Medical (Professional Performance) Bill

HL Deb 21 July 1995 vol 566 cc477-500

11.7 a.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, That the House do now resolve itself into Committee.—(Baroness Cumberlege.)

On Question, Motion agreed to.

House in Committee accordingly.

[The CHAIRMAN OF COMMITTEES in the Chair.]

Clause 1 [Professional Performance]:

Baroness Jay of Paddington moved Amendment No. 1:

Page 1, line 10, after ("deficient") insert ("(measured against published performance standards and key performance criteria)").

The noble Baroness said: The purpose of the amendment is to make the legislation more precise about how professional performance is to be judged. Throughout the deliberations on the Bill in another place and at Second Reading in your Lordships' House, questions were raised about how to define a seriously deficient medical performance—a definition which is clearly central to the functioning of the new procedures.

Ministers in both Houses have acknowledged that the question of definition is difficult and seem to have accepted that establishing practice codes and guidelines will be left entirely to the General Medical Council. In another place, the Minister, Mr. Sackville, reported at the Committee stage that the General Medical Council will soon publish a new version of its so-called Blue Book under the title: Good Medical Practice. It will be the touchstone against which professional performance will be assessed and judged, although he noted that there could be departures which were serious and which were not covered by the GMC guidance.

In this House at Second Reading, the Minister, the noble Baroness, Lady Cumberlege, said that: Serious deficiency in professional performance is a departure from good medical practice, whether it is covered by the GMC guidance or not".—[Official Report, 29/6/95; col. 894.]

The noble Baroness went on to say that she appreciated that what she was giving was "a rather woolly definition"—her words. But she too placed her faith in the publication of the new GMC guidelines, which she hoped would make the issue of standards clearer.

This does not seem to be a satisfactory situation. My amendment, Amendment No. 1, does not attempt to establish descriptions of good, bad or seriously deficient medical practice. But it seeks to place on the face of the Bill that the performance criteria should be explicit, should explicitly refer to the terms of the Bill and not be part of general guidance to the medical profession left to the GMC. It may be that the kinds of codes which I seek will be included in the new Blue Book, in which case there seems to be no problem about placing them on the face of the Bill. After all, the National Health Service and those who work in it have accepted the need for performance indicators across the whole range of health care. Areas of practice which might in the past have been seen to be solely matters of individual professional judgment are now subject to objective assessment. The introduction of medical audit has made it possible to review performance against agreed consistent standards.

It is true that these changes have sometimes been resisted by traditionalist members of the medical profession, who complained of threats to their clinical freedom. But clinical freedom has sometimes meant doing things as they have always been done and not in accordance with advances in medical science or in the best interests of the patients.

It is exactly that kind of rather blinkered approach that the Bill seeks to prevent. The Bill should also seek to make clear that performance will be judged across key objective criteria and will not be differently judged variously, for example, according to personal prejudice or perhaps on the basis of different local practice.

If the primary legislation does not state categorically that consistent national standards will be published and adhered to, then there will be endless opportunities for argument and debate about what constitutes a serious deficiency in performance. One can see this being any medical practitioner's legal adviser's field-day. It is almost certain that in these circumstances procedures will be delayed and there will be a lack of efficiency in achieving precisely what the Bill sets out to make clearer. This situation cannot be helpful to the overall purpose of the Bill, with which noble Lords on all sides of the Chamber agree and which we all welcome; namely, to improve both medical standards and the confidence of patients. I beg to move.

11.15 a.m.

Lord Walton of Detchant

While I sympathise with the intention underlying this amendment, so ably proposed by the noble Baroness, Lady Jay of Paddington, I believe that to include it in the Bill would in many respects be an error. My reasons for saying so relate to the fact that the purpose behind the Bill is to give additional powers to the General Medical Council—additional to those that it already possesses—to enable it to discipline doctors guilty of serious professional conduct and to take action to rehabilitate or otherwise deal with doctors whose health is sufficiently seriously impaired as to put patients at risk.

The whole objective of the Bill, as the noble Baroness said, is to empower the General Medical Council to take appropriate action in relation to doctors whose professional performance falls below an acceptable standard. Having made that point, however, the conduct and health procedures have relied upon definitions which some may regard as being woolly, but which have nevertheless stood the test of time. The problem about attempting to codify professional performance in the precise way that the noble Baroness suggested is one that is far beyond the capability of any body of medical practitioners with the legal and lay advice upon which it is likely to rely at the present time.

