§ Lords amendment: No. 1, in page 11, line 12, after ("2") insert (",3").
11.34 am§ Mr. Michael Fabricant (Mid-Staffordshire)On a point of order, Madam Deputy Speaker. I raise this matter while my hon. Friend the Under-Secretary of State for Corporate Affairs is still in the Chamber. Is he to make a statement about the marvellous news in the west midlands—I have the privilege to be a west midlands Member—that £80 million of intervention funding is to be made available by the Department of Trade and Industry? We are seeing a £400 million investment of private money from the Jaguar motor company, some—
§ Madam Deputy SpeakerOrder. I cannot allow the hon. Member to raise a point of order simply to make observations. The matter is concluded.
§ Mr. Austin-WalkerI beg to move, That this House doth agree with the Lords in the said amendment.
Hon. Members will remember that the Bill received all-party support during each stage of its passage through the House, for very good reasons. It was understood that the Bill was concerned with the protection of national health service patients. The same was true in the other place. There has been all-party agreement on the Bill's principles and scope. I wish to reassure hon. Members immediately that the amendment does not alter those principles or scope.
The amendment was introduced in the other place by the Government. It received cross-party support. It deals with a technicality. It clears up a difficulty in the drafting of the Bill, and relates to the timing of the commencement of the Bill, when enacted, in relation to the coming into force of the Health Authorities Act 1995.
The Bill rightly refers to "health authorities". It refers to the new authorities that will come into existence on 1 April 1996 when the Health Authorities Act comes into force. Family health services authorities are not health authorities within the meaning of the National Health Service Act 1977. To allow the provisions of the Bill to apply to family health services authorities before April 1996, provision had to be made for reference to health authorities to be read as references to family health services authorities. Clause 14(5) provides that where clauses 2 and 6, which set out the arrangements for the suspension of practitioners and for the constitution of the tribunal, refer to a health authority, that means a family health services authority until 1 April 1996.
Regrettably, clause 14 omitted an additional reference to a health authority. The additional reference is contained in clause 3. One of the effects of clause 3 is to bring tribunals into line by removing practitioners' right of appeal to the Secretary of State against directions of the NHS tribunal. Such appeals will be made to the High Court on a point of law. Perhaps most importantly, the 1232 clause provides health authorities with the power to implement tribunal directions that practitioners should be disqualified. That is the central point of the Bill.
If clause 3 had remained unamended, tribunal directions to disqualify practitioners between the date of commencement of this measure and 1 April 1996 would be meaningless. They could not be put into effect by family health services authorities. By bringing clause 3 into the ambit of clause 14(5), the problem will be overcome.
I believe that it would have been possible technically to delay the implementation of clause 3 until after the Health Authorities Act came into force. I discussed that possibility with the Department and with officials of the NHS executive. However, the Government concluded that it was preferable to table the amendment to preserve the Bill's intentions. I agree with that view and I am happy to accept the amendment.
As I said on Second Reading, I presented the Bill in the light of the experience of some of my constituents because I believed that their safety was placed at risk by the existing arrangements. I raised those matters with the Minister of State. He and I normally exchange angry views across the Chamber but I hope that the Under-Secretary of State for Health, the hon. Member for Battersea (Mr. Bowis), will convey my thanks to the Minister of State for his positive response to me. I also thank Baroness Gardner of Parkes for taking the Bill through the Lords, the officials in the Department of Health and especially those in the national health service executive for their assistance. The amendment is small but important. I commend it to the House and hope that hon. Members will give the Bill final approval.
§ Mr. Paul Boateng (Brent, South)On behalf of my hon. Friend the Member for Dulwich (Ms Jowell), who speaks for the Opposition on these matters and is unavoidably detained by a long-standing constituency commitment, I welcome the amendment, whose intentions have been explained by my hon. Friend the Member for Woolwich (Mr. Austin-Walker). The House and the millions of national health service patients who will benefit from the Bill owe him a debt of gratitude. He has done the House, his constituents and the nation a great service by introducing this much needed and extremely helpful measure. We are happy to do all that we can to speed it on its way.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)I am grateful to the hon. Member for Brent, South (Mr. Boateng), who is standing in for his hon. Friend the Member for Dulwich (Ms Jowell), for his endorsement of the Bill and the amendment. I am sure that he will forgive me if I express even more gratitude to the hon. Member for Woolwich (Mr. Austin-Walker) who has steered the Bill through the House and spoken to the amendment. I am grateful to him for the gracious way in which he spoke about my hon. Friend the Minister of State. I shall certainly pass on his message of a ceasefire, or perhaps a temporary ceasefire. That will be treasured by my hon. Friend who, I am sure, will read Hansard in bed tonight with a little glow of pleasure.
§ Mr. BoatengIf that is all he gets pleasure from I feel sorry for him.
§ Mr. BowisI do not think we should follow the hon. Member for Brent, South down his pleasure routes.
1233 I am also happy to accept thanks to Baroness Gardner of Parkes and to the officials in my Department and in the NHS executive. I am sure that they will be appreciated.
As the hon. Member for Woolwich said, the amendment seeks to correct an anomaly that would arise if clause 3 were not brought under the scope of clause 14(5). The Bill has the Government's full support and I am pleased, or fairly pleased, to be here to take it through what I hope will be its final stage before Royal Assent. I had the pleasure of dealing with the Bill in its earlier stages and it went to the other place with the Government's blessing.
