§ (2) In subsection (2)—
- (a) the word "or" after paragraph (a) shall be omitted; and
- (b) at the end of paragraph (b) there shall be inserted "or
- (c) in relation to an individual to whom subsection (6C), (6D) or (6E) applies."
§ (3) After subsection (6B) there shall be inserted—
- (a) medical practitioners undertaking to provide general medical services,
- (b) persons undertaking to provide general dental services,
- (c) persons undertaking to provide general ophthalmic services, or
- (d) persons undertaking to provide pharmaceutical services.
§ (6D) This subsection applies to an individual who is—
- (a) a director of a body corporate included or seeking inclusion in a list referred to in subsection (6C)(b) or (c),
- (b) a member of a limited liability partnership included or seeking inclusion in a list referred to in subsection (6C)(c),
- (c) a member of the body of persons controlling a body corporate (whether or not a limited liability partnership) included or seeking inclusion in a list referred to in subsection (6C)(d).
§ (6E) This subsection applies to an individual included or seeking inclusion in any list prepared by a Health Authority under—
- (a) section 28DA of the National Health Service Act 1977 or section 8ZA of the National Health Service (Primary Care) Act 1997 (lists of persons who may perform personal medical services or personal dental services), or
- (b) section 43D of the 1977 Act (supplementary lists), and to an individual included or seeking inclusion in any list corresponding to a list referred to in paragraph (a) prepared by a Health Authority by virtue of regulations made under section 43 of the Health and Social Care Act 2001 (which provides for the application of enactments in relation to local pharmaceutical services).".'.—[Mr. Denham.]
§ Brought up, and read the First time.4.55 pm
§ The Minister of State, Department of Health (Mr. John Denham)
I beg to move, That the clause be read a Second time.
§ Madam Deputy Speaker (Mrs. Sylvia Heal)
With this it will be convenient to discuss the following: Government new clause 12—Conditional inclusion in medical, dental, ophthalmic and pharmaceutical lists.
Government amendments Nos. 40 to 109.
Amendment No. 32, in clause 28, page 31, line 11, at end insert—
'(7) Before making regulations under this section the Secretary of State must consult such organisations as he thinks fit appearing to him to represent medical practitioners providing personal medical services or personal dental services as the case may be.'.
§ Government amendments Nos. 110 to 113.
Amendment No. 31, in clause 34, page 36, line 27, at end insert—
'(4) If the relevant authority makes a direction to a Health Authority under subsection (3) it shall make directions at the same time requiring the Health Authority to contract with each participant in a pilot scheme brought to an end as a result of a direction under subsection (3) to provide Part II services from the premises from which he was participating in the pilot scheme.'.
§ Government amendments Nos. 132, 137 and 139.
§ Mr. Denham
I should like to preface consideration of this group of amendments with some introductory remarks that will put them into context. In this group, we are proposing two new clauses and various amendments to clauses 20 to 29. Together, they will substantially update the provisions for managing primary care practitioner lists. The health authority lists of practitioners underpin health authority systems for managing primary care services and for assuring quality.
The clauses will modernise the system by giving health authorities powers to suspend or remove practitioners from their lists; by extending those arrangements into the new service delivery arrangements, such as personal medical services, under part I of the National Health Service Act 1977; by giving health authorities powers to remove practitioners from their lists on grounds of their unsuitability, as well as in the interests of the efficiency of the service or because of fraud; and by giving practitioners rights of appeal to the Family Health Services Appeal Authority against decisions by their health authority to remove them from its list.
At the same time, we are reconstituting the appeals authority, so that it will be fully independent of the Secretary of State, and including provisions to ensure that the new system operates quickly to address any risks to patients or to the service and effectively to deliver outcomes that are proportionate and fair to practitioners.
The legislation is, however, only part of the new arrangements that we are putting in place. We are developing primary care trusts and clinical governance arrangements. In the next year, beginning in April 2001, we are introducing appraisal for all general practitioners. We are also introducing the new National Clinical Assessment Authority.
We think that only a very small number of practitioners are likely to be removed or suspended under the new arrangements. Suspension or removal may not be the best response. In the first instance, support through clinical governance or reference to the NCAA may be the appropriate response. We need to know, however, that we have effective powers in place if they are necessary.
This group of amendments includes Government new clauses 11 and 12. Although I accept that there seems to be a long list of amendments in this group, they are designed to give effect to the proposals which I explained in Committee and which I have just outlined. They are 344 intended to refine the provisions, to deliver a consistent approach for all the primary care practitioner professions and to achieve the best balance between safeguarding patients and the rights of the practitioner.
