| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Baroness Thomas of Walliswood: My Lords, I had not intended to speak today and I refrained from doing so in Committee, because I am aware that my
noble friend Lord Lester is more than capable of defending himself under any circumstance whatever. But since I was challenged by the noble Lord, Lord Borrie, to show Front-Bench support for my noble friend's Bill, I stand here to say just that: we support the Bill. As the Liberal Democrat spokesperson on women, I certainly feel no obligation to challenge the wording of my noble friend's Bill.
Lord McIntosh of Haringey: My Lords, I expressed the Government's view of this Bill in a rather lengthy speech at Second Reading and I do not propose to add anything. But the noble Lord, Lord Borrie, should not draw any conclusions, favourable or unfavourable, from my silence.
Lord Lester of Herne Hill: My Lords, I am very grateful to everyone who has spoken. Briefly, I shall deal with some of the points. First, in defence of the Government, I fully understand the position that they have taken, as I am sure the House does. The position has been expressed by the noble Lord, Lord McIntosh, and by the other Minister who spoke at an earlier stage. I shall summarise it as follows: the Government take the Bill very seriously. They are not in favour, at this stage of their policy development, of having a single equality Bill. They are instead busily working on the regulations that will come before Parliament in May, as I understand it, to give effect to the EU equality directives that cover some of the ground dealt with more widely in this Bill. I am sure that the civil servants dealing with the matter will look at the Bill and think about some of the ways in which it approaches problems to see whether they believe those provisions to be sensible or otherwise.
So I am in no way discouraged by the fact that neither the Government nor the main Opposition have tabled a series of amendments. Indeed, in a previous debate, the noble Baroness, Lady Buscombe, was kind enough to indicate very clearly, as did the noble Lord, Lord Cope, today, that the Conservative Party is favourable to simplifying the law, producing coherence and greater accessibility, and therefore approves of the Bill's aims without necessarily subscribing to every part of it.
Secondly, I am glad that the noble Lord, Lord Borrie, believes that I have hit the target as regards his first concern—not about sex discrimination in clubs, which I shall come to in a moment. As I understand it, he is favourable to Amendment No. 2 as it stands.
I shall explain some matters that the noble Lord, Lord Cope, raised about the amendment. It applies only if the principal purpose of the club is to enable the benefits of membership to be enjoyed by persons who are members of any one or more of the groups listed. For example, it would apply to a gay club or a heterosexual club—a club of a particular sexual orientation—only if its principal purpose were to give benefits to straight members or gay members. If it did that, it might be offensive, but it could put up a notice excluding those of a different sexual orientation. That is how it works.
There was also criticism of the un-plain English in paragraph 42(2)(b). I take full responsibility for that, even though it was drafted by a highly skilled former parliamentary counsel. The purpose of the sub-paragraph is plain enough. It is to stop discrimination leaking unnecessarily into places that it should not, as a result of an over-broad interpretation of the exception. I shall look again to see whether even plainer English could be used to deal with that.
The only other point is the familiar one raised repeatedly and always forcefully by the noble Lord, Lord Borrie, about sex discrimination in clubs. As noble Lords know, paragraph 43 excludes from the scope of the Bill single-sex clubs, run for profit or otherwise, but keeps within the scope of this Bill what was in the Bill introduced by the noble Lord, Lord Faulkner of Worcester. That Bill was supported by the Government and by those of us on these Benches and the Conservative Benches. I hope that the noble Lord, Lord Borrie, will not mind my describing him as being a bit like Captain Ahab with Moby Dick in pursuing the issue again and again. We all understand well what his position really is.
What we are doing is not coercive; we are saying that, if a club, as a matter of the free choice of its members, allows women as well as men to become members or associate members, it must treat them equally. Its constitution and its workings must focus on the fact that that will be the principal object. If that is the principal object, the club will be liable. If the club's main object is to give benefit to women or to men, it will be beyond the scope of the Bill.
