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As for squaring the circle, yes, the Commission will bring forward proposals in the autumn and its clear remit is to square the circle, though it is never easy. I also recognise the need for the Government to bring forward their own views in the proposals that they will make to the Commission, and the fact that we will be in recess in September. I will certainly come back to my noble friend and all noble Lords on that, because the Government may be able to make their views known in July before the Recess.
Lord Inglewood: My Lords, would the noble Baroness not agree that, from the debate that we seem to have had this afternoon about democratic deficiencies, one aspect of democracy is that there is no absolute form
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Baroness Royall of Blaisdon: My Lords, yes, it is very difficult to have common views expressed across 27 member states. It is, in many ways, extraordinary that the European Union exists. I also agree with the noble Lord that we would not wish other member states to tell us what to do. That is precisely why we are not telling Ireland what to do, if that is what the noble Lord is referring to in any way. It is up to the Government of Ireland to decide whether they wish to hold a referendum, and that is what they have decided to do.
Lord Stoddart of Swindon: My Lords, first, the noble Baroness the Leader of the House, in her reply to the noble Lord, Lord Pearson, pointed out that 80 per cent of decisions were made by co-decision with the European Parliament. I would point out that even if the British Members voted as a group, they could always be outvoted by over seven to one. Decisions that might be inimical to this countrys best interests could be passed, irrespective of the views of the British Government or the British people.
Secondly, I noted the reply of the noble Baroness to the noble Lord, Lord Woolmer. Has she seen that in this mornings Daily Telegraph, Stuart Fraser, the chairman of the City of London Corporations policy and resources committee, said:
That is in direct opposition to what the noble Baroness and the Government believe. I would like to know whether the corporation has been consulting and whether the Government will listen to any representations that it might make.
I have one more question. The Commission believes that these changes can be brought in under Article 95 of the EC treaty on the approximation of laws to operate the single market. Is that so, or will Parliament have to ratifyand first discussthe proposals, and then ratify any treaty that may be needed to bring these proposals into effect?
Baroness Royall of Blaisdon: My Lords, I understand the noble Lords point about co-decision and the fact that the will of the British Government and, perhaps, British Members of the European Parliament will not necessarily be in the majority in any co-decision procedure, but that is what the European Union is all about. I do not deny that.
As for the views of the chair of the City of London quoted from the Daily Telegraph, I have not read the article. I am confident that the Government will have consulted many stakeholders in the City of London, that they will continue to do so and they will listen and act in the City of Londons best interests.
Lord Stoddart of Swindon: My Lords, I was referring to the new proposals for regulation of financial institutions. I may be wrong, but I understand that the Commission believes that the measures can be brought in without any treaty organisation or any new treaties being brought forward, in which case they would come into operation without the agreement of the British Parliament.
Baroness Royall of Blaisdon: My Lords, as I understand it, these were normal proposals from the European Commission. They will be discussed and legislated on in the normal way and they will not require any treaty amendment in any shape or form. If I am wrong on that point, I will certainly come back to the noble Lord.
Lord Alderdice: We have here a series of amendments tabled to address the proposals by Her Majestys Government for a medical adviser service, effectivelythat there would be medical advisers to the various coroners. That is a welcome development building on our earlier debate on the various changes, the possibility of partial post-mortems, particular investigations and so on. The idea that we would have medical examiners seems a positive development that we welcome. It is something that in many ways has been lacking for some time. That the Government have taken a step along this road is a step very much in the right direction. However, there are a number of questions about the system being put in place. The Government have rightly found it necessary to identify the position of Chief Coroner to bring the whole service together. It would be important in the development of any service but, particularly in one that is somewhat devolved down to local authorities to address, the position of Chief Coroner seems important. There are also particular responsibilities placed on the Chief Coroner to draw together patterns of illness, disorder, disease, death and anything that will be helpful at a national level.
It does not seem unreasonable that there be a national or chief medical adviser who would assist the Chief Coroner and perform similar functions with regard to the medical examiners or advisers throughout the country. However, the Bill does not say that there shall be a national medical adviser or chief medical examiner, so I and my noble friend Lord Thomas of Gresford have tabled the amendmentnot as a new
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I note some of the arguments that were adduced by the Minister in the other place; namely, that lots of people were involved, including various staff and people from different backgrounds. That is a fairly thin argument because no one else has a national service such as the medical examiner service or the medical adviser service. As regards there being lots of other people involved such as porters, and the fact that they cannot all be represented at the national level, that is absolutely true but it is hardly the point in this connection.
