HL Deb 27 March 1979 vol 399 cc1473-96

3.4 p.m.

Report received.

Clause 1 [Constitution of Central Council]:

The PARLIAMENTARY UNDERSECRETARY of STATE, DEPARTMENT of HEALTH and SOCIAL SECURITY (Lord Wells-Pestell) moved Amendment No. 1: Page 2, line 4, leave out from ("midwives") to end of line 5 and insert ("health visitors or registered medical practitioners, or have such qualification and experience in education").

The noble Lord said: My Lords, with permission, I shall speak at the same time to Amendments Nos. 6 and 7. These Amendments have been brought forward to meet points raised in Committee by the noble Lord, Lord Smith, when he was supported by the noble Baroness, Lady Young. Lord Smith sought to clarify the position of doctors on the new bodies and he wished it to be put beyond doubt that persons with "qualifications and experience in medicine" would be called "registered medical practitioners"; he thought that that would be better phraseology. Lord Smith made the point that there had always been a special relationship between members of the medical profession and nurses, and that doctors had for a long time been referred to as registered medical practitioners. Having looked at the matter, the Government have come to the conclusion that this would be reasonable and as a result the Amendment is introduced. It will necessitate a change in two other places in the Bill, as represented by Amendments Nos. 6 and 7. I believe this will serve to make the position absolutely clear and remove any doubt. I beg to move.

Baroness YOUNG

My Lords, subject to anything the noble Lord, Lord Smith, may say, I wish to point out from these Benches that we are glad the Government have seen fit to bring forward these Amendments. They meet what I felt to be a weakness in the Bill, in that what was meant by "medically qualified" was never either defined in a definition clause or set out in detail in Clause 1. It seemed necessary that the intention behind the Bill—that the council should include such persons as were clearly meant to be registered medical practitioners—should be clearly stated. I do not know whether what is proposed will meet Lord Smith's complete point, because there is still no guarantee that such a person would be put on the council, but at least it shows that where someone is representing the medical profession, that person will be a registered medical practitioner. I feel this is a major advance on the Bill as we saw it in Committee and we should be happy to accept the Amendment.


I am glad to support the Amendment, my Lords. Until today I had some major anxieties about the Bill and it was apparent when the Bill was discussed in Committee that a number of noble Lords were unhappy too and shared my opinion that there was a flaw, that it should be corrected before the measure was finally passed and that the Bill should give some guidance in relation to what the noble Lord, Lord Briggs, earlier referred to as the key relationship between the medical profession and the nursing profession. In its original form, the Bill did not do so.

In relation to the Central Council, to take an example, the unique help which the medical profession has always given to the nursing profession—it does now and must surely continue to do so in the future—should not be left to the imagination by referring merely to those who, have such qualifications and experience in education, medicine or other fields as … will be of value". That was felt by many to be a somewhat perfunctory reference to medicine, lumping it together, as it were, with anything that might come in handy.

It was not merely that the medical profession was taking umbrage over the fact that its willingness to continue helping the nursing profession should be dismissed in a somewhat cavalier fashion. The medical profession certainly should not seek—and I believe does not seek—any privileged position. As I said to your Lordships on an earlier occasion, to me the only group deserving of privilege is the patients. As the Bill left the position it was possible to comply with the letter of the Bill; to set up, for instance, the Central Council with the Secretary of State's appointments filled by educationalists and those experienced in other fields, without having any doctors at all on the committees. If anyone quarrelled with that, I suppose that under the wording it would have been possible to appoint a couple of vets and to say, "This is veterinary medicine, which is a branch of medicine." Surely it is better that there should be no ambiguity here, and if registered medical practitioners is what is meant, surely the Bill should say so.

Since the Committee stage I have spoken several times with the noble Lord, Lord Wells-Pestell, and he has been good enough to write to me two long and detailed letters on the matter. I wish to thank him warmly for those letters and to say how much I have appreciated throughout this matter his courtesy, consideration and understanding in relation to the point that I was trying to make. I now believe that any difference between us has disappeared. The suggested change in the wording is not merely a change in description. I believe that it will achieve precisely what I have been trying to achieve. It provides guidance, not dictation. It makes clear that the help that the medical profession should give to the nursing profession is distinct from the links between the nursing profession and other disciplines, and it makes it plain by implication that the preservation of this is important if the changes in the education of the various branches of the nursing profession are to succeed.

Personally I experience no pain whatsoever in withdrawing an earlier suggestion that the way to solve the matter would be for the Bill to lay down in advance the precise number of doctors to serve on the various committees: four here, three there, and so on. After all, it is the quality of the advice, not the volume, that matters. I believe that the co-operative approach and the new suggested Amendment make my own Amendment to Clause 1 unnecessary, and so in supporting the Amendment I wish to point out that if the House decides to pass it, I shall not take up time by moving my own Amendment.


