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Meanwhile, we must recognise that our society is based on a framework of law, particularly with regard to the advancement of interests that are challenged and threatened. Those who need to feel safe in our society need protection, which is created significantly by the framework of law, and I am grateful to my noble friend Lord Harrison not only for opening this debate but for identifying pieces of legislative achievement under Labour Administrations, including this one, that have enhanced the freedoms of our individuals.
Lord Patten: I listened with care to everything that the noble Lord, Lord Davies of Oldham, has just said. He will correct me if I am wrong, but it seems that his belief is that the only way, in the words of his noble friend Lord Harrison, to make the United Kingdom a more tolerant, democratic and open society is to use legislation on every occasion to bring this about.
Lord Davies of Oldham: My Lords, I am not saying, nor did my noble friend Lord Harrison suggest, that only legislation brought this about, although legislation is an important component that conditions the perspectives of society. One obvious example is the Disability Discrimination Act. There is no doubt at all that our improvements to the rights of the disabled across a whole range of activity in our society have been based on legislation. I recall a time, as no doubt noble Lords can, when an airline refused to allow disabled passengers on to its aircraft because, as far as it was concerned, they were an extra burden and it did not cater for them because it was a cheap-fares airline. We could do nothing about it because the legislation did not extend beyond the airport terminal to the tarmac and entry into the aircraft. It was a foreign
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I am grateful to my noble friend Lord Harrison for raising a number of issues. He talked about free access to theatres. That is pushing things a little further, but he will know that the National Theatre and others have pioneered cheap £10 tickets for major productions in the West End-a reflection of some progress in that area. He also emphasised the particular importance of something that was not picked up by any other speaker in the debate: the right to roam. There is no doubt at all that freedom includes freedom in this area. At one stage, landowners thought that this threatened their interests, but on the whole the Act has been hugely successful and has promoted opportunities for our citizens that are greatly appreciated.
The noble Lord, Lord Patten, moved on to the important issue of tolerance. I hear what he says about religious freedom, which is of the greatest significance. Our society cannot be free unless there is proper protection for religious freedom and people are free to worship in the way in which they are called to do so, but he will appreciate that part of our difficulty is that there are some who masquerade under the religious banner and who are a threat to our society. I have met many imams-I represented a constituency with a very large number of Muslim constituents, so I know of imams' wonderful work and leadership in their communities-but the noble Lord will also know that we have to watch with care those who carry the title without any commitment to the teachings of Islam, who have a very distorted perspective of the concept of jihad and who are a constant physical challenge to other people. Within that framework there is bound to be an area of constraint. As to the more general positions that he put forward on religious freedoms, no one could possibly take exception to the thrust of his arguments.
The noble Lord, Lord Roberts of Llandudno, emphasised a number of points. He stressed that devolution and other legislation brought increased opportunities for participation in the devolved Administrations. I want to reassure him on his cardinal concern about postal votes and the general election, particularly with regard to our forces serving in Afghanistan. I am with him entirely on that. The Government are eager to reassure the House that we will make proper arrangements in time for the participation of our forces personnel in the next general election. The problem with the prescription put forward by the noble Lord, Lord Roberts, is that we would need changes to primary legislation to change the dates of postal voting. He will recognise the impossibility of us being able to offer that at this stage.
My noble friend Lord Anderson brought in some important points. He emphasised the extent to which we had to challenge racism in our society and how we have made progress in a more tolerant society. I want to reassure him on binge drinking, which predates
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My noble friend Lord Borrie took us down memory lane in referring to the contributions of Anthony Crosland and Richard Crossman to the development of our society. He emphasised that the process of enhancing personal freedoms has a long history to it, as did my noble friend Lord Judd in his emphasis on issues of constitutional change. I acknowledge that there always will be defects with regard to our constitutional arrangements which need to be challenged. He will also know that since 1997, we have had significant Acts of Parliament on constitutional change-not least the whole nature of this House has been transformed by the Act which changed its composition a decade ago.
I was very grateful for the contribution from my noble friend Lady Kennedy of The Shaws. She knows that from time to time she makes a contribution that makes the hair curl of those of us who serve in the Government Whips Office and, to put it mildly, we have our anxieties. In counting Opposition votes, I have noted that my noble friend is often among them. In her terms it is for the very best of reasons, which she often articulates on the Floor. But today she brought a measure of encouragement as regards the way in which we could look at the processes of consultation with our communities with the confidence of the judgment that they would show. I do not think that there is the slightest doubt about that affirmation of the concepts of democracy to which we all subscribe. I am conscious that this House is just a tad away from the full embracement of democracy, but many noble Lords share her perspective, which she identified in such an important and constructive manner today.
