---

Health and Social Care Bill

It is clear from my own recent discussions with the medical profession and bodies that represent doctors that the proposals in the Bill for the creation of responsible officers have created a good deal of unease and uncertainty. Underlying that unease is a mixture of thoughts. The responsible officer will have to look in several directions at once. He will have to command the confidence of his peers, his employers, the GMC and patients. He or she will have a lead role in supporting good clinical governance and in the performance management of doctors. He will have to take part in the management of clinical investigations arising from adverse incidents or complaints. To achieve all this, he or she has to be a person with an unusual set of competences and skills. The question that I have asked myself is how many people of such calibre there are, given the large number of trusts that need to make these appointments. By any measure, the responsible officer will perform a pivotal and powerful role in the trust of a kind that, not to exaggerate the point, could make or break the health of the organisation. As we have heard, it is the Government’s view that medical directors will often be the people best placed to become responsible officers. I have no reason to dissent from that view, although I do not think that it will necessarily be the right thing to do in every case. What will matter above all are the calibre and personal qualities of the individual. There is an important pastoral dimension to the role—the need for the responsible officer to be able to support and assist doctors who may be struggling for any reason. That takes a certain sort of person. Equally, it is obvious that internal politics and professional jealousies can influence, or be seen as influencing, the agendas that underlie how poor performance is managed. I very much identify with the points made in that context by the noble Baroness, Lady Finlay. Good training in the role will therefore be essential. Good training has to be based on best practice. Examples of best practice need to be identified and built on. It is not clear to me who will undertake this rather special sort of training and I should be glad if the Minister could say something about it. How will we be able to arrive at a position where, as far as possible, there is consistency of decision-making and practice around the country among responsible officers? Indeed, how will we know whether there is consistency? How will we know whether a responsible officer has in some way fallen short or abused his or her position? Amendment No. 143 attempts to get to that particular issue. Inevitable tensions will arise in the role of a responsible officer where that person is also the medical director. Acute trusts have performance targets. There are often shortages of doctors in key specialties. There is always an imperative to maintain patient throughput and to keep the doctors that one has in post working. At the same time there is a need to appraise and revalidate doctors fairly and to investigate adverse incidents fairly. How will a responsible officer, as part of the organisation’s management team, be able to balance those opposing pulls? Will he or she not have an inbuilt conflict of interest, and how will that conflict be reconciled? How do you ask someone to be loyal to an employer while at the same time being fair to professionals and patients by upholding professional standards in a scrupulous way? That will not be at all easy and I do not envy anyone faced with such an onerous burden. My other question relates to doctors who are not employed by an NHS organisation. There are many doctors practising independently in all sorts of environments and capacities—not only GPs, who are the most obvious example, but doctors in industry and commerce, doctors in the Armed Forces, pharmaceutical physicians and other doctors in private practice of all kinds. Who will act as responsible officers for these practitioners, especially in places where there is often no management structure? Will it be a mandatory requirement in PCTs that there should be a medical director, as there is in acute trusts? It would be helpful to have the Minister’s guidance on that as well. Finally, it would be useful to hear from the Minister how a responsible officer will liaise and interact with the GMC affiliate. The plans for GMC affiliates have changed considerably since they were first announced. We need to be clear how duties and responsibilities will be divided between responsible officers and affiliates. I wonder whether this idea would benefit from being piloted in certain locations before being rolled out universally. Does the Minister think that that might be sensible and are there any examples from abroad of the model from which lessons can be learnt? Does she think that the concept of having one responsible officer in an organisation is consistent with the proposal, which I have seen advanced, that the responsible officer could in practice delegate his or her responsibilities to a deputy? It seems to me that the idea of a deputy somewhat cuts across the notion of individual accountability, but the idea has been put forward as a way of spreading what will undoubtedly be a considerable workload on the shoulders of the responsible officer. At the very least, that workload will require administrative support. Will it be up to individual trusts to make their own arrangements to provide such support? I hope that the Minister can shed some light on these complex matters.