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Earl Howe: I am grateful for that explanation and I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 31, as amended, agreed to.

Clause 32 [Suspension and disqualification of practitioners]:

Earl Howe moved Amendment No. 186:



"( ) a supplementary list, or
( ) a services list,"

The noble Earl said: The clause seeking to establish supplementary lists and the clause seeking to establish services lists make specific mention of disqualification but states that those grounds may not be necessarily those stated under the clause. I do not understand why not. If new regulations for suspension and disqualification of practitioners are required, surely patients deserve the protection of all practitioners being treated equally. The practitioners, too, deserve that clarity. The amendment adds to the list those practitioners named on lists created under the Bill. In doing so, it seeks to ensure that all practitioners working in the community are subject to the same disqualification conditions. I beg to move.

Lord Hunt of Kings Heath: I hope that I can reassure the noble Earl. The problem arises because we are seeking to amend the 1977 Act and on occasion the different lists appear to be treated in a different way. The words in parenthesis "but need not" are only included in the subsection in a technical capacity to amplify the word "may" which precedes them. The words are necessary to emphasise the fact that it may not be possible to duplicate exactly for supplementary and services lists every aspect of the removal and suspension regime that applies to main contractors under Clause 32. That is due to the fact that there are different contractual arrangements inherent in the various lists and that certain parts are not applicable. For example, Section 49H will not apply to persons on the supplementary list who will all be individuals.

As the Bill already makes provision for the removal and suspension regime in Clause 32 to apply to doctors on supplementary and services lists, I hope that the noble Earl will feel that the position is covered.

Earl Howe: I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Earl Howe moved Amendment No. 187:


    Page 29, line 19, at end insert--


"( ) In sections 29B, 36, 39, 42 and 43 the expression "grounds of unsuitability" means, in relation to each such person, grounds as would enable the Health Authority, or on appeal the FHSAA,

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to be satisfied that it is necessary for the protection of members of the public, is otherwise in the public interest, or is in the interest of such person, that such person is unsuitable for inclusion in the respective list, and elsewhere in this Act the word "unsuitability" shall be construed accordingly."

The noble Earl said: During the Commons Committee stage on 25th January, the Minister, Mr Denham, undertook to introduce an amendment on Report setting out the circumstances in which a health authority may suspend a practitioner. An amendment to Clause 33 was introduced. However, I thought that it was the aim of the Government to define the term "unsuitability" on the face of the Bill. They do not appear to have done so.

The wording of the amendment reflects that in new Section 41A of the Medical Act 1983, which governs the work of the GMC's Interim Orders Committee: for the protection of members of the public, in the public interest or in the interest of the GP deemed to be unsuitable. Such a definition of "unsuitability" would help to ensure that health authorities do not remove or suspend a GP or refuse to include a GP on the medial list for spurious reasons. I would be grateful if the Minister would clarify the Government's position and explain why they are not willing to be as specific with the definition as I had understood they intended to be. I beg to move.

Lord Hunt of Kings Heath: The Government's view remains as it was in the other place; that is, that "unsuitability" is properly capable of a wide interpretation and should be left so. We believe that there are precedents in other legislation--for example, in employment rights--and that any definition set out on the face of the legislation might constrain the consideration of health authorities inappropriately. The approach that we favour, and which we shall seek to adopt, is to set out in regulations the criteria which health authorities must consider, without preventing them from applying other criteria where the particular case warrants it.

I know that the BMA's GPC has been pressing for a definition of "unsuitability" on the face of the Bill. I am not unsympathetic to the thrust behind that. However, we believe that this is the wrong approach. Amendment No. 187 draws on wording from the order last year--the Medical Act 1983 (Amendment) Order 2000--which established the GMC's Interim Orders Committee with the power to make interim suspension orders and the circumstances in which a medical practitioner may be suspended and not disqualified. The definition which the amendment borrows defines the circumstances in which the GMC committee may suspend a doctor, not disqualify.

The substantive point I want to make is to distinguish carefully between the grounds for removal and those for suspension. Grounds for removal need to be broad enough to capture all the potential risks to patients or the NHS that might arise. The grounds for suspension need to be drawn more narrowly to protect the practitioner from inappropriate action by the health authority--at suspension, no case against him

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or her has been proven--but to allow the health authority to act quickly where it considers that there is a serious and immediate risk to patients or to the NHS.

