Orders of the Day — Health Visitors

– in the House of Commons at 10:36 pm on 6 May 1981.

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Motion made, and Question proposed, That this House do now adjourn. —Mr. Goddard.

Photo of Barry Sheerman Barry Sheerman , Huddersfield East 10:40, 6 May 1981

Listening to earlier speeches, I was reminded how appropriate it is to bring to the attention of the House a specific injustice. Like the right hon. Member for Down, South (Mr. Powell), I hope that the House will not feel that I am making much of little for the sake of doing so.

As was well said by my hon. Friend the Member for Holborn and St. Pancras, South (Mr. Dobson), the House is concerned with the administration of justice and with injustice. He mentioned the Tolpuddle martyrs and the injustice to poor people who did not have a vote and who had very few rights in the eighteenth century. The injustices in the late twentieth century are as real, but are of a different nature. I hope that the House will pay attention to the injustice clone to Mr. Edward Myer of Dalton in Huddersfield. The cause is the complex bureaucracies that we set up by statute to run our affairs.

I believe that at the end of my passionate pleading, the Minister will say that the matter is outside his province and that he cannot help, although perhaps I am being pessimistic and he will take action. After trying every other avenue, such as the ombudsman—although no ombudsman can help in this matter, because it concerns personnel—an Englishman has a right to ask his Member of Parliament for help. We have seen an array of lawyers here this evening. Recourse to the courts is expensive, especially in my constituent's complex case. As was the case 200 years ago, much of our legal system is not available to people of only modest means. But I make no great case of that this evening.

I shall first trace the particulars of the case. My constituent, Mr. Myer, qualified in 1963 as a psychiatric nurse in the National Health Service. In July 1966 he became a registered mental nurse. In July 1968 he became a registered general nurse. Then, from September 1968 to September 1969, he took a specialised course to qualify as a health visitor. My constituent was one of the first men to become a health visitor. The House will recall that this was just before the time when we moved very much to change the law regarding the kinds of work that men and women could do and be reimbursed for doing. The course was for men and therefore excluded obstetrics because a male health visitor was not expected to be active in the delivery of infants.

After qualifying, my constituent proceeded to work for five years as a very good and efficient full-time health visiting officer. Being an intelligent young man and keen to extend his education, in 1974 he took a course at Manchester University and received a master's degree in education. Being even more industrious than many of us, at the same time as he was working as a health visitor he was taking Open University courses, and in December 1974 he obtained a first class degree from the Open University. As the House knows, that is a very difficult course as the study takes place in one's own time.

My constituent, having been awarded a Master of Education degree in philosophy at Manchester University in December 1975, went on to take a doctorate in the philosophy of health education.

It will thus be seen that I am describing a young man of tremendous drive who became a health visitor and then went on to the more theoretical side of his profession. He therefore left the practical side of his profession for some five years. Indeed, as well as the qualifications that I have enumerated, in August 1976 my constituent was awarded a graduate certificate in education at the Huddersfield Polytechnic Holly Bank campus, which is a very fine institution of education training. It is therefore clear that this man has undertaken a great deal of academic and practical education.

In February 1980 the young man returned to his original profession as a health visitor and proceeded for six months to pursue that profession. Then, to both his own and the Kirklees health authority's astonishment, he was given to understand that he was no longer qualified to do the job for which he originally trained. Between 1974 and 1976, because of measures affecting equality of employment and legislation passed by the House, the whole nature of the health visitor's job changed. Men and women health visitors are now on an equal footing, so that men may now receive obstetric training and do exactly the same job as a woman health visitor, including the delivery of infants.

Here a complication arises. Over a two-year period, the governing body responsible for the training of health visitors—the Council for Education and Training of Health Visitors—did not buy time in the media or space in the Nursing Mirror or advertise in The Times. It merely put out a press release. It also informed senior nursing officers in all hospitals that if a male health visitor did not take the small extra top-up in obstetrics, he could not qualify—after the two-year period—as a health visitor. A qualification had been undertaken in good faith. The man had passed the examination. Nevertheless, it would not be recognised by an employing authority if that condition had not been observed.

My constituent did not know of the moratorium. During that two years he was busy in the groves of academe in Manchester university. He was pursuing a theoretical course. When he returned he did not read the Nursing Mirror. He did not attempt to see old students. As a result, although he has a qualification, has every right to pursue it and is willing to take the extra top-up in obstetrics, the governing body of the Council for the Education and Training of Health Visitors will not allow him to do so.

