Health and Social Care Bill

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Dr. Brand: Or doctors.

Mr. Swayne: The hon. Gentleman is correct. I was prompted to ask that question by a representation that I received from Lloyds Pharmacy, which is worried about clause 26 and the provisions for disqualifying practitioners. It says:

    While we welcome any measure which enables individual misconduct to be dealt with effectively, we are concerned that this Clause could enable entire pharmacies or chains of pharmacies to be prevented from operating as a result of the misconduct of an individual pharmacist. Our concern hinges on what the Government means by ``person'' in the Clause.

It is referring to clause 26 and goes on to say:

    If a ``person'' is defined as being a single individual only, the Clause has our full support.

    If a ``person'' is defined as being a corporate body, it seems to us this could mean that, should a single employee misbehave (ie an individual pharmacist within the corporate pharmacy ``person''), an entire company could end up being removed from a Health Authority's list.

That would be highly inequitable. That confusion could be avoided if there were a provision for pharmacists and ophthalmologists similar to that in clause 23.

Mr. Denham: Clause 23 deals with dental corporations. Most dental practices are owned by individual dentists or partnerships, but a limited number are owned by corporate bodies that employ the dentists. Boots has recently acquired a corporate body, and the largest, Integrated Dental Holdings Ltd., has a multi-million pound turnover.

Experience shows that limited liability status helps such bodies to raise capital for investment in building and equipping new dental surgeries, so we want to encourage their growth while ensuring that patients have the same protection that we provide for patients of practices directly owned by dentists.

It may not be commonly known that the number of corporate bodies is currently limited by restrictions in the Dentists Act 1984. Some trading is possible, and new bodies have recently entered the field by buying shell companies, which have ceased to trade. The restriction dates back to the Dentists Act 1921, when the number of corporate bodies was frozen because of concerns that clinical and ethical requirements might be overridden by commercial interests. However, there have been major improvements in the safeguards provided by company law and, with the introduction of the NHS, by the disciplinary controls that we are discussing and enhancing today.

We have positive experience of the widespread involvement of corporate bodies in providing pharmaceutical and optical services for NHS patients. The hon. Member for New Forest, West asked why there was a provision about dental corporate bodies and not others. It is because there is an existing provision for the ophthalmic profession, and there are pharmaceutical regulations that list corporate bodies, but dental corporate bodies are not covered. The proposal corrects that anomaly.

Dr. Brand: For completeness, will bodies providing medical services under PMS be mentioned?

Mr. Denham: The contracts that are held for PMS are not analogous to those held by the commercial trading organisations referred to in respect of pharmacies, opticians and dentistry. I am not sure that it is the same issue.

Dr. Brand: There is a move towards one-stop shops, especially within large chemist chains, which provide ophthalmic, dental and medical services in walk-in clinics. Thus there must be parallel arrangements for corporate bodies that may want to move into that market.

Mr. Denham: I am not convinced that that is so. People provide PMS either under a GMS contract or a PMS contract under the National Health Service (Primary Care) Act 1997. The arrangements that are allowed for the provision of medical services are fully and adequately covered.

The hon. Gentleman may be suggesting that some time in the future there will be a rise of corporate medical organisations contracting commercially to the NHS, but that is not the case now, nor is it on the horizon. It is not something that the Bill will encourage.

Mr. Hammond: Will the hon. Gentleman give way?

Mr. Denham: No, as I want to make some progress.

We plan to remove the restriction in the Dentists Act 1921 through enabling powers included in the Regulatory Reform Bill currently before Parliament. The extensive consultations and parliamentary scrutiny proposed in that Bill mean that it will be the end of the year before the change comes into effect.

First, however, we must guarantee NHS patients the same protection whoever treats them. The clause will protect patients who receive dental care from corporate bodies by enabling health authorities to contract with a corporate body for the provision of general dental services in the same way as they contract with individual general dental practitioners. As a result, health authorities will be able to remove from their lists all dental providers, including corporate bodies and/or the dentists they employ, if there is evidence that they are unsuitable. For example, directors of a corporate body who are not dentists may be involved in fraudulent abuses of the fee regulations or they may fail to provide adequately equipped surgery premises. In such cases, the health authority could remove the company from its list. I hope to table amendments on Report that will prevent the same directors reappearing as a new company and going on to the list. I hope that that will allay the hon. Gentleman's concerns.

Any response should be proportionate. The failure of a dentist in a corporate body to provide an adequate service in one part of the country should not usually lead to the entire organisation being shut down or deemed unsuitable, and the measure's appeal provisions will prevent that. However, if there were wrongdoing at the top, that option would be borne in mind.

Question put and agreed to.

Clause 23 ordered to stand part of the Bill.

