§ Question proposed, That the clause stand part of the Bill.
§ The Second Deputy Chairman of Ways and Means (Dame Janet Fookes)If the Committee is agreeable, we can take clauses 2 to 6 together.
§ Mr. Austin-WalkerClause 2 did not have an airing on Second Reading. It is important that it has one now, because the clause is the essence of the Bill. The clause enables an authority to apply to the tribunal for a practitioner to be suspended prior to a substantive hearing of the tribunal. It enables the tribunal to make a direction 480 that a person shall be suspended if it is satisfied that it should do so to protect patients. The essence of the Bill is the need for the NHS to protect patients.
Under the National Health Service Act 1977, any person or body may make representations to a tribunal that a practitioner shall be disqualified. The tribunal itself decides whether such representations need to be heard. That is to avoid the tribunal having to hear frivolous or vexatious representations. However, the tribunal is obliged to hear representations if they are made by a health authority.
For the same reason, under the clause the power to make application for suspension will be restricted to health authorities. If other bodies or individuals have information which suggests that a practitioner should be suspended, they have a duty to lay that information before the health authority, as it is the family health service authority which is the regulator of local family health services.
If the tribunal considers that a practitioner should be suspended to protect patients, it may make an order that the practitioner is to be regarded temporarily as being removed from any relevant list. For this purpose, the practitioner will be deemed to be unfit to provide relevant services in any capacity. That will be mandatory on the tribunal under the clause. The question at issue will be patient safety.
The initial period of suspension would lapse when the tribunal, following a hearing, disposes of the case by issuing a decision whether or not the practitioner should be disqualified, unless that decision includes a further direction that the suspension should continue. That further period of suspension would prevent a practitioner returning to practice until his appeal rights had been exhausted or, in the case of no appeal being made, until the disqualification direction is enforced by the health authority at the end of the period for appealing.
To preserve due process the practitioner is given the right to be heard by the tribunal, to call witnesses and to produce evidence in his defence before the tribunal decides whether or not to make a ruling. So that a suspension application should be heard as quickly as possible, the chairman or deputy chairman will be able to consider a suspension application sitting as a judge in chambers. Regulations will provide the procedures for that.
Clause 2 also includes an enabling power to make regulations that will provide payments to be made to practitioners who are suspended. In my view it is necessary to make such provision for suspended practitioners to continue to receive income from the NHS. If a practitioner is self-employed, the effect of suspension is to remove that practitioner's livelihood. Suspension must, therefore, be paid. At that point nothing will have been established against the practitioner.
Clause 3 would remove the current unrestricted right of appeal to the Secretary of State for Health. It provides that, where the tribunal has determined that a practitioner is disqualified, the health authority or authorities concerned shall remove his or her name from the list at the end of the period for bringing in an appeal, or at the end of the appeal process if an appeal is made.
481 The Franks committee recommended that appeals from decisions at all tribunals should be made to a court. There is an anomaly in current legislation, and the clause would bring the NHS tribunal into line with good tribunal practice.
Clause 4, which deals with the removal of disqualification, follows on from that. The provisions of the National Health Service Act 1977 give a practitioner two routes by which he or she may apply for reinstatement following disqualification. At present, a practitioner may apply either to the NHS tribunal or the Secretary of State for Health.
The effect of the clause is that applications for reinstatement shall be made only to the tribunal. The provision under which the Secretary of State could reinstate the practitioner is linked to the appeal provisions within the 1977 Act. Since the provisions for making appeals to the Secretary of State are being removed, it follows that the tribunal alone should decide applications for reinstatement. As is the case for other tribunal decisions, decisions on reinstatement may be appealed on points of law to the High Court.
§ Question put and agreed to.
§ Clause 2 ordered to stand part of the Bill.
§ Clauses 3 to 14 ordered to stand part of the Bill.
§ Schedule agreed to.
§ Bill reported, without amendment; considered.
§ Order for Third Reading read.
1.46 pm§ Mr. Austin-WalkerI beg to move, That the Bill be now read the Third time.
The Bill is concerned with the work of the national health service tribunal. It contains provisions designed to enable the tribunal to work more efficiently and to offer greater protection for NHS services and, therefore, NHS patients.
My interest in the Bill arose from a situation in my own constituency a couple of years ago. I draw the attention of the House to the parliamentary questions that I asked on 28 October 1993 and 18 January 1994. I engaged in subsequent correspondence with the hon. Member for Bolton, West (Mr. Sackville) and the then Minister of State, the right hon. Member for Peterborough (Dr. Mawhinney). Both Ministers accepted that there was a need for changes in the legislation, in the interests of patient safety. I am extremely grateful to the hon. Member for Winchester (Mr. Malone) for his support and co-operation, which has enabled me to support the Bill today.
It is invidious to name individual civil servants, and I shall refrain from so doing, but I would like the Minister to convey to the officers of the NHS executive in Leeds, who have been of enormous assistance, my thanks. I also thank the officers of the House. In particular, I thank Jo Rodin, the former chair of the Greenwich and Bexley family health service authority, for her advice, wise counsel and, indeed, support when I was dealing with the case in my constituency, to which I now refer, as I think that it will highlight to the House the problems that exist at the present time, which the Bill seeks to amend.
