Nursing Homes and Nursing Agencies (Northern Ireland) Order 1985

HL Deb 30 October 1985 vol 467 cc1581-6

12.18 p.m.

The Parliamentary Under-Secretary of State, Northern Ireland Office (Lord Lyell) rose to move, That the draft order laid before the House on 11 th July be approved.

The noble Lord said: My Lords, I beg to move that the Nursing Homes and Nursing Agencies (Northern Ireland) Order 1985, a draft of which was laid before this House on 11th July 1985, be approved. The purpose of the order which is before us this morning is to provide powers under which the use of certain laser techniques in medicine or surgery, including cosmetic surgery, can be regulated. The order will make it possible to regulate these techniques by bringing premises in which they are used within the definition of nursing homes in the Nursing Homes and Nursing Agencies Act (Northern Ireland) 1971. It will also empower the department to specify the type of laser techniques which are to be controlled and to make regulations specifying the records to be kept about laser treatment. This order will put the law in Northern Ireland into line with that of England and Wales.

Over the past few years there has been an increase in the use of lasers for the removal of tattoos. The stronger types of laser are potentially dangerous and those at risk are mainly young people who may wish to remove an unwanted tattoo acquired perhaps without realising that it would not merely fade away. The stronger type of laser which it is intended to control can, in the hands of unskilled practitioners, cause serious damage. This type of damage includes such things as burns to the skin which may need subsequently plastic surgery and can even include blindness. For this reason it is clear that safeguards are necessary in this area of lasers and their techniques.

It is the contention of the Government that the powers in the order before us today are both necessary and, we hope, uncontroversial. The Government also believe that it is right to have them available sooner rather than later and, to minimise delay, the order has been laid in your Lordships' House without a proposal being published. I am sure that your Lordships would agree that in these particular circumstances this is the proper way to proceed. With that, I commend the order to your Lordships.

Moved, That the draft order laid before the House on 11th July be approved.—(Lord Lyell.)

Lord Prys-Davies

My Lords, we are happy to support the provisions of this order which are similar although not identical—and I would wish to emphasise that point—with the relevant provisions to be found in Statutory Instrument 1984 No. 1578 which applies to England and Wales. The order extends the 1971 Act to include nursing homes used for treatment by "a specially controlled technique". Those are the words used in the order. The order goes on to define the meaning of the phrase used. By this phrase, as used in this order, there is meant a

"technique of medicine or surgery … which … may create a hazard for persons treated by means of it or for the staff of any premises where the technique is used".

One must emphasise that this term in this order is given a much wider meaning than that given in the 1984 statutory instrument applying to England and Wales. In Northern Ireland, it seems to me, the net is cast very much wider and it is not clear to me at least why this should be so. Why is it that in the England and Wales order the phrase is restricted to the techniques using laser 3B projects and laser 4 projects. Perhaps the Minister can explain that.

As the Minister has explained, the order also introduces record-keeping requirements in relation to the application ot these techniques and we go along with the requirements. I have not been able to find out how well the current regulations operate in the Province or how great is the mischief which this order is designed to meet; because the order and its background has not been debated on the Floor of the Assembly which is pretty close to the scene of events. We have always valued the debates in the Assembly because they are always based on direct knowledge, information and experience. We are at some loss to understand why this order was not laid in October 1984. I cannot but sympathise with those who are critical of the lack of consultation.

We must always have it in mind that an order which affects the lives of people should wherever possible be the subject of consultation, debate and of question. It should always be subjected to the full pressure of public debate. It seems to me that the department cannot have it both ways. If the department assumed—as I think quite correctly—that there would be universal support for the provisions of this order and that they could therefore proceed without consultation and without the delays occasioned by consultation, why was it not laid before Parliament in October 1984 when the England and Wales order was introduced; or, indeed, in the interval since then? And if, in October 1985, the department can proceed without consultation, then why was the order not introduced in October 1984? Why the delay of 12 months? But having said all that, I am glad on behalf of our Benches that the order has been introduced and it would appear to be altogether right and proper.

Lord Donaldson of Kingsbridge

My Lords, we are happy to support this order from these Benches. I shall be interested to hear the answers to some of Lord Prys-Davies's questions but, irrespective of the answers, I think that we can fully support it. I should like to take this opportunity (which is the first we have had) on behalf of my noble friend Lord Hampton and myself of congratulating the new Secretary of State, wishing him the luck that he will certainly need and expressing the hope that he will be successful in bringing to a satisfactory conclusion the negotiations so well-initiated by his predecessor. Having said that, we are happy to support the order.

Lord Blease

My Lords, I rise in support of the points made about the procedure arrangements by the noble Lord, Lord Prys-Davies, and I join with the noble Lord, Lord Donaldson, in his remarks about the new Secretary of State. There are three matters which I shall be grateful if the noble Lord the Minister will consider in his reply to this brief debate. The first point that I wish to put is this. Will the necessary subordinate legislation arising from this order to effect controls over the use of laser techniques be referred to the Northern Ireland Assembly and to both Houses of the United Kingdom Parliament? Further, what is the likely timescale for the introduction of those regulations?

The second point is this. The order states that the Department of Health and Social Security will have the power and authority to control and register working performance, and to require records to be kept. In practice, who will be responsible? Will it be the Department of Health and Social Security or the health and social service boards? I ask this because I have reason to believe that this division of responsibility and authority at times has given rise to considerable misunderstanding and, I think, inefficiency in the operation of the provisions of the legislation.

