HL Deb 10 June 1999 vol 601 cc1652-60

10.16 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman) rose to move, That the draft Orders of Council laid before the House on 18th May be approved [20th Report from the Joint Committee].

The noble Baroness said: My Lords, the orders before the House tonight extend state registration to the three professions of speech and language therapists, clinical scientists and paramedics under the Professions Supplementary to Medicine Act 1960. We have carefully considered the case for each group on its merits. Their very diversity highlights the enormous range of skill and dedication deployed in the modern healthcare team.

Recently in your Lordships' House we have spent many hours debating the need to strengthen and modernise professional self-regulation. As for strengthening, I know that the three professions concerned, and the nine already state registered, are united in warmly supporting this proposal to widen the scope of regulation to include them. As regards modernising, they are all equally anxious to get on with updating the framework within which they work. For the future, the Government are committed to consulting on proposals to bring the existing legislation up to date and to reflect the enormous changes in healthcare provision, professional practice and education since it was first enacted. We believe that it is right to proceed with the measures before your Lordships not only because of the work that each of the professions has put into building a case for registration, but also because they and the public will then benefit at the outset from any revised statutory framework that Parliament may agree.

I turn to the three professions that we are considering tonight. Speech and language therapists work across the whole range of human communication disorder. However, the majority work with children. Communication problems may result from learning difficulties, stroke, head injury, cancer of the mouth and throat and degenerative disorders such as Parkinson's disease. Speech and language therapists enable clients to communicate to the best of their ability assessing the nature of the problem and providing treatment, advice and support sometimes through the use of sign language, communication aids or other methods of communication. They work closely with families, carers and members of other professions in a wide range of settings.

Clinical scientists apply scientific principles to the delivery and development of diagnostic and therapeutic procedures and services. They develop equipment, participate in problem-oriented research and development and are involved in the audit of the services provided. They work closely with medical staff and with other healthcare professionals. Clinical scientists practise in one of several disciplines including audiology, biomedical engineering, clinical biochemistry, clinical physiology, clinical microbiology, embryology, genetics, haematology, immunology and medical physics, working in different ways depending on the specialty. Some clinical scientists interact directly with patients and others give advice on which critical decisions are based.

Lastly, paramedics: they provide immediate care to the public and patients with acute clinical emergencies. They assess, treat and monitor patients in a systematic way according to national clinical protocols adapted to the requirements of local communities. The treatments provided include invasive procedures such as intravenous cannulation, intubation and the insertion of chest drains and the administration of a specified range of emergency medications, including analgesics. Paramedics typically will be the first health professionals on hand in an emergency.

The broad effect of the orders before us is to extend the 1960 Act to these professions alongside the nine already covered. Those nine are chiropodists, dieticians, occupational therapists, physiotherapists, radiographers, medical laboratory technicians, orthopists, prosthetists and orthotists and arts therapists. Each order establishes a professional board within the umbrella of the Council for Professions Supplementary to Medicine, the CPSM.

Each board's function is to promote high standards of professional education and conduct within the framework of the CPSM whose duty is to co-ordinate and supervise the activities of all boards. Each board has a duty to prepare and maintain a register; approve institutions, courses of training and qualifications leading to state registration; determine applications for admission to the register on the basis of qualifications and experience obtained either in the UK or elsewhere; and set up investigating and disciplinary committees to produce guidance on conduct and to deal with individual cases of misconduct.

Once registered, practitioners will be entitled to call themselves "state registered speech and language therapists" or "state registered clinical scientists" or "state registered paramedics." The use of those titles by a person who is not registered will be an offence, as will the use of any title or description which falsely implies that he is registered under the 1960 Act.

The Act requires that the board should have a majority of members from the profession concerned. The boards will each have a total of 15 members appointed by the CPSM of whom eight will be nominated by the profession in the first instance and thereafter elected by registrants. The remaining members will include medical practitioners, educationalists, representatives with special interests in each profession and—a development which the Government strongly support—representatives of employers and of patients and carers.

If each measure is approved, the membership of the CPSM will also increase from 27 to 36 because the Act requires that all boards have a professional representative on the council and that the number of medical and professional members should be equal. The third, lay, member for each board preserves the balance of the representation between professional and medical and other members.

Statutory regulation is a privilege and should not be granted just because the profession concerned aspires to it. It should be justified because it provides safeguards for the public which would not otherwise be available. We are satisfied that unlicensed practice in any of these fields has the potential for harm to patients and that state registration provides better protection for patients and the general public.

