| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Baroness Noakes: I thank the Minister for that reply. However, nothing he has said has explained why a pooled fund is necessary to achieve the results he has outlined; those results could be achieved in various ways. I asked some specific questions but I did not receive specific answers. However, in view of the lateness of the hour, I ask the Minister to reflect on the questions and to write to me so that we can resume our conversation at a later stage if necessary. Meanwhile, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 155 to 158 not moved.]
[Amendment No. 159 not moved.]
Clause 23 [The Council for the Regulation of Health Care Professionals]:
10.45 p.m.
Baroness Northover moved Amendment No. 159A:
- Page 29, line 17, leave out subsection (1) and insert—
The noble Baroness said: In moving Amendment No. 159A, I shall speak to Amendments Nos. 159B, 164A, 164B and 165A to F. Although they appear in a later group, I should also like to speak now to Amendments Nos. 167 to 169 because they are consequential on this group.
The amendments seek to replace the proposed council with a health Joint Select Committee. The Committee on Delegated Powers has advised that limits should be placed on the original powers in the Bill and—as the Minister will shortly propose, which we welcome—that new rules should be the subject of an affirmative resolution by both Houses. We feel, however, that that will leave much that is simply not right about the proposal for an overarching council across the healthcare professions.
Let us return to first principles: what are the Government trying to do, and what should they be doing? Let us hope that their intention is to make the various health professions more accountable and more transparent and to ensure that there is greater co-ordination between those professions. If those are their aims, we fully share them.
In the report on the Bristol Royal Infirmary inquiry, Professor Kennedy recommended the creation of a,
The functions which the Kennedy report envisaged such a council performing included ensuring that there is an integrated and co-ordinated approach between
We welcome the proposal that there should be co-ordination across the health professions in the way Kennedy recommends. But what about accountability and transparency? We have a serious problem with the Government's proposals. We are in danger of setting up another quango to second guess what the regulatory bodies are doing without the depth of knowledge and experience that they have. We are in serious danger of bogging down the council in looking at endless complaints against the professions by jaundiced patients even if the council then rules the complaints not worthy of further consideration.
How can we make things accountable and transparent? The medical profession became professionalised in the 19th century. Self-regulation was part of that. Nursing and the other health professions followed. There are strengths and weaknesses in such independent self-regulation. We have to preserve the strengths and tackle the weaknesses. Accountability and transparency are areas of potential weakness.
We propose that those bodies that regulate the health professions should be accountable directly to Parliament. The health bodies should report each year to a Joint Select Committee, appointed by the House of Commons and the House of Lords. They should report in public and that is where they should answer and be scrutinised. The Minister may say that the Government have no power to request the establishment of such a committee. Indeed, when Frank Field in another place made a similar suggestion he was not even able to table such an amendment. The Government, or others could introduce proposals for just such a committee, and the issue could be debated in both Houses which could decide to set up a Joint Select Committee.
This proposal deserves careful and considered scrutiny, not dismissal on some empty pretext. There is already a precedent in the Ecclesiastical Committee which has equal Members of both Houses of Parliament and which has existed since 1919. The proposal is commanding attention. I note that Sir Denis Pereira Gray, writing on behalf of the Academy of Medical Royal Colleges, welcomed the proposal, supporting the notion that both the GMC and the Post-Graduate Medical Education Standards Board should report to Parliament directly and be subject to open parliamentary scrutiny and recommending a new parliamentary committee to achieve this. He argues that doctors want true, open accountability to Parliament, which in itself is quite a change.
The BMA is also broadly supportive of the proposal of a Select Committee of both Houses to whom the regulatory bodies would be accountable. Meanwhile the King's Fund comments that there is a lack of thoughtfulness in the Government's proposed accountability arrangements for the council. The suggestion that professional regulators should be accountable to the new council, and through it to Parliament, raises more questions than it answers. The King's Fund describes this as an "unsatisfactory fudge" and argues that the lack of clarity risks further alienation of professionals who already feel disengaged from the debate and are suspicious of unspecified intentions. If the Government want professionalism to drive quality healthcare they need to attend to their relationship with those professionals. The King's Fund, as the Minister knows very well, cannot be considered to carry a torch for the professions. The warnings should be heeded.
