Standing Committee E
Thursday 25 January 2001(Afternoon)
[Mr. John Maxton in the Chair]
2.30 pm
The Minister of State, Department of Health (Mr. John Denham): I beg to move,
That the Programming Order of the Committee of 18th January be amended—
(1) in paragraph (1), at the end, by inserting the words `(save on the afternoon of Thursday 25th January, when the Committee may sit until Seven o'clock)'; and
(2) in the Table, by leaving out the entry in the third column in respect of the 5th sitting and inserting instead '7 p.m.'
The resolution does not deal with a possible sitting on Monday afternoon, but if we do not make sufficient progress this afternoon we might need to convene the Programming Sub-Committee later.
Question put and agreed to.
Clause 22
Unsuitability for inclusion in medical, dental,ophthalmic and pharmaceutical etc. lists
Mr. Denham: I beg to move amendment No. 116, in page 15, line 6, at end insert—
`( ) In section 29A (medical lists), after subsection (4) there shall be inserted—
``(4A) Regulations may make provision in relation to the supply to a Health Authority, by a medical practitioner who is included in their medical list (or, as respects paragraph (a), by arrangement with him) of—(a) information of a prescribed description; and
(b) a criminal conviction certificate under section 112 of the Police Act 1997 or a criminal record certificate under section 113 of that Act.'''.
The Chairman: With this we may discuss the following: Government amendments Nos. 117 to 120.
Amendment No. 170, in page 15, leave out lines 29 and 30.
Government amendment No. 121.
Amendment No. 171, in page 16, leave out lines 1 and 2.
Government amendment No. 122.
Amendment No. 172, in page 16, leave out lines 16 and 17.
Government amendments Nos. 123 to 126.
Amendment No. 173, in page 16, line 29, leave out from `inclusion' to end of line 31.
Amendment No. 174 page 16, line 35, at end add—
`(7) In sections 29B, 36, 39, 42 and 43 the expression ``grounds of unsuitability'' shall mean, in relation to such person, grounds that enable the Health Authority (or on appeal the FHSAA) to be satisfied that it is—
(a) necessary in the public interest or for the protection of members of the public; or
(b) in the interest of the person concerned
that such person is not included in the respective list and, elsewhere in this Act the word ``unsuitability'' shall be construed accordingly.'.
Government amendments Nos. 127 to 133.
Mr. Denham: This is a lengthy group of amendments, so before speaking to the clause in general terms, I shall discuss the amendments themselves.
Clause 22 forms a key part of our package of measures to improve the quality of delivery of primary care services—a subject on which I touched in our discussions on Clause 19. Clauses 25 and 27 also deal with lists, and taken together clauses 22, 25 and 27 cover doctors, dentists, pharmacists and optometrists. They cover non-principals as well as principals, and practitioners under part I or part II of the National Health Service Act 1977. Between them, the clauses apply the same principles and procedures to each list, and any variations are those required by the circumstances of the particular group. Clause 22 deals with part II principals by amending the existing powers.
Clause 22 will also deliver more consistency to the provisions applying to each practitioner group. That is important, because although each practitioner group has distinct and different roles, in each case potential risks to patient safety can arise through the possibility of inappropriate or unscrupulous behaviour by a practitioner who is unsuitable for the role.
It might come as a surprise to some to learn that health authorities do not already have such powers. They have the power to refuse admission in some circumstances, but it has become clear that the powers are currently drawn too narrowly to be applied uniformly across the four practitioner groups. I should make it clear that, as now, the process of entry to the health authority list will be wholly separate from the processes through which a general practice selects new partners.
On the issue of unsuitability, to which Opposition amendments Nos. 170 to 174 relate, the clause will extend the grounds on which a health authority may refuse admission to its relevant practitioner list. Health authorities are already required to hold lists of all principal practitioners providing medical, dental, optical and pharmaceutical services. The new provisions will strengthen the power of health authorities to control the provision of family health services in their area. Crucially, they will allow health authorities to refuse a practitioner's entry to a list on the grounds of unsuitability or fraud. Unsuitability is capable of wide interpretation, so we will set out in regulations the criteria that health authorities must consider in reaching decisions on those grounds.
