Clause
109
Reference
of cases by Council to
court
Sandra
Gidley:
I beg to move amendment No. 234, in clause 109,
page 54, leave out lines 7 to
11.
The
Chairman:
With this it will be convenient to discuss the
following amendments: No. 235, in clause 109, page 54, line 27, leave
out from ‘Committee)’ to end of line
31.
No. 236, in clause
109, page 54, line 38, leave out from ‘Committee)’ to end
of line
42.
Sandra
Gidley:
This is a probing amendment. Clause 109 amends
section 29 of the Health Care Professions Act 2002, extending section
29 of the Act to enable the CHRE to refer to the High Court cases
relating to impairment of fitness to practise on grounds of ill health.
That is in addition to its existing powers to refer cases
relating to misconduct and professional
competence.
I tabled
the amendment because of concerns relating to the fact that, currently,
health cases are generally private proceedings. I have concerns about
sensitive details on an individual’s health eventually being
made public in ways that might not be helpful to that individual. My
concerns might be covered by clause 98(4)(d), but I am still not sure
whether that is the case, despite some discussion about it this
morning.
I hesitated
slightly about drafting the amendment in this way, as I did not want to
create a loophole whereby an individual who realised that they had done
wrong could somehow try to present a case as a health case. An argument
might be made for something to be heard by a health committee rather
than a disciplinary committee. I was not sure how that might work in
practice. Clearly, if that was a consequence of my amendment, it would
be problematic, because we are
trying to achieve greater openness about misdoings generally and it
would be contrary to that
spirit. However, it
would be helpful if the Minister could explain why it was thought
necessary to widen the scope of CHRE referrals. Has he any examples of
where the system has failed? Bearing in mind that the cases referred
are those the CHRE believes too lenient, does he not have concerns that
if the CHRE has got it wrong the personal details of people on whom a
judgment has been made may be subjected to greater public view than
necessary? Can the Minister clarify how many cases have been referred
to the High Court to date by the CHRE and what proportion of them have
been judged by the Court to be too lenient—in other words, where
it has upheld the concerns of the CHRE to a certain
extent?
Mr.
Bradshaw:
I cannot give the hon. Lady the figures that she
asks for but I shall endeavour to find them and let her have them.
However, she accepts in her comments that there may be circumstances in
which the physical or mental health of a health care practitioner may
impact on their conduct or ability, and consequently have implications
for the safety of their patients or the wider public. We believe
therefore that the health committees of regulatory bodies have a role
in ensuring patient and public safety in the same way as conduct and
competence committees, because patient safety must be the
priority.
However, we
fully support the need to handle cases of ill health with sensitivity,
as we discussed when we covered hearings in private. The need for
better support and rehabilitation for professionals struggling with
health problems was recognised in our White Paper, but whatever the
cause of poor performance, patient safety must come first, and we are
clear that professionals who pose a risk to patient safety must be
identified and dealt with appropriately but
sensitively.
Sandra
Gidley:
I am still not entirely clear about the
circumstances in which private details, such as mental health details,
will be kept private. All the professions will be interested in greater
clarity about how the provision will work in practice, because we are
talking about somebody’s potential livelihood, and about
cases in which people might get better. Mental health
problems are rarely understood and are often viewed unsympathetically
by those without expertise, and I do not want to be party to
legislation that has the potential to lay details of somebody’s
mental health problems open for all to see. At a later date, the person
might fully recover, but that knowledge of their problem might prevent
them from obtaining employment. I understand that it is a stigma
problem, but it is essential that we get the balance right. However, I
beg to ask leave to withdraw the amendment.
Amendment, by leave,
withdrawn.
Clause 109 ordered to stand
part of the Bill.
Clause
110
Responsible
officers and their duties relating to medical
profession
Mr.
O'Brien:
I beg to move amendment No. 54, in
clause 110, page 56, line 27, at
end insert—
‘(7A) The
responsible officer must be clinically
qualified.’.
The
Chairman:
With this it will be convenient to discuss
amendment
No. 80, in
clause 110, page 56, line 35, at
end
insert—
‘“clinically
qualified” means qualified in a manner that the Secretary of
State shall by regulation
define.’.
Mr.
O'Brien:
The clause sets out the framework for responsible
officers, so obviously many Committee members will have been waiting
with bated breath to reach this crucial aspect of the Bill. Amendment
No. 54 would ensure that the responsible officers were clinically
qualified professionals—to be determined by regulations.
