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21 Jun 2007 : Column 515WH—continued

She says that because she details at length in the following paragraphs the extraordinary exchanges of views between and within Departments, and how eventually they came to a halt in the 1980s. It is a salutary lesson on how, in considering the detail, we sometimes lose the bigger picture. Since the Brodrick committee’s recommendations in 1971, the system has gone unchanged and still dates from the origins of the cremation system in the early 1900s.

In the final paragraph of the third report, Dame Janet concludes:

That is a salutary lesson to all of us. Dare I say it, in our recent deliberations on those issues, we have begun to see the mirroring of some of what happened in the 1970s and 1980s. It is difficult to cut through the different perspectives held by different Departments and interests. However, it requires a very definite political decision to reform the system, which I believe is what we now have, following the promptings of my hon. Friend.

Mr. Lansley: I do not want to intrude on the private grief of Departments trying to resolve these matters between themselves, but I have a question. I am not clear about the extent to which some aspects of reform, such as the establishment of medical examiners in primary care trusts, which clearly the Minister and his colleagues favour, can make progress, notwithstanding the fact that Ministers are waiting for the point at which they can introduce legislation. Does the Minister share that view? I imagine that he might. Introducing legislation to reform the regulation of health care professionals alongside reform of death certification and the coroner system would be desirable. Given the current situation, the regulation of health care professions is not something that need be delayed very long beyond the next Session. It feels as though we should have a timetable in mind.

Andy Burnham: The hon. Gentleman will accept that these matters are extremely complex and of huge import for everybody—for the whole of society. I hope—speaking openly, for once—that we might have a Bill at the end of this process. It would be wrong to call it the Shipman Bill, but it would be the Bill—

Mr. Lansley: Or two Bills.

Andy Burnham: It would be the Bill or the two Bills that deal with these matters. I hope that they would be dealt with either in one Bill or in more than one concurrently, so that we could consider them in the round, deal with them from a parliamentary point of view and achieve parliamentary consensus on them. There are different timetables on how quickly that consensus can be gained. The package of proposals that we introduced on professional regulation achieved a measure of consensus earlier this year. I am sure that there are different views on elements of the package, which I may touch on. We are now working through a detailed package relating to death certification.

To give the hon. Gentleman some reassurance, my right hon. Friend the Prime Minister, at my request, made a definite decision in the early part of this year that we should reform death certification and that there should be a unified system covering both burials and cremations, with scrutiny by an independent medical examiner linked to the local clinical governance team in the PCT. That was a definite decision of the Government and, for as long as I hold this job—which, who knows, may be only a few days—I will work to ensure that progress is made on that. However, I believe that progress will now be made, because there is growing consensus about how we can take the proposals forward.

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A detailed discussion paper will be introduced soon in a consultation paper. That is at a fairly advanced stage of preparation. I hope that it could lead to legislation —if there is broad agreement about the proposals—at the same time as measures dealing with professional regulation.

Dr. Evan Harris: I hear what the Minister says and I am grateful to him in so far as he is giving us an understanding of Government thinking, but he did refer to something that might be called the Shipman Bill. May I ask him to reflect on that? There are good reasons why Government legislation should not be too closely linked to a particular tragedy. The danger is that anyone who, for good reason, seeks to oppose any of the measures would have to face the impression being given, perhaps by the media or political opponents, that they are unsympathetic to it. With the Bill that became the Human Tissue Act 2004, which might have been called the Alder Hey hospital Bill, there was a danger that someone expressing real concerns about over-regulation would be perceived as displaying insensitivity or a lack of understanding of what had happened at Alder Hey, which certainly for my part was not the case and was not the case with the Royal College of Pathologists either.

Mr. Mike Hancock (in the Chair): Order. You will have to learn to be a bit briefer than that, Mr. Harris.

Mr. Lansley: Dr. Harris.

Andy Burnham: I take the point made by the hon. Member for Oxford, West and Abingdon. It was, perhaps, inadvisable of me to suggest that that label could be applied to the Bill. I was seeking to make a point about the breadth and depth of the reports from Dame Janet Smith’s inquiry and that we are also dealing with the recommendations of other inquiries relating to very serious professional misconduct. I simply wanted to say that it is desirable, in my view, to introduce a package of legislation at the same time, so that the matters could be considered in the round, because that would be helpful for all concerned.

The hon. Member for South Cambridgeshire mentioned the private grief of Departments. That may be the case, but he should read the third chapter of Dame Janet Smith’s third report, to which I referred, because colleagues of his who are still in this place were engaged very deeply in the relevant matters. I am not making a party political point, by the way. It is simply that there is a salutary lesson in that chapter for Governments generally about how such matters can be resolved. They ran aground in the 1980s for precisely the reasons that are set out. I hope that when we finally put the proposals before the House, we do not allow that to happen again.

