NHS Reform and Health Care Professions Bill

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Dr. Richard Taylor: I was delighted to hear, when the Minister was talking about clause 23, that he wholeheartedly supports independence from the Government. I should like clarification on amendment No. 203, which seems to me to remove the necessity for amendment No. 188 and probably also for amendments Nos. 189 and 256, which are very much supported by the BMA, the GMC, the Royal College of Nursing and the Chartered Society of Physiotherapy.

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Mr. Heald: I hope that the hon. Gentleman does not accept that amendment No. 203 would remove the need for amendment No. 189, which would provide for equality of numbers between ministerial and regulatory body appointments to the council. Surely that balance is important.

Dr. Taylor: My understanding is that if the appointments are made by the independent appointments commission, which amendment No. 203 suggests will be the case, they will not be Government appointments to the same extent.

Mr. Heald: Yes, but the balance of the numbers would remain the same: one more appointment for the NHS commission. Does the hon. Gentleman not agree that it would be better to have equality between its appointments and those of the regulatory bodies?

Dr. Taylor: I shall wait to hear the Minister's comments and hope that they clarify the position.

Dr. Harris: Just before the hon. Gentleman finishes, I should like to check one thing with him. Amendment No. 203 provides for appointments to be made by the independent NHS Appointments Commission, and therefore more independently of the Government, but that does not necessarily deal with the issue of whether there should generally be a professional majority or equality in the council. That is a separate point. One does not have to have a suspicion of the Government over independent appointments—although it helps—to be concerned about the broader question of whether we are seeing the end of professional self-regulation as a result of the loss of that majority.

Dr. Taylor: All that I am trying to address at the moment is independence from the Government. I believe that to be the most important aspect.

Mr. Hutton: May I clear up one or two misunderstandings that have emerged during the discussion? They were highlighted in the contribution just made by the hon. Member for Oxford, West and Abingdon. This is absolutely not the end of professionally led self-regulation. I tried to make that very clear in my arguments on clause 23 and on why we need the UK council. The council will not supplant the role of the GMC or any other body in professionally led self-regulation in those fields.

Dr. Harris: They are concerned about it.

Mr. Hutton: I think that that point is, however, accepted by the GMC and the other bodies, who broadly support the establishment of the UK council. The GMC has expressed support for the principle of a lay majority on the council.

Dr. Harris: I know that the Minister has only just started, but I must stress that if there were not broader concerns about powers in clause 25, I would have little disagreement with what he is saying. Perhaps I should have made it clearer that my concern about this matter is strongly linked with concern about the extent of the powers in clause 25. I do not want to stray too far down that route, but the Minister will need to reassure me about those.

Mr. Hutton: I very much look forward to reassuring the hon. Gentleman about them later. He rightly says that that is a matter for a subsequent discussion, and I do not want to intrude into debates on clause 25 now. However, he is quite wrong to say that clause 25(2) creates a wide power of intervention. It absolutely does not. We have tried to narrow it down to what we regard as the essential minimum reserve power that the UK council will need to discharge the responsibilities that this House will, I hope, give it in that area.

I accept the general argument that concerns expressed about clause 25 are connected to those expressed about schedule 7 and clause 23. I hope to address that later. I think, however, that the hon. Gentleman was wrong to describe clause 25 as allowing a wide power of intervention. We have made it very clear that it is a reserve power, to be used as a last resort. It is an essential tool to enable the council to do its job properly on our behalf.

The amendments cover a wide range of issues. Amendment No. 255 would give the Council for Professions Supplementary to Medicine, or its successor body the Health Professions Council, three seats rather than one on the Council for the Regulation of Health Care Professionals. We have already discussed why I would find that proposition difficult to accept.

