House of Commons Hansard Debates for 25 Apr 1995

Mr. Deputy Speaker (Mr. Michael Morris): Order. I can help the hon. Gentleman. If the Bill does not cover the illustration that he is giving, I am afraid that he is out of order. If he thinks that it might, he would be in order.

Dr. Spink: I am greatly indebted to you, Mr. Deputy Speaker; you are absolutely right. However, perhaps we should consider whether the Bill should be extended to cover that matter. I think probably not; the Bill should go forward as it stands because it is an extremely good Bill and we should not delay it. We need to consider other measures to follow behind it. I note that you are leaning forward in your Chair again, Mr. Deputy Speaker, so before you stand up I shall sit down.

8.39 pm

Mr. Peter Atkinson (Hexham): I apologise to the House because although I was here to listen to my right hon. Friend the Secretary of State's introduction to the Bill, unfortunately I then had to attend meetings elsewhere

Column 734

in the House and so missed what has clearly been a long and interesting debate. I hope that in my few remarks I shall not be unduly repetitious.

Mr. Nicholas Brown: Only someone who has not attended the last two hours of debate could possibly describe it as interesting.

Mr. Atkinson: I do not think that I should be tempted to reply to that comment--although I must point out that I hold the Bill in my hand, not the research document from the House of Commons Library. I join in the general welcome for the Bill, which is an important measure that will do a great deal to improve medical standards in this country. It should be made clear that the Bill is in no way a criticism of the national health service or of doctors. We should say time and again, even at the risk of being repetitious, that Britain has a first-class health service and that the majority of doctors and medical practitioners are of an excellent standard and take great trouble about retraining and keeping up to date with modern trends in medicine.

The Bill is a kind Bill. It is not intended to attack or harry general practitioners who may fall foul of it. Instead, it makes provision to retrain them, to support them and to bring them back into the fold as competent doctors.

I want to pick up a point made by my hon. Friend the Member for Beckenham (Mr. Merchant) about there being some gaps in the Bill. I do not want to be out of order, Mr. Deputy Speaker, but I must say that I believe that in time we will have to extend the process to developing areas of medicine such as chiropractors--something that my hon. Friend the Member for Aylesbury (Mr. Lidington) knows a great deal about--or even bone setters, as they are known, who are increasingly moving into a quasi-medical position.

I speak from a position of considerable luck because I represent a rural constituency. It has isolated communities, but within them there are first- class medical practices, health centres covering most of the constituency and an excellent general hospital. I am sure that the provisions in the Bill will not need to be applied to any doctor in my constituency.

One concern that I have about the Bill is the effect that a vindictive patient might have on a perfectly competent GP. I know that the Bill provides for a screening system, but I am concerned that an individual GP could be dragged before a committee time and again simply because of complaints from a troublesome nuisance patient. As patients learn more and more about their rights--as they should--the odd troublemaker might seek to pursue a vendetta against a GP.

There is also the question of who pays for retraining. That issue should not be left in the air. I appreciate that one of the problems with such a short Bill is that a great deal of the detail is to be left to regulation, which I understand must be approved by the Privy Council. That always causes Members of Parliament to feel slightly ill at ease because we are being asked to approve a Bill that is not complete.

The question of who pays for retraining is important. Doctors may be self- employed, but usually they are employed by the family health services authority. There are also some peripatetic locums who move from one position to another. Who would be responsible for retraining those people? I do not think that the local health

Column 735

authority or the hospitals should take on that retraining. I hope that my hon. Friend the Minister will respond to that point when he replies.

Another point that needs consideration is the appeals procedure. The Bill is complicated, but my understanding is that if a GP felt that he had been wrongly convicted--that is perhaps not the right word--his only recourse would be to the law. There is no opportunity for an accused doctor to disagree with the screening process or the professional judgment of his peers. I wonder whether there should be such a gap in the Bill.

Will the hearings of the General Medical Council's committees be held in public? The GMC's proceedings are usually open to the public. One difficulty could be that, much to the delight of the tabloid newspapers, marvellous stories about doctors in trouble with their patients could be splashed across newspapers--even though the allegations are often totally unfounded. Will doctors who have to appear before the GMC committees be granted privacy when their cases are heard?

Despite those few reservations, I very much welcome the Bill. I hope that the details in the regulations will be more thoroughly discussed in Committee because, as I have said, there is a slight feeling of ill ease that such a short and compact Bill should rely on other people adding to it to make it work.

