which have been waiting some eight years to be implemented. There are other matters, besides just setting up committees, which are of great importance in the report.

The noble Baroness, Lady Vickers, has spoken about health visitors. I too have had letters from, and have met, members of that admirable part of the nursing profession and I hope that we shall be able to do something to help them. I also would support the district nurses because they too have a great part to play. Although they may be included under the Royal College of Nursing umbrella, as indeed are almost all nurses, I should like the district nurses also to have a status and standard in the set-up because they do a wonderful job in the community. I had planned to say something about health visitors, but the noble Baroness has said it all and therefore I shall leave them. However, I make it clear that I support all that she has said and I think that they are of very great importance.

It has been suggested in one of the meetings that we had with different groups that it would have been a great help if, say a year ago, before the Bill was brought out and discussed in another place, we had had a White Paper. This could have been discussed by all the interests in the profession before the Bill was founded. I do not know whether that was suggested by any of the Governments concerned—after all, there have been several Governments since the Briggs Report was inaugurated—but it certainly would have been a help. I understand that it was quite difficult for some of the groups to get in touch with the Department as regards the planning of the Bill and it would have been good if there had been a little more consideration. In most Acts of Parliament of this kind one has a Green or a White Paper put forward and discussed by all the interests. This is brought in before the introduction of the Bill and thus there is a better background from which to work. Perhaps that was not possible but it is a pity that it was not done.

I hope that we shall have—and here I appeal to the noble Lord, Lord Wells-Pestell, and to the Deputy Chief Whip—a good deal of time to discuss the matter in Committee. Today we have had a very late debate. There are very few people present but some admirable speeches have been made, all of which could with great benefit have been heard by a larger audience. I hope that when the plans for the Committee and Report stages are made the Government will ensure that there is more time and that a more propitious hour than half-past ten at night will be set aside to discuss this matter. In the meantime, I have listened with great interest to what has been said and I shall do my best from these Benches to help in any way I can to improve the Bill.

10.30 p.m.

Lord WELLS-PESTELL

My Lords, I am sure that it is the wish of your Lordships that I should not keep you too long. However, there are a number of points which have been raised tonight by noble Lords and which I must try to deal with rather briefly. The noble Baroness, Lady Young, drew attention to the fact that here was yet another Bill for the implementation of which there would not be any money. The noble Baroness really must look at the paragraph headed "Financial Effects of the Bill" in the Explanatory and Financial Memorandum. That says very clearly that: In any case it is unlikely that the new bodies would be in a position to recommend changes before 1982/3 at the earliest. There will be some additional cost during the handover period … before the new bodies take on the functions of the old. It is proposed to adjust existing programmes to accommodate this particular item of expenditure. I accept that money will not be available—unless, of course, authority is given for it—to effect any changes in the training programme. But this is not primarily a training Bill, but one which seeks to bring about a certain number of organisational changes. With great respect, I do not think that there is any real validity in the argument that the noble Baroness, Lady Young, has put forward.

The noble Baroness also drew attention to the question of misconduct and said how unfair it would be if a nurse, a midwife or a health visitor was charged with misconduct when it was someone else's fault or due to some series of happenings which prevented the person from carrying out his or her responsibilities properly. Nobody can be charged with misconduct and found guilty of misconduct if it can be established beyond all reasonable doubt that it was due to the fault or the intervention of someone else.

Baroness ROBSON of KIDDINGTON

My Lords, with all due respect, it could be due to exhaustion or tiredness. That is a very difficult thing to prove.

Lord WELLS-PESTELL

My Lords, I am not so sure that it would be difficult to prove. Over a good many years there are any number of members of the medical profession who have appeared before disciplinary boards and have been accused of some quite serious offences. But they have been acquitted because there has been proof to the contrary. This is very much a red herring and it is a great pity that we should suggest that the Bill as at present worded will give rise to serious miscarriages of justice. There is no justification for implying that sort of thing.

Lord SANDYS

My Lords, may I interrupt the noble Lord on that? I am sure that it was not the intention of my noble friend Lady Young to suggest that. She was suggesting something rather different—namely, that proceedings should take place in private. She did not make particular reference to this, but we shall make reference to it again later: further proceedings will be much more in line with those of the General Medical Council Act.

Lord WELLS-PESTELL

My Lords, if the noble Lord had contained his soul in patience for a little longer, I should have got round to dealing with that. The noble Baroness referred to Clause 12. That clause restates existing legislation. The problem of industrial action needs to be looked into in the wider context and also as to its effect upon the professions. The noble Baroness raised the point about hearings in public. Clause 12(4), which deals with this, is a parallel provision to the provisions in the Medical Act. If it had not been, there would have been criticisms because we were adopting an entirely different kind of procedure.

Lord PITT of HAMPSTEAD

My Lords, will the noble Lord give way?

Lord WELLS-PESTELL

My Lords, I shall not give way any more. This is the last time I propose to give way.

Lord PITT of HAMPSTEAD

My Lords, this is quite an important point. If I understand the Minister aright, he is suggesting that the nurses should go through the sort of experience that the doctors go through when the disciplinary committee of the General Medical Council is dealing with complaints against them.

