HL Deb 13 December 2001 vol 629 cc1517-31

9.31 p.m.

Lord Hunt of Kings Heath

rose to move, That the draft order laid before the House on 15th November be approved [10th Report from the Joint Committee].

The noble Lord said: My Lords, some of the remarks that I made in introducing the previous order are applicable to this one so my speech will be briefer.

This order is consistent with the order that we have just discussed. It will replace the Council for Professions Supplementary to Medicine (CPSM) and its 12 uniprofessional boards. It makes the same provision and gives the same benefits for the allied health professions and the patients who use their services, as the previous order does for nurses, midwives and health visitors.

Importantly, the HPC will be able to initiate proposals for the extension of regulation to new groups. This is a big step forward. The CPSM was restricted by law to covering only 12 professions, but the HPC has no such restriction. I pay particular tribute to the patience of such groups as the Association of Operating Department Practitioners and Perfusionists who did not secure the limited slots available with the CPSM. I know that they and other professional groups will look forward to the new HPC taking that work forward.

The HPC will have an option to have 25 members, 13 professional and 12 lay, where the president is a professional, as is the case with the appointments made to the shadow council. Of the 13, one will be the president and the rest will each represent one of the professions regulated by the council. We would not expect those members to do the work by themselves. The council must also have four statutory committees to cover the main functions of a regulatory body. Those committees will be multi-professional too, but there is no limit on their membership.

The council will have wider powers to deal with individuals who present unacceptable risks to patients set out at Articles 22 to 33 of each order. It will have powers to deal with registrants whose fitness to practise is impaired, whether through ill health, lack of competence, or misconduct. That will be a big improvement on the current limited powers of the CPSM, which is able to deal only with infamous conduct in a professional respect and has only one option for action which is striking off.

The council will also have a critical role in positively guiding and supporting the vast majority of practitioners whose fitness to practise is never in doubt. In addition, the council may set up any other committees and panels that it needs. It will have extensive opportunities to co-opt non-members to advise on professional matters or on national policy or to carry out detailed casework within the strategic framework that they set.

I understand that one issue that will be discussed in the debate on this order is the matter of chiropodists, particularly unregulated chiropodists. The profession is split into those currently regulated, who have a full three-year degree training to cover footcare across the whole ill and well population, and the unregulated, who, I believe, train chiefly to carry out basic footcare on otherwise healthy people.

The order provides a transitional pathway to registration, open to those who can demonstrate that they have been practising safely and effectively or that their qualifications and experience are comparable to the current requirements for registration. I know that there are some concerns about how that will operate. I assure the House that both sectors are meeting regularly under the facilitation of the Department of Health and the shadow Health Professions Council with a view to reaching an agreed position on the requirements for registration before the new council is established next April.

In the order we have sought to tackle gaps in existing legislation. We have also taken on board the concerns raised by the professions and by consumer and patient organisations. They are unanimously in support of the order being passed. I understand that there are concerns, particularly about chiropodists, but I believe that the order is the best way forward. I commend it to the House.

Moved, That the draft order laid before the House on 15th November be approved [10th Report from the Joint Committee.]—(Lord Hunt of Kings Heath.)

Earl Howe

rose to move, as an amendment to the above Motion, at end to insert "but that Her Majesty's Government should also lay an amended order containing a provision for a practicable transitional period for entry of unregistered members of the chiropody profession to the register of the Health Professions Council and for wider representation on professional advisory committees".

The noble Earl said: My Lords, I thank the Minister for his comments on the order, which is very welcome in principle. We all recognise the importance of protecting professional titles and ensuring proper standards of training and competence on the part of those who administer treatment to patients. As a concept, the establishment of a Health Professions Council with enhanced powers compared with those of the CPSM is also a positive step forward.

