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Earl Howe: The Minister must have his little jibe. I take the point. Nevertheless, he has given a helpful answer, and I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 27 agreed to.

Clause 28 [Conditional inclusion in medical, dental, ophthalmic and pharmaceutical lists]:

[Amendment No. 164 not moved.]

22 Mar 2001 : Column 1543

3.45 p.m.

Lord Hunt of Kings Heath moved Amendment No. 165:


    Page 24, line 36, at end insert--


"( ) If regulations provide for a practitioner's removal from the list for breach of condition--
(a) the regulations may provide that he may not withdraw from the list while the Health Authority are investigating whether there are grounds for exercising their power to remove him, or after the Health Authority have decided to remove him but before they have given effect to that decision; and
(b) the regulations must include provision--
(i) requiring the practitioner to be given notice of any allegation against him,
(ii) giving him the opportunity of putting his case at a hearing before the Health Authority make any decision as to his removal from the list, and
(iii) requiring him to be given notice of the Health Authority's decision and the reasons for it and of his right of appeal under subsection (4)."

The noble Lord said: In moving Amendment No. 165, I shall speak also to Amendments Nos. 166, 184, 204 and 210. Through these amendments we are seeking to be explicit in ensuring a consistent approach across the administration of the main, supplementary and services lists maintained by the health authority.

Paragraph (a) of Amendment No. 165 relates to limiting the circumstances under which a person can withdraw from the health authority main lists while he is under investigation by that authority. That ensures that the same limitations apply to any person whose continued presence on a list is subject to the completion of a health authority investigation and the implementation of any subsequent decision, whatever the reasons for that investigation and whatever the list. Similar provisions are made in relation to the supplementary, main and services lists respectively.

At paragraph (b), the amendment sets out certain mandatory processes that must be followed by the health authority in reaching a decision to remove a person from its list for breach of a condition imposed on that person's inclusion in the list. Again, we are ensuring consistency on the face of the Bill rather than merely in regulations by spelling out the same mandatory processes that must be followed in relation to those decisions as are already prescribed for removal, suspension and conditional inclusion decisions in relation to the supplementary, main and services lists.

Amendment No. 166 is technical and ensures that the appeal provisions in new subsection 43ZA(4) are accurately cross-referenced to subsection 43ZA(1), which sets out the range of decisions available to the health authority.

Amendments Nos. 184, 204 and 210 relate to certain mandatory processes that must be followed by the health authority in reaching decisions to suspend, remove or conditionally include a person on its supplementary or services lists. Again, by spelling out the same mandatory processes that must be followed in relation to these lists as are already prescribed for

22 Mar 2001 : Column 1544

the main lists at Clauses 28 and 32, we are placing a consistency of approach on the face of the Bill rather than simply in the regulations. I beg to move.

On Question, amendment agreed to.

Lord Hunt of Kings Heath moved Amendment No. 166:


    Page 24, line 37, leave out "do so provide" and insert "provide as mentioned in subsection (1)".

On Question, amendment agreed to.

Lord Hunt of Kings Heath moved Amendment No. 167:


    Page 24, line 42, at end insert--


"(ca) on any review of an earlier such decision of theirs,".

The noble Lord said: In moving Amendment No. 167, I shall speak also to Amendments Nos. 168 and 169. This group of government amendments concerns Clause 28. This clause further modernises the management of the primary care list system by providing a new power for health authorities conditionally to accept a practitioner on its medical, dental, ophthalmic, pharmaceutical or dispensing doctor lists. That will be in similar circumstances to those in Clause 32, which allow the health authority contingently to remove a person from a list.

This new power will apply only in fraud and efficiency cases. It does not extend to suitability cases on the basis that an individual is either suitable or unsuitable for inclusion on a health authority list.

In some circumstances, a health authority may conclude that the risk posed by a practitioner is not so great that his application to the list should be refused. The person's clinical practice may not be in question, but it would be inappropriate to allow him to practise without additional restrictions or closer monitoring by the health authority.

In such a case, a health authority will be able to impose conditions on that person to ensure that the identified risks of prejudice to the efficiency of the service or to the prevention of further fraud are eliminated. If a practitioner subsequently fails to meet such conditions, a health authority will be able to vary them, impose new ones or remove the person from the list.

The amendments are all aimed at delivering a consistent approach to the administration of the three lists. Our aim is that, so far as the different contractual positions allow, the lists should operate in a consistent manner.

Amendment No. 167 corrects an oversight in the provisions for appeals connected with conditional inclusion in the main health authority list. It introduces at new Section 43ZA(4) a right of appeal against the decision of the health authority following a review of the conditions imposed upon a practitioner.

