HC Deb 04 March 1992 vol 205 cc387-98

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Mrs. Sylvia Heal (Mid-Staffordshire)

I beg to move amendment No. 1 in page 4, line 30, at end insert—

'(2A) In that subsection, at the end of paragraph (c) there shall be inserted— (ca) advise the Secretary of State on arrangements for monitoring the provision of courses of further training for nurses, midwives or health visitors already registered;".'. The amendment seeks to provide for an overview of the strategic planning of nursing education. Serious concern has been expressed by professional and trade union groups as well as by Opposition Members that the funding for nursing education is to be passed to the regional health authorities without adequate protection for its use and monitoring. We welcome the Government's agreement to ring-fence funds for nursing education, but we are still worried by a lack of long-term assurance on the issue.

The amendment will help the Secretary of State to ensure that the assurances given by the Minister in Committee closely to monitor post-registration as well as pre-registration budgets from the centre are met. In that way, the commitment will be given statutory force, which I am sure the Minister will welcome, so that Government intentions are not misunderstood or deviated from.

The national boards' role as validators of training courses and institutions would be enhanced as, under this amendment, they would be in a position to monitor nursing education developments and ensure that the Secretary of State is aware of any developments or discrepancies that need addressing.

In the absence of statutory ring fencing, which has been rejected by the Government, effective monitoring of nursing education spending by regional health authorities is vital to reassure the professions that their future education is financially secure and strategically planned. Although we do not doubt the professionalism of the national boards in their provision and administration, their outlook could be parochial rather than have the required objective and long-term vision that is crucial to nursing development.

I have had representations on the issue from nursing organisations and unions, as well as from individual nurses, and, like my hon. Friends, I share their concern about the security of long-term nursing education from health authority cuts. For many health authorities, it will be an easy option, when pressed for money for basic nursing and midwifery courses, to consider cutting essential courses such as family planning or neo-natal nursing courses.

It is vital that the number of places is monitored annually; the number of midwife teachers to provide such courses must also be monitored. Without adequate provision for post-basic education for midwives, the standard of midwifery care in Britain will obviously be affected. That will have a knock-on effect for mothers, babies and their families. Our midwifery service is considered to be the best in the world, and that is the way it must stay. We need to ensure that the conditions are right in order to protect our midwifery services. Unless there is an opportunity for midwives to develop their knowledge through post-registration courses, midwifery will become a less attractive career prospect for many women.

The report of the Select Committee on Health on maternity services, published today, is the result of evidence from professionals and consumers concerned in maternity care and, as such, is likely to receive widespread support. That report, which I welcome, emphasises in its recommendations the importance of women having greater choice in the type of maternity care that they receive, whether at home or in hospital, and says that the majority of them regard midwives as the group best placed to provide the continuity of care through pregnancy and childbirth. A weakened midwifery profession will not be in an optimum position to implement the recommendations. The report also refers to the importance of education in ensuring that the midwifery profession remains highly skilled.

As the Minister for Health pointed out in Committee, she did not think that her Department could adequately provide the necessary monitoring because it was too detached from the workplace. I do not share her doubts about the Department of Health's capacity to monitor effectively if it so desires. However, to cater for her nervousness about whether her Department is capable, the national boards are ideal agents of monitoring. They are in close contact with nursing education through their work of validation and will comprise practising nurses, midwives and health visitors who will have the necessary experience to be able successfully to monitor health authorities and their nursing education provision.

The Minister has already agreed that monitoring post-registration and pre-registration training is important and the amendment simply gives that belief an assurance of statutory force. I commend the amendment to the House.

The Minister for Health (Mrs. Virginia Bottomley)

The amendment is misconceived in seeking to involve the national boards in the arrangements for monitoring post-registration training. We debated this important Bill with a great deal of agreement, and I made it clear that it must be for the NHS, not the national boards, to do its own work force planning and ensure that training provision is adequate for its needs. The role of the boards is different. It will be their job to accredit institutions and to validate courses, to ensure that the standards of professional education of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting are met and to collaborate with the UKCC in the provision of improved training methods.