There are so many amendments because the legislation is complex and necessarily deals with each practitioner group separately. There are four separate groups—doctors, dentists, pharmacists and optometrists—and one hybrid group composed of dispensing doctors. Four of those groups—doctors, dentists pharmacists and dispensing doctors—may now operate under part I or part II of the 1977 Act. Consequently, it may be necessary to replicate a simple to technical amendment several times. New clause 11, for example, is accompanied by 17 consequential amendments.
I propose to concentrate in my opening remarks on the more substantive amendments, beginning with new clause 11 and its consequential amendments. Current legislation does not allow a health authority to have access to the criminal record of a doctor working in general practice. In requiring a doctor to declare his criminal convictions when he applies to join a health authority list, it is our intention that the health authority should take action to verify the information that it is given. To do that, we have to rely on the Home Office's new Criminal Records Bureau, which was established in part V of the Police Act 1997, to provide criminal records checks for employers.
§ 5 pm
§ Mr. Denham
I would like to make a little progress, if I may.
Our policy, supported by those responsible for setting up the Criminal Records Bureau, has been that the health authority should have the fullest possible report from the CRB to ensure maximum protection for the public. The Bill currently provides that health authorities will be able to obtain from the planned Criminal Records Bureau certificates issued under sections 112 and 113 of the 1997 Act to confirm the completeness of any declarations made by a doctor about criminal convictions.
New clause 11 would also enable health authorities to obtain section 115 certificates. These are enhanced criminal records certificates which provide valuable additional information to health authorities, albeit in a small number of case s. They might well help to keep an unsuitable practitioner off the health authority lists and out of primary care. As such, we do not think we should lose the opportunity to improve the level of protection available to patients.
§ Mr. Denham
I shall give way first to the Opposition Front-Bench spokesman on the ground of seniority and then to the hon. Member for Lichfield (Mr. Fabricant).
§ Mr. Hammond
I do not wish to get in front of my hon. Friend in the queue. By what process did the Government originally conclude that the standard certificates were adequate and subsequently conclude that 345 an enhanced certificate would be appropriate? Could not the Government have reached that conclusion in Committee?
§ Mr. Denham
That is a somewhat metaphysical question. The consultation document issued last summer indicated the need for the broader range of scrutiny through the Criminal Records Bureau. We are ensuring that legislation reflects that policy intent.
§ Mr. Fabricant
I am grateful to the Minister for giving way to me, finally. Is he aware that the Criminal Records Bureau will be using the police national computer to access the information as to whether someone working in the health service has a criminal record? Is he aware that the Home Office admits that up to 65 per cent. of the records of the Phoenix database—the system used on the police national computer—are either out of date or wholly inaccurate? How will the Minister ensure that a doctor, nurse or someone else in a position of responsibility will not be accused of having a criminal record when they do not have one? More worryingly, w hat provision has he made for those who do have a criminal record that does not show up in the CRB investigation? Also, what fee will be charged for the CRB inquiry? Will it be at enhanced or standard level?
§ Mr. Denham
Issues of accuracy are important, but they are for Home Office Ministers. We will work closely with the Home Office and we will need to follow Home Office guidance on the use of the Criminal Records Bureau. A code of practice has been set out by the CRB on the handling of data and information. I assure the House that we will work closely with the Home Office on the issue. Clearly, we wish to avoid circumstances where people are unfairly accused of crimes or are reported for complaints in relation to which they are not guilty.
I understand that a Home Office decision on the fee is imminent, but there has been no announcement as such. I do not know what the fee will be. Clearly, we will need to discuss this with the professions. The system of remunerating professions varies; there are variations in the systems for paying expenses and so on. The liability for various expenses varies from profession to profession; that is something we will need to discuss with them.
§ Mr. Fabricant
The Minister will be aware that there are provisions for the transmission of what the Home Office calls soft data. That is not covered in new clauses 11 or 12. What is the reason for that omission?
§ Mr. Denham
I should have to refer back to the drafting to clarify that point, but I can tell the hon. Gentleman that the new clauses do include what is called section 115 data—the soft intelligence to which he referred. I do not have the text of the new clauses to hand and so cannot point to the exact line as the hon. Gentleman might wish me to, but I assure him that the point is covered by the proposed amendments. Perhaps he was trying that question on, but 1 assure him that I understand what the new clauses are intended to achieve.
