HL Deb 09 December 1991 vol 533 cc525-33

7.25 p.m.

Read a third time.

Clause 5 [Functions]:

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper) moved Amendment No. 1:

Page 4, line 32, leave out ("the words from "and shall" to the end shall be omitted") and insert ("for the words from "have" to the end there shall be substituted "take account of any difference in the considerations applying to the different professions."").

The noble Baroness said: My Lords, at the Committee stage of this Bill an amendment was tabled which sought to restore to Section 6(2) of the 1979 Act the words which Clause 5 had removed. That amendment was withdrawn upon my undertaking that a Government amendment would be brought forward at a later stage.

At the time I explained that we remained of the view that Section 6(2) of the 1979 Act was not, as it stood, consistent with the new constitution and role of the national boards, given that the new boards will not have a representative function. I did, however, agree that there should be some provision in Section 6 of the 1979 Act, requiring the boards, in discharging their functions, to take into account special considerations which apply to particular groups within the professions, including midwives.

I hope that your Lordships will agree that the amendment before us discharges that undertaking. The boards will no longer be required to have regard to the "interests" of special groups, which is an inappropriate formulation, given their new constitution and role. The existing duty imposed on the UKCC, as the representative body, to have regard to the interests of all groups within the professions, including those with minority representation, will remain, in Section 2(6) of the Act.

Lord Carter

My Lords, I believe the Minister is referring to Section 6(2).

Baroness Hooper

My Lords, I stand corrected. As a result of this amendment the boards will be required to have regard to the different considerations applying to the different professions, which can cover such matters as their respective size, history, tradition, culture, training, knowledge base, style of practice and organisations. I beg to move.

Lord Carter

My Lords, I welcome the amendment and thank the Minister. An undertaking was given at Committee stage that the Government would return with new wording. The Government amendment is a better expression of the rather convoluted amendments I moved at that time to give effect to the real anxieties expressed by the different professions that different requirements were not properly catered for by the original wording. As the Minister said, it is particularly important for midwives and health visitors.

The Minister answered a point that I was about to make. I was intending to ask whether the wording to "take account of in the amendment has the same weight as, shall have proper regard for which is in the 1979 Act. It seems to me that they have rather less weight than the words in the Act. She seemed to say that that was the intention of the amendment. If that is the case, she will have to continue to give reassurance to the minority professions that they are going to be properly looked after. She said herself that to "take account of has rather less importance or less weight than the previous wording, shall have proper regard for". I shall not detain the House now but she may find that the professions including the midwives and health visitors are still asking for reassurance on that point.

Baroness Hooper

My Lords, if that is the case then I am happy to give that reassurance.

On Question, amendment agreed to.

7.30 p.m.

Clause 8 [Proceedings about the register: constitution of committees]:

Baroness Hooper moved Amendment No. 2:

Leave out Clause 8 and insert the following new clause:

Proceedings about the register: procedure

("8.—(1) Section 12 of the 1979 Act shall be amended as follows.

(2) In subsection (2) (committees of the Council to be constituted to hear and determine proceedings about the register) for "hear and determine" there shall be substituted "deal with".

(3) In subsection (3) (constitution of committees dealing with proceedings about the register)—

  1. (a) for "The committees shall be constituted from members of the Council; and" there shall be substituted "The committees need not be constituted exclusively from members of the Council, but the rules shall provide, in relation to committees constituted by them, that there shall only be a quorum if a majority of those present are members of the Council."; and
  2. (b) the remainder of the subsection shall become subsection (3A).").

The noble Baroness said: My Lords, the desirability of this amendment emerged in our consideration of the question of cautions, which is the subject of the next amendment. In that context, we needed to look in some detail at the way in which the UKCC's new preliminary proceedings or investigating committees will operate. I am now advised that Section 12 of the 1979 Act shows signs of having been drafted specifically with reference to the existing arrangements whereby disciplinary proceedings are dealt with by the UKCC only after referral by the national boards. In particular, it appears that the reference in subsection (2) to the constitution of committees to hear and determine proceedings may not be entirely apt to describe the functions of a preliminary proceedings' committee. We have therefore concluded that Section 12(2) could with advantage be modified. As the requirement required is outside the scope of Clause 8 as it stands, a new clause is required to replace it, which is the effect of the amendment. I beg to move.

Lord Carter

My Lords, again, we welcome this amendment. It goes to the point that was raised by my noble friend Lord Desai at Committee stage. As regards subsection (2) of the new clause and the words "hear and determine" which are substituted by the words "deal with", that is presumably a drafting point to give expression to the point that the Minister made. It is not entirely clear that the amendment meets the points raised at Committee as regards consultation between the UKCC and the midwifery committee, for example, and that their cares and anxieties will be taken into account in the constitution of the committees.

