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Suspension of Hospital Medical Practitioners Bill [H.L.]

7.27 p.m.

Baroness Knight of Collingtree: My Lords, I beg to move that this Bill be now read a second time. It came into being because a serious number of hospital consultants have been victims of a most unjust system. I gave full details of the situation in your Lordships' House on 13th January 1999 and I shall not take time tonight repeating all I said then. But I will remind the House of the salient points.

I want to make it crystal clear from the beginning that neither I nor any of those who are kind enough to support me in this matter are in the slightest degree interested in excusing or protecting doctors who behave wrongly. That is not the purpose of this Bill and it is not the purpose of any of the speeches which I am sure will be made in its support.

However, I continue to make the case for doctors who are suddenly suspended by their hospitals without being told what they are supposed to have done, with no right of appeal, kept on suspension for months or even years and literally locked out of their hospitals at once. I know of a case in which the wife of a suspended hospital doctor was dying of cancer in the same hospital and, because of his suspension, he was not even allowed to visit her.

Sometimes doctors are not even informed when they have been found innocent. That cannot be right. A doctor's reputation, good name and career are totally destroyed. These days, the medical profession moves so quickly that if a doctor has been out of the system for even a short time it is virtually impossible--or, if not, then it is extremely difficult--to return to making a success of his career. Therefore, careers are destroyed. There have been breakdowns, debts and suicides over this matter, and I cannot stress sufficiently that the seriousness of the situation screams for a remedy.

Even if all the doctors were guilty, there is no justification for treating them in that way. Even felons who commit the worst crimes in the criminal calendar are treated better than those trained and dedicated hospital doctors. However, the overwhelming majority of them are not guilty; they are found to be innocent of all charges. In the debate last year, I stated that out of 201 cases of suspended doctors that I knew of, only 25 were subsequently found to be guilty of the charges against them. I repeat: only 25 out of 201 were found to have acted wrongly. Some of the remaining 176 must wait years to be cleared.

I also listed some of the trivial reasons why consultants had been, and still are being, suspended. One consultant, for example, merely wrote a repeat prescription for his ward sister. Another deleted from his own files on his own patient, whom he had treated for a very long time, repetitious details which he did not feel were necessary. That was enough; he was suspended. Another helped with a charitable appeal

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for equipment, then, with others, spent the money on the very equipment for which the appeal had been made. That was enough; he was suspended.

Your Lordships should also bear in mind that, because the suspended doctors receive full pay throughout the period of their suspension and legal costs are involved, this wrong and crazy system costs the NHS millions of pounds. A recent study on the matter came up with a figure of £10 million to £12 million per annum. I have been monitoring the situation myself for 40 years and I hate to think of the sums of money that have been wasted in this way over that period of time. As I listened to the previous debate, I considered in how many ways the money could be better spent. Other noble Lords will have their own ideas about that.

However, it is not only a question of the waste of money; the system deprives patients who need care of the specialist who supplies it. Only this week I have received letters from people in Coventry. I read from one such letter:


    "There is deep public concern in Coventry, especially among women breast cancer patients, that Miss Ackroyd--a surgeon they greatly admire and respect--has been 'removed' from her duties".

I am told that already 600 people have signed a petition asking for her reinstatement because she is such a good doctor and has served them so well. Now, those patients are treated in a kind of piecemeal way. Apparently, one doctor has been brought in and another may or may not be. This is a case where patients are being deprived by the system of a much loved, greatly respected and, from what I gather, extremely efficient doctor.

Following the debate in January last year, I drew together a committee with representatives drawn from the BMA, the HCSA, the medical defence unions (there are two) and from other interested people and doctors who, either themselves or perhaps within their family, have experienced the evil of suspension. I chaired the committee and we worked for six months. Finally, we drew up a list of nine points which we felt should be established in order to remedy the situation and to give fair play.

Following that, the Summer Recess intervened. However, as soon as I could, I set to work with parliamentary draftsmen to produce the Bill now before your Lordships. It incorporates all the nine points which we worked upon. At this stage I should like, if I may, to pay a most warm tribute to a very expert lady from the parliamentary draftsmen's department who helped me. Her help has been absolutely invaluable.

Since then, the Chief Medical Officer has produced a document which I was assured advocated procedures which would address the situation just as effectively as does this Bill. I was informed that it contained all that was needed to gain justice for hospital doctors who are suspended. I rushed off to the Library to find a copy of this miraculous document. It was not there; neither was it in the Printed Paper Office. I am much indebted to the noble Lord, Lord Hunt, who arranged for me to

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be sent a copy. I received it on Monday and read it eagerly--every page of it. I was never more disappointed. I should have known. I had already received reports from several medical sources that the solutions offered in the report failed in almost every respect to solve the problem. Of course, the BMA has made its views about it quite plain, and I have no doubt that the noble Lord, Lord Hunt, has received a brief on the matter from the BMA. The BMA is very disappointed and does not consider that the proposals will help a great deal.