The Government’s action programme for strengthening the safeguards on controlled drugs was published in December 2004, and action is nearing completion. The fourth report of the Shipman inquiry considered how Shipman could have amassed such a lethal armoury of diamorphine, and the recommendations are intended to deal with that very point. I shall set out the key elements of the programme which have been introduced. First, the new governance arrangements introduced in the Health Act 2006 build on existing NHS clinical governance
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processes by requiring all health organisations to appoint an “accountable officer” with specific responsibility for controlled drugs to share information and to collaborate in action needed to protect the public.

The second key element is restrictions on prescribing controlled drugs, placing on all health care professionals a clear requirement to prescribe only within their professional competence. The third element is strengthening the audit trail for controlled drugs, for instance by capturing information on the private prescribing of controlled drugs and developing and implementing an audit trail for controlled drugs requisitioned for internal use by GP practices.

The fourth element is improving information for patients on the therapeutic uses and special status of controlled drugs. Fifthly, we are working closely with professional bodies to improve the education of health professionals in the appropriate use of controlled drugs and in the special precautions needed.

On the issues raised by the Shipman inquiry’s fifth report and the reports of the Ayling, Neale and Kerr/ Haslam inquiries, the crucial first step is the initial identification of causes for concern. In Shipman’s case, despite the ingenuity with which he attempted to cover his tracks, potential clues were missed. In the case of Clifford Ayling, that was compounded by the failure of different NHS organisations to combine the information that each held.

Health care organisations need to work with information of two types. The first is routine indicators of clinical processes and outcomes, which, taken together, give a broad view of the clinical performance of clinical teams and individual clinicians. The second is information derived from complaints from patients and carers and from concerns raised by other professionals or organisations. Clearly, information of that type needs to be used sensitively and with appropriate safeguards to ensure that the reputations of health care professionals are not unfairly impugned. The Government will work with professional, NHS and patient organisations to develop further the use of routine quality indicators and to agree guidance on the appropriate use of softer forms of intelligence, in particular on the safeguards that should apply to the sharing of such information between organisations.

Complaints and concerns are potentially a vital source of information that may indicate poor professional performance or abuse. However, patients, carers and professional colleagues need clear signposting so that they know where to register their concerns. They may need support and help in articulating concerns, and reassurance that they will be taken seriously. In particular, they will want reassurance from those responsible, including senior managers, that action will be taken to ensure that there will be no recurrence of the incidents that caused concerns and that organisations take on board the concerns as part of their ongoing service improvement.

This week, the Government launched a consultation proposing comprehensive reform of the complaints system for health and social care. Key features relevant to the debate are proposals for a right for patients with complaints against a GP to go directly to the PCT, rather than to the practice itself; closer collaboration between organisations receiving complaints to ensure that complaints are speedily routed, where necessary, to the most appropriate body; developing good practice on keeping complainants informed
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about the progress of their complaint; placing a responsibility on PCTs to maintain an overview of complaints against GPs; and working with the NHS to build capacity and skills for investigating more serious allegations.

I have always believed that the NHS needs to adopt a more open culture in handling complaints from the public. Too often in the past, the tendency has been to allow the shutters to come down and to push complainants towards the legal process. There needs to be a learning culture at the very bottom of the NHS so that complaints are received and acted on. In the vast majority of cases, patients’ motivation in bringing complaints, including to Members of Parliament, is to prevent what happened to them from happening to somebody else; it is not to seek financial redress or to take the NHS to the cleaners. It is important that the NHS understands that and works with it.

Where local information indicates a potential issue over professional performance, health organisations have a responsibility to take whatever action is needed to protect patients and, where possible, support and help the professional to get their career back on track. Experience shows that intervening early—before problems have become ingrained—is far more likely to be effective, and that is a major theme of the White Paper on professional regulation, “Trust, Assurance and Safety”, which we published in February.

In recent years, the Department has agreed new arrangements with the professions to clarify and strengthen such processes in primary and secondary care. The new arrangements incorporate important safeguards, including the separation of the investigation of concerns from the formal decision-making process. Despite those reforms, the Shipman inquiry considered that primary care trusts did not have adequate powers to protect patients in the case of poor performance by GPs. The Government agree and will this year carry out a review of the operation of the performers list system, relating it to the proposals for reform of professional regulation, to which I will now turn.

The Shipman inquiry’s fifth report was critical of many aspects of the regulation of the medical profession, particularly the lack of clear standards for judging fitness to practise, the lack of demonstrable independence in the adjudication of the most serious fitness-to-practise cases and the way in which earlier proposals for the revalidation of doctors had been implemented.

Given the radical and, in places, controversial nature of the inquiry’s recommendations on those points, the Government decided in early 2005 to set up a review of medical regulation under the chief medical officer and a separate review of non-medical regulation under the then NHS director of human resources, Andrew Foster. Those reviews reported in July 2006, and, following a period of consultation, our final proposals were published in the White Paper on professional regulation, which I mentioned.

