Health and Social Care Bill

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Dr. Brand: I support the spirit behind these amendments. The issue of gifts to practitioners is extremely difficult. It is churlish to turn down a gift, especially when people have made a special effort. In the appropriate season, we are frequently given a brace of pheasant. We particularly appreciate it when it comes from the wife of the gamekeeper, because she prepares them for the oven. I am afraid that the nobs who shower me pheasant, do so literally—it is difficult to know when they were shot, but that is good for anatomical skills.

However, there is a real difficulty with the issue of gifts having a reasonable value, because people appreciate gifts, and that works both ways. We have a large orchard and have large bowls of apples in the waiting room. I am not trying to keep people away by giving them an apple, and nor am I trying to bribe them to come. It is an interaction between communities and the people who serve them. It is important for there to be a monetary value, and for us to distinguish between gifts that are of personal benefit and gifts to the practice, which predominantly benefit other patients or other staff. I cannot see anything in this clause that helps to deal with that particular issue.

I know that there are rules and regulations for trusts. People often want to express their gratitude for the hard work done in a hospital, and a box of chocolates for the nurses is appropriate, as is a donation to the league of friends. I hope that, when the regulations are drawn up, the Minister will bear in mind the fact that independent contractor have a particular difficulty. Anything that is bought out of gifts they do not have to buy themselves. That could be interpreted as extra moneys going towards practice facilities that are of direct benefit to the practitioner, so perhaps they should be spent on extras, such as sound systems and extra chairs.

Mr. Denham: Although I have no fundamental objection to amendment No. 184, it is unnecessary because we intend that regulations should specify a value for gifts. I will leave it to the hon. Member for Runnymede and Weybridge to decide whether he wishes to press me on the point, but I hope that he will be satisfied with that assurance.

Mr. Hammond: The Minister will know that the pharmaceutical industry's voluntary code sets a limit of £5 on gifts to general practitioners. What monetary value does he have in mind?

Mr. Denham: Those matters are for discussion with the profession, but it is well known that the figure of £25 has been bandied about in discussions with the BMA over recent months. The figure has not been finalised, but it gives an idea of the order of magnitude involved. We will need to return to parliamentary counsel on the issue. I would prefer not to bring forward an amendment on that on Report, but I have no fundamental objection to the notion of a specified value.

I agree that a comparison of the proposal with the ministerial code of conduct appears at first sight to suggest that it costs five times as much to buy a Minister as it does to buy a general practitioner. I would not want to argue that that is an example of market forces at work. It is obviously not a relevant comparison. I shall make a few points about the position of Ministers and hon. Members. My understanding of the ministerial code of conduct is that we are required simply to refuse gifts that might give rise to concerns about their effect on our impartiality, and that we must give back or buy gifts with a value of more than £140. Members of Parliament must declare any gift of more than £125 in the Register of Members' Interests, which is open to the public. There is an important difference between a register that any member of the public can look at, and a register such as we propose for GPs, which we have never suggested should be open to the public.

A more relevant comparison would be with the guidelines for employees in the NHS—although I acknowledge that there is some difference in the position of those working in hospitals and that of general practitioners. We have sought to achieve the right balance and to have a broadly consistent approach. We have just published guidance on commercial sponsorship within NHS hospitals. Sponsorship was defined as funding from an external source, including funding of all or part of the costs of members of staff, NHS research staff, training, pharmaceuticals, equipment, meeting rooms, costs associated with meetings, meals, gifts, hospitality, hotel and transport costs, provision of free services, buildings or premises. It includes among its requirements the declaration of gifts and other forms of sponsorship valued at more than £25, while the proposal that we are discussing requires that gifts from pharmaceutical companies should be declared. The BMA strongly supported that guidance, stating that the vast majority of GPs would be more than willing to comply with it.

Our guidance on commercial sponsorship does not replace the guidance issued to the NHS under the previous Administration: ``Standards of Business for NHS Staff''. That document addressed the difficult issue of gifts from patients, and made it clear that NHS staff, including doctors, should decline all gifts from patients other than those of low intrinsic value. I agree with the hon. Member for Isle of Wight that in the vast majority of cases—with the exception of small gifts such as a box of chocolates or flowers—staff routinely encourage patients to make donations to a league of friends or a local appeal, which is what grateful patients often do.

Mr. Hammond: The Minister fails to distinguish between a personal gift to a member of staff and a gift made for the benefit of the hospital or, if is it to the GP, for use in the practice. Does the Minister accept that there is a relevant distinction between a bottle of whisky and a box of sphygmometer cuffs?

Mr. Denham: Yes, of course. I do not know what the position is for NHS staff if patients personally present them with a gift of hospital equipment, because that usually goes through a different route. However, it is important to note that the emphasis of these provisions is on declaration within the organisation rather than refusal of a gift. What we will end up with as a result of these regulations is a system of disclosure akin to that for NHS staff. Declarations of financial interests will have to be made, and that is right. It will be known whether a GP owns a private nursing home to which he refers patients, whether he has an interest in a pharmacy, or whether pharmacists and opticians have similar possible conflicts or overlaps of interest. The move is toward an appropriate consistency.

What attitude should we take towards gifts from patients to GPs? If we took an approach that was wholly consistent with the position of staff employed in the NHS, we would have to require that all gifts should be refused unless they were of low intrinsic value. Although it is hard to define, the relationship between a general practitioner and his patients over a long period is often somewhat different. That is why we are requiring declaration of gifts over a certain value, rather than taking the harder line of requiring GPs to refuse gifts, as would be the case in a hospital situation.

Very often the relationship between GP and patient is highly positive, but it can also be a potentially problematic relationship between a powerful GP and a vulnerable patient. Having this information available is a useful safeguard, so that if grounds for concerns arose, the pattern could be examined.

The hon. Member for Runnymede and Weybridge asked me about his amendment on bequests. I understand his point, and I certainly see why the information might be of advantage. However, I have identified a host of quite considerable practical difficulties in running such a system. I make no promise about introducing further measures, but I shall give the issue further consideration. I accept that such information could be useful, but I would not want to introduce a system that could not work in practice, or that could be discredited.

Mr. Hilton Dawson (Lancaster and Wyre): I believe that GPs should be treated exactly the same as other professionals working in the NHS and in other care fields. Although it is nice to think of the ruddy, rural GP receiving a brace of pheasants from his patients now and then, we are trying to modernise the NHS. Everyone is aware of the vulnerability of patients, and of the relationships that can develop between people who are being looked after and their carers. I do not see why GPs should be in a different category. I have nothing against GPs: I value their professionalism as much as that of anyone else in the health service or in the social care field. If we want consistency, it should not be appropriate for patients to give those who care for them any more than the normal tokens of politeness and decency. We should ponder on that.

4 pm

Dr. Brand: I am happy to respond to the hon. Member for Lancaster and Wyre (Mr. Dawson), whose opinions I normally value a great deal. There is an enormous difference between being a general practitioner, who has to live in the community that he serves, and a doctor, who has to work in an institution or hospital. I have known most of my patients for more than 20 years, and the gifts do not all go in one direction. If Mrs. Salmon does not bring us some smoked salmon on Christmas eve, we might go hungry because we had planned on having it; but she may join us instead for a meal on boxing day. How can we resolve that difficulty? Not only is she a very good friend, she has been my patient for 25 years. It can be difficult, because the gifts are not given for a particular episode of care. I hope that such relationships will continue, although I suspect that they are getting fewer. I now get more bottles of sherry than I used to receive of whisky.

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