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Health and Social Care Bill

My Lords, I congratulate the noble Lord, Lord Darzi, on the way in which he introduced the Bill, and I apologise to other noble Lords for missing some of their speeches. I had to try to juggle my appearance upstairs at the committee of the noble Lord, Lord Sutherland, taking evidence on taxonomy and systematics, and being present to hear the excellent speeches in this Chamber. The Bill contains fundamental changes to the way in which healthcare organisations and practitioners are regulated. Some of these changes are of great concern and there is a very real risk that a number of the provisions in the Bill—particularly the reduction in the standard of proof and the creation of responsible officers—will seriously undermine the confidence of healthcare professionals. Patients must be confident that they will receive the same standards of care whether treatment is delivered in a primary or secondary care setting. The Minister must convince us that bringing primary medical care into a national regulatory framework is the right approach. I declare an interest as a registered dental practitioner who is indemnified by the Medical Protection Society. A further concern is the establishment of the Care Quality Commission. I note that the Government’s response to their consultation paper, The Future Regulation of Health and Adult Social Care in England, suggested the possibility of bringing NHS primary medical care providers within the regulatory framework of the CQC. The quality of NHS primary medical care is currently monitored, but not regulated, by the Healthcare Commission. The Government have suggested that this additional layer of regulation would be justified because general practice is becoming increasingly complex, with more services being delivered by a diverse array of providers. I would be concerned if an additional tier of regulation for primary medical care services was so onerous and intrusive as to interfere with the day-to-day care of patients. I also question how the new framework would relate to the new proposals for local regulation in the form of ““responsible officers”” at PCT level and the existing national system of professional regulation. Changes to the delivery of primary care have already changed the personalisation of the doctor-patient relationship—the provision of out-of-hours care is a good example—and further regulation could make this even worse. Clause 116 enables the Secretary of State to make regulations requiring healthcare bodies to co-operate with each other, particularly in connection with the sharing of information which relates to the conduct or performance of any healthcare worker and which may show that that worker is likely to constitute a threat to the health and safety of patients. Any policies introduced to overcome the current limitation in information-sharing must include safeguards to protect innocent healthcare professionals from being unjustifiably accused of being a potential risk to patients. I hope that the Minister will be able to specify the type of information that will be recorded, who will have access to it and in what circumstances, and whether it will be publicly available. Can the Minister also provide some assurance that the regulations will set out the categories of information that can be held and to whom it can and cannot be disclosed? Sharing and collating relevant information is important to protect the health and safety of patients, so the regulations will need to be accompanied by clear guidelines for the quality of information to be included and assurance given that unsubstantiated, subjective rumour and gossip will not appear on the practitioner’s record. The Minister will surely agree that information should only be disclosed where there is a legitimate justification in the interests of patient health and safety. Unrestricted access without regard to confidentiality is not in the public interest as it will only damage relations between employers and employees and could unjustifiably damage individual reputations. It takes many years to build up a reputation and only days to destroy it. I have serious reservations about the proposal for the creation of a new role of responsible officer which I understand, in practice, would be the organisation’s medical director. While there are benefits in establishing consistent, transparent and fair mechanisms of regulation at a local level, I would like to see provision in these reforms for a better use of existing clinical governance processes and structures at a local level to enhance mechanisms for the early identification and rectification of problems. The new role of responsible officer will entail a significant extension in a medical director’s responsibility, authority and workload. It is contemplated that responsible officers will be respected, senior doctors who will have the credibility and support of doctors, managers and patients. On a practical level, I cannot see how there will be a sufficient number of senior doctors with the professional standing envisaged who will be not only willing, but able, to assume such onerous responsibilities. An experienced clinician will not necessarily be endowed with the skills needed to be a successful manager or leader. The wrong approach at local level can have disastrous consequences, including a protracted and adversarial process which is destructive rather than constructive in outcome. There is currently a lack of high-quality and consistent training for the role of medical director. I hope that the Minister will agree that it is essential that responsible officers are properly trained and bring the necessary qualities of fairness, objectivity and investigative robustness that will enable them to command colleagues’ confidence and respect. It is crucial that the Office of the Health Professions Adjudicator commands the confidence of the profession by ensuring that proceedings are procedurally fair. To this end I agree with the noble Lord, Lord Walton, and support proposals made in another place for there to be a legally qualified chair of fitness to practise panels which, in my view, would be sufficiently experienced to ensure effective case management and that standards of procedural fairness are met in hearings which are particularly complex. The importance of a legally qualified chair is even greater as panels will have to grapple with the application of the sliding civil standard of proof. In conclusion, I am pleased to see provision in the Bill for the appointment of legal assessors to advise fitness to practise panels on points of law. Legal assessors bring essential legal expertise, guidance and an element of independence to the proceedings. I hope the Minister can assure me that the legal assessor will continue to be available to panels even where a legal chair has been appointed. Many of the reforms set out should be welcomed, but it is already obvious that there will be some late evenings during the subsequent stages of the Bill.