The problem is that so many specialties exist in medicine that to attempt to lay down precise published performance standards for each of them and key performance criteria would be an incredibly difficult task. Hence, this amendment—though one which has a worthy intention—is not one that could be carried out in practice. Over many years the profession has had experience in assessing the performance of undergraduate medical students at final examinations in medicine with the advice of experienced external examiners; and the officers of the Royal Medical Colleges have a great deal of experience in assessing performance in postgraduate examinations.

There has also been a major development in the introduction of methods of the audit of professional performance carried out voluntarily by members of the profession. This expertise will be drawn upon by the General Medical Council in its efforts to undertake these performance procedures and to make sure that doctors who are not performing up to an appropriate standard are dealt with appropriately, as set out in the Bill. But to try to lay down these procedures in precise terms in statute would be inappropriate. Such performance criteria would have to be regularly updated and modified according to developments in medicine.

The Blue Book to which the noble Baroness referred is not a code of practice. It is a guide to the medical profession about standards of practice and professional behaviour. It is about to be published as updated. I believe that it will form the cornerstone of the form of professional procedures and assessment procedures upon which this Bill will depend. Therefore, I have to say that I am not able, on the advice that I have received, to support this amendment, despite accepting wholly the intentions underlying its proposal.

The Government agree with the noble Baroness's intent. It is important that a doctor knows the limits within which he should work and the standards that he should meet. It is equally important that the public should have information available so that they know what to expect. The General Medical Council is empowered to issue guidance on standards of conduct and ethics. This Bill will empower it to do the same for standards of professional performance. Of course the guidance will be updated regularly.

However, a doctor cannot be judged on a set of published criteria alone, as the noble Lord, Lord Walton of Detchant, outlined. Such criteria will be constantly changing, and a published document can soon become outdated. To require the Committee on Professional Performance to make judgments on published standards alone would constrain it, and may act against the public interest.

Therefore, in order to give the Committee on Professional Performance the ability to carry out its task appropriately and effectively, it is important that published criteria form just one aspect of its reasoning. There is a body of unpublished, but widely acknowledged, standards which also needs to be considered. This must also be taken into account. In the light of these arguments, I hope that the noble Baroness will feel able to withdraw the amendment.

Baroness Jay of Paddington

I am grateful to the Minister for that response, and indeed to the noble Lord, Lord Walton of Detchant, for his very authoritative views on this matter. There is perhaps some confusion about the exact terminology that is to be used. I recall that at Second Reading the Minister said that she hoped there would be greater clarity about this whole area before the Bill left this place.

The distinction between guidance and a code, which the noble Lord, Lord Walton, clearly made, in terms of the General Medical Council's publications, is precisely what concerns me a little. I am still unclear whether the guidance which will be published by the General Medical Council will, as it were, be specific to the standards of professional performance which are to be judged under these new proceedings or whether it consists simply of more general pieces of advice to the medical profession about the general standards that it should maintain. If it is the latter, it seems to me that it will not be sufficiently tight or specific to enable the very well informed and, as the noble Lord, Lord Walton, said, extremely experienced members of the committees involved to make the assessments that will be necessary.

My primary concern is not to establish some kind of false external criteria which have simply to be adhered to, but rather to enable the committee to work effectively and not constantly be tripped up, as I said when I moved the amendment, by an articulate doctor or his even more articulate legal representatives running rings around the concept of serious professional failures.

That was the spirit behind the amendment. Having heard what the Minister said and the authoritative comments of the noble Lord, Lord Walton of Detchant, I beg leave to withdraw the amendment at this stage. However, I hope that, before the Bill finally leaves your Lordships' House, we may be able to obtain some slightly more specific guidance in this matter.

Amendment, by leave, withdrawn.

Baroness Masham of Ilton moved Amendment No. 2:

Page 2, line 14, at end insert: ("and such requirements may include conditions for retraining and supervision").

