NURSES, MIDWIVES AND HEALTH VISITORS BILL

HL Deb 13 March 1979 vol 399 cc504-57

3.13 p.m.

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

My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, that the House do now resolve itself into Committee. (Lord Wells-Pestell.)

On Question, Motion agreed to.

House in Committee accordingly.

[The Lord Aberdare in the Chair.]

Clause 1 [Constitution of Central Council]:

Lord SMITH moved Amendment No. 1: Page 2, line 7, at end insert (",and not less than four shall be registered medical practitioners appointed by the Secretary of State after consultation with the medical profession.").

The noble Lord said: In moving this Amendment to Clause 1, I think it will be helpful at the outset to say that the arguments that I shall put forward are precisely those which I shall employ later on in relation to the Amendments which are in my name to Clauses 4, 5 and 7. It will therefore save much of the time of the Committee if I am permitted to advance these arguments in detail now in relation to Clause 1, and when we come to Clauses 4, 5 and 7 perhaps I may move those Amendments with some brevity, without repeating in detail—

Lord WELLS-PESTELL

Will the noble Lord allow me to interrupt? As I understand the Marshalled List of Amendments, if the noble Lord is to speak to the first Amendment, which he is in the process of doing, I think it will be necessary for him to speak also to Amendments Nos. 6, 7 and 8.

Lord SMITH

I thank the noble Lord. May I so do? I think it will save the time of the Committee if I deal with these arguments in detail now, but not on a second, third and fourth occasion later on. Each of these four Amendments relates to a failure of the Bill to draw any distinction between the medical profession and other disciplines which might provide members of the Central Council, the boards and the midwifery committees—very important committees indeed—and I should like to explain why it is my belief that it is necessary to alter this state of affairs.

I should start by saying that it is important to me to make clear my motives in moving Amendments, so that they should not be misunderstood. The objectives of the Bill, which surely are those we would all support, are to provide the best possible training for nurses, midwives and health visitors and, provided that all three of these groups are satisfied that their interests are properly looked after, then I and, I am sure, other noble Lords will be very anxious to see the nursing profession achieve their ambitions through the swift passage of the Bill. Having co-operated with and helped colleagues in the nursing profession for a great number of years, and enjoyed doing this, I should not want in moving Amendments to be seen to be introducing conflict where I believe none exists, and I hope that when I have spoken the Minister may agree to look again at this matter without dividing the Committee on the issue.

In referring to the membership of these important bodies—the Central Council, the boards and the midwifery committees—what the Bill says in regard to the Secretary of State's own appointments is this: The Secretary of State's appointments shall be made from among persons who either are 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". It is not too much to say that the medical profession was unanimously appalled at the thought that, in the organisation of the training of the nursing profession, the whole of medicine can he regarded as just one of a number of possible disciplines that might be useful, lumped together in the Bill under the general heading: … education, medicine or other fields as … will be of value". I should regard it as quite impossible to contemplate the organisation of the training of the nursing profession, other than in the context of the total care of the sick.

The reason why these two professions are so interdependent is that those within them have a common objective—not degrees. not diplomas, not the intellectual satisfaction of examinations, not the advancement of science for its own sake, but, much simpler than that, the interests of patients. This is why the nursing profession is the closest of all to the medical profession. Indeed, modern medicine would be as ineffective without good nursing, as would modern nursing be irrelevant, except against the background of enlightened medicine. We are linked together as no two other professions are, and to ignore this close and key relationship is a serious omission which I believe should be corrected before the Bill passes.

I am, of course, well aware of the arguments which have been put forward from time to time against singling out the medical profession in this way. One of them that I have heard is put like this: that surely this would place doctors in a special, different and privileged position and that therefore others would want the same. But doctors are already in a special and different position when it comes to helping the nursing profession. They always have been so. When the noble Lord, Lord Briggs, spoke at Second Reading, he rightly called this a key relationship. So far as the argument that this would place doctors in a privileged position is concerned, certainly it would not do so. I believe that there is only one group of people who should be privileged; namely, the patients.

The second argument that I have heard is that if doctors were singled out in this way, they would want to dominate the scene; they would want to dominate the nurses, whereas they should be running their own affairs. But the Central Council will have 45 members. If one inserted a minimum figure of four, as is done in this Amendment to Clause 1, although one knows that in another place a minority gets its own way, surely that would not be so with a minority of four among 45, quite apart from the fact that in my experience doctors have no very great reputation for unanimity about anything.

Ever since 1931 when, as a medical student, I became aware of what the nursing profession did in hospitals for patients, it has been quite apparent to me that to try to get one's own way against the judgment of just one senior, experienced nurse is not worth the attempt. As a junior, I was too frightened to try, although as a junior I knew that I was always right. As a surgeon in my middle years, I did not bother to try because I knew that I should be defeated and that this could be because the case which seemed so good to me might not appear to be so good as all that to others. And as a senior in this position, I would first examine my own judgment to see where I might perhaps have gone wrong.

So far as dominating a roomful of the most experienced of senior nurses is concerned, I would venture to think that few Members of this noble House have had the experience of attempting this, and I can assure your Lordships that it is just not on. I have frequently had the pleasure and privilege of sitting in committee with colleagues from the nursing profession and, one among many, I have invariably found that within minutes I appeared to have got them just where they wanted me. Domination of the nurses by this small number of doctors among 45 is not only something which could not happen but also something which doctors would not seek in any way. They seek to be co-operative and to provide highly specialised advice at a time when medicine is becoming more and more complex. Year by year this specialised advice becomes more and more important.

The third argument which has been put forward is that to insert any figure at all would tie the hands of Ministers in their later appointments by order. But, in that it has been conceded already that there will be doctors on these important committees, how can it be wrong, if one grants that there is a special relationship, to insert a minimum figure of some kind? Some would go further and specify the particular kinds of doctor who are needed, on which particular committees they should serve, and so on. I believe that this would be going too far, but to specify a minimum number seems to me to be right.

Frankly, I am hopeful that the degree of difference between the arguments I have put before your Lordships and the Government's stance at the moment is not so great as is apparent. The Government's view, as expressed by the noble Lord, Lord Wells-Pestell, at Second Reading, is the same as mine on the importance of medical representation. But the Government's view is that it can be safely left until after the Bill has been passed to appoint by order any doctors who should sit on these various committees, whereas I believe that we should in some way emphasise the unique importance of the co-operation between these two professions. It seems to me that to insert a minimum figure is probably the simplest way, the actual figures being based upon the present representation of the profession on the bodies which are going to be replaced by these new committees. It is because the end point appears to be the same that I hope very much that the Minister may indicate some willingness on the part of the Government to look again at this matter, so that a Division of the Committee may be avoided and so that there may be some prospect of closing this gap in the Bill before we consider the matter again at Report. I beg to move.

3.27 p.m.

Lord WELLS-PESTELL

I am sure that all your Lordships have listened very carefully and with considerable interest to what the noble Lord, Lord Smith, has said. May I try to correct what may well be some misunderstandings. Very few of the Bills that I have been concerned with which have been before your Lordships' House have resulted in more discussion between the people concerned than this one. A good deal of thought has been given to what should go into the Bill.

I should like to remind your Lordships that the main purpose of the Bill is to establish a United Kingdom Central Council for Nursing, Midwifery and Health Visiting and to establish four national boards. The Central Council is to prepare and maintain a central register for qualified nurses, midwives and health visitors and to determine, by means of rules, education and training arrangements. This is essentially a Bill for nurses, midwives and health visitors, and its purpose is to enable them to prepare for education, training and registration.

If one looks at the Bill, one finds that membership of none of the bodies to be established is prescribed, not even that of the council and the national boards. The detail and composition will be set out in subordinate legislation. The Bill does no more than give a general indication of the kinds of people to be appointed. For example, in the case of the Central Council, a maximum membership of 45 is set, and it is stated that the majority of the members are to be nominated to the council in equal numbers from each of the four national boards. This is designed to give the maximum flexibility for the future in deciding the precise composition of the boards.

I have listened with great care and I have had an opportunity—albeit a short one—of discussing this matter with the noble Lord, Lord Smith. The whole purpose of the way in which the Bill is phrased is to enable the widest possible discussions and exchange of views to take place between the Central Council and the national boards as to who should be on them. This discussion has not yet taken place. It is merely the bones of the whole thing that we find in the Bill at present. If the composition was set out in detail on the face of the Bill, it would not be possible to alter it without an amending Act, and at the present moment we do not know, other than the fact that the membership of the Central Council and the national boards must consist in the majority of members of the three bodies for whom the Bill is designed.

I accept that it will be necessary to appoint people from the medical profession, from the educational field and from various other fields that have a real concern in nursing and midwifery and health visitors, but at this stage we do not know how many; we do not know what fields of skill and competence will be needed. If one sets out in the Bill the number of people to be put on these various boards and the Central Council, we may find ourselves in the difficult situation of not having enough room for certain important interests and too much for the others. I said that, if the composition was set out in the Bill, it would not be possible to alter it without an amending Act, whereas if it is enshrined in subordinate legislation it is a relatively simply matter to make adjustments to meet the changed circumstances. Therefore, it would seem right to preserve this flexibility so far as possible.

I think it was the noble Lord, Lord Smith, who pointed out, during the debate on Second Reading in relation to the reference in Clause 4 to representation of the general public, that it would be wrong to spell out part of the composition of the new bodies without giving the full details, and, as I said earlier, to give full details would destroy the flexibility for the future. There is no doubt whatsoever that there will be medical representation on the council and on the four boards. In fact it is to be found explicitly stated in Clause 1(4) and in Clause 5(5)(b). It is clearly set out there that this is so. Furthermore, my right honourable friend the Secretary of State and my right honourable friend the Minister of State have given assurances to that effect and have said in a letter to the Joint Consultants Committee—of which the noble Lord, Lord Smith, was a member at the time—that there would be full consultation with the medical profession on the proposals for membership and on nominations, and this has been accepted by the profession. They know this and they have accepted the situation, but to set even a minimum number of medical members without any reference to the overall size and other representation on the bodies would create what could well be an impossible situation.

As I have said, it is enshrined in the Bill; it has been clearly stated by my right honourable friends and the medical profession and they have accepted this. I want to say to your Lordships, with great respect, that this is not the time to put in the Bill explicitly that there should be four or there should be three or there should be two representatives. That there will be representatives from the medical profession is not in doubt, but when the new structure is being established we must look at the requirements of the national boards and the Central Council and then appoint accordingly.