I should like the Minister's assurance that this point will be looked after by Section 12(3) of the 1979 Act which states: The committees shall be constituted … are selected with due regard to the professional field in which that person works". Presumably that is enough to satisfy all the professions that their professional interests will be looked after in the constitution of the committees. We welcome the amendment with that slight caveat. As I have said, it gives effect to what we were seeking in the amendment moved in Committee by my noble friend Lord Desai.

On Question, amendment agreed to.

Baroness Hooper moved Amendment No. 3:

After Clause 8, insert the following new clause:

Cautions

(" . After section 12 of the 1979 Act there shall be inserted—

Cautions.

12A.—(1) Without prejudice to the generality of section 12, rules under that section may make provision with respect to the giving, in the course of disciplinary proceedings, of cautions as to future conduct.

(2) Rules under section 12 may also make provision with respect to the keeping by the Council of a record of any caution as to future conduct given in the course of disciplinary proceedings.

(3) For the purposes of this section, "disciplinary proceedings" means proceedings for removal from the register or a part of it for misconduct."").

The noble Baroness said: My Lords, again at Committee stage there was a cross-party amendment which had the intention of enabling the appropriate committee of the council to administer a formal caution in cases where professional misconduct had been established but where the issues were not deemed to be sufficiently serious to warrant removal from the register. The sponsors of that amendment agreed to withdraw it on my undertaking to bring forward a Government amendment meeting the intention of their amendment.

I should say for the record that it remains our view that there is already power to include provision about cautions in the rules under Section 12 of the 1979 Act. As I indicated at Committee stage, we have come to the conclusion that since your Lordships have been so persuasive on this point that it would be perhaps helpful to make this point explicit on the face of the Bill. Therefore, the amendment as drafted reflects the further consideration that we have given and the further consultation which we have had with the officers of the UKCC. I hope therefore that the amendment will commend itself to the House.

Perhaps I should explain that subsection (2) is designed to overcome any possible objection that the recording of a caution is not a procedural matter in relation to the proceedings in which it is given; arguably, it is something which would arise after those proceedings. The potential significance of it relates to later proceedings. I hope that that makes the position clear. I beg to move.

Baroness Cumberlege

My Lords, perhaps I may say how grateful I am to my noble friend the Minister for moving this amendment. As many noble Lords may know, this Bill has afforded me my first experience of amending a Bill and although I would not claim the result of the successful amendment will have earth-shattering consequences for the good of the entire human race, I am convinced that it is in the public interest; that it will make a contribution to ensuring the highest standards in the nursing, midwifery and health visiting professions; and that it will further enhance the efficiency, fairness and the reputation of the United Kingdom Central Council.

I am extremely grateful for the support of a number of noble Lords from all sides of the House; for the precision and quality of advice from the registrar, Mr. Colin Ralph, and Mr. Reg Pyne, the assistant registrar, and the officers of the United Kingdom Central Council. But of course my most heartfelt thanks are due to my noble friend the Minister who from the outset was sympathetic, courteous and encouraging and whose judgment in this matter I believe to be spot on.

I am mindful though of the words of wisdom from the noble Lord, Lord Carter, who himself privately cautioned me by saying "Because you have had this amendment accepted, don't think you will necessarily win successive ones". I am sure that is sound advice. Throughout my childhood I was cautioned by many—not least by my headmistress, who when I left school warned me to keep off the gin until I was 40 as I would need something to fall back on. And I have to say that she was right, and I wish I had! So, as one not unaccustomed to being cautioned, I very much welcome this amendment and say more seriously how grateful I am to my noble friend the Minister for the drafting of this amendment and for the positive effect that this Bill will have in its entirety on maintaining the highest possible professional standards in nursing, midwifery and health visiting.

Lord Carter

My Lords, I am sure that the whole House is dying to know what the noble Baroness got up to at school to produce the warning to keep off the gin until she was 40. This new clause is wholly welcome. At first sight it seems to meet all the requirements that we were seeking at Committee stage. However, I cannot help pointing out that at that stage the amendment was in two lines whereas now we have 14 lines. I suppose that is what happens when you ask a parliamentary draftsman to express the point.

There is one query concerning the wording which I mentioned to the Minister just before we started these proceedings. Subsection (3) of the amendment states: For the purposes of this section, 'disciplinary proceedings' means proceedings for removal from the register or a part of it for misconduct". That seems draconian. It means that removal from the register is the only reason for instituting disciplinary proceedings that presumably relate to serious offences. That would be governed by the wording in Section 12 of the 19 79 Act which deals with removal from the register. Perhaps we cannot deal with the matter in this place, but the other place might look at it. Would it not have been more useful if the Bill had allowed for offences less serious than those meriting removal from the register but still requiring a reprimand or a caution?

