Health and Social Care Bill

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Mr. Hammond: The Minister has just given a precise example of what the regulations might say. Are we to infer from that that the Department of Health has draft regulations prepared? If so, would it be possible for members of the Committee to see them?

Mr. Denham: To the best of my knowledge, we do not have a full set of draft regulations. However, there are issues that I shall refer to that have been discussed by the Government and the British Medical Association. Although those discussions are, as yet, unfinished, we have indicated our intentions. The hon. Gentleman will be aware that the specific point that I just mentioned is already incorporated in the test as part of the regulations introduced in the wake of the initial conviction of Harold Shipman. We discussed that matter in the House, and the provision merely reflects that for the sake of consistency in the regulations. Government amendments Nos. 119 to 126 make similar provisions for the lists for other professions.

Finally, Government amendments Nos. 127 to 133 make minor consequential changes to the numbering of certain new provisions introduced by clause 24, to which we shall come in due course.

3 pm

Mr. Hammond: I suspect that we have now had most of the debate on the amendment through interventions on the Minister's speech, but I would like to make one or two additional points.

It is incumbent on the Minister to explain why the Government have tabled so many amendments at this stage—at total of about 90 over the next few clauses. We understand that they have arisen from consultation and discussion with the representative bodies. We have no problem with that process having taken place, just as we—I can speak only for the official Opposition—have no problem with the amendments themselves. However, it is extraordinary that the Government apparently find it impossible to have sensible discussions with the people who know how these things work before publishing the Bill. Why do the Government consider it appropriate to publish a Bill without, one presumes, any real consultation with the bodies that they acknowledge need to be consulted, to consult them after it is published and then to table 90 amendments to three or four clauses? That does not seem the most sensible or efficient way to proceed. Indeed, it is slightly disconcerting in a Bill that makes provision to consult those very organisations before issuing regulations. Perhaps the Minister could give us some of the deep background to that peculiar train of events.

We recognise the driving force behind the clause. I suspect that the groundswell of feeling that such a measure was necessary started before the Shipman case, but that case has added impetus to the idea that we must deal with unsuitability. However, the Minister is getting himself into difficulty by confusing unsuitability in the sense of medics who must not be allowed to deal with patients with a much more amorphous concept of unsuitability based on a feeling that one would not want to employ a certain chap because he is not quite the ticket. The Minister's conflation of those separate notions is dangerous. Health authorities will be able to decide whether to include people on their list and might reject one chap on a Monday because he is a pathological serial killer and another on a Tuesday because he has been divorced twice or has something in his history that does not make him the most appropriate employee. There is a qualitative difference between such cases. Our definition of unsuitability would deal with that by allowing exclusion from the list only on grounds of real unsuitability—someone being a menace to themselves or to the public.

The Minister seems to be saying that there is a serious level of unsuitability and if someone falls into that category he or she must be debarred across the country. That is obviously right and proper. However, there is a lesser level of unsuitability, which would mean that someone might be unsuitable in Cheshire but suitable in Cornwall. We accept that there may be differences between the decisions of different health authorities, but such a system could have a slightly alarming outcome because—although the Minister denied it when I raised the matter with him earlier— it seems self-evident that in some parts of the country more people wish to practice as general practitioners than there are vacancies, while in other parts of the country there is a desperate need to get general practitioners into service. Such regions will typically be the most deprived parts of the country: inner city, run-down areas where health authorities are crying out for GPs. Frankly, it beggars belief that health authorities that are desperate for practitioners will not apply standards that are easier to meet than health authorities that have plenty of doctors and have no problem in providing a service whether or not they admit a given person to the list. Whether or not the Minister intends it—I feel certain he does not—so long as there is a shortage of GPs, the clause as it stands will serve only to heighten the inequalities in provision of service, instead of reducing them, which is the Government's stated objective.

