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21 Jun 2007 : Column 540WH—continued
The earliest that we can hope for the coroner reforms to be fully implemented—the hon. Member for Oxford, West and Abingdon (Dr. Harris) asked me about that—is 2010. That is not unreasonable at this stage. I recognise the frustration that some people feel about the pace of progress, but I cannot make decisions on future legislative programmes. We need to ensure that the hon. Member
for South Cambridgeshire’s frustration does not turn to disappointment, and we do not want momentum to be lost.
My hon. Friend the Member for Calder Valley asked me about deaths abroad. When a death takes place overseas, the body is brought back to England and Wales and the coroner investigates the circumstances, as he would if the death took place in this country. That will remain the same. Families in those circumstances will get the same powers as others under the new Bill to challenge coroners’ decisions, although the death certification process is not the same.
My hon. Friend the Member for Denton and Reddish raised important points about medical regulation and GMC affiliates. It is important to say how we envisage those affiliates working. I agree with the hon. Member for South Cambridgeshire that the system being developed is, in many ways, not punitive. As the chief medical officer made clear in his document, “Good doctors, safer patients”, the idea is to create a supportive system whereby doctors exhibiting signs of difficulty, perhaps through alcohol or drug misuse, are supported, referred to bodies such as the National Clinical Assessment Service and offered help and support to get their careers back on track.
The revalidation process will contribute to that. GMC affiliates will have a key role in placing recorded concerns on file so that there is a record of things brought to their attention. Even if they are not felt worthy of being taken to the GMC, they should nevertheless be recorded as concerns. That will build the more detailed system that my hon. Friend was looking for. We will close the regulatory gap between the GMC, which is at the end of a long process in many cases, and examples of practice that give rise to concern at a local level. I hope that he appreciates that.
I wish briefly to touch on an issue that we have not mentioned. As well as the reform of the death certification system, the Government are considering adding to the draft Coroners Bill a provision recommended by the Constitutional Affairs Committee to place a statutory duty on doctors to report to coroners particular types of deaths, such as those that are in unnatural circumstances or are violent and fit certain characteristics. We will set out our proposals on that in a consultation paper, which is currently being considered in draft form. The hon. Member for Oxford, West and Abingdon referred to that and I hope that he will be reassured.
On death certification, I was pleased to hear the hon. Member for South Cambridgeshire say that having the medical examiner within the PCT was the right thing to do and that he did not feel it should give rise to concerns about conflicts of interest. However, that is a legitimate point to consider.
It is important to say that if we create a unified system of death certification it will apply to burials as well as cremations. At the moment the charging structure falls heavily on people whose relatives are cremated, and any new system will have to create a unified charging structure. It is important that that is done carefully and sensitively when the details are considered.
The role of the medical examiner receives a lot of criticism, but it will be hugely strengthened by Connecting for Health and the national programme for IT. An examiner sitting at a PCT will be able to call up the
necessary documentation, have immediate access to records and speak to family members if it is deemed necessary. It will be an easy, streamlined process. The system has the potential to be neither costly nor bureaucratic and will do the job that Dame Janet envisaged for the coroners service.
The hon. Member for Oxford, West and Abingdon spoke about doctors’ lower tolerance towards poor practice and the importance of their not being hounded. They are important points and the two need to be balanced. He often talks about Government targets as though they were inherently antithetical to good patient care. I hope he understands that our targets are about the generality of the population getting access to basic standards of care. It is not enough for the system just to deal with the patient before it. Obviously, any health care system must consider how it is meeting the needs of everybody, not just those who come into the system because it is their turn in the queue. I wish sometimes that he would temper his description of targets. They are designed to improve the system for everybody, not to work against the interests of patient care. I believe that the hon. Member for South Cambridgeshire made that very point. I would not want doctors to be hounded as a result of the new system. It is crucial that professionals who express concerns about a colleague are protected, and I assure hon. Members that that is very much part of our thinking.
We had a useful debate on the standard of proof, and I suspect that we will return to the subject another time. Again, I was pleased to have the support of the hon. Member for South Cambridgeshire. Perhaps there is a need for better communication with the medical profession so that people fully understand what is being proposed and so that liberties are not taken with the serious issue of people’s livelihoods, but Lady Justice Smith and the chief medical officer both firmly concluded that what has been proposed is the right thing to do. In my view, too, it is the right thing to do, and the Bill will include the proposal.
On the composition of the General Medical Council, I believe that the hon. Member for Oxford, West and Abingdon said that he supported the proposal for parity between lay and professional representation. He is nodding, so I am pleased. Personally, I preferred a lay majority—I will be open about that. I felt that that would be right, but, in discussion with the medical profession and the GMC, I accepted that parity was a fair compromise and that it enshrined the two interests that have to be balanced. In many ways, it perfectly embodies the balance that has to be struck between the public interest on the one hand and the professional interest on the other. That is what we are seeking to do.
