NHS Reform and Health Care Professions Bill

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Dr. Andrew Murrison (Westbury): I should declare an interest, as I am a subscriber to the GMC, the main body being considered. That does not mean that I am necessarily arguing for it; quite the reverse. Having suffered over many years from an increasing subscription, I must say that the GMC, even now, sends shivers down my spine.

The Government have some catching up to do. The GMC has done a great deal to put in place measures to prevent tragedies such as those that we have recently seen, especially in the light of the Kennedy report. We must not lose sight of the fact that much of what we are considering today would not have a material effect in preventing some of those tragedies. Some things that we discussed earlier in the Bill might do that, but I do not think that this will.

I believe that this part of the proposal is ill-conceived. It treats the various professional groups under discussion equally, when they are not equal numerically or in terms of their professional responsibility and accountability. That might be acceptable, but we need to bear it in mind. We should not assume that because the clause deals with the bodies equally, they are equal in numbers or responsibility. The professions allied to medicine are especially concerned with the proposal and the representation that they would have on the council, were the clause enacted.

We must recognise that the proposal would sound the death knell of self-regulation. It will give us an over-arching body, able to direct closely the functions of the professional bodies. That will have a knock-on effect on the ability to attract the best in the professions to take part. At the moment, I can speak only for the GMC because it is the body about which I know most, but there is a great deal of status in becoming a member of that organisation, and much competition to do so. It attracts some of the very best in the profession. I fear that, with the degrading that we are discussing today, it will be increasingly difficult to attract some of the top people from my profession—and, I suspect, from the other professions under consideration—to take part in the crucial matter of regulating. Regulating one another is important and sensitive, and needs the best minds in those professions. I fear that the quality of the bodies will be diminished by the proposals.

The cost of the council is rather opaque. The Minister must make clear whether the regulatory bodies themselves will fund it, or whether the money will be found centrally in some way.

The independence of the new body is very important. I am sure that we will hear much from hon. Members about their concerns that the body be independent of ministerial control. That will require some parity in ministerial and non-ministerial appointments. It is important for regulatory bodies to be accountable to Parliament, as is currently the case. The Bill does not seem to establish any proper lines of accountability. We need a little more clarity on the lines of accountability of the regulatory bodies and the council.

The council will be able to intervene at the conclusion of a case by referring it to the High Court if it feels that that is desirable for the protection of members of the public. That will be of real concern if the power is not used very sparingly indeed. It could quickly become the norm for cases to be appealed, in effect, to the High Court. That would diminish the responsibility of the GMC in particular. In this context, we are really talking about the GMC. Various other bodies that have written to me have been keen to point out that they hear only a very small number of cases of professional matters such as negligence. It is principally the medical profession that is in the firing line.

In the light of the Kennedy report's recommendations, one welcomes the measure. However, there appear to be many gaps and matters that require explanation, and I should be grateful if the Minister clarified the issues that I have highlighted.

Dr. Richard Taylor (Wyre Forest): I have two questions for the Minister, the first of which concerns health visitors. The national body and many local health visitors have expressed distress about the fact that their title is missing from the Nursing and Midwifery Council. Can the Minister advise me on how to convince health visitors that they are not being neglected and cut out? The second point concern chiropodists in the independent sector, who carry out well in excess of 50 per cent. of routine basic foot care. Given that only a single, state-registered representative will be on the council, what measures will be put in place to protect those chiropodists who provide a vital role in the independent sector?

Dr. Evan Harris (Oxford, West and Abingdon): It is difficult to do anything other than welcome clause 23, which, in establishing the Council for the Regulation of Health Care Professionals, implements a recommendation of the Kennedy report, even though it was foreshadowed, under a different title, in the NHS plan. Liberal Democrats have always made it clear that we support mechanisms to improve quality, and the co-ordination of quality assurance is an important factor in that regard. In general, we support the thrust and the recommendations of the Kennedy report, but we must not lose our critical faculties. We must recognise that it is an important source of advice and contribution to the debate. It is appropriate to look at what the report said about the council, and to flag up some questions that the Government must answer in future discussions. Page 435 of the report sets out the recommendations' desired effects, including that central Government

    ''create independent mechanisms for regulating the quality of healthcare and the competence of healthcare professionals.''

Will the Government confirm that that is indeed the purpose? If there are subsidiary purposes, they should be spelled out. Recommendation 39 of the report mentions the need for ''overarching organisations'', and states:

    ''A Council for the Quality of Healthcare should be created''.

However, the Bill does not establish one. Recommendation 39 also states:

    ''A Council for the Regulation of Healthcare Professionals should be created to bring together those bodies which regulate healthcare professionals (including, for example, the General Medical Council . . . and the Nursing and Midwifery Council); in effect, this is the body currently referred to in 'The NHS Plan' as the Council of Healthcare Regulators. These overarching organisations''—

the report is talking about quality organisations—

    ''must ensure that there is an integrated and co-ordinated approach to setting standards, monitoring performance, and inspection and validation. Issues of overlap and of gaps between the various bodies must be addressed and resolved.''

That is a clear and effective summary of what we believe the council should do. I hope that, in subsequent discussions, the Government will stick to those principles, or clarify the areas in which they wish to go further.

