Standing Committee B
Thursday 12 December 2002
(Morning)
Mr. Win Griffiths in the Chair]
Clause 4
Health Professions Wales
8.55 am
Mr. Bill Wiggin (Leominster): I beg to move amendment No. 12, in
clause 4, page 3, line 20, leave out subsection (3).
The Chairman: With this we may take amendment No. 16, in
clause 4, page 3, line 20, after 'functions', insert 'in relation to health care professions and health care support workers'.
Mr. Wiggin: First, the Hansard for our previous afternoon sitting is not available. I asked for it yesterday, but it is not here. I see that you have taken care of it already, Mr. Griffiths.
The Chairman: I have already been informed that, in this modern day and age, the IT system is causing problems. It is hoped that the proceedings will be published on the internet on Saturday and that the hard copy will be available on Monday. Apologies, but it is beyond our control.
Mr. Wiggin: Thank you, Mr. Griffiths.
In August 1997, the Health Professions Wales was one of four UK health departments commissioned to review the statutory framework for the regulation of nursing, midwifery and health visiting. The report recommended a smaller and more efficient UK-wide body, the Nursing and Midwifery Council. That explains the roots of the Health Professions Wales. At the same time it was decided to replace the Council for Professions Supplementary to Medicine, established under the Professions Supplementary to Medicine Act 1960, with a more focused Health Professions Council.
The two orders establishing those bodies were approved by Parliament and made on 12 February 2002. The orders provided that the National Assembly for Wales may create or designate a body with which each council may enter into arrangements for ensuring that the councils' standards for education were being met. Since that date, a shadow HPW—technically within the Assembly, but in fact a continuation of the WNB—has been fulfilling the necessary functions. The shadow body has 23 employees and costs £1.5 million a year. Clause 6 will provide a proper statutory footing and a welcome degree of independence.
The new HPW has an ambitious agenda, extending some way beyond that of its predecessor. The National Assembly Minister confirmed that Wales was taking a lead in creating the HPW, but emphasised that it was early days yet and that she was in regular consultation with other Health Ministers in the UK. UK standards were indeed envisaged, which brings me back to the
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fact that the original idea was to have a UK-wide body, in respect of exercising functions relating both to health care professions and to health care support workers. I hope that that explains why it is important to incorporate reference to both within the Bill.
Witnesses to the Select Committee raised the possibility of problems arising from the power of the Assembly to direct the HPW, cutting across the proper performance of its functions carried out on behalf of the NMC or the HPC. The Select Committee recommended that the National Assembly's power of direction to the HPW should expressly require prior consultation regarding functions carried out by the HPW on behalf of the HPC or NMC.
During my research, I have followed up quite a lot of the evidence given to the Select Committee. The Nursing and Midwifery Council welcomed the establishment of Health Professions Wales and noted that its functions related to health care professions and health care support workers. While the NMC does not anticipate that there will be occasions when a direction from the Assembly would run counter to the requirements of either the NMC or the Health Professions Council, it notes that the possibility exists.
9 am
Equally, it noted that the Bill will give the Assembly powers to abolish Health Professions Wales. Should that power be exercised, it will expect that any organisation that has entered into contractual relationships with the HPW would be given due notice so that appropriate and effective arrangements could be made. It is worth drawing the Committee's attention to the health care professionals within the remit of the HPW. They include arts therapists, clinical scientists, dieticians, health visitors, medical laboratory scientific officers, medical physicists, medical physics technicians, midwives, nurses, occupational therapists, orthoptists, paramedics, physiological measurement technicians, physiotherapists, podiatrists and chiropodists, prosthetists and orthotists, radiographers and speech and language therapists. I could perhaps do with a bit of speech and language therapy at this early hour. I put it down to the fact that I have not had my Weetabix yet.
