House of Commons Hansard Debates for 25 Apr 1995

Mrs. Bottomley: I can certainly confirm that the Bill refers to all doctors. If I can make a bit more headway before the next intervention, I shall make that absolutely clear.

The Bill is part of our commitment to ensure that the national health service lives up to the highest standards expected by the public. Already, we have had dramatic improvements in the responsiveness and quality of care available. The changes that I recently announced to the systems for handling complaints, following the Wilson report, is part of that movement. Similarly, the new code on openness is a further example of how we are getting better at responding to the needs of patients and the expectations of the public.

The heart of the health service is its doctors, nurses and other clinical staff. Their dedication, professionalism and quality are rightly a source of national pride. They are respected throughout the world.

All of us in the House acknowledge the tough job that clinicians have to do. That demanding job does not get easier when the expectations of the public rise with demographic changes and, inevitably, there is always a finite budget. Only recently, the case of Child B brought into the full media glare some of the complex ethical decisions that clinicians regularly face in their normal working lives.

Doctors have been at the forefront of the culture change in the NHS. They are now rightly expected to be held accountable for the vast sums of taxpayers' money that they spend, as well as for the care that they provide. Most doctors recognise that as a valid feature of a modern health service, where it is no more acceptable knowingly to misuse its resources than it is to pursue a course of action which is clinically unsound.

Column 672

The NHS has to be well and strongly managed. Many doctors respond positively to that by becoming involved in the management of the service, whether through GP fundholding, for example, where family doctors are able to back their clinical judgment by direct access to the budget that they control, or through the other many opportunities as medical or clinical directors of the new health authorities, as directors of public health or by offering professional advice. There are now unlimited opportunities for doctors to influence and shape the development of the health service.

Doctors are no longer the unchallenged paragons they once were in the eyes of the public. Patients are better informed, more assertive and more ready to question and complain. That certainly puts pressure on the medical profession, which is held to account in an ever more public atmosphere.

A new climate is spreading, where treatments are analysed on the basis of clinical effectiveness and outcomes. Clinical audit is well established. Our pioneering research and development strategy is spreading on a systematic basis information about the latest state of medical knowledge. Tomorrow my hon. Friend the Minister will be launching the next phase of our movement towards evidence-based medicine with the Cochrane collaboration. All those changes mean that the practice of medicine takes place ever more in the limelight and is subject to increasing scrutiny.

Mr. William O'Brien (Normanton): I appreciate the opportunity to intervene on the Secretary of State and I acknowledge the report that she has given about doctors. Will she confirm or deny that she intends to introduce performance indicators for doctors and other clinicians in the health service? How will that system operate if she intends to introduce it?

Mrs. Bottomley: I have no such intentions; I am simply describing the atmosphere in which medical practice now takes place. It is subject to scrutiny and evaluation in a way that was inconceivable even 10 years ago and it means that all doctors are under greater pressure to keep up to date with the latest advances in medicine. As medicine becomes more complex, capable and involved, there is a pressure and an obligation on all professionals to ensure that they are protecting their patients and serving them according to the latest knowledge and understanding of care.

In general practice it is now often possible to treat and to manage diseases, such as heart disease, stomach ulcers and asthma, which once required a high degree of hospital care. Doctors, particularly in family health services, used to work in professional isolation. Today fewer general practitioners work alone because there is a much greater emphasis on team working. GPs and specialists increasingly work side by side in modern medical centres, bringing what was once thought of as hospital care closer to patients. Nurses, doctors and other professionals work together in community health teams and there is closer working between GPs and clinicians in hospitals. That does much to improve the treatment and care of cancer sufferers, for example. Only yesterday, we unveiled our framework for the future of cancer services. That close linking and greater sharing of knowledge between GPs and clinicians in hospitals and the patients and public is a theme of that new framework. All those new developments mean an unprecedented change in the

Column 673

way in which modern medicine is delivered. A doctor has a clear duty to keep up to date, to know what is appropriate and what is not, and to know when to seek help and advice from colleagues. To its credit, the profession has recognised those changes and the need that comes with them to assess continually the performance of doctors. I pay tribute to the General Medical Council whose work has resulted in this Bill. The Bill stems from the profession's recognition that, no matter how qualified, dedicated or expert the majority of its members may be, the standards demonstrated by a small number of practitioners will from time to time fall below what patients have a right to expect. In those cases, proper procedures must exist that will enable action to be taken to protect patients and to raise the quality of care.