Mr. Heald: Paragraph 75 of the report, on page 349, states:

    ''An effective system . . . needs an independence from the professions and from government''.

Does the hon. Gentleman agree that that is a very important point? [Interruption.] I was quoting from page 349, paragraph 75.

Dr. Harris: I do not doubt the hon. Gentleman's source.

The Chairman: Order. We cannot have two hon. Members on their feet at the same time. Has the hon. Member for North-East Hertfordshire finished his intervention? It was a long one.

Mr. Heald: Yes.

Dr. Harris: I accept that the hon. Gentleman was being helpful in giving me time to find the reference.

Recommendation 72 of the Kennedy report is explicit:

    ''The Council for the Regulation of Health Care Professionals should be established as a matter of priority.''

I accept that the Government are establishing the body as a matter of urgency. Indeed, they are doing so before we have had their formal response to the Kennedy report, which means either that the Bill is an urgent response to the issue or that they are taking their time over their response to the report. The report continues:

    ''It should have a statutory basis. It should report to Parliament. It should have a broadly-based membership, consisting of representatives of the bodies that regulate the various groups of healthcare professionals, of the NHS and of the general public.''

In so far as the clause goes, we want to give it our full support. Of course, the clause refers to schedule 7, which concerns the balance of that body's membership. Nevertheless, the Government should be commended on the relative speed with which they have brought forward the proposal. They have sought to stick relatively closely to the Kennedy prescription, rather than their original prescription in the NHS plan, and we warmly welcome the clause.

Mr. Hutton: I thank those hon. Members who support clause 23. The hon. Member for North-East Hertfordshire is concerned about some of the details, and I shall respond to his points in a moment.

Out of all the hon. Members who spoke, the only one who indicated a lack of support was the hon. Member for Westbury (Dr. Murrison), and he prefaced his remarks by drawing attention to the fact that he is a member of the BMA.

Dr. Murrison: I subscribe to the GMC because I am obliged to; I am not a member of the BMA.

Mr. Hutton: I understand that the hon. Gentleman feels that this is needless bureaucracy that would not advance the issues that we are trying to address. That is probably the minority view in relation to the proposals, which we sent out for consultation in the autumn.

Dr. Murrison: Just to clarify, the Minister is putting words into my mouth. I said that I broadly support the clause.

Mr. Hutton: I am grateful to the hon. Gentleman for pointing that out. I missed that part of his remarks, but I am sure that he said that. However, the general tone of his remarks was less supportive than that of the other hon. Members who spoke in relation to the clause. We must address whether existing arrangements are satisfactory. In my view they are unsatisfactory, which is why we have brought forward these provisions.

Turning to the remarks made by the hon. Member for North-East Hertfordshire, it is not the case that because Professor Kennedy recommended that we establish this council we simply accepted his recommendation. We have looked carefully at Professor Kennedy's arguments, which have been the subject of detailed quotation between the hon. Members for Oxford, West and Abingdon and for North-East Hertfordshire. I shall also be selectively quoting parts of the report in a moment. The arguments why a body with the powers that we are recommending should be established are carefully set out in Professor Kennedy's report. If we want to avoid the trap of establishing a pointless extra tier of bureaucracy, we must be clear that the council should have a range of reserve powers to use in certain situations.

It is to avoid the suggestion that this is a pointless tier of bureaucracy that we have brought forward these proposals. We do not want the council to become a talking shop, and it must fulfil a range of specific and valuable functions that will enhance the concept of professionally led self-regulation. Indeed, it must increase public support and confidence in the system of professional self-regulation. I would be the first to acknowledge that the professions have recently made significant steps forward in their approach to professionally led self-regulation, which is to be welcomed, but it does not subtract from the logic of Professor Kennedy's arguments.

He was mindful of those changes in preparing his report. We strongly support the Kennedy report's conclusions in that respect. I will return to those arguments in favour of the council in a second.

11.15 am

Several hon. Members spoke effectively about important principles that should underpin the work of the council, and I agree with them in general. The hon. Member for North-East Hertfordshire mentioned the need for independence from Government and I strongly agree with that. As he knows, we have been examining ways to strengthen and support further the independence that all Committee members, I think, want. We have tabled several amendments that are designed to do that, and we will come on to them later. We are at one with the hon. Gentleman on that matter, although we will have some difference of opinion about the details. That is to be expected, but I do not think that the principle separates the two sides of the Committee.

The hon. Gentleman also mentioned accountability and the role of Parliament. That is an interesting area. I should make it clear to the Committee that the UK council will not supersede existing lines of accountability for regulatory bodies. Those will remain in place. The council will be given an overarching responsibility for co-ordination and for promoting patients' and the public's interests in self-regulation. Those are important functions. The lines of accountability of the new UK council will be to Parliament, because it will be to Parliament that it submits its report.

The hon. Member for North-East Hertfordshire raised interesting arguments about how that accountability would be expressed in terms of the arrangements that we make in this place. Opposition Members will be glad to know that I am not about to legislate in that area. I do not think that that would be appropriate for Government. As the hon. Gentleman rightly said, such matters are for the House to consider, in the light of how the new council wants to discharge its responsibility of oversight.

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Prepared 11 December 2001