Baroness YOUNG

I wonder whether I might press the noble Lord, Lord Wells-Pestell, a little further on his reply. I think he made the point that no Bill has had more discussion beforehand than this one, and I am sure he is absolutely right and that it has had a great deal of discussion. But, judging from the amount of correspondence that I and my noble friends have received, it suggests that whatever the discussions may have been we have not altogether reached total agreement on how the Bill should proceed, because there seem to be a number of areas which are still not quite settled.

I should like to thank the noble Lord, Lord Wells-Pestell, for sending me notes on clauses which of course are very helpful, and naturally I looked at the note on this particular subsection to see what it said. It is interesting that the wording is slightly different in the notes on clauses than it is in the subsection. It begins by explaining that the council will need to draw on expertise outside the nursing professions, in particular both medicine and general education, so that it actually reverses the order of the professions. I do not know whether there is any particular significance in that or whether it is just a drafting point. But it leads me on to wonder—as the Amendment moved by the noble Lord, Lord Smith, is much more tightly drawn, either than the proposal in the Bill or the explanation given in the notes on clauses—whether the experts' advice in medicine could be from people with medical qualifications who are not doctors and whether he envisages a situation in which it would be possible, within the terms of the Bill as it is now drawn, not to have any doctors on it at all and still to have medically qualified people.

Reading again the report of the noble Lord, Lord Briggs, it seems to me that it is intended in his proposal which is set out at page 190—where it says, … non-nurse members should include, among others, doctors, people with knowledge in the field of general education, health service administrators, financial experts"— to make it quite clear that it is doctors who are being referred to. It is important that we should clear up the point. We are talking about doctors, and not somebody with just a medical qualification but who is not a doctor.

Lord WELLS-PESTELL

If I may, I should like to deal with that point. The noble Baroness drew attention to the fact that she has received, and she knows that I and others have received, a vast amount of correspondence; but I would suggest that she has not received one letter in which there has been a demand for a specific number of doctors on any of the committees. I certainly have not had one.

To answer her other point, let us be quite clear about it: When we speak in the Bill of medicine and the medical profession it means what I should have thought it was quite clear that it should mean; that is, that this is a medical practitioner—not an educationalist with a medical degree or anybody else with a medical degree but somebody who is a practising member of the medical profession. Having regard to the importance of the Central Council and the national boards, I should have thought that it would need to be somebody who had a very real skill and competence over many years. That is the understanding on my part, and it is the understanding on the part of my colleagues, the other Ministers in the Department and everybody I have met so far.

Lord WYNNE-JONES

I have listened with considerable sympathy to the argument adduced by the noble Lord, Lord Smith, in regard to having medical practitioners represented. However, I should like to ask him a question about the wording of the Amendment. It refers to: … not less than four shall be registered medical practitioners appointed by the Secretary of State after consultation with the medical profession". What exactly is meant by "consultation with the medical profession"? I can fully understand that there ought to be medical practitioners there, and I also accept the reasonableness of my noble friend's argument that it is almost inevitable that there will be and that the number will probably be in excess of four. I think the total number that there can be of these appointed members is something like 21; I think there have to be 24 from the other bodies, unless I have done my arithmetic wrong. Consequently, there are bound to be a number of medical practitioners. But if they have to be appointed after consultation with the medical profession they will then be put into the same category as those people who come from the different branches of the nursing profession, which are actually nominating their people. Here one would have a further degree of nomination, and I should like to ask: Who would do the nominating?

Lord SMITH

If I may answer that question, the normal method of consultation in regard to matters of this kind is, of course, through the channel which exists between the Department and the Joint Consultants Committee. I was not going to refer to this committee, but the noble Lord, Lord Wells-Pestell, has already done so. I therefore feel that it is perhaps not irrelevant to say that the medical profession has been most anxious to make its views known in this matter during the two years that the Briggs Co-ordinating Committee has been preparing for the future legislation. The only trouble was that every attempt by the medical profession to be represented was not accepted, and during the course of these two years' unavailing struggle a letter was received which did not exactly cause a great deal of pleasure among the profession. It said: The Committee recognise the part the medical profession could play in nurse education and training". We thought "could play" a rather offhand dismissal of the traditional help and co-operation which the profession has always sought to give and continues to wish to give. I imagine that, if indeed these appointments occur later after consultation, it will be the normal consultation which exists now through the Joint Consultants Committee.

Lord BRIGGS

At this particular stage in the bringing into life of a council which has not existed before, I find it very difficult to conceive of the Secretary of State himself being willing to nominate less than four members of the medical profession. I should like, too, to reiterate that certainly when I produced my own report the committee was considering not merely people who are concerned with medical education but representatives of the profession actively involved in different aspects of medicine, and related indeed to the different groups of committees which are set up or proposed in this structure. I do feel, however, that at this particular stage and after very long discussions it would be extremely unwise to add clauses referring to numbers of particular groups. It seems to me that it would be much better to work on the basis of trying to secure some kind of effective understanding between now and the time when the first members are appointed. If any one particular group of people seeks in relation to this rather complex structure to secure statutory numbers for itself, this seems to me to be rather the wrong way of setting out to secure the objects of the legislation.

I regard the relationship between the doctor and the nurse as being a key relationship, and this goes far beyond the question of nursing education to the actual conditions of work in which the nurse finds herself or himself. But, if one once begins to put numbers in, there will also be difficulties in trying to lay down, for example, how many people should he concerned with education, where they should come from, and what should be the consultative groups with whom one would have to discuss in relation to those people. One of the most serious problems in relation to the future of nursing is the improvement in all kinds of ways of nurse tutoring and the taking of a really effective look at the role of the nurse tutor in terms of changing conditions in medicine and changes in the nature of the educational system and the way in which this approaches the learning process.

I am disturbed, therefore, although I fully understand Lord Smith's concern, that at this particular stage there should be a wish to insert numbers and to refer to a formal consultative process. I cannot conceive, however, of any Secretary of State ever finding himself in the position where, with this size of council, there would be fewer than four people concerned with medicine, not in its educational aspects but in its scientific and other aspects. There, it seems to me, the key relationship stands.

Lord LEATHERLAND

I want to ask my noble friend whether this particular subsection (4) is not too loosely drawn to be really effective in the way we want it to be. Let me read a passage from it: The … appointments shall be made from among persons who either are nurses, midwives or health visitors …". It does not say there shall be nurses, midwives and health visitors; it merely says that they shall be drawn from among those classes, which does not seem to me to be an all-inclusive way of expressing it. Then it goes on still further to cast doubts as to whether those three classes are legitimately entitled to be on the committee, because it says: or have such qualifications and experience in education …". So on the one hand you have somebody who is among the nurses, midwives and so on, and on the other hand you have people who are qualified in education. It goes on again "or other fields …", as the Secretary of State may decide.

So first of all you have three classes mentioned, and then you choose somebody from among those three classes; it does not stipulate that you shall include somebody representing each one of those classes; then it goes on to say you shall have that or something else, and then you can have something else. It looks to me as though we want a little more precision in the drafting.

Lord WELLS-PESTELL

If the noble Lord will allow me, in case others have not read Schedule 1, I should say that the subsection to which my noble friend has referred has to be seen in relation to Schedule 1, which says under paragraph 1(2): The persons nominated by each of the Boards shall include at least two practising nurses; one practising midwife; one practising health visitor; and one person engaged in the teaching of nursing, midwifery or health visiting ". So it is clearly set out and that is the compulsory minimum. The composition of the boards will, of course, include many more of each of those.

Lord DRUMALBYN

May I ask one question, to which I think I must know the answer, but I feel it would be relevant in enabling the Committee to make up its mind. Would I be right in supposing that the Secretary of State would make his appointments under subsections (4) and (5) only after the nominations had been received from the national boards, and that he would have in mind the possibility of representing all those who need to be represented on the Central Council? Secondly—this will depend very much on the maximum that is set—is it envisaged, as a possibility at any rate, that the national boards might nominate a doctor?

Lord WELLS-PESTELL

We must bear in mind as regards the setting up of the national boards and the Central Council that the Secretary of State will have a good say about the nominations. As I have already pointed out, he has made it perfectly clear that certainly the medical profession will be represented. However, at this stage I cannot say what the proportion will be. My noble friend who sits behind me, Lord Wynne-Jones, when referring to 45 said that there must be a majority of 23 as against 22. One must envisage that the membership of the national boards as well as the Central Council must have a much higher number of health visitors, midwives and nurses because it is their particular concern. Therefore, one envisages that there will be more than just a simple majority of 23 to 22 because, of necessity, there must be more nurses, midwives and health visitors.

As regards the question of whether the national boards will be able to nominate a doctor, at this stage I do not know because in the early stages it will all be done by agreement with the Secretary of State until the whole matter is established. Once it is established the Bill provides for elections every so often.

Baroness ELLIOT of HARWOOD

I should like to ask a question arising on Schedule 1. It lists the numbers and types of nurses, but it does not mention the district nurses. It may be that, as I am to raise the matter on Amendment No. 3, we should discuss it then, but it is extremely important that the list of nurses in Schedule 1 should certainly mention district nurses, because that is a most important and slightly controversial matter that has been raised in connection with the Bill.

Furthermore, I entirely support what the noble Lord, Lord Smith, said about the relationship between the medical and nursing professions. It is obvious that he is entirely right about that. I also support the noble Lord, Lord Wells-Pestell, in not wanting to insert a number. I think that it would be better to leave the number out. However, not to mention the medical profession, as the noble Lord, Lord Smith, has said, is a grave error and I hope that it will be clear to anyone who reads the Bill after it has become an Act of Parliament that the medical profession is a vital ingredient. If that is not so it will be a one-sided Bill.

Lord WELLS-PESTELL

I do not think that one is entitled to suggest that the Bill does not specifically mention the medical profession. It says: Qualifications and experience in … medicine", but that is interpreted to mean the medical profession. If I may say so, it has been made perfectly clear time and time again, by both my right honourable friends the Secretary of State and the Minister of State for Health when they have discussed this matter, that there is no doubt whatsoever in the minds of the people who have been closely connected with the matters—the co-ordinating body and all the other people with whom we have been associated—that that is precisely what it means; it means medical profession, and not someone who has a medical qualification as an offshoot of something else.

The noble Baroness, Lady Elliot of Harwood, mentioned the question of district nurses. There are various types of nurses but they come under the heading "nurses". A moment or two ago I set out under Schedule 1 the minimum number of two nurses and one each from three other groups. However, there are mental nurses, district nurses and ordinary general nurses, but they are all nurses. I think that the various factions of the nursing service will, in fact, find their way on to the national boards and the Central Council.