My Lords, it ought to be acknowledged that the Amendment is a great improvement to the original Bill, and I hope that all sides of the House will feel that it is the result of most careful and sympathetic consideration on the part of the Government; and as such we all ought to welcome it. The new wording is so wide that where it refers to having: such qualification and experience in education it might also be extended to cover even unregistered practitioners, such as osteopaths, chiropractors, and other so-called practitioners. This is a matter on which many of us would have rather severe reservations, and I take it from my noble friend that such people as I have mentioned are not totally excluded from the Bill.


My Lords, with the leave of the House I wish to point out that at the Committee stage I made it perfectly clear that my right honourable friend the Secretary of State, who will be responsible for nominating people for membership of the Central Council and the boards, has always had every intention of appointing people from the medical profession, now to be referred to in the Bill as "registered medical practitioners". We ought to bear in mind that when the time comes to make the appointments, the Secretary of State (whoever he or she may be) is unlikely to appoint to a body of this kind, people who may not be acceptable to the nurses, midwives, health visitors, and medical profession generally.

On Question, Amendment agreed to.

[Amendment No. 2 not moved.]

Clause 3 [Standing committees of Council]:

3.16 p.m.

Lord WELLS-PESTELL moved Amendment No. 4: Page 3, leave out line 10.

The noble Lord said: My Lords, in moving Amendment No. 4 I wish, with your Lordships' permission, to speak at the same time to Amendment No. 8. As your Lordships will see, the first Amendment is a paving Amendment. The Amendments are intended to meet the commitment I gave during Committee to bring forward Government Amendments, after consultation with the draftsman, to clarify the position of any district nursing committee. Your Lordships will recall that the noble Baroness, Lady Young, introduced Amendments for this purpose in Committee, and I was able to accept them in principle, though I could not accept them as they then stood.

The effect of the present Amendments is to put beyond doubt the problem of district nursing by making it clear that any committee established for district nursing—and Ministers have already promised that there will be such a com- mittee—will be a joint committee; that is, one serving both the new Central Council and the national boards. I hope that the noble Baroness, Lady Young, will feel that we have honoured the commitment and that she will accept the Amendments. I beg to move.

Baroness YOUNG

My Lords, once again I am most grateful to the noble Lord, Lord Wells-Pestell—this time for bringing forward the two Amendments. As the noble Lord rightly said, we debated this matter at the Committee stage, when he undertook that if I withdrew my Amendments he would bring forward Amendments on Report. This matter has been of very great concern to district nurses, and I believe that the two Amendments now before us entirely meet their point; and we are most grateful to the noble Lord.

On Question, Amendment agreed to.

Clause 4 [The Midwifery Committee]:

Baroness YOUNG moved Amendment No. 5: Page 3, line 28, leave out subsection (3) and insert— ("(3) The Council shall assign to the Committee all matters relating to midwifery practice; and the Committee shall—

  1. (a) consider any matter so assigned and report on it to the Council;
  2. (b) where it thinks fit, include in the report recommendations for the making or amendment of rules concerning midwifery practice; and
  3. (c) before reporting to the Council, consult the Midwifery Committee of each of the National Boards.").

The noble Baroness said: My Lords, we are concerned here with yet another matter which we discussed at length at the Committee stage, when the noble Lord, Lord Wells-Pestell, assured me that this was a question about which he felt concerned. I should like to remind your Lordships briefly of the history of the matter. When the Bill was originally published the position of the Midwifery Committee had not been considered, and a provision which came to be known as Clause 4 was inserted in the Bill during the Committee stage in another place. On Report the Government moved an Amendment to delete a subsection of the clause. This has caused great concern to the midwives because they now feel that their position under the Bill is weaker than that afforded to the health visitors and, subsequently, to the district nurses. The midwives feel that there should be a sense of parity between the three groups.

I wish to refer your Lordships to the point at issue. We are concerned that under Clause 4(3) the Midwifery Committee has power only either to amend or to revoke the rules referred to in Clause 15, while Clause 8 provides for the health visitors to be consulted on a whole range of other matters. When I raised this matter in Committee the noble Lord, Lord Wells-Pestell, said—and I refer to column 534 of the Official Report of 13th March: 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 …".