The noble Baroness said: Amendments Nos. 2 and 3 are being taken separately. In moving Amendment No. 2, I wish to make it clear that I have both the interests of the doctors and the public—the patients—equally at heart. The amendment would put clearly on the face of the Bill the provision that, when a doctor had been suspended from registration, for the protection of members of the public or in the doctor's interest, the committee could impose conditions for retraining and supervision.

I consider that this amendment is desirable because I feel that the public need reassurance that something constructive will be done. There has been a great deal of concern and dismay among the general public over some tragic cases which have been widely publicised. Let me quote the headlines from a few newspapers printed since the Second Reading of the Bill.

The Universe, Sunday, 2nd July: This waste of a beautiful life. Twelve-year old Katie from Moulton, Northampton, died from blood poisoning after a routine appendix operation".

The article says that the family is still horrified by the chain of events leading up to the youngster's death. The whole story will have been widely read.

The Times, Tuesday, 11th July: Doctor accused of injuring women with bungled keyhole surgery".

The Times, 14th July: Doctor failed in duty to his patients".

Earlier this year, the Evening Standard had a full page spread with the headline: The brain tumour that six experts failed to diagnose".

Up and down the country in local papers and the nationals one reads many such stories. It is no wonder that there is a worried and confused public when they hear that the most famous hospital of all, St. Bartholomew's, is under threat of closure. How can they understand that when there is a shortage of British doctors and a much quicker throughput of patients in the hospitals, which puts much more pressure on hospital doctors and on general practitioners once the patient goes home and needs continuing care. The public have campaigned for the hospital which they trust and respect. They feel that nobody is listening to them.

There are many reasons why some doctors fall below acceptable standards and need a period to get back to a good working standard. In an inner city where there are still single handed practices and in rural districts with large, sparsely populated areas it could be very easy for doctors to slip back into unacceptable ways and again become seriously deficient without support and a period of probation with supervision to keep them on the correct track.

Having training and supervision clearly written into the Bill might help to regain some of the public's confidence and reassure the doctor, who might feel isolated and vulnerable without the knowledge that he would have a helping hand when he needed it. I beg to move.

The Lord Bishop of St. Albans

I have been tempted to rise to my feet to express my support for this amendment proposed by the noble Baroness, Lady Masham of Ilton. I congratulate her on the way in which she persuasively presented it.

Far be it from a clergyman to dictate how the medical profession should run its affairs, especially as the Church of England has demonstrated that it has much to learn in the field of discipline and adjudication. The only thing that can be said—it needs to be said in the Lincoln case—is that there has been no cover up, which could so easily have happened, when justice would not have been done or seen to be done. But enough of that.

We are dealing with matters of professional incompetence and with a process of retraining and rehabilitation. No comparison between the rehabilitation of doctors and of clergy can be made, but there are certain parallels. The Minister may care to consider whether they have any bearing on the amendment before the Committee.

The Church has developed plenty of experience in seeking rehabilitation for some of the clergy who have been suspended, for whatever reason. It has a sophisticated system of inhibitions and limited permission to officiate, which in my experience works well and is designed to balance the potential usefulness of a restored priest against the need for him to achieve credibility in the eyes of the Church and the parish. The parallel, which I believe can safely be drawn, is that becoming a doctor and becoming a priest involve qualifications but not just qualifications. It is not the same as passing a driving test where, if one drives badly, one can be compelled to take the test again and then carry on along the road. Being a doctor or priest involves qualities as well as qualifications, and particularly being able to sustain the confidence of patients or parishioners. Where that is lacking, no amount of diplomas will compensate.

It has certainly been my experience that rehabilitation in the eyes of the general public can best be served by insisting on a period of restored ministry under supervision, usually (in the case of the Church) as an assistant curate for a year or two. The priest is then able to earn himself not only a good reference or two but the heartfelt appreciation of a congregation which sees that he has made good and is all right again. They can trust him.

I hear many of my people speaking about having great faith in Dr. This or Mr. Surgeon That. Surely it is that kind of rehabilitation that the Bill aims to achieve. Therefore, I commend the amendment and hope that the Minister will consider the parallels that I have suggested as she thinks further about the Government's proposals.

Lord Rea

I rise briefly to support the noble Baroness's amendment. It adds some useful conditions. It spells out some of the actions which might well be covered by the Bill as it is now but it is useful to have that phrase and particularly the matter of supervision once the period of suspension is over and the doctor is back carrying out his professional work. I expect the noble Baroness, Lady Cumberledge, will have something to say about that. Perhaps she can say whether or not the requirements which the amendment incorporates are already covered under the Bill as it stands.