Clause 24

Declaration of financial interests, gifts, etc

Mr. Hammond: I beg to move amendment No. 184, in page 17, line 29, after `gifts', insert `above a specified value'.

The Chairman: With this it will be convenient to discuss the following amendments: No. 175, in page 17, line 30, at end insert

    `or to be received, including any bequests in favour of the practitioner by patients'.

No. 181, in page 17, line 30, at end insert—

    `(5AA) Any regulations under (5A) above which specify a value above which gifts must be declared, shall specify such value by reference to the limits from time to time set by the Ministerial Code for such declarations by Ministers of the Crown.'.

No. 176, in page 17, line 39, at end insert

    `or to be received, including any bequests in favour of the practitioner by patients'.

No. 177, in page 17, line 39, at end insert—

    `(1AA) Any regulations under (1A) above which specify a value above which gifts must be declared, shall specify such value by reference to the limits from time to time set by the Ministerial Code for such declarations by Ministers of the Crown.'.

Mr. Hammond: I do not know whether other hon. Members have noticed the wonderful howler in paragraph 105 of the explanatory notes, which talks about doctors normally being obliged to

    refuse to all patients except those of low intrinsic value.

In the run-up to the general election, I am already working on how selectively to quote that and turn it into a Government definition of a patient of low intrinsic value.

The five amendments would insert a de minimis concept into the arrangements, so that they would refer to gifts within a certain value, eliminating a bureaucratic structure for gifts of minimal value.

First, the amendments would ensure that expected future benefits were declarable. All members of the Committee will be familiar with that concept. The rules on declaration of interests in the House include declarations of any expectation that the Member might have of a future financial benefit. Especially given the concerns raised by the Harold Shipman case, the expectation of future financial benefit is a material consideration, so we have made specific reference to bequests.

Secondly, the amendment, as tabled, may not do the trick. However, I hope that the Minister will accept the suggestion that practitioners who are aware that they are beneficiaries of a patient's will should register that fact. It may be argued that many doctors are genuinely unaware that they are beneficiaries of people's wills. I find the idea slightly strange, but I am told that it is not uncommon for people to make general practitioners beneficiaries of their wills. However, when practitioners are involved in persuading the patient to draw up a will or in helping to redraft the will, they will have knowledge of it and that should be required to be registered.

Dr. Brand: I am sure that the hon. Gentleman would not be surprised to learn that medical practitioners are often promised future benefits in wills that never arrive. I have problems with the hon. Gentleman's concept because to publish the fact of expectations will put unreasonable pressure on patients, who will feel that they are obliged to fulfil their perhaps rash idea, which they may have had at some soft moment.

Mr. Hammond: I understand the hon. Gentleman's point. However, in view of the events that have occurred, the fact of expectation is material and relevant. If a general practitioner stands to benefit financially from the demise of a patient, that fact should be brought to the notice of a responsible body—the health authority, in this case—if not placed within the public domain. It is a relevant fact that should be recorded somewhere. However, we will hear what the Minister says about that amendment before we continue our debate.

The third purpose behind the amendments is to set the value threshold by reference not to a specific monetary amount but to the threshold for declaration of gifts by Ministers of the Crown. That seems entirely equitable and reasonable. That threshold is £125. No doubt the Minister would argue—and I would not disagree with him—that Ministers of the Crown would not be likely to be influenced by receiving a gift, certainly not a gift with a monetary value of less than £125, and are mature enough to be able to accept small gifts without it distorting their powers of judgment.

One is entitled to ask why medical practitioners are not assumed to be similarly discriminatory and able to receive small gifts without being unduly or inappropriately influenced by them. The case in logic for linking the monetary threshold to the monetary threshold that is applied to politicians is unanswerable. It would be grossly insulting to doctors to suggest that they are of a different calibre when it comes to making moral judgments about financial gifts or incentives that they are offered.

I emphasise that the amendment does not require the threshold to be set at the same level as for Ministers of the Crown, but merely by reference to it. It could be twice the level for Ministers of the Crown or half the level. The amendment would also have the singular advantage that, as the ministerial code levels were adjusted over time, there would be an automatic updating to take account of inflation and/or society's changing perception of the corruptibility or otherwise of those in positions of office. I think that has benefits.

I acknowledge that this group of amendments is not technically perfect. Indeed, due to nothing other than laziness on my part, they address only general medical services and general dental services; I could not bear the thought of writing out the same amendments twice again in order to cover ophthalmic and pharmaceutical services. I hope the Minister will take them as pointing in that direction. We would like to hear his views, and if he believes the amendments have any merit, we could perhaps return to them at a later stage in the Bill's progress and make sure that they are technically perfected.

3.45 pm

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