I have also made it clear that we fully recognise the responsibility of the NHS to ensure that nurses, midwives and health visitors can maintain and develop their professional skills at post-registration level. In that context, I am, for example, looking forward to receiving the UKCC's PREPP—post-registration education and practice project—formal proposals and discussing with it the implications for the NHS. I have already had informal discussions with the chairman of the UKCC, Dame Audrey Emerton, and her team, and I hope that we can carry matters further forward.

We also recognise the responsibility of the NHS to ensure that sufficient nurses are trained in specific post-registration skills to enable the changing demands on the service to be met. The hon. Lady is aware of the many specialist areas in which it is fundamental for the delivery of health care to have nurses in sufficient numbers with those particular post-registration skills. I refer to the large groups of the district nurses, health visitors, community psychiatric nurses and to specialist areas such as burns, plastic surgery, renal surgery, paediatric intensive care, neo-natal intensive care, accident and emergency and theatre nursing.

There have been occasions when we have decided from the centre that it is necessary to ring-fence money particularly to ensure the development of a particular specialty. For example, a former Secretary of State ring-fenced £3 million particularly for the training of high-tech nurses because we are only too well aware that having a sufficient supply of properly qualified staff determines our ability to maintain momentum and provide high quality care. We are making special arrangements in that regard, and although the amendment is misguided in seeking to give responsibility to national boards, that is not to say that monitoring training is unimportant.

We told regional health authorities in England that post-registration education and training, which is designed to provide specific professional skills, should for the time being be funded from a separate and protected regional budget, managed in a similar way to that for pre-registration training. Budgets will be rolled forward from year to year in the ordinary way, and it will be open to regions to vary them in the light of changing work force demands. Any such variation should, however, be open and transparent.

We are ensuring also that both pre-registration and post-registration budgets are closely monitored. I said in Committee that we are still working on the precise mechanics, and we shall hold early discussions with the service. I want to be certain that the arrangements that we put in place are consistent with the new approach to planning and commissioning training for NHS non-medical staff generally that will be introduced on the basis of the principles set out in 1989, in working paper No. 10. Many health service staff will be equally concerned with those arrangements.

I remind the House that, although we made it clear that specific arrangements for post-registration training will be subject to review in the light of experience, current arrangements will continue as long as necessary. We have no plans for changing them in the foreseeable future.

The hon. Member for Mid-Staffordshire (Mrs. Heal) referred to the Select Committee report on maternity services that was published today. As she knows, there has been a 23 per cent. increase in midwives since 1979, which is of great significance. The report reveals that the pendulum has swung back to recognition of that which the hon. Lady rightly identified as a major strength of our maternity services. It is hard to identify any other health service in the world in which the qualified midwife plays such a significant role. Midwives, like nurses and health visitors, have much to gain from the Bill.

It would be inappropriate to accept amendment No. 1 because, clearly, mechanisms are in hand. It is in the interests of us all—whether as Ministers, NHS managers, or members of the nursing profession—to ensure that training is properly monitored and developed.

Amendment negatived.

Mrs. Heal

I beg to move amendment No. 2, in Page 4, line 37, at end insert— '(4A) After subsection (1) there shall be inserted— (1A) In approving an institution under subsection (1) above, National Boards shall pay special regard to the suitability of library facilities available to students of that institution.".'. The amendment seeks to highlight the rapidly deteriorating library facilities for nurses engaged in pre-registration and post-registration training and the inability of library services to provide adequate facilities for Project 2000. In drawing attention to that worrying situation, I emphasise the specific need for library facilities to become a significant factor in the national boards' course validation process.