There has been some misunderstanding about the nature of the representative role but, as the hon. Gentleman himself argued, we do not envisage that the representatives of the regulatory bodies who will serve on the UK council will represent individual professional groups. They will be there to draw to the council's attention the experience that they have of regulation within their professional areas. It has long been the case, in relation to the Council for Professions Supplementary to Medicine, that there is a uni-professional regulatory body. That council is wide-ranging in scale and remit. It covers 12 discrete professional areas and there has been consensus and support for a long time for the uni-professional regulatory body in the area of professions supplementary to medicine. To disturb and shake that up now would not be terribly helpful.

The hon. Gentleman was, however, right in saying that there is no perfect way to ensure representation. I accept that, but there is usually a right way and a wrong way. The right way might not be the path of 100 per cent. consensus, but this is a matter for judgment and the House—Ministers, and hon. Members on both sides—must ultimately reach a decision. If in saying that there is no perfect way forward the hon. Gentleman means that there will not be 100 per cent. consensus, I agree with him. However, the arrangements that we are proposing for professional representation on the council are closer to the spirit of Kennedy than the alternatives that we have had on offer today. I will return to that point, because I want to quote Professor Kennedy on it.

Amendment No. 188 would ensure that the Secretary of State appointed the seven English non-professionals on the council on the recommendation of the NHS Appointments Commission. It will not surprise the hon. Member for North-East Hertfordshire to learn that we have a problem with the amendment: not with what it seeks to do, but with the way in which it would achieve it. As he is aware, the NHS Appointments Commission is a creature of secondary legislation, brought into existence under, I think, section 8 of the National Health Act 1977. I might be wrong about that section, but it was set up under the power that that Act granted to establish special health authorities. In general terms, it is a mistake to refer in primary legislation to the creatures of secondary legislation. I am sure that the reasons for that will be apparent to the Committee. I cannot accept amendment No. 188, but I consider that amendment No. 203 addresses the hon. Gentleman's concerns. He is right in his characterisation of the purpose of my amendment.

Amendment No. 189 would give the council an equal balance between members appointed by the regulatory bodies and those representing public and health care providers. Amendment No. 256, tabled by the hon. Member for Oxford, West and Abingdon, would reverse that, and give a majority to the regulatory bodies. There is a polarity of views from Opposition Members on that point. If we study the Kennedy report carefully—I shall draw the Committee's attention to a comment in it in a moment—it should become clear why we have chosen the path that we have, rather than the alternatives on offer.

Government amendment No. 203 makes provision for the NHS Appointments Commission to appoint the English non-professional members of the council. It is our version of amendment No. 188. In a sense, I agree with the analysis offered by the hon. Member for Wyre Forest of the effect of amendment No. 203 on the other amendments tabled by the hon. Member for North-East Hertfordshire. I consider that it does negate those amendments. As I understood it, the hon. Member for North-East Hertfordshire was concerned about the appointment of seven members by the Secretary of State in England. Amendment No. 203 entirely removes that argument from his arsenal of invective against the Government's proposals because the Secretary of State will not make those appointments. The hon. Gentleman's concerns have been addressed by our suggestions.

Mr. Heald: The Minister is absolutely right that that amendment changes the circumstances, and it is very welcome. However, the issue remains of the balance between regulators and lay members. The Minister still needs to address the subject of equality and balance.

Mr. Hutton: I intend to do so shortly. However, the hon. Gentleman's argument, as I recollect it, was constructed on the premise that there was a need for balance between the regulatory body members and the non-regulatory body members because of his concern about Government appointments. That element of his argument, which was rightly identified by the hon. Member for Wyre Forest, is shot down by amendment No. 203. I shall deal with his wider area of concern later.

Government amendment No. 204 removes redundant words that give the impression that the Secretary of State can intervene by regulations to decide on the number of members of the council. We wanted to remove any uncertainty about that.

Government amendment No. 205 is purely technical and consequential on Government amendment No. 187.

Government amendment No. 187 is a wonderful thing. For the first time in my experience—your experience as a Minister, Miss Widdecombe, is much more extensive than mine—the Opposition had tabled an amendment that was exactly the same as the one that I wanted to table.

 
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