Baroness YOUNG

I am sure that we have all listened very carefully to what the noble Lord, Lord Wells-Pestell, has said. No one doubts for a minute his great sincerity about this matter. However, it is the job of the House during a Committee stage to make absolutely clear what in fact the Bill will say. The noble Lord is right in saying that it is not his intention, the intention of his right honourable friends in another place, or indeed of anyone who has been involved in the drafting of the Bill, that "medical profession" shall not mean what it is generally taken to mean—that is to say, qualified medical practitioners—and that they are not to be included on the General Council. That, I think, is the point that is being made by the noble Lord, Lord Briggs. The fact of the matter is that, as we know, when people come to interpret the law they do not read Hansard and take into account what has been said during the Committee stage of a Bill, or indeed at any other stage; they take into account what the Bill actually says. It is our job in law to make clear Parliament's intention. For, should a case arise where something was being put into effect not as Parliament intended, there is nothing, so far as I can see, to prevent it from happening.

I absolutely accept that perhaps Clause 1 is the wrong place in which to move the Amendment, and perhaps it ought to be moved in relation to the Schedule to the Bill, or drafted in a somewhat different manner to include somewhere in the Schedule to the Bill "qualified medical practitioners", or whatever may be the precisely correct terminology. However, I wonder whether the noble Lord would take the matter away and look at it again in the light of the general discussion which has been expressed in the Committee. I am sure that we are all absolutely in agreement on the principle of what we want to achieve. Our doubts are that the Bill may be so drafted as not to make that clear at some future date. We feel that we ought to try to get the Bill drafted as correctly as possible. I wonder whether the noble Lord would take the matter away and look at it again?

Lord WELLS-PESTELL

That is not a device, if I may say so with the greatest respect to the noble Baroness, that I want to accept. In the ordinary way if there were any real doubt or a possibility that anything that I had said was not likely to take place I would he happy to do so. I point out to your Lordships that I said at the very beginning that the composition of the boards and of the Central Council will be set out in subordinate legislation. That means that an order must be laid before both Houses of Parliament. It will be a negative procedure order. It will be available for some considerable time. If any Member of your Lordships' Committee feels that it does not reflect accurately what I have said today and that it is in any way suffering from any shortcoming, there is no reason why that order should be accepted; it can be rejected. Bearing in mind that there is no doubt in the mind of the parliamentary draftsman who has drafted the Bill, and no doubt in the minds of my right honourable friends that it is the medical profession and it will be the medical profession, I should have thought, with very great respect, that it would not be unreasonable for me to say to the noble Lord Smith, that I hope he will feel able not to press the Amendments, but to withdraw them because I feel that I have given all the assurances that it is possible for anyone to give. If the subordinate legislation seems to fall short then the remedy is in the hands of both this House and another place.

Baroness YOUNG

There is always a difficulty about subordinate legislation on a Negative Resolution. One would have to vote against the entire order, and if one disagreed with just one particular point, one would not wish to vote against the whole order. I take the noble Lord's point. Of course, it is possible for this House to vote against an order, but it would be an unusual procedure. What one cannot do, of course, is to amend an order, and, if one did not like it, that is probably what one would wish to do. That is why it is very important to try to get this matter right at this stage.

Lord SEGAL

There is one very important reason why we should support the whole principle of flexibility at this stage. As I see it, the representation on the council should not be entirely on the basis of all the interests affected by this Bill receiving adequate representation. What is so important from the point of view of the training of nurses is not only the qualifications of members on the board, but that they should also have a gift of teaching and an understanding of the difficulties under which our nurses of today have to work. The question of teaching arises in addition to their manifold routine duties of nursing in the wards and the care of patients. As I see it, it is not so much an essential principle of representation as a full understanding of the difficulties facing the nursing profession.

That is why at this stage, when there is such a wide consensus of opinion, I think that it would be wise to preserve the principle of flexibility. Although it would be quite wrong for me to make any suggestion at all to the noble Lord, Lord Smith, who moved this Amendment, if it requires further consideration, perhaps it might be withdrawn at this stage and, if necessary, be considered at a later stage of the Bill.

Lord WELLS-PESTELL

Perhaps this suggestion would help the noble Lord, Lord Smith, and the noble Baroness, Lady Young. If the noble Lord feels able to withdraw these Amendments, perhaps he and I—and, if necessary, anyone else—could meet between now and the next stage to see whether we can clarify the situation.

Lord SMITH

Until the very last moment I was seriously disappointed that we had not got any further and that the noble Lord, Lord Wells-Pestell, did not appear to believe that the Government could look further at recognising this very important relationship between two professions. However, a great many important remarks have been made. It is now clear that we are talking about medical practitioners. We are all agreed that there must be a sufficiency of those on all these important committees. The contribution of the noble Lord, Lord Briggs, was particularly helpful.

I welcome the suggestion that between now and the next stage of the Bill there can be some further conversations so that these matters are put into their right perspective, and so that this relationship, which is so important to me and to many Members of this Committee, is strengthened. In view of that suggestion, and because I shall want to read the record of this debate carefully, it would not be right to divide the Committee at this stage. However, if necessary, I shall return to the matter later on. Therefore, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

On Question, Whether Clause 1 shall stand part of the Bill?

Baroness YOUNG

I should like to raise one small point here. It arises in relation to Clause 1(6). I think I am correct in reading Schedule 1 as saying that the chairman, who would be appointed initially by the Secretary of State, would serve for a term of three years. Is that correct? It does not seem to be specified in the Schedule. As the first chairman is an appointment made by the Secretary of State, it would be helpful to know for how long the appointment would stand. If the noble Lord, Lord Wells-Pestell, cannot immediately answer that question, perhaps he would be good enough to write to me about it.

Lord WELLS-PESTELL

I think that the noble Baroness is perfectly correct. That is my understanding of the position, but, if that understanding is wrong, I shall certainly let her know.

Clause 1 agreed to.

Clause 2 [Functions of Council]:

4.6 p.m.

Lord WELLS-PESTELL moved Amendment No.2: Page 2,line34,at end insert— ("( ) The powers of the Council shall include that of providing, in such manner as it thinks fit, advice for nurses, midwives and health visitors on standards of professional conduct.").

The noble Lord said: I beg to move the second Amendment. The purpose of the Amendment is to make clear that the council has the power to provide advice to the professions as a whole and to individuals on matters relating to professional conduct. The Amendment fulfils a commitment made in another place by my right honourable friend the Minister of State.

I think I am right in saying that the original Amendment was moved by the Opposition in another place on Report and required the council to provide guidance for the professions. I understand that that was not acceptable because of the likely difficulties that would arise in interpreting the legal status of such guidance. Some might interpret that what was not expressly prohibited with regard to professional conduct might, by implication, be permitted. Guidance provided by the council could not, however, be expected to cover all the circumstances where misconduct might arise.

The present Amendment has much the same wording as is to be found in Section 5 of the Medical Act 1978. Debate on that Act covered the identical ground, and it was finally agreed then by both Houses that the best approach in that case was for a power rather than a duty to provide advice. I beg to move.

Baroness YOUNG

I am sure that the whole Committee would wish to accept the explanation for this Amendment given by the noble Lord, Lord Wells-Pestell, and to agree with the point that he makes. I rise really to say that it seems perhaps ironic that this should come as an Amendment at this stage—although one appreciates the reason for it—when, in a very disturbed society, the one group of people who seem to be exercising the highest of professional conduct are, of course, the nurses; they are setting an example to everybody. It would be a good thing to place this on record at this time.

On Question, Amendment agreed to.

On Question, Whether Clause 2, as amended, shall stand part of the Bill?

Lord WYNNE-JONES

With regard to this clause, which sets up a new authority which will, I understand, take full charge of training and standards of training throughout the nursing profession, I should like to ask my noble friend Lord Wells-Pestell what will happen in the interim period. Presumably this new council will not be set up overnight. At present I think that there are some five or six bodies which control the education of the different branches of the profession. Is it visualised that these will disappear—as the Bill says they will—when the Bill becomes an Act, or is it supposed that they will continue in existence and that there will be a period before the new council is set up?

Lord WELLS-PESTELL

My noble friend Lord Wynne-Jones is perfectly right; the dissolution of the six main existing bodies—which I shall not set out—is to be found in Clause 21. There are also three smaller bodies: the Joint Board for Clinical Nursing Studies, the Joint Board for Clinical Nursing Studies in Scotland and the Panel of Advisers for District Nursing Training. Like all the other existing training bodies, they will cease to exist once the new bodies are fully operational.

As I said a moment or two ago, Clause 21 provides for the dissolution of these bodies. However, there will have to be a hand-over period during which the new bodies prepare to take over the work of the present bodies. I think one realises that this will be a complex operation as there will be a need to harmonise the differing practices—for example, registration, the use of computers—between the various existing bodies. Only when this process is completed—and I want to emphasise only when this process is completed—will the present bodies, including the General Nursing Council, be dissolved. I am not going to try to predict the exact timing of this hand-over, but I think one has to face the fact that it may take two years; thus, the General Nursing Council is unlikely to be dissolved before the end of 1981, as we see the situation.

Lord LEATHERLAND

I wonder whether my noble friend can give us a satisfying assurance on the little point I shall raise. What will be the status after this Bill has passed of, first, State registered nurses, and, secondly, State enrolled nurses? Will they have the same standing in their profession that they enjoy today?

Lord WELLS-PESTELL

Under the new structure there will be the registration of all nurses. At the present moment the registration applies to the State registered nurse, but under the new structure it is envisaged that all groups of nurses, whether they are State registered as we understand the term today, whether they are enrolled nurses, whether they are mental nurses, and so on, will be registered. As the noble Lord will know, one of the recommendations of the Briggs Committee was that there should be a common training given to all nurses. I think the Briggs Report, if I can quote it accurately, suggested that the common training for all nurses should be about 18 months, and then they could go on for higher qualifications and specialisation. In answer to my noble friend, the registration will be a registration for all nurses and the new structure will mean that they will all have in future the common training.

Clause 2, as amended, agreed to.

Clause 3 [Standing committees of Council]:

[Amendment No.3 not moved.]

4.13 p.m.

Baroness YOUNG moved Amendment No.4: Page 3,leave out line 8.

The noble Baroness said: I have not moved Amendment No. 3 because it has been overtaken by Amendment No. 4. For the convenience of the Committee, I should like to speak at the same time to Amendment No. 14. These two Amendments in fact cover the same point as Amendment No. 3 but I think on a better drafting of it. The history of these Amendments is quite a long one but they deal quite specifically with district nursing, and they of course refer to the point that my noble friend Lady Elliot referred to under Clause 1, among other matters.