However, as the Minister said, one group of professionals—the large group of non-state registered practitioners of chiropody and podiatry—are far from happy with the order. Chiropody is unique among the 12 or so professions covered by the HPC in that it is the only one split almost 50:50 between state registered and non-state registered practitioners. Both sections account for about 8,000 members, although the non-state registered sector is slightly larger.

The split goes back to 1945 when five British chiropody organisations amalgamated and began offering their members to serve the needs of the newly formed National Health Service. They subsequently became the examining body for the purposes of state registration under the Professions Supplementary to Medicine Act 1960. At that time there was no compulsion and little incentive to be registered, unless one wished to work for the NHS. For that reason, the other half of the profession, represented by the British Chiropodists and Podiatrists Association and the SMAE Institute, which had not amalgamated, opted to remain unchanged.

The issue for non-state registered chiropodists is that, upon approval of the order, to be able to work as a chiropodist or podiatrist in the community they will need a three-year honours degree. The existing qualifications of those 8,000 practitioners will officially count for nothing, no matter how long, how safely or how successfully they have been practising.

Nobody, least of all the BCPA, has an interest in allowing sub-standard chiropodists to treat patients. Everyone wants proper regulation. However, the way in which the order will impact on the chiropody profession flies in the face of common sense. All of a sudden we shall be faced with the prospect that a substantial number of chiropodists and podiatrists who are doing important and valuable work will no longer be available to look after their patients. A large decrease in chiropodist numbers will put added pressure on an area of the NHS that is already over-burdened.

The HPC may or may not take a sensible, pragmatic view of this issue. However, the HPC will be dominated by the state-registered sector; the independent sector will have no representation on it whatsoever. I am quite certain that the state-registered sector is approaching these concerns responsibly and will want to avoid a large fallout of numbers, but the matter is largely not within their hands. A two-year transitional period has been allowed for to enable independent practitioners to transfer to the new registry. That period is totally impracticable bearing in mind not only the 8,000 applications that will need to be considered and processed, but independent-sector students who are due to qualify after the critical period.

It should be possible to find a way forward. There are already provisions to enable state-registered practitioners to be registered automatically even if they have no academic degree. So far, however, the picture looks exceedingly unclear. I am sorry to say this, but the Government give the impression that they have rushed the matter along without sufficient thought or discussion. They now seem to be throwing up their hands and saying, "It's all too difficult; the profession itself must sort out the problems". I believe that that is not a responsible position for Ministers to adopt. We are not talking about some small minority of under-qualified or unsuitable people from whom the public need to be protected; on the contrary, it is a very large number of skilled practitioners who to a greater or lesser extent have relieved the pressure on the NHS for very many years and do not feel that the Government have done them justice.

The order will enable the Government to wash their hands of the problem in the knowledge that the chiropody profession will now be fully regulated. It is deeply regrettable if that is all that matters to the Government. The Government should have felt that they had a responsibility to resolve these difficulties.

Perhaps I may turn to other matters of concern as reflected in my amendment. The Society of Chiropodists and Podiatrists, which represents the state-registered sector, is worried that there will not be adequate representation for each profession on the HPC. Without that, the society fears that the HPC's main aim will not be achieved—the effective protection of the public. I am aware of the proposals to establish professional advisory committees, but the PACs will only be ad hoc working panels to advise on specific projects; as I understand it, they will not be standing committees. Unless sufficient representatives of each profession have a real input into the HPC, it is hard to see how the public are to be reassured by what is now proposed. I wonder whether the Minister could comment on that.

Additionally, the society wants to see a role for the professional advisory committees in ensuring that the four United Kingdom countries are effectively represented in the deliberations of the HPC. There is currently no guarantee that each profession from each of the devolved countries will have a voice on the HPC, although that is apparently what the Government want to see. All that the Government have provided for is for at least one of the professional members and alternates to come from each UK country. As the society has stated, that could mean that a biomedical scientist from Scotland could end up representing all the Scottish professions on the HPC. How practical and how fair do the Government think that that would be?

