§ 9.35 p.m.
§ Baroness Andrews rose to move, That the draft order laid before the House on 28 April be approved [18th Report from the Joint Committee].
§ The noble Baroness said: My Lords, I am going to cut short my speech, in view of the hour. I propose to write to noble Lords if they want further information about training opportunities, and so on. I shall whizz through as fast as I can.
§ The order will introduce statutory regulation for operating department practitioners—ODPs. It will strengthen public protection for patients undergoing operations by setting and maintaining in law standards of practice, training and conduct for this group of healthcare staff who are closely involved in the delivery of patient care. It will bring ODPs in line with their medical and nursing colleagues who work in the same area.
§ I do not know how much noble Lords know about ODPs. I knew very little, and I am very impressed with what I have learnt about the role they play. They are important healthcare professionals who have to ensure that every operation is as safe and effective as possible. Their work takes in the whole range of peri-operative care, from preparing anaesthetics right through to taking care of the patient when they are coming round.
§ The history of the profession goes back to the 1970s. I shall not rehearse it, but I will say that the qualifications over the years have changed as the role itself has developed. We have moved from an NVQ to a Higher Education Diploma in Operating Department Practice, which will come into operation this October.
§ ODPs are skilled members of the medical team, and they are important to ensuring the patient's recovery. Not only are they employed within operating departments, but they are also now being employed in accident and emergency and cardiac arrest teams. If we are to deliver a modern and responsive health service, we have to ensure that they meet national standards set by an independent regulator.
§ The order has the warm support of the Association of Operating Department Practitioners and the entire profession. But if they are to benefit from Agenda for Change, they have to be able to register by October 2004. Failure to do so could damage recruitment and retention of ODPs.
§ The protected title is proposed, as it is currently in use by practitioners and recognised by members of the public. We are not going to protect alternative 368 titles, such as "anaesthetic practitioner" or "surgical practitioner", since these titles are already in use and they reflect different roles. We propose to protect the single title of ODP.
§ The legislation also proposes opening a new part of the HPC register for ODPs. This means that there will need to be new members of the council—registrant, alternate and lay. This will increase the HPC from 12 practitioner members and 11 lay members to 13 practitioner members and 12 lay members. I am sure noble Lords will know that once ODPs are regulated they will have to pay fees of £60.
§ The order has been the subject of extensive consultation over three months and has attracted, I am pleased to say, broad agreement. The provisions of the order are compatible with the European Convention on Human Rights.
§ This programme has grown out of the order that set up the Health Professions Council in April 2002, which was designated with the power to regulate new professions that were currently unregulated. This is the first new profession to be covered in this way. It will be followed by applied psychologists in 2004; healthcare scientists in 2005; and psychotherapists and counsellors in 2007–08.
§ The effect of the order will be to bring ODPs within the remit of the Health Professions Council, the role of which is to set standards of proficiency, conduct, performance and ethics under Article 21 of the HP order; to set standards of education and training under Article 15 of the HP order; to maintain a register of those who meet the standards and are fit to practise under Article 5 of the HP order; to have a mechanism for investigating complaints; and to deal with registrants who cease to meet the standards by taking any necessary action. That, of course, will be the responsibility of the HPC's "fitness to practise" system.
§ I shall conclude my contribution at this point. I have available a great deal of detail about how we shall incorporate the Association of Operating Department Practitioners, which has brought the profession to this point. I pay tribute to it. There are 6,000 members already on the voluntary register. There are a further 10,000 outside it, many of whom share the same training and qualifications. We wish to make sure that such people are also registered because they have the right qualifications. To ensure that people who came into the profession early are able to register, grandparenting arrangements have been introduced to enable them to prove that they also have the right training and qualifications. I shall happily write to noble Lords about how we intend to achieve that.
§ With that very short explanation, I commend the order to the House.369
§ Moved, That the draft order laid before the House on 28 April be approved [18th Report from the Joint Committee].— (Baroness Andrews.)
§ Earl Howe
My Lords, we welcome the order and I thank the Minister for her introductory words. Operating department practitioners have very considerable professional responsibilities for patient care and there can be no doubt that professional self-regulation under the umbrella of the HPC is entirely right and appropriate.
I do not have any comments of major importance other than to congratulate all involved in laying the groundwork for the order, including officials in the department and, particularly, the Association of Operating Department Practitioners. I wonder, however, whether I could ask a couple of subsidiary questions.
In any new move of this nature there has to be a managed transition. As the noble Baroness said, there are 6,000 practitioners already on the association's register but probably up to 10,000 ODPs who are practising but not registered. That is a very large number of unregistered practitioners. The extent of the professional competence of this latter, very large, group of people is a closed book. Some will no doubt have reached standards of competence which they can demonstrate readily and there will be little difficulty in admitting them to the new register; others, however, will need to be formally assessed and undergo the relevant training before completing a test of competence.
