Previous Section Back to Table of Contents Lords Hansard Home Page

Baroness Northover: My Lords, I thank the Minister for that reply. It is clear that debate on the issue is now well and truly opened. Matters are already moving along. I am encouraged by what the Minister has said and implied although I shall study the precise details. In some ways, it is nice to be moving unusual amendments among the 72 other amendments. However, I beg leave to withdraw my unusual amendment.

Amendment, by leave, withdrawn.

[Amendment No. 63 not moved.]

Clause 24 [Powers and duties of the Council: general]:

[Amendments Nos. 64 and 65 not moved.]

Earl Howe moved Amendment No. 66:

"( ) No recommendation made under subsection (2)(c) may include a recommendation to amend an ethical code of practice that has been formally approved by a regulatory body."

The noble Earl said: My Lords, in Committee we debated extensively the functions and the role of the proposed new council for the regulation of health care professionals. In those debates I made clear my support for the concept of such a body, but I also outlined my concerns, which are shared by senior members of the profession, that the way in which the council sets about its business will be critical if the integrity and the ethos of each profession is to be maintained.

"Integrity" and "ethos" are difficult concepts to pin down. However, we can speak of them meaningfully. I believe that the essence of a profession is that it is a body of men and women who determine what constitute proper standards of practice, training and ethical behaviour. That is not to say that there is no other group of people who have a legitimate interest in such decision making. On the contrary, the GMC recognises the value of informed lay opinion, as evidenced by its decision to increase the percentage of

30 Apr 2002 : Column 646

lay members on its governing council. But, as the Minister recognises, there is a sensitivity in these matters.

When we look at the role of the new council, I do not believe that there is any disagreement or difficulty about what I understand to be its principal remit: it is there to make the professional regulators better at what they do. As the Minister put it previously, it is there to provide the "energy for improvement". One example given by the Minister was that we should imagine that the regulators were invited to pool their experience on using the findings of overseas regulatory bodies, so that those bodies with the best systems could spread best practice among the rest. The Minister also spoke of the council as encouraging the regulatory bodies to conform with the principles of good professional self-regulation.

None of the latter presents me with any difficulty, but there is a line beyond which it would be mistaken and wrong for the council to tread. If there is one element of a profession that is fundamental to it, it is surely its ethical code of practice. In medicine, the document Good Medical Practice is now some six years old; well established in the United Kingdom, and internationally acclaimed. In a real sense, its precepts define the way in which the profession sees itself. I would be very concerned if the council were to take it upon itself to make a recommendation to a regulatory body that proposed a change to its ethical standards of practice. Indeed, I would go as far as to say that a lay-dominated council would have no standing on issues of that nature. I should be most grateful if the Minister could enlighten us on the issue, and provide some reassurance. I beg to move.

Baroness Carnegy of Lour: My Lords, I support my noble friend's amendment. In Committee, I said that the concept of this council alarmed me. I am not as sanguine on this matter as my noble friend, but I believe that the professions are somewhat nai ve in assuming that the council does not have seeds within it that could endanger our democracy. I believe that free professions regulating themselves are basic to a democracy.

My noble friend has found a way to improve the Government's proposals. I am sure he is right to say that the ethical standards of a profession and the way that it sees itself are basic to what makes a profession. I should be happy if the Government were to accept this amendment. Indeed, I suspect that a number of people who are not necessarily in the profession but who think about what makes a democracy safe would also be happy. Perhaps the Government will consider accepting my noble friend's proposal.

7.15 p.m.

Lord Hunt of Kings Heath: My Lords, the noble Earl raised a very interesting question in Committee. I have studied carefully the codes of ethical practices. I trust that I can reassure him on the matter. I must draw a distinction between the power of the council to make recommendations to the regulatory bodies and the

30 Apr 2002 : Column 647

power of council to issue directions subject to the parliamentary processes that we agreed, and amended, in Committee.

I must make it absolutely clear that the council does not have the power to compel a regulatory body to accept any changes that it recommends. The council can make directions only in relation to rules that require Privy Council approval. I can assure the House that that does not include professional standards and ethics. Primary legislation does not provide for regulatory bodies to set ethical standards by rules subject to Privy Council approval. However, there may be circumstances where it is appropriate for the council to make recommendations to the different regulatory bodies. That would occur mainly in an effort to encourage greater consistency across the professions, and would go with the grain of the work already taking place within a number of the regulatory bodies.