As I said, we on these Benches have no quarrel with the principle of this order. Our complaint is that the Government should have taken a little more time and trouble to ensure that the concerns that I have outlined were eliminated. That should not have been beyond the wit of man. Regrettably, however, they have taken the decision that it is more important for the order to be rushed through, loose ends and all. I hope that the Minister can provide us with some real reassurances on those important matters. I beg to move.

Moved, as an amendment to the Motion, at end to insert "but that Her Majesty's Government should also lay an amended order containing a provision for a practicable transitional period for entry of unregistered members of the chiropody profession to the register of the Health Professions Council and For wider representation on professional advisory committees".—(Earl Howe.)

9.45 p.m.

Lord Clement-Jones

My Lords, I join the noble Earl, Lord Howe, in thanking the Minister for his exposition of the effect and benefits of the new Health Professions Order. In some ways, clearly, putting together the order for the new Health Professions Council to replace the CPSM has been even more difficult than the previous order. But it is clear that most of the professions involved are broadly supportive of the order, believing that it offers a better regulatory system than the current one. I particularly welcome the common registration for independent and state sector practitioners and the type of protection that that will give.

Yet as the noble Earl, Lord Howe, said, there are still strong concerns and problems. In the jargon of the trade, many of them are uni-professional concerns; that is, concerns that relate to individual professions and not necessarily to the scheme as a whole. One of those concerns relates to the practice advisory committees.

Under the previous 1960 Act there was a scheme of boards for each profession which was set up to regulate education and training for each of the 12 professions. Under the order there will be no statutory uni-professional arrangement. However, there will be professional advisory committees which can be set up by the council under paragraph 3(12)(b) of the order.

There is no compulsion for those professional advisory committees to be set up, nor is there any clear ambit for their responsibilities. Those committees should be standing committees with a clear remit.

In addition, as the noble Earl, Lord Howe, said, there is concern among some of the professions about the representation by each of them from the different nations in the UK on the slimmed-down council. The Minister and the council need to ensure that, as far as possible, the interests of the four countries are represented on the council. Perhaps the Minister can explain how that will be achieved under the order as it now stands.

Finally, there is unhappiness at the level of representation on the council among those professional bodies which reflect effectively two or three disciplines, such as the prosthesists and orthotists, or the arts, music and drama therapists. What comfort can the Minister give to those professions who feel that the size of the new body will cause problems to those individual disciplines?

Lord Hodgson of Astley Abbotts

My Lords, I must begin by apologising to the Minister because I was unable to attend the briefing he kindly held on this order the other day. Therefore if he tells me that the points I make were covered there, I accept that reprimand and pray his indulgence this evening.

I support the broad principles behind the order and its purpose. As more and more consult what is rather inelegantly called in this order the "relevant" professions, those professions are making an increasingly valuable and widespread contribution to our health and welfare. Therefore, conversely, the general public are ever more entitled to seek some form of imprimatur of their conduct, behaviour and competence.

I should like to ask for the Minister's reassurance on three points. The first concerns the grandfathering, which takes place in paragraph 6(3)(c) on page 11. I pray in aid here the fact that I was a board member in the City of one of the first regulatory authorities which required us to bring together individual registers and combine them. When we began to do this under the Financial Services Act in the late 1980s, early 1990s, we found that there was considerable difficulty in ensuring that the right standards of competence were held by all participants. It presented us with many practical problems. The grandfathering proposal in this order, while obviously attractive in theory, is not always as attractive in practice.

The proposal before us is designed to raise standards, to impose common levels of competence and so increase public confidence. The reassurance I seek from the Minister is that he is really convinced that this wholesale grandfathering from the 1960 Act will not undermine the authority and reputation of the new body. Clearly, some difficulties in the early days of the new body would severely damage its public reputation.

