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Lord Patel: My Lords, much of what I wanted to say has already been said, and so I shall be brief. I declare an interest, in that I am a current member, although rather green, of the GMC council.

I support the order and the five elements within it of powers of interim suspension, a tougher restoration regime, a duty to disclose to the Department of Health and employers, a power to co-opt non-members on to the fitness to practise committees, and a power to take action on overseas convictions. The provisions will strengthen the self-regulatory role of the GMC. The argument about three or five years has now passed; and I believe that we should settle for five years.

The order is only a small step towards a modern framework of medical regulation. Far more significant, I believe, will be embedding the process of revalidation, the proposals emerging from the structural review regarding fitness to practise, and the review of the constitution and governance. I would support a smaller council and 50:50 lay:medical membership of the GMC.

I agree with my noble friend Lord Walton that the BMA resolution was at the least unfortunate and unwarranted. There should be no doubt of the GMC's commitment to reform and the strengthening of self-regulation. I support the order.

1 p.m.

Lord Hunt of Kings Heath: My Lords, this has been a remarkably well informed and interesting debate. The noble Lord, Lord Walton, was an outstanding president of the GMC and did many things to modernise the GMC during his presidency. I noted

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with interest his comments about his frustration in trying to get changes made to its procedures. This is the first time we have debated an order laid under the provisions of the Health Act 1999. The order concerns a crucial matter. I am happy to pay tribute to the GMC's role in helping us take these matters forward.

The noble Lord, Lord Walton, mentioned the public debate on the role of doctors, the public's perception and the kind of media flurry that we have witnessed in the past few weeks. I say to the noble Earl, Lord Howe, that I continue to pay tribute to the vast majority of health professionals in this country and to doctors in particular. As we take forward the changes to the health service and the national plan, we need very much to walk arm in arm with those professionals. The whole process of developing the national plan has involved many doctors and other professionals, leaders of the professions and people in the field who are leading change. That is the partnership approach. It is the only way in which we shall establish the kind of changes we wish to see in the National Health Service.

The noble Earl, Lord Howe, and the noble Lords, Lord Walton and Lord Patel, referred to the deliberations of the BMA last week. All I say in that context is that I believe that it is in the best interests of the profession and the public that the profession as a whole pulls together, works together and marches in the same direction. That is also the foundation on which we wish to work in partnership with the profession in regard to the changes that need to take place in the health service.

The noble Lord, Lord Walton, referred to the workload of members of the GMC. I do not think that anyone can disagree with that. That is why I think that the proposal of the GMC to co-opt 50 non-members, 30 of whom will be lay members and 20 of whom will be medical members, is widely to be welcomed. I am sure that it will greatly assist the GMC, both in bringing in more people from outside but also in dealing with the backlog of cases on which I shall comment in a moment.

I turn to the five-year minimum erasure period. I was glad that the noble Lords, Lord Patel and Lord Clement-Jones, supported that period. I am aware that there has been considerable debate as to whether that is the correct period. However, I reiterate the points that I have already made. The doctors we are discussing represent the most serious cases. When a doctor is struck off, he or she should not expect to return, save in the most exceptional circumstances. Given the seriousness of the cases that will be considered under these procedures, the Government believe that a five-year minimum period gives practical meaning to the presumption that when a doctor is struck off it ought to be for life.

The noble Earl, Lord Howe, mentioned the position of doctors who are forbidden to practise for a lengthy period being unable to gain practical experience of technological and other changes affecting patient care. Any doctor who after the five-year period wished to apply for restoration, must first be able to satisfy the GMC that he or she can satisfy an assessment of

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knowledge, skills and aptitude to practise medicine. This kind of assessment is already in place for overseas doctors who may wish to practise medicine in this country. However, I fully accept that the GMC will need to consider how that test should be applied in these cases.

The noble Earl, Lord Howe, also asked how the five-year period complies with the requirements of the European Convention on Human Rights. I am advised that the right to practise as a doctor has an economic value and therefore constitutes a possession in the context of Protocol No. 1 of the European Convention. An erasure from the medical register is clearly an interference with that possession. There are three tests as to whether any interference is justified: that it is in accordance with the law; that it is in the public interest; and that there is a fair balance between the interest of the individual and that of the public. It is the Government's view that the five-year erasure period is not incompatible with those conditions.

The noble Lord, Lord Walton, correctly pointed out that the GMC cannot erase a doctor struck off in another country without a complaint. The order before us today does not address that matter. However, we shall bear that matter in mind for the next round of changes relating to the GMC's own review of its fitness to practise procedures. I very much take that point on board.

I turn to the question raised by the noble Earl, Lord Howe, with regard to the backlog of cases. I am happy to say that in his letter to the Secretary of State in May, Sir Donald Irvine stated that by the autumn the GMC should not have delays in handling new cases other than in bringing those which have completed screening forward for hearing by the relevant committee. By the end of 2001 waiting times will be within an acceptable standard. We must hope that the addition of new members from outwith the GMC, which I have already mentioned, will very much help that process.

The noble Earl, Lord Howe, asked about language tests. The EC directives on free movement mean that the GMC cannot require doctors of EC origin who have qualified in the EC to satisfy a language test as a condition of registration, although it can in the case of other overseas doctors. However, NHS employers are responsible for ensuring that doctors whom they employ have a satisfactory command of English and can communicate effectively with patients and colleagues. NHS employers have been issued guidance on language testing and their responsibilities. I should be happy to send that guidance to the noble Earl.

The noble Lord, Lord Clement-Jones, asked a number of questions concerning the procedures under which the order will operate. Assuming that the order is accepted by the House today, I confirm that the rules of procedure will be made known shortly. Many of the concerns that the noble Lord has raised will be covered in those rules. There are various safeguards; for example, an interim suspension cannot exceed 18 months. After that period has elapsed, the GMC would have to apply to the courts to seek a further

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extension. In addition, the first review of the interim suspension has to take place within six months and at three month intervals thereafter.

The noble Lord asked whether a doctor could be made the subject of an order without prior knowledge. I confirm that no order can be made by the interim committee unless the practitioner has been afforded the opportunity to appear before the committee or be represented at the hearing. The rules also provide that if a doctor is not present and is not represented, the committee can proceed with the hearing if it is satisfied that all reasonable efforts are being made to serve the papers.

The noble Lord, Lord Clement-Jones, asked a number of questions about information. I understand that the GMC may disclose any information relating to a doctor's fitness to practise or professional conduct which it considers to be in the public interest to disclose. The GMC intends to use this broad discretionary power sparingly and mainly to disclose information to other public bodies and thereby help to ensure that action necessary to protect patients is taken. I assure the noble Lord that the GMC proposes to develop guidance setting out the criteria it would normally expect to apply when disclosing information under this power. The GMC recognises that its use of the power would rightly be open to legal challenge if it was thought to be acting unreasonably.

A number of questions were asked about the whole issue of future regulation. I am afraid that I shall have to disappoint noble Lords; I am not in a position to respond to the questions. These matters are under consideration and final decisions in relation to the GMC need to await the outcomes of the Bristol inquiry and the Shipman inquiry chaired by the noble Lord, Lord Laming. In the meantime we are encouraging the GMC to make proposals for radical reform for consideration by the Government later in the year.

I hope that I have been able to respond to many of the points raised by noble Lords. I am very appreciative of the general support the House has given to this order.

On Question, Motion agreed to.

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