8.46 pm

Mr. Robert Key (Salisbury): I was detained at the start of this afternoon's business, so I look forward to reading the early part of the debate in Hansard . I want to raise some important issues which I do not think have been covered in earlier speeches.

Over the years, Members of Parliament have to deal with many cases in their constituencies. Some can be easily resolved, but more usually they cannot. When a professional conduct case is involved, it is usually beyond the competence of a Member of Parliament to make a judgment, any more than a Health Minister can make a judgment on a clinical matter. That is no different from the behaviour that the British people would expect of lawyers, accountants or any other professional person. It is the whole essence of professionalism. Standards apply to a profession and we expect people in that profession to maintain them. I was fortunate enough to be a teacher for 16 years before I entered the House and I learned the essence of professionalism in the world of teaching.

The cases with which we have to deal as Members of Parliament vary widely, and sometimes we are fortunate enough to gain some professional insights. I served as a member of the Medical Research Council, where I saw what many would regard as the rather esoteric end of the market. However, it gave me an enormously important insight into the challenges facing the medical profession, both in this country and elsewhere.

Some of the cases that our constituents bring to us turn out to be not quite what they seem. That is why I warmly welcome the Bill. It will help us in our role but, above all, it will help citizens who feel aggrieved and it will help those members of a profession who may occasionally have unwarranted charges made against them. Sometimes cases are brought before us and there is incomplete information. A patient is aggrieved, he disbelieves his GP and he wants to take the matter further. Only a few weeks ago, I was told of a constituent whose mother had

Column 736

allegedly died of bed sores in hospital. Of course that was not the position, but the relatives felt aggrieved. I regret that the symptoms were much more serious, but, all told, it was a hard time for the family concerned.

There is the occasional malingerer and the occasional example of a night- time call-out when a doctor reluctantly gets out of bed and travels miles in rural constituencies. Like my hon. Friend the Member for Hexham (Mr. Atkinson), I represent a rural constituency, and I know how it must feel. No doubt, doctors there can incur the wrath of their patients when appearing less than enthusiastic at the prospect of a journey of some miles to visit someone who is unwell. In all those cases, the patient may feel aggrieved, and occasions may arise when professional misconduct takes place. Generally speaking, however, that is not the case.

The danger involved in politicians talking too much about the issue is that they give the impression that professional misconduct is commonplace when the reverse is the truth. In my experience, it is extremely exceptional to have any serious case--the sort of case that might be covered by the Bill in relation to professional performance in the medical profession. We should be careful.

We need to deal with one or two other issues, on which I should be grateful for the advice of my hon. Friend the Minister. The first involves the question: what do we mean by "professional conduct?" One of the things that has interested me in my constituency is the improvement in the past decade in medical services provision focused on the village health centre. That has made an enormous difference to the quality of life in general, and particularly to the medical quality of life for tens of thousands of my constituents. A substantial building programme has taken place. There are more than 100 villages in my constituency, many of which boast a good primary health care facility. The financial arrangements under which those health centres have been built put a considerable responsibility on the professionalism of doctors who are partners. Does the Bill and the concept of professional performance extend to the financial management and responsibilities of those health centres?

Should something go wrong with the complicated mortgage structure of some of those centres, might professional performance be called into question? Would it bring the profession into disrepute if, for example, a partner who had gained substantially because of the capital increase in the value of the building made off with the loot, so to speak, in a way that might be regarded as underhand? I have no evidence that that has ever happened, but, as primary health care increasingly receives substantial sums of money from the taxpayer, it is not unreasonable to ask whether professional competence in the medical profession extends not just to the service and the bricks and mortar of a practice, but to the extremely expensive software and computer equipment, and to the ancillary staff, who are so important in an advanced health care system such as we have now. That issue should be explored.

Mr. Lidington: I find myself in considerable sympathy with my hon. Friend's line of argument. Does he think that, when dealing with conduct, the Committee that will be appointed after, I hope, Second Reading is given to the

Column 737

Bill, might amend the Bill to include a clause on conduct falling short of the standard expected of a doctor, much akin to the clauses already included in the Osteopaths Act 1993 and the Chiropractors Act 1994?

