Community Practitioners' and Health Visitors' Association

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Response to the Draft Order Establishing the New Nursing and Midwifery Council

June 2001
We are pleased to see that many of the points made in our earlier response have been incorporated in the current proposals, though by no means all. We welcome the fact that we have four health visitor places on the new Shadow Council who will remain in place until April 2004, and who will have a clear voice, equal with nurses and midwives, in moving the Council’s agendas forward.
We very much welcome that the proposal for alternate members of council was accepted and that the President of the first and subsequent council will be elected from the Council’s membership. We also welcome that there will be powers to pay fees and allowances to members of the Council and its committees.
We are puzzled as to why the male pronoun is used throughout the draft order instead of the female as at present. We are also extremely concerned that the Register is to be made available on request to whoever asks for access to it. We see that this could place registrants in danger from stalkers or those members of the public wishing to abuse the information received.
We are still concerned that there is the intention to introduce a layer of screeners to the fitness to practise procedures (Article 23). We still feel that this will delay the processes of the Council unacceptably. We still feel that an additional appeals process will simply repeat an already lengthy process (Article 36).
We do not feel that performance procedures like those of the GMC are a useful addition to the Council's work. We view these as procedures, which should be part of good management within clinical workplaces where clinical supervision and annual performance reviews should be an accepted and essential part of working life (Article 28).
This response has been made after consultation with members in Scotland, Wales, Northern Ireland and England. The views expressed here reflect a consensus across the United Kingdom unless otherwise stated.
Our following response is in two parts. The first details our extreme concern about the anomalous position health visiting holds on the Council and the ambiguity of this within the draft legislation. The second deals with specific parts of the draft legislation that we wish to comment on.
The Position of Health Visiting within the Draft Order
The CPHVA would like to take this opportunity to remind the Department of Health of its first two recommendations following the J M Consulting process in 1998. These two recommendations were that:
  • any change to the register must continue to protect the public by ensuring that the health visiting qualification remains mandatory and registered
  • that the register should allow for the registration of all specialist community practitioners and their qualifications should also be mandatory for practice
Over 80 per cent of our members who took part in this consultation exercise saw themselves as part of the family of specialist community practitioners. They recognised the escalating amount of care being delivered in the community setting and that if the public were to be protected; this care must be supervised and delivered by appropriately educated and competent practitioners.
These practitioners must be skilled in preventive as well as acute intervention services. The new regulatory framework should provide the public with a clear accessible pathway to identify such practitioners on the register.
What the Association was recommending in 1998 was a part on the new register for community and public health practice. When it became apparent that this recommendation was to be ignored, steps were taken to at least retain public protection for health visitor practice. We were pleased that the ministerial decision taken ensured equal representation of health visitors on the Council with their nursing and midwifery colleagues.
We were saddened that an opportunity for a more flexible and forward thinking regulatory framework for community and public health practice had been lost. We believe that it is for this reason that transparency and cohesion around the sections of the draft legislation concerning the make-up of the register and the election process has been compromised and that the health visitor members of the new Council find themselves in their present anomalous position.
Unless our original recommendation can now be acted upon, the CPHVA can only submit the following response but to the proposals outlined in the consultation document, which concern the position of health visiting within the new legislation.
We welcome the flexibility encompassed in the proposed scheme, which should facilitate the development of new patterns of practice in nursing, midwifery and health visiting. However, we feel that it is important for health visiting to be acknowledged both in the title of the Council and in the legislation in order to adequately secure the safety of the public. Health visitors are currently uniquely accountable through their registration in the area of public health, recently recognised by the Health Select Committee, and need to be centrally involved in bringing about a new framework of standards for work to promote the health of the public. For the present, this requires a commitment to ongoing representation of health visitors and maintenance of the health visiting register. A suitable vehicle for achieving a new framework to move forward for public health would be the establishment of a health visiting committee, though other groups, such as school nurses, clearly also need to be involved.
Whilst we recognise the need for flexibility in the legislation, to take account of the pace of change, the current total lack of mention of health visiting within the scheme could lead to failure to ensure a place on the register for all those engaged in public health practice at specialist or advanced level and failure to protect the public in the broad and developing arena of community based public health practice. The consequences of such a failure are likely to be large scale where individuals fail to recognise and seek to proactively manage potential threats to health.
Within Scotland, where there is a significant focus on the development of public health nursing practice to improve the health and wellbeing of individuals, families and communities, it is imperative that there are rigorous mechanisms in place to ensure the standards of emerging education programmes to meet the changing needs of society are developed. This will maintain quality standards for the delivery of public health practice.
A large number of Scottish members have expressed grave concerns over the omission of the health visiting title as they feel that this may mean a loss of function in view of the emerging public health nurse title and role.
