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Baroness McFarlane of Llandaff: I rise to speak to the amendment tabled in the names of my noble friends Lord Walton of Detchant, Lord Kilpatrick of Kincraig, and Lady Emerton, who is, unfortunately, out of the country this week.

I do not want to reiterate all that my noble friend Lord Walton has said and take up the time of the Committee. As always, he has presented the arguments with cogency. However, I should like to say that all the healthcare professions to whom I have spoken have been in absolute agreement with the amendments. Not only the powerful medical profession, but also nursing, midwifery, health visiting, dentistry, pharmacy and many other professions recognise the importance of self-regulation for the interests of the public. We are at one in the wish to see self-regulation perpetuated.

However, as I talk to different professions, I believe that we are also at one in recognising the usefulness of orders for making quick and flexible changes. Therefore, I do not want to stand in the way of those who wish to use orders to see changes brought about in the profession, so long as such orders do not interfere with the fundamental roles of self-regulation.

As the report from the Committee so rightly states, and as the Minister quoted, striking the right balance between primary legislation and orders is the great conundrum ahead of us. Those of the nursing, midwifery and health visiting professions to whom I have spoken want to see many of the Government's proposals go forward so that there is flexibility, but they do not want to lose the right of self-regulation. That is why I asked the Minister for an assurance that there would be the same protection under orders. The Minister gave that assurance. I should like to probe a little as to how the noble Baroness can give the assurance that protection will be the same under orders as it would if written on the face of the Bill.

At Second Reading, the Minister indicated that the J.M. Consulting report had been published. The comments from the Department of Health, published the same day, indicated that the Government would seek to table an amendment to repeal the Nurses, Midwives and Health Visitors Act 1997 and that that, presumably, would be replaced by a body created by orders. Does that mean that nursing, midwifery and health visiting are entirely written out of the Bill and that their self-protecting powers and self-regulatory powers are entirely lost? I should like a reassurance that the protections we seek to build in by the amendments will be available in orders and that legislation will be put in place.

We are given so many reassurances. It sounds wonderful, and we think, "Yes, let's go forward with this". But, what happens? We are reassured that

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everything can be dealt with by an affirmative resolution. But what happens if an order is brought by an affirmative resolution and then negatived? Would we then have no powers to take forward what has been agreed? I should like reassurance about the mechanisms that will be available to us in orders, and exactly what is implied, particularly for the professions of nursing, midwifery and health visiting.

Lord Colwyn: I, too, should like to support the amendments. I only regret that I was a little slow and did not put my name down to be one of the main supporters. I apologise for that. I know that my noble friend Lady Gardner of Parkes, who was formerly an elected member of the General Dental Council, also supports the amendments. She has a prior engagement outside the Palace of Westminster and is unable to speak tonight.

The Committee will be aware that I am a practising dentist. As such, I know the value placed by my profession on maintaining the highest professional standards. Dentists provide care to their patients, whether under NHS or private contracts, from dental practices which they own and manage; practices which are predominantly in the high street, not hospitals and specialist centres. High standards and consumer satisfaction are what make dental practices thrive. Therefore, it is not surprising that the dental profession places a high value on professional regulation.

Under the leadership of Dame Margaret Seward, and with the support of the profession, the GDC has been focused on how better to protect the public. The Conservative Government promised to introduce much-needed reforms to the Dentists Act 1984. Those changes, which have become key issues, included recertification; a statutory obligation to provide evidence of continuing professional education on a five-yearly cycle, and the fact that current procedures, which deal with fitness to practise, focus only on misconduct and health matters and do not deal with poor performance.

The council, again with the approval of the profession, has been ready to introduce a statutory scheme to ensure that dentists whose clinical performance is a potential risk to the public are given the opportunity to relearn skills, with the ultimate sanction of their practice being restricted if they fail to demonstrate competence.

My purpose in highlighting these issues is to remind the Government that the council has sought legislative change and has been restricted by the nature of the current Dentists Act. The opportunity which this Bill provides to make the necessary changes by order, rather than through primary legislation, is welcome. However, as we have heard, the order-making power, as written into this legislation, does not contain the safeguards and limitations which the GDC and other regulated health professions feel are necessary to ensure a continuing independent role. The need for more lay members and the commitment to the principles of professional regulation exercised by dentists themselves are important issues.

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As currently drafted, the Bill does not protect the council's core functions. Education at both undergraduate and postgraduate levels, continuing professional development, recertification, and the monitoring of poor performance are key reforms in the public interest.

Finally, the GDC is unique among the health regulatory bodies in having statutory responsibility for hygienists and therapists who are important members of the dental team, a team that also includes dental nurses and dental technicians who also seek statutory registration. The Bill, as drafted, does not provide an opportunity for change which must be in the interests of the public and the profession. The Minister says that she wants to strengthen and modernise the systems of professional regulation. The amendment provides the necessary limitations and safeguards which the health professions seek.

Lord Rea: These amendments have been spoken to eloquently by two senior members of my profession and eminent members of the nursing and dental professions. They have expressed extremely clearly their concerns about the Bill with regard to professional regulation, and particularly self-regulation.

