HL Deb 30 July 1982 vol 434 cc503-7

2.50 p.m.

Lord Trefgarne

My Lords, I beg to move the fourth Motion standing in my name on the Order Paper—namely, that the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (Electoral Scheme) Order 1982 be approved.

Some of your Lordships may be familiar with the setting up of the United Kingdom Central Council and four national boards for Nursing, Midwifery and Health Visiting under the Nurses, Midwives and Health Visitors Act 1979, but I will very briefly go over the background and bring your Lordships up to date on what has happened since the Act received Royal Assent in April 1979, and how the election scheme fits in.

The Act arose out of the report in 1972 of the Committee on Nursing chaired by Professor Asa Briggs—now, of course, the noble Lord, Lord Briggs—which recommended a unified statutory structure for nurses, midwives and health visitors. The bringing together of all specialist interests into one structure should make it possible to identify needs across the board, and to examine the interrelationship between basic and post-basic training. The ensuing Nurses, Midwives and Health Visitors Act 1979 made provision with respect to the education, training, regulation and discipline of nurses, midwives and health visitors, and the maintenance of a single professional register. It does not implement any of the detailed Briggs recommendations on nurses' education and training, but establishes the framework on which future changes can be made. This framework is provided by the establishment of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, and of four national boards, one for each country in the United Kingdom. They will replace the nine existing statutory and other training bodies which will be dissolved under the Act.

The Government see the setting up of the five new bodies as the means of developing the education and training of nurses, midwives and health visitors throughout the four countries of the United Kingdom, and we place a high priority on this task. Most of the Act has riot yet come into force, but the United Kingdom Central Council and the four national boards were set up in November and September 1980 respectively.

With effect from 15th September 1983, each of the national boards will consist partly of members directly appointed by my right honourable friend the Secretary of State and partly of elected members. The elected members will be elected under an electoral scheme proposed by the Central Council and approved by my right honourable friend, and shall, in accordance with the Act, form the majority of each national board. The electoral scheme is being given effect to by the order before your Lordships.

I turn now to the details of the scheme. It is made up of three main elements: the creation of an electoral roll, the securing of candidates and the voting method. The electoral roll has been created on the basis that nurses, midwives and health visitors will be invited to "opt in" to the election scheme. Following a publicity exercise, all nurses, midwives and health visitors will be invited to take part in the election, and their eligibility to do so will be confirmed from existing records. Secondly, on the securing of candidates, the scheme proposes that there should be three categories of candidates; namely, practising nurses, either registered or enrolled; practising midwives; and practising health visitors. It also proposes that the proportion between these three categories should be four practising nurses to one practising midwife and one practising health visitor.

It is also hoped, and expected, that the third aspect of the election, the voting method, will enable the various professional groups to achieve adequate representation. The single transferable vote method was chosen as being the most likely to secure a broad representation, as the experience of the Electoral Reform Society, who have been advising the Central Council on the scheme, had shown. During consultation, considerable support for this system was demonstrated. Should the interests of minority groups fail to secure adequate representation, my right honourable friend would look at the range of experience of the elected members in considering his appointments, and would thus have an opportunity to rectify such gaps in representation.

Finally, the election scheme is designed for the first election only. It will be thoroughly evaluated by the Electoral Reform Society, to assess, for example, the extent to which representative assemblies are achieved, and the evaluation study will consider in time for future elections whether this is the most appropriate arrangement. My Lords, I beg to move.

Moved, That the draft order laid before the House on 8th July be approved.—(Lord Trefgarne.)

2.55 p.m.

Lord Wallace of Coslany

My Lords, I should like to thank the noble Lord, Lord Trefgarne, for his explanation of this order, and assure him that he is on a less sticky wicket than he was in the case of the previous discussion. In general, I would welcome this move; and no doubt the House will probably have the beneficial advice of the noble Baroness, Lady McFarlane, who has had a most distinguished career in the nursing field. This is a body which is partly-elected, partly-appointed. I am wondering how the appointed members will be selected. I assume that the Minister will have a submission of a panel of names from which he can make a choice. I assume that probably some of the non-elected might even he on that list. One of the worrying features of this is the representation of nurses involved in the mental health field which, we know, is rather overlooked and has been neglected for some years. The Minister gave some assurance that any balance would be adjusted when the names are appointed by the Minister.

Another matter which intrigues me is this. I notice that on the nomination paper the date of birth entry is optional. I do not know whether this is an attempt at sexual discrimination by the Government or the Government exercising absolute discretion. One knows that some ladies are a bit sensitive about their age, and some of us males are. That is a light point. I hope that this scheme will work adequately. We have an assurance that it will be monitored. I think it is a step in the right direction. I support the order.

Lord Banks

My Lords, I should like to thank the noble Lord for his explanation and to say that we on these Benches support the order. I rise principally to welcome the adoption of the system of the single transferable vote, and I am glad that the noble Lord has told us that this was felt to be the way in which fair representation could be obtained. I look forward to the Government's adoption of this system in other spheres.