When I read the report I wondered why this much vaunted document did not give us what we need. I came to the conclusion that the Chief Medical Officer and the rest of us view the problem from fundamentally different angles. The main--and I believe perhaps the only--aim of the medical officer's report is to deal with doctors who behave wrongly. I am not surprised about that because there have been many cases in recent months, and indeed even years, where doctors have behaved wrongly. We read screaming headlines about it in the press. We know all about what happened in Bristol and in various other places, and a shudder of horror goes through the public when they read about it. I can well understand why the Chief Medical Officer felt that that was the problem. The document's first and main aim is to deal with doctors who behave wrongly. The whole thrust of it is "dealing with poor performance".

I must say with some regret that the language is lofty but really rather woolly. It talks about "professional self-regulation", "implementation of standards and quality improvement", "co-ordinating mechanisms to prevent poor clinical performance"--that is a favourite; it is mentioned twice!--and "developing skills in handling poor performance". The document suggests that doctors should receive retraining, be monitored and obtain medical treatment. The doctors I am talking about are trained. Many have been working for years and would find it rather insulting to be monitored when they do not even know what they are supposed to have done.

The doctors I am talking about do not really need medical treatment, or at least they did not, though they might after a few months or years of being suspended, because it is an agonising experience to go through.

I shall detain the House for a few moments with an example of what I am saying and why I believe that that is the aim of the Chief Medical Officer. He said:


    "The strategy set out in this consultation document aims to bring to an end the past failure in preventing, recognising and dealing with poor professional performance in medicine".

On the next page it states:


    "Across the NHS as a whole the present arrangements for dealing with poor clinical performance exhibit serious weaknesses".

I can understand him being worried about that but the point I make is that that is not the problem that the Bill seeks to address. The Bill's aim is to prevent injustice and to speed up the procedure whereby a competent, proficient consultant can be suspended for months or years without even the slightest attempt at fair treatment.

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I remind the House that the problem is said by the BMA to be increasing. The Chief Medical Officer acknowledges the need for procedures to be speeded up but that is really the only need which is met in his proposals. It is as though he is treating a bunion and we, or the Bill, are treating glaucoma--two totally different problems.

The nine points on which the Bill is based incorporate the precise steps which experts in the field think are essential to remedy the situation. The first is that suspension should take place only to protect patients, staff, evidence or the doctor himself and should not be confused with the disciplinary process. That is something else with which the Chief Medical Officer's report deals. It talks about the disciplinary process. The Bill is not concerned with that.

Reaching a decision on whether or not to suspend must be dealt with urgently. The Bill then deals with who should be responsible for making the decision; namely, the chief executive of the health trust. Then it says that the allegations against the doctor, the classification or category in which they lie and the reasons for suspension must be clearly stated and made known to the accused in writing without delay. That is absolutely fair and right.

The Bill then goes on to provide that the doctor should have an immediate right of appeal against the suspension and how that appeal should be dealt with. The trust must then decide within one calendar month of the decision to suspend whether prima facie evidence exists to invoke a disciplinary procedure and if so, whether suspension should continue. All the nine points deal with the matter of urgency and not allowing people to be strung on that particular rack for months, if not years.

Any decision to exclude the doctor from hospital premises must be made separately from the decision on suspension. The reasons for it--namely, that the doctor poses a danger to staff or has an ability to tamper with evidence--must be relayed to the doctor concerned.

The Bill then deals with the fact that the decision to suspend must be notified immediately to the NHSE, which is then responsible for monitoring the continuation of the suspension. Again, that is a move to make sure that it does not go on.

There are two more small points. At no time can the inquiry panel add new charges to those originally put forward. It must deal solely with the existing charges unless the doctor himself agrees. That provision is included because there have been cases where some doctors found themselves suspended; the inquiry found they were totally innocent of all the charges, but they remained suspended while there was an attempt to find some further possibility of other charges. That cannot be fair.

Full reasons for the suspension of a hospital doctor must be conveyed to any private hospital where the suspended doctor has admitting rights. Many doctors working as consultants work in private hospitals. We felt that it was important that those private hospitals should be kept informed.

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Therefore, I hope that the House will agree that the nine points are carefully put together, and I believe that they are just, fair and right. The Bill puts those nine points into effect. There may be a few amendments to be made. Nobody would suggest for a moment that one can always get everything perfect first time round. But those are the main aims and I think that they are fair.

The Bill is the result of a great deal of work. I started working on this 14 years ago, when I first became aware of this kind of case, during the time that I was a Member of the other place. The Bill has the support of Members on all sides of the House. It is totally non-political. Several noble Lords have written to me, regretting that they cannot be here this evening to speak in support of the Bill.

The Bill is quite literally the only way that the present inhumane situation can be remedied. I beg to move.

Moved, That the Bill be now read a second time.--(Baroness Knight of Collingtree.)

7.45 p.m.

Lord Rea: My Lords, the noble Baroness, Lady Knight, certainly does not let this issue slip out of the parliamentary view. All doctors and many of their patients will be grateful to her for that. Although we know that this very fair and well thought-out Bill will almost certainly not reach the statute book, it gives us a further opportunity to examine the situation and to assess progress, if indeed there has been any, since the noble Baroness's Unstarred Question on 13th January of last year.