There are currently some 7,500 speech and language therapists registered with the Royal College of Speech and Language Therapists. The training required is exacting and the normal route to qualification is a four-year honours degree course leading to a certificate to practise issued by the college. Speech and language therapists work with some of the most vulnerable members of the population; with children in pre-school settings, nurseries and community clinics and in mainstream and special schools, and with children who have communication problems which may be part of a physical, learning or emotional difficulty. Some of the children have autistic spectrum disorders, stammering or severe language disorders, which will make accessing the school curriculum very difficult.

Adults with learning difficulties may be seen in their own homes, while adults with neurological problems may be seen in an acute hospital setting. The most common danger to the public is the promise of easy cures or simplistic diagnosis, leading to psychological damage, financial loss and deterioration in the patient's condition. Patients and their carers need to know that a registered speech and language therapist will offer a service based on accredited training and professional guidelines and that any complaint will he appropriately dealt with.

There are an estimated 2,500 clinical scientists employed in the NHS in Great Britain, of whom 1,700 are voluntarily registered. All entrants to the basic training require a first degree in an approved science subject. On completion of a further vocational training, graduates are eligible to join the voluntary register held by the Registration Council for Scientists in Health Care following the satisfactory completion of designated vocational training.

Clinical scientists work across a broad range of patient groups, from before birth to extreme old age. Most clinical conditions directly or indirectly involve the services of clinical scientists who provide advice directly to doctors. They apply scientific principles to the delivery and development of diagnostic and therapeutic procedures and services. It follows that clinical scientists have a great capacity to do harm if they lack or misapply the skills required of them. Protection of the public can be achieved only if high standards of education, training and conduct are applied to ensure that clinical scientists are competent to practise.

Perhaps I may now turn to paramedics. There are an estimated 9,000 qualified paramedics in the United Kingdom who provide an integral part of pre-hospital care. All entrants to training are required to complete a 400–600 hour course at ambulance service centres. The syllabus, qualifications and awards are overseen nationally by the Institute of Health and Care Development, which issues the paramedic certificate to those individuals who have demonstrated professional competence at the conclusion of the training programme. The profession promotes and manages effective and efficient ambulance services within the public sector and seeks to develop education and training for the highest standards of pre-hospital care.

Paramedics' practice routinely involves invasive or risky procedures. The capacity for harm by staff who are inadequately trained or experienced is considerable. They act on their own initiative, exercising their own judgment, often in an unsupervised capacity when delivering emergency patient care. They will only use standard and well-established clinical procedures.

Each of the three professions has consulted widely on the proposals now before the House. They have balloted their members, who have overwhelmingly supported them. These proposals are endorsed fully by the CPSM, which has secured the support of all nine of its existing boards; and the professions have also canvassed support from a wide range of other health professions.

The sole expressions of concern have been from the Institute of Biomedical Science and two non-NHS ambulance services. The IBMS supported state registration of clinical scientists but favoured a joint board for them and for the medical laboratory scientific officers who are already covered by the 1960 Act. Similarly, the ambulance services supported state registration of paramedics but wished to strengthen participation by non-NHS staff in areas such as access to and recognition of training.

We have considered all the representations very carefully, obviously including the concerns that have been expressed. As far as concerns the points made by the Institute of Biomedical Science around career and education pathways for biomedical and clinical scientists, we are anxious that the boards and the professions concerned should explore all possible avenues for closer working. I have asked the chairman of the CPSM, Professor Brian Edwards, to convene a meeting shortly of all the interested organisations to explore the scope for greater collaboration. I understand that particular options under consideration include such areas as a joint secretariat, exchanges of observers and members and a joint education forum. I hope that we can take these proposals forward in a way that will satisfy some of the concerns expressed.

We also believe that there is scope for further explanation and dialogue between all parts of the paramedic profession around such issues as participation by individual practitioners, access to initial training and updating and the treatment of qualifications and experiences obtained outside the NHS. Again, these are essentially matters for the profession itself to resolve. The concerns that have been expressed should not outweigh the clear benefits in terms of public protection that state registration will deliver. We believe it to be wrong that professions that have well-prepared cases which command wide support and are consistent with the Government's commitment to strengthening professional self-regulation should be delayed and that the public should lose the benefits of proceeding now.

The merits of state registration begin and end with the patient. State registration offers the public an objective assurance of the high standards of training, conduct and practice to be expected. It also offers incidental benefits, such as providing a benchmark for employers; assisting in workforce planning by keeping a continuous record of the pool of qualified staff; offering an opportunity to strengthen collaboration between the family of health professions; and providing a coherent mechanism for dealing with overseas qualified practitioners, including those from the European Economic Area, wishing to exercise their right to freedom of movement.