There is grave cause for concern. There has been injustice as a result of bureaucracy. That bureaucratic creature is a little distant from this House, but in some ways it is responsible to the Minister. Therefore, I urge the Minister to use all the powers at his disposal to put right the severe wrong that has been done to a constituent of mine in Huddersfield.

Photo of George Young George Young Parliamentary Under-Secretary (Department of Health and Social Security) 11:51, 6 May 1981

The hon. Member for Huddersfield, East (Mr. Sheerman) has made a perceptive and well-researched case on behalf of his constituent, Mr. Myer, who comes through as a conscientious and energetic individual, who has much to contribute to the National Health Service. The hon. Gentleman has been energetic in pressing his case on me and on my Department. I have a large file of correspondence on this subject.

As the hon. Gentleman anticipated, I must tell him that no Ministers have at any stage beeen involved in the decisions regarding Mr. Myer's application to be registered as a health visitor; those decisions—as the hon. Gentleman knows—are assigned by statute to the Council for the Education and Training of Health Visitors. However, as the hon. Gentleman said, he has every right to ventilate his constituent's grievance in the House. I shall do my best to explain the position, as I understand it.

Mr. Myer did a course in health visiting in 1968–69. I understand that he subsequently took up employment in the community nursing service, which at that time was still the responsibility of local authorities. It appears that he continued in that employment until August 1974. It is important to make it quite clear that Mr. Myer was not at that time employed as a health visitor. The hon. Gentleman said that Mr. Myer became a health visitor. Perhaps that was a slip of the tongue, because he did not. Furthermore, he could not become a health visitor, because he had not been admitted to the register of health visitors, which is an essential pre-condition for employment as a health visitor under the terms of the National Health Service (Qualifications of Health Visitors) Regulations 1972. Indeed, in the early 1970s, it was not possible for a man to become a health visitor, since no man could possess the part 1 midwifery qualification, which was then an essential requirement for registration. There have since then, been changes in this aspect. However, that was the position at that time.

For the same reason, although Mr. Myer may, as a registered nurse, have been employed in the health visiting service, working alongside health visitors, he could not have undertaken the full range of health visitor responsibilities, which would be liable to include obstetric work, because he had not done the course in obstetrics. I emphasise that point. I do not question Mr. Myer's good faith, nor do I seek to belittle his efforts. However, I wish to make it clear that there is an important distinction between working as a registered nurse in the health visiting service and being employed as a fully-fledged health visitor.

I understand that at the time in question a number of men had taken health visitor training courses but, like Mr. Myer, they could not become health visitors. Apparently some local authorities employed them in support of health visitors and gave them the job title of health visiting officer. I understand that that title did not have any formal status but was regarded as suitable for use in the circumstances.

In 1972 the Council for the Education and Training of Health Visitors introduced a change to its training rules, which took effect from 1 January 1973. The purpose of that change was to enable men who had satisfactorily completed a health visitor training course to undertake a subsequent period of obstetric training to enable them to qualify for admission to the register as health visitors. That was a reversal of the normal pattern, which had always been, as it is today, that appropriate midwifery or obstetric experience was required before training as a health visitor. Until the early 1970s, it had not been possible for men to gain the necessary obstetric experience, and it was for that reason that the council made a special provision to meet the needs of those men, such as Mr. Myer, who had already completed a health visitor course but who had not until then been able to qualify as health visitors.

The rule change took effect from January 1973. I mention that because Mr. Myer was, apparently, at that time employed as a registered nurse in the health visiting service, where he continued for a further year and a half. It would have been open to him at any time during that period to seek to obtain the necessary obstetric training. I understand that that takes about 12 weeks. That would have entitled him to apply for registration as a health visitor. I mention this because I believe that Mr. Myer's failure at that time to take advantage of the opportunity that was then available to him—whatever may have been the reason for that failure—must have weighed strongly against him in his subsequent attempts to be admitted to the register.

I referred to the 1973 change of training rules. I should mention that this is the one point at which there is ministerial involvement, as proposals by the council for rule changes require ministerial approval before they can become effective. But it is the council's responsibility to consider and propose the changes. The council proposes and the Minister disposes.