Subsequently, the noble Lord has written me a very long letter on this point, for which, I may say, I am very grateful, but, on reading the letter very carefully, I am not at all sure that it meets the point of the midwives. The letter does not discuss their point, which is that they believe their committee is weaker than that of the district nurses. It merely says that it is a constitutional distinction, and that the committee on the midwives is the only one to be consulted, whereas the district nurses and the health visitors, in their turn, have to consult a number of boards before they can make a report to the full council. It seems to me, therefore, that the letter, although making a perfectly valid point, does not really meet the objective of the Amendment that, with my noble friends, I have put down, nor indeed the very real fears of the midwives.

I believe that we ought not to let this Bill go until we have had an opportunity to hear further from the Government on this matter, because I think it would be unfortunate if at this late stage one party to this Bill felt aggrieved that it was being singled out for treatment somewhat inferior to that meted out to the other sections, the nurses and the health visitors. So it is really on the point of principle, rather than on the constitutional point, that I have put this Amendment down again on Report. I beg to move.


My Lords, as the noble Baroness, Lady Young, has made perfectly clear, we in Government have given a great deal of consideration to this. As she quite rightly points out, I wrote her a very long letter—longer than I wanted it to be, quite honestly—because I felt it was essential that one covered the situation almost word for word. Since then I have been able to have further discussions with my advisers, and at the same time we have consulted legal draftsmen on this, and what I want to say to your Lordships is this. I am advised, and am almost convinced—not having any great legal knowledge at all, I say "almost convinced"—that the wording in the Bill itself is preferable. Two crucial issues are at stake here: the definition of midwifery practice and the lines of communication between the various midwifery committees. It is important to look very carefully at these two points in order to understand why the original wording of this subsection was modified at a later stage during the Bill's passage through another place; because this clause was first introduced in Committee in another place (where, I think the noble Baroness will agree, they gave it a good deal of consideration) and it was felt that any other wording was much more likely to lead to confusion than the wording in the present Bill.

When one comes to think of midwifery practice, this phrase has quite a distinct meaning. It relates to the definition of those tasks and clinical procedures which a midwife can undertake. It does not—and it is important to realise this—mean midwifery training or education, nor the regulation of the profession. It is, in fact, a fairly narrow field, but one vital to the protection of the public. So the midwifery committee which is going to consider midwifery practice will be considering something which is in itself very clearly defined and very limited. As I say, it is important to realise that it does not mean midwifery training or education, nor the regulation of the profession.

If one looks at what functions the Central Council will have in relation to practice, it becomes clear that these are limited to the making of rules on practice under Clause 15, which sets it out very clearly. Supervision of practice is a matter for the council supervising authorities under Clause 16, and the responsi- bility for giving guidance to supervising authorities rests with national boards, as stated in Clause 16(4). Thus, the Central Council's remit in this narrow field is itself narrow. It was therefore thought desirable, in order to avoid any potential misunderstanding and confusion of the remit of the council and boards, to redefine in more accurate terms what it is that the council can assign to its midwifery committee in relation to midwifery practice. As I have already stated, all it can assign are matters relating to making rules. Thus, the wording of the Bill is in substance identical with that of the Amendment as far as the preamble to Clause 4(3) is concerned, with this important difference: that the wording of the Bill is clearer, and eliminates—I say this with great respect—the possibility of confusion. I think everyone, including the noble Baroness, would feel that this is of supreme importance in a Bill.

May I say just a word or two about the lines of communication. I am sorry to take so much time, but I accept what the noble Baroness says: this is an important matter, and we must get it right. This was a point which was discussed in Committee, when it was explained that the present wording of the Bill again represents a clarification of what was originally introduced. It would be quite wrong for a subordinate committee of one body, which is precisely what the council's midwifery committee is, to have a formal relationship with a subordinate committee of another body; namely, the midwifery committees of the national boards, because the Central Council is going to have a widwifery committee and each of the four boards is going to have a midwifery committee. The parent bodies carry the ultimate responsibility for what is done, and must therefore have a general oversight of what their committees are doing; otherwise, there is a danger that their authority will be undermined and that they will not be carrying out their statutory duties responsibly when it comes to formal consultation. It must, therefore, as a matter of good constitutional practice, be conducted between one parent body and another; that is, between the council and the boards.

As I have said, each of the four boards and the council has a midwifery committee; the midwifery committee of each of the boards will report to its respective board, and the midwifery committee of the Central Council will report to the Central Council. It is that kind of communication which I think is likely to be considerably upset if your Lordships adopt the Amendment which is before the House. But, as I said to your Lordships in Committee, this does not preclude informal links, and one must look, not only at what is in Clause 4 but also at what is in Clause 7(4), which requires national boards to seek the views of their midwifery committees when consulted on matters relating to the rules of midwifery practice. Thus, there is a channel for the national boards' committees to voice their views; but it is one of more constitutional propriety than that first incorporated into the Bill.

