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Health and Social Care Bill

Amendment No. 32, which leads this group, would remove the Secretary of State's power of direction in relation to the CHRE. It is exactly the same as my amendment No. 207, which was tabled at the Commons Committee stage. The Government conceded after the point was raised again by my noble Friend Earl Howe. Of course, we welcome it and thank the Government for listening, even if they did take the whole process of the Bill to do so. Lady Justice Smith told the Committee during its oral evidence sessions:"““it is important, particularly in the health sphere, that the adjudicatory body should be seen to be independent of Government because the Government are a huge customer of healthcare; the biggest customer of healthcare. Therefore, it is important that there should be no suspicion that the Government are in a position to pull strings behind the scenes, as to what goes on. Absolute clarity and absolute independence are really important.””––[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 42, Q82.]" The Minister rejected my amendment in Committee on the grounds that there was"““no intention to fetter the body's freedom””" but"““to ensure that, where necessary, a Secretary of State can ask the council to prioritise certain areas of its work load over others: for example, in cases in which there is particular public concern””.––[Official Report, Health and Social Care Public Bill Committee, 22 January 2008; c. 421.]" That is as clear an admission of the political meddling that the Bill enables as one is likely to get. I am glad that the Government have conceded that point. I would be grateful if the Minister outlined why and how his views have changed since the Committee stage and why it was not possible to concede the points at that time. Exactly the same points were made to advance that argument in this House as were made in the other place, as the Minister mentioned. Amendments Nos. 33, 34, 55, 57, 58 and 59 were tabled in response to the Lords Delegated Powers and Regulatory Reform Committee and to Conservative amendments tabled by my noble Friend Earl Howe. The DPRRC recommended that regulations conferring responsibilities on responsible officers under new section 45B of the Medical Act 1983, as inserted by clauses 114 and 115, should be subject to the affirmative resolution procedure on their first exercise by each of the appropriate authorities. I note that the DPRRC made three specific recommendations and that the Minister accepted them all. The Minister will be aware that we called for regulations under clause 114 to be subject to the affirmative resolution, along with all the other regulations in the Bill. The House will recall that a quarter of the clauses in the Bill are dependent on regulation—a high proportion. In addition, there are a number of Henry VIII clauses that enable the amendment of primary legislation by secondary legislation, although the majority are already covered by the affirmative resolution. I am glad that the significant new step in regulatory policy—the creation of responsible officers—will have proper parliamentary scrutiny at its outset, at the very least. In Committee, we tried to pin down some of the policy on responsible officers. The discussion was framed by the concerns expressed by Lady Justice Smith during her oral evidence. She told us:"““I really find it difficult to know how responsible officers are going to work and what role they will play in revalidation. I do not get that from this Bill.””" She went on:"““I cannot tell from the Bill how it will work, which bothers me. I am worried about responsible officers””.––[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 42-43, Q83.]" One suggestion is that PCT medical directors will be the responsible officers. Indeed, the Minister told the Committee that while the Government"““do not seek to be prescriptive, we think that a medical director would be perfectly appropriately for this role””" and that"““it would not require a full-time post.””––[Official Report, Health and Social Care Public Bill Committee, 22 January 2008; c. 431-33.]" PCT medical directors are already busy and have many priorities. In her oral evidence, Lady Justice Smith noted that, saying:"““I am really unhappy about that for several reasons…I do not like the idea of a medical director, who already has a lot of jobs, having to take on responsibility for revalidation as well as all his other jobs. I think that that is too much.””" Part of her desire to have the responsible officer as a separate role arises from her concern that"““the revalidation process should be clear and understood, that it should be summative and a proper test, and that it should not just involve shuffling pieces of paper around and rubber-stamping them””." The Medical Protection Society has also made that point. To show how the responsible officer's position could cause serious conflicts of interest, I hope that it will help the House if I cite a short example. Let us say that a local doctor prescribes an essential cancer drug for a patient and that that puts strain on the PCT's budget. Suddenly, the doctor finds himself at the wrong end of inquiry by the local GMC affiliate medical director. How does the GP know that the inquiry is genuine and not contrived? How does the medical director, the GMC affiliate, know that he is not being influenced in his regulatory decisions by pressure from his PCT chief executive? Lady Justice Smith noted the reverse possibility. She said:"““There is a real tension between, on the one hand, an employer's desire to keep all of his employees in post, revalidated and fully qualified, and, on the other hand, the possible need to refuse to revalidate somebody, in which case their services might be lost entirely, diminished or put on hold, from which problems might arise. I am unhappy about that. I cannot tell how it will work, but it looks to me that it might be like that.””––[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 43, Q83.]" Dr. Hamish Meldrum of the British Medical Association said:"““It comes back to the whole business of having confidence. We are aware of people—medical directors in trusts, or otherwise—whose loyalties have been primarily to their trust. We are not saying that their loyalties should be to the profession, but they should be to the wider benefits of health care. It is about achieving that balance by a degree of separation of function and a degree of separation of loyalties from the employer, and having an effective and practical operation. That is quite difficult: I accept that.””—[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 67, Q148.]" The PCT medical directors are themselves the employees of PCTs, so their impartiality in the regulatory management of local doctors cannot be guaranteed. Responsible officers should be completely independent of the local PCT as in that way they are more likely to command the trust of local doctors and hence ultimately make the scheme more successful. As yet we have no confirmation that PCTs will not be encouraged or coerced, either by policy or by funding issues, to merge the two roles. Responsible officers provide an opportunity for a dedicated individual to pick up the early warning signs in, for example, prescribing practice. That allows an opportunity to improve performance. In an open system of benchmarking, that could be an effective asset to the local and national health economy, and to the professionalism and morale of local doctors. Given the contention surrounding the policy, I am glad to see this Government concession to pressure from the DPRRC and to points made by the Conservatives and Liberal Democrats, both in this House and the other place. I trust that the affirmative resolution procedure will provide an opportunity for proper parliamentary scrutiny of the proposals. I hope that the Government will listen to the hopes of the profession in order to make the policy work best, for patient protection and better patient care. I turn now to Lords amendment No. 35. It would require the appropriate Minister, when making regulations on the sharing of information about health care workers among specified bodies, to"““have regard to the importance of avoiding unfair prejudice to health care workers against whom unsubstantiated allegations are made.””" Liberal Democrat members of the Committee spoke about this matter, as did my noble Friend Earl Howe in Grand Committee. In Committee, the Minister said that the protections needed in respect of sharing unsubstantiated allegations would be made"““plain in the secondary legislation.””––[Official Report, Health and Social Care Public Bill Committee, 22 January 2008; c. 438.]" What has changed the Minister's mind to bring us to where we are today? Can the Minister confirm whether there will be official processes—perhaps a formal alert system—to avoid tittle-tattle and unfair stigmatisation?