Project 2000 is an important development in nursing education, in providing a modern nursing profession prepared to meet the new challenges of future medicine and patient care. It has, however, resulted in students adopting different learning methods, as well as the implementation of a broader-based curriculum encompassing areas previously given less emphasis—such as ethics, philosophy, sociology, psychology and environment. Students also undertake much more academically based work involving increased use of library facilities.

Project 2000 threatens to be derailed because library provision has been virtually ignored. The switch to new training programmes revealed the haphazard approach taken by nursing schools and colleges to ensuring that their library facilities can meet the increased demand that those changes necessitate.

It is difficult and unproductive specifically to apportion blame, because nursing colleges are under pressure to supply library services that they are ill equipped to provide. The national boards make no requirement to ensure that a validated institution has the necessary back-up facilities. It is apparent that the knock-on effects of Project 2000 were not adequately appreciated and that the library base was already low.

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Library funding must be planned to take account of long-term needs. Last year, the Government made one-off, stop-gap payments to some libraries, but they were inadequate to ensure continuous high-level payments and did not meet the most serious problem facing libraries—that of providing qualified staff. There is no planned approach to library provision. Some libraries are excellent, well staffed and well stocked, but many are staffed and managed by clerks who are not appropriately trained in library administration.

The Nursing Times recently highlighted the problems of a patchy library service. It cited a survey of nursing and midwifery colleges in one region, where disparities between libraries show large differences in the ratio of pupils to staff and books. That magazine's informative feature on nursing libraries highlighted other evidence of a patchwork service that is struggling to cater for the needs of the profession.

Wrexham college of nursing is linked to Bangor university, which is 70 miles away, but its library facilities are inadequate. Students must travel to Bangor for books which involves a round trip of 140 miles. That is a ludicrous way to educate our nurses. The absence of on-site facilities for students is a huge waste of time and resources, and the existing arrangement places on individual students difficulties additional to those that they face in managing their studies and meeting their responsibilities and obligations.

Shropshire and Staffordshire college of nursing and midwifery in my own region is linked with Wolverhampton polytechnic, which takes students from Shrewsbury, Stafford, and Telford, who must travel 40, 25 and 12 miles respectively to obtain the books that they need. The success of Project 2000 is jeopardised by that situation, and it is important that libraries are a key factor in course validation.

If our nurses are to be trained to the high standards to which we are accustomed. Project 2000 courses must be able to offer the proper materials. Course curriculums are designed to expand and consolidate nurse training, but there is little point to them if students cannot have access to the material that they need to achieve the excellent standards that we take for granted.

Students' hard work is being thwarted by a lack of research and learning material. A leader in the Nursing Times of 12 February comments: Libraries are a cornerstone of any education system and the need for good libraries has never been greater. Amendment No. 2 acknowledges an obvious but often neglected fact, and provides the impetus for ensuring that libraries have the appropriate resources and materials to support their institutions' training courses. It aims at making sure that funding is not diverted from libraries at times of cuts, and that libraries complement courses rather than act as an optional extra.

The Royal College of Nursing states: quality nursing requires quality libraries, supported by professional library staff, to ensure good patient care. That is the ideal maxim by which we ought to assess our nursing education, and one which national boards should observe when validating courses. I commend the amendment to the House.

Mrs. Virginia Bottomley

Although I have considerable sympathy with the concern reflected in the amendment, I hope that I can persuade the House that it is unnecessary. The hon. Member for Mid-Staffordshire (Mrs. Heal) has raised some important points, and I shall ensure that the appropriate national boards are made aware of them—particularly the point about the college in Wales.

As I have said, the future role of the national boards will be to accredit institutions, to validate courses to ensure that the UKCC standards of professional education are met and to collaborate with the UKCC in the promotion of improved training methods. In the process of the boards' accreditation of institutions, those institutions are already expected to demonstrate to the satisfaction of the boards that they have a level of education resources sufficient to support their programme. That, of course, includes library resources, and takes into account the extent and range of publications and of librarian support for the students, particularly where multiple sites are being used. Obviously, when—as with project 2000—there is a link with institutions of higher education, the boards take into account the library facilities available in those institutions as well.