When doctors are guilty of serious professional misconduct or when a doctor's fitness to practise is seriously impaired by ill health, the powers exist to act. Doctors who are accused of serious misconduct appear before the GMC's professional conduct committee, where the evidence is tested to the criminal standard of proof in adversarial proceedings. Doctors who are found guilty can be struck off. Similarly, the GMC has powers to suspend from the register those doctors who are too ill to perform their duties.

However, no such powers exist to deal with doctors whose performance may be seriously deficient but who, nevertheless, fall short of those extremes. The GMC receives details of a number of cases upon which it cannot take any formal action, even though it may be apparent that the underlying performance of the doctor concerned is very poor. At present, those doctors are beyond the law; they can remain on the register and the council has no power even to require them to address their shortcomings. That is bad for patients and bad for doctors.

The Bill plugs the gap. It is a Government Bill, but the House will be aware that the initiative came from the GMC. I pay a warm tribute to Sir Robert Kilpatrick, president of the GMC, who has been the primary influence behind the changes. He set up a working group to examine the problem and he single-handedly carried through consultations with a wide range of individuals and organisations both within and outside the medical profession. A period of formal consultation followed in 1992, and in November of that year Sir Robert secured the agreement of the GMC to proposals that differ little to those which appear in the present Bill. Indeed, I can say that, on being appointed as Secretary of State, three years ago, almost the first invitation that I received was to discuss with Sir Robert these proposals and how we could secure a journey to the legislative Chamber to ensure that they were enacted.

Sir Robert retires at the end of August this year. If enacted, the Bill will be a fitting tribute to his energy, determination and powers of persuasion as well as to an outstanding period as president of the GMC. In large part due to his efforts, the measures in the Bill command the wide support of the medical profession. They also enjoy cross-party support. I am grateful to the right hon. Member for Derby, South (Mrs. Beckett) for the support that she has given to the Bill in principle, and to the Liberal Democrat spokesman similarly. The hon. and learned Member for Montgomery (Mr. Carlile) sits on the

Column 674

GMC, as does the hon. Member for Gower (Mr. Wardell) and, indeed, my hon. Friend the Member for Chislehurst (Mr. Sims), to whom I pay particular tribute, as he is the longest-standing Member of Parliament on the GMC and has been closely involved in the "fitness to practise" proceedings.

It may be of assistance to the House if I speak at this stage about the GMC in a little more detail. The GMC is the self-regulatory body of the medical profession. It consists of 102 members, 89 of whom are qualified doctors, the rest representing different professional and lay interests, including, as I have said, Members of Parliament from each of the main political parties. The House will be aware that, at present, the GMC is taking forward proposals to increase its lay membership--a further example of the need for all professions to ensure that they carry the confidence of the public in the vital work that they do.

The GMC's primary role is to maintain a register of all those who are qualified as medical practitioners. That duty provides an assurance to the public that all registered doctors are qualified to practise. The GMC must assure itself that those admitted to the register are competent. It must also ensure that those on the register remain fit to practise. As the Merrison committee put it in 1975,

"the maintenance of a register of the competent is fundamental to the regulation of a profession".

That remains as true today as it did in 1975, or, indeed, at any time since the passing of the original Medical Act in 1858. In essence, that is the subject of today's debate. How can the GMC ensure that doctors on its register have maintained their competence in a fast-moving medical environment and continue to meet the high standards of performance set by the medical profession?

The Bill does that by making important changes to the professional regulatory powers of the GMC. New professional performance procedures will be introduced; and two new statutory committees--the assessment referral committee and the committee on professional performance--will be created to implement the new procedures. We propose to establish those new procedures in a way that is consistent with the principle that self-regulation is the most appropriate way for the medical profession to be governed and that it is the best way to maintain the high standards that the public rightly expects of its doctors, and which the great majority of doctors achieve. That principle is both long established and cherished by the profession, and it is one which the Government support.