On that occasion, my noble friend Lady Hayman ended her reply as follows:


    "I hope that, in replying to your Lordships this evening, I have made clear that we recognise that there is a problem, and that we are taking firm action to produce solutions and improvements in the current system. However, I must reiterate that that has to be done as part of an overall commitment to improving the quality of care and protecting patients. The systems in place at the moment have not served either some suspended doctors or some patients well in the past. It is our responsibility to change them as part of the modernisation of the National Health Service and to ensure consistently high standards of care for all patients".--[Official Report, 13/1/99; col. 270.]

It is for my noble friend's successor, my noble friend Lord Hunt, to tell us what action the Government have taken since then and what changes in procedures are either in place already or are proposed.

The department's report published last November, Supporting Doctors, Protecting Patients, does not really offer very much to improve the current unsatisfactory position. Further work is needed to ensure that the suspension procedure is used only to protect patients, or the doctors themselves, when the clinical care being given by a practitioner is of an unacceptably low standard.

Other disciplinary matters should be dealt with by procedures which involve interviewing the doctor concerned and with verbal and, finally, written warnings. In normal employment practice, the employee concerned has the right to representation

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at each of those stages and, in most cases, continues at work unless the behaviour is actually dangerous. He goes on working, unless that is the case, until an agreement is reached or the employee is dismissed or agrees to some redundancy terms. Good employers will often suggest counselling or offer opportunities for the employee to retrain if that is relevant. The noble Baroness has told how, in this case, it very seldom is relevant.

There is a strong case for returning to national, across the country, guidance on disciplinary procedures. I am sure that that is something which the noble Baroness's Bill would ensure. There is still a tendency for trusts, in varying degrees, to use suspension as a disciplinary measure when the problem first requires investigation of the facts. Suspension may be appropriate if patient safety really is at risk; but usually it is not.

In my speech during the debate on the Unstarred Question tabled by the noble Baroness, I quoted some of the points made by the British Medical Association's Consultants Committee in response to the October 1998 internal review by the Department of Health of the procedures for the suspension of hospital doctors. Doubtless my noble friend Lord Hunt has in front of him the BMA document of that date and any current statements by that association. Many of the points made then are recorded in my speech in last year's Hansard. Therefore, I do not need to repeat them.

Sadly, in the BMA briefing which I had before this debate, the same points are made as those in January 1999. In other words, there has been little progress, except in Scotland where a report entitled Suspensions--a New Perspective was published last April. The recommendations contained in that report were accepted by profession, hospital and health authorities alike, and appear to be working well. If it can be done in Scotland, surely it needs only a further heave to bring in a system in England and Wales which will work here and meet the points which were made so well by the noble Baroness.

However, the problem has not gone away. As the noble Baroness mentioned, the number of NHS consultants suspended from work has been increasing, according to the BMA. In four out of five cases of suspension, concerns about clinical competence are not upheld. However, as the noble Baroness said so well and fully, patients are denied the services of a doctor unnecessarily for months or even years.

I shall be delighted if my noble friend can say that the British Medical Association is wrong and that the trend is now coming down. But I am afraid that that will not just happen. A new, fairer, broom is required to sweep out the inefficient and unjust non-system which now appears to prevail in too many trusts. The noble Baroness's Bill points the way forward. Why do not the Government incorporate its main content, as hinted last year by the noble Baroness, Lady Hayman, as part of the proposed modernisation of the health service?

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7.53 p.m.

Lord Colwyn: My Lords, I declare an interest as a council member of the Medical Protection Society. I listened with interest to my noble friend Lady Knight and commend her on her sterling work on behalf of hospital and medical practitioners.

Since the publicity associated with the General Medical Council's determination of the Bristol case, which was alluded to by the noble Lord, Lord Rea, there has been a surge in the number of doctors suspended from their NHS posts. Where there is a threat to patients, removing the danger is obviously right, but steps short of suspension may be adequate; for example, the doctor might well agree to cease certain areas of work during an investigation. Outright suspension has serious consequences for both the doctor concerned and for the service that he or she is providing. Doctors, as well as patients, require protection, first, from unnecessary suspension and, secondly, from unduly prolonged periods of suspension.

Suspension in employment law is meant to be a neutral act. Doctors, especially consultants, are high-profile individuals within their hospitals. Their absence cannot go unnoticed and inevitably it will be assumed that there is no smoke without fire. The doctor is stigmatised, and that stigma is compounded if he or she is excluded from the trust premises, as that carries the implicit suggestion that some ghastly act might be committed if the doctor is allowed back into the hospital. There is a lack of expertise in many trusts in the way in which these matters are handled. There is a strong case that medical directors and chief executives should be required to seek legal advice before taking unilateral action.

The majority of the suspensions are measured in months, not days or weeks; some extend to years. During that time, the doctor's skills are eroded. The National Health Service is deprived of resource and, most invidious of all, the individual's position is progressively undermined to the extent, in some cases, that his or her position becomes untenable even if exonerated at the end of the inquiry. There is also a need for a simplified and easier system of redress for doctors whose cases are mishandled.

