Health and Social Care Bill

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Mr. Hammond: The miserable puritanism of the hon. Member for Lancaster and Wyre does not appeal to me. I hope that the Minister agrees that it should be possible to modernise the NHS without losing the human touches that characterise it. Relationships between those who work in an organisation and those who use it exist also between doctors and their patients.

Mr. Adrian Bailey (West Bromwich, West): In view of the hon. Gentleman's opinion of my hon. Friend's miserable puritanism, I take it that he disagrees with his party's leader that the Government should be purer than pure?

Mr. Hammond: That is slightly—[Interruption.] As my hon. Friends said, Labour Members might wish to steer clear of such subjects.

Although he has not enjoyed the pleasure of our Committee discourses before, the hon. Member for Lancaster and Wyre will not have been shocked or surprised by my comments—any more than I have been shocked or surprised by some of the things that he has said about me. The trick is to keep the insults in order, as I am sure the hon. Gentleman would agree.

I am grateful to the Minister for undertaking to look into the matter of bequests. I realise that it will not be easy, but that potential route of abuse has been shockingly highlighted by recent events. I urge the Minister to reconsider a link between the ministerial code and the threshold for declaring the value of gifts. I wonder whether we need to distinguish between gifts for personal use and those that are given for the benefit of service. For example, an item given to a hospital that is intended to be kept on the ward and used would not have to be medical equipment. I accept that patients do not arrive bearing boxes of medical supplies in gratitude for their treatment, but they sometimes buy relatively expensive pieces of equipment. It is not uncommon for patients to want to give something to the hospital; someone whose child has been treated in a paediatric ward may want to give some toys or curtains to brighten up the place. It would be a miserable NHS if it was not considered appropriate to accept such small tokens, not for the personal use of any member of staff, but for the general benefit of staff and patients.

Mr. Dawson: I enjoyed the hon. Gentleman's good humour, but I was not arguing that small gifts and the odd kindnesses of ordinary human relationships should be removed from the equation. I had in mind bequests and the substantial amounts that people sometimes give.

Mr. Hammond: I am grateful for that clarification. There are probably three categories: one is minor, insubstantial personal gifts and another more major gifts and financial interests of a personal nature. The Minister touched on a GP's interest in a pharmacy. I must admit that I was surprised—that is putting it mildly—when I discovered that the General Medical Council allows general practitioners to have interests in pharmacies that may dispense the scrips that they issue. That is a highly relevant financial interest and the health authority should know about it in order to be able to monitor the doctor's prescribing activity and ensure that it is not irregular.

The third category of gift is that not intended for the personal use of the recipient. That would clearly not include a pheasant, but it might include a small piece of equipment or something to brighten up the surgery. I accept that there is a difficult line to tread in the case of GMS, because without such a gift the practitioner might have to dig into his own pocket to buy the equipment. However, it seems to me and to many in the pharmaceutical industry that there should be a distinction between something of benefit to the practitioner and something that will be used in the practice to the mutual benefit of both parties. Its use in the practice will benefit patients and practitioners, but it also benefits the pharmaceutical company whose name it bears, by providing advertising.

Yesterday, I encountered an example of what I am describing. Let me own up; I was given a copy of a medical textbook by a pharmaceutical company. The cover value is $25. I was told that the company would like regularly to be able to give those books to general practitioners—not for them to take home and squirrel away on their book shelves, but because they would be useful in the practice. However, under the pharmaceutical industry's current voluntary code of conduct, it is not permissible to give a medical textbook with a value of $25 to be kept and used in the practice, and perhaps referred to by the practice nurse. That strikes me as slightly bonkers. I hope that the regulations will exclude gifts of that nature, which are intended to benefit the practice rather than the practitioner.

Mr. Dawson: There is another distinction to be made, between pharmaceutical companies, which are well able to look after themselves, and patients.

Mr. Hammond: The hon. Gentleman is right. The clause points in two directions: first, towards preventing what I hope are rare instances of manipulation and exploitation of parents, of the kind that we have heard about recently; and secondly, in the direction of the widespread practice of giving small items in the normal course of business not as gifts but as advertising material. The question is of achieving the right balance.