The value of self-regulation has been further demonstrated by the fact that it was, as I have said, the GMC itself that first identified the gaps in its powers and took the initiative in asking the Government to introduce the measures that are now set out in the Bill. The professional performance procedures proposed will go a long way towards plugging the gap. They will do so in a novel way. The procedures are not there to ascertain whether the doctor is guilty of a particular instance of alleged deficiency. They do not offer individual redress for patients' complaints, although patients will receive feedback.

The Bill aims to achieve what many people say that they want when they complain: to see that something is done to stop a similar incident happening again. The purpose of the new procedures is to inquire into the underlying causes of any problems that have been

Column 675

reported. The GMC will consider whether the matters complained of, particularly where there has been a series of complaints, show a pattern of serious deficiency in the standard of the doctor's professional performance. If that is the case, the doctor will be asked to have his performance assessed by a panel independent of the GMC, which will include two doctors of the same specialty plus one lay doctor. The panel's key role is to identify whether there are any significant weaknesses in the doctor's performance, to discuss those with the doctor and to give advice on what the doctor can do to remedy the position.

What I have described is initially a consensual process. The aim of the Bill overall is remedial. Wherever possible, we want expensively trained doctors to be put on the right track. However, it is important that the procedures work where the doctor does not consent. Therefore, much of the Bill provides for where the co-operation of the doctor is not engaged or where it breaks down for various reasons. It also provides for a doctor's registration to be suspended or for conditions to be attached to registration if that would be in the public interest and would help to protect the doctor's patients.

Mr. Gareth Wardell (Gower): I support the Bill and, as the Secretary of State said, I am a member of the GMC. While a doctor is suspended and going through the procedures, will his registration on the GMC's register show that he is suspended, so that the general public can be aware of that?

Mrs. Bottomley: I understand that while the inquiry is under way, the register will show the suspension. I well understand the hon. Gentleman's concern that patients' interests should be safeguarded in that way.

Dr. Charles Goodson-Wickes (Wimbledon): At the risk of sounding patronising, I wonder whether I could help my right hon. Friend. I imagine that by the time such a position was shown on the register, it would not fall within the cycle of that register's publication.

Mrs. Bottomley: That is true, but it is important that the information is available to those who wish to have access to the register.

Mr. Wardell: I am grateful to the right hon. Lady for giving way again. I am concerned that under part 3 of the procedures, the doctor could go round and round in a loop, for a period even exceeding three years. Despite what the hon. Member for Wimbledon (Dr.

Goodson-Wickes) said, as I understand the procedures it is possible for a doctor to be retrained and continue to be retrained for quite a lengthy period. Would the Secretary of State be happy to put some limit on the period that a doctor can keep going round the loop?

Mrs. Bottomley: The hon. Gentleman makes a good point, which can be explored further in Committee when he will no doubt wish to develop his argument.

Dame Elaine Kellett-Bowman (Lancaster): What about the engagement of locums? Will people be warned so that they do not inadvertently engage such doctors?

Mrs. Bottomley: That is something that the doctor concerned would need to discuss with his employers--either a trust or the family health services authority,

Column 676

depending on the doctor's circumstances. Much would depend on the seriousness of the matters under consideration.

As I have said, it is important that we are prepared not only for cases where there is consent, but for those where the doctor does not consent. The Bill provides for cases where the co-operation of the doctor is not engaged or where it breaks down for various reasons. It also provides for a doctor's registration to be suspended or for conditions to be attached to the registration, if that would be in the public interest and would help to protect the doctor's patients. I commend to the House a short paper prepared by the GMC on its proposed performance procedures. It explains step by step how the system works. A number of copies have already been placed in the Library. I shall, however, go through the course of a case where the doctor agrees to the process and then explain in more detail how the system will cope with an unco-operative doctor. I am aware that in Committee it will be possible to scrutinise that journey in even greater detail. The GMC will identify doctors whose performance is seriously deficient through information sent to it: for example, through patients' complaints, information from other doctors, or cases referred following NHS service committee hearings. Overall, the GMC expects that the number of doctors subject to assessment under the new procedures will be in the order of 100 to 150, of whom 50 to 75 might be subject to remedial training or sanction.

