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Viscount Mersey: My Lords, perhaps the noble Lord will allow me to say that I in no way wish to associate my views with those of Mr. van Hoogstraten; he is breaking the law by blocking footpaths.

Lord McIntosh of Haringey: My Lords, I am grateful for that observation. I should love to follow the noble Viscount and talk about Wainwright and

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long-distance paths but time will not permit it. However, even though there has been little reference to it, I wish to say a word about the creative industries. Our mapping exercise is the first that has ever been conducted about the economic and cultural significance of the arts, design, music, the media and publishing. It has produced quite startling results. Sixty billion pounds worth of activity in the economy is generated by the creative industries; £8 billion of exports, which is 16 per cent. of the global market for exports of the creative industries; 1½ million employees are involved. Employment in the creative industries is growing at 5 per cent. a year.

It is something to which we have for the first time given the searchlight of government attention. We have set up a cross-departmental or "joined up"--I apologise for the jargon--Creative Industries Task Force. It will look at a sectoral approach to the need for government intervention in encouraging exports, in providing finance for creative ventures and in dealing with issues of intellectual property.

There is a link which I do not wish to neglect from that subject to education. It has been properly a theme of the debate this evening. We are determined to promote lifelong learning. I must emphasise that the lifelong learning we wish to promote is leisure learning as well as vocational learning. I do not remember who criticised Schedule 2 to the education Act 1988 but that Act allowed the Further Education Funding Council to fund leisure courses as well as vocational courses. I believe my noble friend Lord Haskel mentioned it. We do not need to abolish Schedule 2; we have already taken the necessary steps.

We have an education unit within the Department for Culture, Media and Sport. We are concerned to raise standards of cultural education and training in schools and places of learning. I entirely agree with those who say we must start in the schools. I know it was suggested in reference to sport, but we must encourage those working in creative leisure and sports activities to strengthen lifelong learning and fight social inclusion.

In the limited time available, I can speak only briefly about sport, then I shall say a word about social inclusion. Those were themes of the debate.

It is clear that we recognise the enormous importance of sport--especially participation rather than spectator sports--in the spectrum of leisure activities. We value sport not only for itself but also for the contribution it can make to social cohesion and what it can do in particular for young people in taking them away from the disadvantages of living in deprived neighbourhoods. We have already taken serious steps, of which I can pick only one or two; for example, the protection of school playing fields. If any school wishes to sell its playing field, it must obtain the Secretary of State's permission before that can be done, rather than, as in the past, simply considering commercial factors.

My honourable friend Tony Banks, the Minister for Sport, heads a policy action team which is dealing with school sport in particular, sport and art as a means to combat social exclusion.

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Let me say a word about the cost of gyms. I understand that the Westminster Gym costs £300 a year; the gym at the Department of Culture Media and Sport costs only £15 a year. It may be that I should not have said that; there might be some tacit subsidy going on somewhere, I do not know. But what noble Lords have said is entirely right.

What noble Lords have said about the theme of unemployment--and the noble Lord, Lord Cowdrey, was particularly eloquent on this point--is enormously important. We do see arts, sports and leisure activities as a whole as being very important in neighbourhood renewal. Our plan for a new deal for communities, which has been allocated £800 million over a three year period, is directed particularly to that. We have set up 17 pathfinder districts and we have a sure start programme for young people in deprived neighbourhoods, which includes provision for childcare, primary health care, play, sport and support for families. My reference to communities brings me back to what was very wisely said by the noble Baroness, Lady Anelay of St. Johns.

This has been a very positive debate which has covered a lot of ground. Much of it--like noise levels--was entirely unexpected and, I am afraid, has remained unanswered. I hope that I have said enough to indicate the passionate concern of the Government for a good resolution of the issues which have been raised in the debate this evening.

7.41 p.m.

Lord Walpole: My Lords, I would like to thank everyone who has spoken in the debate. Having introduced the subject, once I sat down I really enjoyed the debate.

The Minister has not told me what I am going to do. Has he forgotten my last question?

Lord McIntosh of Haringey: My Lords, this is an enabling government. I would not dream of being prescriptive.

Lord Walpole: Thank you.

My Lords, there were some interesting and surprisingly varied speeches. I would like to thank everyone individually but that would take too long.

I will say, quite honestly, that I have two disappointments. I shall not put them in any order of importance. I am sorry that the noble Lord, Lord Haskel, did not mention anything about cycling; I am also sorry that the Leader of the Opposition, who was some form of a Minister in a previous government, did not come and speak today. I thought he looked extremely nice as a Minister for tourism when he was bouncing around in various things in the early 1980s.

I thank all noble Lords very much indeed. I thank the Minister for the answers he has given. I asked quite a lot of questions and I think I got the answers. If, having spent nearly 10 years in this House, the one thing I do achieve at the end of this debate is to get departments talking to each other and realising that the decisions that individual departments make have an enormous effect

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on other people, I feel that I may have achieved something. I beg leave to withdraw the Motion for Papers.