The medical profession is a profession under siege. Currently up to 40,000 patients a year die as a result of hospital accidents and one in 14 suffers an "adverse event", such as diagnostic error or operation mistake. Only a tiny proportion pursue any claim, but the number is on the increase. The Government have tremendous difficulties with current figures on litigation. Health authorities in England and Wales spent £1 billion in 1998-99 on settled claims and an estimated £2.4 billion is unpaid in current cases where the claimant is likely to win. There is possibly another £3 billion to £4 billion on claims which are as yet unreported. Perhaps the Minister can comment on that and on how it might affect the new funding announced for the health service.

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We know that the majority of doctors are hard working and do a tremendous job, often in very difficult circumstances. However, that is not the stuff of headlines, which remain the province of the Shipmans and Ledwards of this world. It is imperative that the current debate on the accountability of doctors is not allowed to distort further the public's perception of the profession.

The Minister kindly sent me a copy of the consultation document Modernising Medical Regulation in which one of the proposals is that the General Medical Council should have an enhanced power to suspend doctors from the medical register on an interim basis, making that power wide ranging and enabling the GMC to act quickly. That is a positive step and should be commended. I know that the General Medical Council is keen to have those changes as a first step towards a reassessment of its powers to protect patients.

As much as public confidence must be restored in the profession, the profession's confidence in those who manage the NHS must also be restored by removing knee-jerk management and over-reaction. Restoring a proper balance is what this Bill is all about. Providing the proper degree of protection to hospital doctors demonstrates Parliament's commitment to fairness and natural justice. The Bill does nothing to undermine proper regulation of the profession but a great deal to protect doctors in whom we have invested large sums of money on training. The Bill is to the good of patients and doctors and there are no plausible arguments to block its passage to the statute book.

Finally, I commend my noble friend Lord Howe and the Minister on taking part in two debates in a row, and recognise their stamina.

7.38 p.m.

Lord Clement-Jones : My Lords, I add my thanks and congratulations to the noble Baroness, Lady Knight of Collingtree, on pursuing this subject so diligently over the years and on dedicating her time, in particular over the past year, to the drawing up of the Bill in conjunction with representatives from so many different interested bodies.

As the noble Baroness stated, it is clearly understandable that in the light of so many recent high profile cases in which medical practitioners have acted negligently, incompetently or even criminally, public and government attention has been focused on toughening disciplinary procedures in an effort to ensure the safety of patients at all times.

Government proposals outlined in March, referred to by the noble Lord, Lord Colwyn, build on the earlier consultation paper, Supporting Doctors--Protecting Patients, and will involve inter alia the implementation of lifetime bans and additional powers of suspension for the General Medical Council. The Health Minister, John Denham, was quoted last October as saying:


    "Recent events have highlighted that the current system is inadequate. Patient safety is paramount and it is vital that the Government--and the GMC--act quickly to restore public confidence".

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He went on to say:


    "The majority of our doctors are hardworking, honest and trustworthy but where problems arise patients need to know we will act fast to protect them and take strong steps to ensure that they receive the best possible care".

I am sure that all the supporters of the Bill agree with both sentiments. They certainly do not intend to minimise the need for patient protection. The GMC itself has been active in promoting the need for new powers and proposals such as revalidation which will ensure higher quality among doctors, and is to be commended on that.

Massive attention is being given at local trust and health authority level, with the assistance of the Royal Colleges, to the issue of clinical governance. However, as we have heard tonight and in previous debates on this matter, there is another group that requires and deserves a rapid response when problems arise: the medical practitioners themselves. Mr Milburn, when he was Minister for Health, recognised the issue, hence the review commenced in October 1998. The noble Lord, Lord Rea, mentioned the response of the noble Baroness, Lady Hayman, when she was Minister for Health in this House.

I am sure that many of us received correspondence from doctors after the debate in January last year, also initiated by the noble Baroness, Lady Knight, outlining severe injustices which had taken place. One correspondent wrote to me as follows:


    "The disciplinary action taken against me and the manner in which it was conducted were excessive and unjust. The procedures pursued by the Trust were deeply flawed leading to 'abuses of process' throughout ... meetings which I was required to attend prior to my suspension were clearly disciplinary in nature and intent but were not conducted according to the Trust's Disciplinary Procedure. I was given no prior warning of impending disciplinary action, no verbal warning and no prior, lesser disciplinary sanction".

I am personally aware of many other cases of suspension which have been inspired by nothing more than professional rivalry. It is notable in these circumstances how much distress is caused not only to the doctor involved, but also to the patients of that doctor who are denied access to the doctor's services. Generally--we have seen the press over the past few months--there are many reported cases where practitioners have been suspended for what seem to be entirely inappropriate reasons; for example, the hospital doctor who was suspended for purchasing a piece of medical equipment for his department for which he had been fund-raising with the trust's knowledge for some time; and the head of a hospital pathology department who disputed the merits of merger proposals and remained suspended for nearly nine months, taking early retirement shortly after his reinstatement.

