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Baroness McFarlane of Llandaff: I support the two amendments in this group, if only in intent because there is a question of terminology in terms of "healthcare assistants" being substituted for "nursing auxiliaries". Without wanting to enter into a sociological discussion of what is a profession, it could be questioned whether nursing auxiliaries are part of a profession.

The principle of these amendments is exceedingly important. Not only are healthcare assistants employed in hospitals where they are theoretically supervised by nurses, although often by default they are not, but they are also employed to give intimate care in patients' own homes without any direct supervision. These are important amendments.

Baroness Hayman: I hope that I will be able to respond, as the noble Baroness, Lady McFarlane, has suggested, to the important substance behind the amendments. My understanding is that as currently drafted the order-making powers are quite wide enough to encompass any action needed to regulate these groups. Therefore, this specific amendment is not necessary to the Bill should that decision be taken. I respect the opportunity that has been taken to raise the issue of the role of nursing auxiliaries or healthcare assistants, however we use the terminology. I was particularly grateful for the way in which the noble Earl, Lord Howe, pointed out that this issue is concerned with lifting standards and respect for the profession as a whole as well as dealing with the particular problem of abuse, which occurs only in a minority of cases.

Nursing auxiliaries and healthcare assistants in the NHS play a very important role, which may not feature prominently in some of the coverage of the health service. They perform a significant number of tasks that in the past would have been considered specifically nursing tasks. They are intimately involved with patients and those who they care for, and the public are entitled to an assurance that only suitably trained and appropriate individuals are employed in positions where there is such contact with patients.

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I recognise the concerns that have been expressed about the development of the roles undertaken by nursing auxiliaries. These concerns have been raised in the past in the context of the need for regulation of support workers. As the noble Lord, Lord Clement-Jones, said, this issue was discussed in the review of the Nurses, Midwives and Health Visitors Act and the conclusion was reached that full-blown self-regulation was probably not the answer. The review recommended a short review of the position regarding support workers. It was recommended that the review should advise on codes of conduct for these workers, standards of training for those groups for which it is appropriate, the establishment of a list of suitably qualified support workers and the enforcement of those recommendations. We have announced our acceptance of that recommendation for such a review and we will go ahead with it.

I think the noble Lord, Lord Clement-Jones, is again tempting me to pre-empt the results of the review by saying what its conclusions would be. I think we should approach matters in a straightforward way and undertake the review.

We have already announced our plans to regulate social care staff in the social services White Paper, Modernising Social Services, by setting up a statutory general social care council. The driving force behind the new council is to increase the protection of service users, their carers and the general public. Any review of support workers within the health service will have regard to the decisions that the Government have already taken in relation to care assistants in the social care field. There is a great blurring of the edges in terms of where people receive treatment. It is important that we make sure that there is proper regulation across the board.

On that basis, and with the reassurance that the powers included in paragraph 11(2)(b) of Schedule 3 would be wide enough to enable legislation to take place on the regulation of these groups should that be considered appropriate, I hope that the noble Lord will consider that the amendment is unnecessary and will feel able to withdraw it.

Lord Clement-Jones: I thank the Minister for that helpful reply. Before responding, perhaps I may put one further question to her. So far as professional or occupational regulation is concerned, there are many other considerations. Clearly, much is happening at the department. What is the timescale for the review that is currently taking place? Will it be completed in a short space of time? The Minister said that it could take two years to settle the current rules of the GMC. This matter is rather more urgent.

Baroness Hayman: I do not have my Civil Service lexicon to tell me whether I should say, "shortly", "soon", or "before too long", and how those expressions translate into weeks or months. Perhaps I may write to the noble Lord and give him details of the timescale currently envisaged.

Lord Clement-Jones: I always think that "presently" is a useful expression. I thank the Minister for that reply.

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I certainly did not mean to under-value the role of healthcare assistants. Indeed, I was one for a short period of time. I believe that they were then called orderlies. I am not sure what happened to that title. They perform valuable services. One of the roles of regulation is to enhance professional self-esteem, training and all the other good things about healthcare. One tends to believe that regulation performs as a yardstick for the worst cases. Again, I thank the Minister and beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Clement-Jones moved Amendment No. 199:


Page 38, line 28, at end insert--
("( ) Orders under this section shall make provision for the regulation of the use of specific professional titles in relation to professions to which subsection (3)(a) above refers.").

The noble Lord said: We have had an interesting debate about protection of title. However, I wish to "ratchet up" the specificity of the Minister's reply.

Paragraph(1)(d) of Schedule 3 has been drawn to our attention. It relates to the privileges of members admitted to practice. It allows an order to be made which covers protection of title. But what protection of title are we talking about? Are we talking about protection of title as regards "registered nurse" or "registered physiotherapist"; or are we talking about protection of common title? Or are we talking about protecting the title "nurse", or "physiotherapist", so that the magic word "registered" does not have to be used in front of the title? This is important to a number of the professions. Perhaps the Minister will comment. We have heard of the Government's welcome intention to include in the orders the question of protection of title. That is very much the "quo" for the "quid" that the Government are proposing in terms of changing the regulatory structure. I beg to move.

4.45 p.m.

Lord Peston: It is difficult to know when to intervene in today's debates. I should declare an interest as an honorary member of the Royal Pharmaceutical Society--the word "honorary" being as it were, in italics, in the sense that no net benefits seem to flow from it in any form. I was not certain whether to intervene now or later in connection with the amendments tabled by the noble Lord, Lord Walton, which are inter-related.

The essential point is that protection of title is a restraint on trade. There is no avoiding that. Therefore, whether we are discussing nurses, doctors or anyone else, in the public interest it must be demonstrated that net benefits flow. Many of those supposed net benefits are set out in the amendments proposed by the noble Lord, Lord Walton, to which I shall speak.

I am convinced that there ought to be protection of title. In practice, the professions generate net benefits to our society despite the restraint on trade. However, as the noble Lord, Lord Clement-Jones, said (I do not know whether it is a "quid" for the "pro" or a "pro" for the "quid") there has to be a pay-off to society. That

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pay-off is concerned with the way in which the professions conduct themselves. I shall address that point in relation to the later amendments.

I hope that my noble friend the Minister will respond positively. I hope that she does not sell the pass and abandon the Government's responsibility for seeing in the final analysis that the public interest is protected. I stand second to no one in my support for the professions. But one of my main concerns is that they do not seem fully to recognise that there is a public interest here. The public cannot simply say, "Oh, yes, we trust you professionals from now to infinity and we do not need a reserve power." Whether my noble friend wishes to discuss the reserve power question now, which relates to the core function question, or whether she wishes to save it for her reply to the noble Lord, Lord Walton, is entirely a matter for her. I support the noble Lord, Lord Clement-Jones, in the desirability of protecting title. It tells consumers what they receive for the title in a properly regulated profession. That is fundamental. However, I hope that in being to some extent supportive of the noble Lord, Lord Clement-Jones, we can also then talk more generally of what we expect from the professions and where the Government stand in representing the public interest. My remarks are a start; I shall not give up on the point when it comes to the later amendments.


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