The noble Lord, Lord Borrie, does not like the drafting of the purpose test in paragraph 43(3) and made that clear on the last occasion, although he has not tabled an amendment and nor have I. I have not tabled an amendment to introduce a different test because, during the debates on the Bill introduced by the noble Lord, Lord Faulkner of Worcester—I read them after our previous debate in Committee—the noble Baroness, Lady Scotland of Asthal, commended the form of words in that Bill as being fit for the purpose. Having read the debate again, I decided, on reflection, that what was in this Bill and in the noble Lord's Bill represented the right approach.
Strictly speaking, I am out of order even to mention all that, as no amendment that deals with that subject has been tabled. However, I thought that, out of courtesy to the noble Lord, Lord Borrie, I should explain why I have dealt with the first of his concerns but will never be able to deal with the second of his concerns. My position, like that of those on both Front Benches, is that a club that allows both halves of the human race to be members should treat those members equally—in the same bar, in two separate bars or whatever. That is not an invasion of personal privacy. In that situation, equality trumps personal privacy and personal choice.
On Question, amendment agreed to.
General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003
2.44 p.m.
Baroness Andrews rose to move, That the draft order laid before the House on 3rd March be approved [13th Report from the Joint Committee].
The noble Baroness said: My Lords, I beg to move that the draft order laid before the House on 3rd March be approved.
The order has already been considered and passed by the Scottish Parliament, on 20th March. That was required because some of the matters covered are devolved. The devolved administrations are, for the first time, given the power to appoint members to the UK body that supervises postgraduate medical education. The order has also completed its stages in another place, and it now falls to this House to consider it. In my view the draft order is compatible with the convention rights.
I turn first to what the order will achieve. Noble Lords may not all be aware of just how complex postgraduate medical education actually is. Many organisations are involved at different stages. At present, there is a lot of potential for confusion. I hope to clear some of that confusion away.
Noble Lords may, however, be aware that the Joint Committee on Postgraduate Training for General Practice has formally supervised general practice training since 1981. Since 1995, the Specialist Training Authority of the medical Royal Colleges has been responsible for supervising specialist training. My noble friend Lord Turnberg and the noble Lord, Lord Patel, have served with great distinction as chairmen of the STA. Both bodies have made a significant contribution to the development of medical education and training. They have done as much as they could within the current limits of the regulatory system. I want to place on record my appreciation of their work over the years.
This order represents the fruit of three years hard work and close consultation at every stage between the Government and the medical profession. It establishes a new body which will reform the way in which we train and educate the doctors of the future so that they are better able to meet the needs of both patients and the NHS. This body will act independently of government. It will be a professional and authoritative body, fully in keeping with the principle of professional self-regulation. Government will have a limited role in the formative process. They will ensure that the board is set up and appointed, then step back to allow the board to get on with its work.
There are default provisions, but I stress that they can only be used should the board ever fail to perform a function. Default powers exist in the current legislation. They have never been used and we do not anticipate having to make use of them in any ordinary
circumstances. We confidently hope and expect that this will be the case with the default powers in this order.Perhaps I may also illustrate the limits to the Secretary of State's power. At various times it has been asked whether the Secretary of State for Health could compel the board to include or remove specific training requirements if he so wished. The Secretary of State would, and is required by ordinary administrative law principles, exercise his powers reasonably. Any decision that the board had failed to perform a function that it should have performed would have to satisfy this principle. It would not therefore be open to the Secretary of State to exercise his default powers where the board had considered and with good reasons decided on specific training requirements.
The reforms will introduce a more flexible system for regulating the education and training of doctors, in which the medical Royal Colleges will play a leading role. The new body will ensure that standards are maintained and developed for training doctors for independent medical practice in NHS primary and secondary care. However, a major change, in keeping with the changing public emphases, is that for the first time the NHS and the public will be well represented.
Other significant changes achieved by this order will be that arrangements for training general practitioners and specialists will be brought together in one organisation; that there will be a new GP register to sit alongside the specialist register; and that faster, fairer and more effective processes will be introduced, which will assess doctors on the practical demonstration of their competencies, in addition to their medical knowledge and their qualifications.