One case that truly highlights the sheer folly of some of the suspensions is the recently reported case of Professor Savidge, a senior blood specialist at St Thomas'. He was suspended for a full 10 months following a complaint about an alleged indiscretion with a female colleague while they were attending a medical conference in Moscow. The complaint was made by a third party. Eventually, Professor Savidge

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was reinstated after no evidence whatsoever had been put forward by the complainant. To this day, Professor Savidge denies having even met the woman cited. Dr Peter Tomlin, who runs a support group for suspended doctors, described the case,


    "as an outrageous waste of time and money".

That clearly must be the case. The common pattern of so many of these suspensions seems to be unfair procedures which provide inadequate natural justice for the medical practitioner involved.

Complaints against doctors have more than trebled in the past six years, according to figures from the GMC. In 1999, there were 3,000 general complaints in comparison to only 1,000 in 1993. As the public appear to become increasingly litigious, the financial burden on the health service grows exponentially. We now know that the total projected liability of the NHS is £3.4 billion, according to the National Audit Office.

Clearly there is a need to provide protection for the accused as well as for patients and complainants in this increasingly contentious environment. We need a set of national standards which apply in the case of suspensions and provide the necessary procedural protection. Clarification of the procedural steps that need to be taken in the case of suspensions is long overdue.

The Bill of the noble Baroness, Lady Knight of Collingtree, is therefore an important step towards redressing the current imbalance. From nearly all the cases we have heard about during the course of these debates, the key issues that appear time and again are fairness, openness and speed. There is no valid reason why some of these cases have dragged on for so long with so little disclosure of evidence and at such cost to the health service.

In addition, as has also been mentioned in previous debates by the noble Baroness and other noble Lords, including the noble Baroness, Lady Kennedy of The Shaws, there are many instances where suspension practice appears to be in breach of the Human Rights Act. As British legal practice moves further forward towards concordance with European law in this field, the provisions of this Bill may well help to avert an even greater leap in the NHS's potential litigation liability. Legislation of this kind, which facilitates the fair and prompt administration of suspension procedure, can only be a positive step.

I believe that the specific steps required by this Bill and the rights provided are highly significant: the requirement for there to be no delay; the requirement for consultation particularly with appropriate practising clinicians; the duty to consider alternatives to suspension and whether it is really needed to protect the interests of patients, staff and the practitioner; the requirement to give written reasons for decisions and to convey them to the NHSE and any private hospitals involved; the requirement to review the suspension; the right of appeal to a tribunal, and the right to appear before it.

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The Bill also helpfully deals with the vexed question of exclusion from NHS premises, so graphically described by the noble Baroness, Lady Knight. We are in her debt for formulating these proposals in a timely fashion, in contrast to the Government who, despite their earlier assurances, failed to introduced anything equivalent. The outcome of their review proved disappointing. The issue is even more important now that it is proposed that health authorities be given the power to suspend GPs. As the noble Lord, Lord Rea, said, it is notable that in Scotland, regrettably so often ahead of us, proposals have been agreed between government and the professions on this matter.

These safeguards are extremely welcome and important. I hope that the Government will give the Bill their full backing in principle so that in Committee we can argue only about the details and not about the principles involved. The Bill should be seen as a significant waymark on the road to ensuring not only the safety of patients, but also the fair and equitable treatment of medical practitioners.

8.8 p.m.

Earl Howe: My Lords, my noble friend Lady Knight is to be congratulated on her assiduous pursuit of these important issues. I believe the Bill deserves our support.

By way of a baseline in this debate, I suggest that there are two propositions on which most speakers, if not all, would be agreed. The first is that professional standards of practice on the part of doctors should be properly assessed. That is the principle upon which clinical governance is based and to which the professions are fully signed up. The new revalidation and fitness to practice proposals are an important part of that agenda. No one wants to see poor standards of clinical care in the NHS.

The second proposition is equally widely accepted; that is, that the procedures currently employed in NHS trusts for suspending those doctors who are believed to be performing poorly are not working, either efficiently or fairly. In some cases, as we heard, they lead to gross injustices. It is those injustices which this Bill is designed to address.

Much has happened since this matter was last debated in January 1999 and it is right that we should be fair to the Government. Last November, as my noble friend mentioned, the Department of Health published its proposals designed to prevent and tackle poor performance on the part of doctors in the document, Supporting Doctors--Protecting Patients. I am grateful to the Minister for sending me a copy.

I shall not anticipate the Minister's speech too closely; he will doubtless wish to explain the document in his own words. But, perhaps unlike my noble friend, I believe the paper makes a positive contribution to the debate. The proposals lay weight on the early recognition of problems and the need to deal with them in a manner that is both easily understood and, as far as possible, non-confrontational. The emphasis is on making sure that patients are not put at risk and on giving support and, where necessary, retraining of

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doctors whose clinical performance falls below acceptable standards. Existing disciplinary procedures would be abolished and a clear set of revised procedures laid down covering the different types of issue--for example, disciplinary, contractual or clinical--that can give rise to complaints in the first instance. Importantly, however, the power of suspending a hospital doctor would remain.