I feel, therefore, that to accept the Amendment would be a retrograde step leading to potential misunderstanding. I am sure that that is something we all want to avoid. I know that some midwifery bodies prefer the earlier wording —but not all of them. I want to suggest to the noble Baroness that she really is not speaking for midwives as a whole. She is certainly not speaking for the midwives in Scotland. I have personally received a letter from them saying that they want the Bill left as it is. That is the view of the midwives in Northern Ireland. The midwives of Wales have not found it necessary to express a view one way or the other.

If this provision is to be changed, then we ought to be absolutely certain that what is being done is being done at the request of the midwives as a whole. I ask the noble Baroness to think about this. I know that she has done so and will do so again, but really she is not speaking for the midwives as a whole. I do not think your Lordships should accept an Amendment unless you could be given that assurance.

3.32 p.m.


My Lords, the noble Lord has given what I call a purist, almost legalistic, answer to my noble friend; and I suppose one ought to be purist and legalistic when one is putting legislation on the Statute Book, in order that there shall be no misunderstanding. Nowadays, however, particularly in this field, I do not think that the Government ought to ignore the general atmosphere surrounding this matter, the general social conditions and the maintaining of the co-operation of all sections of this great service. I could not help feeling in his very persuasive speech that the noble Lord went a long way towards agreeing with my noble friend. I think there is no question of challenging what it is. He used the word "challenge". I think that what my noble friend would ask him to consider—and it could be done on Third Reading because we can move Amendments in this House at that time —is this. Is there no way of finding words which do not go so far as this Amendment but which reflect the concern that my noble friend has said exists in an important quarter and which the noble Lord himself admitted is there?

The fact of his admitting it was demonstrated by his persuasive suggestion that there will, in any case, be informal contact to do what this Amendment is designed to do. He is recognising the need to have informal contacts, the need for some sort of contact. I should have thought that, if there were some way of introducing into the Bill words which reflect the advance that the noble Lord has made towards my noble friend's Amendment, it would be helpful. I admire his legalistic and purist approach. There is nothing wrong with that; but the wider atmosphere ought to be taken into account. I would ask him, even at this late stage, whether he could not give my noble friend some assurance that he will look at the point again to discover whether some words can be found to be written into the clause which will meet the halfway agreement that seems to have been reached—rather than standing rigidly and using words like "ought not to be challenged".


My Lords, the noble Lord, Lord Harmar-Nicholls, has just put forward a plea for what seems to me to be the formalisation of the informal. He has suggested that the informal discussions described by my noble friend Lord Wells-Pestell would take place and therefore he asks: "Why not put it, in a formal way, into the Bill?" But it would appear that this really strikes at the heart of all informal discussions. If you have informal dis- cussions, then they are much easier and freer than formal discussions. I should have thought, after listening to my noble friend Lord Wells-Pestell, that the argument was rather strong for not having a further step of formal consultation.

The new structure which is proposed here does mean that there will be proper discussion all the way through. It means that when, in the end, the committee makes its proposal to the council, the council is bound to take into account the views of the national boards on which are represented the various midwives' associations. Consequently, one has all the channels of proper consultation. But I should have thought that it was the experience of most of us that the more formal channels we introduce, the more delay occurs and the more difficulties arise—because, somewhere or other, someone who has had already his or her opportunity to make a case will cone up through this new channel and re-make the case and will perhaps be able to delay proceedings still further.

My Lords, after reading the Bill—and I do not claim to be in the slightest degree an expert; but I have taken the trouble to look at the Bill—it seems to me that the Bill provides all methods of sensible communication. In fact, I should have thought that the risk may be that it has already too many channels of communication. To bring in one more channel would merely tend to make the whole proposed machinery very cumbersome—not unworkable; no machinery is ever unworkable unless people refuse to make it work. But the machinery can be troublesome and the introduction of any fresh stage into what is already a fairly complicated procedure would be undesirable.

Baroness YOUNG

My Lords, with the leave of the House, if I may reply to noble Lords who have spoken and, in particular, the noble Lord, Lord Wells-Pestell, I am grateful for that lengthy explanation on this Amendment. On this constitutional point he has made it much clearer that if Clause 4 (which deals with the midwifery committee) is concerned only with midwifery practice, then one can see that the way Clause 4 has been drafted is much clearer than was the original drafting of this clause and which my Amendment would put back into the Bill. That I absolutely accept. But what he said to me that is extremely important—and which I accept that I had not fully understood before—was that this clause is concerned only with midwifery practice. I had thought that the midwifery committee was a committee designed to look after midwives and, in particular, their education and their training. But the noble Lord has made it clear that they are not to be consulted about education or training—which, I would remind the House, is, in fact, the purpose of the Bill. It seems to me that we have clarified a point which has not come out before.