Responsible officers should be medical professionals rather than health
care managers or management consultants, for example. Doctors have also
expressed concern that responsible officers should not be the same
medical directors of primary care trusts under whose authority the
various doctors
work.
5.30
pm
This discussion
should be framed by the concerns raised by Lady Justice Smith during
her oral evidence. She told us:
“I really find it
difficult to know how responsible officers are going to work and what
role they will play in revalidation. I do not get that from this
Bill.”
She
continued:
“I
cannot tell from the Bill how it will work, which bothers me. I am
worried about responsible officers”.——[Official
Report, Health and Social Care Public Bill Committee, 8 January
2008; c. 42-43, Q83.]
If
PCT medical directors are also the responsible officers, it will give
them too much power over individual doctors, and they will have the
power both to discipline and to sack the doctors on their patch. PCT
medical directors are already busy, and they have many priorities. In
her oral evidence, Lady Justice Smith said:
“I am really unhappy
about that for several reasons...I do not like the idea of a
medical director, who already has a lot of jobs, having to take on
responsibility for revalidation as well as all his other jobs. I think
that that is too
much”.
Her desire for
making it a separate role arises partly out of her concern
that
“the revalidation
process should be clear and understood...it should be summative
and a proper test, and...it should not just involve shuffling
pieces of paper around and rubber-stamping
them”.
The Medical
Protection Society has made the same point.
The role of the responsible
officer could cause serious conflicts of interest. Suppose that a local
doctor prescribes an essential cancer drug for a patient, which puts
strain on the PCT’s budget, and he suddenly finds himself at the
wrong end of an inquiry by the local GMC affiliate medical director.
How would the GP know that the inquiry was genuine rather than
contrived? How would the GMC affiliate medical director know that his
regulatory decisions were not being influenced by pressure from the PCT
chief executive? Lady Justice Smith noted the reverse situation. She
said:
“There is
a real tension between, on the one hand, an employer’s desire to
keep all of his employees in post, revalidated and fully qualified,
and, on the other hand, the possible need to refuse to revalidate
somebody, in which case their services might
be lost entirely, diminished or put on hold, from which problems might
arise. I am unhappy about that. I cannot tell how it will work, but it
looks to me that it might be like that.”
——[Official Report, Health and Social Care Public
Bill Committee, 8 January 2008; c. 43,
Q83.]
Angela
Browning:
We discussed that matter when we took oral
evidence and it is important to get the clause right. Within certain
disciplines, particularly in hospitals, there are often shortages of
doctors. Because of the need to meet targets and keep patient
throughput, the medical director who undertakes revalidation is going
to be in a difficult position. He must do his job as required by the
primary care trust, or according to the Government’s
requirements sent from on high, and, at the same time, he must be
responsible for revalidation. One could see all sorts of tension
arising in such a situation. I am talking narrowly about doctors in a
narrow sense, but there are many different types. The Government need
to get the measure right, so that the pressure I described does not end
up on medical directors. Their role should be clearly defined and the
problem I described, which was clearly identified in the oral evidence,
should be resolved in the Bill.
Mr.
O'Brien:
I saw the Minister nodding when my hon. Friend
talked about getting it right, so, in that sense, we are at one. My
hon. Friend highlighted the fact that every system in the world and
every law that we pass here deals with human motivation and is
man-made—nothing comes down from on high. However professional,
experienced, responsible or extraordinarily intelligent the people we
are talking about are, we cannot escape the fact that people are
influenced by motivational factors.
The only way
to address my hon. Friend’s point is to take an extreme
case—it is absolutely germane to what I am saying. We might find
such an event inconceivable, but, tendentiously, we live under a regime
of top-down targets rather than the bottom-up approach that we keep
urging the Minister to adopt. Targets drive the performance criteria
and measurements. However, anyone in any walk of life who is involved
in management knows that what one measures is what one gets. If
measures and targets are put in place, and if, as in so many cases,
they have year-end performance bonuses and money attached, and if one
is desperately hoping that by achieving those targets, one will have a
sufficient bonus that means that one can at last put the new kitchen in
place, one would have a motivation to aim for the targets. That is what
targets are for. However, if that motivation runs counter to the
shortage of doctors in hospitals, for instance, we end up with a
tension. The latter situation might lead to a target being missed and a
bonus not being paid. Whatever explanations may be given or whatever
exceptional circumstances might be pleaded at the time that that is
negotiated, on a human resources department basis, it is insufficiently
clear in the Bill.