I am grateful to my noble friend Lord Mitchell for his contribution. It was an important one that identified areas where enormous progress has been made. He is right to celebrate diversity, particularly in our capital city, and he is right to emphasise that we would not have got the Olympic Games without being able to present that argument. However, I take on board his point about anxieties in some communities. We know that there is a fascist element represented by a minority party in our society that poses a threat to all minority groups, and we know also that tensions arise from time to time between minority groups. My noble friend was also right to say that although universities of course have to cherish freedom of speech and debate as their essential role, it is also important that they remove any element of fear that might obtain with regard to some in their communities.
I am grateful to my noble friend Lord Graham and to the noble Lord, Lord Dholakia, for his precise identification of the need to advance civil liberties. I regret that I am not able to pay full tribute to all the
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4.50 pm
Lord Harrison: My Lords, in swiftly ending the debate I shall respond to the suggestion of my noble friend Lord Anderson that I spoke in a partisan way. I thank all my colleagues on these Benches, but would like to point out that in the form of the Liberal Democrat Benches, both physically and philosophically, I have two fellow travellers. I would like also to thank all the other Members who spoke in the debate. With that, and with the hope that noble Lords will read the debate in Hansard, I beg leave to withdraw the Motion.
Marriage (Wales) Bill [HL]
Order of Commitment Discharged
4.51 pm
Lord Rowe-Beddoe: My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Unless, therefore, any noble Lord objects, I beg to move that the order of commitment be discharged.
Co-operative and Community Benefit Societies and Credit Unions Bill [HL]
Main Bill Page
Copy of the Bill
Explanatory Notes
Third Reading
4.52 pm
The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord Davies of Oldham): My Lords, I have it in command from Her Majesty the Queen and His Royal Highness the Prince of Wales to acquaint the House that they, having been informed of the purport of the Co-operative and Community Benefit Societies and Credit Unions Bill, have consented to place their interests, so far as they are affected by the Bill, at the disposal of Parliament for the purposes of the Bill.
Lord Tomlinson: My Lords, briefly, perhaps I may express my gratitude for the support of three different groups on this Bill. First, I thank the Treasury for all its help in the redrafting of various clauses to overcome the objections that came from two Select Committees of your Lordships' House. That work is very much
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Bill passed and sent to the Commons.
General and Specialist Medical Practice (Education, Training and Qualifications) Order 2010
General and Specialist Medical Practice (Education, Training and Qualifications) Order 2010
Motion to Approve
4.55 pm
That the draft order laid before the House on 18 November 2009 be approved. First report from the Joint Committee on Statutory Instruments.
Baroness Thornton: My Lords, the order being debated today is the first in a series of legislative instruments implementing the recommendations made in the report of the Tooke inquiry, Aspiring to Excellence-Findings andFinal Recommendations of the Independent Inquiry into Modernising Medical Careers. This is quite a complex order and my remarks will be quite lengthy. I apologise in advance for that. However, I hope they will be helpful in facilitating the discussion.
The draft order is made under powers in Section 60 of the Health Act 1999. It abolishes the Postgraduate Medical Education and Training Board and transfers its functions to the General Medical Council. The Postgraduate Medical Education and Training Board was created in 2003 and took over the functions of its two predecessor bodies-the Specialist Training Authority, the STA, and the Joint Committee on Postgraduate Training in General Practice, known colloquially as the JCPTGP-in September 2005. It currently approves standards for assessments, trainers and programmes for the delivery of postgraduate medical education and training, and monitors training, quality standards and outcomes through inspection visits and other arrangements in the UK. It also awards certificates of completion of training, CCTs, and determines the eligibility of doctors for inclusion on the specialist and GP registers. The effect of the draft order is to transfer to the GMC statutory responsibility for delivering these functions, which are central to ensuring the delivery of effective patient care.
The GMC already has responsibility for setting and assuring standards in undergraduate medical education and for ensuring that all doctors participate effectively in continuing professional development to ensure that they keep their skills up to date after completing training. While taking on responsibility for postgraduate medical education and training is a significant extension of the GMC's remit, it is in a functional area in which the GMC already has a strong track record.
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When the Postgraduate Medical Education and Training Board was created in 2003, it brought together, for the first time, responsibility for setting and maintaining standards in both postgraduate general practice education and training and specialist medical education and training. The rationale for merging the functions of the Postgraduate Medical Education and Training Board with the GMC originates from the report of the Tooke Inquiry, Aspiring to Excellence-Findings and Final Recommendations of the Independent Inquiry into Modernising Medical Careers.
This is not a new idea. It was first recommended in 1975 in the Merrison report. The Tooke inquiry demonstrated dissatisfaction among the profession with the current fragmented system and found evidence that the medical profession sought an education and training standards-setting authority that was independent of both the Government and the NHS, had strong lay representation and which could work in close partnership with the profession. Such a body would also need to draw on relevant specialist expertise to facilitate flexible training and set standards across the continuum of medical education, from undergraduate studies through to postgraduate qualification and continuing professional development.