Motion for Papers, by leave, withdrawn.

Hospital Disciplinary Procedures

7.43 p.m.

Baroness Knight of Collingtree rose to ask Her Majesty's Government whether they will consider the case for changes in the procedure to deal with alleged disciplinary misdemeanours by hospital doctors or consultants, particularly to speed up the process.

The noble Baroness said: My Lords, the situation I raise tonight causes gross injustice. Hospital doctors in Britain today can be suspended from duty and locked out of their hospitals without being told why. They can be left on the rack for months or years with no appeal. Sometimes they are not even informed when an innocent verdict has been reached. Their rights to justice, as defined in international human rights laws, are totally ignored.

Sometimes patients also suffer, not only because of shortages of staff, but when the suspended doctor is the only one who can give a specific treatment. I have at least three letters on my desk at the moment pleading the cause of these particular patients.

I certainly do not support doctors who behave wrongly, incompetently or unprofessionally, but of the 201 doctors suspended since 1986 only 25 have been judged to have acted wrongly. Of the 176 others, some had to wait years to be found innocent; others had to wait for many, many months--but every single one of them has suffered. Make no mistake, suspension in these circumstances involves very great suffering.

Some 13 years ago a resident in my former constituency came to my surgery. She told me that her husband, who was a consultant at the Queen Elizabeth Hospital in Birmingham, had been suspended some 18 months previously and sent home on full pay. She wept as she told me that both she and her husband felt it immoral to take money which had not been earned. And yet bills had to be paid; there was no other source of income and the doctor could not earn money elsewhere as a doctor.

Added to that, suspension has a devastating effect on honest professional people who have status and reputation in their area. Friends, neighbours, acquaintances and, where there are children in the family, even schoolfellows get to know all about it, and a heavy cloud of suspicion and shame hangs over the whole household.

After seeing that poor lady, I contacted the health Minister and the local health authority. I am afraid that little or nothing was done. Two and a half years after that man was suspended he was found to be totally innocent of all the charges against him. But by then his wife had died. I believe that her death was directly

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caused by the stress, worry and upset that she had to undergo. I have never forgotten that lady. I often remember her with shame.

The injustice of that case has been duplicated many times, and it is still going on. What often amazes me is the triviality of the charges made against the doctors. One consultant was suspended because he wrote a repeat prescription for his ward sister. Another one tidied up his patients' files and, in order to slim them down a bit, he took out several of the notes that he himself had made on the many, many visits the patients had made because those notes were repetitious. That was sufficient--he was suspended and accused of wrongdoing. A third consultant, with full official consent, had helped with a charitable appeal for funds for a piece of equipment which was needed in the hospital. His crime was that he actually spent the money which had been raised on the equipment which the hospital needed.

There are scores of instances. I have not the time to mention more than very few. I will mention one more. It concerns a doctor accused of over-claiming for petrol which he had used on official duties. The whole machinery was involved and he was suspended. Finally, checks were made which showed that, far from over-estimating, he had substantially under-estimated the petrol that he had used--in fact by several thousands of pounds. Of course, the local health authority then had to pay the money back--and quite right too.

The situation that I have described costs the health service millions of pounds. Consultants do not come cheap. All consultants who are suspended get full pay throughout the months or years of their suspension. One estimate I have seen calculates that it has cost the taxpayer at least £100 million, not only in salaries that are being paid but in the cost of the inquiries. Expense is involved in setting up panels of inquiries that comprise three people who act as judges. Sometimes compensation or damages are paid because, quite understandably, some doctors sue.

Guilty doctors must be dealt with, but there is no doubt that a great deal of public money, that could be far better spent on patient care, could be saved if settlement was expedited. Whether the doctor is innocent or guilty, the procedure should be speeded up. I do not argue that inquiry should not be made, but a process that may extend over years and years is far too long.

For 13 years I have been raising this matter in letters to Minister and others, in debates in the other place and in parliamentary Questions. I have also taken delegations to see Ministers. There has been a small improvement but cases drag on and too many quite unnecessary cases are brought. The BMA has written to me twice since the announcement of this debate. Its second letter, which I received only on Monday, gives a glimmer of hope. The BMA is making proposals to the Government to alleviate the situation. I know not whether those proposals will bear fruit. Will the new National Health Service Bill help? Perhaps the noble Baroness, in replying, can tell us something about that.

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Some doctors pin faith on the Human Rights Act passed by Parliament last year. They may be right to do so but I am not very optimistic. New rules will certainly help if they are adhered to, but some that are already in place are ignored. For example, I understand that where professional incompetence is alleged there must be at least two doctors on the panel to judge the matter. I know of one current case where that rule is being flouted, and there may be many others. Who checks who is on the panel? Is it right that the health authority that normally brings the case also selects the panel to judge it so that the accuser is both judge and jury? That is positively Gilbertian. Justice may or may not be done but in such circumstances it certainly is not seen to be done.

