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Health and Social Care Bill

I am not sure how closely the hon. Gentleman has been following the debate. He ought to know that, as has been repeatedly put on record, we have strongly supported a change in the rules. I am a little perplexed about how the question could even have entered his mind, but perhaps he has not been able to follow the Bill's progress as closely as his question might have merited. We have not voted against the Bill, and we welcome the changes. What I am talking about is charitable status, which I hope is deeply important to the hon. Gentleman. If the GMC is not a charitable body, there will be a series of consequences. Let me proceed with my argument. It may help to clarify any confusion that may have arisen in the hon. Gentleman's mind. The Government may argue that we should not bind the hands of the Charity Commission, a body that operates independently of Ministers, but there are clear precedents for such action in other legislation. For example, further and higher education corporations are designated charities under section 41 of the Teaching and Higher Education Act 1998, and common investment funds are classed as charities under section 24 of the Charities Act 1993. Amendment No. 81 is intended to prevent the operation of fees from introducing any ambiguity to the designation of the GMC as a registered charity. As the Liberal Democrats tabled amendment No. 2, it will be for a Liberal Democrat Member to speak to it. The others are Government amendments. While most of them appear to be tidying-up measures, amendment No. 48 appears to disqualify hon. Members from sitting on OHPA adjudication panels. I do not believe that involvement with the OHPA is prohibited by membership of the House of Commons, and I should be grateful if the Minister could explain what changes the Governmentintend. If the answer is not satisfactory, I dare say that the matter will be pursued in another place, but, as the Minister must be aware, some Members are currently involved in the adjudication processes of the GMC. We also need to tackle the issue of the costs of the OHPA. I thank the Minister for furnishing us with the report on the costs that we had requested, although I was disappointed that we did not receive it before the Committee stage. I hope that he will be able to provide the independent report by financial advisers engaged by the GMC, which was supposed to be available at the end of January and which is mentioned in column 365 of the record of our Committee proceedings. The Government report divides the costs into three groups: set-up and transition costs for the GMC, other costs to be paid by the Department, and adjudication and running costs. The set-up costs, the Government finally reveal, will be about £3 million to £4 million over two years, but they are to be ““further refined””. The other costs, such as those of High Court referrals or big cases, have not been estimated, and I should be grateful if the Minister could identify the nature of that liability. The adjudication costs are not expected to exceed the current GMC costs of around £11.5 million. The running costs are not identified, which is odd, but the paper does identify a probable increase of between £20 and £30 per registrant per year. That would increase the General Medical Council registration to more than £400 and that of the General Optical Council to almost £200. A full GMC registration on the medical register is to rise to £390 a year with effect from April this year, having been frozen at £290 since 2002, and GOC registration stands at £169 per annum. It also suggests running costs for the OHPA of about £6 million per annum—I hope that the Minister will be able to confirm that figure. We remain deeply unsatisfied about the independence of the OHPA. We have searched Government amendments for where the Minister might give assurances about the independence of its decision making, but as the organisation is created the Department will needlessly still have its hands all over its finances. That is neither necessary nor desirable. Concerns remain over the civil standard of proof, which we discussed earlier and the Government failed to address. We were also looking for permanent legally qualified chairs, but we have now assented to a different situation. The Government must recognise that as the Bill progresses a full response is required on professional regulation and the impact that the practice of defensive medicine might have on our NHS, particularly financially—I hope there will be time to provide that when the Bill is considered in another place. I am sure that the Minister recalls that this was one of the areas of greatest contention during oral evidence sessions, and I think all Members were concerned about the BMA presenting the idea that the new regime would create over-defensiveness. I do not wish to be too critical—those giving that evidence must have thought that they were making representations on behalf of their members—but we need to bottom out what has been expressed on behalf of doctors about the impact of what is going on in terms of defensive medicine because we do not want that, and I do not believe it is likely to be a trend or a consequence; I would not be able to support the Bill if I did. Although I do not believe that to be the case, it is important to take such representations seriously and address them, rather than simply dismiss them out of hand. If necessary, we might have to appeal, through the BMA, to make sure that doctors are reassured that they need not be over-concerned about that. I have been getting the impression that the Minister might feel that that is a worthwhile point, which is good. The Government amendments on professional regulation would give the power through secondary legislation to impose a lay majority on the regulatory bodies. The GMC has been arguing for parity, and that makes sense for the confidence of both the public and the profession. I dare say that that will be pursued in another place. I have spoken to amendment No. 81 and I have addressed the other issues that arise. If the Minister does not provide a satisfactory response on the charitable status of the GMC, I might need to press the amendment to a Division.