The Government are committed to promoting excellence in the NHS through the introduction of clinical governance and to ensuring the protection of patients and the public. More open and accountable systems of professional self-regulation have an integral part to play in this. We want to work with the professions to build on and strengthen them.

The CPSM has striven over the years to improve its accessibility and is currently responsible for a total of some 103,000 registered practitioners. Adding these professions will further increase the number of registrants and provide an opportunity for the CPSM to play a leading role in strengthening public protection. These measures, if approved, will provide a scheme of self-regulation at arm's length from government and funded by the practitioners themselves.

The Government are satisfied that speech and language therapists, clinical scientists and paramedics have sufficiently developed standards, identities and purpose to join the family of mature professions already regulated by the CPSM. Therefore, I commend to the House the making of these orders by the Privy Council. I beg to move.

Moved, That the draft Orders of Council laid before the House on 18th May be approved [20th Report from the Joint Committee].—(Barness Hayman.)

10.30 p.m.

Lord McColl of Dulwich

My Lords, I thank the Minister for her usual clear exposition, and also her very precise pronunciation at this late hour of the tongue-twisting nouns "prosthetists" and "orthotists", which require a knowledge of ancient Greek.

What is not at all clear is why the Government have chosen only these three professions, and why this has to be done now. As the Minister mentioned, there are many suitable professions that need to be included. Apparently, the significance of trying to push these three under the wire is that there will be a freeze-out after 1st July which is likely to be quite a long one. So surely that is a reason for getting on with examining all the applicant professions and getting down to considering the importance of patient protection and what the priorities in that area should be.

Clearly, ambulance paramedics would be seen to qualify. But what about speech and language therapists? Is there really a threat to the public from unregistered speech and language therapists? I do not quite understand the Minister's case. The trouble is that accepting these three professions will necessarily mean excluding the others for a considerable length of time. Does the Minister know quite how long that will be?

The issues relating to clinical scientists are somewhat different. Medical laboratory technicians are already included, but clinical perfusionists and other groups of scientific and technical staff are excluded. Surely there are arguments for having some unified body for these professions. We should like to have seen appraisals and evaluations for these professions in some sensible document setting it all out. We are really being asked to make a choice without evidence and evaluation. We are concerned with the important issues of prioritisation and are being asked to approve it just a few days before the door is shut, after the Government have admitted that the existing regime is flawed.

But it is not just a problem of prioritisation of applications from different professions. If the statutory instruments are approved, there will be in perpetuity a two-tier system: the old professions under PSMA and the new professions which will not be devolved at first but eventually will be different in England, Wales and Scotland. Will the existing PSMs, including the three in the statutory instruments, retain rights of appeal to the Privy Council, or have the Government decided that the successor body is to lose the rights? If the PSMs are to retain the right, will it be only those established under the old regime, thus further emphasising the two-tier system that is being introduced?

In summary, first, there is an unacceptable lack of any coherent argument for giving these cases priority. There has been no systematic appraisal, no evaluation and no details of the objectives. There has been no comparative analysis of competitive bids. We are really being bulldozed in the dark. Secondly, a case has been made by the Government for changing the system, but why not wait, instead of forcing this through under what the Government describe as an obsolete system, if the new system we are to get will be better?

Those professions that are brought in under the new system cannot be guaranteed a single unified professional regulation for the UK. But siphoning off pressure with these three, it makes it less likely that the others will be sorted out. It may be good news for the three professions, but bad news for the others waiting in the wings. It is also bad news for the public to the extent that these are not the right priorities. I shall be interested to hear the Minister's comments.

10.36 p.m.

Lord Clement-Jones

My Lords, I join the noble Lord, Lord McColl, in thanking the Minister for her thorough examination of the desirability and effect of the orders. I know that the professions concerned under the orders are appreciative of the way in which she has dealt with them and brought them in at this stage. They are also grateful to her for treating the professions as established professions for the purposes of consultation on the Health Bill.

On these Benches, we are well aware that as soon as the Health Bill is passed, the newly constituted boards for the professions will disappear. However, those professions, having had discussions with the Minister on the new Bill and its effects, must accept the situation. That is the nature of the way in which the abolition of the 1960 Act takes place. The opportunity will then arise on the passing of the Health Bill, not only for restructuring of the Council for Professions Supplementary to Medicine, but also for the introduction of protection of title. It would be interesting to hear from the Minister what timescale is envisaged for the granting of that protection and what type of protection is being contemplated. I assume that it will go further than the ban on using the words "state registered", which is what the current legislation provides for.

