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There is widespread agreement that the composition of regulatory body councils is central to both perception and effective regulation. Thus, the White Paper Trust,Assurance and Safety set out a substantial programme of reform to the system for the regulation of healthcare professionals. This programme was debated in some detail during the passage of the Health and Social Care Act and the Health Care and Associated Professions (Miscellaneous Amendments) Order, which was made in July. The noble Baroness correctly raised many questions during the Bills passage through your Lordships House.
Following the legislations introduction, the Government have been working closely with the General Medical Council to develop the proposed constitution
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In its Proposals on Healthcare Professional Regulation (published in November 2006prior to the Governments White Paperthe GMC emphasised that the new regime had to command the confidence and support of all the main groups with an interest in patient safety and quality of healthcare. It proposed a smaller council with a balanced composition, which would reflect patients and the public, doctors, the NHS and other healthcare providers, the medical schools and medical royal colleges.
The GMCs proposals included equal numbers of medical and lay council members, and acknowledged that routes to council membership had to command confidence through a fair, independent and transparent appointment process that was free from government influence.
I turn to specific points raised by noble Lords. The noble Baroness, Lady Finlay, and my noble friend Lord Rea raised the issue of the end of professional self-regulation. It seems that professional self-regulation is not based solely on the presence of a professional majority on the council. Registrants will continue to be actively involved in many levels of the processes of professional regulation through the approval of education and training, the continuing development of standards and the involvement of independent practitioners on fitness to practise panels.
The noble Baroness, Lady Finlay, and the noble Lord, Lord McColl, raised the issue of clinical independence. I assure the House that it is not the Governments intention to inhibit clinical judgments in any way. In terms of the GMC it will be essential that the council is able to draw on clinical expertise at all levels of its organisational processes, including, for example, through the three new education boards. Medical expertise does not have to be drawn from the council.
I turn to the appointments of the chair, which the noble Baroness, Lady Finlay, and the noble Lord, Lord McColl, raised. The Government have agreed with GMC proposals that the chair of the council should be elected by the council from among the council members. There is therefore no requirement in the constitution that the chair must be a medical practitioner. It is open for the council to choose the most appropriate member to take up the post of chair. Transitional arrangements have been made in the constitution order to provide for the existing chair to continue in post for a period of six months to provide a period of continuity during the first few months of the new council.
Likewise, there are no deputising arrangements for the chair and no standing vice-chair. That is deliberately there to ensure that there is no factionalism. We want this body to act as a strategic body for the medical profession. It is important from the start that factionalism does not emerge, which is about medical and non-medical members of the council.
The noble Baroness asked why not allow registrants to elect the medical members of the council from a long list drawn up by the Appointments Commission. The requirement to have a fully appointed council is set out in the medical Act. It was inserted by a Section 60 order made in June this year. This constitution order cannot override the requirements in that medical Act. The move to have a fully appointed council was a major White Paper commitment and part of the reforms that the GMC brought forward.
The noble Baroness asked whether the Department of Health would be able to exercise undue influence over the way in which the GMC works. I see no reason why that would be the case. In practice, the oversight role in relation to health professional regulators is being taken on more and more by the CHRE. Appointments to the council are being carried out by the Appointments Commission, which appoints against specific criteria agreed with the regulators.
The key principle of the White Paper, Trust, Assurance and Safety, is that the councils should be clearly independent of all sectorial interests, including the Government. The noble Baroness raised an issue about appointments being made before legislation was laid in Parliament. The noble Baroness will be aware that current membership of the General Medical Council will expire on 31 December 2008. In view of the short timescale, the Appointments Commission in consultation with the GMC began the recruitment process in order to be in a position to make appointments as soon as the constitutional order was made and laid before Parliament.
The Appointments Commission received over 160 applications from medical professions. The process of sifting and interviewing candidates prior to the completion of the consultation process of the draft order did not pre-empt the outcome of the consultation process. Following the interview process, the Appointments Commission had a pool of appropriately qualified lay and professional candidates from whom it could draw without prejudice to the final decisions about the size and composition of the council. The constitution order was made by the Privy Council on 29 September and laid before Parliament on 6 October. Final appointments to the GMC were confirmed by the Appointments Commission on 15 October.
The issue of a quorum was raised by the noble Baroness and the noble Lord, Lord McColl. In 2007, Niall Dickson, the chairman of the Kings Fund, chaired the national working group which had the objective of enhancing confidence in the health professionals regulatory bodies. It considered a range of issues relating to the constitution and membership of regulatory body councils. The report recommended that no group should have guaranteed places on the council and that members should include registrants
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The noble Baroness, Lady Barker, raised the issue of people who have been subject to fitness-to-practise action being able to serve on the GMC. This is not automatic. The Appointments Commission is barred from appointing anyone whose appointment could be liable to undermine public confidence in the profession, but we decided that the bar should not be an automatic bar because some candidates might have faced sanctions from autocratic regimes elsewhere in the world.