Surely, there should be a rule that any such panel must inform the accused if he is found to be innocent. One doctor believed that he was still suspended and was forbidden to enter his hospital nearly nine months after the panel had acquitted him of all charges. Nobody told him. That cannot be right.

Another worrying aspect is that suspended doctors are normally forbidden to enter the hospitals in which they work. That is usually their local hospital. If they become ill--many do given the pressure on them--they cannot be treated in their local hospital. One consultant was treated and as soon as that was discovered he was packed off elsewhere neck and crop. I do not know whether or not he got a bed. I believe that to be wrong. If a member of the doctor's family is in hospital that doctor may not visit that relative. I am aware of one case where a doctor's wife was dying of cancer in a hospital and he was not allowed to visit her. That is inhuman.

For a hospital doctor suspension is a terrible event. His present as well as his future is blighted. Obviously, it will be very difficult if not impossible for him ever to get back on the career ladder if he has not been practising medicine for a year or more.

Finally, I believe that the situation that I have described is in breach of human rights as defined in the UN Declaration and the section of European law that deals with this matter. I remind noble Lords that that section has been agreed by the British Government. These doctors enjoy far fewer rights than criminals in ordinary courts of law. Suppose that after a defendant has waited three years to have his case heard the stipendiary magistrate and two other lay magistrates listen to the evidence for five solid weeks and, because there is no case on which they can convict him, they adjourn the matter and then personally go off to seek further evidence which they hope will be sufficient to convict. Let us suppose that after that nothing further is said and the case continues to this very day four and a half years after it began. However black his crime, no criminal can ever be used thus in a British court, but that has happened to a hospital doctor whose case remains unresolved.

I hope that I have made a case for these ill-used men and women and that your Lordships will agree that the procedure must be overhauled and speeded up because the present situation is intolerable.

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7.57 p.m.

Baroness Kennedy of The Shaws: My Lords, I hope that it will be recognised that the noble Baroness raises an issue of substance tonight. She has highlighted the current problems in the disciplinary procedures operated by our hospital trusts. It is right and proper that all professionals should be subject to scrutiny in the performance of their role. It is in the public interest that the highest standards are maintained. It is the duty of the Royal Colleges, professional organisations and hospital trusts to ensure quality of performance. However, the current procedures are ineffective in producing that outcome.

We all want to see bad doctors removed from harm's way, but doctors are being suspended for reasons other than their medical competence. Very many of the cases that come before the panels described by the noble Baroness relate to matters that are totally unconnected with medical competence. Too often, complaints and subsequent suspension derive from all kinds of friction between members of staff, from personal clashes and for other reasons that can be dressed up as harassment and so on. That may mean that the very people from whom we want to protect patients are not subject to discipline, but that those who are competent are subject to unacceptable processes.

Why do the procedures not deal with incompetent doctors? I suggest that there are inadequate review procedures of clinical competence and inappropriate appraisal systems. There is no central procedure to review skill and ability. With respect to the colleges, I believe that self-regulation has not quite got to grips with those problems.

One of the difficulties is the unwillingness of doctors to point out the incompetence of colleagues; yet the best people to judge the skill of a medical practitioner are his or her fellow practitioners. It is sometimes only when the failings become truly gross that doctors steel themselves to act against a colleague.

I have recently had drawn to my attention the case of a consultant who called into question the conduct of a younger colleague. He was concerned, among other matters, about her wearing of earphones in the operating theatre so that she could listen to music on her personal stereo; yet he, having raised that issue and others relating to her conduct, ended up being the one suspended.

My concern is that trusts can suspend without full disclosure of the case against the doctor. There are also no time constraints on the delivery of the details of the complaint. It is therefore difficult to get legal advice to rebut the case before an outcome. This offends profoundly against the principles of natural justice. The doctor is not entitled to representation before a trust panel. There is no agreed national procedure and therefore trusts can deal with complaints in very idiosyncratic ways and by internal procedures. Where a trust is acting against a doctor, which it can do within six months and it can suspend a doctor for periods which are often very much longer, because the procedure is an internal one there is no person from outside the trust on the panel. As the noble Baroness, Lady Knight,

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indicated, this can mean that the complaint coming from the trust is heard internally by members of the trust. There are unconscionable delays, as the noble Baroness indicated, from months to years, and there are no rights of appeal.

All these matters fly in the face of the principles of justice that we would expect in every other area. As a lawyer, unlike the noble Baroness, I imagine that these actions by trusts fly in the face of the Human Rights Act which will come into force next year and I expect that there will be many hearings before our courts calling into question the acceptability of such procedures. It seems to me that this is an opportune time for the Government to put in place national guidelines and proper procedures which adhere to the principles of the Human Rights Act.