The third point on which I wish to ask the Minister a question is this. I understand that consideration is being given to the need to update the legislative provisions of the Nursing Homes and Nursing Agencies (Northern Ireland) Act 1971. From representations made to me and from my own observations and knowledge of the situation I am convinced that there is an urgent need to bring under more strict supervision and control the existing standards, the facilities and indeed the payments being extracted from patients in private nursing homes in Northern Ireland. May I ask the Minister how soon we may expect this amending legislation? With those remarks, I join other noble Lords who have spoken in welcoming this legislation.

Lord Lyell

My Lords, we are grateful to all noble Lords who have spoken on this somewhat technical order together with the more technical points of legislation which have been rightly raised by the noble Lord, Lord Prys-Davies. I stress to the noble Lord and to all noble Lords that the order is fairly short. It has been introduced just now with one specific purpose and that is to provide for the regulation of laser techniques in the removal of tattoos. I am given to understand that the order will enable the DHSS in Northern Ireland the necessary powers; but as to the implementation of those powers and as to who will be responsible, perhaps I may inform the noble Lord, Lord Blease, that I have taken his question on board and hope to be able to inform him about that before the end of the debate. If that is not possible, I shall write in detail to him.

12.30 p.m.

I am very grateful for the support that all your Lordships have indicated for this order. The noble Lord, Lord Prys-Davies, raised several points, one of which was echoed by the noble Lord, Lord Donaldson, as to why the order had been laid in July and debated today. As your Lordships will be aware, this order is being discussed under the shortened form, as it is called, of normal procedure. This is used infrequently. As your Lordships have understood, it bypasses the public pre-parliamentary consultative stage, whereas I understand that normally for an order of this type, the time taken up by the consultation period and a full gap between the discussion of the order and its coming into force is as much as 64 weeks, which is almost 16 months. But the shortened form of normal procedure is authorised by my right honourable friend the Secretary of State only after his very careful consideration. I do wish to assure your Lordships that in the future, as in the past, we shall use this particular procedure very selectively and in accordance with the strictest possible criteria.

We have looked carefully to see whether any lessons can be learned from the unusual chain of events when the order was brought forward from another place. I should like to stress to the noble Lord, Lord Prys-Davies, that fresh instructions have been issued to all the departments involved in Northern Ireland. A key point which I hope all your Lordships will welcome is that in future, where my right honourable friend the Secretary of State approves the preparation of an order under the shortened form of procedure which we are using today, he will at that stage write to the party leaders in Northern Ireland and indeed to the Opposition spokesmen, informing them of his decision and explaining the reason why no proposal is being published at that stage.

The noble Lord, Lord Prys-Davies, also raised the question of lasers and I think he was leading me on to somewhat technical ground. He mentioned a Class 3B laser and a Class 4 laser: whether that is the beam or the ray I am not entirely sure. But the noble Lord has asked this scientific question and I am able to answer him to some extent by telling him that any technique of medicine, or even surgery, which is applicable in this case, I think,—and that includes cosmetic surgery and is specifically targeted towards the removal of tattoos—is intended to be controlled, and the definition of these laser products can be found in Part I of British Standard No. 4803:83, Radiation Safety of Laser Products and Systems.

I am afraid I come before your Lordships without the relevant British Standard but I do not think your Lordships would wish me to go further into the intricacies of this. May I, therefore, let the noble Lord, Lord Prys-Davies, have note of the details? The noble Lord may possibly know the details of the British Standards already but I certainly do not. For that I apologize, and I should like to send details of the Class 3B and the Class 4 laser products to the noble Lord. I think that might be of considerable help to him and certainly it will be to me.

I am given to understand that the particular problem which the order seeks to cure has become apparent within the last twelve months or so. The noble Lord, Lord Blease, may have further knowledge of this and perhaps we may discuss it later, but advertisements have appeared relating to the removal of tattoos and these removals are often carried out in an unsupervised way and by unqualified persons. I understand that tattoos can be removed by these different types of laser products.

A particular welcome for the order was expressed by an honourable Member in another place—I believe he is classified as a "reverend honourable Member"—who recalled that at one wedding ceremony at which he officiated the young man had "I love Barbara" tattooed on his arm whereas in fact the bride's name was Mary. So probably there have been some problems, but that may not be a case which occurred last year. Possibly the methods of removal which have solved this problem came into use during the past year.

We are very grateful to the noble Lord, Lord Donaldson, for his intervention and I shall pass on all his kind words. I personally am very grateful to him for his compliments to my right honourable friend on his new appointment. I am afraid I cannot say what is going on regarding other matters: that will have to wait for another day. But we are grateful for the noble Lord's good wishes and indeed for those of his Alliance colleague. They will certainly be welcomed as well.

The noble Lord, Lord Blease, asked me about the responsibility and I am able to tell him that the health and social services boards will enforce the subordinate legislation. The noble Lord also asked about techniques. These techiques will be defined in a subordinate order on the same lines as the definition in English legislation. This will make it easier for other techniques to be covered should the need arise. That was a point which was first raised by the noble Lord, Lord Prys-Davies.

The other reasons why we were not able to bring forward this order earlier—and this confirms the point I made to the noble Lord, Lord Prys-Davies—was that we were not aware of this problem in 1984. We seized this opportunity of introducing legislation as soon as the potential problem was recognized. I am happy to stress the word "potential", since we are not aware of any grave injuries caused by the misguided use of these laser products, as I think we would call them.

I would assure the noble Lords, Lord Prys-Davies and Lord Blease, that the Assembly will be consulted within the next two or three months on subordinate legislation which would cover these techniques. That will bring us through the late autumn and the early winter. I am also able to tell the noble Lord, Lord Blease, that the 1971 Act is being reviewed to see what changes may be needed.

I hope I have covered all the points that have been raised, but should I have missed any details we will write to the noble Lords concerned. With that, perhaps I may say again that I am grateful for the reception which this order has received from your Lordships.

On Question, Motion agreed to.