Mr. Hutton: The wording in the 23(2)(a) is consistent with the recommendations of the Kennedy report. The council's powers of direction which appear under clause 25 are separate matters. The exercise of such powers and the circumstances in which they can be used are defined in clause 25. When I described why we have decided to establish the new council, I said that it is important that those interests that we have identified in 23(2)(a) are promoted because that is the purpose and rationale of an effective system of professional self-regulation. That paragraphs states:
''interests of patients and other member of the public''
It is difficult to imagine any other set of underlying principles on which we could rest a system of professionally-led self-regulation.
Dr. Harris: That is a helpful answer. Is the Minister's view that one can only adequately promote the interests of patients and other members of the public through this body with a non-professional majority, however slim? The corollary is that when there is a professional majority, there may be tension between the promotion of the interests of patients and other members of the public, and the promotion of the interests of the profession.
Mr. Hutton: The hon. Gentleman tabled an amendment to explore these issues, but Kennedy was clear that the best people to represent the views of patients and the public are the patients and the public, not members of professional groups or regulatory bodies. There is an inescapable logic behind that argument and we shall return to the matter later this morning when we discuss another amendment tabled by the hon. Gentleman.
I am grateful for the general support that Committee members have expressed for establishing the council. I understand fully that the regulatory bodies and Conservative Members are concerned about the way in which the council will discharge its functions and we shall debate that shortly. However, I am encouraged by the strength and support that has been expressed today for the principle behind the establishment of the council.
Question put and agreed to.
Clause 23, as amended, ordered to stand part of the Bill.
The Council for the Regulation of Health Care Professionals
Dr. Harris: I beg to move amendment No. 255, in page 73, line 4, leave out 'regulatory body' and insert
'of the regulatory bodies referred to in section 23(3)(a) to (g)(i), and three members appointed by the regulatory body referred to in section 23(g)(ii) or the successor regulatory body (within the meaning of Schedule 3 to the 1999 Health Act) to the Council for Professions Supplementary to Medicine, the Health Professions Council, established by an Order in Council under section 60 of that Act.'.
The Chairman: With this it will be convenient to take the following amendments: No. 188, in page 73, line 6, after 'appointed', insert—
'on the recommendation of the NHS Appointments Commission.'.
No. 189, in page 73, line 12, leave out 'one fewer than' and insert 'equal to'.
No. 256, in page 73, line 12, leave out 'one fewer', and insert 'one more'.
Government amendments Nos. 203 and 204,
Amendment No. 226, in page 73, line 25, at end insert—
Government amendments Nos. 205 and 187.
Dr. Harris: This is a large group of amendments and, as is often the way, the schedules dealing with membership and appointment attract controversy. That is evident from the number of amendments, which is unfortunate because there are larger issues at stake. It is interesting that a number of Government amendments are included in this group, and they will be welcomed by Committee members from all parties.
Amendment No. 255 raises the issue that was discussed on clause 23 stand part; the difficulty perceived by some, if not many, members of professions that are regulated by the Council for Professions Supplementary to Medicine, soon to be the Council for the Regulation of Health Care Professionals, that they are under-represented on the new council. It is important to understand what representation means. The Minister made it clear that he wanted, rightly, the new council to have representatives from the different councils who can describe the way in which they work and share best practice. The Minister may argue that the health care professions that are regulated by the Council for Professions Supplementary to Medicine are not so different that it would be impossible for issues that will be discussed at the new council to be adequately represented by a member of that council who happens to be a member of one of the 12, but not of the others. There is some logic in that and the way in which schedule 7 is drafted makes that easy.
The Minister may argue that apportioning members on a numeric basis opens a raft of separate issues—for example, that there are many more nurses than doctors, even in Oxfordshireand that we should have proportional representation. I am certainly not suggesting that, which should reassure hon. Members who have a vested interest in the status quo. Nevertheless, it is important to put the case for the amendment, if only to give the Government the opportunity to recognise that we are starting from the existing system of health care professional bodies and councils, rather than from where logic would have led us had we started from scratch.
It is remarkable that there will be a representative from the council that regulates chiropractors and a separate representative from the council that regulates osteopaths, which are important, but not necessarily more important than the 12 health care professions currently represented by the Council for Professions Supplementary to Medicine. Yet, there will only be one representative of the vast number and the wide range of professions currently regulated by the CPSM.