The effects of such hearings on the lives of doctors who are eventually cleared of any failure on their part are considerable. It does not take much to imagine the effect. Stigma can often remain, even though a person has been cleared. There is always the horrible business of people imagining that there can be no smoke without fire. Career momentum is interfered with when many months out of action can be involved. The stress is considerable and is felt not just by doctors, but also by their families.

The cost to us, the community, is also considerable, in precisely the way that the noble Baroness outlined, not just financially but because in many cases we then lose the performance of able and committed practitioners.

We are talking about something substantial: the existence of procedures which are unacceptable. Although it is right that there must be ways of bringing to book people who behave badly within the professions and that that should be done with alacrity, it is only right and proper that doctors, like everyone else, are given the opportunity of having the case put before them clearly and of defending themselves, that that is done with speed and that they are able to have proper advice as to the conduct of such hearings. It is also right that at an early stage when a complaint has been made they should be allowed to have an independent adviser with them at any disciplinary step.

I hope that, on hearing these concerns, the Government will put proper procedures in place with speed before the Human Rights Act comes into force.

8.4 p.m.

Lord Colwyn: My Lords, I too should like to thank my noble friend Lady Knight for asking this Question this evening and to congratulate her on her persistence with this subject. In view of the extensive publicity given to medical problems recently, her timing is perfect and I hope that it will give the Government a chance to clarify the position and assure the medical profession that there is not a national campaign against consultants and doctors.

I should declare an interest in that I am a council member of the Medical Protection Society, which provides indemnity for tens of thousands of doctors in

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this country and all over the world, and chairman of Dental Protection, which looks after over 40,000 dentists worldwide.

The medical profession is--and I am sure, will remain--subject to more systems of accountability than any other. One clinical incident may give rise to investigations under the NHS complaints and disciplinary procedures, perhaps including the health service commissioner, a coroner's inquest, a clinical negligence claim, a General Medical Council inquiry, a criminal prosecution and, if the doctor is in the Armed Forces, a court martial. The Secretary of State repeatedly tells us that the vast majority of health professionals are doing a good job, often in difficult conditions. It is the responsibility of all of us to ensure that those circumstances are not more difficult than they need be. In the wake of the recent Bristol inquiry, the Secretary of State for Health, the right honourable Mr. Frank Dobson, appeared on the television programme "Newsnight" to say that, in his view, all three surgeons should have been struck off the medical register. Leaving aside the effects of this injudicious comment on Mr. Dhasmana--he was the one surgeon whose name remained on the medical register--and the doctor's employment difficulties, Mr. Dobson's comments appear to have precipitated a rash of suspensions, special leave and other euphemistic alternatives for enforced absence from work.

In employment law suspension is meant to be a neutral act, but when a doctor is suspended his colleagues and the rest of the hospital staff inevitably discover the fact soon after his departure. As the noble Baroness, Lady Kennedy, said, believing there to be no smoke without fire, the doctor's reputation is already tarnished. The news is likely to reach patients and the press, where coverage damns the doctor's conduct before any investigation has commenced, let alone concluded.

Doctors should be suspended from work only when patient care is jeopardised. Periods of suspension must be minimised by ensuring that the doctor concerned is immediately informed of the reason for suspension and given access to all documents on which the trust relies or that are necessary for preparing the doctor's defence. A timetable must be agreed, rather than imposed, as soon as possible. Following assessment--and assuming, as is usually the case, that the doctor will return to work--return to work must be properly managed. Colleagues must be made aware of their own responsibilities to facilitate the doctor's return.

The current zeal for suspending doctors from their work, often for considerable periods, militates against the efficient running of the National Health Service and the public interest by diverting funds from patient care to payment of legal costs and, in some cases, payment of compensation. Furthermore, it lowers the morale of the medical profession--already at a low ebb due to resource shortages--further exacerbated by suspensions.

But the rash of suspensions is just one way in which doctors are being treated unfairly. Last week, two junior hospital doctors who had been working at Great Ormond Street Hospital were acquitted of the manslaughter of

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Richie William. Richie's death is a tragedy. His family, and in particular his mother, have, I am sure, the deep sympathy of this House and the entire nation. The headline in the Daily Mail the following day read:

    "Shameful--Hospital blunders killed this little boy but these doctors won't say sorry".
A photograph of the two doctors was also featured on the front page. The facts of the case were set out in detail in court. It was reported that Richie's death was considered to be due to a number of procedural problems within Great Ormond Street and in fact no criticism was made of Dr. Murphy at all. Yet in a factually inaccurate report, the Daily Mail took it upon itself to castigate the doctors. Like lawyers, politicians and anyone else one cares to mention, doctors make mistakes. The nature of their work means that those mistakes may result in permanent injury or death; and, should a doctor be at fault, that doctor must live with the results of that error for the rest of his or her life.

Morale in the medical profession is low. The time has come to replace the rhetoric with action and educate the public, and those who manage the NHS, away from the current blame culture to more realistic expectations and the creation of a more supportive environment in which doctors can care for their patients without constantly having to look over their shoulder. Doctors must be accountable, but there is no point in allowing investigations to linger on for interminable periods, undermining the efficient delivery of healthcare.