We intend that a health authority be able to consider a wide range of issues relating to the applicant, or, where relevant, to directors or other persons controlling a body corporate. They include criminal convictions, the adverse findings of a licensing or regulatory body, personal references, qualifications and previous career history—in other words, issues similar to those that any employer considers before engaging someone. We intend that barring from the list should be automatic where someone has been convicted for murder, is not on the relevant professional list—not quite as serious a matter, but a none the less suitable ground—or is subject to a national disqualification. In other cases, the decision would be at the health authority's discretion.
Before refusing a person's application on the grounds of unsuitability, we would expect a health authority always to consider criteria such as: the nature of any criminal offence or professional regulatory investigation; the length of time since any offence was committed or since the conviction or investigation; whether there are other offences to be considered; the penalty imposed on conviction or the outcome of the investigation; the relevance of the offence or investigation to his provision of family health services; the likely risk to patients or impact on the national health service or on confidence in it; and whether he has been refused admission to, removed from or suspended from other health authority lists, and the facts involved in such cases.
We intend to set those criteria in regulations. The list will not be exhaustive, in order to allow health authorities to apply other criteria that are relevant to each case. It will be for the authority to decide how much weight to attach to the criteria in the regulations and to other relevant factors.
Mr. Philip Hammond (Runnymede and Weybridge): The Minister is racing through his brief. The import of his comments seems to be that different health authorities could reach different decisions based on the same regulations. Does he really intend that a practitioner who applies in one health authority area and is rejected should then be able, quite properly, to apply in another area and be accepted?
Mr. Denham: If a practitioner applied in one health authority area and was rejected, and no national disqualification was in force, he could then apply to a different health authority, which, under the clause, would have to take proper account of the fact that he had been rejected by the other authority. We do not seek to establish a system that leads to wide variations in performance, but it is possible that there may be grounds for refusal on a specifically local basis that would not apply in another area.
Mr. Hammond: I am a little surprised by the direction of the Minister's comments. I point out to him the obvious danger involved. In a previous sitting, we discussed disparities in the general practitioner population in different parts of the country. Are not two distinct classes of health authority inevitable—those in popular areas, which are able with more care to pick and choose GPs for inclusion, and those that are desperately struggling to get enough doctors and not able to apply such choosy criteria? That may be the perverse outcome of the Minister's proposals.
Mr. Denham: It would be a perverse outcome. That is partly why the individual practitioner has the right to appeal to the Family Health Services Appeal Authority and the health authority has the right to submit to the FHSAA that a disqualification relating to a person whom it did not want on its list should apply nationally. Moreover, it is reasonable to expect health authorities to take seriously the decision of another health authority—including those outside England, in Wales or Scotland. I stress to the Committee that the health authority is legally required to take into account any previous refusals and the other factors that I mentioned if no national disqualification is in place.
I do not believe that a health authority would be able consistently to apply a higher standard because it was in a more sought-after area. At any hint of that happening, the practitioners affected would apply to the FHSSA, which would examine the case purely on the grounds of suitability. It would not take into account the popularity of the area where the GP hoped to be on the health authority list.
Mr. Hammond: Does the structure of the clause mean that the Government have effectively given up on organisations such as the General Medical Council, the General Dental Council and the General Optical Council? Although the Minister has discussed mandatory grounds for unsuitability, he could cover those grounds if the likes of the General Medical Council are working properly by stipulating that nobody may be included on a health authority list unless they are also on the list of the appropriate body. If he has confidence in the ability of those bodies to function in future, it would be better to make the mandatory criteria relate to inclusion on their lists, and leave the health authorities with what he refers to as discretionary criteria.
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