One of the responsibilities, among many others, that we think would be appropriate to establish is to ensure certain standards and training among medical examiners throughout the country. I recall that when I raised this at Second Reading the Minister helpfully commented that there had been discussions about standards, training and courses with the relevant royal colleges. I had mentioned the Royal College of Pathologists in that regard but the Minister advised us that the Academy of Medical Royal Colleges had been involved in this and that things were well advanced in terms of producing training and courses. We would like to push this a little further to see whether the Minister can help us further. We have tabled amendments concerning regulations about the training of medical examiners and the standards that should be set for them. We are a little concerned about the consequences of not doing this although I have no doubt that the Minister will say it will be in the regulations. However, when one is trying to set up a large service such as this all round the country, certain areas will attract very high-quality people because there are people in place who could move fairly seamlessly into the new positions, which will offer more authority and more opportunity to use their skills. However, in other places such people will not exist or will not be available, or the people who have been doing the job will be past their sell-by date and will take this opportunity to step down. There may not be somebody there to take over.
Therefore, we harbour concerns that people who might not be as well qualified as one would hope and who are without the necessary experience might take up these positions unless clear standards are set and clearly stated qualifications are required. Therefore, we have tabled an amendment which proposes that those appointed will have to have undertaken a course and have qualified from it. Attending a course is one thing but showing that you have learnt something from it is another matter. Some of these matters may be able to be dealt with in other ways than being included in the Bill, but we want to press that matter a little further.
The standards, training and qualifications of the national medical adviser must be a substantial concern. If we are concerned about that at the local level we are even more concerned about it at the top level. Therefore, Amendment 49 proposes:
This goes to the heart of the matter. We need someone who has the necessary experience to give advice at a national level to the Chief Coroner on issues concerning untoward death, to see whether patterns are emerging, standards are being adhered to, people are being appropriately trained, or whether serious difficulties are emerging while the new service is being put into place which need to be raised at a national level. One way to monitor that could be to table an amendment stating that the Chief Coroner should produce a report to your Lordships House and the other place after a few years to see how the service is operating. However, in educational terms we are much happier with continuous assessment than with periodic examinations. Therefore the idea of having a national medical adviser is that their constant and consistent responsibility would be to observe how this new service is developing and to bring advice to the Chief Coroner, Ministers or Parliament to say, This was a good idea but here are some flaws, hitches or problems.
We welcome the Governments move towards having medical advisers or examiners all around the country. However, we want them to be properly trained and qualified; they should be monitored and provide the required information; and there should be someone at the heart of thingsa national medical adviserto give advice to the Chief Coroner and to provide appropriate monitoring and supervision of medical advisers around the country. I beg to move.
Baroness Finlay of Llandaff: I have amendments in this group and I welcome all the comments of the noble Lord, Lord Alderdice; I do not dispute any of them. I completely concur with the need to stress training and agree that the exam should be the equivalent to licensing and incorporate revalidation.
There is a general welcome from medical examiners but there is a concern which we need to express. If they are part-time you may find that one is working in the morning and another in the afternoon; when there is a complex case perhaps only the coroners themselveswho are, as now, on call 24/7would effectively provide the continuity required. Partly to get around that and partly because if you have a national service you need to set national standards, my amendments use the term Chief Medical Adviser. It is only the name that alters; however, one difference is that I have said that the chief medical adviser should be there to,
because if there is to be consistency across the UK it will be important that their performance is managed from many aspects. I did not add that this person should be there also to advise the Chief Coroner, because that is tied up in the title. If you are an adviser, your role is to advise. It would be duplicative to call a person an adviser and then state that they provide advice.
I have also suggested that whoever is the chief medical adviser needs to have more experience than that required of the medical examiners, which is why I have stipulated that the chief medical adviser should have been qualified for 10 years and have had seven years in practice.
I know from my very helpful discussions with the Minister before Committee that the Government are thinking of appointing two senior peopleone as a medical adviser to the Chief Coroner and another to oversee the medical examiners. If I am right, I understood that the medical examiners would be overseen by someone in the Department of Health, but that the person working directly with the Chief Coroner could be employed within the Ministry of Justice. I have a slight concern about having two people at the top of the system rather than having a more vertical structure. My preference would be to have one chief medical adviser with a deputy chief medical adviser who may be the person responsible for overseeing the standards of the medical examiners around the country; so there would be some career progression. The reason for my concern is that I am slightly worried that they could inadvertently give different messages. It would be no good for anyone if they did not get on and, therefore, gave different messages. A lot of the message-giving will relate to the way in which research is interpreted and the way in which new advances in examination techniques come along and the emphasis that is put on them.
We all know that someone who develops a new examination method in pathology can be very keen and slightly overegg the claim about how useful it will be. They do this in pursuit of the methods developmentnot dishonestly but just because they are very keen. Therefore, it might be helpful to have someone right at the top who is able to temper whatever information comes in, and I concur with the suggestion from the noble Lord, Lord Alderdice, that that person should have training and experience in forensic pathology.