After all, £207 million has already been allocated to project 2000. I had the pleasure of visiting the college in Wolverhampton that serves the hon. Lady's constituency, for an inauguration. It is important for nurses, and student nurses, to be able to benefit both from the caring, hands-on work experience provided by the training, and from the classroom-based side, for which library facilities are needed.

As I undertand it, there has never been an occasion when a board has refused validation of a course because of unsuitable library facilities, although on occasion boards have made recommendations about the improvement of facilities. That shows not only the high standard that prevails, but the thoroughness with which the boards undertake their task. I have no doubt that, should they feel that the library facilities are not satisfactory, this is a step that the boards would not hesitate to take.

There has been considerable investment in recent years in the provision, maintenance and improvement of library facilities. For example, regional health authorities were allocated the substantial sum of £5 million in 1991–92, as part of project 2000 funding, specifically to enable them to meet the effects of pay and price increases, bursary increases and other locally identified needs related to the implementation of project 2000, such as—this was made explicit—library additions. As a follow-up exercise, the English national board is currently monitoring how much of this funding was spent on libraries. That is relevant to the hon. Lady's speech.

I mentioned in Committee last month the generous donation from the General Nursing Council Trust in this respect. The sum of £1,000 per college—£2,000 in the case of larger colleges—has been allocated by the trust, through the English national board, with the express purpose of improving library facilities. Last, but by no means least, the English national board has given £60,000 this financial year to four regions, to enable them to improve their library resources.

All that goes to show how seriously both we and the boards take the provision of library facilities. There is no question but that "special regard" will continue to be paid to them, as part of the process of approval of training institutions. They are, however, part of a much larger whole, and I think that it would be invidious and perhaps unnecessary to single out this one aspect in the way that the amendment suggests. The boards need to satisfy themselves not only that library facilities exist, but that there are adequate clinical placements and that the teaching is of a proper standard. They must deal with a range of other issues. They are faced with the same old difficulty: once one issue has been identified, others of equal validity may be called into question. As I have said, however, substantial investment has been made in library facilities.

I recognise the concern expressed by the hon. Member for Mid-Staffordshire, and I shall ensure that the relevant national boards are aware of it. I hope, however, that, in the light of what I have said, the hon. Lady will not press the amendment.

Amendment negatived.

Order for Third Reading read.

8.24 pm
Mrs. Virginia Bottomley

I beg to move, That the Bill be now read the Third time.

Hon. Members will recall that the main purpose of this important Bill—in brief—is to change the constitution and functions of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting and the four national boards for nursing, midwifery and health visiting —the five statutory bodies set up under the Nurses, Midwives and Health Visitors Act 1979.

The Bill changes the constitution of the central council from a body the majority of whose members are nominated by the national boards to one the majority of whose members are elected by the professions to which they are responsible. It also changes the constitution of the four national boards from one of elected to one of appointed bodies. At the same time, it takes away the role of the national boards in managing and financing the provision of nursing, midwifery and health visiting education and training.

In line with the principles of the NHS reforms, that function would be devolved to health authorities, except in Northern Ireland, where existing arrangements will continue to apply. It also centralises all professional-conduct investigations at the council, avoiding duplication of effort, rationalising an important function and removing some of the delays that prove so grievous for those involved.

Mr. O'Brien

On Second Reading, I drew attention to the problems that affect some state-registered nurses who wish to gain further qualifications under Project 2000, and are having great difficulty in obtaining co-operation and support from the training colleges. I refer in particular to St. James's training college in Leeds. Will the Minister explain why my constituents who want to train under Project 2000 are not receiving the co-operation to which they are entitled?

Mrs. Bottomley

I do not blame the hon. Gentleman for his difficulty in getting the precise terms right. On Second Reading, we had some discussion about the exact status of those involved. I think that the hon. Gentleman has now raised the case not of state-registered nurses, but of state-enrolled nurses who wish to move on to a Project 2000 course.