Mr. Key: My hon. Friend raises an important issue and I tend to agree with him. For example, clause 1 refers to the committee on professional performance finding that a fully registered person has been "seriously deficient", but in what respect? That needs to be explored in Committee. I have no doubt that it will be, and it is important that it should be.

Mr. Lidington: Again, the two Acts to which I alluded and which relate to professions that complement orthodox medical practice have something to teach us. They distinguish between incompetence in the practice of the medical discipline concerned and misconduct more broadly defined. The Chiropractors Act, for example, refers to someone being found "guilty of professional incompetence" and distinguishes between that and

"conduct which falls short of the standard required of a registered chiropractor".

That distinction is already embodied in those two Acts and Ministers might wish to consider it in Committee and during the Bill's later stages in the House.

Mr. Key: Paragraph 9 of the schedule to the Bill states: "In Part III of Schedule 1 (Committees of the General Medical Council) after paragraph 21, there shall be inserted the following paragraphs".

They mention the assessment referral committee and the committee on professional performance. Even that, however, does not really help us or get us far. I dare say that my hon. Friend the Minister will have some answers for us on what exactly is meant by professional performance. There was perhaps a danger in assuming that, when the General Medical Council identified a gap in its responsibilities, that gap would be easily filled. It may not be easy even to decide what the gap is, let alone whether the Bill fills it.

As I have said, any professional misconduct by the medical profession is exceptional. I, too, pay tribute to the high standards in the national health service. I have always relied on it. I have no interest to declare as a subscriber to a private health scheme because I am not. The only private insurance that I have is with my dentist, who decided voluntarily a couple of years ago that he wanted to go down that road. He made the right decision. It proved good value for money for my family because, apart from anything else, as someone who only last Saturday reached his 50th birthday, my teeth are pretty rotten, and my three children have, I think, one filling between them, so the dentists will do themselves out of a job if they are not careful. I have no financial interest in the matter. I and my family believe that the NHS is superb.

I have come across one serious and tragic case. I shall not refer to it in detail because it is still running, and I fear that it will run and run. It involves the death of a child. That constituency case has brought home to me the gravity of professional misconduct or, indeed, misjudgment and it has led me to examine in some detail exactly what happens to a member of the medical profession when something goes wrong.

Column 738

Again, lest it be assumed that the Bill has identified a gap that we can easily fill, I draw the attention of the House to the fact that, with the increasing complexity and technological involvement of the medical profession, it is sometimes very hard to identify which link in a chain might be at fault or, indeed, guilty of professional misconduct.

It is clear that there is a chain of many links and that things can so easily go wrong. In my constituency case, for example, when the child was first taken into hospital the nurses perhaps did not examine the child as quickly as they should. At that time there was not an absolutely standard procedure laid down for all cases in which a patient suffering from suspected poisoning was brought into the hospital. So time was lost. A doctor was not fetched by the nurse. The pathology department was short staffed because it was a Saturday. Part of the kit was unavailable. A computer link to another hospital north of the border was down because of a technological problem and, again, it was a Saturday. And the consultant was not fetched early enough because the earlier steps had not been followed.

The independent professional review revealed that one person could not clearly be held to blame. There was a series of deficiencies in procedure. Not only the medical profession but the administration was at fault because no administrative procedure had been put in place to cope with the situation in the first place. Moreover, the case was not brought to the attention of the chairman of the trust until nearly two years after it all happened.

Cases in which there may well have been some professional misconduct can sometimes take a long time to investigate, and justice is therefore harder to apply. There is a long chain between the patient, the administration, the nurses, the junior doctors and the consultants.

Mr. Peter Atkinson: My hon. Friend has fixed on a particular point. He mentioned the business in clause 1 about where professional performance is found to be seriously deficient. In the example that he has described, would he say that any one of the doctors could be called seriously deficient?

Mr. Key: Yes, I would, but that is not for me to judge. That is precisely why the General Medical Council exists. It is a serious point. The length of time between the incident which led to the death of the child and the revelation of what had gone wrong meant that junior hospital doctors had moved on to other jobs elsewhere in the country. So the national health service trust in which the incident occurred was not in a position to discipline the juniors involved in the case. We therefore return, despite the chain, to the need to have a General Medical Council and for it to have adequate procedures. That is why I support the Bill, despite my reservations.

