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The Chairman of Committees: My Lords, this has been a remarkable debate in a number of ways to which I shall refer in a moment. It has been a major occasion for the House and a very valuable debate. In a debate in which 24 Members of your Lordships' House have taken part, I believe that I should not be forgiven if I referred by name to every Member's speech. Therefore, I ask the forgiveness of those whose speeches I do not refer to by name. In particular, I ask the forgiveness of the Members of the three Front Benches and of the Convenor of the Cross-Bench Peers for not referring to their speeches in detail.
However, this I do say. One of the remarkable features of the debate has been the way in which the speeches from the three Front Benches and the speech of the noble Lord, Lord Weatherill, the Convenor of the Cross-Bench Peers, have provided collective leadership to this House. It is remarkable because I do not believe that that often occurs. It is remarkable, too, because I venture to say that it is in accordance with the finest traditions of this House when it comes to regulating and ordering the procedure and rules of order of the House. It is a collective leadership and a collective form of order which we in this House pursue and benefit from.
There is another remarkable feature of the debate. Although a number of arguments ran through many of the speeches, a particular thread ran through a great many. Time after time, noble Lords stated that there was no evidence of abuse. I venture to agree with that assertion. The remarkable aspect is that noble Lords who expressed strong reservations, and noble Lords who are in favour of implementing the recommendations of the report of the sub-committee of the noble and learned Lord, Lord Griffiths, and the recommendations of the Procedure Committee, have stated that too. There has been a general acknowledgement that there has been no evidence of abuse. As the noble Lord, Lord McIntosh of Haringey, said, we have no means of knowing whether or not there is a measure of abuse. But the fact remains that there has been no evidence of abuse. It is not without significance that both noble Lords who expressed strong reservations and noble Lords in favour of going ahead with the proposals have made that statement. Therefore notwithstanding that fact, noble Lords from all sides of the House wish on the whole to proceed with the recommendations. That thread aroseif I do not mix my metaphors too muchfirst, in the speech of my noble friend Lady Young; and other speeches followed.
In their speeches, the noble Lords, Lord Campbell of Alloway and Lord Boyd-Carpenter, have performed a real service to the House with assiduity, as they customarily do. They have expressed opinions of value. Whatever position one takes, they have expressed views which cannot and should not be ignored, and which should be expressed because they exist. As at Question Time and on other occasions in your Lordships' House, once again they have performed what I would say is a real service to your Lordships' House.
A number of individual, specific points have been raised. Perhaps some of them do not apply on this occasion. Therefore, if your Lordships will forgive me, I shall not deal with them all. However, there are some which should be mentioned. The noble Lord, Lord Chalfont, raised the point about whether or not there is a power to suspend a Member of the House. I find it difficult to give an answer to that question off my own bat. However, to an extent only, an answer is to be found in paragraph 54 of the report of the committee of the noble and learned Lord, Lord Griffiths. It states that the legal position is doubtfulalthough I paraphrase, I hope that I do not do so inaccuratelyand it should be assumed that there is no such power. I add the observation, "so far as it goes", because there is no conclusive, absolute definition in answer to that question. If I may say so to your Lordships, it seems fairly safe for our purposes at least for the time being, unless anything more tangible emerges, to adopt that assumption. I cannot take the matter further than that, but I hope that that is of some help to the noble Lord, Lord Chalfont.
A number of other specific points have also been raised. For example, the noble Lord, Lord Skelmersdale, referred to some difficulties which could arise, if your Lordships decide to accept the recommendations and proposals, in interpreting what amount to declarations of interest of a particular kind. He instanced the case of a father who had been supporting the interests of mongol children, having a mongol child himself, and whether that person should declare an interest. I ask the noble Lord, Lord Skelmersdale, to forgive me but I cannot tonight off the cuffand nor, I suspect, could many of usgive a definitive answer. If such a case arises and there is difficulty, the interpretation will develop in the course of the conduct of our affairs. It is inevitable that we could not predict all the instances that might arise so we cannot define them. There are bound to be occasions when points come up for interpretation.
Other points also were mentioned. As I have already indicated, and I hope that it is acceptable to your Lordships, I shall not deal with them at this time. They might arise if and when the resolutions are placed before your Lordships or, if the resolutions are passed, they might arise in the course of the development of our proceedings.
I will say this, in attempting to draw conclusions from the debate. As has already been pointed out, among the 24 Members of your Lordships' House who have taken part in the debate, two of the speakers expressed the strong reservations to which I have already referred. The other Members of your Lordships' House who have spoken have formed what I venture to conclude has been
There is one other consensus which I think emerged, again a general consensus, and I suggest that it is fair to draw a conclusion about it. It is that if it is right that there is a general consensus on the principle, there is also a general consensus that we should proceed with all due practical speed. That again has emerged tonight throughout your Lordships' House. If that is right, then, subject to the passing of tonight's Motion, we can feel that the House would wish to proceed in that way.