The second point concerns continuing professional education. It is a commonplace that we live in an age of rapid change, and the healthcare world is not immune. That is not just as regards the practise of professional skills, although that is obviously very important; it also covers the whole area of professional relationships. We no longer live in a deferential age but in a questioning age. Professional relationships have shifted and are continuing to shift.

I seek the Minister's reassurance that as regards Article 15(1)(b) on page 19 he believes that there is imposed a sufficiently clear duty for there to be a proper programme of continuing professional education. As a layman I did not find the wording of that clause particularly clear or compelling.

The last point concerns the discipline of the incompetent or errant. Until last summer I was the deputy chairman of a private hospital group. It was a for profit acute hospital group. In such companies one does not employ doctors, consultants or surgeons; one provides a facility within which they practise. But although one has no authority over their professional conduct, one has an interest in their competence because of the impact on the reputation of the hospital.

We found that complaints against doctors took a very long time to be heard by the GMC. They took many months and often one to two years. That was in no one's interest. It certainly was not in the interests of our company. It was not in the interests of the doctor, who had a cloud hanging over him the whole time. Above all, referring to our primary duty mentioned in the last debate, it was not in the interests of the patient, whose safety might be compromised.

I do not see in this order any requirement for urgency in the disciplinary procedures. I believe that the new body should have some duty imposed on it to act with sufficient celerity. If we are seeking to build public confidence we need to ensure that complaints are addressed promptly. I would therefore like to hear the Minister's views on that issue as well.

As I have said, I believe that this is a welcome order and I am pleased to see the emphasis that we are giving to the relevant professions. But I would like to hear the Minister's views on those three points.

Baroness Masham of Ilton

My Lords, can the Minister give an assurance to the House that in the interim period of state registration of chiropodists, there will be enough of them to deal with the ever-growing elderly population and the increase in the number of people with diabetes? Can the Minister say how a non-state registered chiropodist obtains full state registration?

Lord Prys-Davies

My Lords, it is rather late and I shall be brief. I support the order. I am very sorry that my noble friend Lord Morris of Manchester is unable to take part in the debate. He is president of the Society of Chiropodists, but he has had to keep a hospital appointment.

I am aware of the concerns, particularly among chiropodists, about some of the provisions of this order. I believe that the most important concern of the state registered chiropodists is that in their view the order fails to ensure that a strong, professional advisory committee will be established for each of the professions. Article 3 empowers the Health Professions Council to establish a PAC and that is obviously an advance. But it must also be said that the Health Professions Council is not under a duty to execute that power. Moreover, although the HPC has established a professional advisory committee, it can also abolish that committee.

The role of an advisory committee is usually to advise on any matter affecting its interests, including reporting on present conditions and making recommendations for future changes. What will be the role of an advisory committee established under Article 3? We have read what the president of the shadow Health Professions Council has had to say. She is in a key position. But the concept which she advanced has come in for criticism. I should be grateful if my noble friend the Minister could say how the department considers that a professional advisory committee should operate under this order.

I refer to an aspect of devolution. As far as I can see, the order contains at least three provisions which relate exclusively to Wales; namely, Article 6(3)(g), Article 20 and Article 45. There may be others which I have missed. Yet nowhere in the explanatory note is there a reference to those provisions. They are nowhere mentioned. I envisage that there will be more such provisions in the future as the Welsh Assembly develops policies to meet Welsh needs. Therefore, it would be helpful to the practitioner in Wales if the explanatory note were to draw his or her attention to the existence of such provisions within the order. That would be a simple improvement which should be built into the explanatory note in the future.

Lord Neill of Bladen

My Lords, I understand that the noble Earl, Lord Howe, raised a concern which I hope the Minister will address. The thrust of the argument seemed to be that a category of chiropodists, for example, would have to acquire a professional qualification over a set period to be able to go on the register, but the timing was such that they could not acquire that within the time limits imposed by the order. The practical effect of that appears to be that, for a period at least, certain people will be driven from their professional activity.