On the point about who is satisfied, I accept that some of the midwives are satisfied; and I am very pleased that that should be the case. I am not, at this particular moment, speaking on behalf of all midwives, but I can say that I have had about 30 letters on the subject all of which are from groups of midwives who are dissatisfied with the Bill as it now stands. In view of the fact that there seems to have been certainly a basic misunderstanding about this point, which I believe is a matter of principle, I would be prepared to withdraw my Amendment and to consult further, with the idea of bringing forward (if I thought it necessary and in consultation with my noble friends) a further Amendment at Third Reading. I think it is very important to get this right. What I should like to say to the Government, because I think it is important, is that the real fear of midwives that they are not going to be consulted about their education and training should be met. We ought to have an appropriate way to do this or an assurance that this is going to take place. In those circumstances, I would withdraw this Amendment, seek further consultations and possibly come back with an Amendment at Third Reading.

Amendment, by leave, withdrawn.

3.40 p.m.

Clause 5 [Constitution of National Boards]:

Lord WELLS-PESTELL moved Amendment No. 6: Page 4, line 33, leave out ("or health visitors") and insert ("health visitors or registered medical practitioners").

The noble Lord said: My Lords, I spoke to this Amendment when moving Amendment No. 1. I beg to move.

On Question, Amendment agreed to.

Lord WELLS-PESTELL moved Amendment No. 7: Page 4, line 35, leave out ("medicine").

The noble Lord said: My Lords, I spoke to this Amendment when moving Amendment No. 1. I beg to move.

On Question, Amendment agreed to.

Clause 8 [Joint committees of Council and Boards]:

Lord WELLS-PESTELL moved Amendment No. 8: Page 7, line 3, at end insert— ("( ) There may in particular be constituted under subsection (4) a joint committee to be concerned with district nursing.").

The noble Lord said: My Lord, Is spoke to this Amendment when moving Amendment No. 4. I beg to move.

On Question, Amendment agreed to.

Clause 10 [The professional register]:

Lord WELLS-PESTELL moved Amendment No. 9: Page 8, line 35, leave out subsection (8) and insert— ("(8) Orders under subsection (2) may, by reference to the part or parts in which a person is registered, prescribe the more advanced qualifications which he must have in order to be treated as a qualified nurse for the purposes of any particular enactment or instrument.").

The noble Lord said: My Lords, in moving Amendment No. 9, with your Lordships' permission I should like to speak also to Amendments Nos. 12, 13, 14, 15, 16 and 17. The effect of these Amendments is to remove from the Bill the expression "fully qualified nurse" which gave rise to considerable debate in another place, and to replace it by "qualified nurse", the term which, after full consideration of many alternatives, was adjudged to be the most suitable, and which I gather will not give offence to the nursing profession.

Perhaps I could explain briefly what the problem is, why we need an expression of this kind at all, and why the one selected for the Bill as drafted met with such opposition. For certain purposes, for example, the Medicines Act 1968, there are certain functions—in that case the custody of drugs—which can only be carried out by a registered nurse; that is, SRN or equivalent. But once the present Bill becomes law, all nurses, regardless of the type of training that they have had and for what purposes they had that training, will be registered nurses because they will go on a register. We have to find another term which will describe the nurse with the more advanced level of qualification. Under the Bill, as your Lordships know, all nurses, whether they are mental nurses or state registered nurses, all with different types of training at different levels, will become registered. So we can no longer use the term "state registered nurse". It is questionable whether we should have ever have used the word "state", but that is another matter.

The term selected, "fully qualified nurse", was disliked by the nursing profession because the word "fully" carried with it the implication that all other nurses were not fully qualified at their appropriate level. My right honourable friend the Minister of State, anxious to meet the desires of the nursing profession, went to great lengths to find a suitable alternative. It was not easy. Advice was taken and a number of people were consulted. The combined efforts of all concerned have resulted in this alternative being devised, and the references in the Medicines Act and other legislation mentioned in Schedule 7 will be amended from "registered nurses" to "registered and qualified nurse", it being understood that the requisite qualifications will be spelt out in orders to be made under Clause 10(8) of the Bill before your Lordships. I trust that this explanation, although a brief one, will have helped your Lordships to understand the purpose of these Amendments and that the solution will be welcomed, not only in your Lordships' House but also elsewhere. I beg to move.