Anyone can bring information about a doctor's performance to the GMC's attention. The doctor may be working in the NHS or private practice. The informant will not have to be personally involved in the matter. For instance, surgeons who have to rectify the mistakes of another doctor-- perhaps of cosmetic surgery--would have a duty to report those matters to the GMC.

I am pleased that the GMC has made the position clear in its Blue Book entitled "Professional Conduct and Discipline: Fitness to Practice". It says:

"It is any doctor's duty, where the circumstances so warrant, to inform an appropriate person or authority about a colleague whose professional conduct or fitness to practise may be called into question or whose professional performance appears to be in some way deficient."

That is an important message and one that is often difficult to have fully accepted and used throughout the service, but all professionals have an obligation to be alert and vigilant about their colleagues' quality of performance.

Employing authorities and trusts will be aware of poor performance from a variety of sources. It is important that the NHS complaints and disciplinary procedures, based on the Wilson review, which we have only recently announced should be carried out properly. In addition, employers should consider whether to refer the matter to the GMC. The GMC and the employer have separate and complementary roles. Some problems will be dealt with entirely by the employer; in some cases, only the GMC will be able to act, and in a minority of cases both will need to take action.

Patients or other relatives who are concerned that other people may be suffering from the same poor treatment as they experience may wish to report it to the GMC. The information given to it will have to be well founded and

Column 677

to give it grounds for considering that the incident is not just a one-off, but an indication of a pattern of poor performance which should be investigated further.

Mr. Jim Cousins (Newcastle upon Tyne, Central): Does not the Secretary of State's remark imply that a single incident can never rank as being serious enough to challenge professional performance? Her last remark seems to imply that repetition is the centre of the argument, whereas a single incident, if it were serious enough, could be serious within the terms of the Bill.

Mrs. Bottomley: If the incident were serious, it might be considered as part of serious professional misconduct, but we are considering here a one-off incident that is not sufficiently serious for the existing procedures, that is of a lower order, and that therefore may be part of a continuous pattern of poor performance. The aim of the proposal is precisely to fill that gap.

Anyone who has given information to the GMC will be kept informed of the action taken at various stages of the process. They will, of course, be notified of the outcome of any hearings by the committee on professional performance.

Whatever the source of information, the GMC must take the matter seriously. The first step is to consider under which procedure the case should be considered. This relates to the point made by the hon. Member for Gower (Mr. Wardell). Should the case be considered under conduct, health or professional performance? Whatever the case may be, the matter will be considered by a screener who will be a medically qualified member of the GMC. In cases of alleged poor performance, the performance screener will be empowered to investigate the background of the case, and to consider whether a prima facie case exists of serious deficiency in the doctor's professional performance. The informant may be asked to make a sworn statement about the allegation.

The screener may wish to take advice from an expert in the same speciality as the doctor under review before deciding what action needs to be taken. The screener will either invite the doctor to undergo an assessment or conclude that no action should be taken. In that case, a lay screener is also involved in deciding that no action is required.

If further information uncovered by the screener suggested that there were health reasons underlying the doctor's poor performance, the matter could be remitted to the health screener under the health procedures. Where no formal action is proposed under the GMC's fitness to practise procedures, the doctor may be invited to comment informally on the information received. Any reply would then be sent to the informant.

Where formal action is proposed, the screener will advise the doctor of the information received by the GMC and invite the doctor to undergo an assessment. If the doctor does not agree with the screener, the matter will be considered by the assessment referral committee. That committee's role is to provide an appeal forum for the doctor who does not agree with the decision of the screener that he should undergo an assessment. It ensures that contested decisions that may affect the doctor's future are not taken by one GMC member alone.

Column 678

Once the committee has considered written submissions from the doctor or given the opportunity of a hearing, it may either direct that the doctor undergo an assessment or decide that there is no prima facie case of seriously deficient professional performance and close the matter. If the committee confirms the screener's decision, the screener will arrange for the assessment.

If I may, I shall go into a little more detail of the assessment process. It will be carried out by an assessment panel which will consist of two medical practitioners from the same specialty as the doctor and a lay person. None of these panel members will be members of the GMC. They will be drawn from lists of specialists nominated by the professional bodies, including the royal colleges and the British Medical Association. Lay members will be nominated by non-medical bodies. The procedures to be followed by the panels will be set out in rules made by the GMC, approved by the Privy Council and laid before Parliament. The panel will also be given guidance and training on how to carry out the assessment process.