If that is the case, have the Human Rights Act implications of that been thought or If one passes legislation which has the effect of depriving a person of a profession, normally, as the noble Lord, Lord Hodgson, said, one has efficient grandfather clauses which ensure that all competent people who have practised a profession are carried on into the new system. There is no guillotine and one does not put people out of business. It may be that the legal premise for that is wrong. However, if a category of professionals could be put out of business by the order as they could not comply with its terms, that would be a grave matter. I hope that the Minister will address it.

10 p.m.

Baroness Dean of Thornton-le-Fylde

My Lords, in welcoming the order I declare an interest as president of the College of Occupational Therapists which greatly welcomes the order which has taken many years to reach the House. I have been president of the college for approximately seven years. I assure noble Lords that in that time, and before, the professions allied to medicine have pressed hard for the kind of order that we have before us. This is not a new idea. It has not been rushed through and it is greatly welcomed by the profession. Certainly, the provisions within the order for closure of title—as a lay person would express it—will prevent those without appropriate qualifications parading as titled practitioners. That measure is extremely welcome from the consumer protection angle.

Both that measure and the proposal to require the regulated professions to provide evidence of their continuing professional development and fitness to practise are welcome and are supported not only by the College of Occupational Therapists but also by the bodies that form the 12 professions which are covered by the order. College members work both in the state sector and private practice but there has been a relationship for many years between the college and universities for validation of degree courses—for which students receive no state aid, unlike nurses who can receive bursaries. That issue should be addressed but it is not before us this evening.

The college, together with allied health professionals, supports the order's provision for a robust system of self-regulation that puts public protection at the forefront. That does not exist at present. Persons are practising in professions allied to medicine who do not have a recognised qualification. The order provides for qualifications to be withdrawn but they must be held in the first instance. That provision is similar to one in the nursing profession where the regulatory body can withdraw a nurse's licence to practise. The order will introduce a similar measure to all the professions that it covers.

I hope that the noble Earl, whose views I much respect, does not press his amendment. The order has been a long time coming. There has been plenty of time for people without qualifications to improve, to ensure that registration is within their grasp. The transitional arrangements should provide for that to happen. If your Lordships insist on specifying who will sit on the new body, what committees it will form and how it will operate, that would tie the council's hands. The new body will not be a closed shop but will have lay representation, which the professions also welcome.

Does the Minister agree that the new Health Professions Council must work in partnership with the College of Occupational Therapists and the 11 other professions? Also, will the Government ensure that the regulated professions play a full and equal part in maintaining high standards of professional practice—if for no other reason than the protection of the public?

The majority of professions allied to medicine welcome the order. They pressed the previous government for such a measure but did not get far. They have been pressing the present Government since the 1997 general election. The order will underpin the quality of services provided. It will ensure that when individuals do not practise to high standards, their professional body will have the authority to withdraw their title. I welcome the order and hope that the House will support it.

Lord Hunt of Kings Heath

My Lords, a common theme has been the importance of the 12 professions that will be regulated under the new council and the hope that other professions will be regulated in future. Considering the challenges facing the National Health Service, there is no doubt that the professions covered by the proposed Health Professions Council will have an important role.

I was somewhat amused when the noble Earl, Lord Howe, said that the process by which the order was brought to your Lordships' House involved "rush"; that is not the word that I should choose. It has been a very long process—too long, in many ways.

As with the NMC, extensive work has been undertaken with the professions, groups that represent the public interest and the department to try to get the matter right, and I believe that we have done so. My noble friend Lady Dean raised an important point when she discussed partnership with the profession. One criticism that I should make of the CPSM's record is that in many cases it had lost the confidence of the professional organisations. I believe that the HPC will work effectively only if, in serving the public interest, it develops a strong partnership with each of the 12 professions.

We have appointed a very good shadow council and I am confident that the right leadership is being provided. I say to my noble friend that I am convinced that the HPC will seek to work in partnership with those professions. Unless the HPC, in protecting the public interest, also allows those professions to feel real ownership in relation to the its work, it will not work effectively.