I shall deal now with new clause 12 and amendments Nos. 69, 70, 108, 109, 112 and 11 Clause 27 already introduces proposed new section 4913 to the 1977 Act to allow a health authority in fraud and efficiency cases contingently to remove a person from its lists. The effect 346 is that a person's continued presence on the list may be subject to specified conditions. If those conditions are broken, the person may then be removed from the list.
That provides a half-way house: a person is given the opportunity to provide family health services but under sensible conditions imposed by the health authority to protect the interests of patients and the NHS. Clearly, if it is possible for there to be contingent removal from a list, it is reasonable to be able to impose conditions when a person applies to join one of the lists. New clause 12 therefore provides for a health authority to have conditional inclusion in a list to match the possibility of conditional removal.
§ Dr. Peter Brand (Isle of Wight)
It is clearly important to have the maximum patient protection regulations, but I am worried by what the Minister said about such regulations being in the interests of the NHS. I am also concerned that new clause 12 uses the word "efficiency" but does not define it. If the word "efficiency" is not used to mean the interests of patient care, will the Minister help the House by defining it?
§ Mr. Denham
The term "efficiency" is not defined in primary legislation, to the best of my knowledge, but it has been used in such legislation for a very long time. It is one of the grounds on which the NHS tribunal is able to remove a practitioner from the NHS. We have sought to include the test of suitability in the new clause, but the amendments as a whole provide a consistent set of criteria needed to meet the tests set by the Bill. The use of the word "efficiency" in new clause 12 merely mirrors a usage that has appeared in legislation since the establishment of the NHS tribunal.
Amendments Nos. 69, 70, 108, 109, 112 and 113 make similar changes to those outlined in respect of the services lists. The remaining amendments in the group cover technical matters. If hon. Members want to go through them in more detail, I should be happy to do so.
§ Mr. John Bercow (Buckingham)
The Minister will not be surprised if I return to my normal, and I think justifiable, hobby horse—the means by which regulations will be approved. Will the Minister confirm that, as usual, the Government intend that the regulations will be subject to the negative resolution procedure—that is, that no debate on the regulations and their detail will be permitted?
§ Mr. Denham
Normally, instruments subject to the negative resolution procedure may be prayed against, in which case there will be debate in Committee. Some of the most important and sensitive regulations in what used to be clause 59 and is now clause 62, which deals with patient information, will be subject to the affirmative resolution procedure. That has been the case since the Bill was first drafted, and it is a mark of the importance that the House and people outside it attach to those provisions.
§ Mr. Hammond
Before I start my speech, I draw the House's attention to my registered interests. They are not directly relevant to the subjects under discussion, but I have declared them at every stage of the proceedings on the Bill.
Amendment No. 31 deals with clause 34, which introduces local pharmaceutical services, or LPS, pilot schemes and provides for a relevant authority—the 347 Secretary of State in England or the National Assembly in Wales—to end a pilot scheme in certain circumstances. The schemes proposed will probably involve providers of part II services who are in place prior to the pilot scheme and, possibly, new entrants, to expand the provision of services in areas where the relevant authority feels that it is not adequate.
To take part in the schemes, new entrants will have to expend capital, principally in establishing a place of business. In Committee and, indeed, before that, Ministers told us that there will effectively be a two-way ticket for pilot schemes in personal medical services and personal dental services. If a scheme ends, the practitioner will be able to return to providing general medical services or general dental services under the former arrangements. Ministers also indicated in Committee that when LPS pilot schemes end, they intend that those involved in providing services through those schemes should have the opportunity to continue to provide pharmaceutical services under part II of the 1977 Act. The amendment would insert into the Bill the assurance that Ministers have given.
That assurance is important because if the pilots are essentially to be terminable at the whim of a politician, it is difficult to see how private sector businesses will be encouraged to invest their capital in setting up premises and delivering the services that Ministers want to be provided under those pilots. It is important that people who are contemplating investing in projects to make the pilots work know that if the scheme is terminated at the Secretary of State's whim, they will still be able to continue to provide pharmaceutical services from those premises and that their investment will be protected. That guarantee is essential to ensure full uptake of opportunities under the pilot schemes, which we support. I urge the Minister to consider including that in the Bill to send a reassuring signal, as I am sure he wants to do, to private businesses whose investment he will be seeking to encourage.
Amendment No. 32 deals with clause 28, which concerns arrangements for personal medical services and personal dental services lists. It is right and proper to include in lists those who are providing those services, which are in addition to the range of primary care services provided. There are indications that the Government are pressuring practitioners to move to PMS and PDS as the preferred modes of delivery. It would be strange if it appeared that providers of those services were being penalised in comparison with providers of general medical, dental, ophthalmic and pharmaceutical services.