8.10 p.m.

Lord Rea: My Lords, I, too, congratulate the noble Baroness on her persistence in beavering away over the years at this thorny problem. In all cases, as all noble Lords have said, whatever the outcome, to be suspended has a serious and lasting effect on the career of the doctor concerned. Although suspension is supposed to be a neutral act and not a disciplinary procedure, there is a natural tendency to regard it as an accusation of some wrongdoing which has a basis in reality.

Although the noble Baroness's Question applies particularly to medical staff, many of the points she raised could well apply to the suspension of other professional staff in the National Health Service, in particular nurses. Although I do not have details of cases against nurses and suspension of nurses, the position could well repay scrutiny.

At the outset I should say that as a doctor I am perfectly well aware that the work of some in my profession is not up to standard and that action needs to be taken to remedy that. The noble Lord, Lord Colwyn, mentioned the Bristol case; and during our discussion we must bear in mind all the points he raised. However, I am also aware that the Government are not satisfied with the current situation of disciplinary procedures in trusts. In October they announced that they were undertaking a review of the procedures. I am not clear whether that review is now under way. Perhaps the Minister can give us a progress report and, even if the review has not started, perhaps she can tell us what the remit of the inquiry will be and how the Government are intending to conduct it.

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It might be helpful to mention some of the points raised by the BMA's Central Consultants and Specialists Committee--the noble Lord, Lord Colwyn, referred to it--as matters which should be considered by the review. I quote directly some of the comments made by that committee. The first is this:

    "Suspension ... should be seen not as an automatic response to a problem, but as a step to be taken only when other possibilities have been considered. For example the doctor might well agree to cease certain areas of work during an investigation"--
but carry on in other areas. Secondly,

    "There is a need for uniform and clear criteria on when suspension is or is not appropriate, for example when patients are clearly endangered"--
as the noble Lord, Lord Colwyn, said--

    "or when investigation would otherwise be seriously hindered".

The third point is this:

    "There is undoubtedly a lack of expertise in many trusts on the handling of such issues, and there is a strong case that medical directors and/or chief executives should be required to seek advice"--
that is, outside the trust--

    "before taking unilateral action. It might be possible for example to establish central or regional units within the NHSE, which would be the repositories of the kind of experience and knowledge previously held by Regional Medical Officers, when disciplinary matters were handled at region before 1990".
The committee believes that,

    "there is a strong case for a return to national guidance on disciplinary procedures, which would ... bring greater uniformity and fairness to the handling of these problems".
The committee continues that,

    "There is a need for readier redress for doctors whose cases are mishandled by employers ... [and for those] subsequently exonerated compensation should be automatically available.

    When problems are identified facilities for remedial action need to be more readily available and more widely understood. Retraining in particular is an area which has hardly been developed".
And in a number of cases if such a system were in position there may well be no need for suspension. The committee states:

    "The profession is aware of the practical difficulty involved in providing a supply of appropriately experienced external assessors who can be rapidly called in to advise. There may need to be a more co-ordinated approach to the provision of this service, which is currently handled in a piecemeal way by a variety of organisations. Employers must also play their part by releasing consultants to act in this capacity".
Here I assume that it means other NHS trusts, and possibly private employers. I should have thought that most unbiased people would accept those points as entirely reasonable.

It is not clear at present how frequently suspensions arise. The National Health Service only holds information centrally on cases lasting more than six months. On 5th October there were apparently only 11 cases still unresolved, according to a Written Answer by my noble friend. To my mind 11 cases lasting more than six months is still 11 too many. The noble Baroness, Lady Knight, has given details of the case of Dr. Bernard Charnley, whose case has taken more than four years to date. That may be a record; I am not sure. The BMA says that it is aware of 25 cases in England alone where it is playing a

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supporting role. There may well be others involving those who are not BMA members or who have gone directly to a defence organisation of which the BMA is not aware.

It seems to me wrong that each trust has its own procedures. In a national service, surely national procedures should apply. Trusts should not act arbitrarily. Giving them that power in 1990 was a mistake by the former government. Why do not this Government put that right?

I also feel that unless there is a gross error or very persistent clinical incompetence, suspension should be a last resort, as the consultants' committee says. If there were speedy procedures, with an outside, independent assessor, together with some system of remedial retraining and/or conciliation, not only would suspensions be less frequent, but some clinical staff might be guided towards better practice, and recalcitrant or over-zealous management could be guided into more constructive dialogue with clinicians at an earlier stage.

I take this opportunity to raise the issue of the so-called Henry VIII powers in relation to the profession's regulatory body, due to be introduced in the forthcoming NHS Bill. Has my noble friend any extra preliminary information she can give us about the contents of the forthcoming Bill?

