NHS Reform and Health Care Professions Bill

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Mr. Heald: I start by commenting on amendment No. 255, which was tabled by the hon. Gentleman. There is an argument that the council should be weighted to reflect the size of membership of particular professions. The hon. Gentleman has suggested the figure of three members for the Health Professions Council as a means of raising the argument, and I would be interested to hear the Minister's view.

I have some concerns about the idea of three members for the Health Professions Council because, for example, the Nursing and Midwifery Council, which does not mention health visitors but includes them, represents three large professions that would be represented by one member. Many more people are employed in nursing, midwifery and health visiting than in all other health professions put together, which means that one would not achieve the calibration that one would want on the council. The Minister may have some thoughts on whether it is right for those three bodies to be represented by only one member. It is an odd suggestion that chiropractors should have the same number of council members as nurses, midwives and health visitors.

I wonder whether the Minister would be prepared to consider the issue between Committee and Report stages because he may have further thoughts on how the council might be more representative. In Europe, the Council of Ministers has a weighted voting system, but that sounds like proportional representation, with which I do not agree.

Dr. Murrison: Does my hon. Friend sympathise with the notion that given that much of the council's business will be connected with the medical profession—because doctors tend to be in the frame when it comes to disciplinary action—it is reasonable that there should be weighting towards the General Medical Council, given that we do not expect the Health Professions Council to throw up a great deal in terms of disciplinary action on issues that are in the public eye, such as the Bristol royal infirmary and Shipman cases?

Mr. Heald: Those are the two competing arguments with which the founders of the American constitution had to wrestle. They decided that the Senate should have one representative from each state—

Mr. Burns: Two.

Mr. Heald: Two from each state. The House of Representatives has a population-weighted franchise. I am interested to see whether the Minister is prepared to consider the matter more fully.

Dr. Harris: Let me pursue the point made by the hon. Member for Westbury because it has some merit. The new council will be set up to promote best practice and it will want to be influenced by the councils' experience. If there is equal representation and therefore equal input, a council representing a small number of people against whom there are few complaints—which would mean that that council had gathered little experience to add to the debate—would have equal weight to the General Medical Council, which has huge amounts of experience. Value will be added by ensuring that that experience is put in.

Mr. Heald: I accept that there may be some professions that have greater experience of criticism than others, and it is true that the GMC has faced much criticism about the way in which it deals with such matters. It is about to reform itself in a manner that most of us would regard as worth while, and it brings a great deal of knowledge and expertise to the council. Some other professions have little experience of criticism or complaints against them, presumably because they deal with issues and practices that are less likely to lead to litigation or serious injury.

Ministers might want to give a little more thought to certain issues relating to the weighting of the council. The Society of Chiropodists and Podiatrists was right to point out in a letter to the Committee that it represents an important profession. As was noted during our discussion of the recent health professions order, chiropodists and podiatrists provide an early-warning system for diabetes. They do tremendously important work, and in the light of moves towards surgical procedures they are moving up the medical practice scale. Perhaps the balance of probability of their receiving criticism and complaints will alter as they undertake different work. Theirs is a serious point. The hon. Member for Oxford, West and Abingdon has tabled his amendment in that spirit, and I shall be interested to hear the Minister's response.

Hilary De Lyon, chief executive of the Society of Chiropodists and Podiatrists, is very anxious to ensure that this issue is properly aired, in part because the Health Professions Council will not establish a statutory professional advisory committee. Through such a committee, many issues relevant to the profession could be fully aired and decisions taken. Because the arrangement will be much more ad hoc than the society would like, the importance of the issue is heightened.

Under amendment No. 188, other members of the council would be appointed

    ''on the recommendation of the NHS Appointments Commission''.

As the Minister said, the statutory regulators made that proposal to protect the independence of the council when such appointments are made. In the light of the Government amendments, to which we shall come in a moment, and subject to the Minister's explanation of them, it would seem that the Government have responded positively to that proposal. I welcome that. It is good when an Opposition discover that a Government agree with them, and we would be delighted to learn that our suspicions are correct and the Minister is indeed of the same mind on this matter.

Under amendment No. 189, the number of members appointed by regulatory bodies would equal the number appointed by Ministers. That proposal, too, would ensure the council's independence, and the statutory regulators and the British Medical Association support it. The BMA has said that

    ''it is important that the chairman . . . and the director will be appointed by the Council. However, there is a contradiction that needs to be resolved between the worthy aspiration of independence of the new body and the provision in Schedule 7 . . . that the Government appointees on the Council will have a majority of one.

    The BMA therefore supports the regulatory bodies' call for equal membership between Government and regulatory body appointees.''

Does the Minister concede that point, or will he at least give further thought to it between now and Report, given that we are in a constructive mode in respect of schedule 7? The independence of the council is vital. The amendment would not give regulatory body appointees a majority over Government appointees, but it would make them equal, and that would be useful.

The Liberal Democrat amendment would establish ''one more'' regulatory body appointee, but I would not go so far.

Dr. Harris: I was saying that the current requirement for a professional majority in the regulation of health care professions ensures professional, rather than Government, self-regulation, with all its associated connotations. One need only look at South Africa to see where such regulation can lead. The Government should at least explain why they are moving away from the accepted practice of professional self-regulation. Is such a move a sign that it can never work in respect of the functions in clause 23, or have matters simply rolled out that way?

Mr. Heald: The hon. Gentleman is obviously entitled to hear the Minister's response. I am not saying that, because the Kennedy report has reached a particular conclusion, that is the end of the matter. Such things need to be argued through, but Professor Kennedy had a point when, in paragraph 75, on page 349, he said:

    ''The purpose of the system of regulation must be to assure the public of the competence of healthcare professionals and, when necessary, to protect them . . . An effective system of professional regulation . . . needs an independence from the professions and from government which allows it to act in the public interest.''

The benefit of my proposal is just that: it offers a division between ministerial appointees and regulatory body appointees that would maintain an entirely equal balance between the Government and the professions. If one accepts the Government's argument that they want to be one up, matters will edge a particular way; if one accepts the argument that the professions should be one up, they will edge the other. On this occasion, Professor Kennedy is right: we should hold the ring and maintain an entirely equal position.

Perhaps the Government and, indeed, the hon. Member for Oxford, West and Abingdon will argue that such a balance would leave no one in charge. However, we do not want a body of two sides—Government appointees and regulators' appointees—but appointees who co-operate, work together and interact. Making the numbers equal would ensure such co-operation.

I look forward to hearing the Minister explain the Government amendments. As I understand it, Government amendment No. 203, which would enable a special health authority to appoint other members in lieu of the Secretary of State, refers to the NHS Appointments Commission. That amendment is welcome, as is Government amendment No. 204, which would reduce the Secretary of State's regulation-making power in paragraph 5(a) by deleting its reference to

    ''the number, or limits on the number, of members who may be appointed''.

To judge by Government amendment No. 205 and the Government's acceptance of amendment No. 187, they have conceded that the Secretary of State's direction-making power over the appointment of, and terms and conditions of the appointment of, staff should be removed. The removal of that power is vital if the council is to achieve independence.

However, we are still tempted to press the Government on the regulation-making power and equality of numbers, and I shall be interested to hear the Minister's views on amendment No. 226 and whether he is prepared to look again at amendment No. 189. It is clearly crucial that regulations be made in a spirit that will achieve independence for the council. The final protection is that the matter must be debated on the Floor of the House or in Committee, given the requirement for an affirmative order. If the negative procedure were used, it would not be so debated.

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Prepared 11 December 2001