We are all grateful to the noble Lord, Lord Wells-Pestell, for bringing forward the Government Amendment No. 10 on the Marshalled List, to which we shall be referring later, and that deals with the complicated question of health visitors. The other complicated question has been that of district nurses. It is a matter on which I am sure we have all received a great many letters. I think that these two Amendments would meet what they are seeking; namely, to have their education and their professional body which would be of a similar status to that of both the health visitors and of the midwives. I understand that their particular reason for seeking these Amendments is that the panel of assessors of district nursing (the body which is at present responsible for district nurse training) in fact covers the whole of the country and gives uniformity to district nurse training nationally, and district nurses are keen to maintain this particular arrangement that they have at the moment.

I think that they have been under some misapprehension and some concern about what happened in another place. They believe that the right honourable friend of the noble Lord, Lord Wells-Pestell, Mr. Moyle, undertook to set up this joint committee. I hope, therefore, that in putting down these Amendments the Government will view them sympathetically and that this may be something that they will feel able to look at and, if the Amendments are not correctly drafted, would feel able to come back at a later stage with corrected Amendments. I beg to move.

Lord WELLS-PESTELL

I shall not deal at this stage with Amendment No. 10, which I shall be moving in due course. What I want to say to the noble Baroness, Lady Young, is that we gave her Amendment a good deal of consideration and we have looked at it from every angle. If I may put it like this, we think that it is reasonable and we agree with it in principle. Ministers have, in another place, repeatedly given undertakings that they would use the powers in Clause 8(4)to establish a joint committee for district nurses which is what the district nurses themselves want. Though the present wording of the Bill is quite sufficient to achieve this, the continuing reference in Clause 3(3) to district nursing as a possible Central Council-only committee is a little confusing and may have cast doubt on what precisely Ministers intended to do. Let me be quite frank about it, the noble Baroness's Amendments clarify the situation and are therefore acceptable in principle.

We realise that district nurses have for some long time wanted to see some clarification of this kind in the Bill. There have been certain difficulties, but I have taken advice on the wording of the noble Baroness's Amendment. I understand that it is not so much defective—I think I am right in saying that—but that it does not appear in its proper place in the clause. I am bound, if I may say so and your Lordships will understand, to accept the advice that I am given. If the noble Baroness is prepared to withdraw Amendments Nos. 4 and 14, then we shall certainly come to your Lordships at the next stage with these particular Amendments worded as we understand from parliamentary draftsmen they should be worded and in the place in the Bill where they should be found.

Baroness YOUNG

I should like to thank the noble Lord, Lord Wells-Pestell, for what he has said. Not being a lawyer, I have never yet managed either to draft myself or to get anybody else to draft an Amendment which parliamentary draftsmen considered to be correct. Therefore, I am only too happy, once the principle has been agreed, to leave it to him and his advisers to redraft the Amendments and, more important, to insert Amendment No. 14 into the correct part of Clause 8. What is important to the Committee, and what we are all grateful to the noble Lord, Lord Wells-Pestell, for—as I know, his personal intervention in this matter—is that the principle is agreed. I am sure that the district nurses will be grateful for this. On those assurances, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

On Question, Whether Clause 3 shall stand part of the Bill?

4.19 p.m.

Baroness YOUNG

On the clause as a whole I have been approached and I have had some considerable correspondence on the subject of training of nurses for the mentally ill and those with mental handicaps. Clause 3(3) is really an enabling clause in that it enables the Secretary of State to constitute other standing committees, including mental nursing; district nursing will have its own committee, but mental nursing remains in this category. First, the fear is that this is simply enabling legislation and that there is no guarantee it will happen. Secondly, nursing care for the mentally ill and those with mental handicaps is of course extremely important. There' is no doubt that where there have been difficulties in hospitals which have called for inquiries, they have nearly all been mental hospitals and many people are concerned about the training and qualifications of everyone undertaking what must be very difficult and worrying work. Perhaps the Minister would comment on those points. Again, if he does not wish to do so at this stage of the Bill, I should be happy if he would either discuss it or write to me on the matter. The point about the training of those involved in mental nursing is important and it would be helpful to have the Government's view on the matter.

Lord WELLS-PESTELL

There is no problem in my replying to the noble Baroness, Lady Young. She is right to say that this is enabling legislation and that there may be doubts in people's minds as to whether there is any intention to create such a standing committee. In Clause 3(3) five are set out—training, clinical nursing studies, district nursing, mental nursing and occupational health nursing—and they are there because it is recognised that they are each making a very important contribution to the community. At present we in the Department are engaged in giving a good deal of attention to the problems of the mentally ill and mentally handicapped and have come to the conclusion that much more needs to be done in this field so far as training for mental nursing is concerned. If I remember rightly, this point is made quite strongly in the Briggs Report.

The reason why we are not setting up standing committees specifically at this stage is that this is a matter in which a good deal of work has been done and a good deal of thought and consideration is being given at this stage to the mental situation, if I may call it such. When we are looking at the construction of what is necessary in the future we want to be better informed and better armed than we are at present, but I can assure the noble Baroness that we feel strongly about this, and I am in a position to say that, in view of the time which the Department is giving now to the whole question of mental nursing.

Baroness YOUNG

Before we leave this point, may I ask the noble Lord if he feels that the national boards will be so constituted as to include someone who has experience of or is qualified in this particular matter of mental nursing and the nursing of the mentally handicapped? I ask that question because not in the Schedules, not in Clause 1 and not in this clause, is it made clear. Is this something else that would be left to the judgment of the Secretary of State or the council?

Lord WELLS-PESTELL

This is one of the reasons why I was asking that we should remain flexible. Many interests have to be provided for so far as the national boards and the Central Council are concerned and I should be very surprised if, in the setting up of the national boards and the Central Council, for which my right honourable friend the Secretary of State will have a large measure of responsibility in the initial stage, something so important as mental nursing will not be considered because of the situation we find the country in at the present time.

Clause 3 agreed to.

Clause 4 [The Midwifery Committee]:

The CHAIRMAN of COMMITTEES (Lord Aberdare)

In calling Amendment No. 5, I have to point out that if that Amendment is agreed to I shall not be able to call Amendment No.6.

4.25 p.m.

Baroness VICKERS moved Amendment No. 5: Page 3, line 20, leave out from ("midwives") to end of line 22.

The noble Baroness said: I realise that I shall perhaps be twitted by the Minister for this Amendment because he will realise that this was one which was introduced by the Opposition and discussed in Committee in the House of Commons. I am therefore, entirely on my own, going against my colleagues in the other House. I regret that this provision states that two members of the general public shall be added to the midwifery committee. I think this is based on the misunderstanding that the midwifery committee have control over trends in obstetric practice and the provision of facilities for home confinement, whereas that is not the function of a statutory body. The addition of two lay members could seriously reduce the midwives' majority. I feel very strongly that if some midwives were unable to attend, for example because of their professional commitments, there would be a majority of non-midwives, and that might result in decisive votes being cast by lay or medical members and thus it would be very difficult to ensure that the midwives have responsibility for their own professional affairs.

All will agree that we are of course always interested in having consumer interests taken into account, but one must remember that midwives are themselves consumers in this profession, and if this is to be achieved by direct representation written into the Bill, then surely all the other committees referred to in the Bill should have similar representation, not just midwives. I am glad to see the noble Baroness, Lady Robson of Kiddington, in her place because she commented on this matter, as we see from paragraph 1659. If the Minister cannot accept the whole Amendment, I hope the woman will be taken out because we do not want statutory women on these committees.

We are getting tired, particularly since the Sex Discrimination Act, of the placing of women into special categories. I am also fortified by what the noble Lord, Lord Wells-Pestell, himself said in column 1681: 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".—[Official Report, 19/2/79.] That cannot be achieved if the midwifery committees are hived off as a separate enterprise. I believe that what is happening is that certain organisations—the National Childbirth Trust, the Birth Centre and the Association for the Improvement of Maternity Services—are thinking that if this goes forward as it is everybody will be forced to go into hospital, and they are very much against that. I believe it is a misconceived idea and I therefore hope the Minister will agree that these points should be thought about again with a view to removing what in my view is a totally unnecessary and unfortunate addition to the Bill.

Baroness MASHAM of ILTON

I apologise for not being here for the Second Reading debate; I was delayed in Dallas. Having been the president of our local midwives and knowing that our future generations will be reliant on the skill of the midwives for safe delivery into the world, I believe Clause 4 needs amending rather than that we should simply leave out from "midwives" in line 20 to the end of line 22. In stating that one of the lay members should be a woman, it leaves this appointment open to abuse and any woman, whether or not she has any interest in or knowledge of childbirth, could be nominated. Surely it ought to be stated that the lay members should have a special interest in improving the maternity and childbirth service.

Like the noble Baroness, Lady Young, I have received many letters from midwives and health visitors throughout the country. They are concerned for their specialised professions. They do not like the Bill, and they already feel that there has been much disharmony between the nurses, midwives, and health visitors. It seems that the Bill is already doing the opposite to what it sets out to achieve. Instead of uniting the professions, it is putting up barriers of defence. I hope that, after the Bill leaves your Lordships' House, the professions will be happier.

Lord BRIGGS

I strongly support the noble Baroness, Lady Vickers, in her attempt to delete the last part of the phrase in question. Having received many letters from people concerned with the midwifery profession, my impression is that there is not the degree of discontent that has just been suggested. When the Briggs Report was produced there was a considerable number of midwives on the committee, and the report has received the support of most of the midwifery organisations. I feel that the idea of having two members of the general public, at least one of whom must be a woman, is really quite wrong, and rests on a misapprehension of the nature of the midwifery committee. This is the only place in the Bill as it stands where the phrase, "general public" is used. It is very difficult to see why at this particular point in the logic of the reorganisation the general public should be mentioned in this part of the Bill, if they are to be mentioned, and not mentioned elsewhere. I dislike very strongly the proposal that one of the members must be a woman, and I hope that we shall get rid of the last part of subsection (1) of Clause 4.

Baroness ROBSON of KIDDINGTON

I rise to support the Amendment and I find myself in rather a similar position to the noble Baroness because certain members of my party supported the Amendment in the other place. I believe that they did so because they had misunderstood the purpose of the Bill itself on the question of the representation of women and the general public on a teaching and training council. I find it difficult to accept that the present wording should remain in the Bill, particularly in view of the comments made by the noble Lord, Lord Wells-Pestell, in our debate on the first Amendment, which laid great stress on retaining the complete flexibility of the establishment of the various bodies and committees. I believe it is essential that your Lordships should remove the words in accordance with the Amendment.

