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Lord Kilpatrick of Kincraig: It is almost three years since I spoke in this Chamber. The occasion was my maiden speech. I was acutely aware of a remark by Sir Winston Churchill about a fellow Member in the

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other place. He said of that other Member that he had missed a great opportunity to remain silent. Accordingly, as I am now on my feet, the Committee will realise just how strongly I feel about the provisions of the Bill and how totally supportive I am of the amendments that have been described in detail by my noble friend Lord Walton.

In 1992, when I had been President of the General Medical Council for three years, the GMC unanimously backed me to approach the then government through the Privy Council to widen the powers of the council to include performance. At that time its powers relating to fitness to practise were confined to misconduct and health. This was a fundamental change because it allowed the council to deal with a deficiency in the day-to-day pattern of professional practice. I believe that a pattern of behaviour of that kind is confined almost exclusively to the medical profession. That cannot be dealt with under the criminal law. Therefore, the proposal was very far-reaching.

That approach having been made in 1992, it was three years before legislative time was obtained. Even then it was on the basis that the council could use its persuasive powers to gain all-party support, which it did. At that time, the noble Baronesses, Lady Cumberlege and Lady Jay, and Lady Robson, (sadly no longer with us) supported the provision and the Act was amended. Having had that experience of extensive consultation and detailed scrutiny which goes into a piece of primary legislation, I am convinced that no fundamental change should be made to a regulatory body such as the General Medical Council, although there are others, except by primary legislation.

At the same time, I am very supportive of the suggestion of having order-making powers. The General Medical Council wishes it had had them a long time ago. I can give a good example of that. From 1978, the council was allowed to deal specifically with the ill-health of doctors. However, under that legislation, which was introduced in an amendment to the original Medical Act, we were unable to suspend a doctor on grounds of ill-health for longer than one year at a time. Having chaired the council's health committee for some years, I found that it had to bring doctors back year after year, building up a large clinic. Clearly, the council needed the ability to impose indefinite suspension for some chronic disorders. In fact, that ability was tacked on by an amendment to the Medical Act relating to performance. However, it would have been a good example of order making not to change a fundamental function but to improve a particular function.

I am struck by the Explanatory Notes which accompany the Bill because they refer frequently to professional regulation. That means the regulation of a profession. The words "professional self-regulation" do not appear in the Explanatory Notes. That is the regulation of a profession by a profession with significant lay input.

I was not able to attend the Second Reading of the Bill, but I know that the noble Lord, Lord Ewing, who I know very well because we come from the same part of the country, said that the professions and the press

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never put their house in order until they are under threat of legislation. That is just not so. It was the General Medical Council which initiated the suggestion relating to performance, and it had to wait three years before parliamentary time was found.

Furthermore, it is frequently said that doctors and the profession are always defensive, but the important question in relation to the Bill is what is to be defended. I can envisage the possibility that Parliament might abolish a regulatory body such as the General Medical Council, which is not possible under the Bill; or it might remove a fundamental function from the regulatory body, which is possible under the Bill. If either act occurred, the position in the United Kingdom would be the same as in the majority of countries of the world. Only a minority of countries have professional self-regulation. They include Australia, New Zealand, Canada, South Africa, the Republic of Ireland and the United States. But if the United Kingdom were to become like the majority, something would be lost. There is a close and significant correlation between high standards of medical practice and professional self-regulation.

I endorse totally what was said so eloquently by my noble friend Lord Walton concerning all the amendments. I urge upon the Minister our view that there should be no transfer of fundamental functions from the present regulatory bodies and that primary legislation and the order-making power should continue within the context of the present regulatory bodies and professional self-regulation under the present relationship with the Privy Council.

Lord Clement-Jones: I rise to add the strong support of these Benches for the amendments. We expressed our considerable concerns about Clause 47. The amendments, which are vastly superior to our Amendment No. 206, go to the core of addressing the concerns of the professions allied to medicine about the terms of the clause. The clear and authoritative exposition of the noble Lord, Lord Walton, was perhaps too modest in expressing the absolutely united view of all those professions about the amendments and about the absolute necessity of altering Clause 47 to incorporate the safeguards.

The huge volume of mail in my postbag, which is awesome to behold, indicates the way in which the professions have united behind the amendments. I believe that they are very much in the interests of the public. It is not a matter of professional self-protection but of public protection. It is quite clear that if self-regulation is to continue, a hard core of elements must remain. The noble Lord, Lord Walton, clearly expressed them as the Privy Council relationship; lay member composition; no transfer without consent; no abolition; the levels of penalties; and jurisdiction over fitness to practise. Those are absolutely essential elements. They are not contained in the primary legislation and they must be if self-regulation is to be protected.

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In an extremely authoritative contribution, the noble Lord, Lord Kilpatrick, made clear the argument about flexibility. Of course we need flexibility, but we must have in primary legislation that core element to safeguard self-regulation.

The noble Earl, Lord Howe, made a strong point about the good will of the professions. In a time of change, we need that good will if we are to ensure that all the new elements are incorporated. The GMC-- I single it out, but the point applies to other professions--has made massive strides, in particular with revalidation. Sir Donald Irvine has shaken up the way in which the medical profession is being regulated and we should welcome that. In return, we should provide those elements in order to ensure that the system, which is beginning to work much more effectively in rooting out incompetence, can work in a proper fashion. I urge the Committee to support the amendments.

5.30 p.m.

Lord Desai: I rise to express doubts about what is going on. The more the noble Lord, Lord Walton, spoke I became worried. Perhaps I may express my experience as a lay member of the Bar Council's committee of professional conduct. All that the Bar Council is worried about is that solicitors do not poach barristers' business. That is all it is interested in. Presumably, solicitors have the same worries about barristers.

It seems to me that self-regulation utterly failed in the City; we know that it failed. Before that, similar arguments were heard about how great self-regulation was. As a reader of newspapers, especially tabloids, I come across many scandals in the health service concerning the provision of medical care for patients. I do not know the technicalities. I am sure that everybody is very careful, and safeguards their professional standing. However, it does not seem that everything is all right in the way that doctors treat patients. I could make a similar comment about judges and barristers, but I shall not do so. However, we can no longer presume that the old regime will stay. Patients want to know more; they demand explanations; they are not satisfied by the way they are treated; apologies are late and appalling things happen.

As an economist I come from a non-regulated profession and I can do only limited harm to people. Anybody can practise as an economist. It is interesting how the debate has concentrated mainly on doctors and the General Medical Council. Of course, it is a most powerful profession, and it is difficult to do anything about doctors or lawyers in this country.

I welcome some of the provisions in Clause 47. The time has come when the public has to know that their interests are being looked after by somebody, and that somebody must be the Government. We can no longer take for granted that the public's interest is properly guarded by the professions. The noble Lord, Lord Kilpatrick, denied the fact that professions do not reform themselves until there are complaints. I believe that professions change only when there is a big row or a big scandal. Thank God that the press in this country

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makes a big row. There have been bad judgments from law courts, and mistakes have been made. I believe that self-regulation is very good, but, as my noble friend Lord Peston stated, we have paid a high price for barriers to entry in return, perhaps, for better quality. The Government must have power to give the public the assurance that if something goes wrong, they have one friend--the Government.

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