I had not intended to speak for as long as this; in fact, I advised those who asked me that I should finish within 10 minutes. I am sorry to have exceeded my own time limit. For the third time tonight, I ask your Lordships' forgiveness and I commend the Motion to the House.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, I beg to move that this Bill be now read a third time. Since there are no amendments, I have been advised that I should say a few choice words at this time and not later.
This has been an interesting Bill, not only of interest to us parliamentarians, but a Bill in the public's interest. The debate has been characterised by a common purpose: to give the General Medical Council the powers it needs to deal with doctors whose performance is, in the words of the Bill, "seriously deficient".
I hope that with the introduction of these new procedures the few disastrous duffers will be quickly weeded out and that the profession's efforts can be concentrated on ways of ensuring that the vast majority of very competent and committed doctors are assisted and encouraged to maintain their medical excellence.
The NHS is the largest employer of doctors and it has a major role in ensuring that they are encouraged to keep up to date with the latest techniques, drug therapies and treatment protocols and that high standards are achieved and maintained. The NHS needs to develop a climate of
I think we can detect the first signs of a global warming in the medical world and we should welcome and encourage the new impetus given by the GMC in dealing with problem doctors. The GMC's guidance Duties of a Doctor, issued in October, exhorts the medical profession:
Those are three aspects of medical practice which are very pertinent to this Bill and I am sure that your Lordships will welcome the clear statement by the General Medical Council that doctors must protect patients when they believe that a colleague's conduct, performance or health is a threat to them. As the GMC says,
Another sign of global warming is the Joint Consultants Committee which has recently recommended action when clinical audit has revealed unsatisfactory practice. It is important that poor performance is picked up early and at every opportunity. The Chief Medical Officer has recently published his contribution to the subject entitled Maintaining Medical Excellence. Despite the common purpose which we share in the Bill, we have vigorously debated important points of principle. The noble Baroness, Lady Jay, with her razor-sharp intellect, has pushed for clarityas she so often doeson the meaning of "seriously deficient performance". I am aware that I have failed totally to satisfy her, but I am sure that she will recognise that clarity in legislation often emerges with time and usage. The decisions of the Committee on Professional Performance will be published and a body of case law developed. With time, the definition will be clearer to us all. The GMC and the NHS Executive will want to ensure that user-friendly guidance is provided both to the public and those in the NHS who deal with complaints and disciplinary matters. This guidance will need to be ready for the start of the new procedures in early 1997.
The noble Baroness, my noble friend Lord Pearson and the noble Lord, Lord Walton, quite rightly explored the reasons why the Bill provided for hearings of the Committee on Professional Performance to be held in private, unless the doctor wishes a public hearingas, of course, he or she is entitled to do in the interests of open justice and under the European Convention on Human Rights. The General Medical Council has undertaken to review the position after the committee has been hearing cases for three years. Leaving this matter to rules approved by the Privy Council with the further scrutiny of Parliament allows for flexibility. But there should be no fear that embarrassing decisions will be hushed up. The GMC intends that all findings of seriously deficient performance will be made public.
The noble Baroness, Lady Robson, in her usual decisive and probing way, and the noble Lord, Lord Rea, have both questioned the arrangements for cases to be transferred between the GMC's conduct, health and performance procedures. I hope I have been able to reassure them that these matters can be left to rules. The GMC has assured me that its rules will enable the swift passage of cases between the conduct and performance procedures.
The right reverend Prelate the Bishop of St. Albans, on his last day in this House, reminded us that even the Church of England has much to learn in the field of discipline and adjudication and that there is a strong case for compassion in these new procedures. But the GMC's overriding concern must be the need to protect the public. My noble friend Lord Milverton, through his own telling experience, reminded us that even Peers may suffer poor treatment.
My noble friend Lord Harmsworth, in probing the voluntary removal procedures, focused our minds on the structure of Clause 2. With his intervention, we were able to improve the wording of the clause to make it clear that doctors cannot use it to frustrate an investigation into their conduct or performance.
The noble Baroness, Lady Masham, raised the problem of ensuring that doctors undertake remedial training when this is necessary. We do not consider that the Bill needed to include a power to make remedial training a condition on a doctor's registration. However, the Committee on Professional Performance will be able to impose such a condition where the doctor refuses to take remedial action and where there has been no improvement in performance.
The scope of the Bill has been widened with the co-operation and encouragement of all parties. We have been able to include two important measures: one to protect the interest of the public by extending the GMC's powers to impose interim suspension until the outcome of the case is decided; the second to aid the treatment of the doctor in the health procedures. At present a doctor is required to go before the health committee each year while under suspension. The Bill will enable the committee to suspend the doctor indefinitely while giving the doctor the right to a further hearing once every two years.