I emphasise what that last important change will mean. For the first time, these assessment processes will address properly the needs of specialist doctors who are not European Economic Area nationals and have qualified or trained outside the EEA. This will benefit thousands of doctors already working in the NHS—many of whom are in the staff and service grades—and are prevented from progressing in their careers because the current system does not allow their experience to be taken into account, together with their training and qualifications, in determining whether a particular doctor has met the required standard.
Doctors are very well aware already of the benefits that this new legislation will bring. As a recent national conference of staff and service grade doctors demonstrated, we have received many supportive responses to our consultations from individual doctors—the majority of whom have undertaken specialist training or have been awarded specialist qualifications outside the EEA. All are already working in the NHS in the staff and service grades. All are currently restricted in developing their careers because the current system does not allow their experience to be taken into account. This will change under the order.
We will have a fairer and a more transparent system. It will ensure that our already high standards in medical education are maintained and developed. And, finally, the order itself is a more flexible and adaptable piece of legislation which will make it easier to make any future improvement to the system of postgraduate medical education and training in the UK. Any such changes will of course be a matter for the board itself to determine.
Why do we need these changes? Let me briefly set out the background. Our medical training system is rightly admired across the world, but this order recognises that it is now right to develop it further to ensure that our future doctors are able to deliver quality services in the ways that they and their patients want. This must be done in partnership with other members of the healthcare team. Furthermore, the medical education and training system must be flexible and adaptable, and capable of responding quickly to changes in the NHS and to developments in education—for example, in improvements to methods of assessment and training.
I mentioned earlier that the system is already very complex. Let me try to pick out the key elements of the new system—one which will be less confusing. The new board will set standards and formally supervise the entire system—ensuring that the doctors it certifies have been trained to the standards it has set. But it will not be responsible for managing, funding or organising the training. That job is, and will continue to be, handled largely by the postgraduate deans in the NHS. Indeed, the system would not work without their invaluable contribution. But the board is the standard-setter, and it will rely heavily in this respect on the work of the Royal Colleges. It will be for the board, based on the advice received, to grant or withdraw approval from training programmes, and to award certificates to individual doctors. That will bring together both general practice training and specialist training. There will be one certificate for both types of doctor.
This is not change for change's sake. We recognise that we must not lose the many excellent features of our current training system. The order will ensure that this does not happen. For example, it clearly recognises the established role and expertise of the Royal Colleges. It ensures that the board and the GMC will co-operate closely with each other. But we should change those aspects of the present arrangements which do not work as well; for example, the current separation of general practice from the rest of medical training and the way that colleges sometimes work almost in isolation from each other.
Reforms of the magnitude in this order need to rest on the broadest possible support. We have had that support from the profession itself as well as the patients and the wider public. We have consulted twice on these reforms. It has been a three-year process. The issues raised in the responses received—there have been more than 300 in total—have helped to shape the details of our policy. As a result of these two consultation exercises, we have probably made well over 100 changes in total. Involving colleges and other
stakeholders in our working groups has been designed to achieve this consensus and has informed those changes.The response to consultation showed a clear consensus that change was needed. We have, I believe, met the concerns which were initially expressed by the medical Royal Colleges and others. This is clearly demonstrated in the recent memorandum of understanding agreed between the Department of Health and the Academy of the Medical Royal Colleges in January. It marks a significant step forward in this direction. The colleges agree that there is no need for each and every one of them, and their faculties, to be represented on the board itself. They know that they will be strongly represented on the committees and sub-committees which the board will set up to tackle the detailed work in relation to each medical specialty.
We are profoundly appreciative of the hard work and of the support of the professional and academic medical leaders. Professor Peter Hutton, chairman of the academy, is a firm supporter of these proposals. He recently said that,
- "sensible negotiation has resulted in a very practical piece of legislation . . . the way in which this exercise has progressed forms a good model for future working between the Department of Health and the Colleges".