Clause 27, which deals with general services, contains a specific requirement for the Secretary of State to consult with organisations that represent people providing those services. There is no similar provision requiring the Secretary of State to consult with people representing providers of personal medical services and personal dental services.
§ In Committee, the Government sought to justify the exclusion of any consultation with the representatives of PMS and PDS on the ground that such services were governed by a different, locally negotiated contract. However, the representative bodies concerned—largely the same as those representing providers of general medical services and general dental services—do not entirely agree with the Minister. The introduction of the national core contract in PMS somewhat undermines the Minister's argument that these contracts are wholly different, locally negotiated and not amenable to national level discussions with representative bodies.
Under clause 27, the Government are proposing to consult with the representative bodies. We think that it is proper and appropriate to include in the Bill a requirement to consult with bodies representing PMS and PDS providers before making any regulations under clause 28. It is not obvious from any debate that has been held so far what objection the Government have to such a provision, especially since, in practical terms, the Government would almost certainly discuss any such regulations with the very same body with which they were discussing clause 27 regulations.
There are 74 Government amendments and two Government new clauses in this group. I am tempted to say that that must be a record, but my time in the House has taught me that that is a dangerous statement to make—and there are Finance Bills to be taken into account. It is none the less a very large group of amendments.
The Minister has told us that these are technical amendments. I have teen through them in some detail and I concede that that is right. For the most part, they are technical and, to some extent, repetitious. It is not the substance of the amendments that concerns me but the Government's need to table this vast number of amendments very late on Monday night. I thought that I was cutting it fine tabling the Opposition amendments at 10.5 pm, during the Division. However, I have since discovered that all he Government amendments were tabled after mine, cutting it very fine indeed.
What that tells us is that when we have rushed legislation, a very short gap between Second Reading and Committee and another very short gap—two or three sitting days—betweel Committee and Report, there is a danger that the drafting of the legislation will be found wanting. Clearly, the Government have found the drafting of the legislation wanting, and so have tabled a vast raft of amendments and new clauses in an attempt to address some of those defects. It would be stretching credulity to imagine that in the frenetic rush between Thursday. when the Committee concluded its proceedings, and 10.15 pm on Monday, when the Government finally tabled their amendments, they had exhaustively examined every aspect of the Bill and discovered every defect, given that the 100-odd defects were not discovered prior to the Bill's consideration in Committee. It is reasonable to assume that more defects will emerge in due course.
It would be useful to reflect on one of the reasons why we traditionally leave gaps between the different stages of our proceedings in legislation. It is not so that we can diligently spend our evenings reading the small print of Bills, but so that bodies outside may have an opportunity 349 to reflect on what the Government propose and suggest to them ways in which the Bill might be improved or tightened up.
§ Mr. Bercow
Does my hon. Friend agree that, in relation to this group of amendments, the Government must be convicted on one of two charges? Either the Minister of State knew perfectly well at, or shortly after, the conclusion of Committee on Thursday night what the content of the new amendments was to be—in which —case it was, at the least, a gross discourtesy not to table them earlier and to give Members and outside organisations an opportunity to study them—or, alternatively, the right hon. Gentleman did not know until some time after 10 pm on Monday what the content was to be—which, if true, is even more disturbing.
§ Mr. Hammond
My hon. Friend is right. The latter prospect alarms me most; it suggests that rafts of further amendments will be tabled in the other place which we shall have an extremely limited opportunity to scrutinise in this place.
To take up my hon. Friend's fist proposition, I was quite surprised to hear the Minister's comments on new clause 11. If I heard the right hon. Gentleman correctly, he suggested that the need for an enhanced criminal record certificate was identified during the consultation procedure last summer. If that is so, I am sure that my hon. Friend will agree that it begs the question—why did the Government not table the amendment during Committee? Indeed, why did they not draft the original Bill so that it reflected the requirement for an enhanced criminal record certificate? I intervened to ask the Minister whether he could throw any light on the matter, but I am none the wiser.
§ Mr. Bercow
The situation becomes curiouser and curiouser. As you know, Madam Deputy Speaker, I am a kindly chap and always charitable towards Ministers; far be it from me ever to cast aspersions on the competence—still less on the mindset—of Ministers. However, in the circumstances that my hon. Friend has just pithily described, is he not concerned 'hat the Minister is becoming almost as unfocused as tile right hon. Member for Hartlepool (Mr. Mandelson)?