The noble Baroness, Lady Barker, also asked whether it would prevent the GMC from having standing orders. That is not the case. It has the powers under Schedule 1(e) of the medical Act to have its own standing orders and we assume that it will go ahead and do so in due course.
I thank my noble friend Lord Rea for his supporting remarks, particularly those concerning Sir Graeme Catto. I endorse them wholeheartedly. I hope that I have addressed the questions raised by the noble and learned Baroness, Lady Butler-Sloss, about the vice-chair.
In conclusion, the Government continue to be committed to improving patients safety and enhancing professional standards, and we will continue to work with the GMC and other regulators to that end. Change is always difficult and I appreciate that members of the GMC have made an enormous contribution over many years, but that particular role is coming to an end. I am confident that they will continue to find active and important roles in their professional regulation. I note that the GMC has written to a number of noble Lords calling on them to reject this Motion. It has pointed out that if Parliament were to reject this order it would not merely put a brake on the GMCs transition to a new constitution, but the council itself would cease to exist at the end of the year.
Baroness Finlay of Llandaff: My Lords, I am grateful to all noble Lords who have spoken, and am particularly grateful to the Minister for her remarks. I appreciate the comment from my noble and learned friend Lady Butler-Sloss about the vice-chair. I am concerned about the need to have a vice chairman in the event of the chairman suddenly becoming ill or being unable to undertake a duty, just as it is good practice in committee to have a vice-chairman who is well briefed and able to stand in.
I completely agree with the noble Baroness, Lady Barker, that a smaller council is manageable and can take sensible decisions and that previously it was too large. I reassure the House that I am not worried about those who are leaving their place on the GMC. Change will probably be a very good thing, and I embrace it. I also endorse the words of the noble Lord, Lord Rea, that Sir Graeme Catto has done an outstanding job in regaining a lot of confidence among the public who lost confidence in the medical profession because of events in Bristol, the Shipman affair, and so on. I hope that we are starting off afresh and well.
I echo the sentiments of the noble Lord, Lord McColl, in relation to the quorum and wonder whether it might be wise for the GMC in its standing orders initially to suggest that to be quorate a third of its members must be medical, or to have something to address the balance to give the medical profession the message that it is not being isolated. This is not about factionalismnot at all; it is about expertise, and making sure that there is the right amount of expertise in the room. I am grateful to the Minister whose words were reassuring. I beg leave to withdraw the Motion.
The noble Baroness said: My Lords, in moving this amendment and speaking to the other amendments in this group, I should make it clear that these Benches are not opposed to the community infrastructure levy. It is more a case of: What do we want? CIL. When do we want it? Not until we are completely satisfied that it will work. That is perhaps not the greatest of catchphrases, but it is a serious point. I congratulate the Minister on her persistence and my noble friend Lord Goodhart and the rest of the Delegated Powers Committee. The Minister has done a sterling job, and has achieved a sterling outcome inwe have used various anatomical phrasesputting more flesh on the skeleton. It is certainly less emaciated. However, the fact that there were so many amendments at the previous stage and there are so many at this stage, and the amendments are not straight forward, proves my point.
The Minister kindly arranged for me to meet officials so that they could explain the error of my ways in opposing the inclusion of this part in the Bill. I thank her and I thank them for their time. They confirmed that, as the document that the Government published in August stated, it is expected that the regulations will come into force not before spring 2009. Given how much store the Government rightly set by consultation, even if the regulations were ready now for consultation, it would be pushing it to have them in force next spring. I know that the Government have been working with stakeholders. I inquired whether it was intended that CIL would be piloted or trialled. I gather that is not the case, but that there will be so-called early adopters. I do not know whether early adoption is likely to relate to where the local authority is with its local development framework and local development documents, but how that part of the process will work and whether it will work exercises us as much as any other.
The charging schedule will go through the examination process. Who will participate? That was an issue for me as long ago as the mid-1980s when I was chairing a local planning committee and we were going through our local plan. The people who participated were the large landowners. My note reads Thames Water. That is to remind me that in my borough it owned a lot of land and had a major interest in taking part in the process. The large supermarket chains always keep a weather eye for opportunities. Will developers who have not yet put sites together, for whom a development may hardly be a twinkle in the eye in the local process, take part? That is unlikely. Perhaps consultants will, hoping then to pick up some fees from those for whom they may keep a watching brief across the country or to whom they may be able to sell the benefit of their services. I worry whether the examination process will be the effective and inclusive process that I know that the Government want it to be.
