Examination of Witnesses (Questions 1-19)
DR PAM WALTER, MS JANICE GOSBY, MR COLIN LEA, DR PETER BURLEY, MS WENDY FAWCUS AND MR THOMAS MOORE
MONDAY 17 JUNE 2002
1. Welcome this afternoon to our inquiry into the Draft National Health Bill (Wales) which is a pre-legislative inquiry. Do not be put off by the formality; this is the way the committees of the House of Commons have to work. This is not the spirit in which we are doing this. It is pre-legislative and the idea is to get an exchange of views, and if it is done in the way that we have to do it, please do not be intimidated at all. Also as one of our aims is to work with the Assembly on that, we have invited those Assembly Members who are interested to sit in on our deliberations, as indeed some of us sat in on theirs on the Health Committee. Dai Lloyd is here
but he is having to leave later so he is not sitting in. Ann Jones is sitting in throughout. Unfortunately because of our rules she cannot ask any questions but maybe you will be happy about that! First of all, in the Explanatory Notes which were published with the draft Bill, which I am sure you will have seen, it is stated that the functions of HPW are already performed I guess by yourselves there. How many people actually work in the unit that exists now and what is the cost of it? Will the same people be working when it becomes an Assembly sponsored public body?
(Ms Fawcus) There are 23 employees working for HPW at this moment in time and for the current financial year we have been allocated a budget of £1.5 million. That is made up of recurring and non-recurring monies. It is our understanding that all existing HPW staff will transfer to the ASPB once that has been established.
2. The Welsh National Board for Nursing Midwifery and Health Visiting was abolished on 31 March of this year. Was that a bit premature would you say? Has it made life awkward for the newly-established Nursing and Midwifery Council and Health Professions Council not to have this properly constituted successor which is being legislated for in the Bill?
(Dr Walter) In order to set up the Nursing and Midwifery Council the previous UKCC central council and national boards had to be abolished. You could not set up the NMC without doing that, so whilst it would have been very convenient if all of that successor body had moved smoothly along, we do not see it as a particular problem for NMC given that we have had very close relationships with the previous Welsh National Board, so we are used to working closely with colleagues there. It is possible through memoranda of agreement to undertake the work that needs to be undertaken until such time as Health Professions Wales is set up as an Assembly sponsored public body.
3. Do health Professions Wales know what has happened to the WNB's employees and the Board's assets and liabilities?
(Ms Fawcus) Yes, all WNB staff transfered to HPW along with all the assets and liabilities so there is continuity.
4. In the memorandum we have had from the Association of Welsh Community Health Councils in talking about Health Professions Wales they say: "We believe this body should enable lay participation where appropriate", but they do not see where they can fit it in in the Bill. Does that happen at the moment? Is it intended in some of the many functions you listed that lay participation would be appropriate?
(Ms Fawcus) Yes, we think so. The WNB had lay board members, and we would hope the same would be the case for HPW. Of course, the actual constitution of HPW has not been put together yet but we hope that would be a constituent part.
5. Thank you. Health Professions Wales, as we understand it, is being created to undertake quality assurance of training "if requested" by the NMC, and quality assurance work on behalf of HPC "if requested". Can the NMC and the HPC explain briefly what they will be requesting Health Professions Wales to do? Will all arrangements for nurse training in Wales be the responsibility of HPW? Similarly, for all health care support workers?
(Ms Gosby) The Nursing and Midwifery Council sets UK-wide standards for nursing and midwifery educational programmes that lead to registration or recordable qualifications and would be requiring Health Professions Wales to assure the quality of those programmes in Wales.
(Dr Burley) For the Health Professions Council likewise as with the NMC. HPC sets UK-wide standards and the discretion in our Order in Council is to delegate certain functions to HPW. However, we are publishing a consultation exercise on 1 July which will include that part of the Order and we are seeking views and will come back to HPW in the light of views and consultation runs over July, August and September.
(Ms Fawcus) Could we just pick that up because you mentioned health care support workers. Neither HPC nor NMC have a regulatory role in relation to health care support workers. In fact, I think the UK Government have yet to establishif it is going to be established at the UK levelif and how health care support workers are going to be regulated. I think Wales is trying to remain ahead and feel that it is necessary that health care support workers are regulated. HPW is to be involved in looking at the training and education that they receive currently. To be very clear, there is no indication from the central government or the Assembly whether health care support workers are to be regulated.