I believe that there has been confusion in the minds of some people about the purpose of the Bill, and that the fear that the entire practice of home confinements might be influenced by the Bill is a mistaken assumption. People ought to be reassured if they consider what has happened in the past. A letter in the Guardian from the Birth Centre supported the Amendment because it was felt that there was a risk that community experience in midwife training might be curtailed, but it should be borne in mind that it was in 1960 that the practice of hospital deliveries was established as the trend in obstetrics. That was the aim at that time. Nevertheless, as late as 1977 the new syllabus for midwifery training, which was circulated to the training schools, contained exactly the same length of community training as previously. Therefore, I believe that people can be reassured that no midwife would want the kind of training in which she was not capable of functioning both in hospital and in the community. Furthermore, I consider that the references to the statutory woman and the general public in the clause are quite wrong.

Lord LEATHERLAND

The speeches of the two noble Baronesses have indicated that this is not a party matter. Both the other parties are split on this question, and probably there will be differences of opinion in the Party for which I speak. The Royal College of Midwives is absolutely against the provision as it appears in the clause in its unaltered form, and the college has suggested that the two lines which the noble Baroness wishes to have deleted, should be deleted. It may be asked why is the provision about lay membership of the committee to be applied only to midwives. It is not to be applied to any of the other categories dealt with by the Bill. Nothing is said about applying the provision to health visitors, mental nurses, or district nurses. It applies merely to midwives. Why should they be singled out in this way? That is what the Royal College of Midwives is asking, and it is also asking that the provision be deleted.

I have never personally required the attendance of a midwife, and I do not suppose that I ever shall. But I was for many years the president of my village's district nursing association and I got to know a considerable amount about the activities and duties of the midwife. The poor girl had to turn out at night on her bicycle and ride across fields. She had to carry it over ditches and so on. Thus, I have very great sympathy with midwives, and I feel that the attitude which the Royal College of Midwives is now taking is the right one.

I do not ignore the value of the general public, but in this respect their views can be made known in other ways. There is something to be said for having a few men and women on the nursing committee in a local village nursing association, but here we are concerned with a national committee with statutory authority, and in view of the fact that the Bill endeavours to make the midwives masters or mistresses of their own destiny, they should be left alone and allowed to get on with it.

Lord WELLS-PESTELL

I am glad to establish yet again that this is a Government of sense and reason. We accept the Amendment.

On Question, Amendment agreed to.

On Question, Whether Clause 4, as amended, shall stand part of the Bill?

4.38 p.m.

Baroness YOUNG

Along with other noble Lords, I have received many letters about the clause, which was inserted in another place at the Committee stage. In its original form it read rather differently because it was further amended on Report, when subsection (3)(c) was removed. There is no doubt that this has caused considerable concern to the midwifery profession, and I have received a great many letters on the point. The writers feel that what they were promised in their original discussion on the clause as it then was—involving a midwifery committee of similar standing to the present committees—has been watered down. Thus, under the clause as it now stands the midwifery committee will in effect be able only to make proposals to amend and revoke the rules which are referred to in Clause 15. This situation has caused concern to midwives. Would the noble Lord care to explain to your Lordships why the changes have been made to the original clause, and does he feel it is true that the functions of the midwifery committee have been altered and watered down by the subsequent Amendments made on Report in another place?

Lord WELLS-PESTELL

I was not aware that the noble Baroness was going to raise this, but in point of fact I thought it might well be advisable at this stage, and whether or not the matter had been raised by the noble Baroness, to say something about the relationship (if I may use that expression) between the midwifery committees of the Central Council and the national boards, and the extension to midwives of the Amendment in relation to health visitors in Clause 8. I welcome this opportunity because I hope it will clear up some of the misunderstandings and perhaps soften some of the feelings which have been expressed.

When what is now Clause 4 was introduced in the Commons, it originally provided for direct consultation on matters relating to midwifery practice between the Central Council's midwifery committee and those of the national boards. This arrangement was strongly opposed by the non-midwife interests, who felt that it was not constitutional for there to be formal links between a subordinate committee of one body and a subordinate committee of another: formal contacts should be between the parent bodies. Such an arrangement would tend to give the midwives a sense of independence and a sense of total separation, which would be counter to the fundamental unifying intent of this Bill.

My right honourable friend the Minister of State accepted that, by providing for what amounted to a parallel hierarchy, albeit in a relatively narrow field of responsibility, midwifery was in effect being hived off, and thus the aim of unification was being undermined. The clause was subsequently amended to make it clear that the formal process of consultation lies between the parent bodies, the Central Council and the national boards. This is not to imply that there will not be a great deal of informal day-to-day contact among the various midwifery committees, which will be of great value; it merely requires that, when it comes to the stage of formal consultation on the making of rules, this should follow the procedure through the parent bodies, who have the ultimate responsibility.

In looking at the revised wording (I am talking now of the present wording) in Clause 4, it is important to look at the wording of Clause 7(4). Clause 4 deals only with the requirement of the Central Council to consult national boards on the recommendations of the Central Council's midwifery committee, but if one looks at Clause 7(4) one sees that a clear duty is placed on national boards, when they are consulted in this way, to seek the views of their midwifery committees. That is very clearly set out. Thus, all the midwifery committees will have an opportunity to comment, and the net effect will be much the same as under the original wording, except that the national boards will also have had an opportunity to express the views of their own committees—and that would seem to be perfectly reasonable when each of the national boards has a midwifery committee. This must surely be to the advantage of all concerned, as the national boards, having been obliged to play some part in the preparation of midwifery practice rules, will have to become aware of what is involved and will gain a greater understanding of the unique features of midwifery, which in the long term can only be to the good of midwives.

I think that perhaps there is no need for me to say much more, unless I refer briefly to the Government Amendment to Clause 8, which specifies what is involved in the procedure of consultation so far as the health visiting joint committee is concerned; that is, that when the committee has been consulted on any matter the council or board shall not act until they have received the recommendation of the committee on that matter. The midwifery bodies, including the Royal College, argue that if it is necessary, in the case of the health visiting joint committee, to spell out what is involved in the process of consulting—that is, in Clause 8(3)—it is equally necessary to do so in Clause 4(2) and Clause 7(3), dealing with the midwifery committees, the wording of which is virtually identical. This is an argument which I think it is on the face of it difficult to resist. I do not think there is need for me to say anything more, and I hope I have given a satisfactory answer to the noble Baroness.

Baroness YOUNG

I am very grateful for that reply. It is, I think, a very important matter. Following up the last point that the noble Lord made, there is a difference in fact, as I understand it, between the provisions. The difficulty so far as the midwives are concerned is, if I have understood it properly, that in Clause 7(4) there is in fact no obligation on the national board to forward the views of the midwifery committee to the Central Council, whereas in Clause 8 there is an obligation. In that sense, there seems to be a difference of treatment from one body to another. If there is a difference, perhaps the noble Lord would look at it; and perhaps this again is a matter about which we might consult before the next stage of the Bill, when he will have had the opportunity to take advice on this point.

Lord WELLS-PESTELL

I should be glad to do that, because I am not sure there is really any fundamental difference. I should like to look at the wording and take advice on it.

Baroness MASHAM of ILTON

May I ask the noble Lord to whom the midwifery committee is responsible? I think this is the question, is it not?

Lord WELLS-PESTELL

As far as the Central Council is concerned, there is a midwifery standing committee appointed by the Central Council, and therefore it has some responsibility to the Central Council. But there are, as the noble Baroness knows, four national boards and each of the national boards, for England, Scotland, Wales and Northern Ireland, also has a midwifery committee which will feed its views and observations into the national board. The national board is represented on the Central Council, and there is no reason why the midwifery committees should not feed the midwifery standing committee. So I should have thought that there was ample opportunity and ample scope for the midwifery discussions at the national board level to go not only to the midwifery standing committee but also to the Central Council

Clause 4, as amended, agreed to.

[Amendment No. 7 not moved.]

Clauses 5 and 6 agreed to.

Clause 7 [Standing committees of Boards]:

[Amendment No. 8 not moved.]

4.49 P.m.

Baroness VICKERS moved Amendment No. 9: Page 6, line 4, leave out ("or by the Secretary of State by order").

The noble Baroness said: With regard to the midwifery committee again, I feel that there are too many regulations in this particular clause. First, Each Board shall consult its Midwifery Committee on all matters relating to midwifery …"; and then, the Committee shall, on behalf of the Board, discharge such of the Board's functions as are assigned to them by the Board or by the Secretary of State …". I do not see how they are ever going to get anywhere when they do not know whether their functions are going to be assigned to them by the board, which I think should be the final body dealing with this matter, or by the Secretary of State.

I should like the noble Lord to let me know at what time the Secretary of State might come in and perhaps change, or not agree with, some of the functions which had been agreed by the committee on behalf of the board. Perhaps he could let me know why in this Bill so many functions are undertaken by the Secretary of State by order. I dislike all these Secretary of State orders in so many Bills. It depends upon the Secretaries of State at the time whether they are sympathetic to the objects or not and whether they have enough time to look into all the details. In this Bill there are many clauses which are guarded or finalised by the opinion of the Secretary of State. I should like to ask how Clause 7(3) will work. I beg to move.

Lord WELLS-PESTELL

I think that there is some misunderstanding here. It is not that the midwifery committee, or for that matter (going down to Amendment No.2) the council and each of the boards shall consult the joint committee and so on; this will be the normal functioning of (shall I say?) the committees and the joint committees. It is that the power vested in the Secretary of State to assign functions to standing committees as well as to their parent bodies is there very much as a kind of reserve, a long-stop, as a safeguard for the minority or specialist groups for whom the committee is established. In the case of these Amendments, they are the midwives and the health visitors. It is to be expected that the parent bodies will assign functions to their specialist committees which will have the necessary expertise; and there is no reason to doubt that they will do so.

However, in the unlikely eventuality of a parent body not assigning a particular function to its committee when perhaps it should do so, there would be the possibility of the Secretary of State making that assignment to ensure that the specialist committee has a proper remit. It is merely done to give protection to minority groups who may have certain things that ought to be considered. If the matters that they want considered are not going to be considered by, say, a particular board or joint committee, and the Secretary of State's attention is drawn to it, he can then say: "Please consider this matter". There is no ulterior motive in this. It is a power which I am sure the Secretary of State would be glad not to have to use. But it is important. I am tempted to say that I do not think that the noble Baroness realises how important it is. The Secretary of State should be in a position, if his attention is called to something which affects one of the minority groups within the nursing, health visitors and midwifery organisations—a matter that ought to be considered and which for one reason or another is not considered—to give a direction.

Furthermore, there are so many things going on outside: reports coming out which impinge upon the medical profession and on the nursing professions and which are things that ought to be considered; and if they are not being considered the Secretary of State in the interests of the community could ask for them to be considered. It is a power which I know he himself would hope he does not have to use. It is a good safeguard, first, for the community and, second, for the minority groups. I hope that the noble Baroness in the light of what I have said will feel it desirable that the clause should remain unamended.