I conclude with the remarks of the BMA, which states:

    "While speedier processes would of course be helpful, a balance must always be struck between speed on the one hand and the need on the other hand to provide for rigorous examination of the evidence, representation of the parties and an appeals process where appropriate.

    Dismissal of a consultant is an extremely serious matter which can effectively end a professional career, and it has always been acknowledged that the processes involved must be seen to be fair and legally robust".

8.19 p.m.

Lord Clement-Jones: My Lords, I add my congratulations from these Benches to the noble Baroness, Lady Knight of Collingtree, on raising this debate. It is not only extremely well timed. What was also impressive was her detailed examination of the disciplinary process and also some of the case histories that she went into. I must bow to the intimate and detailed knowledge which has been demonstrated in this debate by a number of your Lordships.

It is a difficult area. Changes clearly need to be made to the regulation of the medical profession and medical practice in the light of the Bristol case and the Ledward case; but, by the same token, there is great anxiety in the medical profession with changes coming down the track, especially when proposals such as the idea of individual naming and shaming by the Committee for Health Improvement are expressed by Ministers. There are some, and I do not agree with them--it is somewhat of an exaggeration--who have even written about a McCarthyite culture taking root.

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As has been clearly expressed today, a great deal of anxiety centres on the act of suspension by hospital managements. There is first of all the issue of cost. It has been put to me that the NHS spends something like £2½ million for every senior hospital doctor it finds guilty of misdemeanour. I find that a staggering figure. I am not sure whether it can be relied upon, but it has certainly been mentioned. One case in Wales which has been documented cost the NHS over £½ million pounds to determine.

It is not only the cost which is cause for concern, however, but the length of suspension. From the most recent figures which I have been able to obtain, between March 1995 and 30th September last year some 44 suspensions lasting for over six months have been reported. In one case it appears that suspension ran for 11½ years. Reinstatement becomes quite impossible after long periods of suspension. Huge personal distress is caused, in some cases leading to suicide.

One of the allegations made is that suspensions come first and investigation then follows. It is also alleged that premature suspension is becoming increasingly the case. The rate of suspensions appears to be greatly on the increase since the Bristol case, although there are as yet no hard figures. It is also important to ensure that formal suspension is not substituted by informal suspension, with the use of devices such as gardening leave, which also appears to be on the increase.

I welcome the Government's review announced in October, but I would echo some of the questions asked previously. Has that review body been set up? Who is on it? When is it planned to report? All those concerned with the current situation agree, however, that for a disciplinary process to be fair there needs to be new and clear guidance as to what first of all constitutes an offence justifying dismissal; what is professional incompetence; what should or should not be included in a tribunal hearing, and when suspension is appropriate. Above all, there needs to be a clear understanding that the rules of natural justice or due process must prevail. Your Lordships have mentioned the extremely important right to representation and advice, and also the issue of the selection of the disciplinary panel.

It is also alleged that the current system does not accord with the Human Rights Act. I was most interested to hear what the noble Baroness, Lady Kennedy of The Shaws, mentioned. Have the Government obtained legal advice on the subject of the Human Rights Act and as to whether current systems accord with it?

Is part of the problem now that local codes apply and not, as before, a national code of disciplinary procedure? In my view, the BMA does make a strong case for a single national code of hospital disciplinary procedure.

Other aspects also need to be considered as part of the disciplinary process. We need to make sure that there are proper mentoring arrangements, especially for

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younger doctors. There is a seeming conflict, for example, between one principle in the GMC's Good Medical Practice code and another. For instance,

    "Doctors should do nothing to make any patient doubt a colleague's knowledge or skill",
yet there is a clear duty in the code to inform about colleagues who they believe are incompetent. Information about processes such as "the Three Wise Men" should be readily available in hospitals.

On the wider issue of the governance system, there appears to be somewhat of a tangle of regulation. There is the GMC; the National Institute for Clinical Effectiveness setting standards; the new Commission for Health Improvement providing external audit; monitoring for our performance tables; new duties on hospital trusts; the medical colleges, where the Academy of the Royal Medical Colleges is drawing up outcome measures against which performance can be assessed; the Audit Commission, which will still have a role in external audit, and the national service frameworks, which will be rolled out year by year.

I welcome this drive towards quality, but the Government need to ensure that there is clear guidance in order that the system is fair both for the patient and for the doctor. At the end of the day, we have to remember that the whole purpose of the disciplinary and quality framework is to ensure that quality is guaranteed in the health service and that public trust and confidence are restored and maintained for the individual patient.

It means achieving standards so that whistle-blowing is not necessary. It is not just about checking competence, but about making sure that at every stage quality improvement is achieved across the whole workforce and not just hospital doctors. Importantly, the disciplinary process and the standard setting process must mean that natural justice is not lost for the doctors who are involved. That is the clear message coming through this debate today.

8.25 p.m.

Lord McColl of Dulwich: My Lords, I too add my thanks to the noble Baroness, Lady Knight, for drawing our attention to this difficult problem and for persisting in her campaign. She is a great fighter for just causes.

