NHS Reform and Health Care Professions Bill

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Mr. Burns: Is the Minister worried that the Secretary of State's power to appoint members of the council might compromise its independence?

Mr. Hutton: Yes, and that is why we have tabled amendments to make it clear that the NHS Appointments Commission, a special health authority, will be responsible for making the appointments that relate to the Secretary of State's role. The devolved administrations will appoint their members directly, but they will be only three out of 10 lay members. The seven for England will be appointed independently, at arm's length from the Secretary of State. We have listened to the regulatory bodies' concerns about that, and agree with them that the last thing that we want to do is to place a question mark, right at the beginning, over the independence and accountability of the new UK council.

Wherever possible, we must maximise consensus on the UK council's role. We are giving it important tasks to discharge on our behalf. I do not agree with the view that has been expressed that the UK council is something of a sideshow or irrelevance. It will have a central role in shaping and developing future regulatory arrangements in co-operation with the regulatory bodies themselves. The point about independence was well made but I thought that I had addressed it in terms of other amendments. Perhaps we can clarify those issues when we come to them.

On the role of Parliament, matters should be addressed by the House itself. It would not be appropriate for a Minister to tell the House: ''This is how I think that this responsibility should be discharged.'' Ultimately, it has nothing to do with me. My responsibility to the House relates to how I discharge my role as a Minister of State in the Department of Health. It is not to tell the House of Commons how it should organise its scrutiny of the work of the UK council.

The Select Committee on Health, which has been mentioned, already has the power, opportunity and right to ask the GMC and any regulatory bodies to give evidence before it. On occasion, it has invited the GMC to do precisely that. That Committee will be able to continue to develop those lines of accountability. It is right to say that opportunities need to be explored in relation to how the House discharges those responsibilities, but that cannot be done effectively in legislation. We are opening up the council to an accountability relationship with Parliament. That is important and, I hope, generally welcome.

The two issues raised by the hon. Member for Wyre Forest (Dr. Taylor) will largely be dealt with by the orders that establish the new regulatory arrangements, rather than by the Bill. The Bill simply ensures that if those orders were approved in another place, the new nursing and midwifery council and health professionals council will fall within the remit of the UK council.

The health visiting profession will be fully regulated by the nursing and midwifery council, so there is no question of it being spirited away from the jurisdiction and competence of the UK council. If the order establishing the nursing and midwifery council were not to be approved, health visiting would remain subject to full regulation by the UK Central Council for Nursing, Midwifery and Health Visiting. There is no question of any potential gap or loophole in that respect.

In relation to chiropody, the hon. Member for Wyre Forest argued for chiropodists to be directly represented on the UK council. However, it is not for Ministers to determine which members of the regulatory bodies can serve on the council, because the Bill stipulates that that should be decided by the regulatory bodies themselves. I should hope that that would be welcomed on both sides of the Committee in the spirit of encouraging professionally led self-regulation.

Dr. Murrison: The difficulty centres on the notion of having a representative from the group of professions allied to medicine, which covers a vast array of professions within the health care sector. Chiropodists are worried that they will not have a voice because, numerically, their membership is dwarfed by that of other groups. Physiotherapists—my wife is one, so I must be careful what I say—are so large in number that they will almost certainly dominate the group, and others may not get a look-in.

Mr. Hutton: I understand the hon. Gentleman's argument, and we have designed amendments that try to address the issue. However, we must be clear about the underlying purpose of the proposals. Representatives of the regulatory bodies will be on the council not to represent professional interests, but the regulatory system to which their profession or group of professions is subject. As the Council for Professions Allied to Medicine regulates 12 separate professions, I assume that the hon. Gentleman would argue for one of each to be represented on the council.

Dr. Murrison indicated dissent.

Mr. Hutton: He would not. To be fair to him, we are not in the business of trying to arrange for every professional group of health care workers to have a representative on the UK council. The point is to have representatives from each of the regulatory bodies who can draw on their experiences of regulation in their professional sectors.

The Council for Professions Allied to Medicine currently includes 12 bodies and may include many more in future, depending on how the council discharges its responsibilities in advising Ministers about sectors that may introduce professional self-regulation, such as psychology, operating department practitioners, perfusionists and others in the queue of those who recognise its benefits. The logic behind the proposals is not to try to identify and represent on the council every separate professional group, but to ensure that it includes a representative from each of the regulatory bodies. I accept that that raises an issue in relation to the CPSM because it is the largest regulatory body representing health care workers in the NHS, and eventually, I am sure, the private sector. The matter requires further exploration, but we shall do so more fully at a later stage.

In relation to chiropody, it is difficult for me to give the assurance that the hon. Gentleman wants because that would cut across the spirit and the letter of the clause. We are not proposing a separate representative on the UK council from each professional group of health care workers. I hope that I have dealt with some of the hon. Gentleman's concerns.

Clause 23 will broadly do four things. First, it will establish the council. Secondly, it will give the council its functions, which are

    ''(a) to promote the interests of patients and . . . the public in relation to the . . . ('regulatory bodies') . . .

    (b) to promote best practice . . .

    (c) to formulate principles relating to good professional self-regulation, and to encourage regulatory bodies to conform to them, and

    (d) to promote co-operation between the regulatory bodies; and between them . . . and other bodies performing corresponding functions.''

Thirdly, the clause specifies which bodies come within its remit; there should be no ambiguity about that. Finally, it will give effect to schedule 7.

The new council will strengthen public confidence in professional self-regulation by acting as an independent defender of patients' interests. It is important to make it clear that the council is not, and should never be seen as, a substitute for professionally led self-regulation. Our system of regulation will be enhanced by greater co-ordination, consistency and accountability, and that is what clause 23 seeks to provide.

The proposals take their cue from Professor Kennedy's report, which states:

    ''The regulatory bodies, embracing . . . matters to do with safety, quality and standards as well as the competence of healthcare professionals, must themselves be co-ordinated and their efforts aligned by some overarching system.''

As the Consumers Association and the National Consumers Council have said, the regulators' accountability needs to be clearer and more consistent. The GMC said that its accountability was largely implicit and that that was unsatisfactory. The clause will remedy that by requiring regulators to conform to principles of good regulation and providing for effective scrutiny where necessary. As well as greater accountability, the new council will promote greater consistency. Professor Kennedy was keen for that and strongly argued for it. In the report, he said:

    ''Duplication must be reduced. Equally, holes in the system must be stopped. Only in this way will the fragmentation and lack of clarity about responsibility for regulating the quality of healthcare, which was such a feature of Bristol, be addressed.''

The BMA also supports the creation of the council and have argued that it will give consistency of action across the professional regulatory bodies.

To sum up our intentions in the words of the Kennedy report, we believe that

    ''regulation of the healthcare professions must be seen in the round and organised accordingly.''

That is what clause 23 seeks to do. I am glad to say that regulatory bodies in general have given the new council their support. We are aware of some of their concerns, particularly on clause 25, but they have been generally supportive and have said that, as regulators of the health professions, they welcome steps to promote best practice and common principles in the interests of patients. They also said that they support the proposed function of the new council as set out in clause 23(2) and want to be held clearly to account for what they do.

Dr. Harris: It would be inappropriate to seek a debate at this point because we will have one under clause 25. However, paragraph 23(2)(a), (b) and (d) includes the word ''promote''—that was presumably chosen for a purpose—as opposed to choosing the expression, ''seek to ensure''. Is that to make sure that clause does not appear to have a directional function, or is it taken from the Kennedy report, or another general framework with which it is consistent?

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Prepared 11 December 2001