6. Do you think it is important thing that they should be regulated?
(Ms Fawcus) We think it is very important in terms of they are giving care to the public and therefore protection of the public issues are very prevalent.
7. From where does the impetus come?
(Ms Fawcus) It comes from the Welsh Assembly government in terms of modernisation of the Health Service. They recognise that this is a very large body of individuals who are giving patient care who are unregulated.
8. Can you tell us who that work would involve?
(Ms Fawcus) In terms of?
9. Health care support workers; who would they be?
(Ms Fawcus) They are anyone who is supporting a member of the professions in the delivery of patient care. That can be very wide-ranging. You will find health care support workers working within the National Health Service. You will also find them in the private sector and nursing homes and you will also find them within the social care setting as well, so across the whole spectrum of health care.
10. It seems surprising that they have never been regulated. Is this something which has been of concern to people in the field?
(Ms Fawcus) I am sure it has. I think it is appropriate that HPC picks this up being the new regulatory body.
(Mr Lea) On a UK basis it covers all the registered sidethe physiotherapists, radiographers and all those allied professions of medicine. We are now going out to public consultation and within that document health care support workers are part of that. We will see what we can do. As it stands, HPW does not have the power to register health care support workers at the moment.
(Dr Burley) Firstly, we are the Health Professions Council and there is a presumption in favour of only regulating professional groups. We understand thatif I can use the right termthe English Department of Health is about to publish some thinking about this because they commissioned a major study on this topic some years back. The other point is if at the end of various consultations it is decided that it is appropriate for the Health Professions Council to regulate support workers then opening a new part of the register is again a function reserved to the Westminster Parliament. It also has to go through quite a long consultation process so, whatever happens, it certainly will not take us by surprise.
11. It is down to the UK Government. Could I ask, before I bring Miss Morgan in again, is it at all possible that the HPC would not ask HPW to do quality assurance? Would it need to be legislated for to make sure that you do it?
(Dr Burley) The way the Order in Council is framed is it uses the word "may" which to us suggests a discretion. There is a body which is about to come into playthe Council for the Regulation of Health Care Professionals (I think that is still the latest title)and it certainly might wish to take a view about the relationship been the regulatory bodies and the National Assembly for Wales generally, so maybe that is a loop to go through, or there could be another Section 60 Order to change that from being discretionary to mandatory.
(Mr Lea) The new Council regulatory body is going to be the regulator covering the regulators.
Chairman: Thank you. Miss Morgan?
12. Can NMC and HPC explain the effect of having different successor bodies in Northern Ireland, Scotland and Wales but of England not having a successor? Will that cause any practical difficulties?
(Dr Walter) If I could start from the NMC's perspective. Having the different bodies in Scotland, Wales and Northern Ireland, no, it does not pose a problem to the extent, as I said before, we have previously had very good relationships with the national boards when they undertook the quality assurance work. Therefore, we are dealing with personnelbecause they, by and large, have moved into these new bodieswho are aware of our standards and systems, and therefore it is possible for them to undertake that sort of work. Not having that body in England has been a challenge for the NMC, but the legislation allows us to make use of what is called "visitors" to undertake that work and these are people who are registrants who are directly accountable to the NMC whom we train and then they undertake the work on our behalf. So we do not anticipate that it is going to pose us a particular problem and there have already been discussions with the Assembly around being able to have a memorandum of agreement prior to a service level agreement coming into place. We are confident that the arrangements that we have been able to enter into will still deliver what we need to have assurance on quality.
(Dr Burley) We are in a slightly different position from the nurses in that our predecessor bodythe Council for Professions Supplementary to Medicinehad no relationship with any of the devolved nursing authorities so we are starting with a clean slate. The issue of how we operate in the different parts of the UK is again something we are putting into our consultation exercise so we will be informed by views on that. We have at the moment an open mind and we are seeking views.
13. NMC express some concern at the clause 4(4) power of the Assembly to direct HPW. Could you explain what is the basis of that concern?