§ Mr. Hammond
I suspect, Madam Deputy Speaker, that you would not want me to pursue the line of argument towards which my hon. Friend tempts me. I am sure that the Minister has heard my hon. Friend's comments and that he will reflect on his own state of mind in his private moments.
If the Government are telling us that an enhanced criminal record certificate is a vital part of the procedure—the mechanism outlined in the measure—new clause 11 is, of course, essential to life Bill's architecture and we have no argument with the substance of the provision. However, the Minister owes the House an explanation as to why, when the requirement appears to be central to the working of the Bill, the Government failed to identify it at an earlier stage; the provision is not about a missing comma—it is a major requirement that amends another piece of legislation. Had the Government failed to recognise the problem one amend this Bill, an absurd situation would have arisen practitioners would 350 have been required to obtain a certificate under the Bill that they were not empowered to do under another piece of legislation—the Police Act 1997.
Either the Minister must explain why the Government have only so recently identified that error in their thinking, or—to refer to the right hon. Gentleman's earlier remarks—he must explain why the Government neither included the requirement in the original Bill nor tabled it as an amendment in the Standing Committee. Bluntly, the Government ought to tell the House whether they became aware of that shortcoming only after the conclusion of the proceedings of the Standing Committee. I look forward to hearing from the Minister in due course.
Government new clause 12 provides for conditional inclusion in lists, with an adequate right of appeal against the conditions. Once again, we have no argument with the principle of the proposal. When I first read the new clause, I wondered why it applied only to providers of general medical, dental and ophthalmic services and so on. I initially concluded that the explanation was that the Bill will already write into the National Health Service Act 1977 proposed new sections 43D(3)(d) and 28DA(3)(d), which will, in effect, provide for conditional inclusion in lists. However, 1 continued to read the amendment paper and discovered that the Government will amend those provisions under Government amendments Nos. 69, 108, 112 and 113. I can only describe that as a mess.
It appears that the Government initially forgot to include part II services in the arrangements for conditional inclusion and now want to correct that under new clause 12, but they then realised that the arrangements that they had included on the conditional inclusion on lists of PMS and PDS providers were faulty and needed to be corrected, which they will do under Government amendments Nos. 69, 108, 109, 112 and 113. Perhaps the Minister will explain exactly what happened.
Perhaps the Minister will also explain why Government amendments Nos. 69, 108 and 109, under which the arrangements on conditional inclusion in lists for PMS and PDS providers will be amended, and Government amendments Nos. 112 and 113, under which the supplementary list will be similarly amended, do not use words similar to those in new clause 12. Why does the right hon. Gentleman still propose for PMS and PDS providers and for the supplementary lists a different regime from those that proposed in new clause 12?
In particular, the two provisions diverge on what I shall call a motive test. Under new clause 12, proposed new section 43ZA(2) will provide such a test. It states:The imposition of conditions must be with a view to—preventing any prejudice to the efficiency of the services…or preventing any acts or omissions within section 43F…No such motive test has been included in proposed new sections 43D and 28DA of the 1977 Act. I should be grateful to the Minister if he would explain that apparent inconsistency.
Government amendments Nos. 40 to 109, which could give the House serious indigestion, are largely technical, but I want to make one or two other points on them. Of course, it is disappointing that the Government have had to table them on Report. On Government amendment No. 59, will the Minister tell us why it has been necessary to replace the term "director of" with the phrasemember of the body of persons controlling"?351 A perfectly good definition of the word "director" exists in company law, which deals precisely with people who exercise the functions of a director and are part of the body controlling a company but may not be called a director. Why have the Government found that amendment necessary? Does that presage a wider amendment of company law to change the definition of the word "director"?
I should like the Minister to tell us about amendment No. 75. First, it will introduce a wholly new concept in legislative drafting. Perhaps I have merely missed the concept previously. It refers to "this group of sections". I have seen references to a section, a subsection, a part or, indeed, a whole Bill, but I have not seen a reference to a group of sections. Incidentally, that reference reappears in Government amendment No. 105. Will the Minister tell us where the group of sections is defined? Which sections belong to the group and which do not?
At a substantive level, amendment No. 75 will create a situation in which, for example, the whole business of a chain of retail pharmacists could be placed in jeopardy by the actions or omissions of a director which may have taken place not during his service as a director but formerly. Perhaps he has failed to divulge information to his current employers. I am charitable enough to imagine that it is the Government's intention that the power in the amendment will in fact be used to impose a condition requiring that person to stand down or to cease to have control over, or a hand in, the running of the business. That would be entirely understandable, reasonable and fair. If the Minister could make that explicit when he winds up this short debate, we would feel much more comfortable.