Let us look at what has been said by the colleges and the medical profession. The Academy of the Medical Royal Colleges, which represents all the colleges in the UK, states that it,
- "strongly supports the philosophy",
- "all the colleges, without dissent, are in agreement".
- "that the Order offers a framework for continued constructive collaboration to maintain, and improve, the standard of health care in the UK . . . there are now opportunities for us to develop Scottish initiatives contributing to an overall UK framework".
- "We support the Government's commitment to reform postgraduate medical education and training. The creation of PMETB offers an opportunity for significant progress towards ensuring that both the training and service needs are met".
- "We believe that the PMETB offers real opportunities and benefits for the development of medical training".
The order is now clearly recognised and accepted as an important step forward in the system of medical education and training in the UK and will build on a great deal of developmental work which has already been taken forward by the profession—for example, on examinations and assessments—and on better ways of quality assuring training. It is in the wider public interest that this close working relationship is further developed and strengthened as the board is established. We will do all we can to ensure that this happens.
One of the key features of these reforms is that, in future, patients and the NHS will have a greater contribution in determining the standards of education and training for doctors. That wider representation will also be reflected in the board's committees where the detailed work will be done. This will ensure that the broader competencies required of modern doctors, such as team working and communication skills, are also included in training curricula alongside the detailed clinical knowledge which they clearly need. In this important respect, the order will help to support all our efforts to improve the quality of care in the National Health Service.
The provisions before your Lordships' House will contribute to the implementation of the major programme of reform we have announced to modernise medical careers, bringing more structure and coherence to the early stages of postgraduate training. We need to ensure that doctors in training grades and in service posts are well supported, and able to plan and develop their careers in the NHS. The board will be crucial to the success of these wider reforms to medical careers.
In addition to making improvements to the system, we are also making a number of other changes that are particularly important to career prospects within the profession itself.
I mentioned earlier how individual doctors in the NHS have welcomed the proposals because they will help them to develop their careers. Questions have been raised in another place about whether these proposals will actually help doctors who are already contributing to the NHS in the staff and service grades, but who want to advance further in their careers. I want to say very clearly today that we have set out to assist these doctors, and that is what the order does. In particular, the order will help many doctors currently working in the NHS with qualifications obtained outside the European Economic Area. They cannot progress to consultant positions in their careers because the current legislative system does not take all factors into account.
The fact that they may have completed additional training, or have years of senior experience in the United Kingdom, makes no difference. If the qualification is not determined to be equivalent to the UK specialist qualification, that is the end of the matter and the individual cannot have his or her name included in the specialist register. Many therefore have no chance of ever becoming a consultant and the NHS is deprived of the benefit that the full contribution of these doctors could make. This cannot be allowed to continue.
The order therefore provides for all training, experience and qualifications—wherever obtained—to be taken into account by the board when assessing the eligibility of applications to go on to the specialist register. If a doctor does not meet the required standard at the first application, that is no longer the end of the story. Doctors will be able to top up their training to meet the requirements. They cannot do this at present.
Training must no longer be seen as a one-off opportunity which ends at a certain point in a doctor's career. The whole point of medical education and professional development is that it needs to be a well-managed continuum throughout a doctor's professional life. That is why, in parallel with the regulatory reforms, we are modernising medical careers, taking forward the proposals set out in the Chief Medical Officer's consultation paper Unfinished Business to develop a more structured system of education early in a junior doctor's career, immediately following registration with the GMC.
Our proposals will deliver a new foundation programme, which will be followed by well-managed and structured programmes, supervised by the board, for all trainees, whether they become consultants or general practitioners. This will include programmes designed for doctors moving back into training from a staff or service grade post. We are taking an all-embracing approach which will include competency-based assessment and encourage that to thrive. This will see all doctors in training working against clear, agreed goals.
Both of these new developments demonstrate the importance of the current competence of a doctor to deliver quality services to NHS patients. The new system will ensure that all doctors will have a fair chance of demonstrating how they meet the high standards that we rightly require of our doctors. I should make one point very clear. This is not about lowering standards but about providing a fairer opportunity to doctors to show how they meet our existing standards.
