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The Minister for Health (Mr. Gerald Malone): I must first refute the scandalous suggestion made by the hon. Member for Newcastle upon Tyne, East (Mr. Brown) that the contributions made by Conservative Members were anything other than extremely constructive. I listened to all of them with care. My hon. Friends, like the hon. Gentleman's colleagues and the hon. Member for Argyll and Bute (Mrs. Michie), contributed to an excellent debate on a complex subject and each raised a number of novel points, to which I shall respond. I must also point out that, had it not been for my colleagues carrying the debate when there were no Opposition Members here to do so, the hon. Member for Newham, South (Mr. Spearing) who, with his usual courtesy, had alerted my colleagues and I to the fact that he was hoping to speak but could not be here until late, would have been thwarted, returning to the Chamber only to find the debate had finished. I, for one, am pleased that he was able to make his valuable contribution.
Mr. Nicholas Brown: I must apologise. I had not realised that the governing party was deliberately keeping the debate going so that my hon. Friend the Member for Newham, South could contribute. I apologise to the Minister and thank him for filibustering in a debate on the Government's own legislation.
Mr. Malone: It was a happy and slightly unforeseen consequence of my hon. Friends' enthusiasm.
I am extremely pleased to be able to thank the hon. Member for Newcastle upon Tyne, East for his remarks in support of an important Bill and for saying that, ultimately, the Bill will pass through Committee with reasonable dispatch, subject to discussion of the very many issues that will be raised in Committee and to which hon. Members of all parties have alluded. I hope that the circulation of the notes on clauses will assist detailed discussion of the Bill later.
Hon. Members raised a wide range of concerns about the responsibilities of the General Medical Council as well as their views on the Bill. I shall try to deal in detail
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with as many as possible and comment on some aspects of the Bill that have not been raised in great detail--and there are some, although the hon. Member for Newcastle upon Tyne, East may not think so.When my right hon. Friend the Secretary of State opened the debate, she mentioned the importance that the Government attach to the GMC's new procedure. I am happy to wind up the debate, but I must make it clear that the Under-Secretary of State for Health, my hon. Friend the Member for Bolton, West (Mr. Sackville), who was here at the beginning of the debate but was unable to remain until the end because he had commitments elsewhere, will take the Bill through its remaining stages.
Several hon. Members mentioned the possibility of a Special Standing Committee. The Government believe that there has already been thorough consultation on the Bill's subject matter. The GMC has issued two consultation documents and we believe that little would be gained by using the Special Standing Committee procedure in this case. I listened with some care to the hon. Members for Newham, South and for Newcastle upon Tyne, East on this subject, but, following the consultation process, it is clear that the Bill is supported by a wide range of professional groups and patient groups which comprise the type of people who would come before such a Committee. They have made their position clear. The remedial approach is supported by professionals; it is preferable to putting doctors through adversarial proceedings of conduct hearings, which are regarded as punitive and would require criminal standards of proof.
As those important matters have been extremely well aired by the GMC in the two consultation documents, it is the Government's view that a Special Standing Committee would not be entirely appropriate as the purpose of such a Committee is to raise novel issues that were not canvassed before the Bill reached Second Reading.
Mr. Spearing: In the bipartisan atmosphere, I thank Conservative Members for bringing to the debate facts and matters that have been transferred from another part of the building and that otherwise might not have been recorded in Hansard . Does the Minister agree that nothing will change the Standing Committee stage? All he is saying is that we are not to have the preliminary of up to three mornings. He says that it is not worth it. How does he know? How can he prejudge what extra might emerge in those Select Committee hearings?
Mr. Malone: I am not trying to prejudge that. There has been a substantial consultation process that is adequate for the Bill to proceed.
Mr. Galbraith: Will the Minister give way?
Mr. Malone: No. I have a substantial number of points to address in the remaining 15 minutes, not least some of those raised by the hon. Gentleman.
I cannot give the undertaking that the hon. Gentleman Newcastle upon Tyne, East sought. I turn directly to a number of points that he raised. First, he asked about the role of the screener. I repeat that the screener, who will be a medical member of the GMC, will decide whether there is sufficient evidence to support an allegation of seriously deficient performance. He will examine the evidence submitted to him and, if necessary, will seek additional information.
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A complaint can be dismissed only with the concurrence of a lay screener. The Government believe that that will afford protection to complainants in that their complaints cannot be dismissed by one individual alone. That provides substantial reassurance.The hon. Gentleman also asked whether retraining is the answer if a doctor is persistently poor. A doctor must be given a chance to mend his or her ways. The Bill is not punitive, but designed to bring people back into line.
The assessment process may be the first time that a doctor is brought to the point of accepting that his or her performance is poor. Training may not be the sole answer. That point was raised by the hon. Member for Newham, South, who said that it might be a fairly complex matter. There may also be a need for counselling or for a period working under the guidance of another doctor. If a doctor does not improve, or performance is found to be so poor that there is a danger to the public, the matter can be referred immediately to the committee on professional performance, which can impose sanctions, conditions or suspension.