My
hon. Friend pointed out this issue in her very timely intervention, and
in reply I referred to an extreme circumstance, which I obviously do
not believe would or should happen. None the less, in doing so I have
rather put it on the record that it is not completely beyond the realms
of possibility. That highlights the issue that we are trying to address
here. I accept that
the Minister is trying to push this issue forward, so that we get it
right. However, it is only right that we understand the tension that we
are up against. It is
probably as well to remind ourselves that Dr. Meldrum of the
British Medical Association
said:
“It comes
back to the whole business of having confidence. We are aware of
people—medical directors in trusts, or whoever—whose
loyalties have been primarily to their trust. We are not saying that
their loyalties should be to the profession, but they should be to the
wider benefits of health care. It is about achieving that balance by a
degree of separation of function and a degree of separation of
loyalties from the employer, and having an effective and practical
operation. That is quite difficult; I accept
that.”—[Official Report, Health and Social Care Public
Bill Committee, 10 January 2008; c. 67,
Q149.]
Primary Care
Trust medical directors are employees of PCTS, so their impartiality in
the regulatory management of local doctors cannot be guaranteed; it is
very much of a piece, this. The responsible officer should be
completely independent of the local PCT. That way, he or she is more
likely to command the trust of local doctors, which, in my view, is an
absolutely essential element of making this process work well and
ultimately making the scheme more successful. I hope that the Minister
will take the opportunity to confirm whether the medical directors will
be, or are likely to be, the responsible officers, and also whether
they will be the GMC affiliates.
During his oral evidence
session, the Minister, under questioning from my hon. Friend the Member
for Guildford,
said:
“We are
not making a specific ruling as to who it should be, just as to what
qualifications the person should have. We think that responsible
officers must be senior doctors with a current GMC
registration.”——[Official Report, Health and
Social Care Public Bill Committee, 10 January 2008; c. 100,
Q242.]
I think that we would all
sign up to that. He
continued:
“There
was much discussion on Tuesday as to whether it should be a medical
director, and that would be perfectly appropriate. In fact, a lot of
the good medical directors are, in practice, already doing this job on
the ground. Yet we are not saying that it has to be a medical
director.” ——[Official Report, Health and
Social Care Public Bill Committee, 10 January 2008; c. 100,
Q242.]
So, I hope that the
Minister will take this opportunity to clarify that his statement means
that there will be true freedom at a local level to choose not to have
the medical director as the responsible officer and that the PCTS will
not be encouraged, or even coerced, either by policy or funding issues,
to merge the two roles.
It is that funding issue that
really needs to be thought through, so that there are no perverse
incentives, or indeed target-driven issues, that then drive behaviour,
both in terms of who should be the responsible officer and what
conflicts they may feel they are facing, even accepting that the
extreme example that I gave, by way of argument, is highly unlikely to
happen in practice; I would like to believe, anyway, that it is
unlikely to happen.
I
was also concerned about another matter. The Minister responded to the
point made earlier by Findlay Scott during the GMC’s oral
evidence that
“adequate
resources must be provided.”——[Official Report,
Health and Social Care Public Bill Committee, 8 January
2008; c. 53, Q107.]
In response, the Minister
stated:
“We are
making provision in the Bill, if necessary, for them to take on
assistants and extra resources to help them do the job if they want
somebody.”——[Official Report, Health and Social
Care Public Bill Committee, 10 January 2008; c. 100,
Q243.]
The Minister refused to
allocate extra money to this process, instead choosing to suggest
that
“We are
giving extra money to PCTs all the
time.”——[Official Report, Health and Social
Care Public Bill Committee, 10 January 2008; c. 100,
Q244.]
With respect, I did not
think at the time that that was an adequate response and I hope that
the Minister will take the chance now to flesh out what he thinks will
actually be the case.
Not only will this measure
impact on how PCTs will choose to interpret the responsible officer
role, but it goes no way to addressing the concerns about training. I
accept that the Minister gave me a positive response when I raised the
issue of training before, so I hope that I can be optimistic about the
way that he tackles the issue in this context.