We seek to ensure that we do not have an over-sized council. Twelve professions are involved and inevitably there will be a limited number of places. Essentially, each profession will have one representative. In that context, my noble friend Lord Prys-Davies raised a concern about the shape and status of the professional advisory committees, which are provided for in the order. It is important that the HPC is left to advance its own proposals about how it will organise its work within the general parameters that are laid down in the order. Setting up PACs is a matter for the HPC.

Following discussions with noble Lords over the past two weeks, I have satisfied myself that the shadow HPC is working in partnership with the professional bodies to ensure that they have confidence in the arrangements relating to PACs. I understand that the HPC will produce proposals that will give wider representation than at present. That would involve more professionals with targeted expertise who would ensure high-quality, speedy and appropriate expert professional input to the functions of the HPC. That would be backed up with full training in those functions.

The shadow HPC welcomes the positive contribution of professional bodies. I should expect the HPC to work through its registrant members to develop a range of appropriate mechanisms to enable the professions to contribute to the successful implementation of the order.

The HPC will need arrangements that take account of the needs of the different professions. That may include regular standing advisory committees and making use of existing networks. The HPC should consult widely among registrants and the professions on its proposal to obtain professional advice before it finalises its arrangements. It will be required to report to the Privy Council each year on how it has carried out its functions. It is envisaged that the HPC will hold frequent PAC meetings, particularly in the early stages while setting up its new procedures.

The order also permits the council to delegate some of its functions to the bodies that it sets up. But the HPC can accommodate all this with a fresh approach. I am sure that the shadow HPC will continue as it has done, working in partnership with the professions to ensure that it has the professional advice and input that it needs.

A very relevant point was raised by, I believe, the noble Earl, Lord Howe, about the concern of state-registered chiropodists in relation to professional representation from all four UK countries in a smaller, more strategic council. One way in which we shall ensure that is through the supplementation of the work of the council by statutory committees plus other networks and committees which can draw on other professionals from each country. Again, in that way, with a flexible, inclusive approach, the HPC will be able to cover the four-country angle. It will also do so by encouraging professions fully to brief council members.

Much of the detailed work involving professional difference will not be handled by the council but by its committees. Again, they may draw on a wide range of professionals from all four countries. But a profession which does not have council representation in a country can always ensure that its concerns are raised both by its own professional representatives and also by its own country members. I am confident that the HPC will be able to handle the four-country issue.

I turn to the question of chiropodists. In doing so, perhaps I may pick up some of the points that were raised by the noble Lord, Lord Hodgson, and others. First, I fully accept the point that the noble Baroness, Lady Masham, made. Chiropodists are very important. I believe that their role, in particular in relation to the mobility of older people, is crucial. The National Service Framework for Older People is the way in which we wish to develop services for older people. Within that, I would expect the role and number of chiropodists to be given full attention.

As the noble Earl, Lord Howe, said, the profession is split into two. In essence, in relation to the grandfathering provisions there is a very important debate as to how long the HPC register should be kept open to allow those who have not been trained on an approved course time either to undertake extra training or to demonstrate experience in safe practice so that they may register before the register is closed to all but those who are trained in the approved way. As the noble Lord, Lord Hodgson, suggested, that method of registering people who do not have approved training is called "grandparenting".

Article 13 of the order provides a transitional pathway to registration which is open to those who can demonstrate that they have been practising safely and effectively or that their qualifications and experience are comparable to the current requirements for registration. In that context, perhaps I may make it clear that in either case the HPC may, but need not, require them to pass a test of competence.