Baroness ELLIOT of HARWOOD

I realise and understand what the noble Lord has said, but it could work the other way. If the council want to do something and the Secretary of State did not want it to do so, could the Secretary of State overrule what the council, whether it be the midwifery or the Central Council, recommend? Has he an overruling power? If he has then that seems to me to be rather dangerous.

Lord WELLS-PESTELL

I have read the Bill—not that I understood it after reading it the first two or three times, and I would not pretend to know it fully now—and I know of nothing in the Bill by which the Secretary of State could countermand. The whole purpose is to create a structure (as I said at the beginning) for nurses, midwives and health visitors to do something for themselves about their own professional situation, standing, training and so on. This is all it is about.

Baroness VICKERS

I thank the noble Lord. He said it is something that they can do for themselves. Now we know that the Secretary of State has an overriding power. When he speaks about other legislation perhaps being necessary as the reason for having the Secretary of State involved, I hope that we shall not be having any other legislation in the near future that will affect this Bill. But in view of what the noble Lord has said, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 7 agreed to.

Clause 8 [Joint committees of Council and Boards]:

The DEPUTY CHAIRMAN of COMMITTEES (Baroness Wootton of Abinger)

I have to call the attention of the Committee to the fact that if Amendment No. 10 is agreed I shall not be able to call Amendments Nos.11,12 and 13.

4.57 p.m.

Lord WELLS-PESTELL moved Amendment No.10: Page 6,line 31, leave out subsection (3) and insert— ("(3) The Council and each of the Boards shall consult the Joint Committee on all matters relating to health visiting and shall not act on any such matters before receiving a recommendation of the Joint Committee which shall be made within such period of time as the Council or Board shall specify; and the Committee shall, on behalf of the Council or of any Board, discharge such of the functions of the Council or the Board as are assigned to it by the body otherwise charged with those functions, or by the Secretary of State by order.").

The noble Lord said: I should like to begin by saying that I have been able to discuss this Amendment with the noble Baroness, Lady Young, and also, although I have not been able to discuss it personally with the noble Baroness, Lady Elliot, or the noble Baroness, Lady Vickers, I wrote to them fully on this matter because I think that one can say that we are of one mind on this. This Amendment, which has the virtually unanimous support of the organisations represented on the Briggs Co-ordinating Committee, including those representing health visitors—that is, the Health Visitors' Association, the Royal College of Nursing, and the Council for the Education and Training of Health Visitors—has been introduced to fulfil the commitment given by the Minister of State in another place that if a better form of words could be found by the health visitors or anybody else that was acceptable, it would be written into the Bill.

In fact, a satisfactory form of words has been found; hence the Amendment standing in my name. It will resolve one of the major problems which has faced us in the Bill: the need to give reassurance to, and allay the fears of, health visitors. Health visitors are in a very special position within the nursing professions. Whereas the vast majority of nurses are concerned with curing ill health, the primary role of the health visitors is its prevention. This means that they work in a very different way from their hospital colleagues, and in a way that is not always fully understood by those used to working in hospital environments. This, I think, makes some of them feel somewhat isolated and vulnerable. Throughout the preparations for this Bill they have expressed anxiety that if their training was the responsibility of bodies on which hospital nurses predominated, their special needs for training might not be fully recognised. That is why the Bill provides for a specialist committee—the Health Visiting Joint Comittee—to be established under Clause 8 so that there can be a single source of expertise available to all the new bodies; that is, the Central Council and the four national boards.

However, despite the existence of this expert committee, the health visitors continued to have real and serious reservations. They wanted to be sure that the joint committee would indeed be a powerful body, whose views and advice would be given the greatest possible attention by the parent bodies. This anxiety was, I think, understandable, though I do not think it was justified. However, in its turn it lead to an anxiety on the part of other groups, especially those representing the broad range of general nursing specialties, that the health visitors were seeking autonomy, or at least a right of veto over the decisions of the new bodies, something which would destroy the fundamental, unifying purpose of introducing a new structure. If the new Central Council and national boards did not take the ultimate authority on all matters relating to the education and training of nurses, midwives and health visitors, they argued, what was the point of creating them? Thus, the understandable fears of the health visitors became—and I am not putting it too highly when I say this—a major challenge to the Bill.

That is why I am so pleased that, at this relatively late stage in the Bill's passage, agreement has been reached on the form of words which does not constitute a threat to the supremacy of the new bodies and yet gives health visitors that all-important assurance that their committee has a real role to play. The Amendment achieves this by requiring that the council and boards shall not act on any matter on which the joint committee has been consulted until a recommendation has been received from the committee; and to ensure that work is not unduly delayed by this process, the council and boards are required to specify a period of time within which a recommendation is to be made. Obviously, this will vary according to the subject-matter in hand, and no doubt the council and boards, on the one hand, and the committee on the other, will be able to come to some arrangement if the time initially specified does not prove sufficient. These are matters to be settled between the bodies, and not prescribed in the Bill.

To summarise, the Amendment provides a neat formula which puts beyond doubt the position of the health visiting joint committee, and demon- strates its importance, but leaves the powers of the council and boards unchanged. It has widespread support from those most closely concerned, and I should like to place on record the Government's appreciation of the strenuous efforts that have been made in order to resolve this tricky problem. The professions have, by their willingness to build bridges and reach agreement, enabled us to get this new structure in being and to work together for the future. This fulfils a pledge which my right honourable friend has given all along. I am grateful to all those who participated. On behalf of the Government, I should like to thank the health visitors for their consideration of the matter, and also to thank the noble Baronesses, Lady Young, Lady Elliot of Harwood and Lady Vickers for their co-operation. I beg to move.

Baroness YOUNG

I am sure that I speak on behalf of my noble friends as well as myself in saying that we are most grateful to the noble Lord, Lord Wells-Pestell, for bringing forward this Amendment at this point. It is very gratifying to everyone that it is an Amendment based on agreement between the professionals and one which they are happy to accept. This is the most important point of all about it. We on this side of the Committee are very happy to accept it, and in those circumstances, because the point has been so well met, we shall of course withdraw our Amendments. I am very happy to support this Amendment.

Lord REDCLIFFE-MAUD

May I say on behalf of all those who have been interested in this Bill in a totally inexpert way—in contrast to those who have moved Amendments—that this is an excellent example of how the Government and the various groups which had points made to them (which the Government did not at first seem to have met in the Bill) have collaborated and so have produced the result in which we all rejoice. From these independent Benches I should like to show my admiration for the work which has been done by the groups who put down Amendments, and for the work done by the noble Lord, Lord Wells-Pestell, in making it possible for those groups to come together and to have that extra time which has enabled this result to be achieved. In passing, we in the Committee might pat ourselves on the back, because in the other place they did not find time to get the agreement which, through the collaboration of both sides, has been achieved here.

On Question, Amendment agreed to.

The DEPUTY CHAIRMAN of COMMITTEES

We now pass to Amendment No.14.

5.5 p.m.

Baroness YOUNG had given Notice of her intention to move Amendment No.14: Page 6, line 38, after ("Boards") insert ("in particular a District Nursing Joint Committee").

The noble Baroness said: The substance of this Amendment has been accepted by the noble Lord, Lord Wells-Pestell, so I do not wish to move the Amendment at this stage.

Clause 8, as amended, agreed to.

The DEPUTY CHAIRMAN of COMMITTEES

The Question is, that Clauses 9, 10 and 11 shall stand part of the Bill?

Lord SANDYS

On Clause 11, there is a problem of clarification. I may be incorrect here but I think there is a misprint in the Bill. I should like to draw the Government's attention to what was said on Report stage in another place at col. 488, when the noble Lord's right honourable friend Mr. Moyle introduced an Amendment. It would help both for record purposes and in regard to the Amendment if I repeated his short speech. The Minister said this: I beg to move Amendment No. 35, in page 9, line 8 after 'kingdom', insert 'or elsewhere '.". He went on to say: This amendment is aimed at clarifying an amendment of my honourable friend the Member for Brent, South (Mr. Pavitt) in Committee which I accepted in principle, so as to make crystal clear the conditions under which people from overseas could be accepted for registration in this country. Unfortunately, my honourable friend's amendment was technically defective because it omitted the words 'or elsewhere'. This amendment puts the position right".—[Official Report, (Commons) 7/2/79.] The Minister moved this Amendment in another place but it now, unfortunately, does not appear in the Bill, despite the fact that it was agreed to. I do not know whether the Government would like to comment.

Lord WELLS-PESTELL

I am not in a position to comment. When I get Hansard tomorrow I shall have to read what the noble Lord has said. I shall look at the quotation and write to the noble Lord.

Lord WYNNE-JONES

This point which has just been raised—

The DEPUTY CHAIRMAN of COMMITTEES

The Committee is really out of order. Clauses 9 and 10 have not yet been agreed to and we have jumped to Clause 11. The Question is, that Clause 9 stand part of the Bill?

Clause 9 agreed to.

The DEPUTY CHAIRMAN of COMMITTEES

The Question is, that Clause 10 stand part of the Bill?

Clause 10 agreed to.

On Question, Whether Clause 11 shall stand part of the Bill?

Lord SANDYS

I do not know whether it will assist the Government if I remind them that this was on the Report stage in another place on Wednesday, 7th February.

Lord WYNNE-JONES

Regarding the question of registration of people living outside the country, this is something which can be of considerable importance and it would be of great value to your Lordships if the noble Lord, Lord Wells-Pestell, would explain what the situation is going to be. There must be very many qualified nurses who are living outside the country and if they are not put on the register, if they return to this country their whole position is jeopardised.

Lord WELLS-PESTELL

I am in some difficulty. I cannot reconcile what has been said in regard to Clause 11. I shall look at this and let both noble Lords know.

Clause 11 agreed to.

Clause 12 [Removal from, and restoration to, register]:

Lord SANDYS moved Amendment No.15: Page 10, line 9, leave out from ("constituted") to end of line 10.

The noble Lord said: We turn to the issue raised in Clause 12 as to whether proceedings should be held in public. It is our view that this should not be the case. We believe that the Amendment, as set out, will represent an improvement and that the Government were wrong to make this proposal in the Standing Committee in another place. I beg to move.