Secondly, we are creating a new GP register. In future, all GPs will need to be on this register. General practice is strongly supportive of this initiative—it has been for some time—and it is supported by the medical profession as a whole. No one currently eligible to work in general practice in the NHS will be excluded; there is no threat to anyone's livelihood. We believe that the GP register will make a big difference to patients and employers. For example, they will easily be able to check a doctor's registration online. Doctors' standards will be visible and accessible to patients.
Finally, the new system is designed to work more efficiently. The board and the GMC will be required in future to give decisions about eligibility for registration of both GPs and specialists within three months of receiving a full application. At present, doctors—particularly those applying from outside the EEA—must often wait for considerable lengths of time for a decision.
Let me quickly go through the order itself. The order creates the board and two statutory committees—the training committee and the assessment committee (Article 3). The board will be responsible for supervising the system of postgraduate medical education and training in the UK, setting standards and ensuring that these standards are applied (Articles 4, 5 and 6). The statutory committees will report to the board and be accountable to it. The board will be able
to set up sub-committees to deal with levels of detail. Royal Colleges will be appropriately represented on these committees and sub-committees.Much of the detail of how the new education system will operate is intentionally not included in the legislation. Let me use this opportunity to again reinforce the independence of the board. The board will draw up its own rules and it will be able to change them to respond to changing training needs. While the board will be able to delegate work and decisions to its committees, it will not be permitted to delegate any of its rule-making powers. This is entirely consistent with the principles of independence and autonomy which have been the hallmarks of our system of postgraduate education and training. These principles are carried forward in the order.
There will be 25 board members, with a medical majority. The chair may be either medically qualified or a lay person. Appointments to the board will formally be made by the Secretary of State for Health and by Ministers in each of the devolved administrations. Each of the devolved administrations will make two appointments—one medical, one lay—and the Secretary of State will make the remainder.
At least six of the medical appointments will be drawn from a list supplied by a body representing the medical Royal Colleges in the UK. At present this is the Academy of Medical Royal Colleges. At least one appointment—lay or medical—will be made from a list supplied by the GMC. This ensures the essential professional input as well as proper representation of patients and employers.
I have gone into some detail because it is a complicated order which has taken a long time to prepare and it is important to get the details right. It has taken us almost three years' hard work to reach this point. The order has been designed in consultation with stakeholders to be flexible and adaptable. It will permit improvements to be made to the system of postgraduate medical education and training.
We are very glad that our proposals have the support of medical organisations and of individual doctors. We believe that they will be of direct benefit to the NHS and to patients because they will help us to produce not only more doctors but better-trained doctors. I commend the order to the House.
Moved, That the draft order laid before the House on 3rd March be approved [13th Report from the Joint Committee].—(Baroness Andrews.)
3 p.m.
Earl Howe: My Lords, I thank the noble Baroness for introducing this important order and for the clear way in which she did so. I wish to be entirely constructive in my approach to these proposals. I am the first to acknowledge that the Government have not only consulted widely on them but have taken account of many of the concerns raised by those who responded, not least the medical Royal Colleges and the GMC. What we have here, nevertheless, is a piece of major reform, and it is right that we should spend a few minutes in examining its implications.
I think we can probably all agree on several positive features. First, the order greatly simplifies what many would regard as a baffling array of regulations currently governing postgraduate medical training and, in so doing, it makes the underlying legal framework a lot less opaque. It also brings together under one statutory umbrella both specialist and GP training, a change which is, I believe, very welcome, as is the creation of a new GP register.
The other main change to be applauded is the way in which medical training is assessed. It is no longer a question of how long a person has trained in a particular discipline, but whether he or she is competent in that skill. Assessing someone's competency carries important implications for who will be able to apply to join the specialist register. As the Minister has just explained, Article 14 contains a provision which will allow for doctors who have gained qualifications outside the European economic area to be assessed here, on the basis of their competency and experience and, if found to meet the prescribed standards, admitted to the specialist register. I welcome that change. Quite a number of doctors practising in the UK cannot currently make this career progression. Both they and the NHS are the worse for that.