Amendment No. 168 makes explicit on the face of the Bill that a decision to remove a practitioner for breaching a condition imposed on his inclusion in the health authority list cannot be implemented until, the

22 Mar 2001 : Column 1545

practitioner having appealed against that decision, the FHSAA reaches a determination in respect of that appeal.

Amendment No. 169 deals with the sharing of information about conditional inclusion decisions. It is vital to the operation of those new list systems, and to the associated health authority powers to admit, conditionally admit, remove, contingently remove or suspend, that information on such decisions is shared. I beg to move.

On Question, amendment agreed to.

Lord Hunt of Kings Heath moved Amendments Nos. 168 and 169:


    Page 25, line 2, at end insert ", and must so provide in relation to a decision referred to in subsection (4)(d)".


    Page 25, line 2, at end insert--


"( ) Regulations under this section may provide for the disclosure by a Health Authority, to prescribed persons or persons of prescribed descriptions, of information of a prescribed description about persons whose inclusion in the lists referred to in subsection (3) is subject to conditions imposed under this section, and about the removal of such persons from such lists for breach of condition."

On Question, amendments agreed to.

Clause 28, as amended, agreed to.

Clause 29 [Dental corporations]:

Lord Hunt of Kings Heath moved Amendment No. 170:


    Page 25, line 12, after "practitioner" insert "who".

The noble Lord said: This is a technical amendment. It simply corrects a typographical error. I beg to move.

On Question, amendment agreed to.

Clause 29, as amended, agreed to.

Clause 30 [Declaration of financial interests, gifts, etc.]:

The Deputy Chairman of Committees : I point out to the Committee that, if Amendment No. 171 is agreed to, I cannot call Amendment No. 172.

Lord Hunt of Kings Heath moved Amendment No. 171:


    Page 25, line 43, leave out from "about" to end of line and insert--


"(a) financial interests;
(b) gifts above a prescribed value; and
(c) other benefits received."

The noble Lord said: It may be helpful if I speak to Amendment No. 171 and allow the noble Lord, Lord Astor of Hever, to speak to opposition Amendment No. 172. After that, I could respond to that amendment.

I begin with a few general remarks. This group of amendments concerns Clause 30. The provisions in that clause seek to apply more consistent rules across the NHS on the declaration of financial matters and in doing so will create a system in which financial benefits or potential financial benefits that are available to a practitioner are handled in an open and honest way. We are attempting to apply consistent standards of

22 Mar 2001 : Column 1546

conduct right across the NHS. Such standards should apply to a hospital doctor as much to a general practitioner and to a pharmacist as much to a dentist.

The guidance that we published recently, entitled Commercial Sponsorship--Ethical Standards for the NHS, requires, among other things, that gifts and other forms of sponsorship that are valued at more than £25 should be declared. Under that provision, for example, it is clear that gifts from pharmaceutical companies must be declared. I understand that we have the support of the BMA in that regard. It said:


    "the vast majority of GPs would be more than willing to comply with the code of conduct".

The guidance complements the existing guidance that is issued to the NHS, which is entitled, Standards of Business for NHS Staff. That document addressed in particular what can be the difficult issue of receiving gifts from patients and it makes it clear that NHS staff should decline gifts from patients unless those gifts are of low intrinsic value.

Our intention is to bring the contractor professions into the same general regime as that which applies to the rest of NHS. They will be required to declare sponsorship, such as gifts from pharmaceutical companies, and they will be required to declare ownership of a pharmacy or a nursing home. Given that fundamental drive towards a consistent but fair scheme, it is clearly inconsistent when we have a situation where a doctor in a hospital has to refuse gifts from patients or where a GP has to declare a gift from a drug representative, but if we do not address the question of GPs receiving gifts from their patients, there would be no requirement for them to declare a gift from a patient.

We recognise the powerful and special doctor-patient relationship that exists in primary care. It is a force for good but there can be misunderstandings and difficulties. There should be no problem about patients providing tokens of gratitude to a GP but we need transparent procedures to prevent that from being abused. For that reason, we concluded that it would not be appropriate to ignore, within those new procedures, the declaration of gifts from patients to general practitioners and therefore for completeness we have included such a provision in the clause.

My dilemma in speaking to Amendment No. 171 is that it is in a sense a response to opposition Amendment No. 172. Perhaps it would be best if the noble Lord, Lord Astor of Hever, spoke to Amendment No. 172 and, if it would be helpful, I could respond to his comments. I beg to move.


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