May I ask him to bear in mind that many of the complaints that may be made against nurses may be suggesting incompetence, carelessness, the wrong sort of attitude, and that these things heard in public, even though the result may be an acquittal, can have a detrimental effect on the nurses' future career? Therefore, what the noble Baroness was saying is something of great substance.

Other professions have disciplinary procedures, but they have their disciplinary hearing in private. The most you ever read is about a barrister being suspended for six months; you do not hear the details of the charge brought against him. It is only in the medical profession that you get that sort of detail. I take it that what the noble Baroness was suggesting was that we should not subject nurses to the sort of treatment to which doctors are now subjected. I cannot understand why my noble friend will not accept this and take it on board.

Lord WELLS-PESTELL

My Lords, all I want to say on that point is that I think we have to look at what is the legal meaning of misconduct. It is something that is basically serious, and very serious. I do not think for one moment that the instances which my noble friend Lord Pitt has given would in point of fact amount to misconduct. The noble Baronesses, Lady Young, Lady Vickers and Lady Elliot, suggested that there had been an element of undue haste in bringing this Bill before Parliament. It was suggested that there had not been enough consultation. It was suggested that some of the people involved in this whole matter had not really been consulted. It was even suggested that there should be a White Paper. But let us look at the facts. There has been extensive consultation ever since the Briggs Report was published. For some years there has been consultation between the various groups that we are talking about and everybody involved. There was a Briggs Co-ordinating Committee which, to the best of my knowledge, was set up in 1977 to help in the preparation of legislation, and the proposals which are before your Lordships tonight in the Bill were considered.

I think it is right to say that representatives of all the statutory and non- statutory bodies were represented: the Royal College of Nurses; the Royal College of Midwives; the health visitors; the unions, NUPE, COHSE, NALGO, and the Association of Nurse Administrators, and representatives from the professions in Wales, Scotland, and Northern Ireland. I think it would have been extremely difficult to get a more comprehensive group of people together to discuss this matter. I should have said that the Briggs Co-ordinating Committee more than discharged its responsibility in consulting over the widest possible field all the interests reflected in this Bill.

There was a comment about the general public. The Amendments to provide for members of the general public on the midwifery committee were introduced in another place by the Opposition. The Government did not like it, and had there been time I would have been only too pleased to give the Government's reason for it, but this was something that was imposed.

The noble Lord, Lord Smith, raised the question of medical membership of the various committees. My understanding is that the Bill provides for medical membership on the council and boards, but the detailed membership will be prescribed by order; that is, it will be enshrined in a Statutory Instrument. It has been accepted that medical representation on the council, boards and their committees should happen; but, as I say, the details will have to wait until discussions have taken place and the various orders setting up the new bodies are prepared, but that has been conceded all along.

The noble Baroness, Lady Elliot, referred to district nurses, and I apologise if I misunderstood her on this. The Minister of State gave an undertaking in another place to use the powers in Clause 8 to establish a district nursing joint committee, and that has been welcomed by the district nurses. As I say, we have given that undertaking. In relation to the point raised by the noble Baroness, Lady Robson, there has been some debate on the lines of communication between the council's midwifery committee and those of the national boards. Some midwives want to see direct and formal links between the midwifery committee at each level, with- out reference to the parent bodies. Though no doubt there will be extensive informal contact between them, the final links must be between the parent bodies if the committees are not to acquire a degree of autonomy which is counter to the basic unifying intent of the Bill.

If the council and boards are to make sensible decisions which affect midwives, they must be aware of the problems facing midwives and understand their unique position and needs. That they cannot do if the midwifery committees are hived off as virtually a separate enterprise. The Bill is drafted so as to allow for maximum consultation between levels, but also to preserve the constitutional niceties of relationships between the parent bodies and their subordinate committees. That is a matter to which a great deal of thought has been given, and I should have thought that this was the best way of serving the midwifery interests.

I am grateful to all noble Lords who have taken part and I have tried to deal with the questions they have raised. I, too, wish to add my personal thanks to the noble Lord, Lord Briggs, for coming here today because he made, as the whole House will agree, a most balanced contribution in which we on the Government side came in for a little criticism, as did noble Lords opposite. We are grateful to him. I am also grateful to the noble Baroness, Lady Ward of North Tyneside, for her contribution. It is a joy for me not to be on the receiving end of what she says; I am the one she is usually taking to task and it is rather nice to see her direct her attentions to Lady Young.

The question of timing was raised. It was a matter of concern to a number of us that this subject came on so late in the day. We had reason to believe that we should have begun two or more hours earlier, but there were, as the noble Baroness will know, four local Bills before the House, and we thought they would take a short time. If she reads tomorrow's Hansard she will see that she will have to take some of the Members of her own Party to task for spending so long on those matters, which should have gone through the House in perhaps one-third of the time. Had they not done so, we should have been home long since.

On Question, Bill read 2^a, and committed to a Committee of the Whole House.