Our proposals include inviting the professional regulatory bodies and specialist organisations such as the royal medical colleges to develop clear standards to determine whether health professionals remain fit to practise. We also propose improving co-ordination between local NHS employers and national regulators—in the case of
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doctors, through a network of General Medical Council affiliates. That system was proposed by the chief medical officer to close what he termed the regulatory gap—a situation in which a professional’s behaviour may be causing local people concern, but there is insufficient evidence to take a complaint all the way to the national regulator.

Mr. Lansley: I am prompted to intervene by the Minister’s remark about the relationship between professional regulation and clinical governance among NHS employers. If I recall correctly—I do not have the quotation to hand—Dame Janet Smith was clear about the desirability of ensuring that we did not rely excessively on NHS clinical governance structures where those who were providing the medical services were not necessarily in NHS employment structures. Does the Minister agree that clinical governance is of great importance not only for the NHS but for health care providers that happen not to be NHS organisations? We should create a structure that is robust in both those circumstances.

Andy Burnham: I agree entirely that that is what we need to create. The systems that we are describing should transcend all organisational boundaries and apply right across the piece. Different organisations will seek to achieve the same ends in different ways, but the principles should transcend organisational boundaries and apply equally to the private sector and the NHS. In that respect, the GMC affiliates could play quite an interesting role. Originally, it was proposed that that should happen at trust or local community level, but following discussion with various stakeholders, the regional or sub-regional level would seem to be the right one. We therefore want to take the proposals forward carefully to ensure that they do what we hope they will, and I hope that they will achieve some of the aims that the hon. Gentleman has alluded to.

The Government’s proposals also include setting up an independent body to adjudicate the final stages of the fitness-to-practise process. That will initially apply to doctors, but the other regulatory bodies will be invited to establish a similar separation between their adjudication and other functions. In addition, we propose to strengthen the current system of appraisal for doctors so that it can become an adequate basis on which to carry out the periodic revalidation of their generic fitness to practise, with separate arrangements for specialist recertification overseen by the appropriate royal medical colleges. Finally, for other professions, we propose that revalidation should be carried out by employers or other appropriate means.

When we leave this issue, as I told the hon. Gentleman, we need to put in place a system that will stand the test of time and which constitutes a generational settlement on these issues. In this day and age, it is not enough to tell the public that we have done the job; the system that we put in place must be seen to be transparent and to uphold the public interest. That is why there should be parity between the professional and lay appointees to each of the regulators.

We can, however, deal with that issue in the parliamentary debate that follows our proposals. Although it is important that we hear all the views on the issue, it would surprise me if parliamentarians of all parties did not agree that
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upholding, and being seen to uphold, the public interest was crucial; indeed, it is in the interests of professional self-regulation, because it will strengthen the image of self-regulation in the mind of the public. We should remember that we are not talking about Government regulation, because those appointed to the regulatory bodies would all be independent.

I have spoken for a considerable time, but I appreciate that I have given only a superficial summary of the action programme that the Government have set in hand to address the many thoughtful recommendations of the Shipman, Ayling, Neale and Kerr/Haslam inquiries. Some of those actions are already in hand, and we are working closely with regulatory bodies and patient, NHS and professional groups to implement the remainder.

Unfortunately, we can never give an absolute assurance regarding criminal behaviour of the kind perpetrated by a Shipman. However, the action that we are setting in hand will make it highly unlikely that any future criminal could go on for as long without being detected. We can achieve that without disrupting the excellent care that the vast majority of our health professionals give their patients day in, day out.

Let me conclude by thanking those hon. Members who are here for the debate for their interest in the issue. I cannot stress enough how important the determination of those hon. Members who represent constituencies in which Harold Shipman practised for so many years has been in ensuring that these matters are adequately concluded. The Government will eventually bring the issue to the right conclusion so that my hon. Friends’ constituents can—this is very important—draw this awful chapter in the history of their towns to a close, and that applies particularly to Hyde. We have some way to go yet, but we are making clear progress towards our goal.

Mr. Mike Hancock (in the Chair): I thank the Minister for that thoughtful presentation; before I call the hon. Member for Calder Valley (Chris McCafferty), may I explain for the record and for the benefit of any of his constituents who may be in the Public Gallery that, although the hon. Member for Stalybridge and Hyde (James Purnell) is present for the debate as a constituency MP, under a convention of the House, because he also happens to be a Minister, he is restricted as to his participation in the debate.

3.20 pm

Chris McCafferty (Calder Valley) (Lab): I am grateful for the opportunity to speak on behalf of my constituents in Calder Valley and those of the Minister for Pensions Reform, my hon. Friend the Member for Stalybridge and Hyde (James Purnell), who, as you pointed out, Mr. Hancock, is in the Chamber but may not speak because of his ministerial responsibilities.

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