The trouble is that we simply have no idea how many individuals fall into the latter category. Is the Minister satisfied that the two-year period allowed in the order to enable unregistered practitioners to apply to become registered is sufficient to ensure that there is no disruption to the NHS? My understanding is that the standard training requirement for a practitioner is a two-year higher education diploma. Therefore, any delay on the part of unregistered practitioners in submitting their names to the HPC for assessment may result in large numbers being technically unfit to practise when the transitional period comes to an end.
Secondly, I understand that the title of operating department practitioner is to be protected, but no other title. I do not question that decision, but what is to prevent someone using the unregulated title of surgical practitioner or anaesthetic practitioner? What steps will be taken in the NHS to ensure that as far as possible those individuals employed to carry out the role of operating department practitioners are professionally entitled to use that name?
Thirdly, will the Minister reassure me that the ADDP will continue to fulfil a relevant role as the professional advisory body for the HPC in relation to operating department practitioners? I am a little unclear about the role it will have. Officially it will be for the HPC to define standards of competence and ethical behaviour and to devise appropriate education and training and to assess fitness to practise, but where 370 will the expertise on those issues within the ADDP be directed, and will it be retained there? What exactly will be its function?
§ Lord Clement-Jones
My Lords, I wish to join the noble Earl, Lord Howe, in congratulating the Association of Operating Department Practitioners. This is the first of the new professions to come under the Health Act 1999. Many of that Act's provisions were reasonably controversial, but it was agreed between us all at the time we debated the Bill that the provisions were a more satisfactory way of allowing the emergence of new professions by regulation rather than having to have primary legislation, provided that those new professions were prepared to come within the umbrella of the HPC.
The HPC is an interesting umbrella; a diverse range of professions nestles underneath it. As always, I suspect one of the key issues for new professions is inevitably—and I suspect it will be the same for the profession coming down the track mentioned by the Minister—so-called grandfathering, which means that there is a controversial area about the training requirements and so on. I do not wish to go much further tonight because of the hour, but I know that such issues are always controversial and I suspect that the Minister may like to say a little about it in her winding up.
I am interested in the reference to Agenda for Change and so on. One hopes that when such new professions are formed and placed under the regulator we will see flexibility and we will not see a new profession building a little regulatory laager; that it will continue to play a flexible role and an even more flexible role in the future, if that is what Agenda for Change is designed to secure.
While congratulating the new profession, I hope that it will not pat itself on the back and say, "This is what we do, our competencies are thus and we don't take a wider role". I hope that that is not the spirit in which it is going forward.
§ Baroness Andrews
My Lords, I have been impressed by the way in which the new profession has developed its competence and its skill over the past few years. I am sure that it will continue to do so. It is an admirable example of a flexible profession.
The noble Earl asked me three questions. The AODP will concentrate on being a professional body, developing the professional scope of practice, advising on training curricula to meet service and professional needs and providing membership services and developing specialist groups. It has no fear for its future. It probably has a very bright future with registration.
The noble Earl raised a serious point about not wanting to see disruption and dislocation in the service. He is right to be concerned about that. We believe that the two-year period is sufficient. The NVQ is running alongside the new diploma; we will not be recruiting to the NVQ any more, but there will not be a gap, as I understand it, between the two.
371 The noble Lord, Lord Clement-Jones, invented the term "grandfathering". The word is "grandparenting". It is a sign of the wisdom that comes with grandparents. The 10,000 people outside the scheme will have to prove that they have practised safely and effectively as an ODP for three out of the past five years. Some of them may have trained. Some young nurses, for example, have been in the health service for many years, and have an HND qualification. They have grown up through the system and continue to make very important and sometimes different contributions.
We do not want to lose those experienced, safe and effective practitioners just because they do not hold the most up-to-date qualifications. Obviously, the HPC must have safeguards in place to make sure that practitioners can have their training and experience assessed properly. They may be asked to undergo further training. We are trying to strike a balance 372 between making sure that those people are not lost to the health service while weeding out people who do not have that experience and training but may be able to acquire it in the future.
The education and publicity for ODPs and employers by the HPC, the AODP and the Department of Health will make it clear that only ODPs will be able to use the title. That will be the legal situation. Anaesthetic practitioners will not be able to use it, nor will the other practitioners referred to by noble Lords. It is a very clear requirement in the legislation.
I hope that that explanation satisfies noble Lords. We have taken this order rather faster than I anticipated. If there are further questions, I would be very happy to write to noble Lords.
§ On Question, Motion agreed to.
§ House adjourned at eight minutes before ten o'clock.