11.30 a.m.

Lord Walton of Detchant

At Second Reading I mentioned that when I had the privilege of serving as president of the General Medical Council from 1982 to 1989, I became increasingly concerned—as did many of my colleagues—over the inability of the council to handle certain problems which were regularly brought to our attention. We believed, and still believe, the discipline and health procedures to be effective. However, it became increasingly clear that the council lacked the procedures to deal with impaired or inadequate professional performance or indeed to deal with doctors who failed to demonstrate the understanding, the human compassion and the communications skills which are so crucial to the good practice of medicine.

The purpose of the Bill is to do exactly what the noble Baroness and the right reverend Prelate suggest. But that purpose will be fulfilled by the regulations to which the Bill will lead, approved by the Privy Council. As matters stand, under the health procedures, for example, if a doctor is found to have a form of ill health seriously impairing his or her ability to practice medicine safely, that doctor is required to undergo a period of full assessment by skilled practitioners. Their advice is then accepted and the doctor is required to undergo treatment under supervision over such period as may be necessary before that doctor is enabled to return to clinical practice.

The purpose of the Bill is to carry out an exact mirror image, in a sense, of those procedures in relation to those doctors whose professional performance has been demonstrably shown to be below an effective level. I am advised that if the amendment of the noble Baroness were to be accepted it would not only raise an issue as to whether the GMC should organise and pay for remedial training but that it would also raise complications in relation to the assessment procedures proposed by the Bill and to follow in the regulations, promulgated and eventually approved by the Privy Council.

The General Medical Council believes that it is better to sort out problems of efficiency first by inviting the doctor to undergo assessment or requiring the doctor to undergo assessment and then indicating to the doctor the standard of performance which he or she must achieve in order for an application for restoration to be given favourable consideration. The regulations will require that doctor to undergo a period of retraining under supervision before he or she is able to apply for restoration to the register and is able to return to clinical practice.

I am advised that if this amendment were to succeed it would be necessary for a whole series of consequential amendments to be drawn up and added to the Bill. Hence, while I again fully support the intention underlying the amendment, I am advised that the regulations which will follow the passage of the Bill will make such an amendment unnecessary.

Baroness Jay of Paddington

Perhaps I may briefly support the amendment and also pursue the question raised by my noble friend Lord Rea and the noble Baroness, Lady Masham. I do not feel that it was quite answered by the contribution of the noble Lord, Lord Walton of Detchant.

As I understand it, the issue of retraining under supervision will indeed be included in the regulations, as the noble Lord, Lord Walton of Detchant, explained. From what the noble Baroness, Lady Masham, said in introducing the amendment, it is certainly my feeling from a lay perspective that it would be helpful if, once that training and supervision were completed, there was some further probationary period, perhaps in the way the right reverend Prelate explained in relation to the clergy. One could almost describe a doctor as once again wearing "L" plates. It would mean that although he had been retrained and the supervised training had been completed, he was nonetheless recognised by the general public and by his patients not to be a fully rehabilitated member of the profession. It is that matter of supervision and probation after retraining which most concerns me. That is why the amendment is important.

Baroness Cumberlege

Perhaps I can start by thanking the right reverend Prelate the Bishop of St. Albans for his insight into this subject. I take the opportunity to express a personal regret that this is the last day that the right reverend Prelate will grace this Chamber. I am very unhappy therefore to have to disappoint him on this occasion.

The noble Baroness, Lady Masham, through this amendment, seeks to empower the committee on professional performance to impose conditions on a doctor's practice which would require him to undergo remedial training or to be supervised by another doctor. Making continued registration conditional on remedial training will usually only be appropriate where the doctor refused to take any remedial action and there has been no improvement in his performance. The performance procedures are designed to allow a doctor's standards of practice to be assessed and, where that standard is deficient, to allow him the opportunity to remedy the deficiency. That point should be reached long before the case is considered appropriate for the Committee on Professional Performance, the committee which can impose conditions on a doctor's registration.