From what has been said so far, it is clear that many health authorities are in a somewhat confused state on this issue. It reminds me of a number of soldiers wandering round in a desert, completely lost. They suddenly caught sight of a general. They rushed up to him and asked, "Do you know where we are?" He was angry that he had not been properly saluted, and so on, and replied, "Do you know who I am?" The soldiers said to one another, "We are in dead trouble now. We don't know where we are and he doesn't know who he is"!

One of the problems with the NHS is that it is a monopoly employer, so that if a consultant is suspended he cannot work. Even if he were in private practice, it frequently follows that the private sector also suspends that consultant. Not only is the consultant totally deprived of work; his income may be halved or more than halved. As has been mentioned, if a clinician is

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suspended, his skills soon diminish and his reputation too. If after several years he is completely exonerated, his practice is very difficult to re-establish. Having a monopoly employer has its disadvantages: it can be a rather unjust tyrant.

Some consultants have been suspended for as much as four years or even longer. This is totally unacceptable. What kind of justice is that? Furthermore, the question of compensation does not arise unless some litigation follows.

Some people are completely broken by the experience. It may quite literally kill them. It has long been known that people can die of grief, and this has now been scientifically established. Such is the trauma of unjust accusations and suspicions that the immune system of that person may be so severely impaired that they become susceptible to severe infections, and even to cancer, and may succumb. The noble Baroness, Lady Knight, has already given us an example of this.

The noble Lord, Lord Rea, quoted a figure of 11 outstanding cases. On this side of the House, we believe that that is a great understatement. I should be grateful to the Minister if she would enlighten us about that. It is probably a much greater number than that.

I too emphasise that if a doctor is incompetent and if he has done something to warrant suspension, clearly that must occur. It is quite unacceptable for doctors not to be accountable. It is reasonable to suspend a doctor if the employing authority genuinely feels that he is a danger to his patients. No one will argue with that.

So far in this debate we have not mentioned the private side, where the situation in many respects is even worse. There are no nationally accepted procedures in the private sector for dealing with complaints from patients and no accepted procedures for investigating a private practitioner's professional conduct or performance. There do not seem to be safeguards in place to protect patients or doctors in the private sector. Therefore, the only option available to private hospitals is to refer a complaint or concern to the GMC. Occasionally a private hospital may suddenly forbid a consultant to use its premises and need give no reason for so doing. The Royal College of Surgeons has been helpful in encouraging the private sector to accept one of its advisers to do a quick investigation into an alleged irregularity. That may later lead to a complaint to the GMC.

The Medical Defence Union has drawn attention to more than a dozen cases where the doctors have been advised by their senior partner, chief executive or medical director that they must not work or else they will be suspended. Others have been ordered to take study leave, special leave, sick leave or gardening leave, which sounds attractive at first sight. That is to enable undisclosed allegations to be investigated.

Not only are those investigations not spelt out, but those doctors were denied any of the other courtesies specified in the NHS Executive's guidelines HSG (94)49; for example, regular updates on the progress of the investigations. Some were kept in the dark for up to six months until they faced formal suspension and disciplinary proceedings. Others were

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asked to retire, not knowing what had precipitated the request. Others went back to work and were never told why they had been on leave. The Medical Defence Union's request for details of those allegations were refused on the basis that they were confidential. They rarely come to light because the doctors affected are reluctant to go public because they are, quite naturally, keen to co-operate as they believe that that is the best way to be exonerated. As the Medical Defence Union rightly said, a doctor who is prevented from working without specific reason is effectively condemned unheard. He naturally feels guilty until proven innocent. That is incompatible with natural justice.

We have dwelt at length on the injustice and the devastating effect which those procedures have on consultants, especially if they prove to be unfounded. But what about the enormous cost? Suspension on full pay for four years will probably cost the taxpayer as much as £0.25 million. That is a complete waste of money. Surely the procedure can be speeded up.

As my noble friend Lady Knight mentioned, a consultant who is suspended from a hospital is forbidden to visit the hospital. In industry, I can understand that an employee who is suspended should not be allowed to enter the building again because he may do commercial damage. Someone working in a situation where either industrial or military secrets were involved would naturally be excluded from the premises. But what is so secret and special about a hospital which should make it essential to exclude a suspended consultant from the premises and unable even to go to his desk?

Clearly what is required is a much more adult and just solution. Suspension is such a potentially serious matter that it should not be the automatic response to a problem. It should be taken only when it is clearly essential. If, for example, a consultant is criticised in the performance of only one type of operation, surely it would be reasonable for an agreement to be reached whereby that particular operation is excluded from his repertoire until the matter is sorted out. The noble Lord, Lord Rea, has already mentioned that.

