Health and Social Care Bill

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Mr. Hammond: I have a brief question. The Minister used the word ``contingently''. This may not be the place to ask, but could he tell me the difference between ``contingently'' and ``conditionally''? It seems a rather nice distinction.

Mr. Denham: I have a helpful note from my officials somewhere in my notes explaining that difference, but I will have to rely on my memory. Conditional has the sense that a practitioner should fulfil certain conditions, whereas contingent essentially means that he should not do certain things. I think that that is the underlying difference. Clearly it does not make sense to say that it will be conditional on someone who has been found guilty of fraud not to handle money. That would be an odd use of the English language; instead, it would be contingent on them not handling money. That is the difference in the English language. I bow to the superior wisdom of parliamentary counsel that this is the correct way of doing it.

Mr. Hammond: For the record, the Minister did that without the benefit of any notes, and we are all terribly impressed, but why did parliamentary counsel not have a look at the dictionary when drafting the original Bill?

Amendment agreed to.

5.15 pm

Amendments made: No. 139, in page 21, line 30, at end insert—

    `(3A) If the Health Authority determine that the practitioner has failed to comply with a condition, they may decide to—

    (a) vary the conditions, or impose different conditions, or

    (b) remove him from their list.'.

No. 140, in page 21, line 31, after `may' insert `decide to'.

No.141, in page 21, line 38, after `49G' insert

    `(other than in circumstances falling within paragraph (b))'.

No.102, in page 21, line 40, leave out `Council' and insert `body'.—[Mr. John Denham.]

Mr. Denham: I beg to move amendment No.142, in page 22, line 5, after `case' insert—`(a)''.

The Chairman: With this it will be convenient to take Government amendment Nos. 143 and 144.

Mr. Denham: The provisions in new section 49H in the Act provide that a health authority may suspend a practitioner while it decides whether he should be removed or contingently removed from a list. In such cases the health authority must specify the period. If the period has expired, amendment No. 143 enables the health authority to continue the suspension for a further specified period.

We do not propose the suspension of family health service contractors to continue indefinitely. We have no desire to recreate in the family health services some of the problems that have been encountered, for example, with the suspension of consultants in hospital services, which we are as Government anxious to deal with. It is in everyone's interest to ensure that the period of suspension is kept to a minimum, but there are cases in which it will be necessary to extend an initial period of suspension while further enquiries are made or a regulatory body considers the case.

Contractors need to be protected from the uncertainty of indefinite suspension. Amendment No. 144 clarifies that if a health authority imposes an initial period of suspension which is running out and then imposes a further period of suspension, the total period of suspension, including the initial period, may not normally exceed the six months set out in the Bill. If a health authority wishes to continue a suspension beyond six months it will be required to make representations to the appeal authority, just as it would have done had it made an initial suspension for a six-month period

Amendment agreed to.

Amendments made: No. 143, in page 22, line 7, at end insert

    (b) if that period has expired, they may impose a further suspension, for a period which they must specify.'.

No.144, in page 22, line 9, after `case)' insert `,

    including in both cases the period of any further suspension imposed under subsection(4)(b),'.

No.103 in page 22, line 28, leave out `(4)' and insert `(6)'.—[Mr. Denham.]

Mr. Denham: I beg to move amendment No. 145 in page 22, line 37, after `and' insert `(except in prescribed cases.)'.

The Chairman: With this it will be convenient to take Government amendments Nos. 146, 148, 104 and 149.

Mr. Denham: Amendment Nos. 145, 148 and 149 clarify the circumstances in which a health authority may or must carry out a review of contingent removal or suspension and the decisions they are able to reach as a result of the review. Amendment No. 146 prevents a health authority from being able to review—

Mr. Swayne: Can the Minister explain what `except in prescribed cases' refers to? Presumably it is the same prescribed cases as are in subsection 5A but could he just explain what those might be?

Mr. Denham: Amendment No. 146 prevents a health authority from reviewing a decision of the appeal authority to impose a contingent removal or suspension on a practitioner. It would be wholly inappropriate for a lower level body, the health authority, to be able change the decision of a higher level body, the appeal authority, hence the reference to ``except in prescribed circumstances'' in relation to a health authority's ability to review a decision. That is what is inserted by amendment No. 145. Amendment No. 104 removes the provision for a health authority to be able to shorten a period of suspension on review.