Where a case does reach the committee, it may wish to make registration conditional on retraining or supervision, or both, in many of the cases where it imposes sanctions. However, the powers that already exist in the Bill will allow the committee on professional performance to impose just those types of conditions. The powers for the committee to impose conditions are similar to those which govern the Health Committee and the Professional Conduct Committee which have, in the past, included making registration conditional on retraining or supervision.

I hope that that explanation meets the points made by the noble Baroness, Lady Jay, and the noble Lord, Lord Rea. We feel that there is no need for this amendment and hope that the noble Baroness will withdraw it.

Baroness Masham of Ilton

My Lords, I thank all noble Lords who have spoken and explained their views. I thank particularly the right reverend Prelate the Bishop of St. Albans and wish him well. I hope we see him back here, perhaps not on duty but as a visitor.

I wish also to say that there is a likeness between the ministry of the Church and the ministry of medicine. There is a feeling that the health service, which belongs to the people, should be an open service. We shall consider carefully what has been said—we have the Summer to digest it—and may come back at the next stage of the Bill. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Jay of Paddington moved Amendment No. 3:

Page 2, line 14, at end insert (", the costs of compliance with any such requirements to be paid out of money provided by Parliament").

The noble Baroness said: I beg leave to move Amendment No. 3 which stands in my name and that of the noble Baroness, Lady Robson of Kiddington. This amendment follows closely the previous one moved by the noble Baroness, Lady Masham, and was in fact originally grouped with it. I hope that when I have explained my reasons for moving it, the Committee will understand why we decided to ask for it to be considered separately.

The amendment is designed to ensure that those doctors who are required by the General Medical Council to undertake remedial training will not be financially penalised by paying for that retraining themselves. If the amendment is accepted, the cost will be borne by public funds.

As I understand the present proposals, doctors who hold hospital contracts—those employed by NHS trusts—may expect retraining costs to be paid for by the relevant employing trust; they at least have the opportunity to apply to their employer for that financial help. On the other hand, GPs (family doctors) as independent contractors with the health service, will be required to pay from their personal budgets. The British Medical Association is very concerned that this creates an unfair distinction between the two categories of doctor, both of whom are liable to be judged professionally deficient on the same basis but who will then be differently treated. On these Benches we believe that this is an anomaly in the Bill which should be prevented by amending it as Amendment No. 3 suggests.

I mentioned at Second Reading that there has been correspondence between the British Medical Association and the Minister for Health, Mr. Malone, about this question since the Bill finished proceedings in another place. The BMA has now asked that the Family Health Services Authority, or presumably from next April the successor Health Authority, should reimburse GPs for any costs incurred. As the noble Baroness, Lady Robson, established at Second Reading, these might include the costs of employing a locum practitioner while the GP attended courses and so on, as well as the GP paying for those courses.

Unfortunately, the noble Baroness, Lady Robson, cannot be with us today, but as the Committee will have seen, she supports this amendment and her name is to it as well. However, so far it seems that the Government are not prepared to act on this apparent anomaly. In his most recent letter, dated I believe 5th July, to Dr. Ian Bogle, who is the chairman of the British Medical Association's General Medical Services Committee, Mr. Malone said: GPs are not employees of the NHS, but independent professional contractors. They are responsible for meeting their own practice costs including the cost of maintaining their professional skills and knowledge. The GMC's guidance is quite clear that it is a doctor's professional duty to maintain his standard of performance by keeping his knowledge and skills up to date throughout his working life … Where a GP fails to do so and his professional performance becomes seriously deficient it is not for the taxpayer to have to spend yet more money on that doctor".

I have two reasons for disagreeing with those points, and I hope that the Minister in this House will accept the amendment. First, it seems to me to be inappropriate to equate the special retraining proposed under this Bill with the general continuing medical education now available to all doctors, and indeed in many cases required of them. Continuing medical education is offered to the profession as a method for maintaining their general knowledge and development in the relevant areas of both science and technology, as indeed Mr. Malone agrees in his letter to Dr. Bogle.

If successful, it is of course very important in preventing some of the failures of competence which could lead to a doctor being reported to the GMC under the new procedures which we are discussing today. However, the continuing medical education programme is not designed to address particular gaps in knowledge or skill, or indeed to counteract any of the more subtle problems of attitude and outlook which several noble Lords raised at Second Reading and which the Minister agreed were covered by the terms of this Bill.