The case in my constituency is not over. That is why I have not referred to it in any more detail. The overriding problem for me is, first and foremost, the enormous distress to the parents that things went wrong and justice was not, at least in their eyes, seen to be done. Secondly, there is the enormous strain on the medical profession. It was not a case of a criminal being identified by a jury and retribution being meted out. It was not like that at all. It was a case of deficiencies on the part of very professional people who had been victims of consequential events. Misjudgments were made. The independent professional

Column 739

review pulled no punches: it said that notice should be taken of some things that some nurses, some junior hospital doctors and some consultants had done. We are not at the end of that particular story.

We should not treat the Bill lightly and simply assume that it will plug the gap which even the General Medical Council has identified. We are dealing with unusual circumstances here. Of the many thousands of cases with which hospital doctors and consultants cope every week and every month, in only a tiny handful do things go wrong.We must ensure, first of all, that the likelihood of things going wrong is minimised. Secondly, we must ensure that when they do go wrong, the machinery exists to put them right without victimising people or stigmatising professionals who have not been guilty of any misconduct.

The provisions in the Bill buttress a system which is quite exceptional in that it leads right up to the Privy Council for appeal. We should be immensely proud of that because it means that we regard the professionalism of medical people in this country as of the highest importance. That means that we have not only the best health service in the world, but the highest standard of doctors. That is why people want to train in this country.

It is the duty of the House to ensure that we support the Bill so that the highest professional standards will always be maintained and the reputation of medicine in this country will be one of which not only we but the whole world may be proud.

9.5 pm

Mr. Nigel Spearing (Newham, South): I whole-heartedly endorse the closing remarks by the hon. Member for Salisbury (Mr. Key). Indeed, I find myself, uncannily, in an almost parallel position. I too had 14 years in education and had to deal with a lot of pupils, families and illness. I probably share the hon. Gentleman's approach to Parliament. Fortunately, the Bill has no party or even any national health service content in principle at all. It is Parliament doing its job for the public.

I too, unfortunately, had a constituency case involving the death of a child. Instead of a chain of unfortunate circumstances, as the hon. Member for Salisbury described, my case concerned one general practitioner who was clearly and very badly wrong. Justice was not done and it resulted in an identification of the gap that we are hoping to fill with this Bill. I too have reservations about the Bill. I cannot say that I support it wholeheartedly. It is good that there is a Bill, whether it be this Bill or the procedures that have been outlined I am not quite so sure, for reasons that I shall now make plain.

I have one other thing in common with the hon. Member for Salisbury and that is being late for the debate. I am very sorry that I was not able to hear the opening speeches. Some hon. Members will know why and others will find out why if they look at today's Order Paper. The Select Committee on European Community Legislation sat for three sessions in Brussels today with Commission personnel and our ambassador there. All the discussions were about 1996 and the change. I have been trying and have managed, through the good offices of colleagues, to be in two places in different countries at once. This debate is about the regulation of a very important profession--such matters, incidentally, of course also relate to education- -which needs protection. Obviously,

Column 740

anybody who is in a critical position--such as a medical practitioner, a nurse or a combination of nurses and doctors-- may always be blamed. It is a natural reaction. But we also have to protect the public. This Bill and the Medical Act 1983 to which it is attached should mark that proper balance. Parliament on behalf of the public must strike that balance.

Such a balance was struck in the Merrison report of April 1975, which is worth putting on record. Paragraph 10 reads:

"We have suggested that the regulation of the profession can be looked upon as a contract made between the public and the profession. It is important to understand in this context that the GMC is merely the instrument for the proper supervision of this contract and that it derives its authority, and its being, from legislation. The legislature--that is, Parliament--acts in this context for the public, and it is for Parliament to decide the nature of the contract and the way it is to be executed."

That sums up the spirit of the debate and what we are about. The trouble is of course that in respect of Alfie Turner, there was no justice, or any for his family. He was a lad from Canning Town who, 12 years ago now, died tragically. He may have died anyway. The case is well known. The great bravery of Mrs. Stafford from Silvertown is also well known. At some risk to herself, she shopped the doctor concerned after the General Medical Council did not deal with him properly.

That deficiency in procedure prompted my private Member's Bill, which has been before the House for nearly 10 years. The GMC has not accepted it, but it has helped to promote the long discussions and detailed consultation in the medical profession, which has resulted in this Bill.

