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Health and Social Care Bill

That is absolutely true. I have the evidence that the General Medical Council received on that matter. There were two clear cases in which the civil standard was increased on that basis. In one, the allegations were made under the civil process, but they were serious allegations that needed serious action. I shall allude to that issue further in a few minutes. What is taking place is not new in respect of quite a lot of the regulation of doctors, of which I have experience. In 2006, the GMC published a package of proposals designed to deliver a modern framework of independent and accountable medical regulation, and the Government's White Paper, ““Trust, Assurance, Safety: The Regulation of Health Professions in the 21st Century””, reflected a lot of the GMC's own paper. The GMC is confident that its current arrangements for adjudication lead to consistent and high-quality decisions. The hon. Member for South Cambridgeshire referred to separate adjudication and said that the BMA might have concerns in that regard. As things stand, the GMC would not disagree with that. It has changed its adjudication panels massively since I first became a member in 1999. I was involved in the changes in governance between 1999 and 2003 that made adjudication as independent from the statutory body as it could be. The BMA's parliamentary briefing says on page 3:"““The BMA does not believe the case has been made for establishing a separate body and does not accept that the medical profession should lose the authority to regulate itself.””" It is fundamentally wrong for the BMA to use words like that. In my experience of the GMC, it has not been a case of doctors protecting doctors—far from it. In the years prior to 2003 when I sat on fitness to practise panels, there was never a case of lay members versus doctors in terms of wanting to come to a decision on a doctor. Such words do not do the profession any good. Sadly, some people still think, wrongly, that it is about doctors protecting doctors—no wonder, when one sees such words in briefings given to Members of this House for the purposes of a debate. The GMC has accepted the Government's decision to establish an independent adjudication body and will use its expertise to help to ensure the smooth transition from where we are now. When we changed the GMC's governance in 2003, the one thing that we could not do was to appeal against any decisions by the adjudication panels, because we had made them independent. I remember going to meetings of the adjudication panels as a lay member, trying to talk the case through with them, and then saying, in a nice way, ““We think you got that decision wrong.”” At least the GMC will now be able to appeal against decisions of the adjudication panels. The GMC is pleased that the Government have accepted its view that it should have the right of appeal, have made it clear that the GMC remains the owner of professional standards, and are protecting in legislation the relationship between the new body and the GMC in the application of the principles of good medical practice. Good medical practice is what the GMC judges all its doctors against, and the fact that it remains in statute is a very good thing. The GMC believes that patients' best interests are best served by independent and accountable regulation. The GMC must be independent of Government as the dominant provider of health care in the UK, independent of domination by any single group, and publicly accountable to Parliament. In response to the hon. Member for South Cambridgeshire, who said that a draft section 60 order is likely to be published at some stage, it was published today, and it looks into some of the areas that he mentioned. The GMC's current model of governance is that there should be parity between medical and lay members without an in-built majority on the council for either. We should aim for an equal proportion of medical and lay council members—a 50:50 split—on the new council that will emerge from the section 60 order. I remember when we moved from a GMC of 124 members, which was by and large dysfunctional—it was a bit like being in Parliament except that Division bells did not ring so we never took a decision on anything; at least that happens here, as dysfunctional a body as we may or may not be—to a membership of 35. A 50:50 split is right and proper. We will see how that will work in the next few days in the details of the section 60 order. The GMC should also have a balanced composition that reflects those who receive and provide health care across the UK—patients and the public, doctors, the NHS and other health care providers, medical schools and medical royal colleges. That is crucial. If it cannot be done numerically, it can be done by ensuring that people on the council have the breadth of experience to play a useful role. The civil standard of proof will apply in any case without the Bill. The GMC decided that quite a long time ago, upsetting the profession well before Ministers did so by publishing the Bill. That mode of travel was suggested by Dame Janet Smith, and it will apply whether we change regulation procedures or not. I will loan my hon. Friend the Member for Dartford (Dr. Stoate) my legal opinion on that and he can read it for himself. The GMC's president, Sir Graeme Catto, is on record as saying that he does not believe that the change will result in more doctors being erased from the register, but it should make it easier to impose appropriate restrictions on a doctor's practice where that is necessary to protect patients. Removing a doctor from the register is a very serious matter, and where the consequences are loss of livelihood, the rigour of the criminal standard of proof, or a standard close to it, is clearly appropriate. On the other hand, the consequences of sanctions other than erasure may be less profound, and that could be taken into account in the evidence required to reach a finding on the civil standard of proof. That approach is wholly consistent with protecting patients and the public interest, and with being fair to doctors. The GMC's legal advice makes it clear that the civil standard of proof is not a rigid criterion by which facts are to be judged, but is to be tailored to the facts of any given case. It is often said that the more serious the facts alleged, the more cogent and compelling will be the evidence required. The application of the civil standard of proof more accurately reflects the true function of the GMC fitness to practise panel. Having had years of sitting on those panels, I completely agree. We would never go for the more serious actions against a doctor without good cause or consider one standard and one only. The panel is not a criminal court and it does not apply the criminal law. In particular, it is questionable whether it is appropriate to retain the criminal standard of proof in a protective rather than criminal jurisdiction, especially when the concerns relate to a doctor's health or performance. That is crucial. The process is there to help the doctor, but often it is too far down the line.