I raised the issue of training
when the Minister was giving his oral evidence. I should be grateful if
he would tell the Committee, first, who will be funding that training;
secondly, when he expects the
“expert advisory group we are
developing”——[Official Report, Health and
Social Care Public Bill Committee, 10 January 2008; c. 100,
Q245.]
to agree the
“competences”; thirdly, when he expects negotiations with
providers of training to begin, and finally, how much he
expects those contracts to cost.
Lastly, during the GMC’s
evidence, the Committee also touched on the issue of soft information
sharing. I do not want us to get into all the jargon that surrounds
data sharing, but I suspect that this matter will be debated by others
at a later stage. I think that the Liberal Democrats have tabled an
amendment to clause 112.
However, there are concerns
that if the responsible officers, without the employee’s
knowledge, share information that is unproven, in the sense that there
has been no investigation, or damaging, in the sense that it might
affect an employee’s reputation, that could be the basis of a
claim that the employer had breached an implied term of trust and
confidence in their contract. Those points often lead to the most
contentious and litigious issues, so it is advisable that they should
be avoided if possible. If we can design measures to avoid them at this
stage, we will have done our job
better.
Sandra
Gidley:
The establishment of responsible officers at local
level is an attempt to have greater local resolution of problems, and
we generally support that broad aim. However, I concur with many of the
reservations highlighted by the hon. Member for Eddisbury. I do not
want to repeat too much of what he said, but even as he was talking,
more questions were being asked in my mind. For example, it is all very
well having a responsible officer who might be a medical director or a
director of PCT, but a portion of the work force might do local work or
work across PCTs, and I am not entirely clear who will be the
responsible officer in that case.
If a problem is highlighted in
an area, will the responsible officer deal with it, or will an
individual living in a certain area have to have an overall responsible
officer. I ask that because I am aware that the responsible officers
for some of the GPs in my constituency would be in the primary care
trust, but a small number work a couple of sessions at the local
hospital in specialisms where there is a demand. If there is a problem
in the hospital, will they have to answer to the responsible officer in
the hospital, as it is not clear what will happen in those cases or how
those people will join up the thinking if there are concerns about an
individual?
There is
also a problem with responsible officers having powers to put recorded
concerns on a doctor’s record. Those concerns need to be
substantiated in some way to avoid personal vindictiveness—let
us not pretend that it does not happen—and so that there is a
right of challenge by the individual, because a doctor could almost be
held to ransom by the threat of having something put on the
record.
There can be
disagreements about the way of practising, and I can think of a local
case where there was a big disagreement between a consultant and a
couple of other consultants concerning procedures that he was using. It
was difficult to say who was right and who was wrong. One consultant
was convinced that he was right and had good evidence to prove his
practice was appropriate, and the other felt that the behaviour of
consultant A was irresponsible. I do not want to go into too much
detail on that, but in such cases it is not clear who provides the
ultimate sanction. One of the problems in that case was closely
associated with the medical director, so where is the right to go
elsewhere if someone is
unhappy?
5.45
pm
With regard to
training, it is highly likely that a responsible officer could
recommend that an individual whose practice, although not dangerous,
was thought to be of concern and was in need of certain training if a
few alarm bells had been sounded. We all know what happened to training
budgets last year. Within a primary care trust, would there be tension
between the financial pressures? Would a responsible officer in a
senior position feel that he had a duty to balance that in some
way?
Anne
Milton:
I reiterate my interest in that my husband is a
medical director and, arguably, a responsible officer—before
their invention. The hon. Lady has highlighted the crux of the problem,
which is the tension between competency—that is what the
responsible officer will be looking at—financial pressures and
the resources available. During the evidence session we did not hear
from the Minister how he intends to resolve that. Does the hon. Lady
agree that, until we can take the step of employing responsible
officers, that does need to be
resolved?
Sandra
Gidley:
The hon. Lady has hit the nail on the head, which
is why I am posing some questions here and now. I am not sure how this
will all be resolved in practice. Bearing in mind that where doctors go
other professions are likely to follow—with different employment
models—my overriding concern is the
potential blurring between employment and regulation functions. I was
quite surprised when I heard Lady Justice Smith say that responsible
officers would have an interest in keeping their staff because my
immediate concern was the exact opposite, in that if a member of staff
was proving problematic, there could be a search-and-destroy
attitude.
