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Medical Act 1983 (Amendment) and Miscellaneous Amendments Order 2006

My Lords, many technical questions have been asked and I shall endeavour to answer them. I am grateful for the support from both Front Benches. I start with some of the points made by the noble Earl, Lord Howe. I agree that what amounts to an approved setting should be clear. Like him, I suspect that it will not be approval for all time, as circumstances will change, and I expect the GMC to be able to cope with that. I am sure that the GMC will consider this issue carefully before it brings forward guidance. There need to be ground rules for the consensual removal or disposal of cases, and I am sure that the GMC will also consider this area. Such cases will be those that are not so serious that a person's registration might be erased or formal conditions might be attached. A lesser sanction of undertakings given by the doctor and agreed with the GMC will be in place and, if those are breached, fitness-to-practise action may follow. I can write to the noble Earl with a little more detail on that. I acknowledge that there is a wide-ranging power for the GMC to disclose fitness-to-practise information in this set of provisions. A section of the report on the consultation draws attention to the fact that the GMC currently discloses much historical information about a doctor’s fitness to practise as a matter of routine. That would occur in situations where the information was already in the public domain; for example, where a doctor had appeared before a fitness-to-practise panel in public and it had decided to erase, suspend or place conditions on the doctor’s registration. So the ability to do that already exists to a large extent. These determinations will always be read in public, and the GMC publishes them on its website. The policy intention here is that these public decisions will form part of the doctor’s record in the list of registered medical practitioners, but if the noble Earl is still uncomfortable with that, I shall be happy to follow up with more detail. Both the noble Earl, Lord Howe, and the noble Baroness, Lady Neuberger, raised the issue of indemnity and insurance. It is government policy for all healthcare professions to have such cover and it is progressively being introduced as Section 60 orders permit. This is a Section 60 order. There are two types of cover and each has a major organisation supporting it: the Medical Defence Union, which proposes an insurance-based approach; and the Medical Protection Society, which favours a mutual approach, sometimes called a ““discretionary indemnity”” approach. They are coming at this from different points of view but the Government's line is that both have worked well for practitioners. We do not believe that it is right for us to tell doctors which system they should follow. The order provides that practitioners can opt for insurance or indemnity cover or a combination of the two. There will be guidance on this from the GMC, which will consult widely. The guidance to the NHS will require it to consult widely. We know that doctors have to show that their cover is appropriate each time they renew their registration, which has to be done annually, so there is an obligation on doctors to prove that they have adequate cover. At the moment, half of all doctors and dentists have discretionary indemnity, and history shows that that meets their needs. My honourable friend Andy Burnham in the other place made it clear that we are not aware of circumstances in which these arrangements have been found to be unsatisfactory. We believe that under these arrangements there are sufficient obligations on doctors to demonstrate that they have adequate cover. Arrangements are in place, so we think it best to leave it to doctors to choose between insurance and mutual indemnity. The noble Baroness, Lady Neuberger, asked whether the Government would insist on minimum standards of indemnity. I think that I have answered that question. As I said, the GMC will make the rules on this after consulting on them, and those rules will require government approval. She also asked whether employers could impose language requirements before employing somebody. Our guidance to the NHS requires them to do so. We are not aware that there is any lack of understanding by employers, or that when they need to assess someone's language competence they do not do so. Concerns were expressed about the limited registration and what qualifications are acceptable. The qualifications accepted by the World Health Organisation will, as now, allow someone to sit the PLAB test, and the GMC will publish guidance about practice settings, so that we can ensure that those are appropriate. The noble Baroness, Lady Neuberger, raised issues regarding changes to the Immigration Rules, which we have debated in this place. I do not doubt that we may have other debates on that. The important point in the context of this order is that any existing leave will continue under the conditions in which it was granted. If someone has valid leave as a postgraduate doctor or dentist, they can continue in their current post and take up any other relevant training posts that they have sufficient leave to complete, until their leave expires. This is a complicated issue on which we have had wide consultation with the various interests. I recognise that some people wish that this had not been brought about, but it is important to bear in mind that the purpose of these changes was to ensure that the expanded number of UK medical graduates could proceed through the postgraduate training courses to specialist qualifications. It is important that we become more self-sustaining in our output of doctors, and do not rely on doctors from overseas being attracted here. That is not to say that we do not recognise the major contributions made currently and in the past by doctors who are international medical graduates. If I have missed anything, I will follow it up and write to noble Lords. That is my best attempt at answering the questions raised. On Question, Motion agreed to.