In August 1974 Mr. Myer left his employment in the health visiting service to pursue his academic studies on a full-time basis. He clearly has pursued those studies with considerable dedication and commitment. One can only applaud the efforts that he has made in that direction.

At the beginning of 1976 the council decided to terminate the special arrangement for men introduced by the 1973 rule change and to make a requirement that, with effect from the September 1977 intake for health visitor training, men as well as women should have obtained an acceptable prerequisite obstetric qualification prior to commencing health visitor training. At the same time, the council decided that those men who had undertaken health visitor training but who had not so far undertaken the necessary obstetric training must do so before the end of 1978 if they wished to make themselves eligible for the award of the health visitor's certificate. I understand from the CETHV that these decisions were widely publicised at the time in the nursing press.

It was not simply that a press release was issued. The hon. Member queried that. I should refer to a letter that Dr. Turner, the principal administrative and finance officer of the Council for the Education and Training of Health Visitors wrote to Mr. Myer on 23 December 1980, in which he said: Notice of these decisions was published widely in the nursing press at the time".

Photo of Barry Sheerman Barry Sheerman , Huddersfield East

We have asked many times for evidence that there had ever been that kind of advertisement. We have been given none. I have been combing the pages of the relevant press and I have been unable to uncover one advertisement.

Photo of George Young George Young Parliamentary Under-Secretary (Department of Health and Social Security)

That comment may be relevant to what I have to say later. I have it in black and white from the principal administrative and finance officer that notice of those decisions was published widely in the nursing press at the time. I should have thought that it was legitimate to ask Dr. Turner to produce copies of the relevant press releases.

By the time Mr. Myer became aware of the new position, which was in the latter part of 1980, it was too late for him to take advantage of the final opportunity in the transitional arrangements.

No one could listen to the account that the hon. Gentleman has given without feeling considerable sympathy for Mr. Myer. The position is, however, that no matter how much sympathy I may feel—I am sympathetic—I do not have any powers in the matter. Since, following Parliament's enactment of the Health Visiting and Social Work (Training) Act 1962, the Council for the Education and Training of Health Visitors has been established, it is to that body that all responsibility for deciding questions of registration has been assigned.

From the inquiries that I have made I understand that there is no formal right of appeal on registration questions from the decisions of the council. Anyone who felt aggrieved and wished to seek redress would have to do so through the courts. It would, however, be open to Mr. Myer to go back to the council and ask it to reconsider its decision in order to allow him to undertake currently the necessary period of obstetric training that would entitle him to apply for admission to the register of health visitors.

I have no locus in that matter and would not wish to mislead the hon. Gentleman. I am not offering any hint regarding the possible outcome—it would be wrong for me to do so—but the case has had a substantial airing and I am sure that if Mr. Myer were to ask the council to review its decision it would take careful account of any representations that he might make. The hon. Gentleman might have a role to play in a request for a review by providing the council with a copy of the report of our debate.

I have sought to explain as precisely as I can the reasons for Mr. Myer's problem. Before concluding, however, I should like to comment on the present position. Mr. Myer is not a health visitor, but he is a registered nurse. As a registered nurse, it is open to him to seek, and to obtain, employment with a National Health Service authority or elsewhere. Any authority employing him could quite properly, if it so wished, employ him in its health visiting service, not as a health visitor but as a registered nurse who has taken a health visitor training course, working in support of health visitors.

The authority would pay him on a Whitley Council pay scale appropriate to the particular appointment. It could, if it chose, describe the post as a "health visiting officer" or could use some other appropriate designation. Any such designation would not have any formal status in Whitley Council terms, but that is not necessary. There are many job titles in use in the NHS nursing service which are not Whitley pay grade.

I hope that I have made the present position clear. Mr. Myer can be employed as a nurse in the National Health Service and, indeed, in the health visiting service, Put not as a health visitor, since that is a formal professional designation which he does not hold and never has held.

Photo of Barry Sheerman Barry Sheerman , Huddersfield East

I thank the Under-Secretary for his comments. Is it not strange that the Council for the Education and Training of Health Visitors has no appeals procedure for a member of the profession? We are in a dangerous position in many supplementary professions if we are developing a council that has no inbuilt appeals machinery.

Question put and agreed to

Adjourned accordingly at two minutes past Eleven o' clock.