I should also particularly like to mention the very knowledgeable and wise contributions from the past presidents of the GMCthe noble Lords, Lord Richardson and Lord Walton. At times it has been difficult to find anything further to add to what they have said.
I hope that Sir Robert Kilpatrick will see the passing of this Bill as a fitting tribute to his presidency of the General Medical Council. I know that the work he has started will be ably taken forward by his successor, Sir Donald Irvine.
Finally, I should like to thank the officials who have helped me with this Bill and for the co-operation I know they have given to Members of this House seeking information. They have worked with diligence. They
We have discussed this Bill thoroughly. I thank all noble Lords who have taken part. Your Lordships' scrutiny has again demonstrated the importance of this House as a revising Chamber. The Bill, although small, is important, in that it marks the determination of the General Medical Council to grasp thorny issues in the interests of patients and the good name of the medical profession. I commend the Bill to the House.
Baroness Jay of Paddington: My Lords, since this Bill was first introduced in another place, we on these Benches have supported its principles. We now wish it a smooth passage on to the statute book. The General Medical Council has rightly recognised the need to extend professional self-regulation so that an assessment can be made and, if necessary, sanctions be applied to a practitioner whose professional performance may be deficient. That is clearly appropriate today, when the increased use of medical technology and rapidly expanding scientific knowledge, together with rising levels in patients' expectations, place new demands on doctors.
We have been very grateful for the detailed and helpful briefings and background information that the GMC provided. We were particularly grateful for the way in which some of the points that we on this side of the House made in debate have been incorporated in its new guidance to the medical professioneven though none of our amendments was successful.
Noble Lords will be aware, as the Minister reminded us, that the General Medical Council has in the past few weeks fulfilled an earlier commitment to issue new professional standards of guidance. This comprehensive pack of booklets called Duties of a doctor replaces the old "blue book" which was discussed at length and in various contexts at earlier stages of the Bill.
The new guidance contains new duties. For example, one of the important issues that we on these Benches and other noble Lords raised at Second Reading and in Committee is the difficulty of regulating that area of a doctor's performance that relates to a doctor's personal behaviour, to his or her personal "bedside manner". It is something that may be of great significance to a patient. I am therefore very pleased indeed that the new guidelines strongly emphasise these matters. In fact, the headline principles included in every booklet and on the front cover of the folder containing them, include the following points:
I am less happy that the specific issues we raised about methods of financing the remedial retraining for defaulting doctors have not been resolved. Noble Lords will remember that I, together with the noble Baroness, Lady Robson of Kiddington, introduced amendments in Committee to try to ensure that no doctor should have to pay personally for retraining, and that the cost should be borne by public funds. Even at this very late stage, there still seems to be an anomaly in the Bill; namely, a hospital doctor can have his or her retraining fees paid by the employing NHS trust, but a general practitioner may have to pay up to £20,000 from his or her own budget for the retraining. I understand, from a conversation today, that the British Medical Association and the Department of Health are still in discussion regarding this situation. I hope that it can be satisfactorily resolved before the Act comes into operation.
It is also disappointing that the attempts of my noble friend Lord Rea at Report stage to try to rationalise the somewhat cumbersome procedures of the General Medical Council committee structure was resisted; although I must say on my noble friend's behalf that he is grateful for the Minister's replies to his queries which she was kind enough to pass to him in correspondence. Unfortunately, my noble friend cannot be present tonight. He feels that many of the points he raised were covered in the correspondence from the Minister. I thank my noble friend Lord Rea for his support during the passage of the Bill. He is certainly not at the disastrous end of the spectrum of medical practitioners but he does have longstanding experience in general practice and wide connections in the medical profession. These provided a useful touchstone against which we could evaluate some of the proposals.
I also thank the Minister for her very clear explanations at every stage of the sometimes complex procedures for which the GMC provided and which clearly govern all the instances that might arise. I thank her, too, for her helpful response to our amendments. It was noticeable that in several of her repliesindeed, the noble Baroness herself mentioned this in her remarks this eveningthe Minister emphasised that she and the Department of Health are relying on the General Medical Council to fulfil informal understandings about some of the necessary regulation that must be complied with; for example, as the noble Baroness mentioned, to review the "in camera" committee proceedings after three years.
We must all have confidence that the GMC will be able to make the new law effective, in spirit as well as in practice. There is every chance that the Bill will improve the regulation and, indirectly, the performance of the medical profession, as well as improving patients' confidence in their ability successfully to protest at inadequate treatment. The front cover of Duties of a doctor has the following noble aspiration: