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Baroness Masham of Ilton moved Amendment No. 2:

Page 2, line 14, at end insert:
("and such requirements may include conditions for retraining and supervision").

The noble Baroness said: Amendments Nos. 2 and 3 are being taken separately. In moving Amendment No. 2, I wish to make it clear that I have both the interests of the doctors and the public—the patients—equally at heart. The amendment would put clearly on the face of the Bill the provision that, when a doctor had been suspended from registration, for the protection of

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members of the public or in the doctor's interest, the committee could impose conditions for retraining and supervision.

I consider that this amendment is desirable because I feel that the public need reassurance that something constructive will be done. There has been a great deal of concern and dismay among the general public over some tragic cases which have been widely publicised. Let me quote the headlines from a few newspapers printed since the Second Reading of the Bill.

The Universe, Sunday, 2nd July:

    "This waste of a beautiful life. Twelve-year old Katie from Moulton, Northampton, died from blood poisoning after a routine appendix operation".

The article says that the family is still horrified by the chain of events leading up to the youngster's death. The whole story will have been widely read.

The Times, Tuesday, 11th July:

    "Doctor accused of injuring women with bungled keyhole surgery".

The Times, 14th July:

    "Doctor failed in duty to his patients".

Earlier this year, the Evening Standard had a full page spread with the headline:

    "The brain tumour that six experts failed to diagnose".

Up and down the country in local papers and the nationals one reads many such stories. It is no wonder that there is a worried and confused public when they hear that the most famous hospital of all, St. Bartholomew's, is under threat of closure. How can they understand that when there is a shortage of British doctors and a much quicker throughput of patients in the hospitals, which puts much more pressure on hospital doctors and on general practitioners once the patient goes home and needs continuing care. The public have campaigned for the hospital which they trust and respect. They feel that nobody is listening to them.

There are many reasons why some doctors fall below acceptable standards and need a period to get back to a good working standard. In an inner city where there are still single handed practices and in rural districts with large, sparsely populated areas it could be very easy for doctors to slip back into unacceptable ways and again become seriously deficient without support and a period of probation with supervision to keep them on the correct track.

Having training and supervision clearly written into the Bill might help to regain some of the public's confidence and reassure the doctor, who might feel isolated and vulnerable without the knowledge that he would have a helping hand when he needed it. I beg to move.

The Lord Bishop of St. Albans: I have been tempted to rise to my feet to express my support for this amendment proposed by the noble Baroness, Lady Masham of Ilton. I congratulate her on the way in which she persuasively presented it.

Far be it from a clergyman to dictate how the medical profession should run its affairs, especially as the Church of England has demonstrated that it has much to learn in the field of discipline and adjudication. The only thing that can be said—it needs to be said in the Lincoln

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case—is that there has been no cover up, which could so easily have happened, when justice would not have been done or seen to be done. But enough of that.

We are dealing with matters of professional incompetence and with a process of retraining and rehabilitation. No comparison between the rehabilitation of doctors and of clergy can be made, but there are certain parallels. The Minister may care to consider whether they have any bearing on the amendment before the Committee.

The Church has developed plenty of experience in seeking rehabilitation for some of the clergy who have been suspended, for whatever reason. It has a sophisticated system of inhibitions and limited permission to officiate, which in my experience works well and is designed to balance the potential usefulness of a restored priest against the need for him to achieve credibility in the eyes of the Church and the parish. The parallel, which I believe can safely be drawn, is that becoming a doctor and becoming a priest involve qualifications but not just qualifications. It is not the same as passing a driving test where, if one drives badly, one can be compelled to take the test again and then carry on along the road. Being a doctor or priest involves qualities as well as qualifications, and particularly being able to sustain the confidence of patients or parishioners. Where that is lacking, no amount of diplomas will compensate.

It has certainly been my experience that rehabilitation in the eyes of the general public can best be served by insisting on a period of restored ministry under supervision, usually (in the case of the Church) as an assistant curate for a year or two. The priest is then able to earn himself not only a good reference or two but the heartfelt appreciation of a congregation which sees that he has made good and is all right again. They can trust him.