As I read it, we will ultimately have a much more flexible system than we do at the moment, but it will require appropriate mechanisms to be put in place to ensure that people's qualifications, training and experience can be properly assessed. The criteria used must be very clear and very tight. That task has to be put in hand. In fact, the practical aspects of these reforms have excited some comment and it would be helpful if the Minister could say something in her reply about a few of them. For example, there will be doctors in the SAS grades who are assessed but are then found to require further training. How exactly is it intended to provide this top-up training, and how will those doctors access the established training programmes? To what extent will an assessor be held responsible for the subsequent professional performance of the person who is assessed?
The other practical issue I want to raise relates to the interaction between the new board, the GMC and the medical Royal Colleges. In the report on the consultation published in February, there is a specific reference in paragraph 28 to the need for all three bodies to work together closely if the new system is to work effectively and well, particularly as regards processing applications for doctors' certification and registration. I agree with that, of course, but it is also self-evident that to have the highest and best standards of medicine in this country, the medical Royal Colleges have to be closely involved in determining the standards of postgraduate medical training.
Equally, doctors who qualify and are admitted to either of the registers will have to submit themselves to revalidation during the course of their career. Revalidating doctors is a responsibility of the GMC. If the standards of attainment in both training and revalidation are to correspond and cohere, clearly the
GMC, alongside the Royal Colleges, has a locus in helping to oversee and shape the work of the new board. It is pleasing, therefore, to see that the board membership will include nominees of both the GMC and the medical Royal Colleges, and that this provision is now written into the order.I have to ask the Minister, however, about paragraph 1(14) of Schedule 2. It says:
- "On a proposal from the Board or otherwise, the Secretary of State may by order vary the size or composition of the Board".
The words "or otherwise" concern me, however. In what circumstances might the Secretary of State be minded to say that nominees of the professional bodies should no longer sit as members of the board? Even the theoretical prospect of that happening fills me with some alarm. I say that especially in the broader context of the Secretary of State's wider powers, which I shall talk about in a moment. Now that the Government have agreed to include the nomination rights in the order, why is that get-out provision there at all?
The Minister will know that the BMA is disappointed that it is not represented on the board. I have considerable sympathy with its view that practising doctors should sit as members to represent the key groups of hospital and general practice, as well as training and career grades. There is no guarantee that the nominees of the GMC or the medical Royal Colleges will be practising doctors with direct experience of workforce planning, assessment and appraisal and implementing working hours agreements. The BMA Junior Doctors Committee is particularly ideally placed to provide that sort of knowledge.
There is also a strong case for GP representation on the board, given the fact that an increasing quantity of service and education is undertaken in primary care settings. Alongside GPs, the BMA has emphasised to me the particular significance of the staff and associate specialist group of doctors, whose needs are very individual and will undoubtedly have to be taken into account by the board. There is a good argument that a doctor from that group should be included in the board membership.
The underlying issue is that doctors must be fit for purpose. That point has been recognised by the fact of enabling the Secretary of State to ensure that NHS interest is represented on the board. I, for one, do not have a problem with that idea. However, I have a problem with the extent to which politicians, especially the Secretary of State, have influence over the composition and actions of the board. We all recognise the importance of professional self-regulation, and I am the first to recognise that the medical majority on the board preserves the essence of that principle. Yet the fact is that the appointments process is largely in the hands of politicians.
Why does the Minister believe that that is necessary? There should be some political appointees—yes; but should they all be? I am uncomfortable with that. Surely, politicians do not need to appoint all the members to achieve parliamentary accountability for the work of the board or for public money spent.
I have a similar concern in relation to the powers granted to the Secretary of State in paragraph 26 of the order. I understand completely that they are billed as "default powers", to be exercised only if the board has, in the opinion of the Secretary of State, failed to perform any of its functions. In that situation, the Secretary of State may issue directions to the board; if the board fails to comply, the Secretary of State may himself give effect to his direction. That means, in practice, that he will step into the board's shoes.