As described, the remedial training which a doctor may be required to undertake under the new procedures will be specifically designed to assist that individual to bring his or her professional performance up to standard. It could be intensive and conducted full-time on a short-term basis. Indeed, the Minister said in her very helpful letter to noble Lords who took part in the Second Reading debate before this stage of the Bill that it could take six months in order to get a doctor back onto the right track.

This obviously will not be the same as attending afternoon lectures or weekend seminars, which often constitute continuing medical education and for which the postgraduate educational allowance exists. The costs will be high. It has been calculated that they may be as much as £20,000 including locum cover.

My second argument for this amendment is about the size of those costs. As I say, it has been calculated that they could reach something in the region of £20,000. As the Bill stands, a professionally deficient GP will face what amounts to a very substantial personal fine of many thousands of pounds, as well as being compelled to undertake retraining. This appears to be in contradiction to the general spirit of the new measures, which is to be remedial and not punitive. It has been responsibly suggested to me that the size of the personal costs which may be directly incurred by an offending GP may actually reduce the effectiveness of the procedures because, for example, colleagues of a doctor who may judge that he is performing badly will hesitate to start investigations which could lead to such harsh financial penalties.

It is particularly important to the health service that this legislation should succeed so that standards of patient care are maintained and improved. In the view of most Members on this side of the House, the NHS responsibility for success should include bearing the costs of remedial retraining for all the doctors concerned. I beg to move.

11.45 a.m.

The Viscount of Falkland

I rise briefly on behalf of my noble friend Lady Robson of Kiddington, who is unable to be with us today, to support the amendment of the noble Baroness, Lady Jay. It seems to my noble friend Lady Robson and to other Members on these Benches that it is unfair and possibly damaging to make the distinction between consultants who are going to be fully reimbursed for their training and GPs. Although the arguments in the letter from the noble Baroness' department say quite correctly that doctors are responsible for all the costs involved in running their practices and so on, and indeed for most of their training, it seems to us that to achieve the standards that we wish in primary care—and it is only fair to patients in particular—there should be a high standard of performance by GPs. To achieve that, remedial training is obviously of vital importance and GPs should be assisted in the same way as consultants.

The noble Baroness, Lady Cumberlege, was kind enough to write to my noble friend on the subject of costs which, I understand, range between £6,000 and £22,000. She confirmed in the letter that the locum costs, which are quite a considerable part of the remedial training, are included in those figures. I hope that the noble Baroness will respond positively to the noble Baroness's amendment. It seems to us that her amendment is consistent with the aims of the noble Baroness and her department to achieve the highest standards for both consultants and GPs.

Baroness Masham of Ilton

I take this opportunity to ask the Minister whether she will tell the Committee how the doctors will be retrained. What will be the position of the medical deans over retraining? Who will assess the doctors before they are put back on the register?

Lord Walton of Detchant

I very much support the arguments which have been set out so very clearly by the noble Baroness, Lady Jay of Paddington, in relation to this issue. At Second Reading I made it clear that the costs of the very complicated procedures which will arise from the passage of this Bill will be borne by the General Medical Council. All of the assessment costs will be covered by it. That means that effectively the medical profession as a whole, through its payments of the annual registration fee, will be paying the costs of the procedures. But I made the case, which the noble Baroness has put so clearly, for suggesting that, while consultants and junior hospital staff, as employees of the National Health Service who come under these procedures, will have their retraining costs paid for by the NHS, that will not be the case in relation to general practitioners, who are, as the noble Baroness said, independent contractors. Therefore, I urge that the case which has been put so strongly by the British Medical Association should be reconsidered by Her Majesty's Government.

Having said that, I find it is difficult I fear yet again to support this amendment for purely technical reasons. The Committee should recognise that this Bill is concerned with the powers of the General Medical Council as defined by statute. The council is not a negotiating body; it is not a body which has any political responsibilities whatever. The issue of payment in this situation therefore is to be raised by a body such as the British Medical Association, which negotiates with government on terms and conditions of service. Solely for that technical reason I would find it difficult to support this amendment.