I sense that we have moved into clause stand part territory, so in anticipation that there may not be a further debate on the clause, I want to mention that generally we support the idea that gifts should be declared. However, that should not be an unnecessarily bureaucratic process designed to catch gifts of very small value or items for use in the practice rather than for the personal benefit of the practitioner. I understand the difficulties in GMS of making that distinction, but I hope that the Minister will manage to do so when making the regulations.

In the light of the Minister's remarks, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendments made: No. 127, in page 17, line 36, leave out `subsection (1)' and insert `the subsection (1A) inserted by section 22'.

No. 128, in page 17, line 37, leave out `(1A)' and insert `(1B)'.

No. 129, in page 17, line 40, leave out `(1B)' and insert `(1C)'.

No. 130, in page 17, line 40, leave out `(1A)' and insert `(1B)'.

No. 131, in Clause 24, page 18, line 11, leave out `(g)' and insert `(k)'.

No. 132, in, page 18, line 13, leave out `(h)' and insert `(l)'.

No. 133, in page 18, line 17, leave out `(3)(h)' and insert `(3)(l)'.—[Mr. Denham.]

Clause 24, as amended, ordered to stand part of the Bill.

Clause 25

Supplementary lists

Mr. Denham: I beg to move amendment No. 98, in page 19, line 1, leave out from beginning to end of line 3.

The Chairman: With this it will be convenient to take Government amendments Nos. 99, 160 and 109 to 112.

Mr. Denham: This clause is about the regulation of practitioners who assist in the provision of primary care services, such as deputies, assistants and locums. They are an essential and sometimes unrecognised part of the primary care work force. It is estimated, for example, that they undertake 20 million consultations each year in general practice. They cover temporary vacancies arising from, for example, sickness, holidays or study leave. However, despite their crucial role, they are largely unsupported and unregulated. A locum can lead an isolated professional life. We want to attend to that gap by integrating them into the range of developing NHS support mechanisms. The list system will enable that.

I do not want to repeat earlier debates about the list system. Many of the same points that were covered earlier with respect to changes to the main list of GP principals apply also to the present topic. However, I need to make a few quick points. The list, together with provisions for the accreditation of out-of hours-providers, will ensure that GP co-operatives and deputising services, as well as mainstream practices, as it were, will have to employ doctors who are on health authority lists. It may interest the Committee to know that any general practice qualified doctor who works as a locum will be granted access to the NHS pension scheme on admission to the appropriate health authority list. It is our intention, subject to parliamentary approval of the regulations, to backdate the entry to the pension scheme to April 2001. We are discussing with the British Medical Association how that might be done.

Amendments Nos. 99, 110, 112 and 160 would provide for a new power of the Secretary of State to make regulations to prevent a person from withdrawing from a health authority principal, supplementary or services list during any period in which he or she was under investigation that might result in removal or suspension from the list. Some unnecessary provisions are also being removed. When considering an application to join a list, the health authority would be obliged to consider the facts underlying any previous decisions by other health authorities to remove the individual from a list. The fact of a previous incident would not, as we have discussed, automatically disqualify a person from admission to a list—unless a national disqualification had been imposed—but the health authority would be entitled to consider it as sufficient grounds for refusing an application.

Of course it would sometimes be advantageous for individuals voluntarily to withdraw from a list if they were under investigation or suspension, or had received notice of an intention to remove them—to avoid a health authority-imposed removal, which could rightly disadvantage them in attempts to gain a place on another list. Avoidance of enforced removal would mean that the individual would have nothing to declare to another health authority. That would be an unsatisfactory and inconsistent state of affairs.

Amendments Nos. 98, 109 and 111 deal with the fact that in the interests of limiting bureaucracy we do not want to force people who are on a health authority supplementary list to reapply periodically. If there are circumstances that warrant a removal based on elapsed time, for example, because a doctor has not worked as a deputy or assistant for a significant period, they can be prescribed in the regulations that will define the circumstances in which a health authority may remove a person from the list. The provisions are, therefore, unnecessary. I hope that that provides an adequate explanation of the amendment and a brief introduction to the purpose of the clause.

4.15 pm

 

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Prepared 25 January 2001