My private Member's Bill was supported, among others, by Dr. Maurice Miller, a former Member of Parliament who is known to many Members present. It was also strongly supported by the hon. Member for Cambridgeshire, South -West (Sir A. Grant), who has joined me to table a motion to refer the Medical (Professional Performance) Bill to a Special Standing Committee.

As many hon. Members have said, this is not a simple matter. I suggest to the Minister that the procedure of taking evidence and deliberating in such a Committee prior to the formal Standing Committee, which is now available to us, is tailor-made for considering this sort of important relationship between a profession and Parliament. I hope that the motion will be given due consideration. The Government Front-Bench do not have to do anything, but must merely say nothing if I am able to move it. Perhaps we will have better legislation as a result.

My private Member's Bill had the support of the right hon. Member for Peterborough (Dr. Mawhinney), the Secretary of State for Transport, who was then a Back Bencher and who knows a thing or two about medicine. It was also supported by my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith), who is an eminent consultant.

I am unable to give the Bill under consideration direct support because, as I explained when I moved the Second Reading of my private Member's Bill on 3 March 1987, there is a lacuna in the present procedure for what we might call conduct and discipline. Under the present arrangements, a doctor must be found guilty of what is

Column 741

termed serious professional misconduct, even if he is to be put on conditional registration, which is the main feature of the performance procedure.

I want to question the link--there must be one--between conduct in one incident and a general level of performance. Perhaps it is easier to assess it from one incident than from a period in which there has to be a serious deficiency in performance.

The word serious is very flexible. It gave rise to the terrible situation in the Alfie Turner case, when Dr. A was not willing to examine or treat the boy, or even call for an ambulance when he was virtually unconscious, and would not even take his temperature. Alfie Turner died of meningitis three days later. The doctor was found not guilty of serious professional misconduct and walked out of the General Medical Council with only a stain on his character. The GMC did not even have the power to put him on conditional registration. My Bill, which has not yet been accepted, would have allowed it to do so.

Enough of my Bill because we now have a Bill before us and that is very important. We should have some reservations about it, however. The first reservation should be about its format, as it has three or four principal clauses, which will trigger off a complex procedure. It took me quite a long time to fathom it out in the official documents. The procedure is not contained in a single diagram but in three diagrams of some complexity. No doubt those familiar with the GMC and the medical profession will be able to understand it. That complexity is another reason why we should study the Bill in a Special Standing Committee for three days, as we are allowed. My second reservation concerns the screening procedure and I am sorry that I was late today as I know that one hon. Member present knows about it. I should have thought that it was controversial to have a single screener, or a screener with reference to just one other person. The process of screening complaints from any quarter will be replicated in the parallel procedure for performance, currently found in the realm of conduct. I have heard it said--we shall no doubt find out in Committee whether it is correct--that members of the GMC's preliminary purposes committee cannot consider cases which the screeners have already dismissed. That may have been changed by now; if not, I hope that it will be changed because it is not good procedure.

Those of us who have been in local government or on Committees of the House know that a chairman's action can be looked at and, even if it cannot be reversed, it can at least be revealed or further endorsed. Unless someone in such a crucial position is open to subsequent inspection, the public have cause for concern. Under the procedures to be adopted, the decisions of one or, at most, two screeners should be open to subsequent examination. After all, if someone writes to a member of the GMC and asks why a case did not come before it, that member should at least be able to look at the case, perhaps in confidence, to see why it was dropped. I do not think that can happen now.

Since introducing my Bill, I have received many letters about delays from all over the country. If someone complains to the GMC, it naturally puts the matter off if the complaint has gone to the family health services authority or one of the learned colleges of medicine. That

Column 742

may be all right, but I have heard many examples where complaints have been brushed off, and the GMC's public relations in that respect do not always induce public confidence.

I have referred to the complexity of the diagrams on procedure. I make no specific complaint that the performance procedure as distinct from the final stages of the disciplinary procedure are held in private, as there may be an argument for that. The problem is that, once a complaint has been considered, and even after the screeners have said that there may be a case, the complaint can be dropped in at least three subsequent parts of the procedure before it reaches the proposed statutory committee--the assessment referral committee--and will not necessarily reach that committee at all. Although there may be nothing wrong with that, if it is not open to GMC members to consider those complaints, the public have cause for concern.

