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Lord Mackay of Ardbrecknish: My Lords, the noble Lord may know, if he has followed the record in Hansard on the previous two Bills for which I have been responsible, that I have taken seriously the reports of the Delegated Powers Scrutiny Committee, and I look forward to receiving that report. I do not think he will make me go any further than that this evening.

Lord Campbell of Croy: My Lords, I was going to say, being on that Select Committee —I do not think there is anyone else on that committee who is here tonight—that we have noted that the negative procedure is there. But, for example, had the Government given themselves powers to put the number of 20, as regards the limit for small firms, upwards instead of downwards, I think we would have thought the affirmative procedure was needed. But having looked through the Bill, I do not think the negative procedure is wrong.

Lord Mackay of Ardbrecknish: My Lords, I thank my noble friend for that. As I said, I look forward to reading the report. As I was saying, the difficulties faced by disabled people are occasionally caused by ignorance and sometimes by outright prejudice, but rarely by the person's ability, or by the disability itself. This injustice—for that is what it is—is, I think (as anyone listening to your Lordships' debate today would realise) unacceptable to the House, and of course it is unacceptable to disabled people. It is equally unacceptable to the Government, which is why we are committed to the creation of a fair, open and accessible environment for disabled people.

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I mentioned at the beginning of this debate that over the past 15 years much has been done to further that aim: there has been the Access to Work programme, which enables more disabled people to take up employment; the introduction of access requirements to the building regulations, which has had a substantial effect on social, recreational and employment possibilities for disabled people; the recent community care reforms, which have created new opportunities for people to get help in their daily lives; and the development of a more comprehensive system of disability benefits upon which expenditure has tripled in real terms since 1978-79.

We have set ourselves a tough task now—perhaps tougher than others before—and that is a pledge to the disabled people in this country that we will eliminate discrimination against them. This will not be easy. It is a goal which cannot be achieved overnight, as disabled people realise. But the Bill now before your Lordships' House represents an enormous stride forward towards the fulfilment of our aims and the redemption of that pledge.

The measures contained within the Bill represent the most comprehensive package ever brought by any government to tackle discrimination against disabled people. It is well worth reminding your Lordships of what it does. For the first time it will be unlawful for employers to treat a disabled person less fairly; for the first time, disabled people will have a right not to be denied access to goods and services solely on the grounds of their disability; and a national disability council will be established to keep the issue of discrimination under review and to advise the Government. Together these represent an enormous step forward in the battle against discrimination. I believe that they will be welcome to the many who care greatly about disability, and they will be crucial to the future happiness and well-being of disabled people. I commend the Bill to the House.

On Question, Bill read a second time, and committed to a Committee of the Whole House.

National Health Service (Amendment) Bill

9.18 p.m.

Baroness Gardner of Parkes: My Lords, I beg to move that this Bill be now read a second time. I am pleased to be able today to sponsor the National Health Service (Amendment) Bill, brought from another place for Second Reading.

This is a worthwhile measure, as I shall go on to explain. It seeks to reform the constitution of an important body, the National Health Service Tribunal, and to provide it with an important power which it does not now have.

The Bill contains a number of measures designed to ensure that the NHS Tribunal, a quasi-judicial body which operates within the domain of the family health services, is able to carry out its work as efficiently as possible. Noble Lords may find it helpful if I explain at this point a little about the tribunal and the way it works. Many of your Lordships will know that practitioners who provide family health services—GPs, dentists, pharmacists and opticians—are not employees of the National Health

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Service; rather they are independent contractors bound by terms of service within the NHS—contracts in laymen's terms. Those contracts do not allow for practitioners to be removed from practice by the authorities which hold their contracts, even where their conduct or the way they practise gives cause for grave concern.

However, there is a body which can disqualify such practitioners from providing family health services, and that is the NHS Tribunal. If a family health services authority believes that a practitioner's behaviour or the way he practises is prejudicial to the provision of services in its area, it can ask the NHS Tribunal to disqualify that person from practice by directing that his or her name be removed from the appropriate family health services authority list of practitioners who are contracted to provide the service. If, after holding an inquiry, the tribunal considers the health authority's concern to be well founded it can do just that—disqualify the practitioner. The doctor, dentist, pharmacist or optician concerned may not then return to practice until the tribunal or the Secretary of State for Health has removed the disqualification.

I must stress that those procedures are quite separate from the procedures used by the regulatory bodies for the professions—the General Medical Council, the General Dental Council, the General Ophthalmic Council and the Royal Pharmaceutical Society of Great Britain. The tribunal exists to enable the NHS to protect the standards of service it provides while the regulatory bodies are quite rightly concerned with professional standards.

So the tribunal is an important body which performs an important function. Noble Lords may wonder why the National Health Service (Amendment) Bill is needed if the tribunal already has the power to disqualify practitioners. I shall explain. The Bill contains other clauses designed to increase the membership of the tribunal and to bring rights of appeal against its decisions into line with those applying to other tribunals. However, the clause I am about to describe—Clause 2—forms the central purpose of the Bill, and I shall concentrate on that.