2.57 p.m.

Baroness McFarlane of Llandaff

My Lords, I rise to thank the noble Lord, Lord Trefgarne, for placing this order before the House and to support it. In doing so, I would declare my interests, because I am a member of the United Kingdom Council for Nursing, Health Visiting and Midwifery, chairman of the English National Board and also chairman of one of the boards which will be dissolved as the Act becomes operative—that is, the Joint Board of Clinical Nursing Studies. In these capacities I have been party to the discussions on the electoral scheme before the House, and I give it my full support.

The noble Lord has outlined the background to the 1979 Nurses Midwives and Health Visitors Act which followed closely the recommendations of the report of a committee on nursing chaired by the noble Lord, Lord Briggs. It is in achieving the structural background for the advances in nursing that this electoral scheme is before the House. I think that the profession regard the electoral scheme as being highly important to see that we get representative assemblies. It is important not just to the profession but in the public interest, because the reforms envisaged by the Briggs Report are now long overdue and, as we enter a highly technical age with a modern health service, a service which needs to be highly sensitive not only to the physical needs, but also the phychological and social needs of the long-term sick, the mentally handicapped, mentally ill and elderly people, the proper governance of the profession is in the interests not only of the progress of the profession but of the service of society.

The representative members of the four national boards and the members appointed directly by the Secretary of State to the United Kingdom Central Council, after consultation with the professions, have been conscious that their first responsibility must be to develop an electoral scheme which would lead to representative assemblies and to submit a scheme to the Secretary of State within two years. This has occasioned a great deal of work, and I should like to enlarge on what the noble Lord has laid before us as to the mechanism whereby the scheme has been evolved and the wide consultation that the council undertook in order to achieve this scheme. It had a five-part staging in consulting the professions. First, a working group of the United Kingdom Central Council was set up. This was very ably chaired by Miss Sheila Jack, herself a qualified nurse, health visitor and midwife.

The scheme evolved by the working group was submitted to the four national boards. After consideration and modification by the boards, it went back to the working group for modification and then out to the profession for consultation. The comments of the profession were received back by the working group and the final report was submitted to the United Kingdom Central Council, debated and approved by them. I think that we can say therefore that there was the very widest possible professional discussion before this scheme was evolved, although the conflicting views of special groups in the profession nonetheless have been considered and been given careful consideration.

As members of this House will have heard, after examination of different voting methods it was agreed with very few reservations that the single transferable vote method was that most likely to ensure a broad representation of different interests in the profession. The three professions have a highly complex internal structure with major specialisations such as—as the noble Lord mentioned—psychiatric nursing, mental handicap nursing and district nursing as well as midwifery and health visiting, nursing education and nurse management. Indeed, a piece of research recently carried out in my own department of nursing in the University of Manchester attempted to identify the specialties in nursing as seen by the nurses themselves and by their employers.

My recollection is that over 50 specialties were named and there was no consensus about the bases on which the specialties should be identified. This clearly creates an anomalous situation if the council chose to specify some specialties for reserve categories, and not others. Some, like psychiatric nursing and mental handicap nursing, are long-standing specialties and have held special statutory qualifications for many years. Others, like occupational health nursing and district nursing, were named in the 1979 Act. Still other groups of specialists within the profession—nurse educators and those with special clinical qualifications—have been equally anxious to have reserved places in the electoral scheme for occupational groups within the nursing category.

The position was forcefully put to the council by professional organisations and unions. But the council was of a view that such was the multiplicity of specialist groups within the profession seeking reserve places that it would be almost impossible to administer on an equitable basis, and that any attempt to do so would erode the effectiveness of the single transferable vote in achieving broad representation of interests. So the council reached their conclusion as an attempt to reconcile the wide-ranging and conflicting views of the bodies it consulted.

I have singled out what I believe to be the most contentious decision of the council in respect of the electoral scheme in an attempt to underline some of the reasons for the scheme put forward. I would suggest that the interests of special groups within the profession will be ensured, first, by the single transferable vote and its ability to secure wide representation, and also by the appointment of statutory and other committees for the special educational interests of special groups by the appointments made by the Secretary of State, after consultation with the profession and, in the last resort, by the evaluation of the whole scheme to be carried out by the Electoral Reform Society after the first election. In the meantime, after meeting nurses, midwives and health visitors in many parts of the country, listening to their representations and receiving deputations, as chairman of the English National Board, from mental nurses and speaking to many other groups of interested bodies, I am convinced that the scheme as laid before the House is worthy of support.

Lord Trefgarne

My Lords, I am grateful to your Lordships for your reception of this Motion, and I am particularly grateful for the informed intervention of the noble Baroness, Lady McFarlane. I hope that your Lordships will now approve the order.

On Question, Motion agreed to.