The hon. Member for Salisbury mentioned appeal to the Privy Council. That is confined to the conduct line of investigation but will be complicated if we are to have two parallel forms of investigation. Although the conduct of a doctor who is guilty of a criminal offence or some other misdemeanour that is not medical must be investigated, we now have no less than four committees: the preliminary purposes committee; the professional conduct committee; the assessment referral committee; and the assessment of professional performance committee. We also have the possibility of appeal to the Privy Council. Unless what is happening in those investigations is crystal clear and open to an extent, even if doctors are anonymous, I fear that difficulties may arise.

I should like to refer to the financial memorandum at the beginning of the Bill. I do not think that we should necessarily worry that doctors who are recommended for some form of retraining should receive it at public expense. I am not sure that that is correct, unless they are employed by the NHS, but I do not want to pursue that. I am interested in the estimated sum, because I cannot understand how it was arrived at. Perhaps the Minister will be able to tell me that when he replies. How do we know how many doctors will go through the retraining process? What standards of serious defective performance will be set by the various committees? How many doctors will be eligible for some sort of retraining or other acceptable courses before they reach the later stage in the retraining process? I cannot see how it was possible for anyone to make a realistic estimate of the amount contained in the financial memorandum. The sum will be paid per annum at the current cost, so what will happen later?

I am not arguing that it is wrong to give money for the retraining of doctors, but someone with a great deal of relevant experience said to me, "By George. Many of these doctors are getting on a bit and haven't kept up." I wonder how capable they are of benefiting from the sort of courses that will be offered. Such doctors may need something more, such as support from their colleagues, or something more subtle than a retraining course. We should ask a lot of questions about those financial arrangements.

I referred earlier to the format of the Bill and I should like to do so again, because of the procedural implications more than anything else. Although the Bill has relatively few clauses, designed to amend the Medical Act 1983,

Column 743

the schedule to the Bill contains about 50 amendments--I accept that some may be minor--to the 1983 Act. Apart from the clauses, the schedule contains two chunks of amendments to be incorporated in the amended 1993 Act. I reckon that those amendments will create a few new complex sections in that Act when they are either laboriously changed in ink or in "Halsbury", or some computer has a go at it. It might be worth while--it may be dealt with in another place--if the relatively few sections in the Act relating to doctors' performance were repealed and replaced by an entirely new section. It would be rather like replacing a unit in a complex piece of electronic machinery instead of trying to tinker with it by changing just odd parts. The meaning of the amended Act would then be clear. Unless that is done it will be extremely difficult to follow the new law. That might mean a feast day for lawyers, doctors and the Medical Defence Union, but it would not be right for us to leave legislation in such a tatty state.

The MDU expressed an interest in my amending Bill. I wrote an article about it in the Journal of the Medical Defence Union issue number one of 1991, in which I said:

"The Bill in essence is as much in defence of the reputation of the profession as a whole, since it would promote confidence in it that doctors deserve and the public have a right to expect." I suspect that that principle should be applied to the 1983 Act, as amended by the Bill, as much as to my own honourable effort. I called my Bill the Turner-Stafford Bill because it was dedicated to two constituents; one, alas, dead while the other lady is still alive. One of the biggest lacunae in today's Bill is its failure to match what my private Member's Bill sought to provide.

Here we have two streams of procedure, a conduct procedure and a performance procedure. There is a triangle, and if one of the preliminary screeners says, "This is conduct; we ought to do this through the conduct leg of the procedure," and the procedure goes through as it did in the case of Dr. A, and in the end the doctor is found guilty of not having done this, that or the other, but his omissions are not considered to have amounted to serious professional misconduct, he cannot even be put on conditional registration. That is what happened with Dr. A.

If, on the other hand, the person controlling the original king points--the first screener--says, "Let us do this under the performance procedure," the case goes all the way through the performance channel and the committee says, "Dear, dear, there has been a serious lapse in performance here," the doctor will get retraining or be put on conditional registration. I consider that the better way of describing it, because the result should be remedial, not penal; we want remedies but not necessarily penalties. In that case the doctor would get something that it would be impossible for him to get under the present law if the case were dealt with under the conduct procedure.

Paraphrasing the legal language, my Bill simply said that if what a doctor had done did not amount to serious misconduct, but was nevertheless conduct unacceptable in a medical practitioner, the GMC would have the power to put him on some sort of conditional registration, however mild. The exact details could be tailor-made for the situation.