Let us look
at the example of a whistleblower who highlights to their local Member
of Parliament certain hospital practices with which they are not happy.
The hospital would obviously not be happy with the fact that those
practices were being highlighted and the medical director might be put
under pressure to find some problem with the whistleblower that could
be used to bring pressure to bear, such as a threat to their employment
record. It is essential that there is a dividing line between those
functions. It is easy to see how the role of the responsible officer
could be abused. I would like to think that all responsible officers
would resist such temptations, but I suggest that there is a finite
chance that the pressure put on the responsible officer would mean that
the laudable aim of local resolution would not be achieved whereas
games playing could be achieved. Potential manipulation of health
professionals in that way is a dangerous road to
take.
Mr.
Bradshaw:
It is worth reminding ourselves that the setting
up of responsible officers to improve clinical governance at local
level was another of Dame Janet’s main recommendations. Far from
the examples given by the hon. Lady, of which we do need to be
cognisant—I will come on to some of the safeguards in a
moment—most of us will have come across examples in our
constituencies, in either the primary care or acute sector, where
certain practices have been allowed to continue for far too long and
issues have not been addressed. We have come upon some such examples
ourselves. That is exactly what the role of the responsible officer is
intended to try to address.
I was grateful to the hon.
Member for Eddisbury for reminding me of my words in the
evidence-taking session. I do not intend to repeat them, but I do wish
to reassure the hon. Gentleman that it is our intention that
responsible officers will be medically qualified and a registered
medical practitioner. We shall lay that down in regulation. Indeed,
many of these issues will be resolved in regulation. I would also like
to point out to him that the amendments would not achieve the objective
that he seeks. Although they would restrict the role of a responsible
officer to those who were clinically trained, it would still be
possible for responsible officers’ duties to be undertaken by
members of other professions or professionals who have allowed their
registration to lapse, or indeed, people who have never been registered
with the national regulator. Even if the hon. Gentleman wanted to press
the amendments, they would not achieve the ends that he
seeks.
On the
potential conflict of interest if responsible officers are medical
directors, we have made it clear that while we do not seek to be
prescriptive, we think that a medical director would be perfectly
appropriately for this role. Many of the best medical
directors are already carrying out most of the duties that responsible
officers would be expected to carry out, in that they already have an
important role in clinical governance. It is important that all
healthcare organisations have effective clinical governance to protect
patients, and the role of responsible officer will strengthen that by
putting some of these functions on a statutory footing. The responsible
officer will be responsible for identifying and managing cases in their
organisation where there are concerns about a doctor’s
performance. The management of those cases would include investigating
the circumstances, instigating remediation and, where appropriate,
referring cases to the GMC for further action. To respond to questions
asked by hon. Members earlier, responsible officers will not
take the action or refuse the revalidation themselves. We believe that
the role is entirely consistent with any good health
organisation’s role in protecting patients. The hon. Member for Eddisbury
made a plea for the system to be bottom-up rather than top-down, and I
entirely agree with him. I refer him to comments made by Sir Graham
Catto, who I quote in preference to Hamish Meldrum of the BMA. He
said:
“From our
perspective, the concept of the responsible officer helps us to bridge
what Liam Donaldson described as the “regulatory gap”
between what happens locally and what happens centrally. We believe
that quite a number of cases that come to us might be much better dealt
with at local level before necessarily being escalated up to
us.”
He went on to
say:
“It would
be very helpful, from our perspective, to have people working in the
local areas who understood the GMC processes, knew when it would be
sensible to refer a doctor to us if they were concerned and could link
more effectively with our own
staff.”
Findlay Scott,
his colleague from the GMC, went on a little later to say:
“We see the appointment
of responsible officers as a further strengthening of local governance
and as a reinforcement of local
responsibilities.”
He
went on:
“There
is substantial evidence from our procedures that early and effective
action could have saved doctors’
careers,”—
that
goes back to what I was saying earlier about nipping a problem in the
bud, so that it does not come to the situation where a more drastic
reaction is
needed—
“if
problems had been identified sufficiently early and not allowed to
drift. Clinical governance has already made a substantial contribution
to that.”——[Official Report, Health and Social
Care Public Bill Committee, 8 January 2008; c. 52-53,
Q105-07.]