I want to repeat a point that I made in my introductory remarks. Both sectors are meeting regularly under the facilitation of the Department of Health and the shadow HPC with a view to reaching an agreed position on the requirements for registration before the new council is established next April. The noble Earl, Lord Howe, chided me because he believed that those discussions should have been completed by now. The Department of Health made strenuous efforts to ensure that the discussions took place, but, in this case, it takes three to tango. Representatives of the non-state-registered sector have proven rather reluctant to engage in the discussions. Having said that, meetings are now taking place regularly. As a Minister, I am very keen to ensure that they come to a successful conclusion.

Baroness Masham of Ilton

My Lords, before the Minister leaves that point, perhaps I may ask him whether he believes that there will be enough people to assess the non-registered chiropodists and how long that process will take.

10.15 p.m.

Lord Hunt of Kings Heath

My Lords, I shall come to that. I believe that this will be a challenge to the HPC but, as I have explained, this matter does not rest with the individual members of the HPC. It is able to use professional people from the field. I am sure that it would be able to find a way to do as the noble Baroness suggests. That is the whole point of facilitating discussions between the two sectors; that is, to ensure that this is carried out as smoothly as possible.

There is a balance to be struck. It is unsatisfactory that we have a situation at present in which people who have not gone through state registration can call themselves chiropodists. We have to protect the public interest. That is the paramount consideration. The noble Lord, Lord Neill of Bladen, raised the issue of human rights in relation to this specific question. The view of the Government is that the order is compliant with the Human Rights Act. Article 12 is applicable. The council must consult those affected on criteria for grandparenting. There is a choice of routes, either through qualifications or experience. Reasoned decisions must be given. Applicants have a right of appeal, first, to council and to the courts. It has to be a careful process. We must uphold the public interest. However, equally we must ensure that those people who do have the relevant qualifications, or can obtain them, or have the relevant experience, are given as much opportunity as possible to enable them to be registered by the council.

The noble Baroness, Lady Masham, asked about timing, which is important. We have received representation from the unregulated sector, which wanted the transitional period for meeting the standards before the new register is closed to all but those with the approved training extended to seven years. The order proposes two years. It is the view of the Government that, given that full training is up to three years at most, the call for a transitional period of seven years seems excessive. It may be designed to allow those who are currently practising to reach retirement before they need to comply with the new standards. There is a difficult balance between public interest and being fair to the unregulated sector. But I believe that that sort of extension is unacceptable.

However, the timetable allows flexibility. If your Lordships approve the order today, the health professions council will be set up on 1st April 2002. It will inherit the register, rules and procedures of the CPSM to begin with, so that there is no break in the regulatory function. During its first year, the HPC will have to propose the parts, protected titles, associated qualifications and standards of proficiency which its new register will encompass. It must consult registrants and prospective registrants on those proposals. It will then propose to the Privy Council, which will ultimately determine the parts, titles and qualifications relating to each profession in the register, which it will then be able to open.

Even if we rush in an unseemly way, I do not believe that that process could be undertaken in less than one year. The expectation is that the process might take up to April 2003. Once the register is open, it will remain open for a transitional period of up to two years before it is closed to all except those who achieve registration by reaching the standard of practice and training the HPC requires. That is likely to happen by April 2005. From now until 2005, a period of about three-and-a-quarter years is likely to be available for those in the unregulated sector who wish to become registered with the HPC and to carry on practising as chiropodists or podiatrists, using whatever title is protected under this order to demonstrate to the HPC that they meet its standards. That is a reasonable period of time.

I also point out—the noble Baroness, Lady Cumberlege, is no longer here that the JM report was published in 1996. It is apparent that that has been the aim of both the previous and of this Government. The unregulated profession has had time to think through some of these issues. We are essentially saying that it has three and-a-quarter years from today before the likely end of the grandfathering provision.

Perhaps I may take up two points raised by the noble Lord, Lord Hodgson. Both were extremely interesting. He asked about continuing professional development. I refer the noble Lord to Article 19 on page 24. That relates to post-registration training. Paragraph 19(1) states: The Council may make rules requiring registrants to undertake such continuing professional development as it shall specify in standards. Continuing professional development is vitally important. The order clearly gives the HPC the power to do it. I am sure that, consistent with what is happening in the other professions, continuing professional development will be a very important factor.