(Dr Walter) I think it is merely because it is there and there is the potential for a direction coming from the Assembly that might cut across requirements for the regulation of nurses, midwives and health visitors. I am not actually anticipating it but the very fact that it is there makes it possible, and we would hope that the very good relationships that we already have with HPW would mean that we would be alerted to something that could potentially cause us problems and vice versa.
14. Could you think of something?
(Dr Walter) You see these words and you have to say because we set the standards and we regulate and we have the statutory duty to do it, therefore there might be an occasionand I am not anticipating itwhen a direction actually cuts across that legislation, and we would not wish to be putting registrants at risk in terms of their ability to practise nor in terms of our ability to protect the public.
(Mr Lea) We are looking forward to having delegated discretions to HPW. We have established a very good connection with them. We are very fortunate in the UK Board of Health Professions Council, which is a UK regulatory body, that we have quite a strong Welsh representation. One or two of our members of Council have been very much involved with the staff of the HPW. We are duty bound to do that and we are happy to do that. We are a UK regulatory body and obviously anything in the regulation side if we do delegate it down to HPW we will be able to do it. We are quite happy to look at that.
(Ms Gosby) From the NMC point of view, we have already set up our first four country meeting which takes place early in July so that we can ensure that the UK-wide standards are being interpreted in the same way in all four countries. We would anticipate such meetings happening twice a year. I think the mechanisms are already there to support and make sure that there are not any issues arising.
(Ms Fawcus) We do share agendas and papers and attend each other's meetings so the officers are pretty much on the ball in terms of what is coming up regarding business and spotting potential areas of conflict. We have been used to doing that for many years.
15. I want to come back to the health care support workers question in a moment but can I make crystal clear the Nursing and Midwifery Council's position. Would you rather see clause 4 (4) removed or do you just seek assurances that there will be this proper consultation if they seek to take it?
(Dr Walter) The latter.
16. Thank you very much. On the health care support workers question, I take on board what you have said about there not being any regulation in the past, but the Explanatory Notes for the Bill refer to a Code of Conduct for health care support workers. Would this be specifically a Welsh Code?
(Ms Fawcus) It is not known at this time. It could go one of two ways. It could be a UK Code and we could be involved with other bodies in preparing a UK Code, or, of course, the whole thing could be undertaken by the UK Government requiring it to be a UK Code, or, in actual fact, it may work in the same way that the Care Councils are working, where they are devising individual country Codes but they are joining together at a UK level to make sure that they can work across boundaries. It could be one or the other but it has not been decided at this time.
17. I know the Nursing and Midwifery Council have concerns about this. You would rather see a UK code; is that right?
(Dr Walter) Given the way that health care is going and you are seeing support workers working with a team of professionals in delivering care much more than just working solely to one professional, then it does seem to us that it would be sensible to have a UK-wide system of regulation.
18. Thank you very much. Clause 4(6) of the draft Bill seeks to define a "health care support worker" and it seems rather wide. Is it your understanding that this is a UK standard definition?
(Ms Fawcus) Yes. It actually comes out of another Act. That is how it has arrived in the Bill in terms of where the health care support worker has come from. It is our understanding that it comes from an already existing piece of legislation. I am sorry, I cannot quote the precise one to you.
19. Do you fear with the new functions envisaged and referred to in paragraph 11 of the Explanatory Notes and in the HPW paper provided that you may be biting off rather a lot?
(Ms Fawcus) I will pass this one to my colleague.
(Mr Moore) Health Professions Wales' officers when part of the previous body (the Welsh National Board) undertook quality assurance activities and monitoring of nursing and health care education for some 20 years in Wales. There is a great deal of expertise which resides in the staff that has subsequently transferred to what we are now at the momentHealth Professions Wales. Additionally, Health Professions Wales at the moment are in the process of attempting to recruit additional allied health professional personnel and health care scientist personnel to add to the expertise available to deliver quality assurance certainly for the Nursing and Midwifery Council and, if so desired and instructed, by the Health Professions Council. So we believe that given the expertise that is lying there, given the relationships that have been built up across Wales over the years, we should be well-placed to be able to deliver those goods without compromise.
(Ms Fawcus) We will be taking on these additional individuals regardless of whether HPC requires us to fulfil a quality assurance role. We need this additional expertise to fulfil the remainder of the remit that has been given to HPW, which is quite extensive.