The Bill as drafted and amended, and the 1979 Act, seem to cover those offences which are serious enough to warrant removal from the register. There must be offences which in themselves only require a reprimand or caution; they are not serious enough to merit removal from the register. There seems to be no way in which the machinery that will now be set up as a consequence of the Bill and the 1979 Act will be able to deal with what one might call the less serious offences. This occurred to me on reading it just before we came into the Chamber. However, it is a point which the Minister might like to think about and write to me.

Baroness McFarlane of Llandaff

My Lords, I too would like—

Baroness Hooper

My Lords, I understand that the noble Baroness wishes to speak on the Bill do now pass part of our proceedings so perhaps we could deal with this point first. Perhaps I may point out to the noble Lord, Lord Carter, that his anxieties over subsection (3) are met by the words at the beginning of subsection (1), Without prejudice to the generality of section 12". It is always confusing in Bills where one is dealing with two sets of documents. However, my understanding is that that puts the matter in the wider context, which I think is what the noble Lord is anxious about.

Lord Carter

My Lords, with the leave of the House, Section 12 of the 1979 Act is all about removal from and restoration to the register. It states: shall by rules determine circumstances in which, and the means by which … a person may, for misconduct or otherwise, be removed from the register". In other words, it implies that an offence is serious enough in the first place to at least merit consideration for removal from the register. That is the only point.

On Question, amendment agreed to.

Clause 16 [Short title etc.]:

Baroness Hooper moved Amendment No. 4:

Page 7, line 5, leave out ("section 2") and insert ("sections 2 and 14").

The noble Baroness said: My Lords, the transitional provisions dealt with in Clause 14 take into account the fact that the prescribed terms of office of the present council and boards may expire before a new council and four national boards are established and enables those members to continue in office until the appointment of members of the reconstituted council and boards, thus avoiding the need for further elections or appointments to the existing council and boards.

In the interests of continuity, therefore, it is obviously necessary that those transitional provisions come into effect immediately Royal Assent to the Bill is given. That is the intention of this amendment. I beg to move.

On Question, amendment agreed to.

Schedule 3 [Repeals]:

Baroness Hooper moved Amendment No. 5:

Page 12, leave out lines 16 to 19 and insert ("Section 6(1) (e).").

The noble Baroness said: My Lords, this amendment is consequential to Amendment No. 1. Perhaps in that context I can correct the record because the noble Lord, Lord Carter, queried a reference I made to Section 2(6), which is in fact correct because it refers to the relevant duty on the UKCC as opposed to Section 6(2) which confers it on the boards. The effect of our amendment to Clause 5 is to "unrepeal", so to speak, the repeal of Section 6(2) of the 1979 Act which is to be amended rather than to be repealed. I beg to move.

Lord Carter

My Lords, the Minister is entirely correct. It is just a fluke that Section 2(6) and Section 6(2) have the same wording.

On Question, amendment agreed to.

An amendment (privilege) made.

7.45 p.m.

Baroness Hooper

My Lords, I beg to move that the Bill do now pass. We have had considerable debate during the passage of the Bill on the role and functions of the reconstituted UKCC and national boards, in particular on the expectations of the professions in relation to these bodies. In the course of that debate anxieties have been expressed about the representations of the professions on the national boards and, happily, I believe I have been able to give assurances about that. We have also had drawn to our attention the anxieties felt by the midwifery profession in relation to the board's role with respect to that profession and the deep concern that the special position of midwifery should continue to be recognised.

As I said a little earlier, I believe that our amendment to Clause 5 will ensure that the boards do take fully into account the special concerns of all three professions. It is to be hoped that we have been able to allay those concerns.

Another issue on which some anxieties were expressed during the course of the Bill was that of the Government's policy on the funding of nursing and midwifery education and training. I should therefore like to take this opportunity to say again, in the clearest possible terms, that we are committed to ensuring that adequate resources are made available for nursing and midwifery education and training. We are also fully seized of the need to protect the nursing and midwifery education budget and we believe that the strategies that we have adopted in this respect by insisting on regional identification of a clearly defined budget, combined with firm, central monitoring, do provide that protection.

We have also discussed the question of the council's ability to administer a formal caution in cases of professional misconduct. I hope the amendment that has been agreed this evening will satisfy everyone—no mean achievement on a legal issue.