The inquiry suggested that a merger of the two bodies responsible for medical education and training would provide the potential for shared expertise, the development of a shared philosophy and facilitate economies of scale. The merger will also create a single competent authority for medical education and training and a single point of contact for doctors, employers and other partner organisations.
Historically, the financial burden of standard setting in postgraduate medical education and training has fallen primarily on the trainee. The Tooke report also revealed that there is strong support for the view that it would be more appropriate for the costs to be borne by the profession as a whole. Transferring responsibility for setting and assuring standards of postgraduate medical education and training into the GMC's remit will enable changes to the current funding structure to be made so that, in future, the system of assuring postgraduate medical education and training could be funded through GMC fees with the burden of costs shared across all licensed doctors.
Both the GMC and the Postgraduate Medical Education and Training Board support the merger, recognising that it creates an opportunity to realise more far-reaching improvements in the way that medical education and training are regulated. During the public consultation on the proposed legislation, there was also very strong support for the proposal, with a large majority of respondents supporting a merger of the two bodies.
Turning to the proposed transfer of functions, I have already said that the draft order makes provision similar to that currently in the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003. I apologise for going into some detail. As the order integrates the provisions of the 2003 order into the Medical Act 2003, it is, I am afraid, rather complicated legislation.
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5 pm
Article 3 of the order formally abolishes the Postgraduate Medical Education and Training Board. Article 4 then introduces a number of amendments into the Medical Act 1983, made in Schedule 1 to the order.
Although the PMETB is currently responsible for setting standards for entry to the GP register and the specialist register, the GMC as the body responsible for regulating medical practitioners currently holds and administers the registers. The GMC will continue to hold and administer the registers once the PMETB is abolished.
However, a number of consequential amendments to the Medical Act 1983 are required in order to ensure that the GMC is able to perform all the statutory functions necessary, both in connection with the keeping of the registers and postgraduate medical education and training generally. With this in mind, paragraph 10 of Schedule 1 inserts a new Part 4A into the Medical Act 1983 dealing with postgraduate medical education and training.
I shall not take up the House's time by going through all the provisions of new Part 4A in detail as there is a comprehensive explanation of them in the consultation paper on the draft order prepared by the Department of Health. I should perhaps mention, however, the provisions where there is a departure from the current legislative position. These relate to the categories of registered medical practitioners, other than those who have been awarded a CCT, who are eligible for entry in the GP register and the specialist register. Whereas the 2003 order set out the eligibility criteria for doctors wishing to be included in the GP register and the specialist register, new Part 4A provides new delegated powers enabling the Privy Council to prescribe such criteria in an order. These new powers, at new Section 34C(2)(c) and Section 34D(2)(c), enable the Privy Council by order to specify other categories of registered medical practitioners who may be entitled to be included on the GP register or the specialist register respectively. There is also a power at new Section 34D(3) for the Privy Council by order to designate specialties as recognised specialties for the purpose of inclusion in the specialist register.
Creating a new regulation-making power will enable any necessary changes to the criteria for inclusion on the registers to be made more quickly and easily in order to reflect changes in the wider external environment. However, I believe that the necessary checks and balances would be provided, as many of the eligibility criteria are derived from European Community legislation. Changes would be consulted on and be subject to approval by Parliament.
The Postgraduate Medical Education and Training Order of Council 2010, which sets out detailed provisions relating to the categories of registered medical practitioners other than those who have been awarded a CCT who will be eligible for entry in the GP register and the specialist register, was consulted on at the same time as the draft order before us today and will be laid before Parliament as soon as this order is made.
The draft order does not make any substantial changes to standards of postgraduate medical education
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The noble Lord, Lord Patel, chairman of the National Patient Safety Agency and former chair of the Specialist Training Authority, was invited by the GMC and the Postgraduate Medical Education and Training Board to lead the ongoing review of the current arrangements, which is due to make recommendations on an appropriate, contemporary approach to medical education and training in March 2010.
Noble Lords may be aware that the GMC and PMETB published for consultation recommendations arising from the review of the noble Lord, Lord Patel, on 11 January. I understand that the outcome of the consultation will then inform the final report and recommendations to the GMC.
A merger in advance of the noble Lord's final report makes sense because it allows the GMC to take an overview of the whole continuous system. The GMC will then be better placed to identify and implement any changes required as a result.
Finally, I should also point out that the order makes a technical amendment to the Medical Act to enable GPs to be included on the GP register without the need to make a request to the GMC when they have been registered temporarily under Section 18A of the Medical Act in the event that the GMC has been advised that a civil emergency has occurred, is occurring, or is about to occur. As part of the Government's planning in response to the recent swine flu epidemic, it became clear that, although the powers introduced in the Health Care and Associated Professions (Miscellaneous Amendments) Order 2008 enabled temporary registration of doctors generally, they did not give the GMC the explicit power to be able automatically to add former GPs to the GP register. To practise primary medical services, GPs need to be included on the GP register before they can be included on their employer's local performers list.
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