Unless I missed it amid the routine of dealing with the other amendments, the Minister failed to acknowledge the small part that the Opposition played in amendments Nos. 84 and 85. We achieved a small victory in Committee by extending the period allowed to practitioners for appeal from 21 days to 28 days, bringing it into line with the appeal deadlines for General Medical Council hearings. We are grateful to the Minister for tabling the amendment, but not for his failing to acknowledge its provenance.
I have one other concern. Amendments Nos. 96 and 99 make changes to the use of the words "practitioner" and "person". They change the word "practitioner" to "person" in a number of places in new section 49K. Superficially, that is an attractive change. A practitioner is a practitioner if he practises, and if he is prevented from practising it is arguable that he ceases to be a practitioner, while remaining a person. However, the word "practitioner" remains in new section 49K(1) at lines 5 and 12 on page 28 of the Bill. Amendments Nos. 101 and 102 also change the references from "practitioner" to "person" in relation to the appeal procedure in new section 49K(4)—at line 32 on page 28, for those who follow such matters avidly. Amendment No. 102, which extends the same subsection, also uses the word "person". The wording appears to me and to my hon. Friends to be inconsistent, but that is possibly the result of shoddy drafting. We have ended up with a single subsection that refers both to "practitioner" and to "person".
352 This large group of amendments amply demonstrates the dangers of rushed legislation. It represents a warning to Ministers of the pitfalls of rushed legislation in general and of this Bill in particular. I am sure that the Minister cannot be happy that his officials, having trawled through the Bill, have found in the space of a week about 100 matters that need correction. He will be as alarmed as I am at the prospect that there will be hundreds more to come before the Bill sees the light of day in another place.
I concede that no issues of great significance are at stake in the substance of the amendments, but I should like to hear the Minister's answers to our specific questions about the Government amendments and new clauses, and to hear something of the story that lies behind the extensive and radical group of amendments that has become necessary.
§ Mr. Fabricant
You will be relieved to know, Madam Deputy Speaker, that 1 shall not consider the 100 or so amendments in the group, but speak to new clauses 11 and 12.
Although I welcome the measure in principle, I wonder whether it will work in practice, at least over the next few years. It just so happens that the Select Committee on Home Affairs, on which I have the hour to sit, is investigating the procedures by which the Criminal Records Bureau will be established. We met the Minister of State, Home Office, the hon. Member for Norwich, South (Mr. Clarke), two days ago, and the Director General of the Data Protection Agency yesterday, and learned some alarming facts, which imply that joined-up government is non-existent in this respect.
No accurate prediction has been made of the demand that might be placed on the CRB. That creates two problems. First, we do not know precisely how large the computer capacity will have to be, how many terminals will be needed and how many people will have to be available to answer the inquiries. Secondly, it is difficult to assign a cost to the service. That is of particular interest to people who, like me, live in cities where health services are declining. The hospital in Lichfield is under threat, as are the services that it provides. According to the local health authority, that is because there is not enough money.
When I asked the Minister how much it would cost the health service to make inquiries about those two matters, he could not answer. I do not blame him for that—he was right to say that he did not know because the Home Office had not yet decided what the scale of fees should be. That corresponded with the evidence that the Home Office Minister gave to the Home Affairs Committee two days ago—so there is a little bit of joined—up government. He was asked when he would be able to estimate when the fee scales would be available, but he could not say. That creates a budgeting difficulty for the national health service at a time when services in Lichfield—I know that you, Madam Deputy Speaker, are familiar with Lichfield—and other parts of the United Kingdom are under threat.
An additional difficulty concerns the accuracy of information held or the Phoenix database, which is maintained by the police national computer and to which the CRB will have access. About 65 per cent. of its records are inaccurate. Either people are detailed as having committed a crime when they have not or—
353 equally worrying—people are not listed as having committed a crime when they have been convicted. The Home Office is working closely with the Association of Chief Police Officers, local magistrates courts and the judicial system in general to try to ensure that the records are kept up to date or made more accurate. However, when I asked the Home Office Minister when the Phoenix database would be accurate enough to be of use to the NHS and organisations such as the scouts and the Guides that will have to make use of it, he could not say.
We have a negative double whanimy—if there is such a thing. The Bill has been brought hastily before the House and we have only three or 'bur hours to discuss huge tranches of amendments. New clause 11 has an interface with section 115 of the Police Act 1997. They relate to the ability to access the CRB, but that will not have accurate information for some lime. We do not know how much time; it seems that the Home Office Minister and the police are unable to say.