An enrolled nurse already has some qualifications. The way forward for such a nurse is to join a conversion course, which will move her on to full registered-nurse status. We discussed the point at length in Committee, and I feel that it has considerable validity. I can give the hon. Gentleman the encouraging news that the number of conversion courses increased from six in 1985 to 225 in March 1991.

It was a condition of the establishment of a project 2000 course that the needs of enrolled nurses should be recognised. We feel, however, that the right approach for someone who is already an enrolled nurse is not to go back to the beginning and embark on a Project 2000 course—which would represent considerable duplication—but to consider a conversion course. In some circumstances, a Project 2000 course has accepted an enrolled nurse, but we would not advocate it.

I know that nurses will welcome the Bill. It follows a series of measures that the Government have introduced to improve nurses' circumstances. The establishment of the review body in 1983 was an important step forward, and the implementation of its recommendations in all its reports this year means that all nurses will gain a 5.8 per cent. pay uplift. A new grading structure has been established so that a long-term career in nursing is more rewarding. The working week has been reduced from 40 to 37.5 hours without loss of pay. In addition, Project 2000 has been introduced—a subject with which my hon. Friend the Member for Chislehurst (Mr. Sims) may wish to deal.

That series of important measures recognises and improves the status of nursing and makes it a more rewarding career. That is evidenced by the fact that the length of time spent in nursing, as I told the House on Second Reading, has now doubled. A nurse used to spend an average of seven years in the service, but now spends 14 years. The Bill, which reorganises training and registration, will be a further development for nurses.

The Bill has been discussed extensively and it is fair to say that the speed with which it has passed through its stages shows the good will that all sides feel for it, and the general recognition of the value of its sensible and worthwhile proposals. We had an enjoyable Committee stage, which is not always the case, and there was considerable agreement on a number of subjects.

We have consulted the statutory bodies at all stages and have not only listened to everything that the nursing, midwifery and health visiting professions have said to us but have acted, in so far as it has been possible, in full accordance with their wishes. We had an extensive debate in Committee on the role and functions of the reconstituted central council and national boards and, in particular, on the professions' expectations of them.

It may be helpful to refer briefly to the report of the Select Committee on Health on maternity services, especially to its implications for the regulation and training of midwives. We shall carefully study the Committee's recommendations about midwifery education and will deal with them in our formal response, but I am sure that the statutory bodies will take careful note of what the Committee has said.

I reiterate the Government's commitment to maintaining the unique and separate nature of the midwifery profession. Midwifery shares, and will continue to share, a common regulatory structure with nursing and health visiting, but its special position will continue to be recognised within that structure, as it has been since 1902. At UKCC level, the powers and responsibilities of the midwifery committee will remain as they are now.

In earlier debates, we discussed the wish of some midwives to change the relationship between the council and midwifery committee by widening the scope of matters on which the council is required to consult the committee and by making it more difficult for the council to reject any of the committee's recommendations. But it is our firm conviction, shared by the statutory bodies, that the current position, whereby the council is required to consult its midwifery committee on midwifery matters, does not restrict its powers and works well. As I said in Committee, I very much hope that future relations between the council and committee will continue to be based, as they have been, on full consultation and constructive dialogue rather than statutory prescription.

We have given a commitment that membership of each national board will include, either as an executive or non-executive member, a registered nurse, a registered health visitor and a practising midwife. We have also formally acknowledged that the boards will need to continue to have special concern for midwifery. That is why we moved an amendment in another place to incorporate the wording of what is now clause 5(5), which requires the boards, in discharging their functions, to take account of differences in considerations applying to the different professions.

I understand that the English national board has recently reaffirmed its commitment to the principle that midwifery education and practice should be determined, validated and monitored by the midwifery profession. That will offer considerable reassurance to those who have been slightly concerned about difficulties that have emerged in recent months. I have no reason to believe that the reconstituted statutory bodies will wish to depart from that principle, although it will be for them to devise detailed arrangements for putting that into practice.