In the context of suspension, the drafting of Amendment No. 187 is helpful in assisting to define the circumstances in which suspension may be appropriate. The drafting captures both the notion of risk to the patient and the wider risk to the NHS or the public good. The noble Earl is right to say that in Committee in the other place we promised to bring forward on Report an amendment based on the wording of a similar opposition amendment. That would set out the circumstances in which a health authority may suspend a practitioner. We made that amendment on Report. It appears at lines 32 to 35 of page 28, or as new Section 49F(1) of the 1977 Act as inserted by Clause 32.

I hope that I have answered the points raised. I believe that, in general, "unsuitability" is capable of a wide interpretation. But that relates to a system in which there are appeals to the FHSAA. I believe that there are sufficient safeguards alongside the advice and guidance we shall give in relation to the criteria to be issued to health authorities.

Earl Howe: I am not entirely satisfied with that answer. It seems to me that there are two degrees of unsuitability. There is unsuitability because somebody is dangerous, either to himself or to patients, and unsuitability because the person is not up to the standard that the health authority might like. I believe that the issues need to be addressed separately, whether in the context of suspension or disqualification. My amendment would cover the situation on page 29, line 17 of the Bill, for example, which as I read it is not covered in the amendment tabled in another place on Report.

I do not want to detain the Committee on a matter of this kind. I shall read carefully what the Minister said and reserve the right to come back to this at a later stage. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Hunt of Kings Heath moved Amendment No. 188:


    Page 31, line 35, leave out from beginning to end of line 40 and insert--


"(9) The Secretary of State may make regulations providing for payments to practitioners who are suspended.
(10) Those regulations may include provision for the amount of the payments, or the method of calculating the amount, to be determined by the Secretary of State or by another person appointed for the purpose by the Secretary of State."

The noble Lord said: Amendment No. 188 deals with payments to suspended practitioners under Clause 32, to mirror the wording in similar provisions in Clauses 31 and 32 relating to supplementary and services lists. Amendments Nos. 189, 190, 196, 197 and 200 are minor, technical and of a clarificatory nature. They are necessary to ensure that the provisions for suspension and removal are consistent and coherent.

22 Mar 2001 : Column 1557

Amendment No. 189 clarifies that suspension of a practitioner has effect until its revocation by the health authority or the FHSAA. Amendment No. 190 extends the health authority decisions which may not be subject to review to include continued suspension pending an appeal against removal. Amendment No. 196 is a minor technical amendment necessary to substitute the reference to "practitioners" in Section 49R with "persons". Use of the term "persons" ensures that non-practitioners, such as corporate bodies, are also covered by the provisions in these sections.

Amendment No. 197 clarifies that national disqualification by the FHSAA prevents any health authority including that person in any of the lists from which he or she has been disqualified. Amendment No. 200 extends the circumstances in which practitioners may not withdraw from a list to persons awaiting removal after breaking conditions of their contingent removal. That closes a loophole.

Amendments Nos. 198 and 199 are more substantive. They both concern the time limit before a practitioner can request a review of the FHSAA's decision nationally to disqualify him or her from health authority lists. Clause 32 currently provides that, except in prescribed circumstances, a person may not request a review of FHSAA's national disqualification decision before the end of certain time limits. That is two years from the date on which the national disqualification was imposed or one year from the date of the last decision.

These amendments ensure that, in prescribed circumstances, the right to request a review will be either less than two years or one year--for example, where a relevant decision of a court or a regulatory body is changed or is overturned--or greater than those periods.

Amendments Nos. 198 and 199 provide for the right to request a review to arise either earlier or later than the periods specified in the Bill. That provision is along the same lines as that operated by the General Medical Council. In summary, doctors removed by the GMC may not apply for reinstatement for five years from the date of disqualification or for 12 months from the date of the last application.

The Bill adopts the principle of the GMC approach but specifies different time limits to recognise the different circumstances of GMC and FHSAA cases. The FHSAA, like health authorities, may remove a practitioner on grounds of fraud or inefficiency as well as their unsuitability. In some such cases a five-year prohibition on application for review may be excessive and the Bill recognises that.

Amendments Nos. 198 and 199 will permit a review of a national disqualification imposed by the FHSAA to be requested after either a longer or shorter period than that specified in the Bill in prescribed circumstances.

In essence, the amendments provide flexibility to ensure that practitioners who are considered suitable to work in the NHS are given the opportunity to do so

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as soon as possible, at the same time as providing better safeguards for the public in the most serious cases. I beg to move.

On Question, amendment agreed to.


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