My own view is that these proposals have a great deal to recommend them. However, as my noble friend pointed out, their defect is that they do not go nearly far enough. The underlying assumption in the consultation paper is that, providing the new procedures are in place--procedures to be promulgated largely, I understand, by means of guidance--the suspension of doctors will not be an issue. That seems to me to be a somewhat pious hope. There is perfectly reasonable guidance in place at the moment, and it has signally failed to achieve a fair outcome. Even if the majority of hospital trusts abide fully by their revised procedures, situations are simply bound to arise where decisions about the suspension of doctors have to be made. If that is so, we have to ask what systems should be put in place to govern the conduct and process of such suspensions.

Nothing in the Government's proposals seems to me to address the issues of equity and fairness that my noble friend has highlighted both in her speech and in this Bill. It is simply not acceptable for the nature of a complaint to be withheld from the doctor whose suspension has itself resulted from that complaint. It is not acceptable for members of a trust to be judge and jury of a complaint that the trust itself has initiated. A doctor should be entitled to representation before an assessment panel. He should have a right of appeal. There should be mechanisms to ensure that delays in hearing a complaint are kept to a minimum. Where doctors are wrongly treated and then exonerated, there should be compensation. Above all, suspension should only be resorted to when patient care is jeopardised and there is no other appropriate procedure open.

Statistically, four out of five cases where there are concerns about a doctor's clinical competence are not upheld. Yet, at present, there is a definite Kafkaesque quality to the suspension procedures as operated in some trusts to the extent that doctors are made to feel condemned, before they have even been heard, for an offence of which they are often completely unaware. As my noble friend Lord Colwyn emphasised, the unjust stigma suffered by doctors and the damage to careers is considerable.

Surely none of this can be consistent with the human rights legislation that is due to come into force later this year. Indeed, because of that legislation, it seems to me to be all the more essential that these issues are gripped and resolved without delay. It really would be deeply unfortunate if, by October--when, I understand, the Act comes into force--we had no adequate systems in place to deal with suspensions, and then found that doctors were resorting to court action to resolve perceived injustices. As at 31st December last, 27 hospital and community medical and dental staff had been suspended for six months or more at an estimated cost to the health service of £2.5

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million. The systems that are needed should be fair, open and transparent; and they should be nationally applied. It should not be acceptable for each hospital trust to have its own, sometimes idiosyncratic, procedures to deal with complaints. I am very far from convinced that a national system is achievable through mechanisms that are not legally binding; which is the reason why I support this Bill.

I understand that the Government have expressed a willingness to negotiate on putting in place a set of formal procedures to cover suspensions. That is welcome. However, what I would like to hear from the Minister is a firm commitment to enter such discussions and a definite timetable for doing so. The Government also need to address the possibility that the systems to be put in place in England will differ from those in Scotland which, in turn, will differ from the Welsh and Northern Irish procedures. It would be retrograde if each part of the Union had a set of procedures that differed in a material respect from procedures followed in another part. What action are the Government taking, for example, to ensure that the proposals contained in Supporting Doctors--Protecting Patients are taken up across the United Kingdom as a whole? Will the noble Lord also look carefully at the suspension procedures as practised in Scotland?

For the reasons that I have identified, I sincerely hope that the Government will not dismiss this Bill out of hand and that they will wish to look further at what it contains. I join my noble friend in commending the Bill to the House.

8.15 p.m.

Lord Hunt of Kings Heath: My Lords, I welcome the opportunity presented to the House tonight by the noble Baroness, Lady Collingtree, to debate this important issue. Like other noble Lords, I am indebted to her for once again bringing this matter to our attention.

These issues affect not just individual doctors; they affect the whole performance of the National Health Service and the quality of service that we offer our patients. Doctors are very important members of the health community. I certainly very much agree with the noble Earl, Lord Howe, that we rely on their expertise and their ethical obligations to ensure that we are looked after properly when we go to see a doctor with our most private concerns.

We know that the great majority of doctors provide an excellent service and give their patients the best possible care. But, sadly, we also know that some doctors let down the profession. They may find the demands being placed on them too great. They may have difficulty in keeping up with the dramatic technological advances made in patient care in the past two decades. Undoubtedly, doctors who provide inadequate care are a danger to patients. There are also others who, because of ill health, pose a threat to patient safety. Although these doctors represent a very small minority, they have undoubtedly damaged public confidence in the medical profession at a time

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when, as the noble Lords, Lord Colwyn and Lord Clement-Jones, have suggested, complaints and litigation are very much a rising trend.

Clearly the paramount interest in all this is that of patients. We must ensure that doctors who are criminal, inadequate or ill will not have opportunities in the future to harm patients. We must have systems in place to ensure that such cases can be easily identified and discovered. When they are discovered, action needs to be taken quickly either by the NHS or the General Medical Council. In these situations, immediate suspension is often the only way to stop a dangerous doctor from threatening patient safety. It has always been the Government's policy that suspension should be used primarily when a doctor's continued practice causes a danger to patients, or when it is necessary to facilitate investigation into serious allegations.