Amendment agreed to.

Amendments made: No. 146, in page 22, line 39, after 'than' insert

    `a contingent removal or a suspension imposed by, or'.

No. 147, in page 22, line 44, leave out `conditionally' and insert `contingently'.

No. 148, in page 22, line 46, at end insert—

    `( ) confirm the contingent removal or the suspension,'.

No. 104, in page 22, line 47, leave out 'or shorten its period'.

No. 105, in page 23, line 1, leave out `conditional' and insert `contingent'.

No. 149, in page 23, line 2, after `conditions,' insert `impose different conditions,'.

No. 106, in page 23, line 2, leave out `conditional' and insert `contingent'.—[Mr. Denham.]

Mr. Swayne: I beg to move amendment No. 179, in page 23, line 7, leave out `21' and insert `28'.

The amendment would extend the time by seven days in which a general practitioner has the right of appeal to the Family Health Service Appeals Authority. The provision of an extra week is consistent with the period for an appeal to the General Medical Council. We regard those two appeal procedures as similar in their consequences for the practitioner if he were delisted. If his accreditation were removed by the health authority, it would be a career-threatening move. Therefore, we think it consistent to equalise the time period.

Mr. Denham: We agree with the thrust of the amendment, for the reasons given. However, we have examined the drafting and found it flawed. If the hon. Gentleman withdraws the amendment, we will introduce amendments on Report.

Mr. Hammond: Will the Minister explain what is wrong with our amendment, as it simply changes the number 21 to 28? The Government may find it disagreeable to accept Opposition amendments, but the Minister is being a bit ingenuous in suggesting that we withdraw our 28 so that he can introduce his 28 on Report.

Mr. Denham: If he wishes, the hon. Gentleman is welcome to take up Opposition time on Report in moving the necessary consequential amendment required on page 23, line 22 to proposed section 49J)(5)(a). However, I offer to use Government time on Report for that purpose.

Mr. Hammond: It was a perfectly simple question and, as it turned out, it has a relatively simple answer. I simply wanted to ascertain that the Minister was not simply being churlish in refusing to accept the Opposition amendment.

Mr. Swayne: I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendments made: No. 150, in page 23, line 11, after `49F' insert `or 49G(3A)'.

No. 107, in page 23, line 12, leave out `conditionally' and insert `contingently'.—[Mr. Denham.]

Mr. Denham: I beg to move amendment No. 151, in page 23, line 14, after '49G' insert

    `, or to vary any condition or to impose any different condition under that section'.

The Chairman: With this it will be convenient to discuss the following amendments: No. 180, in page 23, line 14, after '49G', insert

    ', or to vary the terms of service of the person concerned for the purpose of or in connection with the imposition of any such conditions.'.

Government amendments Nos. 152 to 154 and 161.

Mr. Denham: The amendments deal with contingent removals and appeals to the Family Health Service Appeals Authority; they clarify the precise nature of the practitioner's appeal rights. Amendment No. 151 makes it clear that a practitioner can appeal to the FHSAA, against not only the health authority's original decision contingently to remove him but any further health authority decision to vary or change the conditions imposed on the practitioner in pursuance of a contingent removal.

Amendment No. 180, tabled in the names of the hon. Members for Woodspring and for Runnymede and Weybridge, and Government amendment No. 152 are designed clarify that a practitioner would have the right to appeal to the FHSAA against any health authority decision to vary his terms of service in pursuance of a contingent removal. That is an essential safeguard, so I am pleased that it has support from both sides of the Committee. I propose that amendment No. 152 is accepted, which I hope will meet the Opposition's concerns.

Amendments Nos. 153 and 161 clarify the position on the rights of appeal. As we have already discussed, the policy intention is that there should be no right of appeal against the decision to suspend. That will be a statutory, time-limited, neutral act, and we want efforts to be focused on addressing concerns and not on legal process. A right of appeal will be available against a decision to remove or contingently remove. The amendments tighten the drafting of the clause, so that it cannot be read in a way that infers a right to appeal against a decision to suspend.

Amendment 154 provides for the practitioner or health authority concerned to apply to the FHSAA for the conditions of a contingent removal imposed by that body to be varied, replaced or revoked.

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Prepared 25 January 2001