We need clear criteria on which to determine whether suspension is appropriate; for example, when patients are actually endangered or when the investigation in the circumstances would be seriously hindered in the absence of suspension. It is clearly important that reasons for suspension are given to the doctor and that the continuation of the suspension be reviewed regularly. I agree with the BMA statement quoted by the noble Lord, Lord Rea. The British Medical Association has been absolutely right to press for speedier processes to sort out those problems.

The situation is getting out of hand and it certainly needs to be put right. I hope that the Minister will be able to supply the answer to that very unsatisfactory state of affairs.

8.36 p.m.

Baroness Hayman: My Lords, I too am grateful to the noble Baroness for raising this important issue. We have had a number of extremely well-informed and

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deeply-felt contributions. Perhaps it is appropriate for me to say at the outset that I do not underestimate the stress that suspension can put on an individual doctor and on his family and how that is felt particularly strongly in cases like those raised this evening when later it is found that there has been no wrongdoing on the part of that doctor.

Equally, the length of time that the process may take is unsatisfactory from everybody's point of view. While the stress and distress caused to the individual doctor has been the focus of most contributions this evening, noble Lords have also referred to the cost to the service, both in terms of payment to the individual doctor and the opportunity costs of service that is not being provided to patients. Therefore, there is a fair degree of unanimity in relation to that.

Perhaps I may restate the Government's policy that suspensions should not be used inappropriately. They should be used primarily when a doctor continuing to practice poses a danger to patients or where it is necessary to facilitate a quick investigation into serious allegations. As I say, it is essential that we look at making those suspensions quick. At the moment, some suspensions still last an unacceptably long time at a very great cost to the NHS and to the individuals concerned.

The noble Lord, Lord McColl, asked me about the figures. Because of the particular concern over the length of suspensions, cases lasting longer than six months are reported to the regional offices of the NHS Executive. Since 31st March 1995, a total of 44 cases of suspension lasting longer than six months have been reported. As at 30th September 1998, the latest date for which figures are available, 14 hospital and community medical and dental staff, including nine consultants, have been suspended for more than six months. That is based on the information which we request centrally but the review, to which reference has been made and about which I shall say more later, will undertake further fact finding to establish more exact figures because, as I say, at the moment, we have no figures available for suspensions lasting less than six months.

I should like to reiterate too that suspension is not a punishment; it should be used only as an essential tool to ensure quality of care and a level of protection to patients. The need to protect patients, though for obvious reasons it has not been uppermost in our debate tonight, is acknowledged and has been acknowledged by speakers. It must be at the heart of government responsibilities.

However, we must strike a proper balance between our responsibilities to protect the interests of patients with that of ensuring that doctors are treated fairly, humanely and with the minimum of delay. The current guidance to the health service aims to ensure that avoidable suspensions do not happen and that, if practitioners are suspended, it is for the minimum necessary period of time. But, of course, as contributions tonight made clear, there is dissatisfaction with the achievement of those objectives.

In answer to the specific question from the noble Lord, Lord Clement-Jones, as to whether current suspension procedures meet the human rights

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requirements of the European convention, the legal advice is that they do. But we are currently discussing with the General Medical Council the implications of the Human Rights Act on its procedures; NHS procedures, equally, will have to be compliant with the ECHR.

It was because of the recognition of the problems and concerns raised tonight that my right honourable friend, Mr. Alan Milburn, in October 1998 asked for a review of current procedures. I have been asked about the aims and remit of that review. It is to produce clear guidelines on when suspension is appropriate; to reduce the time that doctors are suspended before a decision is made; to avoid the issue to which the noble Lord, Lord McColl, referred--the unnecessary costs of long suspension--and to seek to strengthen local capacity to deal with complex cases. That issue was raised during the debate. It is not an outside and external review; it is being carried out internally, but will consider the evidence submitted to it. The BMA's contribution, to which reference has been made, will obviously be particularly useful in that area.

I am always nervous of giving a date by which reviews will be completed or announcements made. I certainly hope it will not be the length of time that some of the suspensions to which reference has been made tonight have taken and that it will be within the next few months.

Many of the issues raised are ones at which the review will have to look. As I said earlier, many issues need to be resolved: the grounds on which suspension is instigated; the information given to a suspended doctor; the issue of the composition of any panel; the timetable during which specific stages of the process have to be completed; and the issue of the perception of the problems that arise as a result of the body which undertakes the review being one that is appointed by the accusing body, the NHS employer. I do not say that that will be simple because some areas are quite complex; but they are the areas on which the review is focusing.

Reference was made to the lack of natural justice inherent in the current processes. The noble Lord, Lord Colwyn, referred also to the varying different processes to which a medical professional who is considered not to be performing properly may be subject. We must recognise that we have a primary duty of care to the patient; and that when a patient goes into hospital he or she needs to be properly protected and their health and safety safeguarded. It is an irony of the present tangle of regulations, to which the noble Lord, Lord Clement-Jones, referred, and to that variety of disciplinary processes that, despite them, we do not always achieve the high standards and public protection that we seek.

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