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Health and Social Care Bill

This has been a useful debate. I thank the Minister for her reply. What doctors will want to be confident about is that the process is fair, in the sense of being consistent—and, if I can use the word without being misunderstood, reproducible. They need to be able to predict in advance how the civil standard will be applied. It is still not wholly clear to me that they necessarily will be able to, which is why I am uneasy about this proposal. We need to bear in mind the fact that two major changes to fitness-to-practise adjudication proceedings are happening more or less at once, the first being the change in the standard of proof and the second being the increase in lay representation. Like it or not, different lay individuals bring their own values to a particular allegation. If a doctor has been accused of conducting an inappropriate internal examination on a female patient, one person on the panel may see that as a minor deviation from best practice, whereas another could regard it as a serious assault. Even if the facts of the case are fully understood, those differences of values are bound to come to the fore on occasion. That is one reason why, when looking back at our earlier amendment, I totally take on board the GMC’s desire to make sure that its indicative sanctions guidance has some standing in the way in which penalties are administered. It is not just a question of penalties; it is also a question of how facts are interpreted. In the case that I have just imagined, the balance of probabilities is not only about whether the doctor conducted the internal examination; it is also about why he did so, what his motivations were and how he conducted himself during the consultation. The judgment of a lay person on those matters could well be quite different from the judgment of someone who is medically trained. I am not arguing against lay membership of panels but merely pointing out that, for the profession to be confident in the integrity and consistency of the process, the combination of a sliding scale and lay membership of panels may create uncertainty rather than confidence. I have a high regard for the GMC and its current leadership and have to say that its latest note to parliamentarians gives us reassurance about how it is approaching the implementation of the standard.