Column 744

However, the GMC said that it did not want those powers. I now suggest--and I shall take the matter up in Committee-- that if such a situation arises the conduct committee, which already exists, should have the power to refer the case back to the performance committee, saying that there had been no serious professional misconduct but that there had been a lack of performance. That would amount to what my Bill would have brought about. Although the GMC was against the idea at the time, I hope that it will reconsider.

The suggestion could form the basis of one of the amendments that we make to the Bill in Committee. I hope that the Committee will be that suggested in my procedural motion, which I hope the House will support as the most appropriate way of dealing with this important Bill, which not only affects all of us as members of the public, but affects all our constituents and also the noble profession of medicine.

9.27 pm

Mr. Nicholas Brown: With the leave of the House, Mr. Deputy Speaker, I should like to respond to the debate--briefly, because I know that we are all anxious to hear the Minister's responses to the questions that he was asked not once but many times.

In my opening remarks I was uncharitable enough to observe that the governing party was padding the debate out and to allege that that was done to avoid exposing the Secretary of State to more contentious debates on health care. The debate has provided a fair amount of evidence to support that contention; it has been good-natured and well-informed, if somewhat repetitive.

The first Government Back Bencher to speak was the hon. Member for Birmingham, Edgbaston (Dame J. Knight); she was the first of several hon. Members to pay tribute to my hon. Friend the Member for Newham, South (Mr. Spearing) for the part that he has played over the years in repeatedly trying to bring before the House the issues addressed by the Bill.

The hon. Lady praised my hon. Friend and his supporters on both sides of the House for their endeavours, and she also mentioned the meningitis case to which my hon. Friend referred. Her words found widespread acceptance in the House when she asked what we could do about a doctor who said that he could not be bothered to see his patient. I must admit that I am pretty sceptical about how much retraining would help in such circumstances, yet retraining is a key feature of the Bill.

The hon. Member for Edgbaston expressed a fear that our health service would approach the American model and become more litigious. I agree with what she said about that, although I fear that the Government's national health service reforms take us in that direction, rather than help avoid it.

In a powerful contribution, my hon. Friend the Member for Newcastle upon Tyne, Central (Mr. Cousins) delivered himself of a highly critical and well thought-through critique of self-regulation. The Government have made it pretty clear that it is the legislation before us, amended as best we can in Committee and on Report, or nothing. They are not considering a more radical reform of the profession or professions.

My hon. Friend the Member for Newcastle upon Tyne, Central expressed uncertainty about the use of language in the Bill. He concentrated on the meaning of the word

Column 745

"serious" and mentioned the number of procedural stages and the influence of old boy networks. The argument about language was well taken up by my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith), who made a similar argument, although about the word "competence". Both words are important. Obviously, the way in which those terms will be defined in practice will set the standards for the profession, and it is right that we tackle those issues now and in detail during consideration in Committee.

That brings me to the contribution of the hon. Member for Chislehurst (Mr. Sims), who told us helpfully and fully of his work on the PPC. I pay tribute to him for that work. He rightly spoke of the importance of the laity in the work of the General Medical Council. However, although he expressed support for the principle of the Special Standing Committee procedure, which Labour Members would like to be followed in that case, he said that he did not consider that it was applicable in those circumstances, because there had been such widespread and thorough consultation.

I am sure that what the hon. Member for Chislehurst says is true, but let me say to him, as gently as I can, that Members of Parliament, especially members of the Opposition, have not been a part of that consultative procedure. If legislation is to pass through this place, it is for the elected Members of Parliament to satisfy themselves that the legislation is properly structured--not for all the outside interests to be so satisfied, and to come to Parliament and treat us as though we were a rubber stamp. Our constituents would not want us to be treated in such a way, and it would be demeaning to this place if we ever allowed ourselves to be treated in such a way. I advocate crisp but mature scrutiny of the details of the legislation, once concise expert opinion has been heard--the same concise opinion to which people in the profession have already been exposed. I consider that that would serve Parliament better than the adversarial Committee procedures that I believe are the ones that the Minister favours- -although I wait to be surprised and perhaps even encouraged.

I make the Minister an offer. I guarantee that, if the procedure that we wish to be adopted is accepted, we shall co-operate fully with that procedure and the Bill will not be unduly delayed. Indeed, that promise was made to him during the Queen's Speech by my right hon. Friend the Member for Derby, South (Mrs. Beckett).