As the House would expect, the GMC has already started work on some of the details involved. In 1993 it appointed Professor Lesley Southgate, a distinguished professor of general practice, to begin developing the assessment procedures in co-operation with experts from each of the specialties. The assessment programmes will underpin the new procedures in the Bill. To give the House a flavour of what it involved, I shall describe her work in a little more detail. Professor Southgate has pilot-tested with volunteers on several occasions her system for assessing GPs. The assessment consists of a review of a doctor's records, a written test of his or her knowledge, observing the doctor in practice, discussing performance with selected third parties, a test of clinical skills and a face-to-face interview, which includes a review of one or two of the doctor's recent cases. Those are certainly rigorous procedures which the GMC is looking to extend into the various specialties. Pilots are under way, for example, for assessing the performance of anaesthetists. In as much as the Government's policies have encouraged those trends, I make no apology. The health service exists for its patients and to provide the latest and the most modern care. However, it is right to recognise the extra pressure that this puts on doctors. Describing how the GPs in the trial had reacted to her grilling, Professor Southgate stated:

"they found it stressful but a great thing once done". Perhaps that is a fair assessment of many of the changes now taking place in the national health service.

At the end of the assessment process, a report will be prepared by the chairman of the assessment panel and sent to the doctor, who will be invited to take on board its recommendations. The doctor will be asked to confirm his acceptance and compliance with the recommendations. If he does not, the matter will be referred to the committee on professional performance.

If the doctor agrees to take remedial action, a period will be allowed for the necessary training or other remedial action and for it to be put into practice before a second assessment is carried out. After this initial period of remedial action, the assessment panel will assess the doctor's progress. If the doctor's level of performance has been remedied, the case will be concluded. Where there

Column 679

has been some progress and further action might be productive, the doctor may be allowed to undertake a further period of remedial action.

If the doctor does not appear to have benefited at all from this remedial period, there may be the opportunity to ask for the voluntary removal of his name from the register. If the doctor wishes, the matter will be referred to the committee on professional performance. Alternatively, the screener will either arrange a further assessment or refer the matter to the committee on professional performance.

It is proposed that a doctor should be allowed to go through the remedial process up to three times--this relates to the point made by the hon. Member for Newcastle upon Tyne, Central (Mr. Cousins) about how long the matter can be perpetuated--but it is not proposed that the number should be prescribed in the rules. The doctor will have the right to have the matter determined by the committee on professional performance at any time following the first assessment.

The committee on professional performance is, indeed, the committee of last resort. The General Medical Council hopes that most cases will be resolved during the consensual part of the procedures. The matters will come to the committee, however, in a number of ways: first, where the screener on receiving an assessment report considers that the doctor's performance is irremediable and the doctor has not agreed to the voluntary removal of his name from the register; and, secondly, where the doctor has not co-operated right from the start or has indeed withdrawn co-operation during the process. The doctor may, for instance, have been directed to undergo an assessment by the assessment referral committee and refused to do so.

Thirdly, the matter will come before the CPP where the doctor has undergone an assessment but is not prepared to agree to the required conditions. The doctor may refer the case to the committee. If the screener cannot get the doctor to agree to the conditions, the case must be referred to the committee. The final way is following a period of remedial action and reassessment, where there has been no significant improvement in the doctor's performance.

The procedures to be followed by the committee will be set out in rules. If the doctor has not undergone an assessment, the committee may require it. If he refuses or has failed to co-operate in some other way, the committee will be able to impose sanctions. Those include suspension or attachment of conditions to registration as appropriate. Where the committee, however, finds that the doctor's professional performance has been seriously deficient, it will be able to suspend the doctor or attach conditions on registration. For example, the doctor may be required to practise under the supervision of another doctor or refrain from performing a particular clinical procedure.

Where the committee considers it necessary for the protection of the public, it may impose immediate suspension of the doctor. The Bill will ensure that the doctor has appeal rights, which are similar to those which exist under the health procedures.