I hear many of my people speaking about having great faith in Dr. This or Mr. Surgeon That. Surely it is that kind of rehabilitation that the Bill aims to achieve. Therefore, I commend the amendment and hope that the Minister will consider the parallels that I have suggested as she thinks further about the Government's proposals.

Lord Rea: I rise briefly to support the noble Baroness's amendment. It adds some useful conditions. It spells out some of the actions which might well be covered by the Bill as it is now but it is useful to have that phrase and particularly the matter of supervision once the period of suspension is over and the doctor is back carrying out his professional work. I expect the noble Baroness, Lady Cumberledge, will have something to say about that. Perhaps she can say whether or not the requirements which the amendment incorporates are already covered under the Bill as it stands.

11.30 a.m.

Lord Walton of Detchant: At Second Reading I mentioned that when I had the privilege of serving as president of the General Medical Council from 1982 to 1989, I became increasingly concerned—as did many of my colleagues—over the inability of the council to

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handle certain problems which were regularly brought to our attention. We believed, and still believe, the discipline and health procedures to be effective. However, it became increasingly clear that the council lacked the procedures to deal with impaired or inadequate professional performance or indeed to deal with doctors who failed to demonstrate the understanding, the human compassion and the communications skills which are so crucial to the good practice of medicine.

The purpose of the Bill is to do exactly what the noble Baroness and the right reverend Prelate suggest. But that purpose will be fulfilled by the regulations to which the Bill will lead, approved by the Privy Council. As matters stand, under the health procedures, for example, if a doctor is found to have a form of ill health seriously impairing his or her ability to practice medicine safely, that doctor is required to undergo a period of full assessment by skilled practitioners. Their advice is then accepted and the doctor is required to undergo treatment under supervision over such period as may be necessary before that doctor is enabled to return to clinical practice.

The purpose of the Bill is to carry out an exact mirror image, in a sense, of those procedures in relation to those doctors whose professional performance has been demonstrably shown to be below an effective level. I am advised that if the amendment of the noble Baroness were to be accepted it would not only raise an issue as to whether the GMC should organise and pay for remedial training but that it would also raise complications in relation to the assessment procedures proposed by the Bill and to follow in the regulations, promulgated and eventually approved by the Privy Council.

The General Medical Council believes that it is better to sort out problems of efficiency first by inviting the doctor to undergo assessment or requiring the doctor to undergo assessment and then indicating to the doctor the standard of performance which he or she must achieve in order for an application for restoration to be given favourable consideration. The regulations will require that doctor to undergo a period of retraining under supervision before he or she is able to apply for restoration to the register and is able to return to clinical practice.

I am advised that if this amendment were to succeed it would be necessary for a whole series of consequential amendments to be drawn up and added to the Bill. Hence, while I again fully support the intention underlying the amendment, I am advised that the regulations which will follow the passage of the Bill will make such an amendment unnecessary.

Baroness Jay of Paddington: Perhaps I may briefly support the amendment and also pursue the question raised by my noble friend Lord Rea and the noble Baroness, Lady Masham. I do not feel that it was quite answered by the contribution of the noble Lord, Lord Walton of Detchant.

As I understand it, the issue of retraining under supervision will indeed be included in the regulations, as the noble Lord, Lord Walton of Detchant, explained.

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From what the noble Baroness, Lady Masham, said in introducing the amendment, it is certainly my feeling from a lay perspective that it would be helpful if, once that training and supervision were completed, there was some further probationary period, perhaps in the way the right reverend Prelate explained in relation to the clergy. One could almost describe a doctor as once again wearing "L" plates. It would mean that although he had been retrained and the supervised training had been completed, he was nonetheless recognised by the general public and by his patients not to be a fully rehabilitated member of the profession. It is that matter of supervision and probation after retraining which most concerns me. That is why the amendment is important.

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