The incident concerned a general practitioner against whom a number of complaints had been made. Indeed, I now understand that he had been the subject of 11 FHSA 482 service committee investigations since 1988. There was a hearing of the FHSA's medical services committee in July 1989. Under regulation 10 of the NHS service committees and tribunals regulations, those decisions were reported to the Secretary of State. The Secretary of State upheld the FHSA's decisions, but the doctor in question sought a judicial review of the Secretary of State's decision. Consequently, despite the serious allegations against him, he continued to practise and to provide my constituents with an inadequate standard of care.
The case dragged on even further. The doctor subsequently withdrew his application for a judicial review, and the Secretary of State referred the matter to the General Medical Council. The council followed its normal procedures, finally recommending the doctor's removal from the register of practitioners, thus ending his ability to practise as a doctor.
The doctor then took an appeal to the Judicial Committee of the Privy Council. A series of what I can only describe as delaying tactics followed, leading to adjournments. Not until January 1994 was the doctor eventually removed from practice; the original complaint and the findings against him took place in 1989.
I should emphasise the seriousness of those findings. They included a pattern of outright refusal to visit patients who needed urgent attention, frequently accompanied by callous disregard of the patients' needs; persistent failure to liaise with other support services, and a degree of inability to work with others in a caring fashion; incompetence in clinical management, illustrated in the cases of four patients who subsequently died; and a failure to recognise responsibilities to the public in relation to controlled drugs.
I do not criticise the General Medical Council or its procedures. It is concerned with professional standards, and I do not criticise those, either. The problem was that, while the investigation was proceeding, the doctor was allowed to continue to practise in the NHS and to provide my constituents with a wholly inadequate and unsafe service.
The family health services authority did all that it could to resolve the problem. It had made representations to the GMC; eventually, in frustration, it went directly to the national health service tribunal, which was able to hear the case. There was an initial delay, because the tribunal chairman had resigned and there was only one chairman. It was some time before a new chairman was appointed. The Bill, however, will improve matters in that regard.
There followed a further series of delays and appeals. Essentially, the NHS tribunal had no power to suspend the doctor pending the final investigations. If this had been a hospital doctor, the health authority or the health service trust would have been able to suspend him on full pay during the investigations, because he would have been the employee of that body. I believe that, when serious allegations are made, NHS tribunals should have the power to make an immediate order for a GP's suspension pending a full hearing and disqualification proceedings.
I hope that the House will give the Bill its whole-hearted support. I know that the Government support the principle, and I am grateful for their backing and that of other Opposition parties. The Bill makes a necessary reform, but its application extends beyond principles. It makes provision to enable the NHS to ensure that a practitioner disqualified by a tribunal is taken out 483 of general practice when it considers that necessary, and cannot work as a locum, assistant or deputy to another practitioner or health authority.
My constituents would not have wished to see that doctor, who had been disqualified by the tribunal, coming back to a neighbouring practice as a locum or assistant. The Bill provides that that cannot happen. The Bill is not concerned solely with doctors. It seeks to protect NHS patients and its provisions will apply to all NHS medical and ophthalmic practitioners as well as to dentists and pharmacists.
I hope that hon. Members will support the Bill, which will secure protection for NHS patients where they are considered to be a risk.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)For the second time today, it gives me great pleasure to support the Third Reading of a private Member's Bill. I congratulate the hon. Member for Woolwich (Mr. Austin-Walker) on the way in which he has brought the Bill to the House and seen it through. I am grateful to him for his expressions of gratitude, which I shall pass to my colleagues. My hon. Friend the Member for Leeds, North-East (Mr. Kirkhope) is in his place and will be able to speed the hon. Gentleman's good wishes to NHS workers in Leeds.
As the hon. Member for Woolwich said, the Bill is designed to amend the constitution and powers of the national health service tribunal, which already has far-reaching powers. However, we need the Bill because the working of the tribunal could be streamlined in several ways and there is a serious gap in the powers that are available to it. The hon. Gentleman gave graphic examples of how the Bill could assist the tribunal.
Although the tribunal operates efficiently and decides representations speedily, it is sometimes hampered by the unavailability of a chairman or members. I am pleased that 484 the Bill seeks to solve that problem by allowing for the appointment of a permanent deputy chairman, lay members and a wider pool of professional members. It will also enable the tribunal to declare that disqualified practitioners should not be allowed to work in the family health service as locums, assistants or deputies to principal practitioners.
Most important, the Bill will provide the tribunal with a power to suspend practitioners from providing family health services in wholly exceptional circumstances so as to protect patients. I assure the House that that power would not be used lightly or for trivial reasons. Health authorities would be able to seek a suspension order only in extreme cases and even then only after it had made representations to the tribunal. There is no question of a suspension order being granted because of a minor contractual dispute. If a further hurdle to that were needed, the cost of bringing a case to a tribunal hearing at which both parties were represented by counsel is a sufficient deterrent.
We must consider what would happen to a suspended practitioner's patients. Of course the needs of patients would be catered for, and if the Bill succeeds in its passage through the House and in another place, as I hope it will, we shall introduce regulations to enable family health services authorities to make alternative arrangements for services to be provided to patients who, because of a suspension, are without a doctor, dentist, community pharmacist or optician.
As I am sure the House appreciates, the need for the tribunal to have a power to suspend practitioners in extreme circumstances is recognised by the bodies representing the professions. It is not in the interests of the overwhelming majority of members of those professions that the excellent service that they provide to their patients should be devalued by the actions of a very few who are unrepresentative of their peers.
I again congratulate the hon. Member for Woolwich on bringing the measure to the House. I wish it well and commend it to the House.
§ Question put and agreed to.
§ Bill accordingly read the Third time, and passed.