That is an extraordinary provision, and it is slightly difficult to imagine what the process would involve. We are all used to default powers in other contexts—usually in situations where it is essential for a matter to be expedited for the public good. I would not have thought that the work of a board responsible for postgraduate medical education and training fell into that category. If, by some awful contingency, the board were to fall seriously short in the performance of its functions, the remedy surely does not lie in the Secretary of State taking over in the form of direct rule. Surely, he should consult members of the profession—the GMC, the Royal Colleges, and other interested bodies—and propose arrangements that would serve to upgrade or replace the PMETB and remedy its failings. The role of the Secretary of State should be essentially as a facilitator, not as a protagonist. But that is not what the order provides for.
One then has to wonder what kind of circumstances might lead to the Secretary of State's default powers. That exercise depends, as I said, on his being satisfied that the board is failing to perform any of its functions. The board's functions are set out clearly in Article 3. However, paragraph (11) of that article allows the Secretary of State,
- "On a proposal from the Board or otherwise"—
- "create a new statutory committee and confer functions on it; or . . . vary the functions of the statutory committees".
I note what the Minister said about reasonableness. It might be thought reasonable for the Secretary of State in the interests of the NHS to influence, and indeed amend, the nature and scope of the board's functions and the bodies with which it is required to co-operate. However, such amendments might not necessarily advance the central objective of postgraduate medical education and training, which is
to make doctors fit for purpose and to instil in them the highest standards of practice. I hope that she can reassure me on that.I end with a question about the timetable for the establishment of the board. Should the House approve the order, I understand that it is likely to be made by the Privy Council at its meeting in mid-May. Advertising for the board members would take place in that event immediately afterwards. If so, the first board meeting is expected sometime in the autumn. However, there will have to be a transitional period during which the specialist training authority will continue its decision-making process about access to the specialist register. Can the Minister tell me when it is expected that the new decision-making process will formally pass to the PMETB?
Once again I thank the Minister for her explanation of the order, and I look forward to her reply.
3.15 p.m.
Lord Clement-Jones: My Lords, I join the noble Earl, Lord Howe, in thanking the Minister for her very comprehensive introduction which I think answered in advance many of the questions that we on these Benches would have liked to ask. We also give a broad welcome to the new board which I think is eagerly anticipated by the medical profession generally. It is the result of some extremely comprehensive consultations which we also welcome. The consultation certainly gave rise to a large pile of documentation which many of us have been reading through in the past few days. The outcome, which I very much welcome, is a series of quite carefully constructed compromises. The board itself will be a competent authority for the purposes of the EU directive on the free movement of doctors. Consequently, we have no great desire to disturb any of the quite carefully constructed architecture in the order itself.
Several changes were made by Ministers as a result of the consultation. For example, initially the chairman was going to be appointed solely by the Secretary of State and not by the board. Now, at least after the initial period, the board will have the right to appoint. We welcome that, although we have some questions about whether five years is the right period.
There have obviously been changes as regards the use of default powers and the duty to co-operate with a body that appears,
- "representative of the medical royal colleges".
Generally the move to competency-based assessments away from the time served basis is greatly to be welcomed. The medical profession and those in the SAS grades mentioned by the noble Earl, Lord Howe, will welcome that. Medical experience will be recognised.