We welcome the idea of co-ordinating professions and making them more transparent and accountable. We differ from the Government in the route that we would take. We would make the professions truly accountable directly to Parliament and not through yet another quango which, in effect, largely answers to government. I beg to move.
Baroness Carnegy of Lour: This part of the Bill applies to the whole of the United Kingdom, including Scotland, and I am pricking up my ears. Of all the groups of amendments in the Bill, those which confirm the setting up of this over-arching body are the ones that the Government could and should abandon.
My understanding of a profession is that it is defined by the fact that it regulates itself; it is not regulated by anybody else. The Government are now intending to regulate the regulatory bodies. The Minister shakes his head, but one only has to look at the amendment to see the power of this over-arching body. It is extremely dangerous.
I hope that the Minister will find time to read the first Reith lecture, which the noble Baroness, Lady O'Neill, gave, and indeed the second one also. The first was all about the dangers of over-regulation and Byzantine arrangements for answerability, the over-regulation of professionals and the lack of trust in them. The series is about trust and the noble Baroness made some important points that are directly relevant to the Bill. The noble Lord, Lord Hunt, should think very hard about this. It is a dangerous arrangement.
Baroness Finlay of Llandaff: I rise to support Amendment No. 159A and speak also to the amendments which stand in my name.
In relation to the proposal for a Select Committee, although it may be repetitious I must reiterate the need for transparency, independence from any kind of political pressure on the regulatory bodies and direct accountability to Parliament. In his excellent report on the tragic cases in Bristol, Kennedy highlighted the need for liaison between the different professional regulatory bodies. That is different from the way the proposal stands in the Bill at the moment.
In a helpful answer to me earlier in response to Amendment No. 114A, the Minister made clear that it was not in the framework of this Committee to call for the establishment of a Select Committee. Will it be possible to have a separate debate outside this Committee, in the House, to establish whether such a Select Committee could be set up
I agree with the Government's intentions in subsection (2). They are all general principles required to ensure teamwork functions at the highest possible level. Such teamwork functions must not be the lowest common denominator and there must be equity in decision making, discipline and conduct where needed. However, I seek reassurance from the Government that the healthcare professions will not be forced together under the proposed council and the fundamentally different areas of knowledge, skills and competency are recognised as crucial points of interplay of all those within a clinical team.
There is a need for independence of the individual professions. That is how innovation occurs. Clear examples have been with revalidation where the nurses have led on continuous professional development and now the General Medical Council is leading on revalidation.
Amendment No. 165 is compatible with Amendments Nos. 165YA and 165ZA which stand in my name. I speak to them as a doctor registered with the General Medical Council and as president of the Chartered Society of Physiotherapy. Let me explain why the regulatory bodies must remain directly accountable to Parliament. This regulation is a reserve power under devolution. NHS services are evolving differently in different parts of the UK and the demands on the professions may well vary in the four different countries of the United Kingdom.
It is noteworthy that concern over the establishment of such a council has come from all of the regulators, including the new Nursing and Midwifery Council and the Health Professions Council. This concern is not from an old guard, nor is it reactionary. It is from the chairman of the new body. The GMC has proposed and is pursuing radical reforms to introduce revalidation for doctors, to have a smaller and more effective council, dropping from the current 104 to 35 members and to increase lay membership from 25 to 40 per cent. It also proposes radically to reform fitness-to-practice procedures to bring together performance conduct and health issues which are all part of fitness to practice. That will increase transparency and allow the GMC to issue warnings to doctors.
The GMC's document Good Medical Practice is small and easily read and written in plain English. It lays out the contract between doctors, patients and society. It stipulates the practice required for patients to know that they are being treated by safe and competent doctors. Kennedy commends that code in paragraph 45 of his report, which suggests that it should be incorporated into doctors' employment contracts and terms of service.
There is concern that by making the regulatory body subject to directions from the Secretary of State in England, openness and transparency may be
It is a real fear that the healthcare professions will not be truly independent of government and that the goalposts of expectations will be moved. Let us suppose that it is a few months before an election. The polls indicate falls for the Government. Sadly, another disaster happens and healthcare professionals are taken to task by the regulatory bodies, but not struck off. Bereaved relatives, angry and grieving acutely, are desperate for public redress. The press start baying for blood.