The hon. Member for Wyre Forest (Mr. Coombs) got his teeth into the briefing notes so ably prepared by the House of Commons Library, although he diverted from them to accuse some patients of unreasonably becoming ill, thereby placing pressure on the national health service. [Interruption.] I hope that I do not do his contribution an injustice, although I hear from the groans of his hon. Friends that I may have paraphrased him unfairly. It is nevertheless the case that there is increasing pressure on the national health service, which shows up in the statistics for complaints and in the much smaller statistics relating to the GMC's ability to cope with complaints.

We had a powerful contribution from my hon. Friend the Member for Cannock and Burntwood (Dr. Wright), who discussed the extent of the powers in the Bill, made the case for the Special Standing Committee procedure

Column 746

that we support and especially placed emphasis on the importance of definitions--an argument that was made by every Opposition Member who spoke.

We then began what I can only describe as a parliamentary filibuster. Conservative Members followed each other and spoke to the briefing notes. The hon. Member for Ribble Valley (Mr. Evans) condemned high-profile complaints and then treated the House to an example of a high-profile complaint. The hon. Member for Croydon, North-East (Mr. Congdon) read the Library note adequately, but he was rehearsing what the hon. Member for Edgbaston had said earlier. The hon. Member for Beckenham (Mr. Merchant) got his parliamentary revenge on me and my former colleague, the late Harry Cowans, for having kept him up late at night in 1984 on the Rates Bill. He clearly harbours a grudge and undoubtedly remembers the inadequate whipping by the Government during the passage of that Bill. He was followed by the hon. Member for Castle Point (Dr. Spink), whom I must congratulate on having managed to find and then read to the House the one bit of the Library briefing note that other Conservative Members had not yet read. At that stage I found myself thinking, "Why me?" The House will recall that last week I attended the passage of a private Bill when I represented, on my own, the parliamentary Labour party as my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) delivered a two and a half hour defence of Bart's hospital. At least he did it with elegance and enthusiasm. Attending parts of today's debate was not like watching paint dry but like listening to it. Even the Minister's parliamentary private secretary fell to reading Scallywag --as far as I could see from here, it was the latest edition. Presumably he was checking to see if the Minister for Health appeared in it. I do not know whether that is part of his parliamentary duties-- [Interruption.] The Minister obviously does not appear in it.

The hon. Member for Hexham (Mr. Atkinson) raised a perfectly good point about accountability. The General Medical Council is not responsible to the Secretary of State for Health; it is responsible directly to the Privy Council. Parliamentarians on both sides of the House are right to be especially vigilant when there is a suggestion that the royal prerogative is to be used rather than a decision of the House.

Every point having been made umpteen times, the hon. Member for Salisbury (Mr. Key) returned to an earlier theme. He would not have known that he was returning to an earlier theme as he entered the debate pretty late and apologised for doing so. He asked what was meant by professional misconduct. The discussion about definitions is at the heart of today's debate. The key question is how should a profession be regulated. I say as gently as I can to the House that it must involve professionals, even if only professional advice. The laity are also important--a subject that we shall want to examine in Committee--because they are there to represent the public interest. The debate's second theme involved the meaning of the key terms in the Bill. As my hon. Friend the Member for Newcastle upon Tyne, Central asked, how is "serious" to be defined and why is the word "serious" necessary? My hon. Friend the Member for Strathkelvin and Bearsden made exactly the same point around the use of the word "competence". We were asked whether a single incident would be sufficient under the new procedures or whether

Column 747

a doctor's performance over time was to measured under the new procedures. I understood the Minister to say that there were circumstances in which a single incident could of itself bring the new procedures into play. We shall wait to see the sort of cases that will emerge. It is important that we understand that a single incident could trigger off the procedures.

Will the Minister tell us whether the Government intend to legislate for the other professions? In my opening remarks I listed the phrases that pertain to disciplinary actions involving the other national health service professions, and a response from the Minister tonight would be helpful.

I conclude by making a plea around the procedural point. It would reflect credit on the House if we dealt with this issue, on which there is no division on principle between us, in a non-adversarial way in a Special Standing Committee, thus enabling people to give evidence to us so that we could make our decisions on the basis of it. It is a suitable Bill for that procedure, and I make the Minister this pledge: if he adopts that procedure, we shall do everything that we can to facilitate it and make it work as it should rather than to frustrate it or use it in a partisan way.

9.39 pm

Next Section

Home Page