Mr. John Gunnell (Morley and Leeds, South): In the hearings held by the General Medical Council at the moment, which are obviously, in general, about professional misconduct, the press are normally present. I have seen nothing in the Bill to show whether the press

Column 680

should or should not be present or whether the decision at which the committee arrives will be made public. At this stage, is the knowledge of the procedure and the result of the hearings entirely within the remit of the GMC?

Mrs. Bottomley: It is the intention that such hearings should be held in private--certainly for the first two years. That is subject to review and, indeed, it is also possible, with agreement, that such matters could be heard in public. Again, the committee may wish to discuss that in more detail. The proposal that for the first two years the procedures are held in private while they are under way has considerable merit.

As the hon. Member for Morley and Leeds, South (Mr. Gunnell) will know, there are always difficulties about how freely, frankly and openly some witnesses are prepared to speak in the full glare of publicity and the press. There is often a tension between wishing matters to be fully open, but knowing that witnesses are somewhat inhibited because they know that every word that they say is likely to be read in the newspapers the following day. The proposal is a considered preliminary response to the new procedures and I am sure that it will be subject to review and careful scrutiny.

If I may turn to the Bill itself, the House will be pleased to know that it is short; it has six clauses. It will give the GMC the necessary powers to make the new procedures work where a doctor is not co-operating and the powers to impose sanctions. Much of it amends the Medical Act 1983. I have placed in the Library a revision of the relevant provisions of the 1983 Act as they would appear on consolidation of the Bill in that Act. The details of the procedures to be followed by the GMC will, as I have said, be in rules. Clause 1 deals with the powers of the committee on professional performance, which has been described as the sanctions committee. It will be empowered to impose conditions on, or suspend, a doctor's registration. It will do so where the doctor's standard of professional performance is found to have been seriously deficient and the committee considers that sanctions should be applied to protect the public.

It is not the intention that the sanctions should be punitive. They are part of improving the service to patients. Although, in the worst cases, a doctor might be suspended indefinitely, the name will not be erased-- doctors will not be struck off. That is a fine, but an importance distinction to make, as the intention of the procedures is remedial. The committee can also impose sanctions if a doctor has failed to co-operate with the assessment process.

Clause 2 covers cases in which a doctor's failings may be considered to be beyond remedial action. The doctor may be asked to consider voluntary removal from the register. Again, the doctor would not be struck off, which has disciplinary overtones. The doctor might be falling behind with the latest medical techniques, which have now become the accepted techniques. The doctor might realise that it is time to call it a day and ask to be removed from the register. We realise that unscrupulous doctors might use the provisions of voluntary removal to frustrate active consideration of their performance. To minimise the risk of the misuse of the provision, clause 2 also provides for

Column 681

the matter to be referred back to the relevant committee for approval, should the doctor apply at a later date for his name to be reinstated on the register.

Much of the meat of the Bill is contained in the schedule, which gives the General Medical Council the power to make rules, to set up the assessment referral committee and the committee on professional performance, and to provide for the constitution and proceedings of the two committees and the assessment panels. The rules will also give the committee on professional performance powers to impose sanctions if a doctor does not co-operate, and to give the doctor a right of appeal to the High Court where such sanctions have been made.

The assessment panel will be given powers to inspect medical records and, where entry to professional premises is likely to be denied, it will be able to apply to a magistrate for a warrant. It will be an offence for a person to obstruct the work of an assessment panel.

The House will appreciate that the procedures introduced by the Bill are somewhat complex. Its aim is simple enough, however. It is a further measure designed to improve the quality of service available to patients from the national health service, and indeed from private practice, and to ensure that they continue to enjoy the highest standards of care from our doctors. It is significant that the Bill has come from the medical profession. It is a sign of how clinicians are responding to the greater expectations made of them and recognising the legitimacy of challenges against the performance of individuals.

There was a time, perhaps, when the profession would not have been so amenable to such a proposition. We can all understand the reasons. The process of scrutiny and review is not always comfortable for doctors, even for those who have nothing to fear from its results. It is, however, an essential part of a service in which we are determined to put the needs of patients first and to maintain their confidence in the service that they receive.

What is important is that the procedures are effective, constructive and fair to staff, as well as to patients. The measures in the Bill fit well with those objectives. They are part of our commitment to a higher-quality health service of which we can all be proud.

