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5.23 pm

The Minister of State, Department of Health (Mr. John Hutton): Anyone who heard the excellent speeches of right hon. and hon. Members will reach the same conclusion that I have reached: that this has been a thoughtful but sombre debate, which is entirely appropriate to the subject. It was genuinely illuminated by important insights into the tragedies at Bristol and the clear and obvious failures of individuals and the national health service. All Members rightly emphasised the need to learn the lessons from Bristol. I shall say more about that later, but, most positively, they rightly decided to look to the future—securing higher standards and better treatment and care, which we all want in the NHS.

The hon. Member for Woodspring (Dr. Fox) opened for the Opposition. I welcome his positive comments and his general support for the response that we are publishing today. He asked a number of specific questions. I shall try to deal with them, but in no particular order, as I have not arranged my notes in that way, although I may surprise him.

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The hon. Gentleman began by asking what have become familiar questions about arrangements that we have established in statutes over the past two or three years relating to inspection arrangements for the NHS. He requested further and better particulars about how we intend to advance the commitment made today by my right hon. Friend the Secretary of State to secure more organisational integration between inspectorates. I thank the hon. Gentleman for welcoming what my right hon. Friend said, and I thank the hon. Member for Oxford, West and Abingdon (Dr. Harris) for doing the same.

The hon. Member for Woodspring was right to say that we must carefully consider these important issues. The changes in question would certainly require primary legislation. I agree with the hon. Member for Oxford, West and Abingdon that, given their importance, it would not be appropriate to try to make such amendments during the passage of the National Health Service Reform and Health Care Professions Bill in another place; that would deny Members of this place a proper opportunity to debate the Bill.

I am sure the hon. Member for Oxford, West and Abingdon understands, as I hope that the House does, that we are not in a position today to go into further detail about the proposed reforms, but, as I think I made clear on Tuesday, it is at the forefront of our mind that the NHS should have a set of arrangements for inspection of quality and performance monitoring that are as streamlined as we can make them, and the least bureaucratic possible. We want those arrangements to add value—not just to help the NHS to deliver high-quality services, but to inform the public better about the quality of those services. Those criteria will inform our thinking, and I am sure that Members will have many opportunities to debate them in more detail.

I was grateful to the hon. Gentleman for recognising the importance of greater public access to information that is comprehensible and adds value. I shall return to that shortly, because several Members asked about it.

The hon. Gentleman asked a specific question about consent, and how we were proceeding with proposals to standardise consent procedures. As he will know, the Department published a standardised consent form last November. Its use will become a requirement throughout the NHS in April. He asked about the standardisation of information. We shall need to develop the issues with the professions, and with patient groups, but the model consent policy will require trusts to make patient information available locally and in a form that people can use—as tapes or pictorial material, as well as written leaflets. Trusts are also required to provide information on local advocacy groups.

Information needs to be tailored to reflect the provision of local organisations and services, and the procedures that a patient is undergoing. We want as much standardisation as we can get, along with as much customisation as we can get. Perhaps that is an example of the hon. Gentleman's failure to understand what my right hon. Friend the Secretary of State said on Tuesday.

The hon. Gentleman asked an important question about the General Medical Council. He asked whether we were minded to seek ways of speeding the important process of investigating allegations relating to fitness to practise. The answer is that we are very much so minded: we will look sympathetically at proposals to speed the processes

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of the GMC and its various disciplinary committees, and to make them simpler. As we are currently discussing those issues with the GMC, however, I do not think that I can deliver more than my statements of general intent.

The hon. Member for Woodspring asked for more information about how we intended to move people from non-traditional backgrounds into medical careers. He and the hon. Member for Westbury (Dr. Murrison) seemed surprised that we want to pursue that objective, although I may have misinterpreted what was said.

The hon. Member for Westbury implied that all the progress that had been made was down to the medical profession—that, anyway, is how I interpreted his remarks. I must tell him, with respect, that I think that the Government have played an important role in introducing change.

Hon. Members asked how we intend to proceed. In accepting Kennedy's recommendation 78, we have acted against a background of action that has already begun. In 1999 and 2000, and in subsequent years, higher education institutions were asked to bid for extra places, and to demonstrate an active commitment to recruiting students from a broad range of social ethnic backgrounds to reflect the patterns of populations served by the NHS. Most of the successful institutions addressed the issue of broadening the socio-economic background of the intake in a number of ways. Those included reviewing their selection processes, promoting outreach schemes and creating new—or increasing the numbers on—pre-medical courses designed to broaden intakes. That is an important policy objective if we are to address some of the concerns that Professor Kennedy expresses in his report and that right hon. and hon. Members have raised on several occasions in the House.

The hon. Member for Woodspring raised several other points and I shall return to his comments later. I calculated that I was asked 49 separate questions during the debate and I shall try my best to answer all of them, but I cannot guarantee to do so. I shall certainly write to hon. Members about those that I do not cover.

Like everyone else who has spoken in this debate, I wish to congratulate my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) on his decision to establish the inquiry. It was his decision to appoint Professor Kennedy, who did a superb job, and to make it a public inquiry, which was undoubtedly the right decision.

My right hon. Friend raised two important issues. He spoke about the need for medical professionals to adopt a more open approach to patients, and he was right to say that that approach creates its own dilemmas. We need to approach the issue carefully, in consultation with health professionals and patients. I agree that information must be fair and not give a false impression. We will need to work with the health professionals and others to ensure that that happens.

My right hon. Friend also spoke about the importance of the way in which patients are treated. As he said, when they or their family or loved ones are ill in hospital they are often under great stress and feel great anxiety. I agree that the training of doctors, nurses and other health professionals has a role to play, and that issue is being pursued. He is also right to say that progress is being made; we wish to maintain that progress, even though it can be extremely difficult.

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Yesterday, I presented some prizes at a writing competition for doctors that was organised by the BMA. It was not, as someone at the event suggested, sponsored by the pharmacists to see who could interpret the doctors' handwriting. Perhaps I should not have said that. The competition was designed to get doctors to write about what brought them into the medical profession and what motivates them to stay in what we all acknowledge is a highly pressurised and stressful environment. The entrants wrote some fabulous pieces on what made them want to become doctors, but the majority centred on the relationship with their patients, their care for their patients and their desire to improve the health of their patients. The points that my right hon. Friend made about the essential relationship between the doctor and other health professionals and the patient lie at the heart of many of Professor Kennedy's recommendations, which the Government have endorsed. That relationship is the key to making the NHS a better service for patients.

My right hon. Friend the Member for Holborn and St. Pancras, the hon. Members for Oxford, West and Abingdon and for North-East Hertfordshire (Mr. Heald) and my hon. Friend the Member for Kingswood (Mr. Berry) all expressed concerns about the law on medical negligence and how a fear of being sued must not deter doctors from being honest about failures or being clear about when things have gone wrong. Other hon. Members talked about the disincentives of the present scheme of tort-based clinical medical negligence law suits. That is addressed in recommendation 119, which deals with replacing the present system with a no-fault compensation scheme.

All that I can say on the issue, which has obviously been the subject of serious concern, is that my right hon. Friend the Secretary of State said that we will publish a White Paper that will consider all the issues in some detail. The way forward will be informed by the work that the chief medical officer, Sir Liam Donaldson, has already begun of talking to the professions, lawyers, patient groups and others, and by what Professor Kennedy has to say on that immensely complicated matter, which also raises human rights issues.

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