Mr. Heald: Is there not a concern that the proposed nursing and midwifery council will represent two very large professions and the health visitors too, although they are not mentioned in the title? Why should they not have three slots, because there are probably as many of them as there are of all the health professionals in the health professions council? How would you calibrate the system?
Dr. Harris: The hon. Gentleman asks you, Miss Widdecombe, how you would calibrate it. I think that you would find it very difficult. I am seeking to accept some of the Government's arguments that representation on this new council cannot be according to health care profession. First, the new council would be large and unwieldy; and secondly, it would still not be proportionate to membership. Of course, I accept that. This is a probing amendment to find out where the Government want to go with regard to the future structure of these councils and whether they recognise that this is a consequence, albeit an unfortunate one, of the fact that one health care profession has a separate council, whereas another regulatory council covers a wide range of organisations.
In an earlier debate the Minister implied that because the proposed council will represent the regulatory functions of the councils that look after all these professions, there is no reason that representation will be any different in its quality or its stress, whether it represents a physiotherapist, a clinical scientist or a podiatrist. Many of those covered by the CPSM have argued that there is a different culture in those professions and that regulation is effectively a compromise between them. That is why there has been such a strong call for uni-professional bodies dealing with education and training.
The Minister will have to accept that because of the structures and the constraints that we are under, something may well be lost and he may need to offer some reassurance that the council will be looking mainly at issues that are unlikely to be affected by the profession of the representative on it. Indeed, the Government might argue that some issues involving best practice will be so clear and obvious that they could be adequately represented by lay members nominated to the council from the regulated councils. I am not saying that an issue need to be simple so that lay members can understand—I hope that I am not misunderstood on that point—but that something that is core to the regulation does not require professional input.
Another question that this debate raises is that when new professions are brought in, they will be under some incentive to have their own council, rather than join the health professions council, as it is soon to be, because they feel that their professional interest, which is already diluted on the council—chiropodists certainly see it that way—will be further diluted on the new council. That may cause difficulty in the speed with which we would want to ensure that there is adequate protection of title, and therefore public protection by regulating the new professions.
Through this amendment, I want the Government to accept that there is no perfect way of doing this given the asymmetry of the current councils. The councils regulate issues such as education and training, which are different in the various professions in the CPSM, on which they take advice from professional advisory committees. Those professions should not be subject to direction or suggestion from the council without wider consultation with the health care professions. The specific issues associated with physiotherapy and chiropody are different from those associated with the clinical sciences. I hope that the Minister has understood my point.
If it meets the Committee's wishes, it may be appropriate to discuss the other amendments. I have appended my name to amendment No. 188, which was tabled by the hon. Member for North-East Hertfordshire and his colleagues. They may feel that the issue has been tackled by Government amendment No. 203. If that is the case, it shows that the Committee can be of some use, which is something that I welcome.
Amendments Nos. 189 and 256 seek to probe the Government on the balance between council members, who are members of the council nominated by the regulatory councils, and the number of Government appointees, albeit that if Government amendment No. 203 is passed Government appointees will be mediated through the NHS Appointments Commission. Government amendment No. 203 provides reassurance for those who are worried that an automatic Government majority, if one includes those appointed by the devolved powers, goes too far in undermining the independence of the regulation of health care professions given the wide directional powers in clause 25.
In earlier sittings, I asked the Government whether they were certain that the protection of patients and the public could better be provided by professional self-regulation than by Government regulation, and the Minister indicated that that was the case. Although I understand that the idea of the council is to identify best practice and to promote the interests of patients and the public, it is still unclear whether that cannot be done with a council the majority of whose members are appointed by the councils. The members may not all be professionals but the councils should appoint the majority. For the council to be effective, it must have the confidence not only of the public and Parliament, but of the professions. If the status quo ante is a professional majority, or at least a majority appointed by the councils regulating the professions, the Government must show a need for that to change to a minority appointed by the councils. I hope that the Government will set out why they feel that that must be the case.
Amendment No. 226 seeks to ensure that some regulations that the Secretary of State may lay to provide for various functions are subject to positive resolution procedure. In earlier sittings I suggested to the hon. Member for North-East Hertfordshire that there were some regulations that it would not be appropriate to die in the ditch over. This type of amendment allows Opposition Members to make a stand because it is in these sensitive areas that positive scrutiny by both Houses of Parliament would be most useful.
Government amendment No. 205 and amendment No. 187, which has become a quasi-Government amendment, seek to reduce the Secretary of State's powers to give directions to employees. I suspect that those amendments will be widely welcomed, and I certainly welcome them.