The noble Baroness has raised her concerns about the practice of doctor suspensions on a number of occasions, most notably in our debate in your Lordships' House last year. I fully appreciate the stress that suspensions can place on doctors and their families. The Government believe that such suspensions should be resolved as quickly as possible. As the noble Baroness said, it makes no sense to keep expensively trained doctors suspended unnecessarily. One has to point out that suspension is often resorted to when there is a question about a doctor's poor performance. Too often, perhaps, a disciplinary route is taken quite inappropriately. We need to help doctors long before they reach the suspension stage and long before they can do harm to patients. I very much agree with the noble Baroness that we need to look at alternatives to lengthy suspensions.

My noble friend Lord Rea mentioned current performance. Since 31st March 1995 a total of 75 cases of suspension lasting over six months have been reported. As at 31st December 1999--the latest date for which figures are available--27 hospital and community medical and dental staff, including 17 consultants, have been suspended for more than six months. That shows a slight reduction over the figures for the quarter ending September 1999. There are indications that the health service has already taken note of the concerns that have been expressed about the way suspensions have been developed and used in past years. The NHS is much more aware of the need for extreme care and caution in resorting to suspensions.

In order to address some of these problems, and indeed the wider problems of dealing with the poor performance of some doctors, the Chief Medical Officer published his paper, Supporting Doctors--Protecting Patients. Hospital doctors' suspension is one of the issues addressed. The consultation on the paper has just finished and we are carefully considering the responses. The comments made by noble Lords tonight will be invaluable in considering those responses.

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I was disappointed in the comments made by a number of noble Lords on the document. I do not share noble Lords' pessimism about it. The noble Earl, Lord Howe, was right to reflect on its positive points. I say to the noble Baroness, Lady Knight, that a key reason for referring a doctor to the new support and assessment service is when a concern is raised but where there is no agreement on the cause of the problem. Quick referral to this service will enable independent assessment of the problem. The doctor may be exonerated or an action plan may be suggested to deal with the problem. In those circumstances, the doctor will be clear about what the concerns are and will have the benefit of an independent review.

I shall return to that matter in more detail later. It is also important to reflect that it is not just the NHS which has a responsibility to patients to ensure that they are safe in the hands of their doctor. We must not forget the role of the General Medical Council, which, through its statutory duties to regulate the medical profession, also has a legal duty to protect patients. Following the tragic and disturbing case of Dr Shipman, the Government propose to widen the GMC's powers so that it can deal more effectively and quickly with doctors whose fitness to practise comes into question. The changes to those powers are intended to strengthen the bond of trust that must exist between doctors and their patients, and to express the Government's and the GMC's determination to apply the lessons of those tragic events so that patients have proper protection.

I return to the details of hospital suspensions. At the time of the debate in your Lordships' House last year, my noble friend Lady Hayman informed noble Lords that the Government intended to order a review of the current suspension procedures for hospital doctors and dentists with a view to speeding up the process. The noble Lord, Lord Clement-Jones, asked me what progress had been made on the review. My noble friend informed your Lordships last year that this was to be an internal management review which aimed to develop a new national policy for suspensions. The review, which took place last year, identified four areas for improvement: the early detection of poor performance which if not remedied could lead to suspensions; the consideration of other options short of formal suspension; more rigorous control of the length of suspensions; and strengthening of local capacity and expertise to manage suspensions.

Noble Lords will see that the issues of suspension and poor performance are linked in those conclusions. I do not believe that it is straightforward: it is difficult to consider those issues separately. They have to be considered as part of the whole package of measures needed to tackle poor performance. Because of that, and before the review of suspensions was completed, the Chief Medical Officer began to address the wider issues surrounding the identification and handling of poor clinical performance. The whole question of suspensions is bound up with those wider issues. It was therefore decided that the conclusions of the review of suspensions should be subsumed within the proposals

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for a comprehensive reform and modernisation of the present arrangements for tackling poor clinical performance in the NHS.

I turn to the specific aims of the Bill. Many of the proposals in the Bill are not, I believe, very different from the findings of the review team, nor from normal practice in most trusts. The noble Baroness proposes that in future the chief executives of NHS trusts are made responsible for the decision to suspend doctors and that they must consult practising clinicians and other appropriate persons as they see fit. In reality, that is what happens now. Normally, prior to the suspension, the medical and human resource directors and the chief executive will all be involved in the decision-making process. Other interested parties, such as the health authority's director of public health, the GMC and the medical Royal Colleges might be asked for help and guidance prior to making a decision to suspend.

The noble Baroness also requires the chief executives to consider whether there are alternatives to suspension and to satisfy themselves that this is in the interests of the patients, staff and practitioner. The Bill also requires them to inform the NHS executive who will monitor suspensions and, if the practitioner has a private practice, the chief executive is to be required to notify the private hospital where the practitioner has admitting rights. The noble Baroness's Bill also requires each suspension to be reviewed monthly by the chief executive and the suspension automatically revoked if disciplinary proceedings are not commenced within one month. The Bill also gives certain appeal rights to the practitioner and requires the chief executive to follow certain rules before a decision can be made to exclude a suspended doctor from the premises.

