---

Shipman Inquiry

I accept what the Minister says. There is a debate to be had about terminology and I did not mean to caricature the Government’s position, but the feeling exists that the alternative to professional self-regulation is some form of regulation by those appointed. One can have an independent appointments system, but there is no doubt that if a number of council members are elected by their profession to uphold its integrity and proper functioning, that will, by degree, represent greater professional self-regulation than a system of appointed medical members combined with an equal number of appointed lay members. I hope that the Minister will accept that there has been a change or, at least, that a change has been proposed, in terms of moving away from professional self-regulation. When the measures come forward in statute, we will take a view on whether we think that the case has been made. A case needs to be made, because there is a danger that non-members of the medical profession may well take a more lenient view—in my experience, that argument can be made. If anything, we must ensure that there is less of a willingness to believe that the doctor is right. In the doctor-patient relationship, too much respect is sometimes shown by the patient for the doctor. The relationship needs to be more one of equals. I was grateful that the Minister responded to my first point. My second general concern is the most important one regarding regulation and the health profession. Even with the best audit trails and the most empowered patients in the world, episodes of poor or impaired practice, malfeasance or malpractice are much more likely to be identified by doctors themselves or their close colleagues. I am sure that the best way of getting the most reports of poor or bad practice by doctors is by relying on people on the inside who can see what is going on and are prepared to report it. Therefore, a test of any new regulatory proposals is whether doctors will be prepared to report their colleagues. If doctors do not think that their colleagues will get a fair hearing or if they think that their colleagues will be abused in the media, as they have been, with little protection and no ability to answer back on the basis of patient confidentiality or legal process, that will be a huge deterrent to people reporting their colleagues. The treatment of doctors such as Professor Southall and Roy Meadow by the media, which continue to report the Meadow case as if he had been struck off or found guilty of serious professional misconduct, is extremely damaging not just to the individual concerned, but to doctors. Doctors say that if this is the way the GMC behaves, by getting it so wrong, as the appeal found, or if this is the way that the media behaves, by, in the case of Professor Meadow, hounding and decrying a man who has made a significant contribution to child protection, there will be a diminution in the ability to pick up real cases of poor practice, because doctors will not report themselves or their colleagues. It is a difficult problem, and I want the Minister to accept that it is real. Individual doctors—not the profession generally—must know that they not only have a duty to report, but that it must be unabridged in any way by a fear of lack of due process. It is appropriate to speak about the standard of proof. Recommendation 81 of the Shipman inquiry’s fifth report states:"““The GMC should reopen its debate about the standard of proof to be applied by””" fitness to practise"““panels. It should consider introducing a rule that the civil standard of proof should apply unless the doctor faces an allegation of misconduct which also amounts to a serious criminal offence””—" I emphasise ““serious criminal offence””. It goes on to say:"““In that limited class of case, the criminal standard of proof may well be appropriate.””" The Government’s response was:"““The Government has decided that all health professions regulators should follow the civil standard of proof. It should be flexibly applied to take into account the circumstances and gravity of individual cases.””" The civil standard of proof is not the balance of probabilities, but a sliding scale that can go beyond reasonable doubt in a criminal case. There is a misunderstanding in the recommendation that only when the charge is of a serious criminal offence should the criminal standard of proof apply. I think—I cannot be certain because the Joint Committee on Human Rights, on which I sit, has not looked into this, but no doubt it will—that there is a real risk of non-compliance with the Human Rights Act 1998 if something equivalent to a criminal charge is to be tested on less than the criminal standard of proof. That does not mean that the wording is not right, because the civil standard of proof can come up to that level, but it is a matter of concern. If we want to have the profession’s confidence without the perception of a witch hunt, we must deal with that, and there is no doubt that it would have interfered with any GMC approach to cases such as Shipman or anything close to it.