---

Health and Social Care Bill

My Lords, I congratulate the Minister on his extremely lucid introduction to the Bill. Because of time constraints, I shall not devote any of my speech to Part 1, except to say in passing that the new Care Quality Commission will have a colossal task in trying to fulfil the responsibilities of the three regulators that will merge to form that single body. Members of that new commission will have to be told that they will have a colossal burden of work if they are to carry out its responsibilities properly. I turn particularly to Part 2, which deals with the regulation of the medical profession and perhaps eventually of the optical profession. I declare an interest as president of the General Medical Council between 1982 and 1989. I remember Lord Hailsham, when Lord Chancellor, giving a lecture entitled ““How to ruin the professions””. In it, he said that professional self-regulation was one of the glories of a learned and civilised society and that the alternative—namely, regulation by the state—was too fearful to contemplate. However, as the Minister and the noble Lord, Lord Carlile of Berriew, have indicated, a number of situations over the past few years eroded to some degree public confidence in that principle of self-regulation. From time to time, in response to perceived crises, the Government have indulged in the creation of large numbers of new quangos intended to regulate medical matters. Do we really need, for example, the Council for the Regulation of Healthcare Professionals—or as it now is, the Council for Healthcare Regulatory Excellence? Do we need a continuing National Clinical Assessment Authority at a time when the revised GMC is going to undertake the new powers defined in this Bill? That is water under the bridge and I say that there are many helpful clauses in the Bill. When I was president of the General Medical Council, following the Merrison royal commission, we had a majority of elected members. The revised GMC will have 24 members—12 lay and 12 medical. They are all to be appointed. That is appropriate, though it is paradoxical that the Government have decreed that there shall be no election of doctors to the new body at a time when they are looking towards a wholly elected upper House—but that is another matter entirely. The present Medical Act requires that the president of the General Medical Council should be a registered medical practitioner. I hope that that will be maintained. I approve of the proposal made by Lady Justice Smith in her excellent report that we should have an office for the regulation of health professionals and that this should involve panels appointed by that body to hear cases where, for instance, a doctor is alleged to be no longer fit to practise, either because of behaviour or even because of health. When I was president of the GMC, I chaired many hearings of the discipline committee—later the conduct committee. It was an article of faith that on every panel where a doctor’s future was being considered, there should be another doctor from the same branch of practice, on hand to give advice. This is an issue of considerable importance. Some, though not all, paediatricians believe that if doctors in the field of child protection had sat on the panels that heard the cases of Sir Roy Meadow and Professor David Southall, the outcomes may have been different. In Clause 98 of the Bill, there is, as the noble Lord, Lord Carlile, said, a very helpful proposal relating to legal assessors. I agree that it is not necessary on every occasion to have a legally qualified chairman of the fitness-to-practise panel. That chair could, on different occasions, be held by an experienced doctor or by a lay person. Where I disagree, bearing in mind the fact that the legally qualified chair could be a highly qualified solicitor, is in thinking that in all instances there should be a highly qualified Queen’s Counsel as a legal assessor advising the panel. Clause 99 concerns clinical and professional advisers. I trust that the Minister can assure me that on these panels the clinical and professional adviser will have a status comparable to that of the legal assessor, who is there to advise on points of law. I believe that these advisers should have the authority to advise the panel on issues relating to the field of practice of the doctor who is being examined by that body. The question also arises of the standard of proof. I, too, believe that the civil standard, applied flexibly, is appropriate. My understanding is that the BMA has begun to recognise that this is likely to be the case. When we come to the responsible officer, the burden of responsibility on the medical director of a regional trust would be enormous. Will the Government consider going back to the old Three Wise Men process, where the responsible officer was a senior doctor, with a lay member, perhaps of the authority, and a doctor, perhaps in another capacity, to advise? To have a single individual is probably going a little too far. Finally, I comment on the educational issues to which my noble friend Lord Patel referred. The Medical Profession (Miscellaneous Amendments) Order 2008, which I understand from the Minister is likely to be incorporated into the Bill, will remove from the education committee of the General Medical Council responsibility for the oversight and regulation of medical education at all stages. It will hand that over to the General Medical Council. My understanding from consultations with Sir Graham Catto is that the education committee will appoint three committees with the appropriate academic members, looking at undergraduate education, postgraduate education—taking that over from the Postgraduate Medical Education and Training Board, which has not been as successful as we wished—and continuing education. I hope that the Government will approve this. I end by saying that I welcome the provisions of the Bill. I look forward to hearing more about the Darzi report on the future of the NHS. When I was privileged, in 1996, to give the BMA lecture celebrating the 50th anniversary of the passage of the National Health Service Act in 1946, I said that I had lived through 14 reorganisations of the National Health Service. Since 1996, in the past 12 years, there have been 24. May we take it that, if and when the Darzi proposals on the future of the National Health Service are accepted and brought into law, we can look forward to a period of stability and that the Government will leave the NHS alone to get on with its job without developing more quangos? With that comment, I welcome the Bill.