Before I sit down I should like to take the opportunity to thank the noble Lords, Lord Carter and Lord Desai, on the Opposition Benches who have contributed to the consideration of this Bill. I also thank my noble friend Lady Cumberlege and the noble Baroness, Lady McFarlane, and others who are not able to be present here this evening but who I know wish this Bill well. The effect of our discussions has resulted in a Bill which has been improved, as is proper, after its passage through your Lordships' House from the Bill which was first introduced on the 5th November. The improvements to the Bill are certainly in no small measure due to the contributions that have been made and which have concentrated our minds.

Moved, That the Bill do now pass.—(Baroness Hooper.)

Baroness McFarlane of Llandaff

My Lords, I should like to take this opportunity, in supporting the passage of this Bill, to thank the noble Baroness for her kindness and patience in listening to the points brought by Members from all sides of the House. We have been able to modify this Bill in some ways which I believe will be very much in the interests of the professions named in the Bill.

I had wanted to intervene earlier to thank the noble Baroness particularly for the third amendment and the power of caution. That is particularly useful. It will expedite the disciplinary work of the United Kingdom Central Council and be of great value.

However, at this stage I want to thank the Minister particularly for her reassurances on funding. I believe there have been many anxieties about that. I thank her for sending me a copy of the letter she wrote to the noble Lord, Lord Carter, in which she made these reassurances explicit. She talked about the need to safeguard and to put arrangements into place to protect the nursing and midwifery education budget against erosion. That is very necessary. She referred in the letter to the twofold strategy which she outlined to us this evening. The letter states: Our strategy for securing this is two-fold. First of all, we are insisting that Regions identify a clearly defined budget for both pre- and post-registration nursing and midwifery education, and make it clear to all concerned what that budget is". The letter goes on to state that when the Bill comes into effect the resources currently allocated to the English national board for nursing and midwifery tutorial costs will be distributed to regions so that they can be added to their budgets. It is good to have that made explicit. The letter continues: it will be open to Regions to vary them in the light of the sort of changing workforce demands which Baroness Cumberlege identified. However, any such variation will be explicit and transparent—there should be no question of the nursing and midwifery education budget being invisibly eroded in response to service pressures". That is a great reassurance to those who have experience of that very thing happening in nursing education.

The Minister then deals with the power to "vire" between budgets in-year to meet unexpected circumstances of one sort or another. The letter states: Any such 'virement', and the reasons for it, would need to be made explicit and justified to all those concerned … The second element in our strategy is central monitoring by the Department. If regions want substantially to vary—in either direction—the share of their overall resources which they devote to nursing and midwifery education, we shall want to know why. As I said to the House, the exact mechanism for monitoring is still under consideration". That is an important element which we have yet to develop. I wonder how some of these suggestions may fit in when nursing education is more firmly identified with the higher education sector.

I thank the Minister for all her work. With her reassurances, I have no problem in supporting the passage of the Bill.

Lord Carter

My Lords, I thank the Minister. Throughout the passage of the Bill she has been as courteous and helpful as she always is. She has largely met the concerns which were expressed in Committee. We said at Second Reading that the Bill was non-contentious and that we would certainly assist its passage, even to the extent, as the noble Baroness knows, of not having a Report stage. I thank the Minister for the helpful letter referred to by the noble Baroness, Lady McFarlane, which she sent to me and others after the Committee stage. I should like to repeat a few words, as the noble Baroness would expect me to, on the ring-fencing of funding. I congratulate the Minister on the progress made during the passage of the Bill. At Second Reading, referring to ring-fencing, she said: the length of time that the ring-fencing will be in place will be as long as it proves necessary".—[Official Report, 12/11/91; col. 509.] In Committee she said: the current arrangements will continue as long as is necessary".—[Official Report, 26/11/91; col. 1294.] She said that for the first few years it would be reviewed on an annual basis. Then, God bless my soul, she states in her letter—and this should be on the record: But what I can say, in addition to the undertakings I have already given, is that we have no plans for changing the arrangements I have outlined in this area in the foreseeable future". We said at Second Reading that we intended to stiffen the Government's resolution in this matter. It seems that we have certainly been successful. The words "in the foreseeable future" will, I am sure, be quoted to the Minister several times in the future. I should also mention the fact that the noble Baroness, Lady Robson, who cannot be present this evening, was particularly anxious that those points about ring-fencing should be expressed. I conclude by thanking the Minister again. We wish the Bill well as it goes to another place.

On Question, Bill passed, and sent to the Commons.

Viscount Astor

My Lords, I beg to move that the House do now adjourn during pleasure.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 7.55 to 8.25 p.m.]