Second Standing Committee on Delegated Legislation
Thursday 6 July 2000
[Mr John Cummings in the Chair]
Draft Medical Act 1983 (Amendment) Order 2000
The Chairman: Before I call the Minister, I should point out that we have the wrong documents in Committee. However, the right ones are on the way.
The Minister of State, Department of Health (Mr. John Denham): I beg to move,
That the Committee has considered the draft Medical Act 1983 (Amendment) Order 2000.
I shall be as brief as possible in introducing the order. I congratulate you, Mr. Cummings, on your birthday.
Mr. Peter Viggers (Gosport): On a point of order, Mr. Cummings. If the Committee has not been furnished with the correct documents, can its deliberations be valid?
The Chairman: I am advised that the correct documents were circulated over the previous week. The incorrect copies were lying on the desk here this morning. Hon. Members should be in possession of the correct documentation.
Mr. Denham: Our doctors are almost without exception hard-working, honest and trustworthy. We all need help from doctors at some stage of our lives. We rely on their expertise and their ethical obligations to ensure that when we have to see them about our most private concerns, we are properly looked after. The great majority of doctors provide an excellent service and give their patients the best possible care.
Sadly, some doctors let the profession down. Doctors such as Harold Shipman bring shame on the whole profession as a result of their criminal acts. Others find the demands placed on them too great and have difficulty keeping up with the dramatic technological advances in patient care over the past two decades. Doctors who provide inadequate care as a result of their conduct, their competence or their health can pose a threat to patients' safety. Although they are only a small minority, such doctors have damaged public confidence in the profession.
The General Medical Council exists to protect patients. It must be truly accountable and guided at all times by the welfare and safety of patients. Recent scandals have highlighted several weaknesses in GMC procedures, which is why we are taking the action proposed today. We must be confident that the best systems for regulation and self-regulation are in place. Present systems must be strengthened and changed. There are currently gaps and loopholes in GMC procedures, which mean that doctors who may be a danger to patients can continue to practise. That is neither acceptable nor in the public interest.
Urgent action is needed to widen the powers of the GMC, so that it can deal quickly and more effectively with doctors whose fitness to practise comes into question. This action is the first step in repairing the damage to the bond of trust between doctors and their patients and should be viewed in the context of the need for wider and broader change, which will be the subject of further discussion with the GMC.
The Government consulted on four proposals to widen the powers of the GMC. First, we consulted on a new power to impose interim suspension or conditions quickly in any circumstances, including cases of performance and health. Secondly, we consulted on giving practical meaning to the GMC's premise that doctors who are erased from the medical register should not expect to return, save in the most exceptional circumstances, by introducing a minimum erasure period of five years.
Thirdly, we consulted on placing a statutory duty on the GMC to notify employers and any other person or body who may need to be informed of doctors whose fitness to practise is being formally considered by the GMC. The GMC will be given a power to require health service and other bodies to supply information or to produce documents relevant to the GMC's consideration of a case.
The fourth point on which we consulted was enabling the GMC to co-opt non-members of the council to the professional conduct committee and other committees to open up the council to wider involvement in its committee work, to tackle the backlog of cases currently under consideration and to bring in wider views and experience. Those proposals were published for public consultation on 24 March 2000.
I am pleased that there was widespread support for the General Medical Council's powers to be enhanced as proposed. Support was strongest from NHS trusts and health authorities. Medical and other health care professional bodies, including the Royal College of General Practitioners, the British Medical Association and several other royal medical colleges also agreed the thrust of the proposals but stressed the importance of striking a balance between the public interest to protect patients, the profound effect of suspension on a doctor and natural justice. It is important to note that the Consumers Association warmly welcomed the proposals, and strongly supports them.
In future, the GMC will be able to impose interim suspension or conditions in any circumstance, including cases involving performance and health. The power will be sufficiently wide for the GMC to act swiftly and more effectively in response to unforeseen circumstances which, if the GMC were unable to act, would place patients at risk or damage public confidence in the medical profession.
