Nurses, Midwives and Health Visitors Bill [H.L.] (Hansard, 12 November 1991)

§ Baroness Hooper

My Lords, I beg to move, that the Nurses, Midwives and Health Visitors Bill, which was introduced in this House on 5th November, be now read a second time. The main purpose of the Bill is to change the constitution of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) and the four national boards for nursing, midwifery and health visiting.

I remind your Lordships that the UKCC is the statutory body for the nursing professions in the United Kingdom responsible for establishing and improving standards of training, maintaining a register of qualified practitioners, and determining whether a practitioner should be removed from the register.

483 The national boards currently have responsibility for approving courses for nurses, midwives and health visitors, enabling them to qualify for registration; approving post registration courses for those already on the register; ensuring that such courses meet the requirements of the central council; and carrying out initial investigations in cases of alleged misconduct. The Bill will change the constitution of the central council from a body the majority of whose members are appointed by the Secretary of State to a body the majority of whose members—some two—thirds-are elected by the professions to whom they are responsible. At the same time it will change the constitution of the four national boards for nursing, midwifery and health visiting from elected to appointed bodies.

In line with the principles of the NHS reforms, the role of the national boards in managing and financing the provision of nursing, midwifery and health visiting education and training will be devolved to health authorities, except in Northern Ireland where existing arrangements will continue to apply. It will also centralise all professional conduct investigations at the council, avoiding duplication of effort and rationalising this important function.

The proposed changes are the result of recommendations arising from a review of the central council and the national boards commissioned by the four United Kingdom Health Departments and carried out between December 1987 and March 1988 by Peat Marwick McLintock, as part of the regular Treasury programme of reviews on non-departmental public bodies

In the event, the review team produced a radical set of recommendations, the general tenor of which I have already outlined. It is that change in the administrative and organisational arrangements of the statutory bodies for nursing, midwifery and health visiting which the Bill seeks to implement. The fundamental principle of professional self-regulation is not being called into question. Indeed, the proposed changes will, we believe, strengthen it. For that reason the amending legislation which is laid before your Lordships is generally agreed to be non-controversial.

The Peat Marwick McLintock report was issued for consultation to the nursing profession in August 1989 and the formal consultation period ended in February 1990. Subsequently, there was a wide range of informal discussions between the health departments, the statutory bodies and representatives of National Health Service management to try to establish the maximum consensus on the way forward.

Following the announcement which my right honourable friend the Secretary of State made in the other 'place on 4th February 1991, the Legislation Advisory Group was established and given the remit of considering what changes would be required to the Nurses, Midwives and Health Visitors Act 1979 in order to give effect to the government decisions on the Peat Marwick McLintock recommendations; that is, to alter the roles of the five state nursing bodies.

The Legislation Advisory Group comprised representatives of the four United Kingdom health departments, the UK Central Council and the 484 national boards. It has had several very productive meetings since it was established in March 1991, and has achieved near unanimity on all details of the proposed legislation. The nursing, midwifery and health visiting professions have been involved at all stages of our deliberations and their contribution has been both constructive and valuable. I take this opportunity once again to thank all the participants for their hard work.

The details of the provisions in the Bill are clearly outlined in the explanatory memorandum. Therefore I will not elaborate on them all at this stage, although I shall be happy to expand on my opening remarks if so requested during the course of the debate. However, I shall make particular mention of Clause 1. It increases the maximum membership of the central council from 45 to 60 and specifies that two-thirds of the membership shall be elected (rather than appointed as at present) under an approved electoral scheme. The remaining members are to be appointed by the Secretary of State, bearing in mind the need to secure that the members of the council shall include representatives of the three professions of nursing, midwifery and health visiting, and also representatives from all parts of the United Kingdom. The council is to have a president and a vice-president appointed by the council from among its members.

The increase in the maximum membership takes into account the increased workload which will be placed on members by the future role and responsibilities of the council, in particular the centralising of all professional conduct investigations at the council. The fact that the majority of members will in future be elected by the professions to which the council is answerable reinforces the principle that the nursing, midwifery and health visiting professions should be fully self-regulating.