Health Professions Wales also gave evidence to the Select Committee. It will liaise with Healthwork UK and other UK in order to maintain a UK-wide perspective in the development of a coherent approach to education and training within the health care sector work force in Wales. It will represent and work with employers and other relevant bodies in conjunction with Healthwork UK to support implementation of lifelong learning within the health care sector. That phrase ''within the health care sector'' recurs throughout the evidence. It will work with the midwives and the health service organisations in Wales and will advise on work-based learning and assessment of competence. It will also assist the clinical governance agenda to reduce poor performance in health service organisations across Wales. It is clear from the HPW's evidence to the Committee that it sees its mandate as being within, for and in relation to
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health care professions and health care support workers.
Even Unison considers that the main advantage to such an organisation is that it consolidates the training and development of those staff groups into a single over-arching framework. It adds that it can be argued that it does not go quite far enough by not including doctors, consultants and other medical staff in such an organisation. Again, it is mainly a welcoming comment from Unison.
Interestingly, the Royal College of Nursing notes that it was unsure of the extent to which powers of direction granted to the Assembly were wholly appropriate. It felt that the Minister for Health and Social Services would, in effect, exercise those powers without the approval of the Health and Social Services Committee or the Assembly as a whole. It sought reassurance that the powers of direction outlined in clause 4(2)(c) and (4) were not intended to be used to undermine the necessary autonomy of the HPW. It felt that it was right that the Assembly as a body should be able to pass secondary legislation to set the parameters of the work of HCW, but added that ministerial intervention, through directions on what are essentially professional matters, will often not be desirable or appropriate.
The Government seem to have accepted the thrust of the Committee's concern that the ambit of the HPW should not be allowed to spread, but there is some doubt when reading subsections (2) and (3) as to whether functions to be conferred by Assembly orders are to be restricted to health care staff. For the avoidance of doubt, the amendment would be most helpful.
The Parliamentary Under-Secretary of State for Wales (Mr. Don Touhig): I welcome you to the Chair, Mr. Griffiths, for what we hope will be our final sitting if we make good progress.
Amendment No. 12 would remove subsection (3) and amendment No. 16 would insert a new set of words, making the Bill more narrow. I hope that I can convince the hon. Gentleman that the amendments are unnecessary and to reassure him in respect of the points that he made.
Modernisation and reform of the health service in Wales requires a flexible approach and the Assembly has to have the freedom to provide for changing standards in health care, training and development. The amendment would prevent that. Changes to the way in which individual professions work will give rise to new requirements for staff's continuing education and training. The amendment would prevent the Assembly from responding quickly and effectively to changing needs.
The Assembly intends to use the powers in subsection (3) to give the HPW responsibility for quality assurance in the continuing education and training of qualified nurses, midwives, health visitors, allied health professions and health care scientists in Wales. If the amendment is accepted, the Assembly would be unable, for example, to require the HPW to
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accredit post-registration workplace and academic training, which would not benefit patients or the health service in Wales. The Assembly would not be able to ask the HPW to take important steps in developing a similar role in respect of health care support workers.
As to amendment No. 16, subsection (3) as drafted provides scope for the Assembly to confirm functions that it exercises on the HPW and the HPW can carry out those functions on behalf of the Assembly. The amendment would prevent the Assembly from conferring functions on the HPW other than those related solely and exclusively to health care profession and health care support workers.
Chris Grayling (Epsom and Ewell): Will the Minister clarify something? He said that the subsection referred solely to the transfer of functions carried out by the Assembly, but it does not actually say that. I hesitate to use a previous example, but if there were to be a much stronger nationalistic tone in the Assembly that said, ''We must have our own qualifications for Wales,'' is there anything in the clause to prevent the Assembly from saying to the HPW, ''We want you to develop entirely exclusive professional qualifications for Wales without reference to the rest of the United Kingdom''?
Mr. Touhig: I was just about to come to that point; I can allay the hon. Gentleman's worries. There is an important and subtle point of distinction that I want to get across in respect of the use of subsection (3): it will not permit the Assembly to confer a ragbag of unrelated functions on the HPW. Subsection (2) already provides that the HPW is to have functions in relation to health care professions and support workers, as conferred by clause 4, which includes those conferred under subsection (3). The point made by the hon. Member for Leominster (Mr. Wiggin) is covered in subsection (2).
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