I asked the Minister earlier about provision for the national health service and others concerned with the new clause to access soft data. After a short pause, he said that the matter was covered by section 115 of the Police Act 1997. I am not sure that it is. I fully accept that the right hon. Gentleman is not a Home Office Minister. However, I ask him to consider the matter in more detail, with the necessary reference. I remind him mat soft data, as they are known, are tremendously important, as they concern police intelligence.
Hamilton, who committed the massacre at Dunblane, had no criminal record. The enhanced criminal record certificate, even if it were up to date, would say that he would be all right to operate as me of the types of practitioner listed in detail in suggested new subsection (6C)(a) to (d) and so forth.
Intelligence information given by the local police force to the Scouts stopped the scouts from recruiting Hamilton as a Scout leader. That intelligence is known as soft data. I am not sure that there are mechanisms in new clauses 11 and 12 that would give the national health service access to such data.
On a day when newspapers are, rightly or wrongly, full of condemnation of the sentences that have been handed down by judges to known and convicted paedophiles, it is prescient to remind ourselves that now, much of the information on paedophiles is, before conviction, available only as soft data. The new clause is a worthy provision, but surely the Government would wish it to identify paedophiles and others who might not yet have a criminal conviction. That can be done only through the acquisition of soft data. As I have said, in the absence of a conviction, the enhanced criminal record certificate would produce a negative. The Minister ha: a duty to the House to ensure that we are satisfied that such soft data are made available.
I shall ask some specific questions. They may be slightly unfair because perhaps they apply more to the Home Office than to the Department of Health, but this is a Department of Health Bill. When does the Minister expect that the information held by the Criminal Records Bureau will be sufficiently accurate to be of real practical use to the NHS? When will the right hon. Gentleman next meet the Minister of State, Home Office to press for the information to be made available to him—assuming that it is accurate? When will he be able to say to the House 354 with assurance, "This is how much the provision will cost the NHS"? What estimate has he made of the number of inquiries that the NHS will make to the Criminal Records Bureau under new clauses 11 and 12 in the next three or four years? When will he ascertain from the Home Office precisely what the charges will be for each such inquiry?
§ Mr. Denham
I shall reply as briefly as possible. The hon. Member for Runnymede and Weybridge (Mr. Hammond) deserves due credit for the extension from 21 days to 28. I apologise to him for omitting to say that in my earlier remarks. I am pleased that there is no argument in the House with the principle behind new clauses 11 and 12, and I am sure that means that we will be able to agree on those matters.
To touch briefly on the main questions raised by the hon. Member for Runnymede and Weybridge, new clause 12 introduces conditional inclusion for part II services. Consequential amendments provide for conditional inclusion in supplementary lists, personal medical services lists and service lists. The hon. Gentleman is simply wrong in his interpretation that the Bill originally provided for conditional inclusion in PMS lists. The new clause and the amendments are therefore necessary.
§ Mr. Hammond
Will the Minister therefore tell me why, under clause 26, proposed section 43D(3)(d) states that regulations may, in particular, include provision onrequirements with which a person included in a supplementary list must comply"?To me, that is a conditional inclusion.
§ Mr. Denham
I may be able to find the time to give an extended reply in due course. However, my initial response is that that covers matters such as the fact that someone should be suitably qualified to be a GP, rather than conditional inclusion in a list. It is desirable that the Bill should be clear, and that there be a specific power covering conditional inclusion in a list, rather than have such inclusion implied, as the hon. Gentleman suggests, in other parts of the Bill.
Amendment No. 59 would change the word "director" to the words "member of the body of persons controlling". The hon. Member for Runnymede and Weybridge said that there was a perfectly satisfactory definition of a director in company law. However, there is a new arrangement: limited liability partnerships do not have directors as such, so to cover them, the Bill needs to include a separate identifier of persons in control. Those partnerships may well be suitable for some providers of health services—in pharmacy, for example.
The hon. Gentleman asked about "this group of sections" which is defined in proposed section 49F(5) in clause 27, and runs from proposed sections 49F to 490. There is an apparent inconsistency between the terms "practitioner" and "person", but in context they are right. The word "practitioner" is used when it refers to a specific practitioner, such as a member of a medical list. The word "person" is used in the legal sense, and was used in the drafting to deal with a list that could include a corporate body, such as a dental list or a pharmaceutical list. There is a reason behind the apparent inconsistency: in fact, it is not an inconsistency.
