NHS Reform and Health Care Professions Bill

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Mr. John Baron (Billericay): To reinforce the point made by my hon. Friend the Member for North-East Hertfordshire, while the Minister is contemplating the matter over Christmas he should remember that the UK council exists ultimately to act in the interests of patients. A ministerial majority of one might be seen by many to create a conflict of interest. We are aiming to ensure that we deliver a health service that meets patients' requirements. The UK council will have an important role in meeting that objective, but its purpose will be to act in patients' interests. A ministerial majority of one contradicts that and I ask the Minster to consider that.

Mr. Hutton: I agree that if that were the case, there would be a conflict, but it is not the case, because there will not be a ministerial majority of one. That is the point behind amendment No. 203, which I laboured at the beginning of my comments, but obviously not sufficiently for the hon. Gentleman to appreciate. There will not be a majority of ministerial appointments to the UK council. The hon. Gentleman has helpfully allowed me to make the point again and it has taken away one of the legs of the stool supporting his argument about equality of representation on the council. He made a fair point, but amendment No. 203 deals with it.

Dr. Harris: I accept what the Minister said, but that was not my argument. I am a member of the GMC and the BMA, but I did not see the briefing from the BMA before the Minister's comments, so I was not speaking from it when I made my point. However, I note that the BMA supports the regulatory bodies' call for equal membership between Government and regulatory body appointees, which suggests that the regulatory bodies support amendment No. 189.

If the Minister is basing his defence of a non-council-appointed majority and a Government-appointed system, albeit mediated through the NHS Appointments Commission, on the quotation from paragraph 75, that same argument could be used to remove the professional majority from all regulatory systems because the words are general and do not state—Professor Kennedy would have done so had he wanted to—that there should no longer be a professional majority or a majority appointed by the councils on such bodies.

Mr. Hutton: I made the Government's position clear on the composition of the membership of the regulatory bodies during an earlier debate and I do not want to go round that track again. We believe in profession-led self-regulation and the UK council is not subtracting from that. We must look at the purpose and role of the council in relation to the clause that we have just agreed in which its principal function is stated to be promotion of the interests of patients and the public. We must ask ourselves who is best placed to perform that role and whether it is members of the regulatory bodies—I agree with the hon. Gentleman that they could be lay members—or members appointed to the council by the independent NHS Appointments Commission specifically to carry out that role. The question is simple and I think that the answer is obvious.

Amendment No. 204 removes any suspicion that the Secretary of State could intervene to tell the council how many members it could have. Paragraph 4 of the schedule also puts that beyond doubt. The council will have one member from each regulatory body and the number of other members appointed by the NHS Appointments Commission and the devolved administrations should always be one greater than the total number of regulatory body members. For example, when the council begins its work it will have 19 members: nine representatives of the regulatory bodies, three representatives chosen by the devolved administrations and seven members appointed by the NHS Appointments Commission.

The purpose of amendment No. 187 is to remove any concern that the Secretary of State would interfere in the running of the council. It is important to put beyond doubt the fact that the council has sole authority over staff appointments and their terms and conditions. That is the purpose of the amendment. I tabled it with related amendments Nos. 203, 204 and 205 to meet the concern of the regulatory bodies about the appointment of members to the council. It seems that the Opposition have also been listening to those concerns and we have come to a happy convergence of opinion.

Amendment No. 205, with amendment No. 187, tidies up paragraph 10(1) to reflect the removal of paragraph 10(2) and (3) by amendment No. 187, with which we all agree.

Amendment No. 255 would give the Council for Professions Supplementary to Medicine and its successor bodies the three representative members for which the hon. Member for North-East Hertfordshire called and I have tried to explain why we cannot accept the amendment.

Finally, the point at issue in amendment No. 226 is that of the regulations governing the appointment of the members of the council—for example, what conditions need to be fulfilled for appointments to be made. Every public body has some sort of provision on such issues. Typical headings include disqualification for appointment because of bankruptcy or having a criminal record, and termination of tenure of office for persistent absence and so on. They also include issues concerning declaration of interest and provision for people to stand aside from proceedings in which they have an interest.

I do not want to over-egg the pudding, but all Governments regularly make such regulations by statutory instrument under the negative resolution procedure. I have not heard an argument today for adopting a different approach in relation to the Council for the Regulation of Health Care Professionals, but there is an argument—I do not want to place heavy emphasis on it—about inevitable delay if the affirmative resolution procedure is used.