Baroness VICKERS

I should like to support the noble Lord, Lord Sandys, on this. I think that nurses are particularly vulnerable to persons making accusations against them. Having been on hospital committees for some years and also now being a member of the League of Friends, I realise that somebody in a mental hospital may make an accusation which is quite unjustified but which has to be taken into consideration. Also, there are people who, when they are not well, feel abused in some way or other and accusations may be made by one individual nurse against another. I think it is unfortunate to have proceedings in public because the Press get hold of such a hearing and it is probably magnified unnecessarily and makes the life of nurses, even if they are acquitted, very difficult indeed. I hope the noble Lord may think that it would be very much better to keep these things out of the public eye. He may say that it has been done publicly before. On the other hand, we have not always had the media or the press so anxious; one remembers several recent incidents in Bristol, and I think it would be much better if things were done by the people themselves and then the results could be publicised. If the person is innocent nothing more need be said, but if they are found to be guilty then the findings can be made public. I hope very sincerely that the noble Lord will consider this, because I believe it would be beneficial for the nurses. They are having a very hard and difficult time at the moment and I do not think we want to add to their difficulties by having this in the Bill.

Lord WELLS-PESTELL

The Amendment would remove the requirement that proceedings for a person's removal from the register should be held in public except in such cases as the council's disciplinary rules may specify. That requirement, if I may remind the noble Baroness, was originally written into the Bill at Report stage in another place in response to an earlier Opposition Amendment. The noble Baroness, Lady Young, referred to this provision in the debate on Second Reading and suggested that disciplinary proceedings for members of other professions were not held in public. That suggestion is not correct in relation to the medical profession. Rules now made under the Medical Act 1956, as amended, require proceedings to be held in public except in so far as the rules provide—more or less the same words as in Clause 12. Where a particular delicate case was to come before the Central Council's disciplinary committee, there is no reason at all why it should not be heard in camera if the rules so allowed, and the rules could allow that. The main grounds allowed under the Medical Act rules for the exclusion of the public are where, in the view of the disciplinary committee, persons involved … would suffer undue prejudice from a public hearing", or where … the circumstances and nature of a case make a public hearing unnecessary or undesirable". The same approach could be taken by the Central Council when they come to make their rules. There is no obligation at all on the Central Council for saying that this proviso cannot be put in. They are free to make their own rules and they can adopt the same rules as are made in relation to the Medical Act, as I say. It could be public for those hearings where it is not going to do, shall I say, unnecessary or undesirable harm, and where it is, it could be heard in camera.

The important point is that by removing the requirement for proceedings to be held normally in public, the Amendment would not automatically lead to all proceedings being heard in camera. The Council would still be left to determine what they thought was best. The disciplinary committee of the General Nursing Council for England and Wales (the principal body currently concerned with standards of discipline and conduct in the nursing profession) at present holds its proceedings in public. There is a strong indication that the profession would wish to see public hearings continue, and there is a strong argument, in such cases of professional discipline, for justice not only to be done but to be seen to be done.

I think the noble Baroness ought to bear in mind that in the last analysis the Central Council can make or adopt rules of conduct, in certain conditions as already appear in the Medical Act, and can decide the kind of thing that must be heard in camera, and other things may be heard in public. I think that from a public relations point of view it would be desirable for that to happen, and that this Amendment should not be pressed.

Lord SANDYS

If my noble friend Lady Vickers agrees, I think it may at this stage be prudent to look at what the noble Lord has said and to make comparisons with the stipulations of the Medical Act 1978. As he rightly says, there is a close comparison and we should like to consider this further. With the leave of the Committee, I would seek to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 12 agreed to.

Clauses 13 to 16 agreed to.

Clause 17 [Attendance by unqualified persons at childbirth]:

On Question, Whether Clause 17 shall stand part of the Bill?

Baroness VICKERS

I should like to ask the noble Lord whether he could explain to me Clause 17(2): … a man who is a registered midwife shall not attend a woman in childbirth except in a place approved in writing by or on behalf of the Secretary of State". I should like to know why this has been put in. I thought now that we had no discrimination and that it had been agreed that men can practise as midwives. It is going to be very difficult to follow this provision. Supposing the woman is in labour and is having her baby and the man is the only person there, how will he get approval in writing from the Secretary of State?

I did not put down an Amendment, but I should like to know the reason for including this. Surely, by now, sufficient men have been trained to be midwives]—I gather that a lot of them are very good at it—and I should not have thought that it was a very practical statement that a male midwife should have to get permission in writing. Women do not always have their babies at an exact time. Will a man have to apply months beforehand? Will he have to send a telegram to the Secretary of State? How will this provision be enacted? I should be very grateful if the noble Lord could tell us why it is necessary to have this subsection in the Bill.

Lord WELLS-PESTELL

I recollect that some considerable time ago—it could be three years ago—I had to introduce some legislation in respect of the training of male midwives, and I believe that it was restricted to two places as an experiment. Subsequently, there were provisions controlling the use of male midwives and what is in Clause 17(2) is merely a continuation of the existing transitional provisions, which were made some time ago. If the noble Baroness looks at subsection (3)(a) of Clause 17, she will see that there are exceptions in cases of urgent necessity. But, as I say, this is merely continuing the provisional arrangements which were made some time ago, with the consent of the bodies concerned, and until this gets off the ground it is considered advisable to continue those provisional arrangements, bearing in mind that under subsection (3) (a) there are exceptions in cases of urgent necessity.

Baroness VICKERS

I thank the noble Lord for what he has said. Does that mean that a man does not have to get permission, if the case is exceptional? It seems to me that three years is rather a long time, and surely, by now, it must be known how many men are trained and how many are capable of undertaking this work. Perhaps the noble Lord could look at this and at Report stage give me a slightly more definite answer, or write to me stating when we are likely to consider bringing male midwives on to the same basis as women midwives.

Lord WELLS-PESTELL

With great respect, this is not really a matter for this Bill. If the noble Baroness wants to know the position of male midwives, and how many there are, that could be answered by putting down a normal oral or written Question.

Clause 17 agreed to.

Clause 18 [Jury service in scotland]:

On Question, Whether Clause 18 shall stand part of the Bill?

Baroness ELLIOT of HARWOOD

I had no idea that midwives serve on juries in Scotland. Do they?

Lord WELLS-PESTELL

I think that the answer must be, Yes.

Lord AUCKLAND

In respect of this rather curious clause, which I must confess I have only just noticed, what is the position of other members of the medical profession, such as physiotherapists, nurses, doctors and so on? Does the noble Lord know whether in Scotland, in England or in Wales there is exemption from jury service? If not, as my noble friend has suggested, perhaps the noble Lord could tell us at the next stage of the Bill why this rather discriminatory provision has been introduced.

Lord WELLS-PESTELL

I understand that this clause is needed to replace the provision of the 1951 Midwives (Scotland) Act. Provision for the exemption of midwives in England and Wales was made in Part III of Schedule 1 to the Juries Act 1974 and in Northern Ireland under the Juries (Northern Ireland) Act 1974. Practising midwives are exempt, because they may be called upon to attend their patients at short notice.

Clause 18 agreed to.

Clause 19 [Finances of Council and Boards]:

5.25 p.m.

Lord PONSONBY of SHULBREDE moved Amendment No. 16: Page 12, line 31, at end insert— ("( ) No person undergoing or seeking training, qualification, examination or certification as a nurse, midwife or health visitor shall be charged a fee under the provisions of subsection (1)above.").

The noble Lord said: Clause 19(1) provides for the Central Council and the national boards to charge such fees as they determine in connection with the training, qualification, examination and certification of nurses, midwives and health visitors. At present, as I understand it, some nurses pay their own examination and registration fees, while others do not. Midwives and health visitors do not pay these fees. The effect of this clause, therefore, is that some nurses, midwives and health visitors will now, for the first time, be charged fees. The Government will say that they are protected, as the terms and conditions of service negotiated by NALGO and NUPE on the appropriate Whitley Council provide for the employing authority to pay the fees, and they will claim that this is a more effective protection than could be provided by an amendment of the Bill.

Inevitably, some part of those fees will go to the administrative costs of the central bodies. Local government officers feel strongly that such costs should be borne by central government or employing authorities, and not by individual employees. As the Boards are being established in the public interest, so that standards can be maintained, it seems only right that the public and not the employees should pay these fees. Local government officers feel that the protection offered by the Government is insufficient. If they are unable to accept the Amendment as tabled, I wonder whether the Government might consider an Amendment along the lines of a guaranteed reimbursement of fees. I beg to move.

Lord WELLS-PESTELL

The Government are by no means certain that this is what the professions, as a whole, want. Behind the Amendment is an essential question of principle; that is, whether or not nurses, midwives and health visitors should as a profession have the right to run their own affairs. The major bodies representing the professions feel strongly that they have that right, and that is a major reason for having the Bill. I suggest that the Amendment is undesirable, because I think that it would, to a very large extent, undermine that principle.

Those who spoke to the Amendment in another place argued that it was wrong for individual members of the profession to be expected to bear the costs of running the new machinery for governing the profession. The purpose of the machinery, it was suggested, was to provide an essential protection for the public against negligence or malpractice by those entitled to practise as nurses. As ultimate responsibility for ensuring that the public has that protection rests with the health authorities who employ the nurses, the costs incurred, it was argued, in registering and disciplining the profession and in seeing that high standards of training are set, should be met not by individual employees but by the employing authorities or by the Government directly. That is the point which my noble friend Lord Ponsonby has made.

The flaw in that argument is that it does away with the basis for any claim made by the profession that they should have the right to control their own affairs. My understanding of the situation is that a very large number of nurses, midwives and health visitors—I shall not say that I am talking about the majority, because I just do not know; we often use the word "majority" when we are not entitled to do so—view this as a kind of independence. It is their show; they want to run it, and they are prepared to pay the dues. It is a principle which is accepted by all other professions.

The proper and more effective way to solve the question of whether and to what extent Government should contribute towards the cost of the governance of the profession is through the Whitley Council negotiating machinery. Through the Nurses' and Midwives' Whitley Council, the Government have already agreed that examination fees incurred by nurses in training should be met in full by their employing authorities on the students' behalf. Similarly, under Whitley Council agreements, health authorities pay 50 per cent. of the cost of student and pupil nurses' index fees. These arrangements are part of the terms and conditions of service of the nurses concerned. It is important to note that the fees, although paid for by Government funds, are in fact charged and credited to the individual nurses concerned. The arrangements do not apply to nurses in the private sector who themselves have to meet the full fees.

If there is concern that the provision in Clause 19(1) allows the Council and boards to charge individual fees without check, it is quite unwarranted. The provision empowers the bodies to charge fees only at such levels and in respect of such matters as the Secretary of State approves. The new bodies do not have a blank cheque, even though the Bill does not state what fees nurses, midwives and health visitors can expect to pay in the future. The Secretary of State is bound to have very much in mind the possible repercussion of any proposals for drastic increases in fees. The whole question of fees, and who pays what, will be some-think which Ministers will in practice wish to watch with considerable care.

