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Health and Social Care Bill

moved Amendment No. 122: 122: Clause 95, page 47, line 8, leave out ““a lay member”” and insert ““two lay members”” The noble Baroness said: This is a probing amendment, but it relates to the constitution of the panels that will determine the future of the relevant doctor. I have already said that doctors are fearful of the GMC, but it would be more accurate to say that they are terrified of it. Doctors know perfectly well that the panel before which they come under a fitness-to-practise hearing will determine the whole of their future life. Therefore, I am querying why the panel has only three members. For some doctors, the fear of the fitness-to-practise panel has been so great that they have actually committed suicide before their hearing, not through guilt but through the burden of shame at ever having been reported to the GMC in the first place, even when that was vexatious reporting and they have known that that was the case, or even when they have known that a hate campaign has been run in the local newspaper against them and they have been unable to respond because of fear of breaching patient confidentiality, but they have known that their practice was not substandard and that they had nothing to feel guilty about. No one should underestimate how devastating a complaint is to a conscientious doctor, let alone when it gets reported to the GMC. The problem with a panel of three is that it seems almost dangerously small. If you have a powerful personality among three people on a panel and one of the other people is not a very powerful personality, it becomes easy to see how that small panel could become biased in its thinking or perhaps overinterpret some items of evidence brought before it and underinterpret others. After all, however well trained the panel members are, they are only human. I am not questioning the validity of people who sit on panels for the GMC. I am questioning the principle of having a panel that consists of only two members. That is why the amendments suggested increasing the number of lay members to two and the number of professionally qualified members to two. I note that under Clause 95(4), the rules can determine the fitness-to-practise panels, but I am concerned that nothing here says that the balance should be equally lay and professional. It would be just as dangerous to have a panel that was loaded with lay membership as it would be to have a panel loaded with professional membership. To have the latter would take one severely back in time. This is a probing amendment that questions whether it is wise to have a panel of only three members rather than a minimum size of five and questions why we do not have a designated balance, accepting an independent chair as the fifth member of a panel. I have discussed this issue with the Medical Protection Society, and it has concerns about the small size of the panel. The amendment about one member who should have relevant professional expertise is also a probing amendment. It is not at all to undermine the role of the professional adviser to the panel; rather, it questions whether, where a small panel is forming a judgment and there is only one professional member on that panel, that person can necessarily interpret some of the complex contextual aspects of the doctor who is up before the panel. You could say, ““Can someone working in the pharmaceutical industry really interpret the full context of modern general practice or vice versa?””. There are some very high-tech and complex areas of clinical practice that are far removed from the low-tech areas. I shall give the Committee an example: contrast inter-uterine foetal surgery with psychogeriatrics. Some of the pressures, the decision-making, the context and the team that one works with are very different. When you look at medical errors and problems that arise, they often have compounding factors from a team rather than being the responsibility solely of the doctor who is up before the panel. It is for that contextual reason that I am asking that it should be someone who had relevant professional expertise. I say emphatically that I am not requesting that one should ever consider that it is someone from the same discipline. Medicine is a small world, and it is easy to have bias. If people have heard about someone being reported to the GMC and so on, their thinking might be biased before they ever come on to a panel. However, I wonder whether one needs to ensure that there is some relevant background to understand the context of the doctor who is before the hearing. I beg to move.