The hon. Gentleman also raised concerns about people being elected to bodies and asked why the Government were moving away from that. There is a clear conflict between representation and regulation in the public interest. The responsibility of anyone serving on a regulatory body in the health care sector is to uphold the public interest and to improve patient safety. I do not doubt for a moment that that is uppermost in the mind of the vast majority of people—in fact, all the people—who are elected to serve on regulatory bodies. Nevertheless, the impression is created that the first priority is to the constituency of people who put the person on to the regulatory body. Indeed, in many ways
it is why we are asking the Royal Pharmaceutical Society to make changes to its structure, too. That body in itself combines a representational role on behalf of the industry as well as a regulatory role, and my view is that the roles are not compatible if we want a transparent and fair system.
Dr. Evan Harris: I will reflect on what the Minister has said. It has implications for elected people who regulate licensing and our planning systems, and who take a quasi-judicial approach. However, I want to reassure him that what he has just said does not alter for one moment my view on targets. Politically motivated targets are contradictory, and they create perverse incentives in respect of appropriate patient care. That is why I thought that the Conservative party was right to seek to abolish them. I was surprised by who was prayed in aid, but it is a matter for that party. I want to reassure the Minister that I have stuck to my view throughout.
Andy Burnham: I know that the hon. Gentleman has stuck to his view. I do not seek to inject a party political note into the proceedings, but it is legitimate for me, on behalf of the Government, to say that waiting lists would be longer today than they are, waiting times in accident and emergency would not be four hours for everybody, and cases of MRSA would not be falling if we had not introduced national targets in the NHS. Experts in the Department tell me that in 2005—the very point at which the national target was introduced—cases of MRSA fell for the first time since 1991, which is when incidents of MRSA began to appear in any significant number. The hon. Gentleman has a view, but I find it impossible to accept that targets are entirely contradictory to the interests of the public or to good patient care.
I believe that I have covered most of the issues that colleagues raised. The hon. Gentleman mentioned metrics and whether trusts would be measured on the number of complaints. That would not be sensible. He may know that the Department has launched a new website this week called NHS Choices. It is not just a website; it is a comprehensive information service for the public, who can find information on the NHS that previously might have been difficult to find or that was in the hands of the professionals.
There are things that the public need to know and should be encouraged to know about their local hospital, such as the number of complaints it receives—I do not understand why that should not be in the public domain—readmission rates, the incidence of MRSA and patient satisfaction rates, but that is very different from saying that anyone is using a performance management regime to make an overall judgment on the organisation. I
agree that that would not foster an open learning culture like the airline industry culture that the hon. Member for South Cambridgeshire rightly referred to, in which complaints are encouraged.
It is absolutely correct that a goodly number of complaints is indicative of an open and learning organisation—it is important to say that. Indeed, in making his recommendations, the chief medical officer carefully considered the parallels between the airline industry and the medical profession. We can learn something from the principle that to err is human, but to cover up the mistake does not serve the public interest. We have to go further in that area.
Issues were probably raised that I have not fully covered, but we shall return to them in the House before long. The Government will continue to listen on these important matters, to make changes if we need to, and to make proposals in a spirit of collaboration and consultation so that this country gets the generational settlement that it needs. As I said, I am grateful for the tone of the debate.
The Department’s officials have provided enormous support in taking forward the proposals. The team has performed exceptionally well. It is invidious not to name everyone, but I mention Gavin Larner, Charles Dobson, Nick Clarke and, in particular, Gina Radford, who encouraged me to address the subject of death certification. I want to put on the record my personal thanks to them for their professional work on the proposals. There are many more people across the Government whom I could mention, but I wanted personally to thank those people for their excellent work on the package of measures. I am sure that they take huge personal satisfaction from the excellent service that they have given to the public.
No system of safeguards can ever provide us with an absolute guarantee against abuse from a criminal as devious and subtle as Harold Shipman. Nevertheless, we are confident that the wide range of measures that we are putting in place, which build on the invaluable recommendations of the Shipman and other inquiries, will deter any future wrongdoing and make it difficult for it to remain undetected.
I thank you, Mr. Hancock, for the way in which you chaired our proceedings, and I thank all hon. Members for attending the debate.
Mr. Mike Hancock (in the Chair): Thank you, Mr. Burnham. Before I put the Question, I want to thank the Minister and all hon. Members for the way in which they participated in the debate. The issue presents real difficulties for many people. The debate was a great credit to the House.
Adjourned accordingly at one minute to Five o’clock.
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