The hon. Member for Newcastle upon Tyne, East also asked about the reinstatement of doctors who had voluntarily removed their names from the register, consequential to the powers in clause 2. If a doctor subsequently applies to have his or her name reinstated, the application for reinstatement will be considered by the appropriate committee of the GMC.
The hon. Gentleman also raised the important issue of meetings in private. Rules will provide that the assessment referral committee will meet in private. One of the reasons for that is that the proceedings before that committee are preliminary in nature and should be held in private, as are the preliminary proceedings committee of the GMC, which considers conduct matters.
I am sure that the hon. Gentleman will have recognised that the Bill provides that rules will be made determining whether proceedings before the committee on professional performance, which is the main committee in respect of the legislation, will be in public or private. Initially, the GMC has taken the view that it would like them to be in private, but it will keep the matter under review. In any event, the doctor who is the subject of the proceedings will be able to demand that the proceedings be public if that is what he or she wishes.
The hon. Gentleman also mentioned other professional bodies and inconsistent powers, to which he asked me to refer specifically in my winding-up speech. He is correct in his summary of the powers of other health regulatory bodies. They differ to some extent and none parallels exactly the GMC's new performance procedures. The Bill results from a medical profession initiative and we would be very interested in proposals for change that any other professional bodies may choose to develop and bring forward. However, such proposals must be developed as carefully as the GMC's measures and should include public consultation, which was a very important element of the GMC's preparation for the Bill. At present, we have no plans to introduce legislation, although we would be prepared to consider the matter if other professional bodies put such proposals before us.
I now turn to the excellent speech by my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), who raised a number of points that I shall address
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directly. She asked, rather pertinently, what clause 1(9) of the Bill means. How will people--for example, employers --know that a doctor has been suspended? That is an important question.Dame Elaine Kellett-Bowman: Absolutely.
Mr. Malone: My hon. Friend will doubtless be glad to hear--as she endorses its importance from a sedentary position--that, if a doctor is suspended, his or her name will still appear on the register simply because the name has not been erased. The registrar of the GMC will ensure that a note appears against the doctor's name to the effect that suspension has taken place or that conditions have been imposed on registration. Anyone who makes a search of the register--as employers should do--will discover what the position is.
Access to the register will also be improved. The GMC is actively exploring ways to make the register more accessible in its up-to-date form, which will be important as matters proceed fairly quickly. For example, it will be made available on the Internet--how fashionable can one get, Mr. Deputy Speaker?--or on CD-ROM. I assure my hon. Friend that the register is checked regularly by employers--12,000 last August--to ensure its effectiveness. It is an extremely active register and I hope that my hon. Friend is reassured by my comments. A number of hon. Members raised the issue of seriously deficient performance. There is no clear definition beyond that in the Bill which, as I said to one hon. Gentleman, is not unusual when drafting legislation of this sort. However, I shall explain what is intended for the future. The GMC will issue guidance setting out the standards of professional performance that will be expected of doctors. It currently gives similar guidance on professional conduct and medical ethics in the blue book, as the hon. Member for Newcastle upon Tyne, Central (Mr. Cousins) mentioned. Future definitions will be advanced in the blue book or its equivalent.
Once guidance is available, the GMC will have a clear yardstick against which to measure a doctor's performance and it can therefore decide whether a doctor has been seriously deficient in his conduct. In addition, I am assured that the GMC will publish the details of the outcome of performance hearings. As the process develops, a clear body of knowledge will build up to which people can refer in much the same way as a body of case law develops in other areas.
My hon. Friend the Member for Edgbaston also raised the question of overseas doctors. She asked whether language difficulties could count as serious deficiencies in performance. I think that that would be unusual because language ability is tested before registration is granted. However, if communications problems prevented a doctor from competently examining a patient, taking a clinical history and explaining treatment plans and things of that sort, it would constitute a serious deficiency in performance--although I think that such an occurrence would be extremely unlikely.
The hon. Member for Newcastle upon Tyne, Central suggested that the profession was too protected. Under the Bill, anyone may send information to the GMC on a doctor's performance--patients, employers, health authorities or other doctors. I disagree with him that it is a profession that is protecting itself. It is an open procedure and I believe that the rest of the House has recognised it as such.
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I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on making an extremely important contribution to the debate, as I am sure he will to the Committee. He knows a tremendous amount and is well-versed in these matters. The next time I pass him in the Library and see him behind a pile of books, I will know what he is doing. It was good of him to enlighten us.The hon. Member for Christchurch (Mrs. Maddock) stated that the ultimate sanction of erasure would be available under the Bill. I would like to point out to her that it will not. I would not like her to harbour any illusion on that point. A doctor cannot be erased under these procedures. A doctor can only be suspended or have conditions attached to registration.
