NHS Reform and Health Care Professions Bill

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Mr. Hutton: The first amendment seeks to add the Pharmaceutical Society of Northern Ireland to the list of bodies within the scope of the Council for the Regulation of Health Care Professions. The second and third amendments together make the same provision for the hybrid status of the Pharmaceutical Society of Northern Ireland, as both a regulator and a professional body—as we have already made in clause 24(5) in relation to the Royal Pharmaceutical Society of Great Britain. The fourth amendment brings the Pharmaceutical Society of Northern Ireland within the scope of clause 27, which relates to the council's power of public interest appeals.

Essentially, the amendments are necessary to reflect the separate ways in which the pharmaceutical profession is regulated across Great Britain and Northern Ireland.

Part 2 of the Bill applies to Northern Ireland as each of the regulatory bodies covers the whole of the UK. In the case of pharmacy, there is a Royal Pharmaceutical Society of Great Britain and a separate Pharmaceutical Society of Northern Ireland. Therefore, in order to apply the Bill properly to pharmacy in Northern Ireland, there needs to be a reference to the Pharmaceutical Society of Northern Ireland wherever the Royal Pharmaceutical Society of Great Britain is mentioned.

As members of the Committee will probably be aware, the regulation of health care professions in Northern Ireland is a matter transferred to the Assembly under the terms of the Northern Ireland Act 1998. That means that the Bill can apply to Northern Ireland only with the consent of the devolved authorities there. However, we have secured that consent and the Northern Ireland executive is happy for us to proceed along the same lines as we are in England, Wales and Scotland.

Amendment No. 198 is self-explanatory and would add the Pharmaceutical Society of Northern Ireland to the list of bodies included in the council. As with the Royal Pharmaceutical Society, the PSNI is distinct from the other regulatory bodies covered by the council in that it is both a regulatory body and a professional organisation. The Bill reflects that unusual status for the RPS and amendments Nos. 199 and 201 simply mirror the provisions in relation to the Pharmaceutical Society for Northern Ireland.

Amendment No. 202 adds the PSNI's fitness to practice decisions to the list of decisions against which the council may appeal in the public interest under clause 27.

Mr. Heald: I welcome the amendments. The Royal Pharmaceutical Society of Great Britain contacted me to explain that its remit does not extend to Northern Ireland, which has its own pharmaceutical society, and that clarification is needed about inclusion of the sister body in Northern Ireland into the new structures. I am sure that it will also welcome the amendment.

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Mr. Hutton: I am grateful for the hon. Gentleman's support.

Amendment agreed to

Mr. Heald: I beg to move amendment No. 225, in page 29, line 15, after 'sections', insert

    'save that the reference to the provision of general dental services in subparagraph 2(d) of paragraph 11(2) of Schedule 3 of the 1999 Act includes the performance of personal dental services,'.

This is a probing amendment to establish whether regulation of the qualifications or experience required to provide general dental services, as set out in paragraph 11(2)(d) of schedule 3 to the Health Act 1999, also covers personal dental services or, if not, whether that is covered in some other way in the Bill.

Clause 23(6) states:

    ''In this group of sections, references to regulation, in relation to a profession, are to be construed in accordance with paragraph 11(2) and (3) of Schedule 3 to the 1999 Act.''

Paragraph 11(2) of schedule 3 to the 1999 Act states:

    ''References to regulation, in relation to a profession, in that section and this Schedule include . . . (d) in the case of the profession of dental practitioner, the regulation of the qualifications or experience required for a dental practitioner to provide, or assist in the provision of, general dental services under the 1977 Act.''

We have dealt with personal dental services in various parts of the Bill and I seek the Minister's assurance.

Mr. Hutton: Once again, I am grateful to the hon. Gentleman who has drawn attention to what he believes is a gap in the provisions as they apply to the council. His amendment would cause references to regulation in the provisions to be read as including the regulation of the qualifications and experience required for the performance of personal dental services. It may be helpful if I explain the background because he has made a fair point and I want to explain why there is no gap.

The section 60 powers in the 1999 Act permit the creation, modification and amendment of legislation covering the regulation of health care professions to be carried out by order, subject to various limitations and procedural safeguards. We introduced those powers in that Act to make it simpler and more efficient to keep the relevant regulatory legislation up to date. Before the 1999 Act, there was always a problem finding legislative time on the Floor of the House to update and modify existing legislation, particularly against the background of a number of professional groups wanting their own new schemes of professional self-regulation.

This group of clauses uses the same definitions for the regulation of health professions set out in section 60 and schedule 3 of the 1999 Act. The schedule refers only to qualifications or experience required by a dental practitioner to provide, or assist in the provision of, general dental services. The amendment would include personal dental services in the scope of the UK council. The schedule relating to section 60 makes particular reference to personal medical services and so, as the hon. Gentleman said, there would appear to be an inconsistency. However, there is a difference between the regulation of qualifications or experience required for personal medical services and that required for personal dental services.