The Bill is needed because no matter how much a practitioner's conduct causes concern for the safety of patients, whether because of a dangerous practice or a cavalier attitude, the tribunal cannot act immediately to protect patients. Before making a ruling on the representations made by a health authority it must first review all the evidence placed before it. There will usually be an oral hearing at which both parties—the health authority and the practitioner concerned—are represented by counsel. Noble Lords will appreciate that all of that cannot be done in a moment. It takes time to process such evidence and to arrange a hearing. Although the tribunal works as speedily as possible it usually takes between three and six months for a case to be dealt with, and during that time patients may continue to be at risk.

The National Health Service (Amendment) Bill addresses that problem by seeking to provide the tribunal with the power to suspend a practitioner immediately where it is asked to do so by a health authority in order to protect patients. That gives time for the tribunal to consider fully the allegations made against him or her without the danger to patients continuing.

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In saying that, I do not wish to create a false impression. In this country we are fortunate in enjoying a very high standard of service from the primary care professions. As a member of one of those professions I know with what seriousness the great majority of practitioners approach their work and the responsibility they feel towards their patients. Dangerously careless and incompetent practitioners are rare, but serious lapses in professional behaviour do occur. Few and far between as they are, it is unacceptable for even one practitioner to expose patients to risk and for the National Health Service not to be able to protect those patients.

Situations have arisen in the past few years where practitioners' conduct has forced health authorities to seek to have them removed from their lists. The Bill was brought to the other place by Mr. John Austin-Walker, the Member for Woolwich. I should like to congratulate him on persuading the Government of the importance of the issue. He had a special interest in the subject because a problem existed whereby many of his constituents were ill served, even endangered, by a neglectful doctor who used every possible ploy to delay proceedings against him for an inordinate length of time. I recall from my own dental service committee days a dentist who dragged out proceedings for almost three years, continuing to destroy patients' mouths throughout that time. That was a rare case, but it was one too many. It was frustrating for those hearing that man's case to know that we were powerless to stop him.

In the case referred to by Mr. John Austin-Walker, the family health services authority was powerless to protect the patient and the GP was callously careless and indifferent. Under these new provisions the authority would be able to suspend him immediately from practising and then investigate further as to whether or not that was right.

Reference has been made to both the professional regulatory body and the National Health Service Tribunal. However, in that case neither was able to act immediately. The case to which I referred involved a doctor, but I have encountered other examples in the dental field because that is the profession of which I am a member. It is now some time since I sat on dental service cases. However, I was also a member of the disciplinary committee of the General Dental Council.

If the National Health Service Tribunal had been able to suspend the practitioner involved, the patient's safety would not have been at risk during the time until the practitioner was finally disqualified from practice.

I can assure your Lordships that the power to suspend is intended to be a reserve power, to be used only in extreme circumstances where a practitioner's standard of service falls very short of that which patients and the National Health Service are entitled to expect. As a professional, I welcome the existence of such a power and I am sure that the majority of my colleagues would support me, as would other professionals. Practitioners who take a pride in the service that they provide are as anxious as the general public that those few who wear their professional responsibilities lightly should be dealt with appropriately. Passing the Bill will make a great difference. The new power will be rarely used but nonetheless will be very effective.

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Your Lordships will wish to know that the Bill also makes a provision enabling the NHS to ensure that a practitioner whom the tribunal disqualifies is unable to take on work as a locum, or an assistant, or a deputy to another practitioner, or for a health authority. That can occur at present. I remember very clearly dentists who were disqualified immediately working under another dentist. The disqualified dentist still met all the expenses and ran the place, but had some young fellow with his plate up "fronting" for him. That was a terrible practice, and nothing could be done about it at the time. Although that could occur at present, I do not believe that it would be usual. However, that is a good aspect of the Bill and a provision which is much needed. It is highly dangerous and very undesirable for someone disqualified to get round the disqualification by such a method.

As your Lordships can see, the Bill contains the provision allowing arrangements to be made for practitioners to continue to receive NHS payments until there has been a final ruling. I believe that such a provision is in line with employment law. Nothing, of course, will have been proved when suspension is directed, so NHS payments should continue. I am sure everyone agrees that that is fair.

The other clauses relate to the constitution of the tribunal. They aim to provide deputy chairmen and a greater pool of members so that business can be conducted as speedily as possible. As I said, the tribunal already does an excellent job but its chairman and members are busy people. Being able to draw upon a larger number will be helpful.

I believe that this is an important Bill which will bring in highly desirable legislation designed to confer on the National Health Service the ability to protect the services that it provides. I commend the Bill.

Moved, That the Bill be now read a second time.—(Baroness Gardner of Parkes.)

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