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Health and Social Care Bill

This has been an extremely useful discussion and I am grateful to all noble Lords who have taken part. There are some extremely difficult issues here. Whether we like the idea of legally qualified chairs or not—and I fully take on board the points made by the noble Baroness, Lady Jones—the possibility of having them is provided for in the Bill. The question that arises is: when should you have a legally qualified chair and when should you not? The noble Baroness, Lady Tonge, put her finger on the problem created by the idea of having pilot schemes, because that must inherently run the risk of at least perceived unfairness on the part of some people. The noble Baroness, Lady Finlay, described the idea as a clinical trial without informed consent. She was right in that. The Minister appeared to make a distinction between more straightforward cases and more complex cases that might turn on a number of difficult legal and ethical considerations. I can see the distinction that she was trying to draw, but, in practice, I would not have thought that the division was that clear-cut. The problem for the OHPA will be where one actually draws the line and makes that distinction. In any event, the outcome in every case has the potential to be very serious for the doctor concerned. Many doctors might argue that it makes no difference whether their case is complicated or simple; what matters is having a chairman who is fair and who knows what he or she is doing. I am not sure that I heard the Minister suggest that the doctor would be able to express a view on the matter, but perhaps that should be thought about. I shall be interested to see how the rules in this area and the supporting guidance are framed. I remain uneasy about whether the proposed arrangements will guarantee consistency and fairness between cases. But, for now—