Baroness Cumberlege

During the passage of the Bill both here and in another place we have debated how the costs of the new procedures are to be met. At the heart of the Government's argument is that doctors are members of a profession. All members of professions have a duty to maintain their skills and knowledge and to keep up to date with the latest developments. Where a professional person is employed, he can reasonably look to his employer for support in maintaining his professional competencies. Where, as is the case with GPs, they are self-employed these costs are part of their practice costs and should be met from their income, as the noble Lord, Lord Walton, has said.

As the noble Baroness, Lady Jay, said, GPs are entitled to a postgraduate education allowance of £2,150 a year. The costs of other training is treated as a legitimate practice expense and is tax deductible. Expenses including training are included in the total amount of remuneration agreed by the Doctors and Dentists Review Body. All GPs will benefit from this whether or not they have undertaken training: they are not reimbursed on an individual basis. The doctor who has failed to take up training opportunities in the past will not have borne those costs met by his colleagues who have kept their training up to date. The money is already in his bank and we think it unreasonable that he should expect more for this purpose.

The cost of complying with conditions imposed by the General Medical Council's fitness to practice committees has always been seen as a cost for the individual doctor to bear. It does not seem right that this cost should fall on either the profession as a whole or the public. Are we to make the same provision for other professions as well? The noble Baroness, Lady Masham, asked whether the postgraduate medical deans would be involved in this exercise with the General Medical Council. I can give her a definitive reply in writing but from a personal point of view I would think it inconceivable that the GMC would not work closely with the postgraduate medical deans. Regarding assessment, it is up to the GMC as to when a doctor is fit to return to practice.

I cannot support the amendment and I do not recommend it to your Lordships. I hope that the noble Baroness will withdraw it.

Lord Rea

Perhaps I may ask the noble Baroness to think about the kind of doctor who gets into these difficulties. On the whole, this will be someone who may have various failures in his life and he will probably not be in a financial position to find extra money. I am told by a former secretary of the inner London medical committee that the benevolent funds that are available to doctors—general practitioners particularly—in difficulty (the Royal Medical Benevolent Fund and the Cameron Fund) are completely stretched and have no further resources to offer to doctors who might be in such a difficulty. I can imagine that bank managers might not be all that keen to help someone who has been suspended from carrying out his professional duties. It would be useful to have from the Minister some word which suggests that the department might be able to offer some assistance, if only for these doctors to get a loan to pay for the cost of their retraining.

Baroness Cumberlege

That is a matter for the individual doctor to negotiate with his bank manager or whoever. We are very clear on this point, as I said in my remarks opposing the amendment. We feel that the medical profession, as other professions, has a duty to maintain its skill and knowledge and to keep up to date with the latest developments. We do not feel it is appropriate to give financial help for the individual case because we give it already in term of the doctor's total remuneration.

Baroness Jay of Paddington

I am grateful to the Minister for her reply and to other Members of the Committee for taking part in this short debate. I am not convinced by the reply. The noble Baroness has still not made the distinction between continuing medical education of a very general kind and of a rather relaxed and part-time nature and the intensive retraining which will be required of doctors who are judged under the new procedures to be seriously professionally deficient. There is also an obvious disparity in the cost. If the allowance for continuing medical education is in the region of £2,000 a year and the cost of retraining is in the region of £20,000, as has been suggested as an outside figure, there is clearly a considerable disparity between what is given for continuing medical education, which I do feel is the equivalent of the specific retraining, and the £20,000 a year which may be expected to be paid for the specific remedial courses.

When the noble Baroness speaks, as she does, of the responsibility of individual practitioners to maintain their personal skills and expertise in developments in medical science, we all appreciate that and would expect it ourselves. However, as I said in moving the amendment, that does not address those difficult and subtle issues which we debated at length at Second Reading of a doctor whose professional attitude and professional relationship with his patients—not his professional skills—may be deficient and which the noble Baroness agreed at Second Reading might be the subject of the kind of proceedings proposed under the new arrangements. I am not aware of there being continuing medical education in changing the bedside manner of doctors, yet that may be something which is the subject of these kind of proceedings.

I suspect that behind the Minister's reply and the attitude of the Government is precisely the rather regrettable attitude to the individual responsibilities of general practitioners, their personal budgets and their personal concerns, and not the collective responsibility for standards in the health service which I would have hoped to see. As I said in moving the amendment, I feel that the effective working of the procedures proposed by the Bill is crucially important to the National Health Service and crucially important to the maintenance of good patient standards and the improvement of patient care. That should be the responsibility of the Government. Therefore, the costs of the retraining should be borne by those who are responsible for what is still the National Health Service. We may need to return to this matter at a later stage. However, for the moment, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 1 agreed to.