The introduction of the Bill to Parliament gives a clear signal to doctors whose performance is not up to standard that the remedy is in their hands-- it is a case of physician heal thyself. I commend the Bill to the House.

4.42 pm

Mr. Nicholas Brown (Newcastle upon Tyne, East): I congratulate the Secretary of State on coming to the Dispatch box voluntarily--I was beginning to think that she did not like coming here--and so soon after her interview with Mr. Dimbleby.

You will recall, Madam Deputy Speaker, that just before the recess, the House--not just the Opposition, but members of the Government--was demanding time to debate the crisis facing the hospital service, especially in London. I should have thought that, now that the Conservative rebels have come back to the fold, it would be safe for the Government to find time for such a debate,

Column 682

but they tell us that there are pressures on parliamentary time. They have found a whole day to debate this Bill, however. The principles that underpin the Bill are not controversial between the parties. The parliamentary Labour party supports the Bill, as do the minority parties, I understand. There is a consensus behind the principles that underpin it. My right hon. Friend the Member for Derby, South (Mrs. Beckett) promised it a fair wind through the House in the debate on the Queen's Speech. Indeed, in 1993, my hon. Friends the Members for Newham, South (Mr. Spearing) and for Strathkelvin and Bearsden (Mr. Galbraith), among others, tried to introduce a Bill designed to achieve the same objectives, so the Secretary of State is perhaps making too much of the courage and determination that the Government are showing by bringing this legislation before us. The Government Whips seemed nervous about exposing the Secretary of State to debate in the House. One of the first--

Mrs. Virginia Bottomley: I have no idea what the hon. Gentleman is talking about. On the first day back after the recess, we had a very successful Health Question Time. All the Government spokesmen wiped the floor with the Opposition spokesmen, who were described in the press as hiding like frightened rabbits, devoid of policy. They were simply exposed for their empty cupboard by all the journalists.

Mr. Brown: What press?

Mrs. Bottomley: The Guardian , The Economist , the Observer and the Health Service Journal . I have never known such a slaughter of the Opposition for their lack of policy on the health front--timid, frightened and devoid of policy, Madam Deputy Speaker. I do not think that I need to say more.

Madam Deputy Speaker (Dame Janet Fookes): Certainly not. That was quite a long intervention. Before we go any further, perhaps we could turn to the principles of the Bill, which is the business before us.

Mr. Brown: I was about to debate the principles of the Bill when I generously, in a bipartisan spirit, gave way to the Secretary of State and allowed her to mislead the House. The truth of the matter is that, when I asked the Minister of State for the estimated cost for local pay bargaining at Health Question Time, he spoke at some length in response, but never gave the House the estimates. No doubt he would describe that as professionalism on his part, but I think that the House understood what he was not telling us.

Let me return to the point that I was going to make before I so generously- -but perhaps wrongly in view of your strictures, Madam Deputy Speaker--gave way. One of the first duties that I and my right hon. Friend the Member for Derby, South had when we were appointed to our new Front-Bench responsibilities was to meet representatives from the General Medical Council. They urged this Bill on the parliamentary Opposition and said that the Government had told them two things--that they could have the Bill, but that there was not enough parliamentary time for it and so they had to get the agreement of the Opposition to ensure that it received a fair wind through the House.

Column 683

How can anyone truthfully say that, in this Parliament, there is not the parliamentary time for a Bill of this nature, Madam Deputy Speaker? We have enough parliamentary time in this Parliament to revise the entire criminal code. One could not possibly truthfully say that there is a lack of parliamentary time. No doubt the reason why we have a full day's debate on this relatively non-controversial matter is that the Government want to avoid debating more controversial matters. The Bill and its underpinning principles are supported by the parliamentary Labour party.

We are being invited to discuss what is effectively professional self- regulation. In the light of some of the decisions that we had to make last week, it is ironic that we are discussing another body's methods of self- regulation. In view of what many people think about the ethics of our profession, it is ironic that we are discussing the ethics of a profession that is held in higher esteem by the general public than ours.

The core of the Bill is self-regulation. Only the General Medical Council has a universal power to restrict a doctor's practice, or bar him or her from practice altogether. No national health authority or trust could prevent a doctor from taking up employment elsewhere, either in the health service or privately.