I am aware that the regulatory bodies have been working together on a statement of common principles for healthcare professionals. The council could, for example, encourage the regulatory bodies to implement that work where it believed that a cross-professional approach would be beneficial. I looked through the code of ethical practice for doctors and found many instances therein that I am sure could apply to the other professions.

I hope that I can reassure the noble Earl that there is a valuable role for the council to play in recommending to regulatory bodies a cross-professional approach to codes of ethics. However, the council could not issue a power of direction to the regulatory bodies.

Earl Howe: My Lords, the Minister has given a most helpful reply. I thank the noble Lord for writing to me about the powers of direction, and also for confirming the contents of his letter. I understand the position; indeed, that is a very important statement and one that will reassure many people. I take on board what the Minister said about the power to recommend a change in the standards of practice of a regulatory body so as to encourage greater consistency across the professions as a whole. I do not believe that to be a controversial suggestion in itself; it implies that the profession would still have the ability to examine such a proposal on its merits. However, my worries would increase if the council took it upon itself to go into greater detail, or to go rather further in that respect and be more specific about a change to a particular code of practice. Nevertheless, we have had a useful debate. I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 67 to 72 not moved.]

Clause 25 [Regulatory bodies and the Council]:

Earl Howe moved Amendment No. 73:

    Page 32, line 1, leave out subsections (2) to (15).

The noble Earl said: My Lords, I raised concerns in Committee over the powers of direction being conferred on the council for the regulation of

30 Apr 2002 : Column 648

healthcare professions. Government amendments to the Bill have created some welcome safeguards as regards the use of those powers. The affirmative resolution procedure in Parliament will ensure that any direction from the council will receive close scrutiny and debate in both Houses; in other words, proper parliamentary accountability.

Like my noble friend Lady Carnegy of Lour, I have deep reservations about granting any powers of direction to a lay-dominated organisation. I believe that that would fundamentally undermine the concept of professional self-regulation. The council will be controlled by political appointees and unelected lay people, who may have no experience of the health professions or of their conduct committees. That is an inherently unsettling prospect. However, I must acknowledge that the regulatory bodies have declared themselves satisfied with the safeguards, so I do not propose to take issue with them.

I would, however, like to raise some concerns relating to the scope of the powers. When one reads the Bill, it is very hard, prior to the establishment of the council, to forecast when and in what circumstances the power of direction will be exercised. I say again, as I said in Committee, that there are no real limits laid down in relation to the sorts of issues on which the powers can be deployed, or how often that can be done, other than the qualifications that are set out in subsection (2). It would not be a healthy state of affairs if directions were issued on a frequent basis. In fact, I hope that it will never be necessary for the council to assert its will against the wishes of a regulator, because that would mean that normal constructive dialogue had reached an impasse.

The sort of situation that I worry about is where there has been, let us say, a story in the newspapers—or perhaps a succession of different stories—involving doctors who have in some way or other acted controversially. One thinks of the Bristol Royal Infirmary or even Dr Shipman, but some other situation could be involved. A head of steam would build up in such cases in the tabloid press. The GMC, let us imagine, invokes its disciplinary procedures and reaches a conclusion with which the press does not agree. The press would whip up criticism of the GMC. The council for the regulation of healthcare professionals would try unsuccessfully to persuade the GMC to revise some aspect of its procedures. It would end up issuing a direction. The direction would go to Parliament. We might say that the verdict of Parliament should be taken as final. If the orders are approved, there should in theory be no more argument. Except that even Parliament is capable of jumping the wrong way in the face of media pressure. One thinks of several pieces of primary legislation that were passed on the back of some temporary frenzy and which, with hindsight, were not wise. One can only hope that the professional regulators will never be put in the position of having to comply with directions that are essentially populist and ill-informed.

The Minister was kind enough to write to me, as I mentioned earlier, with answers to some of the questions that I raised in Committee. One of the points

30 Apr 2002 : Column 649

that I raised was about the words, "must comply", which appear in Clause 25(11). I asked whether they should stay in the Bill. It seems to me that once a resolution has been passed by both Houses of Parliament there is an automatic duty to comply with it because it is the law of the land. I should be grateful if the Minister would set out the reasons for the position that he has taken in this regard—I confess to not fully understanding it. I beg to move.

Next Section Back to Table of Contents Lords Hansard Home Page