We are particularly concerned to ensure consultation and transparency in any process of altering the areas of competence or qualifications that may be registered (refer to Part 3, sections 5 & 6). We want urgent clarification on how any such decisions will be reached.
We believe that the regulatory system must enable health visitors and school nurses to develop constructively to embrace the current government's public health agenda, and to protect the public's health interests at the wider level in communities. It is crucial to ensure that the specialist educational requirements for practitioners to fulfil a public health role are acknowledged and fully protected. This is a distinctive area of work, the education for which should be led by health visitors and school nurses, and should be mandatory for practice in this area. In the last decade we have seen many changes in the educational preparation and the role of health visitors. Concerns have been expressed both about the competence of newly qualified staff in the rapidly changing environment and the needs of existing or returning staff for adequate standards of continuing professional development for public health work. Individuals must achieve and maintain the capacity to consistently achieve community and population health outcomes so that practitioners can remain fully accountable for public health work.
Finally, there is a clear dissonance between article 5 and those sections setting out the underlying election rules (Schedule I) and the transitional arrangements (Schedule 2). Article 5 appears to rule out health visiting as a discrete entity on the register. Urgent clarification is required within legislation to ensure that the new council is able to establish a part of the register for health visiting
We propose that Article 5 of the draft legislation and those sections setting out the underlying election rules [schedule I] be rewritten to include specific mention of the election of health visitors as a specific registrant group. The current position gives the appearance of reneging on an earlier ministerial agreement, which we consider is not the way to treat a group of practitioners who are trying to move the public health agenda forward inclusively and who wish the public to be protected by receiving a service from appropriately educated and competent public health practitioners.
Further Comments on Particular Aspects of the Draft Order
We have only commented on parts of the draft order where we have specific comments to make.
Page 16, (3)
Apart from future legislative changes being facilitated faster, what are the other implications of accountability of the Council being to the Privy Council?
Page 18, 6 (g)
As this is reflecting the implementation of the Welsh Language Act of 1993, we support this proposal. We would also urge that this Act is incorporated clearly into the work of the new Council.
Page 18, 8 (3)
We have grave concerns for the safety of registrants if every person who asks for a copy of the register can have one. Without further safeguards, registrants’ details could also be accessed by commercial companies who could use this information for marketing products.
Page 19, 9 (5)
Surely it is only people who are refused their application to be placed on the register who should be sent a letter from the Registrar. If all registrants have to receive a letter this would place an unacceptable cost on the regulatory process.
Page 20, 10 (2)
In our last response we pointed out that ‘good health and character’ must be defined much more clearly. We also feel that this requirement should only be for those whose registration has lapsed, not for those routinely renewing their registration.
Page 22, 15 (1)
We would prefer the term ‘competence’ to be used throughout rather than the term ‘proficiency’.
Page 23, 16
We are still unhappy with the term ‘visitor’ in this context. We feel the term ‘assessor’ more accurately describes this function.
Part V
We welcome the aim of dealing with complaints against registrants within twelve months. We feel, however, that this aim is severely compromised by some of the procedures contained within this draft order such as the appeals process and screeners.
The new Council should, in our view, have more flexibility within the order with less prescribed processes.
Page 26, 20 Part IV
The word ‘may’ in this paragraph should be changed to ‘shall’ as it is important that a Welsh body is so designated.
Page 27, 22 (a) and (b)
Why is a distinction made here between a registrant who makes a fraudulent entry to the register and one who is not fit to practise?
Page 27, 22 (7)
In the spirit of fully recognising the importance of devolution, we support the concept of the investigating committee meeting on a rotational basis in the four countries.
Page 2a, 25 (2)
If speed of process is required, why is the change being introduced to notify all registrants who are subject to an allegation of misconduct?
Page 31, 28 (3)
We would wish to see criteria listed for what constitutes lack of competence. The use of suspension for lack of competence would make it almost impossible for a registrant to seek to regain a suitable level of competence for practice.
Page 53.3 (2)
More clarification is needed here so that it is clear that practitioners can only vote for practitioners in their own country.
Page 54, (4)
While understanding that recent experience on the register should preclude people serving as lay members, experience from many years before should not.
Page 54, 7 (2)
All practitioners are different and have different experience. The only criteria for a replacement should be that registrants are on the appropriate part of the register and practise in the right country.
Page 59, 3 (2)
How can alternate members be effective when they do have a vote, if they are unable to participate in the work of the Council at any other time? We strongly disagree with this. Their role and participation in the work of the Council needs clarification as does the system of reimbursement of their time and expenses.
We hope that our comments will be noted and acted upon especially in relation to community and public health practice at present represented by the Health Visitor members of council and the place for Health Visiting on the register.
We wish the new Council luck and shall look forward to a positive working relationship with it.