The proposal was well received; many responses commented on the inadequacy of the current arrangements and the need for improvement. Doctors whose names are erased from the medical register represent the most severe cases of conviction or serious professional misconduct. When a doctor is removed from the register, it is on the premise that he or she should not expect to be restored. The presumption is that if someone is struck off, it is for lifesave in exceptional circumstances. At present, however, a doctor whose name is removed may apply to have it restored after 10 months. If unsuccessful, he or she may reapply every 10 months thereafter. Between 1988 and 1999, 153 doctors' names were erased and 39 restored.
The GMC proposed a package of measures, including a minimum erasure period of three years. The Government welcomed those proposals but thought that they did not go far enough and proposed a minimum erasure period of five years. That would more closely match the GMC's policy that doctors who are erased from the register should not expect to return, and give practical meaning to the presumption that when a doctor is struck off, it is for life, save in the most exceptional circumstances.
The present arrangements need to be tightened, especially in relation to the period a doctor has to wait before he or she can apply for restoration. Views on the minimum period of erasure fell into three fairly evenly matched groups: those who agreed with five years; those who argued that more than three years would be tantamount to a life ban; and those who had no fixed view and were more concerned about having a rigorous assessment of a doctor's fitness to practise before he or she could be restored to the register. Given the weight of public interest in the protection of patients, the Government believe that a minimum period of five years is not disproportionate and is compatible with convention rights.
I pay tribute to my hon. Friend the Member for Ilford, North (Ms Perham) who proposed a ten-minute rule Bill on the subjectarising from a constituency caseand considerably assisted the campaign to get the measure being discussed today on to the statute book.
There was strong support for the new disclosure provisions, especially from private health care organisations, medical agencies and universities, in respect of doctors working in the NHS on honorary contracts.The proposals to allow the appointment of non-GMC members to committees were also well received by the majority of respondents.
There is anxiety and dissatisfaction about the time taken to resolve cases referred to the GMC and about the mounting backlog of cases. The proposal will bring to the GMC a much-needed patient perspective to fitness-to-practise issues. It will be helpful to involve non-members, including medical and lay people, to open up the council's work and to make it more transparent, speedy and accountable. We shall ensure that the GMC has a transparent selection process and proper training for non-members co-opted to GMC committees. The outcome of the consultation confirmed that there is strong and widespread support for the GMC having the powers that it needs to act swiftly and more effectively when a doctor's fitness to practise is called into question.
We have made a substantial additional provision since the original consultation. During the consultation period, reference was made to the case of a doctor who had come to this country from Canada, where he had been convicted of raping and behaving violently towards a female colleague. The police reported the doctor to the GMC in June 1994, but the case was not determined until January 1996, when he was struck off. The GMC is at present considering a similar case.
Those cases reveal the inadequacy of the existing arrangements, whereby the GMC cannot affect the registration of a doctor who has been convicted of a criminal offence abroad. The narrowness of the scope of the Medical Act 1983 compares unfavourably with the Dentist Act 1984, which allows the General Dental Council to determine suspension or erasure when a dentist has been convicted of a criminal offence in this country or an offence abroad which would constitute a criminal offence in this country.
The Government believe that what matters most is the protection of the public from doctors whose fitness to practise is called into questionfor whatever reason and who would represent a serious threat to patients if they were allowed to continue to practise until the GMC had completed its consideration. We therefore agreed to a clause giving the GMC the power to suspend or restrict the registration of a doctor convicted of a criminal offence abroad that would constitute a criminal offence in this country.
Following consultation, the order has been improved to provide greater clarity, to avoid conflict with other enactments, to make it explicit that it covers doctors holding provisional, limited and full registration and to ensure that it complies with the European convention on human rights.
The country was shocked by the recent cases of Harold Shipman and Rodney Ledward, which exposed serious deficiencies in the GMC's arrangements for dealing with doctors who represent a danger to patients if they are allowed to continue to practise. As I said, doctors arealmost without exceptionhard-working, honest and trustworthy and we rely on them. The majority of doctors provide an excellent service and give their patients the best possible care, but we cannot allow doctors like those whom I mentioned to tarnish the reputation of the good, hard-working majority.
The Government and the GMC are determined to apply the lessons of those shocking events to give patients the protection that they deserve. Wider and broader changes therefore will be the subject of further discussion with the GMC. Strengthening the GMC's powers in the important and significant way that I outlined is a first step to repairing the damage to the bond of trust between doctors and their patients. I commend the order to the Committee.