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Health and Social Care Bill

As I understand it, these new sections codify and make statutory the position of the medical director that exists in many trusts. However, as my noble friend said, the Bill extends the role to PCTs and the private and independent sector. The responsible officer role is intended to protect patients, improve systems and act early to support and remediate doctors when concerns are raised about their practice. This appears to be in line with the wish of the noble Lord, Lord Darzi, that health services should be clinician-led, a concept that I warmly welcome. In the past, many members of the medical profession have shied away from taking the responsibility of managing and running the organisations in which they work. I do not find that surprising, because their education is about combating illness and restoring health. It is only when doctors achieve a consultant post that they are suddenly thrown into the maelstrom that is management. Without preparation, it is hardly surprising that they shy away. My company is designing and delivering courses on leadership for SpRs and trainee GPs. Our participants are bright, keen, wonderful young people, but they are breathtakingly naive when it comes to understanding the organisation in which they work. They express anger that, after working in the service for eight years, they have never met a member of the top team and have no idea what the chief executive or the director of finance does. They have no idea what a PCT is, yet these are the people who will shortly be in charge of a clinical department. So what do they do? They ask the previous incumbent, who says, ““Well, this is the way I have always done it””, so we get no change. Huge efforts are being made by deaneries, strategic health authorities and the department to ensure that the next generation of consultants, senior partners in general practice and public health doctors have the skills and support necessary to ensure that we have successful leaders, not only in clinical fields but in the organisations in which they work. The responsible officer will be a critical part of that leadership and should not only put into place and maintain the clinical governance systems but ensure that all doctors are providing a safe, high-quality service. As I understand it, he or she will also ensure that appropriate training and professional development are available to doctors. Perhaps the Minister can tell me if that is part of the role. Will this person identify issues at the earliest possible stage and help doctors to get on track before problems escalate? What mechanisms are available to an NHS organisation whose responsible officer shuns the difficult decisions and fails to be tough and to call his colleagues to account? I mention this because I have often heard of medical directors who have tried to take tough decisions but have been urged by their colleagues to be gentle. I have heard the phrase, ““Just have a word with him or her in the car park””. However, car park conversations do not work and the responsible officer will have to have the bottle to use the organisation’s HR policies; in some cases, those exempt doctors, which I do not think is right. It is essential for the responsible officer to be a part of the senior clinical leadership of the healthcare organisation and a member of the management board. That will make it easier to take appropriate action where problems arise that may be caused by dysfunctional systems rather than the performance of individual doctors. For example, I have been told of a case where the hospital introduced single-use instruments, which resulted in a number of post-operative complications. It transpired that the problem was not related to the performance of the doctors but was to do with the design of the instruments. In other cases, the problem might turn out to involve relations between several members of the clinical team rather than one individual. In such cases, a responsible officer who is a senior clinical leader in the organisation must be in the position to take whatever action is needed to protect patients and to support and help the individuals involved. I share the concerns of my noble friend about consistency, but I suspect that organisations are so different that they will probably want to have different systems. Let us take as an example the acute trust in Leeds, which is on two sites and may have 2,000 doctors. One would expect perhaps to have more than one responsible officer in that trust. Clearly, as my noble friend said, it is important that accountability is clearly defined. I take the point made by the noble Baroness, Lady Finlay, about GMC affiliates. This seems to be a moveable feast. We are never quite sure how that whole concept is going to relate to responsible officers. I should be grateful if the Minister could tell us a bit more about that.