In terms of
how the responsible officers would fit in with the GMC and its
affiliates at national level, they would have statutory
responsibilities to ensure that doctors in their organisation are fit
to practise and that the right processes are in place to protect
patients. The GMC would still be the national regulator for all doctors
in the UK. As I have said, responsible officers would not decide
whether a doctor was re-licensed. They would make recommendations to
the GMC, but the GMC would continue to be the regulator in that regard
and responsible officers would be required to liaise with the GMC on
individual fitness to practise cases, where responsible officers judged
that national sanctions may be required.
As for the safeguards,
responsible officers will be subject to exactly the same disciplinary
procedures as other doctors. Complaints will be made either through the
NHS complaints procedure or to the GMC. We will provide detailed
guidance for responsible officers to ensure that they document their
concerns only when appropriate.
Anne
Milton:
I do not doubt that the theory is good, nipping
poor practice in the bud, but does the Minister envisage it being a
full-time post for the average PCC? Will it be one full-time post or
two? It would be useful to have some indication as to what he thinks
will happen in practice.
Mr.
Bradshaw:
My current thinking is that it would not require
a full-time post. However, an existing medical director, part of whose
job is to carry out such functions, might need to employ some support.
The role would need to be devised locally. I shall say in a moment why
we believe that there will be a need for extra resources and extra
support. It will be a requirement under the Bill. Indeed, we are
providing for that support through the comprehensive spending review to
be announced in the autumn.
We accept that there will be an
additional work load, but we expect that those burdens will be
containable, the costs being offset by the benefits of improved quality
and patient safety, and by obviating the need to escalate the sorts of
cases to which I referred earlier and to which the GMC drew attention.
Under the Bill, we require organisations to provide the
necessary resources for responsible officers to carry out their
role and to ensure that organisations that provide responsible officer
functions to others are not disadvantaged. The Bill makes
provision for responsible officer costs to be provided by those
receiving the service.
Training will be developed,
through the expert advisory group that we are developing, on deciding
the necessary competences for responsible officers. Once we have agreed
those competences, we will negotiate with the pension providers to
develop and deliver specific training on the role of responsible
officers. The sub-group doing that work will include medical directors
and GMC, BMA and NHS management, including HR specialists.
I hope that I have reassured
hon. Members on the role of responsible officers and how they fit into
the general system, and on the support that will be available to them
and to local trusts in order for them to do their jobs properly. It is
so long ago now that I have forgotten whether we are debating one or
more amendments, but however many there may be, I hope that the hon.
Member for Eddisbury will not press them.
Mr.
O'Brien:
I listened carefully to the Minister. To put it
in context, the Minister rightly pointed out that this provision comes
on the back of a recommendation from the then Dame Janet Smith, now
Lady Justice Smith. In her evidence she said that she could not see
from the Bill how it would work, and given the way that the Bill is
drafted, one can understand that. The Minister sought in his response
to give us some finer grained detail.
We heard about
pressure, and not only from my hon. Friend the Member for Tiverton and
Honiton, meaning that in certain settings it might be too much of a
problem to get rid of somebody. We then heard from the hon. Member for
Romsey, who if I interpreted her remarks correctly sought to show why
there might be too great a risk of victimisation. A spectrum of risk is
obviously being contemplated, and although I welcome what the Minister
had to say about training, we are still left with those conflicts and
potential misunderstandings.
The Minister said that he
expects to see a lot of these matters dealt with in regulation. Given
the genuine concern expressed in our debate, I rather hope that the
Committee will have the opportunity to see those regulations, at least
in draft form, on Report. If that is not feasible, I hope that they
will be ready for those who will be considering the Bill in another
place. I am sure that that will be an important way of setting the
matter in
context.
6
pm
On the same
basis as I have done previously, to ensure that the point does not get
lost, I would like to press the amendment. It is for no other reason
as, looking at the numbers in the Committee, I recognise that I may be
adopting a forlorn position. None the less, by pressing the matter, I
hope to keep the Minister’s feet to the fire on that point. I
hope, too, that we may see the regulations, at least in draft, brought
forward when we are considering the relevant measures in the Bill. It
is such an important area to get right, not least because we are
putting such responsibility on the responsible officer. We must ensure
that they are in the best position to carry out the functions
successfully. On that basis, I seek the opportunity to
divide.
Question
put, That the amendment be made:—
The
Committee divided: Ayes 6, Noes
10.
Division
No.
11
]
Question
accordingly negatived.
Mr.