We welcome the new GP register alongside the specialist register and the more flexible admission to the specialist register. However, I refer to the
question—the Minister went some way to answering it by way of an assurance, but chapter and verse is needed—of whether it is only academic or research knowledge and experience that make a doctor in the grades that we are discussing eligible for consideration. That point was raised by my honourable friend Dr Harris in Standing Committee in another place. I think that due to lack of time the Minister, Mr Hutton, said that he would write to my honourable friend. However, it would be useful to be given further clarification. On the face of it—perhaps I have not read every jot and tittle of the order—it seems that academic research rather than practical skills confers eligibility. It would be useful to hear more detail on that matter from the Minister.We very much welcome—this has resulted from the way in which the board was set up—the apparent streamlining of the system of hospital visits by the Royal Colleges. It has long been a grouse of mine that over 28 bodies are now entitled to visit, inspect and audit acute hospitals. The more we can boil down the number of visits that are made, the better. It would be useful if the Minister could shed a little light on how that process will operate. Clearly, the board itself, as the regulator in these circumstances, will carry out that process on behalf of the Royal Colleges, but what residual responsibility will the Royal Colleges feel that they have in that regard? How will the process work out in practice? After all, the Royal Colleges will have some delegated responsibilities. They will have membership of some of the committees. Will they feel obliged to carry out inspections as well?
The noble Earl, Lord Howe, described the measure as a radical set of proposals. Perhaps my perspective is rather different. I believe that the setting up of the board is a significant step but I do not see it as a very radical move in many respects because the responsibilities of the NHS, the universities and the postgraduate deans for implementing training and performing to standards remain largely undisturbed. Accountabilities for different aspects of training seem, certainly to the uninformed onlooker, rather confusing.
The Minister told us that the funding and implementation of the training would be carried out by the postgraduate deans. There is the whole new "unfinished business" agenda announced by the health Minister which will be implemented not by the board, as that is the regulator, but essentially by the postgraduate deans and the NHS itself, as I understand it. Accountabilities will be extremely important in judging whether that extremely hefty agenda is successful and whether there is sufficient clarity of responsibility. Will the board have the ability to influence how "unfinished business" is put into practice? Certainly, the borders are unclear at the moment.
How do the responsibilities of the board fit in with workforce planning by the NHS? We have seen great improvements in that regard but it is crucial to delivery within the NHS. Also important is that perennial old chestnut, training numbers. The NHS has grappled
with that over a number of years, and it is still a huge issue. In passing, I wonder whether the department is trying to do too much in the current circumstances. The agenda is massive, grappling not only with the implications of the working time directive, but changing the whole system of training junior doctors, instituting the board and so on. That is biting off a huge amount of reform in one go.Having said all that, I have doubts on some individual areas, but the Minister can satisfy them in her reply. The noble Earl, Lord Howe, raised a large number of them and I certainly do not intend to repeat them all. The independence of the board is absolutely crucial, as is self-regulation, the principle that the Minister enunciated. I very much welcome the fact that there will be a majority of doctors on the board. The model of the GMC, which is responsible to the Privy Council, could however have been adopted in the case of the board, and I would very much like to hear the Minister explain why that model was not followed.
The noble Earl went into the use of the Secretary of State's default powers in great detail and very effectively. They are extremely important. The Minister more or less gave us the kind of judicial review test, saying that the Secretary of State will be reasonable in the actions that he takes in exercising his powers under article 26 and other default powers. Some examples of where in practice the Secretary of State would exercise his powers would be extremely useful, because they are very wide. The legislation states,
- "has failed to perform any function".
The question of nomination of board members is very important. As we know, for "special health authority" in the order, one needs to read "NHS Appointments Commission". I assume that that is the regular way in which nominations will be made. The Minister's assurance on that point would be extremely welcome.
The noble Earl talked about GP representation on the board. We place great emphasis and importance on having practising doctors on the board, whether they are indeed official representatives of the BMA or not. We also believe that junior doctors should be represented. A range of practising doctors should be represented, to ensure that they can give a proper perspective to the type of training that they are responsible for regulating. We share the noble Earl's concerns on the timing of the establishment of the boards.
My final point is on the issue of delegation to the Royal Colleges. It would be useful for the Minister to explain what will happen in practice, as well as explaining the relationship with the GMC, which the noble Earl mentioned. I welcome the fact that the GMC and the board are joined at the hip, so to speak.
A little clarification about how that relationship will work is extremely important, and I look forward to the Minister's reply.
| Next Section | Back to Table of Contents | Lords Hansard Home Page |