Concern has been expressed about the need for some form of health consumer representation on the reconstituted central council—a point that was made well by my hon. Friend the Member for Chislehurst on Second Reading and subsequently in Committee. We accept that it is clearly more important than ever that the wider public interest in the regulation of the professions should be adequately reflected in the appointed membership. In Committee, I took pains to assure the professions that, in considering his appointments to the central council, my right hon. Friend the Secretary of State would wish to take account of the need to reflect the interests of health service consumers and would take wide soundings about the appropriate individuals who could make that special contribution to the council.

I have already mentioned the Government's position on the funding of nursing and midwifery education and training, especially post-qualification education and training. We are committed to ensuring that adequate resources are made available for nursing, midwifery and health visiting education and training. We estimate that about £880 million will be spent on such training this year.

In our view, two main principles should underlie arrangements for organising and financing education and training. First, decisions governing the supply of nurses, midwives and health visitors should be taken as close as possible to the point of service delivery to ensure that decisions are responsive to local needs and to the changing requirements of employers. Central top slicing of a significant proportion of the funds for nursing and midwifery education, as happens now, is inconsistent with that principle. Secondly, the Government have a duty to ensure that, overall, mechanisms are in place to ensure an adequate supply of properly trained nurses, midwives and health visitors to meet the health needs of the nation for today and tomorrow.

Against that background, we intend that the regional health authorities, in consultation with employers, should have the main responsibility for identifying the demand for qualified nurses and midwives, for deciding the number of students who need to be recruited and trained and for funding pre-registration nursing and midwifery training. To enable that to happen, clause 5(2) removes the existing duty of the national boards to provide or arrange for others to provide education and training, so permitting the transfer of funding for the education and training of nurses from the national boards to health authorities and health boards.

We believe that this short Bill is vital to the future of the nursing, midwifery and health visiting professions. The reconstitution of the profession's statutory bodies will result in increased efficiency and effectiveness in the administration of those bodies and more direct accountability to the professions that they represent. I have no doubt that future historians of the professions will see the Bill as a major milestone in that history.

8.38 pm
Mrs. Heal

Once again, I welcome the Bill on behalf of Labour Members. We believe that it is an important and necessary development for the nursing profession. It modernises and updates the Nurses, Midwives and Health Visitors Act 1979 and streamlines the functions and structures of the UKCC and the national boards, which the 1979 Act left somewhat confused.

We have been disappointed by the Government's inflexibility over some of the Bill's inadequacies. The Bill has enjoyed rare consensus for a health measure, and we had hoped that the Government would be willing to entertain some amendments that, we feel, would have greatly improved it.

In preparing to debate the Bill, I have been in contact with the Royal College of Nursing, the Royal College of Midwives, the Confederation of Health Service Employees, the National Union of Public Employees and the Health Visitors Association. They have been very helpful in discussing the content and implications of the Bill and must be commended for the professional and practical ways in which they have represented their members and sought to achieve the best possible legislation for the nursing professions.

As I said, there are still major concerns. I draw the House's attention to the worrying decline in the number of students seconded to health visiting courses in the past 15 years. In 1975–76, there were 1,086, but that figure declined in 1989–90 to 847. More recent figures for 1990–91 are not yet available, but the United Kingdom Standing Conference of Health Visiting Lecturers has reported a further drop of 100 students, to approximately 750.

That is a very worrying trend, which does not appear to be the result of a lack of suitable applicants. In fact, many candidates are now forced to search nationwide for secondment. It seems that there is insufficient funding for secondments, which has led to a drastic reduction in available opportunities for students. That is even more worrying, as it appears that funds supposedly ring-fenced for nursing education are not being used.