The General Medical Council is a statutory body. It is independent of Government and receives no public funding. It is financed by a levy on registered doctors and, interestingly, is answerable to the Privy Council, not to the Secretary of State. As the Secretary of State told us, the GMC currently has two sets of disciplinary procedures. The first deals with conduct--doctors whose behaviour suggests that they may be unfit to practise. It can deal only with single acts of serious professional misconduct, which was the point made in the intervention by my hon. Friend the Member for Newcastle, upon Tyne, Central (Mr. Cousins). The second set of disciplinary procedures deals with doctors whose health may affect their fitness to practise.

To date, unless it has been found that a doctor's fitness to practise has been seriously impaired by ill-health, or unless a doctor has been found guilty of serious professional misconduct or convicted of a criminal offence, the GMC has no power to act against an individual practitioner. That is a substantial cause of public disquiet. The profession's failure to regulate itself because it does not have the powers to do so is unfair on complainants and, of course, on those charged with the supervision of the profession. In 1993-94, the General Medical Council received 1,626 complaints. Of those, only 195 made it beyond the preliminary screeners and only 83 cases were referred to the professional conduct committee for investigation. Clearly, that is unsatisfactory and it is right that we should consider remedial legislation.

The reason for not proceeding with complaints is often that the General Medical Council's powers are too restricted. That is the issue with which the Bill seeks to deal. The Bill will add a third set of procedures, which will provide powers to discipline doctors whose general performance over a period of time is revealed as seriously flawed. The Bill will allow the GMC to exercise discipline

"in those situations where a doctor's pattern of professional performance appears to be `seriously deficient'--in other words, so blatantly poor that patents are potentially at risk".

Column 684

Before dealing with some of the issues of detail, which we shall explore in Committee if we cannot get a response from the Minister tonight, may I raise a procedural point? The Order Paper contains a proposition to refer the Bill to a Special Standing Committee and I understand that the question can be put forthwith at the end of the debate. The idea is that, instead of the normal adversarial way of proceeding in Committee, where one side puts its inquiries and it is hoped that the Minister or Secretary of State, if she is to serve on the Committee--it would be nice to see her do so--answers the questions. The alternative procedure is to sit in a forum where specialist witnesses-- presumably from the General Medical Council, the British Medical Association and patient groups--can give their informed opinions to the Committee, which, having heard their advice, can then make decisions on the issues.

In principle, that procedure has much to recommend it. When I was a member of the Labour party's Treasury team, I argued that the Finance Bill could be better dealt with if some of the specialist issues were taken in such a forum rather than in Standing Committee. I do not know the Government's attitude to the procedure, but if they decide to adopt it for a Bill that is, in principle, not contentious, in a spirit of consensus and co- operation the Opposition will co-operate fully with it. I hope that, in so saying, I put a persuasive argument to the Minister of State who, I suspect, will take the Bill through its Committee stage.

We shall want to explore issues such as the Bill's structure. It has been argued that it might have been better to adopt a structure that was, essentially, put forward in the Bill introduced by my hon. Friends in 1993, which would have modified the rules for serious professional misconduct in such a way that serious under-performance would be deemed to be serious professional misconduct, rather than to introduce a third new procedure. Although there are arguments on both sides, I prefer to explore the rights and wrongs of the two different ways of proceeding with professionals than to argue it out with Ministers in an adversarial setting in Committee. The Minister will, no doubt, argue that what has been done in the Bill is right and could not possibly be done in any other way. I am not sure that that is true and I should like to listen to professional specialist opinion.

I should also like to explore with the Minister whether it is realistic to think that a doctor whose performance has been so persistently bad that he is putting patients at risk could ever be reformed by retraining. The Bill puts a great deal of emphasis on training and retraining, but there will come a time when no amount of retraining will achieve the required result and, sooner or later, someone will have to say that. I want assurance that the procedures will do so.

The assessment referral panel--the body that can require doctors to undergo assessment--will meet in private. The Secretary of State said that there were good reasons for that, and I understand them. However, it is an important principle that justice, as well as being done, must be seen to be done. Complainants will have no right to ask for a public hearing and I should like to test the arguments on whether that should be so. Obviously, I understand what the Secretary of State said, but countervailing arguments deserve to be explored.

Next Section

Home Page