The hon. Member for Oxford, West and Abingdon said that he might want to press his amendment to a vote and I understand that. I said during an earlier debate along similar lines that the issue is not one to die in the ditch for, but the hon. Gentleman apparently wants to do that. However, given the technical nature of the issues covered, I would query whether a convincing case could be made for the affirmative resolution procedure.

12.30 pm

Mr. Heald: I shall reply to the Minister's comments one by one. It is welcome that the Minister has tabled amendment No. 203, which covers the ground of the appointment of lay members by the NHS Appointments Commission. I am prepared to accept his assurance that the intention is to delegate that responsibility to the commission, so amendment No. 188 has done its work because it has prompted a Government amendment.

In respect of amendment No. 187, I am pleased that the Minister has agreed that the appointments of staff are not to be directed by the Government. That is also welcome. However, the thorny issue remaining is the equality of numbers in membership of the council between lay representative and regulatory bodies. The Minister usefully promised that, over Christmas, he would spend his time in Richmond house mulling over that—I hope that he gets a mince pie too. On that basis, I will not press the amendment, or seek a Division on any amendment today, but will, on Report, return to the question of equality of numbers on the commission and will wait to hear from the Minister before deciding whether to press for the regulation-making powers to be dealt with by the affirmative resolution procedure. Those two issues are linked.

Dr. Harris: It is important to state that amendment No. 226 on the affirmative resolution procedure was ''more'' of an issue to die in a ditch for, rather than ''the'' issue. I hope that my remarks were clear because I would not want it to be thought that I had invested more in this amendment than in others that I consider to be more important. Secondary legislation is introduced on such a large scale that there is a need for increased scrutiny and it is appropriate for Opposition Members to probe the issues. Later, it will be interesting to see what happens to the amendment. Often, many issues relating to secondary legislation on the regulation of the health professions are dealt with before delegated legislation is introduced. That is important because the Government may not get it right the first time.

I will not add greatly to the discussion about equality of numbers, which relates to amendments Nos. 189 and 256, or to what the hon. Member for North-East Hertfordshire said. I agreed with much of what he said and the way that he said it. The Government's difficulty in respect of the Kennedy report is also ours. Hon. Members have already said that we do not have to endorse the report simply because it exists. However good the report is, things can be read both ways.

I am reassured by the Minister's repetition of his view that the councils directly regulating the professions will continue to be a form of professional self-regulation. That is his strongest point; he need not pray in aid the paragraph that he quoted from the Kennedy report—he is an hon. Member and has given us an assurance. The part that he quoted stated:


which I assumed to be the system of regulation—

    ''cannot achieve its purpose if it is a system which is designed and operated solely by particular professionals''—

not professions—

    ''for their professional peers.''

I do not think that when it was drafted it was expected that the report would be scrutinised in the way in which we scrutinise legislation, so it would be of only limited value to go into that in greater detail. The danger of extrapolating from those sorts of comments is that it might imply Government support for a wider change from the principle of professional self-regulation, as exemplified—we need not get too carried away about this—by the majority on those councils, because it is more than simply a numbers game. I look forward to rejoining this debate at later stages.

Finally, with regard to amendment No. 255, I am pleased that I was able to pre-empt some of the Minister's points, otherwise it might have sounded as if he was pointing them out to me for the first time. If there is a discussion in the council about an important matter that generally comes up only in relation to the regulation of the General Medical Council or the General Dental Council, the majority of members on the council will not have had direct experience of that issue. Therefore, the danger is that if policy is made by a body that has no experience in dealing with such matters, something will be lost in the formulation of that policy. To a certain extent that is one of the issues that amendment No. 255 opens up. As I accepted in my opening remarks, there is no perfect way, so I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendments made:— No. 203, in page 73, line 13, at end insert—

    ''4A (1) The Secretary of State may direct a Special Health Authority to exercise his function of appointing members of the Council under paragraph 4(1) (e).

    (2) If he does so, the 1977 Act has effect as if—

    (a) the directions were directions of the Secretary of State under section 16D of that Act, and, accordingly,

    (b) the function were exercisable by the Special Health Authority under section 16D.''.

No. 204, in page 73, line 16, leave out from ''including'' to ''any'' in line 17.

No. 205, in page 74, line 6, leave out ''Subject to sub-paragraphs (2) and (3),''.

No. 187, in page 74, leave out lines 9 to 13.—[Mr. Hutton.]

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