§ 4.30 p.m.
§ Lord SANDYS
My Lords, on behalf of my noble friend Lord Cullen of Ashbourne I beg to move that the draft Nursing Qualifications (EEC Recognition) Order 1979, laid before the House on 2nd July, be approved. The Order in Council before us is designed to make those changes in existing legislation which are necessary to implement the EEC Nursing Directives. The order is made under paragraph 2(2) of Schedule 2 to the European Communities Act 1972, and in line with the established procedure, is subject to Affirmative Resolution. By this means Parliament is given an opportunity to debate the way in which the Government intend to meet our Community obligations. I am sure that, on a matter which concerns nurses, the House would most certainly wish to have this opportunity.
Although the Treaty of Rome itself aims to encourage free movement of persons and services throughout the Community when rendering those services depends on possession of recognised professional qualifications, member States—quite rightly—want to be assured that any national of another member State wishing to practise within their country is trained to an equivalent standard as members of that profession in their own country. This is essential as a protection for the public. And that is why the Treaty provides for the issue of Directives covering the mutual recognition of qualifications and the right of establishment for various professional groups.
The first health profession for whom Directives were signed was the doctors in 1975. The Nursing Directives followed two years later in 1977, and I think it is fair to say that the United Kingdom played a major part in getting agreement as, in many ways, our system of nurse training is more advanced than anywhere else in the Community. That is not to say that we are perfect—I am sure there are many aspects which could be developed—but it is, I believe, significant that the United Kingdom will be the first country to complete the process of implementation. We are, in short, leading the way.
1844 Although the purpose of this debate is, strictly speaking, a limited one, to approve the order making certain changes to existing legislation, I think I should explain briefly what the Directives are all about. There are, as is customary in these matters, two Directives; the first concerned with the mutual recognition of qualifications and the right of establishment, and the second concerned with the content of the training which leads up to the award of those qualifications which are to be recognised. The aim of the two documents is quite simple: to ensure that nurses responsible for general care—and I must emphasise that we are here speaking only of registered general nurses, not those trained specifically in the care of the mentally ill, or mentally handicapped—will in future throughout the Community have undergone a comparable form of training, covering the same theoretical subjects and including the same practical experience, so that their training can be recognised by all Member States and they can practise freely in any country of the Community. For the United Kingdom, as I have said, this means relatively minor changes in existing patterns of training. It does, however, mean that we have to make some equally minor changes in the administrative arrangements which govern the profession. These are contained in the Order in Council we are now discussing.
Article 1 is a purely technical point, dealing with commencement of the order. Article 2 contains some definitions. The real substance of the order starts in Article 3, which deals with the amendments needed to the Nurses Act 1957, the present head legislation governing the profession in England and Wales. It inserts two new sections to that Act, 3A and 3B and a new Schedule 1A which lists the European qualifications which will give a right to be registered (just as our own nurses are registered) under Section 3A. The new Section 3B deals with an important point. It provides that registration lapses on failure to satisfy the General Nursing Council, the registering body, that the registrant has the knowledge of English necessary to render nursing services in the United Kingdom.
In making this provision we are taking exactly the same line as was taken in the medical Directives, in placing a duty on the 1845 competent authority—the registering authority—to ensure that those wishing to work in the United Kingdom have an adequate command of English. The validity of this approach has, in the case of the doctors, been challenged by the EEC Commission, who have suggested that we are in breach of our Community obligations, as we are, in their view, making language testing a prerequisite of registration and right of establishment, something which is contrary to the Treaty of Rome. Indeed, they have indicated that they might take the United Kingdom Government before the European Court. But we remain firmly convinced that our position on the medical Directives is entirely in line with our EEC obligations and for that reason have adopted the same approach here. The Directives place a specific duty on Member States,to see to it that, where appropriate, the persons concerned acquire, in their own interest and"—more importantly—in the interest of their patients, the linguistic knowledge necessary for the exercise of their profession".It is our contention that the right body to determine that linguistic competence is the registering body, the body which under existing legislation has the responsibility for ensuring that a nurse is competent to carry out nursing services.