I found it disturbing to hear the Minister repeatedly talking about employment practices and defining unsuitability to include factors that an employer might take into account when employing somebody. Returning to the discussion before lunch, we are seeking to be clear in our minds that the Minister is not attempting to undermine general medical services. GMS is not employment; it is not an employer-employee relationship, but a contractor-contracting relationship and precisely for that reason it is not appropriate to use the criteria that an employer would consider when he is employing someone.

I suppose that I should be pleased that the Minister has decided that amendment No. 174 have some applicability, however it is a shame that we tabled it in respect of the wrong clause. I understand the logic of his argument, but I think he is potentially making a serious mistake in confusing the two degrees of unsuitability—unsuitability because someone is dangerous either to himself or to patients and unsuitability because someone is not up to the standard that the health authority might like. We would have much preferred the two issues to be addressed separately.

If the Minister has confidence in the future of the General Medical Council and believes that the current programme of reform will be successful in restoring public confidence in that body, it would be right and proper for dangerous unsuitability to be dealt with by reference to whether a person is on the GMC's list. The Minister told us that it is necessary sometimes for the NHS to be able to move quickly in the case of a practitioner who is deemed unsuitable in order to suspend him from practice. It is equally important that the GMC is able to act quickly. Our objective should be not to put in place a separate mechanism subject to the Human Rights Act 1998 and to proper quasi-judicial practices within the NHS because we simply accept that the GMC will always be too slow, but to make the GMC process acceptable rather than duplicating the whole thing.

I accept the Minister's argument that there may occasionally be NHS reasons for not employing someone that would not be give the GMC reasons to exclude that person from the medical list. However, I cannot envisage—and the Minister could not give us any examples—circumstances where those NHS reasons would apply in one health authority area but not in another. We ought to take a general view that when Ministers bring Bills to Committees, giving themselves new powers, they ought at least to be able to present to the Committee an example of when such a power might be required. For the Minister to say that he cannot think of a single example of when a variation between one health authority and another might be justified invites us to question whether there is a need to allow such a discrepancy to arise.

The Chairman: Before I call the hon. Member for Isle of Wight, I should point out that the selection list marked ``3 Revised'', which was distributed before this sitting, is incorrect. We are using the selection list that was distributed before this morning's sitting marked ``3''. The cut-off time is now 7 o'clock and not 5 o'clock.

Dr. Brand: Medical lists are maintained by health authorities but it is unusual not to get on a medical list if one is suitably qualified, has suitable prescribed experience, is registered with the GMC and has insurance. Those are the criteria. The Bill introduces another qualification—suitability for the job. If we are going to introduce that, I find it surprising that the criteria will not be set out in regulation or applied nationally. That can be done be through health authorities, as agents of the Secretary of State, but I should have thought that if one health authority approves, that approval should be automatic for all others. I can see real difficulties through delay, for instance. If one applies for a partnership in a practice that covers two or three health authorities, by the time one has gone through the two or three processes to determine suitability, the job may have gone. The Government are missing an opportunity to streamline the approval system as they are streamlining the disqualification or the suspension system, which I fully support.

As the hon. Member for Runnymede and Weybridge (Mr. Hammond) said, suitability has been a matter for the applicant's prospective partners. They should be the best judges of whether a suitably qualified and registered person is right for that locality. That job is done by the health authority for single-handed practices, and I would assume that it is done by the health authority or the agency running a personal medical service project, if it is to be delivered through a directly employed practitioner. We are creating an extra barrier for people who may not fit the idealised picture of the family doctor. They may not get approval in the health authority area except through an appeal mechanism, by which time the vacancy may well have gone. It is likely to ghettoise people into the less attractive areas.

The other issue that the Minister has not addressed is whether there will be approval of a list and whether it will vary with the type of practice that is being considered. One of the powers that the Minister does not have is the ability to deal with a practitioner who falls out with his partners and establishes a single-handed list. There are apparently no powers in the Bill to prevent. Consequently, people who are excluded from a partnership because their mental health is unstable, or they have problems with alcohol or drugs, although not serious enough to warrant formal notification to the authorities, are made even more vulnerable.

 
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