Baroness YOUNG

My Lords, there was considerable discussion about this particular point in the Committee stage in another place and we on this side of the House welcome these Amendments brought forward by the noble Lord, Lord Wells-Pestell. I agree with him, the use of the term "fully" applied before some kind of a qualification is open to doubt; it suggests that some nurses are not properly qualified. The word "fully" is much too loose a term when applied to a qualification. It should not be written into a Bill. Therefore these Amendments make the intention of the Bill much clearer and we are glad to support them.


My Lords, during the Committee stage of this Bill, I raised a point which seems to be germane to this Amendment. I asked what was going to happen first to the description, "state registered nurse" and, secondly, to "state enrolled nurse". It seems to me that the position of the state registered nurse will be fully covered under the new orders that are to be drafted; but what will be the position of the state enrolled nurse? Probably the difference between the two is the same as the difference between a second lieutenant and a company sergeant major. We should like to know whether anything derogatory of the state enrolled nurse is to be applied to her under the new terminology that is to be introduced. What will the state enrolled nurse be known as? She will be known as a registered nurse, as the SRN is known as a registered nurse; but what other qualifications either in brackets or subordinate to the term "registered nurse" will be used?


My Lords, one of the main purposes of this Bill is to keep a register of all nurses. Those of your Lordships who are familiar with the Briggs Report will know that it is suggested that all nurses should undergo a basic training, and that should last for 18 months. At the end of 18 months they will have been given sufficient training and competence to enable them to do a certain degree of nursing. "Certain degree" is my phrase, and is not from the Briggs Report. They will then be enabled to register as nurses. Those nurses who want to go on and take further training with a view to getting added skills will be able to do so for up to a further 18 months. Some will want to specialise perhaps in mental nursing; others in different forms of nursing.

They will then be enabled to be known as a registered mental nurse or something of that kind depending upon which branch of nursing they are in. The basic training will enable persons to become nurses, but whether at the end of the 18 months' period they will be entitled to be known and registered as nurses with these added skills is doubtful. I think I am right in saying that the present state registered nurse, because she is a state registered nurse has undergone training for three years, can handle drugs and administer them under supervision. The state enrolled nurse, who has a training period of only two years, is not permitted to do that. The effect of the recommendations from the Briggs Report is that all nurses will have the basic training and then if they want to specialise in other fields they will be able to do so.

On Question, Amendment agreed to.

Clause 19 [Finances of Council and Boards]:

3.50 p.m.

Baroness ELLIOT of HARWOOD moved Amendment No. 10: Page 13, line 10, at end insert— ("(6) Where duties or functions under this Bill are carried out by a Joint Committee, finances shall be made available by the Central Council and National Board for these purposes.").

The noble Baroness said: My Lords, the purpose of this Amendment is to make clear within the Bill that if duties and functions are to be allocated to a joint committee by the Central Council and national board, these bodies receiving the monies, finance shall be made available to such a committee to enable these functions and duties to be carried out. To illustrate the point, I should like to quote from the Minister of State, Mr. Roland Moyle, speaking in Standing Committee B in the House of Commons on 14th December 1978 about the work of the education and training of health visitors. He said this: I endorse every word of my honourable friend the Member for Brent South (Mr. Pavitt) about the work which the Council for the Education and Training of Health Visitors has carried out since it was created in 1962. It has been excellent work and, in fact, when I last met the health visitors I was so impressed by the work done by the staff of the Council that I said I was sure that arrangements could be made to ensure that the staff would move over in a body to the health visitors joint standing committee to carry on their good work based on their experience. Therefore, I yield to no one in the admiration that I express for the work of the Council for the Education and Training of Health Visitors and in my support for the continued expansion of health visiting. I believe I have done enough to show that it has a very important role to play in the future Health Service".

Those are words of very high praise concerning the training and education of health visitors. Obviously, it will mean a certain amount of expenditure and finance in order to carry on the new system of training of health visitors and indeed the other training work which is required. Without the funds to do that, a joint committee would be virtually unable to function and the National Council for the Education and Training of Health Visitors is rather afraid that this Bill might result in a lowering of standards in the education and training of health visitors, unless it is possible to see that the standards of training are maintained and indeed improved.

It is therefore necessary that there should be some provision to make sure that there can be a continuance of this training, and also of training in other spheres, and that it should be provided by the Central Council and the national board. I hope very much that the noble Lord, Lord Wells-Pestell, will consider this as simply dotting the i's and crossing the t's of what really ought to happen. I hope very much he will feel he can accept this Amendment, which is purely intended to make it quite clear that the training and education of health visitors will be carried out in the best possible way under the Bill. I beg to move.