At first sight the Bill's subject matter seems somewhat arcane. The National Health Service Tribunal is perhaps not much in the public eye. The hon. Member for Woolwich spoke about his personal experiences and about the tribunal's important function. It is a quasi-judicial body which considers representations from family health service authorities that individual practitioners should be removed from authorities' medical, dental, pharmaceutical and optology lists. Doctors, dentists, pharmacists and ophthalmists may provide family health services as unrestricted principal practitioners only if they are included in such a list. The NHS tribunal is the only body with the power to remove them from a list and thus from general practice.
As the House would expect, the tribunal's powers are rarely invoked and only in extremely serious cases where a practitioner's conduct or practice is such that the family health services authority feels that the provision of services is in jeopardy. The tribunal is asked to consider only about five or six cases a year, but they involve circumstances, about which the hon. Member for Woolwich spoke at an earlier stage in the Bill's progress, where patient care may have been compromised either directly, because the practitioner poses a physical threat to his patient, or indirectly, because the standard of care that he provides falls far short of that which the NHS, patients and the House have a right to expect.
11.45 am
In cases where the tribunal considers an authority's concerns to be justified, it may order the removal of a practitioner's name from the appropriate list and may even prevent its inclusion in similar lists that are held by other authorities. I pay tribute, as I am sure does the hon. Member for Woolwich, to the tribunal's chairman, Adrian Whitfield QC, for the assiduous way in which he and his colleagues perform their functions.
The tribunal has far-reaching powers but the Bill is valuable because the workings of the tribunal could be streamlined in several ways. It is valuable most of all because there is a serious gap in the tribunal's available powers. The Bill allows for the appointment of a permanent deputy chairman, lay members and a wide pool of professional members. That would better equip the tribunal to carry out its functions with the required speed.
The Bill will enable the NHS 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. At present no such restrictions are available to the tribunal, even when it feels 1234 that it would be wholly inappropriate for a disqualified practitioner to provide services as a locum, assistant or deputy. The Bill will plug that loophole.
The measure removes a practitioner's right of appeal to the Secretary of State for Health but will leave in place the right of appeal that is provided by the Tribunals and Inquiries Act 1971 to the High Court on a point of law. The Franks committee recommended that appeals from decisions of all tribunals should he made to a court. The provision brings the NHS tribunal into line with good tribunal practice. Most importantly, 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.
The family health services authorities, which make representations to the tribunal, said that the continued inclusion of a practitioner's name in one of their lists would be detrimental to the provision of services in their areas. They will be able to ask the tribunal to suspend that practitioner from duty with immediate effect where it is felt that that is vital to protect patients. If granted, that order would remain in force until a tribunal was able to hear in full the representations made against the practitioner in question.
Some hon. Members may have thought that the power that I have outlined already exists. Of course it does for practitioners who are employed in hospital and community services. That is why, in the topical case of Dr. Kiberu, such steps were possible. But the key word is "employed". Family health services practitioners are not NHS employees. They hold a contract of service with the NHS and are regulated by family health services authorities. Their contracts of service do not contain a clause allowing for suspension or disqualification from practice, nor can the powers that are available to the professional regulatory bodies, which in any case are to protect professional standards, assist in the immediate removal of practitioners from family health services authorities' lists.
At present there is no means by which a practitioner can be removed from practice immediately, even when that appears to be essential to protect patients. It is plain that the NHS needs power to do that, although from what I have said about the rarity of tribunal hearings the House may appreciate that we do not expect the power of suspension to be used often. However, such cases arise when the conduct or practice of a practitioner may be such that fears are raised for the safety of his patients. In such cases, the NHS needs to be able to act quickly to secure above all else patient safety.
That is why the NHS is grateful to the hon. Gentleman for bringing the Bill forward. The amendment does not alter the substance of what the Bill seeks to achieve. It is the substance of the Bill and the purpose of the NHS tribunal that the amendment protects. As the hon. Gentleman said, we foresaw real difficulties if the scope of subsection 14(5) was not extended by an amendment to cover clause 3. As the hon. Gentleman has described, clause 3 removes the arrangements under which practitioners may appeal to the Secretary of State for Health against decisions to disqualify them. It goes on to provide health authorities with the power to implement tribunal directions that practitioners should he disqualified.
1235 New health authorities will not be established until 1 April 1996. Therefore, without the amendment, family health services authorities would not be able to carry out directions of the national health service tribunal to disqualify practitioners. It follows that such directions made before 1 April 1996 would have been meaningless. Only the most serious cases are referred to the NHS tribunal. The hon. Gentleman brought this Bill before the House with patient safety at the forefront of his mind. I recall the eloquence with which he cited a case in his constituency where patients had, at the very least, been put at serious risk.
Clearly it would be nonsense if NHS tribunal directions to disqualify practitioners could not be implemented for however short a period as a result of a technicality. Bringing clause 3 under the scope of subsection 14(5) will put that right. It is simple and will ensure that the hon. Gentleman's intention in introducing the Bill and the House's earlier understanding of its provisions are preserved, so I am grateful to the hon. Gentleman for piloting this amendment and the Bill through the House. I hope that the House will view it as favourably as it has the Bill and that hon. Members will allow the Bill to complete its final stage, coupled with thanks to the hon. Gentleman.
§ Lords amendment agreed to.