We saw exactly that situation in the tragic case of Dr Philip Evans, an excellent GP who had been a personal friend since we were students. He took his own life as a result of unbearably damaging allegations in the local press. How could any government resist the pressure to state that they would re-examine the issues, implying a possible raising of the stakes, even though the decision had been equitable for all the healthcare professions involved and all the evidence had been considered?
An article in the British Medical Journal on medical error by Albert Wu states:
Amendment No. 173 removes the power of direction completely and is therefore to be supported. I support also Amendment No. 166, although I have reservations about its wording, as it would not be practicable for all the professions as a whole to be consulted, although the professional regulatory body should certainly be consulted.
Amendment No. 172 is important. There may be a request which on examination would not be in the best interests of patients. I should be grateful if the Minister would reassure me that the term "co-operation" as outlined in the Bill means that the regulatory body must listen to, consider carefully and make a reasonable decision on an issue. The amendment ensures that one professional regulatory body can stand out for evidence on what is best for patients, even when that position is against the interests of some of the professions.
The Minister has not yet spoken to Amendments Nos. 174 to 179, but perhaps I may outline some of my concerns because I realise that we are running late. I cannot support these amendments because they represent a compromise position between the Bill as it stands and the maintenance and regulation of the healthcare professions as independent from the
Earl Howe: Lest the Committee is in any doubt, I should point out that it is my name and not that of an interloper that appears at the head of this amendment. I should like to express my support for the concept of a Joint Select Committee of both Houses.
The chief defect of the council is that, from the standpoint of each individual health regulator, it purports to offer accountability to Parliament at one remove. As the Bill stands, only the council has direct accountability to both Houses of Parliament. That seems an unsatisfactory way to proceed. While under the Bill the council will be able to exercise control over the individual regulators and (if we accept the government amendments) will be accountable to Parliament for any directions that it may issue, what surely matters to Parliament and to us all, at least as much as any differences of opinion between the council and the regulators, is the way that the regulators discharge their functions year in and year out. If accountability to Parliament in this context is to be taken seriously and be truly visible, that accountability should surely take the shortest route. It should also be delivered in a manner that allows for maximum openness, and, if need be, for cross-examination. A Select Committee to which all the regulators would be answerable would provide an ideal vehicle for the process.
All this begs the question of whether there is any need for the powers of direction to be enjoyed by the council for the regulation of healthcare professions. If the regulators report to and are called to account by Parliament directly, then an affirmative resolution, if ever one were required, could be triggered through the mechanism of the Select Committee and its reports. As has been said, it is not for this place or the Bill to establish such a committee; that is a matter for Parliament. However, the Government's views on the proposal will be of some importance. It would be useful at this stage to hear the reactions of the Minister.
As the noble Baroness has included a later group of amendments with this one, perhaps I can speak briefly to Amendment No. 168 which points to a part of Clause 24 that seems to me to sound alarm bells. It appears to give the Government carte blanche at some future date to widen the remit of the council in virtually any way they choose.
As I read it, paragraph (e) of subsection (9) could allow the council to involve itself in every single area of policy and activity with which a "regulatory body" is concerned. The Explanatory Notes make it clear that paragraph (c) could not be used to enlarge the council's powers of direction, which is important; nor,
"(1) The bodies referred to in subsection (3) shall in each year submit a report to any joint select committee appointed by the House of Commons and House of Lords to perform the functions prescribed in this Part ("health joint select committee")."
"Council for the regulation of Healthcare professionals",
as an "overarching organisation" responsible for bringing together the various health regulatory bodies.
"although patients are the first and obvious victims of medical mistakes, doctors are wounded by the same errors; they are the second victims. Nurses, pharmacists and other members of the healthcare team are also susceptible to error and vulnerable to its fallout . . . They too are victims".
Sadly, human fallibility is an inescapable reality.
11 p.m.
Next Section
Back to Table of Contents
Lords Hansard Home Page