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Baroness Andrews: My Lords, I hope that noble Lords will bear with me while I arrange my papers so that I can answer at least some of the questions raised this afternoon. First, perhaps I may say how grateful I am for the very warm welcome that the order has received. All credit should go to those who have worked so hard and with such great thought and conviction regarding the need for change in this respect.
Many detailed questions have been raised. I hope to answer as many as possible. Primarily, they appear to be grouped around issues. For example, there are issues regarding the independence of the board and the powers of the Secretary of State; and issues which deal with the representation of doctors and the needed assurances that there will be a medical majority with doctors being represented appropriately.
A number of issues were addressed by the noble Lords, Lord Patel and Lord Clement-Jones, and the noble Earl, Lord Howe, including the range of experience regarding the notion of competence and the necessary mechanisms in relation to it. There are issues that deal with the workforce and how what we are trying to do in order to expand and change the workforce of the NHS will reflect, impact on and be, as it were, regulated by the board itself. That brings in
issues regarding visiting panels and so on and the delegation that the noble Lord, Lord Turnberg, talked about in relation to the power. The noble Earl, Lord Howe, raised the issue of the timetable. The noble Lord, Lord Patel, raised the issue of the appeals mechanism.I shall try my best to give assurances on most if not all of those matters. I start with the issue of the board's independence and the assurances that noble Lords seek on the powers of the Secretary of State. We can give with total conviction the assurance that it will be an independent board. The Secretary of State will have the power to nominate the chair in the first instance. The nomination of other members of the board will be as has been agreed and which has come forward in a variety of ways.
There will be at least six places—there may be more—from the medical Royal Colleges, and at least one place from the General Medical Council. There will be six places via the devolved administrations; 19 appointments will therefore notionally be made by the Secretary of State but, in fact, they will be generated by the expert and devolved bodies in the field.
The process of advertisement and selection will be delegated to the NHS Appointments Commission. The reason why the Secretary of State has that role in the first instance is the need to ensure that the first board has balance and authority and is robust and representative.
I was asked why the board does not approximate more closely to, say, the GMC. In fact, that is a slight misreading of the powers of the GMC, because the Department of Health is not as much an arm's length body as it would appear from the fact that powers are located in the Privy Council. The Department of Health has a close link with the GMC through the Privy Council, so the GMC does not provide an appropriate model in this case.
On the question of powers held by the Secretary of State, it is important to reflect that his default powers are not new. They have been held in another form under the STA, which could give direction about administration. The powers in the order approximate to those held under the Medical Acts. So essentially, we have not invented anything in the order. The default powers are important because, should there be such exceptional circumstances as a failure of function—we have no examples to offer noble Lords, because such powers have never been used—or systems failure, we need those powers to rescue the board. We fervently hope that they would never be needed.
The noble Earl asked why the Secretary of State had power under Article 3(11) to create a new statutory committee. That article entitles the Secretary of State to vary the functions of the training or assessment committee or to create a new statutory committee, simply because the power must be exercised by statutory instrument, which is obviously subject to the negative parliamentary procedure. During consultation, many respondents felt that the functions of the statutory committees needed to be capable of
being altered. So that is a safeguarding mechanism to allow change to be made without having to go through more elaborate or Draconian measures. In fact, it was the doctors' representatives who asked us to include such a power to avoid arbitrary or artificial limits on the committees' functions. The power allows us flexibility for the evolution of function.The noble Earl also asked why there is power to vary the size and composition of the board. Again, we need the flexibility to do so. As he said, there will always be a medical majority and a requirement that the devolved administrations appoint one medical and one lay member. But we want to build flexibility into the procedures, so that if the board concludes that change is needed we do not have to make amendments via a Section 60 order of the primary Act. That has been agreed with the Royal Colleges and others in negotiation.
I hope that those reassurances reinforce the board's intention to operate independently and the Government's intention to ensure that it does.
A related aspect of independence is the composition of the board—why, for example, the British Medical Association will not be on it and whether there will be sufficient GPs. Essentially, the board's composition will be driven by the applicants. At least six people will be nominated through the Royal College, and at least one through the GMC. We will be extremely interested to see the range of specialities and health service representation that comes forward when we advertise the posts. We are confident that we will get the representation of doctors and of many of the groups that we wish to see. But much will be in the hands of the Academy of Medical Royal Colleges and the GMC in terms of nominations.
There is no reason why there could not be a specialist committee of the board simply for general practitioners. General practitioners and, indeed, many more members of the Royal Colleges will be represented on the sub-committees on training and assessment and any other committee that the board chooses to appoint.