There is confusion about where the funds are since they were transferred from the Polytechnics and Colleges Funding Council under working paper 10 to maintain health visitor and district nursing training levels. It appears that many district health authorities are unclear about where and whether money is available for these courses. I call on the Government to take immediate action to investigate and then to act.

There is known to be a shortage of qualified health visitors in the north-west and some health authorities such as Oldham, Trafford and Rochdale have vacancies that they cannot easily fill. We were assured that that could not happen with ring-fenced funds, but it is happening now. That is why we tabled amendments in Committee to give statutory backing to ring fencing. We feared that, without the protection of statute, funds might be mistargeted or misused. The Government have refused to accept that, but they must take action to ensure that the undertakings that they give are observed.

It is important for the future development of nursing and for the morale of nurses that the people involved see practical evidence that their future is protected. Health visitors see that training courses for their professions have been drastically reduced, and one must question the Government and seek an adequate explanation.

In 1989–90, Teesside had 12 places but now has no course. Reading had 32 places and now has 20. Liverpool had 24 places but now has none. These are cuts in training and provision. Thirty per cent. of health visitors are over the age of 50 and, although there is a stable turnover of staff at present, one can easily envisage a sudden drop in availability of experienced and trained health visitors in the next few years.

Health visitors and other community care nursing professions play a vital role in the promotion of good health and the prevention of ill health. Their efforts are crucial to the success and development of a public health policy. Labour is committed to improving the health of the nation, and a Labour Government would launch a national health initiative to promote a healthy Britain. Such a strategy will cut through departmental boundaries and encompass every Department in promoting better life styles and social conditions for the maintenance of good health for all. Tackling poverty and inequalities will be vital steps, sadly ever more necessary today following 13 years of social neglect by the Government.

The nursing professions will play a vital role in educating, monitoring and preventing ill health among the people of Britain. They can do that only if they are given the opportunity and facilities to train and educate for the new challenges of the next decade and beyond. The Bill has been designed to do exactly that. Labour believes that certain aspects and statutory guarantees would have been more effective in achieving the stated aims of the Bill, but we do not wish to delay its progress on to the statute book.

We shall watch closely to ensure that the Government's pledges and assurances that we have sought on behalf of nurses and patients are honoured, and we shall watch with interest and shall support the opportunities for nursing that we hope the Bill will create.

8.45 pm
Mr. Roger Sims (Chislehurst)

I am sure that the hon. Member for Mid-Staffordshire (Mrs. Heal) cannot have overlooked the fact that the Government introduced their own health of the nation campaign some time ago and that it is successfully under way. However, I have no wish to inject a party-political note into the debate; that is the last thing I want to do. I do not wish to detain the House and speak only because the Minister for Health tempted me to do so by referring to me.

The Minister referred especially to the Medicinal Products: Prescription by Nurses etc. Bill which has passed through all its stages in this House and had a Second Reading in another place on Friday. I hope that it will reach the statute book before we must all flee these buildings.

The Minister also referred to the publication today of the report on maternity services by the Select Committee on Health of which I am a member. I am sure that she will agree that it will prove to be a milestone in the history of maternity services. It refers frequently to the admirable work of midwives and, in particular, advocates that they be given a higher professional status. It is an extremely detailed report and I shall avoid the temptation to go into it because, fortunately, it has already been extensively reported in the media.

The Bill is the third measure today that has received all-party support and is well on its way to the statute book. This is perhaps a useful opportunity to point out to the nursing professions the enormous respect in which they are held and the great support that they have not only in the House but in the country from all political parties, at a time when the divisions between the parties will be highlighted. Perhaps it is just as well for the public to realise that, whatever words are exchanged in the next few weeks, it is possible for hon. Members to find some issues —such as those that I have mentioned—on which we are united and able to work together for the common good.

Although I suspect that health will be only one of the issues that will be well to the fore in the coming election, I hope that people in the health professions will realise that, whatever our political party, they have our full support and our admiration.

Question put and agreed to.

Bill accordingly read the Third time, and passed, with an amendment.

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