Baroness VICKERS

My Lords, I should like to support what has been said by the noble Baroness, Lady Elliot, because this is going to entail a great deal more work for the nurses concerned. We are going to have all these committees, which I gather add up to about 80 meetings a year, and a possible attendance could be 563. I gather the average attendance is about 17.29. This is probably going to entail considerable expense to many nurses to get to these meetings. They are very independent people who have always financed themselves up to date, but with all this extra work being added they are rather nervous that they may not be able to carry on as they have done in the past, because included in the number of meetings are of course the advisory committees for Northern Ireland, Scotland and Wales.

Furthermore, I gather that many nurses may have to attend the Finance and General Purposes Committee and also the Joint Staff Consultative Committee. As I understand it, the average attendances at these meetings, for health visitors alone, on the figures that I have, is about 15.8 attendances a year. Even if these bodies meet only four times a year, this would increase the demand by 24 and that would give a minimum requirement of 39.8 meetings each year. This is speaking of attendances relating to only 26 members, speaking for health visitors. Therefore, I think it would be very advantageous if we could have some reassurance that if the expenses are very large there would be a possibility of assistance under this Bill. I am not suggesting that we should decide exactly on what they should get on this occasion, but I suggest that there should be some financial aid so that these nurses in various sections could carry out their duties as well as they wish to and as well as has been done in the past. I should like to support this Amendment.


My Lords, what is wanted by both noble Baronesses who have just spoken is clearly set out in Clause 19. Where a joint committee carries out a function of either the board or the council, finances for those activities would be given to the committee in question by the council or the board. This is exactly, as I say, what appears in the clause itself. If your Lordships would turn to Clause 19, you will see that it deals with the finances of the council and the boards and sees that they have the resources to carry out their responsibilities. In Clause 19(4) it says this: The Council shall reimburse the Boards in respect of expenditure incurred by them with the former's approval in so far as that expenditure is not defrayed by fees received by the Boards or funded by the Secretary of State with grants under subsection (3)". It then goes on to say in subsection (5): Any sums required by the Secretary of State for making grants under subsection (3) shall be paid out of money provided by Parliament". The fact that the council or a national board decides to assign specific duties to a joint committee, or for that matter to one of their own committees, does not vitiate their ultimate responsibility for seeing that that duty is carried out. They are therefore responsible for ensuring that the committee to which they have assigned a duty has the necessary means to fulfil its obligations; otherwise they would be open to the challenge of not complying with the duties placed on them by statute.

To take a specific example, if a national board assigned to the Health Visiting Joint Committees responsibilities under Clause 6(1)(b) of ensuring that health visiting courses within that country met the standards laid down by the Central Council as to the kind and content of training—something which one would indeed expect to be assigned to a specialist committee—that national board would then have to make sure that the committee had the financial means to carry out its assignment.

One cannot put in any Bill, if I may say so with the greatest respect, words and sentences to cover every kind of expenditure. One would have then to put in about rates, rent, lighting and heating. All this is covered by the responsibility given to the boards in this case to assign certain responsibilities to their sub-committees because each board has a finance committee. The Central Council has a finance committee, and it is their job, when they assign things to other committees, to see that they have the means to carry out what is assigned to them.

I hope this serves to reassure both the noble Baronesses who have put down this Amendment that this is really covered. No mention of joint committees is needed because the processes they have in mind are implicit in the way the Bill is constructed. The parent bodies must finance their own joint committees and, equally, they must finance their share of joint committes. Once the Amendment was put down, I took advice on it, and I am advised by Parliamentary draftsmen that the provisions in the Bill do meet the situation. To add what both noble Baronesses have in mind would be rather superfluous, if I may say so.


My Lords, might I ask one brief question? I am not sure whether it is strictly relevant to this Amendment, but I should like to know whether the accounts of this particular QUANGO are open to inspection by the Public Accounts Committee of the House of Commons.


My Lords, this is not a QUANGO, and I am sure that the nurses, the midwives and the health visitors would take a very poor view if it went out from your Lordships' House that this was a QUANGO. This is a body which is responsible for registering some of the most important people in the community, and for seeing that they get training and so on. Its accounts will certainly be available to members of the public and, as it will receive money from the Government—I do not know how much, at this stage—it will certainly be accountable for the way it spends that money.


My Lords, I was rather interested in the noble Lord's reaction to the word. Is there something disreputable about being a member of a QUANGO? If the midwives would find it objectionable to come under that umbrella term, what about all those eminent people who have been put on the various QUANGOS? We thought that their job was to be applauded. T think that the reaction showed some kind of conscience, such as I should like to see the Government show on other occasions.