O'Brien:
I beg to move amendment No. 55, in
clause 110, page 57, line 26, at
end insert—
‘(5A) In
conferring powers under subsection (5), the designated body must have
regard to—
(a) patient
safety,
(b) the continuing
professional development of medical healthcare professionals,
and
(c) the continuing
professional development of healthcare
managers.’.
I was forlorn, indeed bereft, at
the results. [
Interruption.
] I take the
sympathetic moans from the Opposite Benches with the sincerity with
which they were
offered.
The amendment
seeks to include in the responsible officer’s role
responsibilities for patient safety and the continuing professional
development of doctors and health care managers, insofar as they impact
on doctors’ performance. I hope that the Minister will find that
of interest, given the training commitment that he has so assiduously
sought to lay
out.
Responsible
officers provide the opportunity for a dedicated individual to pick up
the early warning signs in, for example, prescribing practice, and to
alert for an improvement in performance. In an open system of
benchmarking, something on which I am particularly keen, that could be
an effective asset to the local and national health economy, and to the
professionalism and morale of local
doctors.
On the other
hand, as we have discussed, the responsible officer could be little
more than a revalidating rubber-stamper and a “copper’s
nark”. That would have the reverse effect on the profession and,
ultimately, would fail significantly to benefit patients and the
public. I hope that the Minister will see the point that, by outlining
what he expects the day-to-day role of the responsible officer to be,
he is thereby able to include experience of and responsibility for
continuing professional development in the competency framework
currently being discussed by his Department, of which I am aware. The
amendment would be useful to help to underpin many of the points that I
acknowledge that he has set
forward.
Mr.
Bradshaw:
As we discussed earlier in the Committee,
patient safety and the quality of care are the core business of every
health care organisation, and the new regime set out in part 1,
particularly the obligation to register with a national regulator, is
intended to enforce that fundamental responsibility. Health care
organisations will need to comply with statutory safety and quality
requirements, which will include ensuring that all staff, both clinical
and managerial, are appropriately skilled and trained to carry out
their duties. Patient safety and the professional development of
doctors lie at the heart of the responsible officer’s role, both
in relation to the duties under this clause and those proposed under
clause 111.
The
amendment would require a designated body to have regard to patient
safety and
“the
continuing professional development of medical healthcare
professionals, and...healthcare
managers.”
when giving a
responsible officer additional duties. That would be in addition to
having regard to the responsible officer’s statutory
responsibilities.
If
the hon. Members intended that responsible officers should consider the
impact on patient safety and on continuing professional development
when carrying out their primary duties, the amendment would not achieve
that. It places a responsibility on the organisation to take those
factors into account only when they decide to assign additional
duties.
We do not want other duties that
might be given to a responsible officer to interfere with the
proper functioning of statutory responsibilities. Beyond that, I do not
see any advantage to patients or to health care staff in unduly
constraining the freedom of health care organisations to combine the
responsible officer functions with other appropriate duties—for
example, clinical duties or a broader clinical leadership role. The
clause would preserve that freedom and I therefore hope that the hon.
Gentleman will agree to withdraw the
amendment.
Mr.
O'Brien:
I am sorry to hear that the Minister has been so
advised, but I am sure that the advice would not have been given unless
it was meant. If it is appropriate, we can return to the matter on
another occasion and on that basis, I beg to ask leave to withdraw the
amendment.
Amendment,
by leave, withdrawn.
Question proposed, That
the clause stand part of the
Bill.
Mr.
O'Brien:
Briefly, I rise to probe the extent of the
Secretary of State’s power with regard to the clause. I note
from the memorandum on delegated legislation that under the clause,
powers are conferred on the Secretary of State in relation to England,
Scotland and Wales. The powers
are
“to make regulations
to designate bodies which shall be required to nominate or appoint
persons, to be known as responsible officers, with responsibilities in
relation to”
professional regulation—that is on
page 51 of the memorandum. Can the Minister explain why the powers are
not devolved? Will responsibilities imposed upon primary care trusts in
Scotland, and local health boards in Wales through this legislation be
recognised in funding through the Barnett
formula?
Mr.
Bradshaw:
I am afraid I will have to write to the hon.
Gentleman with clarification on that point.
Question put and agreed
to.
Clause 110
ordered to stand part of the
Bill.
Clause
111 ordered to stand part of the
Bill.
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