Articles 4 and 5 make similar innovations in the head legislation for Scotland and for Northern Ireland, the Nurses Act (Scotland) 1951 and the Nurses and Midwives Act (Northern Ireland) 1970. Article 6 deals with what is known as "prestation". This is the situation where a nurse registered in another Member State wants to come to the United Kingdom and work as a nurse for a short period—perhaps to accompany a sick person who needs constant nursing attention to see a specialist—but does not intend to work here in a more formal sense. Obviously, in the type of case I have outlined it would be foolish to expect the nurse to obtain full registration here in order to carry out a very limited duty. Far from facilitating free movement, in such circumstances it would be a positive hindrance. A procedure has, therefore, been devised which makes such arrangements possible, but does not leave the system open to abuse by people who might not, in the normal way, be accepted for registration. This involves making a 1846 declaration of the type of services to be rendered and showing proof of qualification in the member State of origin to the registering authority. Article 7 is, I think, also quite an important point. It contains a vital safeguard by providing for disciplinary procedures for those giving nursing services, as under Article 6, while visiting the United Kingdom.
This leads me on to something on which, as it is not specifically mentioned in the order, I think I should give some reassurance. That is the arrangements for those nurses from other EEC countries who are not just visiting the United Kingdom but have exercised their right of establishment and intend to work here. As the amendments proposed to existing legislation make clear, such a person will be registered, if they have one of the recognised qualifications, in exactly the same way as our own nurses. That includes being of good character. And once registered, the "EEC nurse", is subject to the same arrangements for discipline as any other nurse on the register. So that if she is accused of professional misconduct, her case will come before the registering authority in exactly the same way as for anyone else. She may have a right of establishment, but that right carries with it obligations.
So far as the effect of the Directives is concerned, I see the coming into effect as an important step for our nurses, in forging closer links with their colleagues in Europe and in giving them an opportunity to broaden their experience by seeing different patterns of health care in different countries. I hope that they will take advantage of this opportunity—and that nurses from other Member States will come here to see what we have to offer. We can all, whatever our calling, learn from the experience of others working in the same field, and this is as true for nursing as for any other field. I beg to move.
§ Moved, That the draft order laid before the House on 2nd July, be approved.—(Lord Sandys.)
§ 4.40 p.m.
§ Lord WELLS-PESTELL
My Lords, once again we are grateful to the Minister for setting out the provisions of the order so clearly. It is a remarkable order in the sense that I found no difficulty understanding it, a surprising thing for me. It is an 1847 order which everyone should look at because it is of some importance. I have no comment to make on what the noble Lord, Lord Sandys, said, other than to ask him three questions.
First, I was glad to hear that we are proposing to insist on a reasonable and adequate standard of the understanding of the English language before we allow anybody to practice as a nurse in this country. I am not unmindful of the difficulties, because I am aware of the difficulties we have run into and are running into so far as doctors are concerned. Can the Minister give an assurance to the House that we will not be deflected from that intention; namely, to see that people who come here as nurses in fact speak adequate English?
Secondly, reference has been made to the fact that under the order we will get certain information about the nurses coming here. My reading of it is that most, if not all, of it will be in the nature of some sort of paper setting out the professional qualifications of the nurse. Is the Minister in a position to give an assurance that there will be accompanying that document some sort of report on the nurse as a person and on her general standard of conduct and behaviour? It would be unfortunate if we found ourselves using nurses from abroad who for one reason or another would not be allowed to continue as nurses in their own hospitals because of some offence they may have committed. I should like to know what safeguard there is in relation to that.
Thirdly, the Minister mentioned in the opening part of his remarks that the order would require some changes in—I think he used this phrase—"the existing pattern of training". I do not know whether that is a fundamental or simple matter, but if it were possible for him to tell the House what those changes are to be, it would be helpful for us all to understand.
§ 4.43 p.m.
§ Lord SANDYS
My Lords, I am grateful to the noble Lord, Lord Wells-Pestell, for associating the Opposition with the order. He asked three questions, the first of which was the need to ensure that nurses intending to come to this country had a standard of English which was sufficient to meet the situation. I think 1848 I can give that assurance; we shall not be deflected from our central purpose of ensuring that that shall be the aim of the professions concerned.
His second question was about the requirements. I think that the registering authority in this country would ask the equivalent authority in the other EEC country concerned to provide a certificate that the nurse fulfilled the registration requirements including that of character, and such certificates would have to be produced. If, however, the country concerned did not provide satisfactory certificates, the registering authority here would have to ask for references as to character.
The noble Lord's third question sought information in regard to training, and I can satisfy him to some extent. At present, in a three-year training programme a nurse covers a range of theoretical subjects and practical placements as defined by the General Nursing Council for England and Wales and its equivalent bodies in Scotland and Northern Ireland to comply with the EEC requirements. The length of training will remain the same and the subjects outlined in the theoretical curriculum are in line with the present syllabus. It is the practical placements which change. All students currently have experience in medical and surgical nursing as well as paediatrics. In addition, a proportion have experience in psychiatry or geriatrics and obstetrics or community nursing. In future, students will be required to have experience of all these areas of nursing and care.