Again I have to ask your Lordships to return to the scope, the function and the purpose of the Bill, which is to provide an organisation for the three groups for their benefit so as to enable them to arrange their training procedures, et cetera. In the circumstances, it does not seem to be unreasonable that the Central Council should have the opportunity to charge a fee. I think I am right in saying that at present one has to pay a registration fee, and I do not envisage that the practice will extend much more widely than that.

Lord PONSONBY of SHULBREDE

I accept a great deal of what my noble friend Lord Wells-Pestell has said. I realise that there is an impasse, but I was hoping that my noble friend might be able to say that one could look at the question of the reimbursement of fees by local authorities. I know that the view is that this question is better dealt with through the Whitley Council machinery than by writing it into the Bill. In view of my noble friend's remarks, inevitably I must withdraw my Amendment, but I shall have to consider whether or not to move a different Amendment on a later occasion.

Amendment, by leave, withdrawn.

Clause 19 agreed to.

Clauses 20 and 21 agreed to.

Clause 22 [Central Council rules]:

On Question, Whether Clause 22 shall stand part of the Bill?

Lord WELLS-PESTELL

I think it is necessary to say something about this clause in view of the correspondence that has been received by the Department relating to Clause 22, and in particular subsection (3). The clause is of a technical nature. There is one feature of the clause to which I should like to draw your Lordships' attention, since it represents a significant change from the present position—namely, the requirement placed upon the Central Council, when making rules, to consult not only the national boards—that is obvious and almost goes without saying—but also more widely. Consultation is to cover the representatives of any group of persons who appear likely to be affected by the proposed rules". This consultation would extend not just to professional and other associations but to health authorities. which have a very real interest in any proposals that have resource or manpower implications for the National Health Service.

In the past, there has been criticism that the Service has not been involved early enough in any proposals for change in training which could affect the way that the Service is run. The provision in Clause 22(3) should help to remedy the situation. We should certainly expect the Council to consult health authorities when they are contemplating major developments, but there is a further safeguard for health authorities. The Secretary of State must approve the rules before they can come into effect. I can assure your Lordships that it is not the habit of Secretaries of State to approve anything without consultation beforehand, certainly not in cases like the present one where there could be serious resource implications for the National Health Service. Thus, there are two points at which authorities can have an input and make their views known.

It is our belief that this arrangement will lead to a closer relationship and a better understanding between health authorities and the training bodies for nurses, midwives and health visitors, something which in the long run must be in the best interests of the Service, the professions and the patients. As I have said, we have received a certain amount of correspondence relating to this point which I thought I ought to bring to your Lordships' notice.

Baroness ROBSON of KIDDINGTON

I am grateful to the noble Lord for his explanation, because I was going to ask for clarification of this point. Having heard what the noble Lord has just said, I am somewhat reassured. However, it seems to me that the wording "representatives of any group of persons" cannot possibly include health authorities. It is not "any group of persons" but a particular body, an authority, that has to be consulted. As I say, I feel slightly reassured by the statement that has just been made, but I still have some reservations as to whether or not health authorities should be specifically included here.

Lord WELLS-PESTELL

Perhaps the noble Baroness will allow me to look at this point to see whether we have gone far enough.

Clause 22 agreed to.

Clause 23 agreed to.

Clause 24 [Citation etc.]:

5.39 p.m.

Lord WELLS-PESTELL moved Amendment No. 17: Page 16, line 7, after ("Act") insert ("except section 21(2)(which shall come into force on the passing of this Act)").

The noble Lord said: Clause 21(2) provides for persons who are members of either the General Nursing Council for England and Wales, the General Nursing Council for Scotland, or the Northern Ireland Council for Nurses and Midwives to continue in office after the passing of the Act until the relevant commencement order is made bringing into force the rest of the clause and dissolving these bodies. The amendment to the commencement provisions in Clause 24(2),as your Lordships will appreciate, is a necessary consequence—a point overlooked in another place—and it allows Clause 22(2) to come into force automatically on the enactment of the Bill. I beg to move.

On Question, Amendment agreed to.

Clause 24, as amended, agreed to.

Schedule I agreed to.

Schedule 2 [Constitution et cetera of National Boards]:

5.41 p.m.

Lord SANDYS moved Amendment No.18: Page 19, line 22, leave out ("two years") and insert ("one year").

The noble Lord said: I beg to move this Amendment on behalf of my noble friend Lady Young. In Schedule 2 we are dealing with the electoral scheme under which the Secretary of State has presented to him a situation whereby the boards are properly furnished with members. This is set out of course under Clause 5(1) and the four national boards—three of which, for England, Wales and Scotland have 45 members each and the Northern Ireland Board has only 35 members. As the Bill is drafted all of those have to be presented to the Secretary of State as nominations within two years.

It is our submission that two years is too long a period for this. For instance, if the Bill suggested that it was a period of, shall we say?, three years or more, the natural tendency of any body when originally set up—any major council—would be to say, "We have got plenty of time. Therefore, we shall not, in our initial work, attempt to make these nominations. We shall see how the committee settles down, we shall think about it, and then probably in the last six to nine months of the period to which we are committed"—that is, two years in the case of the Bill—"we shall put forward these nominations". I think the Government ought to give us very concrete evidence whereby the period of two years must be adhered to. We have listened to what the noble Lord, Lord Wells-Pestell, has said on Clause 2, under which the functions of the council are dealt with, and of course it is one of their functions to ensure that the scheme is put forward. We believe it is a great pity if the Government extend the period beyond one year to two, and we hope that they will reconsider this matter. I beg to move.

Lord WELLS-PESTELL

I say this very kindly; I do not think the noble Lord, Lord Sandys, is being realistic about this. When we consider what is involved, I believe it really is a physical impossibility to achieve in one year everything that is set out in this Bill. First, the creation of four national hoards; each of those boards to have its own midwifery committee, its own finance committee; there is a health visitors joint committee, there is the central committee and there is a finance committee of that; there is a standing committee and, as we have discussed this afternoon, there may well be other committees. It is an enormous organisation. This has to be—not planned, because it has been planned—carried into effect. The present bodies have to continue. Once it has more or less taken shape there must be an appreciable hand-over period, and I think it is expecting far too much to expect to achieve that in one year.

Having said that, I should like to make it abundantly clear that the existing provision of two years is a maximum. I do not share the view of the noble Lord that because one sets it at two years people will not move in the matter for some considerable time. From my point of view, there is every reason to suppose that they will because the Secretary of State is personally involved in this, and it is expected—and rightly—that the council will give priority to the preparation of this scheme and will be able to submit a scheme to the Secretary of State in a reasonable period, well within the two-year period.

To insist that the task is completed in one year would cause a lot of difficulties, and it might easily result in an unsatisfactory scheme coming forward for approval. Preparatory work will need to be carried out by chief officers of the new body, and it will not be possible for the necessary staff to be in post and ready for work until some months after the bodies have been established. In arriving at the figure of two years—originally in the Bill and now restored as a result of a Government amendment at the Report stage in another place—I want to stress that advice was sought from the General Nursing Council of England and Wales, the only profession with any experience of preparing an electoral scheme on a large scale. We consulted them and we were advised, although I agree that their electoral scheme is not on so large a scale as will be necessary under the Bill, so that will add some considerable time. Their advice was that it would be unwise to accept a lesser period.

We have taken their advice because we thought it was prudent to do so. They have had experience and that is their advice; that is why I am saying that it ought to be a maximum of two years, but obviously everybody would like to get it out of the way much sooner. I hope that will go some way towards reassuring the noble Lord, and, if I may say so, he is quite right to raise this matter. There has been much evidence in the past as to when this should come into effect, and perhaps sometimes we have not paid sufficient attention to it.

Lord SANDYS

The noble Lord, Lord Wells-Pestell, has been very forthcoming in this particular case in advising your Lordships of the discussions which have taken place outside. In view of the fact that he has given us this information, that it was on the advice of the General Nursing Council and the other important considerations which he has stressed, I think it would be for the benefit of the Committee if I were to withdraw the Amendment.

Amendment, by leave, withdrawn.

Schedule 2 agreed to.

Schedules 3 to 5 agreed to.

Schedule 6 [Adaptations for Northern Ireland and its National Board]:

Lord WELLS-PESTELL moved Amendment No.19: Page 25, line 14, leave out ("and 3,") and insert (",3 and 4,").

The noble Lord said: In moving this Amendment, with your Lordships' permission I should like to speak also to Amendment No.21. These Amendments are of a technical nature, but I can take them shortly. Schedule 6 contains the adaptations to the Bill which are necessary to meet the different constitutional position in Northern Ireland. These Amendments are consequential on Amendments introduced elsewhere in the Bill at Report stage in another place on qualifications of auditors. I beg to move.

On Question, Amendment agreed to.

5.50 p.m.

Lord WELLS-PESTELL moved Amendment No.20: Page 25, line 24, column 1, after ("(5)") insert ("(6)").

The noble Lord said: This is a similar Amendment. There should be a reference in that part of the Schedule to Clause 5(6). Clause 5(6) was added to the Bill at Report stage in another place, but the necessary cross-reference in Schedule 6 was omitted. The Amendment I am now moving makes good that omission. I beg to move.

On Question, Amendment agreed to.

Lord WELLS-PESTELL moved Amendment No.21: Page 25, line 45, at end insert—

("Schedule 4,Paragraph 3.	The Secretary of State.	The Department of Commerce for Northern Ireland.
Schedule 4,Paragraph 3.	Section 161(1)(a)of the Companies Act 1948	Section 155(1)(a)of the Companies Act Act (Northern Ireland)1960".).

On Question, Amendment agreed to.

Schedule 6, as amended, agreed to.

Schedule 7 agreed to.

Schedule 8 [Repeals]:

Lord WELLS-PESTELL moved Amendment No.22: Page 32, line 14, column 3, at end insert ("Schedules 1 and4.").

The noble Lord said: With your Lordships' permission, in moving Amendment No.22 I should like to speak to Amendment No.23 also. These are technical Amendments. They are repeals which became necessary following the introduction of this legislation, which had been overlooked earlier. I beg to move.

On Question, Amendment agreed to.

Lord WELLS-PESTELL moved Amendment No.23: Page 32, line 41, at end insert—

("1967). 80.

The Criminal Justice Act 1967.

In Schedule 3,Part I, the entries relating to the Midwives Act 1951 and the Midwives (Scotland) Act 1951.").

On Question, Amendment agreed to.

Schedule 8, as amended, agreed to.

House resumed: Bill reported with the Amendments.