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The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): Professional social workers train for the Diploma in Social Work. National Vocational Qualifications at various levels are available for other social care staff. The Training Organisation for the Personal Social Services has now delivered to Government a national training strategy for social care and proposes to issue it for consultation. This training strategy includes proposals for foundation level training for all social care staff and contains supplementary reports on residential care and child care. The Government are considering their response to the strategy.
Lord Hunt of Kings Heath: We believe that the public are generally satisfied with the excellent job done by the vast majority of doctors in the National Health Service. This is reflected, for example, by the recent national patient survey, which showed very high
There is, however, no room for complacency in ensuring that high standards are maintained. Part of the thrust for clinical governance is the Government's desire for clinical services to become more responsive to people's needs by encouraging active and effective patient and user involvement in service development.
The medical profession has recognised the need for all doctors to respect the right of patients to be fully involved in decisions about their care, and this has been enshrined in the General Medical Council's guidance Good Medical Practice. The Government are determined to work with the medical profession to modernise the system of professional self-regulation to ensure that the public's confidence in the profession's ability to maintain high standards is sustained.
Lord Hunt of Kings Heath: There is no evidence to suggest that doctors are retiring earlier than in other professions. The most recent research about doctors working abroad indicates that less than 8.5 per cent. of doctors qualifying in United Kingdom medical schools leave to work abroad at the end of their pre-registration training. Almost the same proportion (7.5 per cent.) of students in UK medical schools are overseas students, many of whom are obliged to return to their own country on completion of their training.
For England and Wales, we collect information from professional bodies, including the Medical Royal Colleges and the Medical Practices Committee, about wastage and retirements. The Specialty Workforce Advisory Group takes account of these factors in advising the Department of Health and the National Assembly for Wales about the numbers of higher specialist trainees needed to meet future assumed demand for consultants and general practitioners.
Lord Hunt of Kings Heath: All confidential papers sent to the working group are expected to be kept confidential by officials and members alike. All documents sent to the working party, unless they are already in the public domain, are marked "for members' use only" by the secretariat and then only sent to members.
We are not aware of any evidence that there has been a breach of confidentiality by any member of the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment working party or an official. However, any formal complaint of such a breach would be investigated.
Lord Hunt of Kings Heath: The Government have considered these guidelines and code of practice carefully. In the policy statement Making Decisions the Government recognised that, together with guidance contained in case law, they provide clarity and flexibility to enable the validity and applicability of advance statements to be decided on a case by case basis.
Lord Hunt of Kings Heath : Advance statements are anticipatory decisions made while a person is capable which are intended to give effect to that person's wishes as to how he or she shall be treated or cared for after the loss of capacity. An advance statement can be concerned with the refusal of medical treatment and are then sometimes known as advance directives.
Lord Hunt of Kings Heath: The removal of artificial nutrition and hydration is in all cases a matter of clinical judgment which is undertaken in accordance with professional advice provided by a responsible and recognised body of medical opinion and the general law. There are no plans to change the law in this respect.
Lord Hunt of Kings Heath: There are no plans to enshrine this judgment in statute law. The Government have indicated that they intend to introduce a provision on continuing powers of attorney (CPA) when parliamentary time allows such legislative changes.
It is a general principle of law and medical practice that all adults have the right to consent to or refuse medical treatment. The CPA is a method by which adults can continue to ensure that their views are respected in decisions concerning their welfare when they can no longer take, or communicate, those decisions themselves. A CPA therefore would allow an attorney to make decisions on behalf of the person without capacity about the withdrawal of artificial nutrition and hydration but only if the person has specifically given authority to do this in the CPA. Where decisions need to be taken in such cases, the healthcare team and attorney should do so in the best interests of the individual concerned.