355 The hon. Member for Lichfield (Mr. Fabricant) asked about enhanced criminal records and soft information. Sections 115(6) and 115(7) of the Police Act 1997 are the relevant provisions which cover the information that he and I wish to see. Most of the other questions that he asked were touched on earlier or—I must, with respect, point out—are matters for my colleagues in the Home Office.
The hon. Member for Runnymede and Weybridge tabled two amendments, with which I must deal. The first relates to local pharmaceutical pilot schemes. The hon. Gentleman is right about the issue, but wrong about the remedy. Amendment No. 31 would mean that if the relevant authority gave directions to terminate a pilot scheme because it was unsatisfactory, it would also have to direct the health authority concerned to make arrangements with all the participants under the national arrangements for pharmaceutical services instead. I accept that if we are to attract volunteers to local pharmaceutical services pilot schemes, especially if they involve the investment of a significant amount of new capital by the provider, we will have to have arrangements for what happens when pilot schemes come to an end.
Clause 39 provides powers to make regulations on the inclusion and reinclusion of premises in pharmaceutical lists. Our intention is that before people start providing LPS, they will be told whether and to what extent they will have a preferential right of return—or, in the case of new providers, transfer—to the national arrangements.
We will consult before we decide the precise criteria for preferential rights, but without prejudging the results of that consultation, I can say that there may well be rights of transfer even when the Secretary of State has to terminate a scheme by direction because it is unsatisfactory. However, that does not mean that we should go as far as the absolute right that would be conferred by the amendment. For example, I do not see why, if the Secretary of State were forced to close a scheme because the service provided had fallen below acceptable standards, the provider should have the right to continue providing the service under part II arrangements.
It would be much better to have the flexibility to tailor the arrangements made in particular cases or types of case to the needs of the health authority and the LPS provider. None of us would want an absolute right to be used as a way of getting round the established rules of entry. That is the main difficulty with the amendment.
§ Mr. Hammond
We are not disagreeing on an issue of principle, merely on the mechanics. The Minister said that he would rather rely on the discretionary power to deal with such a situation as it arose, but is not the problem that in order to attract capital investment into under-provided areas, there will have to be a right up-front? Unfortunately, that may mean that rights are given in advance to a provider who subsequently turns out to be the reason why the pilot fails. If the Minister cannot give the necessary guarantees up-front, surely he will not attract the investment that he seeks.
§ Mr. Denham
I agree that people will not come forward with money unless they believe the investment to be reasonable. However, the way to deal with the problem is not by writing an absolute right into the Bill. It would be best dealt with case by case, scheme by scheme—otherwise, we will be issuing an open invitation to exploit the situation, not because people want to provide pharmaceutical services in an innovative way, but because that seems like a way round the normal restrictions on rights of entry.
Finally, amendment No. 32 would require the Secretary of State to consult appropriate organisations of PMS or PDS practitioners be fore making regulations about the lists. We intend to mirror in those lists the conditions that apply to GMS or (IDS lists. However, as I said in Committee, we do not believe that we should put into the Bill formal negotiating rights in respect of personal medical services, for example.
PMS pilots are voluntary contractual arrangements entered into at local level. The existence of a core contract does not alter the fact that the arrangement is voluntary. Although we discuss arrangements for PMS with representatives of the British Medical Association and a great many other organisations, both informally and through the PMS implementation group, we do not believe that writing formal legal negotiating rights into the Bill is the right way forward.
Of course, GPs entering PMS have every right to be represented locally by the local medical committee. No one is saying that they should not be represented in negotiations at local level, but there is a difference between that and extending formal legal negotiating rights over PMS through the Bill, as the hon. Gentleman seeks to do.
§ Mr. Hammond
The right hon. Gentleman is saying that because PMS is a voluntary scheme, people who enter it should not haw statutory negotiating rights. In Committee, the Minister could not rule out the possibility that PMS would cease to be a voluntary scheme, with single-handed practitioners, in particular, being forced into it at some stage. Can he give an undertaking now that if PMS ceases to be a purely voluntary scheme, he will take measures to gig e statutory rights of consultation to those who are to be included other than voluntarily?
§ Mr. Denham
Clear1y, we would have to examine the position if the contract were national rather than local. As the hon. Gentleman knows, our approach with regard to single-handed practitioners is through agreed changes to the national contract. We shall discuss that with the general practitioners committee of the BMA in the months to come. The concerns that have been expressed about single-handed practices can be addressed through appropriate changes to the national contract. That is our preferred way forward.
I hope that I have dealt, albeit briefly, with the substantive issues raised in the debate.
§ Question put and agreed to.
§ Clause read a Sec9nd time, and added to the Bill.