The noble Lord, Lord Clement-Jones, asked about the links between the GMC and the Academy of Medical Royal Colleges. The order provides that there is a duty on the board to co-operate with the GMC and the Academy of Medical Royal Colleges as the representative body. There could not be a more explicit demonstration of the intention to work closely with the medical profession than including in the order that duty in what I hope are explicit and reassuring terms.
On the timetable, we hope that the Privy Council will pass the order at its next meeting. It will come into effect in October, when the board is set up. Advertisement and appointment will occupy the time between now and October. The board will run in parallel with the STA and the General Practitioners Training Committee for a year. We expect the full transfer of powers to take place some time at the end of next year. We know that the process is complex. We do not want it to be rushed or compromised, which is
why additional resources have been put into making it as robust and effective as possible. The functions of the STA and the other training committee will continue in parallel, so there will be no discontinuity.The noble Lord, Lord Clement-Jones, asked about workforce issues. As he said, it is a matter of agenda. Part of the order's function and significance is, not least, expanding the number of people who will be able to join the specialist register through an emphasis on competence. We will expand the number of people who can serve the health service in that way. But, as the noble Lord said, Unfinished Business on modernising medical careers looks to reforming the postgraduate medical curriculum in different ways, with a new foundation year, for example. But it also looks to building into it curriculum assessment and competencies. So we have two parallel processes in which the board will be closely involved as the regulator and the standard-setter. It will have a major job to do in regulating the process as it evolves over the next few years. That is a major, coherent change in medical education and training.
The noble Lord, Lord Clement-Jones, also asked about visiting panels. We are conscious of the great seriousness—I hesitate to use the word "burden"—of the process of visiting panels. But it is a very important process, which will continue and be reviewed. I am sure that the Royal Colleges and the board will discuss how best to manage that in future. A review is taking place at present.
The noble Lord, Lord Turnberg, asked whether the board would supervise training. He also asked about its delegation powers. The board is legally responsible for training. It may delegate activities and decisions to its committees or sub-committees, which may be Royal College-based, as I suggested. However, the requirement for designated competent authorities to supervise training emanates from EC Directive 93/16/EEC. The board is the competent authority under that requirement for specialist training. The directive requires that the competent authority supervise specialist training. It is identical to the wording of the requirement in the European Specialist Medical Qualifications Order 1995.
We envisage that the board will fulfil its duty to supervise training by virtue of its standard-setting functions, its approval functions and its ability to organise visiting panels in respect of postgraduate medical education and training. It has the power to appoint persons to visiting panels and to make rules as to the composition of visiting panels.
The noble Lord, Lord Patel, asked a specific question about appeals. I can give the noble Lord the assurance that he seeks. The appeals panel will have to be independent. Doctors need an independent panel to handle appeals, and they must have confidence in
that independence. No member of the board or its committees or sub-committees will be able to sit on an appeal panel. That is the guarantee of independence that the noble Lord seeks.A major issue was raised about the opportunities presented for training. We are convinced that the order will make a major difference. To the noble Lord, Lord Clement-Jones, I say that, by "training", we mean practical training, not just academic training. All experience, wherever obtained, can and will be taken into account, together with qualifications and training. We are creating a level playing field for doctors with different sorts of experience.
As I understand it, doctors who are, at the moment, excluded from the specialist register because they do not have additional training or experience will be able to apply to the board and demonstrate how they reach the standards set in the new ways. The board will be able to assess doctors in terms of the standards that they have reached. Assessing experience is a particular skill that must be developed over many years. We look to the board to develop its rules on the basis of common sense. If the doctor is assessed as needing top-up training, he will be able to apply through the postgraduate deaneries for a suitable training programme. Those programmes will be different from traditional programmes. They must be designed to respond to the needs of the doctors who will come through different routes with different qualifications and experiences. We will look to the deaneries and the board to manage the process.
If I have neglected to answer any questions, I will be happy to write to noble Lords. In conclusion, I must say that doctors already understand the advantages of the new system. We have had the first application to the new board, even before the legislation has been passed and the board set up. That application came from a specialist doctor from the Indian sub-continent seeking entry to the specialist register. In his country of origin, he is an associate professor in his speciality. He has previous NHS experience and holds a fellowship from a medical Royal College in the UK. That is precisely the sort of benefit and bonus that we want to see for the NHS. We cannot and should not pre-judge board assessments of individual doctors, but we believe that there are many more in a similar position.
We have had overwhelming endorsement. Because it is one of several initiatives in postgraduate medical training, the board will set the standard for all postgraduate medical education, as we have described it. In that way, we hope to give the NHS doctor of the future a clear career path, to the benefit of all the things that we are trying to do to modernise and improve the NHS and to the particular benefit of patients. I am grateful to noble Lords.
On Question, Motion agreed to.
- House adjourned at four o'clock.
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