My hon. Friend the Member for Wyre Forest (Mr. Coombs) was concerned that the devil is in the detail of the Bill--as it is with so many other pieces of legislation that come before us. The rules that will be made by the GMC are subject to detailed scrutiny by the Privy Council after consultation with Department of Health lawyers. My hon. Friend the Member for Croydon, North-East (Mr. Congdon), and a number of other hon. Members, asked whether a single act that fell short of serious professional misconduct could be dealt with by the proposed procedures. I said at the time that the answer was yes, and I confirm that. That single act may trigger the action, but the action itself as it goes forward will look at the outcome of the assessment process. Of course, the assessment process will not be based on the single act but will look far more broadly at the track record of the doctor.
Mr. Nicholas Brown: Will the Minister give way?
Mr. Brown: Is the Minister adjusting what he said to the House earlier about a single incident?
Mr. Malone: No, I am not. I am saying that the single incident may trigger the procedure, but clearly, by its nature, the assessment process does not look just at the single incident that has been raised. It is expected that an iceberg of problems will be revealed once the assessment committee begins to look at it.
Perhaps the hon. Gentleman will pursue that matter in Committee, as I want to move on to a few other points, particularly that raised by the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). I think that I am the only hon. Member to pronounce his constituency correctly this evening. Doubtless he will be grateful for that. He raised the point that a doctor may be an incompetent orthopaedic surgeon but be all right to practise in other areas. He asked what could be done about that. The GMC will be able to place specific conditions on a doctor's registration.
The hon. Member for Cannock and Burntwood (Dr. Wright) asked whether the GMC should treat doctors who ignore concerns about a colleague's conduct, health or performance as guilty of serious professional misconduct. The GMC will take action, I can assure him, where it discovers that a doctor is not fulfilling a professional obligation, as outlined in the GMC blue book. So that will indeed happen.
A number of my hon. Friends raised other points later in the debate. I should like in particular to deal with the point raised by my hon. Friend the Member for Castle
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Point (Dr. Spink), who asked why there was no reference to the role of the health service commissioner in the Bill. The GMC is, of course, an independent statutory body and is in no way related to the health service commissioner, who can take an interest only in the NHS. A number of other matters were raised on the Bill. I cannot refer to them now, but doubtless they will be raised in Committee. The measure has not simply been sought by the GMC but been endorsed by the Government and the Opposition parties. That is quite right. It is an important measure, not just for the medical profession but for patients, who will be reassured by the fact that there is unanimity on both sides of the House about the principle of the Bill, although amendments might well be tabled in Committee. I am delighted to support the measure, to bring it to the House, to make a real improvement, not just for patients but, in the proper context, for the medical profession. It is better to retrain doctors who become less competent, rather than to penalise them. I recommend the Bill to the House.Question put and agreed to .
Bill read a Second time .
Motion made, and Question put forthwith pursuant to Standing Order No. 61(2),
That the Bill be committed to a Special Standing Committee.--[ Mr. Spearing. ]
The House divided: Ayes 37, Noes 133.
Division No. 135] [10.00 pm
AYES
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Beckett, Rt Hon MargaretBeggs, Roy
Beith, Rt Hon A J
Betts, Clive
Brown, N (N'c'tle upon Tyne E)
Chisholm, Malcolm
Dalyell, Tam
Davidson, Ian
Donohoe, Brian H
Dowd, Jim
Fatchett, Derek
Foster, Rt Hon Derek
Foster, Don (Bath)
Galbraith, Sam
Gordon, Mildred
Gunnell, John
Hinchliffe, David
Jones, Barry (Alyn and D'side)
Kirkwood, Archy
Lewis, Terry
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Loyden, EddieLynne, Ms Liz
McFall, John
Maddock, Diana
Mahon, Alice
Maxton, John
Michie, Bill (Sheffield Heeley)
Oakes, Rt Hon Gordon
Powell, Ray (Ogmore)
Prentice, Bridget (Lew'm E)
Rendel, David
Ross, William (E Londonderry)
Skinner, Dennis
Spearing, Nigel
Taylor, Matthew (Truro)
Tipping, Paddy
Wright, Dr Tony
Tellers for the Ayes: Mr. Harry Barnes and Mr. Jim Cousins.
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NOESColumn 752
Aitken, Rt Hon JonathanAmess, David
Arbuthnot, James
Arnold, Jacques (Gravesham)
Atkins, Robert
Atkinson, Peter (Hexham)
Bates, Michael
Biffen, Rt Hon John
Booth, Hartley
Bottomley, Peter (Eltham)
Bottomley, Rt Hon Virginia
Bowis, John
Brandreth, Gyles
Brazier, Julian
Bright, Sir Graham
Brooke, Rt Hon Peter
Browning, Mrs Angela
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