It is to the Minister's credit that she has pressed on with those professions who were ready to do business. However, the schemes should not be set in concrete for all time and the Minister was reassuring on that. There is a view which the Minister mentioned that there may well be advantages in some of the professions being regulated jointly with others. It has been represented to me that there may be a case for clinical scientists being regulated alongside closely related other professions such as the medical laboratory scientific officers mentioned by the Minister. That may or may not he the case, but it would be helpful for the noble Baroness to indicate that there is a considerable degree of flexibility. I thought it was also helpful in that context that she mentioned the dialogue being encouraged between the different professions.

It is a difficult moment. We are seeing the end of regulation by one Act and the beginning of a new era under another Act. The points relating to devolution raised by the noble Lord, Lord McColl, may make this process somewhat lopsided. However, because certain professions have been identified earlier than others we on these Benches do not want to impede progress on these orders. We are content to support them because of the protection that they will give to patients. We wish these professions well in their new status.

10.40 p.m.

Baroness Hayman

My Lords, I am grateful to both noble Lords who have spoken and will try to reply to the points they have made. The Government have not simply picked out three petitioning professions from among a range and given them priority. These cases were already prepared. It takes quite a long time to prepare a case under the Professions Supplementary to Medicine Act, and the provisions of that legislation are available now. These professions took two or three years building up a case which was considered carefully first by the CPSM and finally by the Government. We saw no justification for waiting until new arrangements were up and running and losing the opportunity to extend public protection. The noble Lords who have spoken are right to say that we are in a transitional phase, but the judgment was that because these three professions had worked up petitions that were valid and considered appropriate it would have been wrong to turn them down.

The noble Lord, Lord McColl, asked whether there was really a danger to the public from speech and language therapists. Apart from the vulnerable groups already referred to, with whom speech and language therapists work—sometimes in their own homes—n the acute sector speech therapists work with people who may have swallowing difficulties following strokes. In that area competence is an essential quality; indeed, the situation may be life-threatening. I believe that they have a case for state registration.

In terms of the law, it is for the CPSM to satisfy itself that all the criteria that apply in considering petitions have been met. The only ground in law for rejecting the recommendations would be if the Privy Council did not agree that the groups concerned were professions supplementary to medicine to which it was appropriate to extend the provisions of the Act. The noble Lord, Lord McColl, said it was difficult to judge how valid these applications were and what criteria were used. Very clear and detailed criteria are set out by the CPSM. I would be very happy to send these to the noble Lord if he might find it helpful. I believe that the petitions themselves have been placed in the Libraries of both Houses of Parliament.

The noble Lord, Lord McColl, asked about the future in the context of appeals to the Privy Council for the successor body to the CPSM. The Government have said that that is a matter for consultation when draft orders for the successor body are published. However, as I said during consideration of the Health Bill, the Government expect appeal and reporting arrangements to remain as they are now; that is, to the Privy Council.

The noble Lord, Lord Clement-Jones, asked about the joint regulation of clinical scientists and bio-medical scientists. This will be for the boards themselves to decide. The Professions Supplementary to Medicine Act is about self-regulation of the profession. However, as I said earlier, there are obvious joint interests and overlaps. We will be doing all we can to encourage those boards to work closely together in the ways I suggested earlier.

The 1960 Act is not an ideal framework for professional self-regulation. It fails to protect common title, its disciplinary procedures are outdated and inflexible and the absence of procedures for continuing competence and continuing professional development means that sick, incompetent or out-of-date practitioners can continue to work without pressure to improve. Educational requirements are inflexible and do not allow for modern methods of delivery. The structures constrain multi-professional working, strategic leadership and effective lay input. That is why we are so keen to get on with the job of reforming professional self-regulation for professions supplementary to medicine.

But something is better than nothing. These professional groups feel that it is important to take advantage of even the system we have at the moment, and even for the limited period of time. We are right to listen to that. We have considered carefully all the representations. We have considered the issue of timing but we have concluded that the professions have well prepared cases for state registration which command wide support and are consistent with the Government's commitment to strengthening professional regulation. That includes our intention to modernise the overall regulatory framework. I believe that these three new registered professions will be able to play a full and constructive part in developing those future arrangements. I commend the orders to the House.

Lord Clement-Jones

My Lords, before the Minister sits down, can she touch on the point about protection of title? Can she give an indication of how the Government's mind is working in terms of the type of protection of title that could be given to these professions?

Baroness Hayman

My Lords, if the noble Lord is trying to draw me on what titles would be protected, that is an issue on which the professions themselves would have to put forward suggestions. There are difficulties and we alluded to some of them during proceedings on the Health Bill. It is one of the areas in respect of which there have been difficulties in the past. We are committed to protecting common title. What exactly the common title or titles will be for each of the 12 professions is something that we will have to look at for the future.

On Question, Motion agreed to.