How long will the process take? I attribute the next piece of analysis to my noble friend Lord Greaves, who has obviously been detained over supper. As he says, the council does research, understands government guidance, holds informal consultations with appropriate developers, regional officers, and so on, prepares reports, revises them and finally gets draft proposals before the council in, say, six months. Council approval of draft consultation takes one month. Publication and the period for consultation take two months. Work on consideration of representation, informal discussions with objectors, and so on, further discussions within the authority, and preparation for revised proposals take four months. Informal discussion with the regional office takes two months. Sometimes, of course, there is a holiday period somewhere in that and further delays such as staff sicknesses and resignations; the regional office personnel may change; informal guidance may change, and all the rest of it. So add on a couple of months for all that.
Then the revised proposal is prepared and put through the council system, which takes a month. Then there is a further period for legal objections, which may take six weeks. Then we get to the examination by the inspector. That takeswhat?six months or so. I have not checked my noble friends arithmetic,
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Another anxiety is whether local authorities will be able to cope. We all knowwe have discussed this many timesthat there is a shortage of planners and of skills in the financing arrangements that CIL will require. It is not so easy to find people to undertake that sort of work within the public sector. I believe that the Government will allow prudential borrowing for local authorities to resource themselves. Of course, borrowing is not grant, it will have to be paid for. The people will have to be found; where will they be? If they are anywhere, they will be in consultancies.
A further area of concern is the boundary between Section 106 and, in the case of highways, Section 278, and CIL. I am told that 50 to 60 authorities, with the benefit of Section 106, are using a tariff scheme. All my instincts say: stick with that and build on it until the detail of CIL is absolutely pinned down and we can be confident in it. That is not least because, outside the big conurbations, it must be likely that local authorities will set the level at nil. Of course, it is their right to do so. The August document states that stakeholders have expressed concern that CIL could affect the level of developer contributions through planning obligations if it is not set at a sensible levela sensible level may be nil. Paragraph 5.23 of the document states:
The answer on the nil level is, in one sense, that that is a matter for them, but there is more to it. If the local authority sets a nil charge or a very low charge, or takes a long time to set the charge, how will that affect central Governments investment decisions? We know that CIL will by no means cover all infrastructure. Will investment be skewed by the attitude that the Government have to how individual local authorities are co-operating? With the best will in the world, people, by definition, are human. It is unlikely that the Government's decisions will be unaffected by that.
I understand that the Government anticipate zoning within local authority areas. Outside a big conurbation, I find it difficult to understand how that could operate. The charge will be set at X in that part of a district and at Y in this part of the district. I do not know how realistic that is, but I know very different attitudes will be taken in different parts of a district. A development that a local community might want could well be affected by that and driven away.
There will be indexation if the development is not commenced immediately or, to put it more precisely, if the levy does not become payable quickly. Again, I do
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When I mentioned the matter to my noble friend Lady Maddock, who, with me and other noble Lords, lived through the introduction of home information packs, she said what a sorry example they were of the Government introducing primary legislation but still working on developing the project. I cannot remember who it was, but someone on the government side recently told me that CIL should not push at the boundaries of viability. Too right!
I end by reiterating that we on these Benches would like an effective arrangement to be in place to assist the achievement of infrastructure. We seriously do not believe that the Government have got there yet, so it is not appropriate to go ahead with the legislation at this stage. Given the way in which these things come out, my amendments are shown as a whole string of amendments to take out all the separate clauses, but the first two are the most important.
This is not a frivolous amendment, and again I should say that I appreciate how much work has gone into presenting us with something much fuller. However, the sheer effort that has had to go into getting us to this stage makes me feel that my argument is the right one. I beg to move.
Lord Dixon-Smith: My Lords, I have a great deal of sympathy with what the noble Baroness has had to say in support of this group of rejecting amendments. I call them that because they would reject the community infrastructure levy. I may say, just to encourage her, that I am less optimistic about the introduction of CIL than she is, because, if I understand matters correctly, it is supposed to become part of normal planning documentation.
Most of the authorities of which I am aware are working on a local development plan that is already a planning document. Therefore, CIL must be part of a new local planning document if it is to be introduced. If it is, these documents are reviewed more or less quinquennially, so we are looking at CIL being introduced in the next quinquennial document. We are therefore some years down the road before CIL can be introduced as a matter of practice. If the Minister tells us that this is merely an add-on to the existing system, we are dealing with something rather different. This is a very real problem.
There is yet another problem. Under our existing practices in this House, about which I have no complaint, we must consider these amendments before we can consider how CIL might and should properly work. The Government have tabled a whole lot of amendments that might well be helpful and may even improve on what is on the Marshalled List. However, we do not really know whether we want to reject what is before us, because we do not know what is before us, because technically speaking we have not dealt with it yet.
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