We have sympathy with some of the aims of the Bill, some of which, as I have indicated, were identified as areas for improvement by the internal review. However, I have one serious concern about one aspect of the Bill which suggests that, where disciplinary procedures are not invoked within one month of suspension, the suspension ceases to have effect. That would mean in the future that, where a doctor is suspected of a serious criminal offence--for example, like Dr Shipman--or where performance has endangered patients' lives or there has been a drug problem, or in cases which, because of their complexity or the need to investigate a large number of matters, are bound to take time, that doctor would have a statutory right to practise, even though the risk to patients is still there. I believe that that would also cut across our proposals for dealing with poor performance. In the few cases when suspension was considered necessary, the Bill would force a doctor into the disciplinary route--the very thing that we are trying to avoid.

I certainly want to ensure that the new system on which the CMO is consulting at the moment will allow us to deal with many of the issues that have been raised in your Lordships' House tonight. I believe that those proposals will help the small minority of doctors whose performance gives cause for concern. In this

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way, in the future, by supporting doctors to improve their performance, we shall see the end of protracted delays and the legalistic inflexibility of the old arrangements. We need doctors' support for that process. Suspending highly trained doctors is an expensive business. It does not help the doctors unless there are means of improvement available to them. It is certainly not good for the taxpayer to have a doctor who might perform reasonably for 90 per cent of the time but requires help to gain the other 10 per cent--for example, through further training-- suspended for lengthy periods unnecessarily. It is not in the public interest to suspend doctors if there are alternatives to disciplinary action.

We are looking at these alternatives. For example, Birmingham Heartlands Hospital is currently developing new ways of identifying doctors' development needs. Problems will now be identified earlier and action taken before patients are put at risk. I am convinced that the proposals contained in the Chief Medical Officer's paper should help poorly performing doctors because it would provide an early diagnosis of the problem in a neutral environment. It would give the NHS, the patient and the doctor an objective assessment of the nature and seriousness of the problem and the action needed to address it.

The noble Earl, Lord Howe, raised the point that suspension would still remain an option. The proposals for the support and assessment service would largely resolve the need for many of the suspensions that currently take place and for several separate and time-consuming investigations. In future, suspensions should only be needed where a doctor refuses to be referred to a support and assessment service; where an employer is investigating or taking action under internal disciplinary procedures because of alleged personal misconduct or failure to fulfil contractual responsibilities; where there is imminent danger to patients and there is a need to ensure that they are immediately protected; and where an employer is dealing with a doctor who is referred back from the support and assessment service with a report concluding that the problem is "serious and intractable".

As I said, the current number of suspensions lasting over six months is 27, the large majority of which are performance related. Under the Chief Medical Officer's proposals, in future, rather than suspending the doctor, these kinds of cases will be referred to the assessment and support service. The Government believe that the proposals contained in the Chief Medical Officer's paper will address most of the current problems surrounding hospital doctors' suspensions.

However, I recognise that in spite of everything that might be done to help poorly performing doctors, there will always be some doctors who are either criminal, incompetent or ill, who will continue to pose a serious threat to patients. In those situations, the Government have to be able to take all action necessary to have systems in place to stop such doctors harming patients.

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We are, of course, carefully considering the responses to the CMO's consultation document. We shall certainly, in the light of that, wish to clarify the circumstances in which doctors should be suspended. For those doctors who are suspended by their employer, we shall ensure that there are robust monitoring processes in place so that doctors are not suspended unnecessarily, nor for an inordinate length of time.

I should say to the noble Earl, Lord Howe, who expressed some scepticism about our ability to manage performance in that area, that we shall ensure that every avenue is explored to avoid suspension and to help the poorly performing doctor.

In answer to the noble Lord, Lord Colwyn, I say again that as a backstop to all these measures we shall be giving the GMC additional powers to suspend a doctor, as well as stopping rogue doctors from coming back on to the medical register. In the meantime, we want to ensure that those few doctors who will continue to be suspended are dealt with fairly--I accept the point entirely--and as quickly as possible. But uppermost in our mind will always be patient safety.

In conclusion, the issue of hospital doctors' suspensions is but a small part of the bigger picture of identifying and handling poor clinical performance. The issues of discipline and poor performance need to be handled as part of a package. I fully accept the point made by the noble Earl, Lord Howe, that the NHS is not exempt from the Human Rights Act and that we must ensure that the way in which we deal with those working in the National Health Service complies with that Act and with employment law. We do not consider that doctors need special treatment in law over and above other citizens; we do not believe that it is either necessary or appropriate to put on to a statutory footing the procedures whereby NHS employers suspend doctors.

We recognise the underlying aims of the Bill of the noble Baroness, Lady Knight. But, as I said, we believe that it is flawed and we are not able to support it. I accept that, undoubtedly, the debate has been timely and informative. I shall certainly ensure that the important issues raised are fully considered in the consultation on the CMO's paper. I assure the noble Baroness that we will take on board many of her concerns in the action we propose to take on suspensions and discipline.


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