I know that my noble friend the Minister may not be able to accept the amendments as they stand, but I hope she will be able to say exactly why she cannot accept them. I hope also that she may have some suggestions about amendments that are acceptable both to her and to my former headmasters--if I may so describe them--the two former presidents of the General Medical Council, compared to whom I am only a schoolboy. I hope that my noble friend will take their concerns into account as they are widely shared not only by those in the medical profession but also by many of the other professions which are currently self-regulating. I daresay that when my noble friend is making up her mind on these amendments she will also take into account some of the remarks made by my noble friend Lord Desai.

Baroness Cumberlege: I intervene briefly and in a spirit of optimism. I take the point made by the noble Lord, Lord Clement-Jones, that one of the great challenges in the NHS is trying to unite the professional tribes. I believe that at a stroke the Government have succeeded in doing that. However, it is a pity that the professions have united against these clauses. I believe that both parties--the Government and the regulatory bodies--want a resolution. Indeed, in January, the Minister's honourable friend said that he was seeking to achieve just that. I know that the Minister, having chaired a hospital trust, recognises the importance of keeping the professions on board in order to provide services of quality. There is room here for accommodation.

I very much accept what the Minister said earlier about the backlog of work that needs to be tackled. I accept that some of the issues dealt with by the regulatory bodies need a speedy resolution and that order-making powers are appropriate in such cases.

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The noble Lord, Lord Walton, said categorically-- I know that he is right--that the medical profession is not seeking to maintain the status quo; it really wants to see some improvements to its regulatory powers. I know that that is true of the other professions also. Perhaps those who drafted the clauses did not have enough finesse or sensitivity to pick up all the nuances. I know that the Minister will have listened carefully to what has been said--she always does--but I hope that if she cannot accept these amendments, she will return to her department to work out provisions that are acceptable to all. I believe that resolution is not far away.

5.45 p.m.

Lord Peston: I start with two very cynical remarks. First, I was interested in what the noble Lord, Lord Clement-Jones, said about the mail that he has received. I, too, have received a lot of mail, but all of it from the professional bodies. I did not get a single letter from a patient or a group of patients saying, "We desperately need to support the professional bodies in our own interests." I should be interested to know exactly what mail the noble Lord received; mine was certainly not the same as his.

Secondly, my heart goes out to the noble Earl, Lord Howe. I think of the many years I spent on that Front Bench and wonder what sort of speech I would have made on this occasion. I conclude that I would have made a very similar speech, if not precisely the same one. I reflect ruefully, however, that I made many speeches against order-making powers and the damage they did, resulting in the end of this and the end of that, only for the government of which the noble Earl was a proud member to march their troops through the Lobbies and defeat me on every occasion. There was no question of weighing the balance; the government simply defeated us. That was because, not only that government, but all governments, want to get not only their Bills through but also their order-making powers. I do not criticise the noble Earl for that. Either I was right then and he was wrong--or perhaps this Government are now right and I was wrong then. In any case we all have our part to play in the great drama that is the House of Lords, and the part of the Opposition Front Bench is to talk about order-making powers and the threat that they pose to the future of our great nation.

Having said all that, perhaps I should add--I have said this previously--that I am a great supporter of self-regulation. Wearing my economist's hat, I believe that self-regulation is an efficient way of delivering what is wanted by the clients who, in this case, are the patients. It would be quite wrong to ignore general principles in relation to this Bill. This matter relates not only to doctors, but to all the professions. I am not one of those who say that all professionals are just a bunch of racketeers although some very distinguished economists do take that view. Indeed, some of the world's greatest economists argue that all the professions are an abomination and need to be abolished. They say that their legislative support should be removed and that they should have to compete in the free market because the free market would expose the good as opposed to the bad. That is not a view I hold,

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but I can tell the Committee that economists who are Nobel Prize winners do take that view. I do not; I do not go that far.

This is a serious matter. Professions have responsibilities if they have the power of self-regulation, and they must deliver the goods. In my experience, my noble friend Lord Desai is right. On the whole, the professions deliver when they are subject to pressure. I do not criticise them for that. I am not a professional in the same sense, but as a professor it never occurred to me that anything I did was ever other than perfect. I always felt that I was doing a proper, professional job. I always professed to be doing absolutely the best I could in the interests of my students. Occasionally, I was subject to professionals saying, "Would you prove that?", and I hated that, just as I am sure that all the leading medical professionals and all lawyers also hate it. That is why I do not greatly criticise the professions for saying, "Don't attack us too much because we'll move when we can." However, it is important also to view matters from the other side.

It had never occurred to me that the Government's position was that they favoured deregulation--perhaps my noble friend will comment on that--or that they intended to use the order-making power in any way other than as a last resort. Occasionally, of course, it may be used as a first resort when the professions themselves want change rapidly and do not want to sit in a very long queue awaiting primary legislation.

As I said earlier, when I was a member of the Council of the Royal Pharmaceutical Society there were matters to be considered including fitness to practise and so forth. One's heart sank when one was told that it would be years before something could be done. I certainly wish to see the order-making power used for that purpose. Therefore, I hope that the Minister will be able to state the Government's intention to reinforce the professions and to be supportive of them. I hope that it will be done in ways which the noble Lord, Lord Walton, and his fellow supporters of the amendment like. But an order-making power is required. That would be in the interests of the professions. It would be seen that their performance was good, not recognisably perfect, but getting better. I hope that my noble friend will speak as sympathetically as she can. However, I shall be a little taken aback if she felt she should accept the amendment.


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