The noble Lord asked another important question: how will the new body enhance and speed up the disciplinary procedure? I agree with the noble Lord that speed is of the essence. The smaller dynamic councils that we hope to establish will lead to swifter and more transparent decision making in addressing public protection issues. The establishment of statutory committees linked to the core regulatory function, including the main areas of fitness to practise work, the investigation committee, the conduct and competence committee and the health committee, give an ability to the HPC to ensure that it has effective procedures.

It is also worth bearing in mind, and as a trailer to the NHS modernisation Bill, which is proceeding rapidly through the other place, that within that Bill is a provision to establish a UK council of health regulators. That council will have an important role to play in ensuring that the different regulatory bodies are working as effectively as possible.

I am grateful to noble Lords for the issues that they have raised. I understand the concerns of the chiropody profession. I reiterate that we shall work as hard as we possibly can with representatives of both sectors to enable the matter to be dealt with fairly and effectively but crucially in the public interest. I am grateful to noble Lords for their attention.

Earl Howe

My Lords, I am grateful to the Minister for his full reply and to all noble Lords who have spoken in the debate.

The Minister has helpfully clarified the element of the proposals relating to the transitional period for registration on to the chiropodist and podiatrist register. Much of the concern expressed by the BChA relates to the practicality of the arrangements for non-state registered members to qualify for registration within the statutory time frame. I understand that there is effectively a three-year plus window in which registration can occur. That will no doubt be sufficient for some.

The concern is perhaps broader than that. Non-state registered practitioners want to know that sensible rules will be applied to enable those among them who can readily demonstrate proficiency to be admitted to the register without undue fuss, and certainly without having to undergo a mandatory three-year degree course. If common sense is not applied to the situation many chiropodists will simply call it a day. I cannot emphasise enough how damaging that would be. Eight thousand practitioners is not only the majority of practising chiropodists but a large number of individuals.

It is reassuring to hear from the Minister that the HPC is doing its utmost to establish sensible arrangements with regard to registration. But some bridge-building needs to take place. I am encouraged by the Minister's stated view that that is happening.

Lord Hunt of Kings Heath

My Lords, I am grateful to the noble Earl for giving way. I want to reassure him that the Department of Health will work hard to continue facilitating sensible arrangements and agreement between the two sectors that the HPC can take forward. We all want a sensible outcome. We do not want to preclude people who have a contribution to make from practising in future. Equally, we must uphold the public interest. The department will work hard to ensure that the process is conducted sensibly and fairly.

Earl Howe

My Lords, I am grateful to the Minister for those reassurances. I am hopeful that his confidence that the HPC will want to work in partnership with the individual professions will be fulfilled in practice. I hope that the HPC will be inclusive in its general approach to chiropodists. I am also grateful for the Minister's assurances about professional advisory committees. I welcome what he was able to tell us about their proposed composition and functions. That clarification is certainly helpful.

This debate has been useful. Several important points have been put on record. The Minister has given important reassurances. In the light of those, I am persuaded that it would not be right to press my amendment to a Division. However, while it is not appropriate to divide the House, I hope that the concerns registered in this debate will be followed through with vigour. I am sure that the goodwill that exists throughout the chiropody profession can be harnessed to ensure not only a meeting of minds but a building of confidence that will unite the profession in a real and tangible sense. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

On Question, Motion agreed to.

Lord Carter

My Lords, your Lordships will be aware that the other place works in a mysterious and, I am afraid, rather stately way to conduct its business. With that in mind, I beg to move that the House do now adjourn during pleasure until 11.30 p.m. That will allow for up to 30 minutes for the tabling of amendments after the Bill has returned from the other place.

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

[The Sitting was suspended from 10.27 to 11.30 p.m.]