I move to another important aspect of the Bill contained in Clause 4. It provides for the non-executive members of a national board to be appointed by the Secretary of State rather than elected, as at present. In future the national boards will be smaller executive bodies with a more limited role and function, directly accountable to the Secretary of State. As regards executive members, the clause provides for certain officers appointed by the boards to be ex-officio members of the boards. It further allows for remuneration, pensions, allowances and gratuities to be paid by the Secretary of State (with the consent of Treasury) to members of the boards appointed by him. Finally, it gives the Secretary of State power to make any further provision with respect to the constitution and administration of the boards as he thinks fit.

Clause 5 amends the functions of the national boards by specifying that they shall approve institutions which provide courses of training for nurses, midwives, and health visitors rather than providing or arranging for others to provide courses at institutions which they have approved. The latter function will in future be discharged by health authorities, except in Northern Ireland where Clause 5(3) ensures that the role of the national board can continue as at present. The amendment reflects the 485 intention to permit the transfer for funding for the education and training of nurses from the boards to health authorities and health boards, where it is considered more appropriately to lie. The clause also removes from the boards their disciplinary investigation function, so that professional conduct matters will in future be the sole responsibility of the council. Finally, it removes a now superfluous requirement on the boards, in the discharge of their functions, to have regard to the interests of all groups within the professions, including those with minority representation. That last amendment is consequent upon the fact that the boards are required to exercise their amended functions in accordance with the rules of the council, which is itself required to have a proper regard for all such interests.

Those are the clauses which contain the main changes the Bill is to bring about. I believe that the Nurses, Midwives and Health Visitors Bill is a non-controversial piece of legislation. It will not, overall, lead to an increase in public expenditure and is not expected to have any effect on public service manpower. I ask your Lordships to grant the Bill a Second Reading.

§ Lord Carter

My Lords, I thank the Minister for a clear exposition of the Bill, as is typical of her. I also congratulate the Government on producing a health Bill which is not contentious, which means that I can be brief when I respond.

As the noble Baroness said, the Bill has been generally welcomed by all the professional organisations involved and it is certainly not politically contentious. From the Opposition Benches we shall do our best to assist its passage. There is no need for me to analyse the nature and structure of the Bill as the Minister has done because, as she said, it is the result of full consultation with the organisations involved.

I wish to deal with one or two matters which we shall need to probe at later stages of the Bill. As regards Clause 1(4) (b), we understand that it is the intention of the Secretary of State to consult organisations in deciding on the one-third appointed members of the council. We may wish to consider whether the intention of a consultation should be written into the Bill to ensure a broader base of appointees, to the effect that the Secretary may or shall consult with the interested organisations. It will be interesting to have the Minister's response as to how she views that as a proposal when we come to the end of the debate.

We also understand that it is the intention of the Government to ring-fence the funding for nursing education at regional health authority level. We shall need some assurances as regards the nature and timescale of the ring-fencing. We shall need to be told what it means and how it will operate. In passing, we wish that the Government's enthusiasm for ring-fencing extended to other areas. The noble Baroness 486 will remember our debates concerning community care. When the noble Baroness responds, or perhaps at a later stage of the Bill, we shall wish to probe a little as to how ring-fencing is supposed to work and how it will be protected.

There is another area of concern of which I know the Minister is aware. I refer to the disciplinary functions of the UKCC. I am sure that that organisation, the Royal College of Nursing and the Royal College of Midwives all feel that, in addition to suspension, there should be a power of reprimand or caution. I understand that an amendment has been drafted to write that provision into the Bill. Perhaps we could save time at a later stage of the Bill if we heard now the Government's reaction to the proposal. I know that all the organisations involved feel that this is an important extension which should be given to the UKCC. I understand that there may be legal problems and perhaps the Minister can advise the House on that.

I have mentioned the Royal College of Midwives. It is particularly concerned that the interests of minority groups such as midwives are properly protected. We shall need to examine that aspect as the Bill proceeds. I believe that in the 1979 Act, which this Bill replaces, the interests of minority groups are specified though they are not in this Bill. Perhaps the Minister can tell us why that change of approach was adopted.

As I said, I shall be extremely brief as the Bill is non-contentious. All the matters I have mentioned can be dealt with quite easily when the House goes into Committee. I know that a number of speakers who are to follow me have considerable knowledge of the nursing professions and that their views will command the attention and respect of the House. I look forward very much to hearing them. It will also give the House a chance to pay tribute to the remarkable job that is done by all three professions mentioned in the Title of the Bill.