By virtue of primary legislation and European Union law, all doctors performing general medical services or personal medical services under a pilot must complete vocational training, which is period of employment after qualification during which the practicalities of general practice will be learned, including clinical learning, and learning about contractual matters. Dentists must also complete vocational training before becoming a principal on a health authority's list. To be able to perform personal dental services under a pilot scheme, there is no need to have completed that year of vocational training, although such a dentist would be fully qualified and required to work under supervision as part of personal dental services.

The hon. Gentleman's amendment is unnecessary because it does not recognise the distinction between the qualifications required to perform personal medical services and those needed to perform personal dental services. I hope that the hon. Gentleman feels reasonably reassured. Although there appears to be an inconsistency in the Bill, the differences can be explained in terms of the vocational and training qualifications required for a dentist to perform personal dental services.

Mr. Heald: That is helpful because it explains the apparent gap in provisions under paragraph 11(2) of schedule 3. I fully accept that the Minister's explanation deals with that, but I will think about it again before Report. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed that, That the clause, as amended, stand part of the Bill.

Mr. Heald: The setting up of the Council for the Regulation of Health Care Professionals is something that we are not minded to challenge directly by seeking to divide the Committee. However, we would like reassurance from the Minister that it is the correct approach.

The background to the council is that the Kennedy report suggested that an overarching body should deal with the regulation of health care professionals and the various bodies described in clause 23. However, some are asking whether it is the best way forward. The fact that Professor Kennedy suggested that such a mechanism should exist is powerful evidence, but the General Medical Council, which is probably the body to have received the most publicity in this area and has been criticised in many high profile cases, has taken steps to amend its procedures and make changes. The GMC's ability to regulate the profession has arguably changed since the Kennedy report.

For example, the new interim orders committee has been effected and further initiatives amount to a radical constitutional change in the GMC. The Minister will recognise measures such as periodic revalidation for all registered doctors and we welcome further changes to the fitness to practice procedures. The Medical Protection Society is an important body that provides indemnity, particularly for general practitioners, and it has made it clear that it is supportive of the changes that the GMC is making—we all are, in broad terms. The MPS states:

    ''A new Council for the Regulation of Health Care Professionals will add a further layer of bureaucracy which, in our submission, is likely to prove superfluous. A better way of improving accountability of the GMC would be to make it directly accountable to Parliament through the Health Select Committee. The proposed Council with powers to the extent set out in the Bill effectively brings to an end the concept of self-regulation. Individual regulatory bodies may be forced to make changes which they consider inappropriate for their own profession. If the Council is to be established, it should be advisory only, with no powers to require or impose change on individual regulators. The concept of an integrated approach is misconceived given the different clinical and professional responsibilities and working environments of each profession. Self-regulation may be imperfect, but is still the best means of regulating the professions. A body comprising doctors or dentists, together with lay representatives, is the ideal way of ensuring the rights of patients and practitioners are protected and the regulatory procedures are fair, transparent and efficient.''

In a later new clause we shall examine whether there is a case for bringing together the four main regulatory and inspecting bodies that the Government have recently created. Would one way in which to deal with that without setting up another council be to build on the procedures that we have in this place by making the General Medical Council and other bodies directly accountable to the Select Committee on Health? That would boost Parliament and play into the current arguments in this place about the way in which our procedures could be developed to make the legislature stronger to provide a greater counterbalance to the Executive.

One criticism of the Government's proposals is that there is an area of weakness when it comes to the independence of the Council for the Regulation of Health Care Professionals. Many provisions will be made by the Secretary of State, although it is good that the Minister is accepting one amendment, who will be able to mould and fashion the Council for the Regulation of Health Care Professionals—his appointees; his direction; his council. It might be more inclusive if it were our job as parliamentarians to be the responsible body to which these various professional regulatory bodies report.

The responsibility falls under the remit of the Leader of the House, who is also the Lord President of the Council. The Privy Council Office is the administration that deals with regulatory bodies, and it is only because these are health bodies that the Department of Health is taking this part of the Bill through the House. The overall responsibility in government for such work rests with the Privy Council Office. A search for reform by the Leader of the House helps the legislature gain prominence and authority. This is his area of responsibility, and he is giving ground to the Secretary of State for Health. In short, Parliament is giving ground to the Executive.

I should be interested to hear the Minister fashion an argument for this further layer of bureaucracy. I am not saying that we shall seek to divide the Committee on the clause, but I should be interested to hear the Minister justify that. As I said to him when we were debating the order that dealt with the Health Professions Council, it is not enough simply to say that because Professor Kennedy thought that something was a good idea, therefore it is a good idea. The Government need to justify and fill out the argument.

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