My Lords, with the leave of your Lordships, I do not think that the noble Lord is in a position to make any comment about my conscience. I reacted as I did, as a result of the way in which his noble friend mentioned the word "QUANGO". I know that it is open to a certain amount of criticism, but it would not be fair to apply it to this Bill.

Baroness YOUNG

My Lords, as I have taken a certain amount of interest in the subject of QUANGOS, may I say that, had I thought that we were establishing a series of them, I am not so sure that I should have been prepared to vote for the Second Reading of this Bill, let alone its continuation. But I should just like to press the noble Lord a little on the Amendment of my noble friends Lady Elliot and Lady Vickers. As I understand it, he has argued that it is implicit in Clause 19 that money will be available for the expenses incurred by joint committees set up under this Bill, although Clause 19 does not in any of its subsections refer at all to a joint committee. It is very important that this should be understood, because it does not seem to me that the expenses of a joint committee can be bracketed with things like rents, rates and lights which are administrative matters.

As I understand it, we are referring to the kind of expenses that would, as a rule, be covered by fees—for example, examination expenses and expenses incurred over qualifications, which would include committee meetings—and not the other kind of expenses. It is essential that we should be assured that members of the joint committees will be treated in exactly the same way as members of either the Central Council or the national boards.


My Lords, with your Lordships' permission, may I say that I think the noble Baroness is being unduly difficult about this. She knows, as well as I do, that this is a joint committee of the council and the boards. It is set up by both of those bodies with a very definite responsibility, which is laid down. If it is assigned anything by the boards or the Central Council, it has to do what is required of it, and it is obvious that it must have the financial means to do it if money is involved, as it will be.


My Lords, I should like to thank the noble Lord very much for the clear, concise and satisfactory reply which he has given to the Amendment which I put forward. It is important to get down in our report what the noble Lord has said, so that it reassures the many different organisations of the nurses and the professions that they will be covered, because, naturally, it would be very frustrating if they found that they could not meet the expenses. But the noble Lord has given us this assurance. I share his view that this is one of the most important and valuable Bills that we have had before the House for quite a long time, and I am delighted to hear what he has had to say.

I shall not press the Amendment and I intend to withdraw it, but I am sure that the health visitors and others who read the report of our debate will feel satisfied that their anxieties will be met. I am sure that we all want to thank the noble Lord for the fact that during the passage of this Bill he has been so co-operative, so helpful and so anxious to make this Bill into something not of a political nature, but something which will help the whole nursing profession. My Lords, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 24 [Citation, etc.]:

4.6 p.m.

Lord WELLS-PESTELL moved Amendment No. 11: Page 16, line 7, after ("section 21(2)") insert ("and this section").

The noble Lord said: My Lords, this is a technical Amendment which rectifies an earlier omission. It ensures that this clause, which specifies how the various parts of the Act are to be brought into force, is itself operative from the moment when the Bill passes into law. Without it, it would not be possible to implement the different provisions within the Bill. My Lords, I beg to move.

On Question, Amendment agreed to.

In the Schedules:

Schedule 7 [Amendments of enactments]:


moved Amendments Nos. 12 to 17 en bloc:

Page 27, line 6, leave out (""fully") and insert (""registered and")

Page 27, line 8, leave out (""fully") and insert (""registered and")

Page 27, line 19, leave out (""fully") and insert (""registered and")

Page 27, line 21, leave out (""fully") and insert (""registered and")

Page 27, line 40, leave out (""fully") and insert (""registered and")

Page 28, line 34, leave out (""fully") and insert (""registered and").

The noble Lord said: My Lords, I spoke to Amendments Nos. 12 to 17 inclusive when I moved Amendment No. 9. With your Lordships' permission, I should like to move Amendments Nos. 12 to 17 en bloc. My Lords, I beg to move.

On Question, Amendments agreed to.

Lord WELLS-PESTELL: moved Amendment No. 18: Page 29, line 36, at end insert— ("Interpretation Act 1978 (c. 30) 29A. In Schedule 1 to the Interpretation Act 1978 (words and expressions defined) at the appropriate place in alphabetical order insert— Registered" in relation to nurses, midwives and health visitors, means registered in the register maintained by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting by virtue of qualifications in nursing, midwifery or health visiting as the case may be.").

The noble Lord said: My Lords, this is a technical Amendment, which is designed to rectify a previous omission by incorporating into the Interpretation Act 1978 a definition of "registered", in relation to nurses, midwives and health visitors. My Lords, I beg to move.

On Question, Amendment agreed to.