Another reason for referring to this person in the Bill rather than simply in regulations is that he will need to have powers in order to deal with difficult situations. The medical examiners will be employees within the primary care trust. They will be dependent on having clear blue water between those employing them and the job that they have to do. That may include investigating and exposing poor clinical practice in their employers and therefore they will need some protection. If the chief medical adviser is referred to in the Bill and has statutory powers, that will build in a degree of protection which I fear may not be there if the appointment is made without being referred to in the Bill. That is why I have been pushing for this. It becomes particularly important in relation to possible prosecutions for corporate manslaughter and so on, which may be difficult to prove. Such cases may become very difficult and contentious, and those who give advice may require a lot of support in providing evidence to the inquest and to any subsequent proceedings. They may need to be represented by a very senior personthe chief medical adviser. My concern is that, if we leave this matter to regulations and do not put something into the Bill, we may not provide sufficient
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Lord Alton of Liverpool: My noble friend Lady Finlay and the noble Lord, Lord Alderdice, have argued persuasively in favour of their Amendments 47 and 48 concerning the role of the chief medical adviser, and I am very happy to support the arguments that they have just adduced. We will come to Amendments 52 and 53 tabled by the noble Lord, Lord Kingsland, to which I have added my name, and, again, I strongly support the sentiments expressed in them.
My own amendment in this group, Amendment 51, relates to the role of the Chief Coroner. It would leave out line 2 on page 11 of the Bill to the word must and insert The Chief Coroner, so that instead of:
During an earlier part of our proceedings, the Minister, the noble Lord, Lord Bach, said that he had written to me about the recommendations of Dame Janet Smith, who chaired the Shipman inquiry. I am grateful for his letter, dated 9 June, in which he says that,
Following that letter, yesterday the Minister answered a Question for Written AnswerHL4220which I tabled last week on the same point concerning how many of the recommendations of the Shipman inquiry had been incorporated into the Bill. The Minister said:
Other recommendations about coroners and death certification have been addressed by alternative means, including the framework within which services are delivered ... the Government are not convinced that the inquirys recommendation for a centralised death investigation service is the most effective model. Our preference is for coroners and medical examiners to be based at a local level, and while there will be close links between the two on specific aspects of their work, we believe that they should not be part of an integrated organisational structure.[Official Report, 22/6/09: cols. WA 247-48.]
I am grateful to the Minister for being so straightforward in his reply but this highlights a fundamental disagreement between the approach the Government are adopting and that which Dame Janet Smith suggested in the Shipman inquiry. There is a fine line to be drawn between accepting the findings of an inquiry and not implementing all its recommendations. Although I accept that, or course, no Government are bound by an inquiry in advance to accept everything that it says, I think the Minister and I would agree that this extraordinary series of reports, the amazing, voluminous evidence that has been published, and these very thorough recommendations, are not something that any of us would dismiss lightly.
When the Government say that they have been taking a different approach from Dame Janet and members of the Shipman inquiry, we do need to be clear what we are accepting and what we are rejecting. From the Ministers Written Answer, these can now be seen to be categorised into two parts. He said that in accepting parts of the inquiry a statutory duty was being laid,
Recommendations made by the Shipman inquiry into matters that are beyond the scope of coroners and death certificationsuch as the control of drugs, complaints arrangements in health and social care, and medical regulation and revalidationare being taken forward by the Department of Health. [Official Report, 22/6/09: cols. WA 247-48.]
I should be particularly interested to hear from the Minister how precisely that is going to happen, whether it is going to be dealt with through legislation or through regulations, and how the House will be told about the progress of those issues that fall outside the scope of the Bill.
Amendment 51 highlights one of the main differences between the two approachesthe Shipman inquiry approach and that of the Government in the Bill. It is Dame Janets strongly held view that the English primary care trusts and the Welsh local health boards should not be the bodies to, as provided in Clause 19 of the Bill,
She believes, and I share her view, that the Chief Coroner would be best placed to do this. That is why I tabled Amendment 51. It straightforwardly transfers the tasks to the Chief Coroner from the PCTs and the local health boards.
I was particularly struck by Dame Janets contention, based on her experience of the Shipman evidence, that local relationships can become too cosy. She says that there is a fundamental issue at stake here: the protection of independence. We must always guard against conflicts of interest and potentially incestuous relationshipsthe Harold is one of us arguments: He plays at the same golf club. He is a member of the same circles, attends the same professional meetings, drinks in the same pub. He is a decent sort of fellow and we must all look after one another. That is a recipe for disaster.
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