Clause 2 [Voluntary removal from the register]:

The Chairman of Committees (Lord Boston of Faversham)

In calling Amendment No. 4, I should point out that if it is agreed to, I cannot call Amendment No. 5.

Baroness Cumberlege moved Amendment No. 4:

Page 3, leave out lines 25 to 29 and insert ("—

1. (a) providing for the erasure by the Registrar from the register of medical practitioners of the name of any person who applies, in the manner prescribed by the regulations, for his name to be erased from the register;
2. (b) providing for the refusal by the Registrar of applications under paragraph (a) above in such cases and circumstances as may be prescribed by the regulations;
3. (c) making provision").

The noble Baroness said: In moving this amendment, I should like to speak also to Amendment No. 6. Clause 2 gives the doctor the option to remove his name voluntarily from the medical register. If a doctor decides he cannot maintain a good standard of performance or does not wish to undertake remedial training, he should be allowed to remove his name from the register. Clause 2 provides for this and other similar circumstances in which a doctor may simply no longer wish to be registered; for example, if he is going to work abroad. It also has the effect of providing a quick and easy way for a doctor to remove himself from practice.

The effect of the amendments is to enable the General Medical Council, when making regulations allowing a doctor to remove his name voluntarily from the register, also to provide for the registrar to refuse an application in such circumstances as may be prescribed in those regulations. The GMC intends to refuse an application for voluntary removal only where the doctor is likely to be subject to the professional conduct procedures. Regulations will be made under Clause 2 requiring the approval of the relevant GMC committee before a doctor could be re-registered following voluntary removal in certain circumstances. That would allow a degree of scrutiny over the return to practice of a doctor who has voluntarily removed his name. It is anticipated that this scrutiny would be exercised only in a small number of cases where there is evidence that a doctor may have voluntarily removed his name to avoid possible fitness to practice proceedings.

However, during the debate in another place there was concern that some doctors might abuse the provisions of Clause 2 to avoid proceedings concerning serious professional misconduct. The Opposition tabled a number of amendments aimed at addressing that but none of them gave the GMC the flexibility it requires. Both the Government and the GMC recognise that there may be some instances where it is justified that the doctor should remain on the register and face a committee hearing, primarily where it is alleged that a doctor has committed serious professional misconduct. In conduct cases it is important for the case to be resolved at the time. If the doctor was allowed to avoid a hearing by voluntary removal and then applied some years later to be restored to the register, it could be very difficult to re-open and prove the case—especially if a considerable time had elapsed. This is not the case with health and performance where the issue is the doctor's fitness to practise at the time he applies for restoration to the register.

The amendments will enable the GMC to make regulations to allow its registrar to refuse applications for voluntary removal in defined circumstances. This will not only give the GMC flexibility, but also send a message to the profession and the public that the GMC takes a grave view on matters of serious professional misconduct.

I know that my noble friend Lord Harmsworth has been concerned that under the previous wording of Clause 2 the GMC might not make regulations covering the application to subsequently return to the register. These amendments bring together the three strands of the GMC's new powers to make regulations about voluntary removal and re-registration. I hope that this will meet my noble friend's concern.

My noble friend's comments on this matter have proved helpful. The amendment we have tabled has tightened up the drafting of new Section 31A. Rather than subsection (2) being separate, it is now a new paragraph of subsection (1), thereby making quite clear the intention to treat these powers as a single package and not as separate matters. I hope that this fact and my earlier comments reassure my noble friend. I beg to move.

12 noon

Lord Walton of Detchant

This amendment corrects an anomaly in the Bill that was not spotted at an earlier stage. I warmly support it.

Lord Harmsworth

I support the government amendment. My amendment, Amendment No. 5, was designed to correct a shortcoming in the wording of the original Clause 2. Clause 2 is permissive. It permits the general council to make regulations authorising the registrar to erase the name of a medical practitioner from the register in certain circumstances. My difficulty is that subsection (2) is also permissive. It permits the regulations to provide for the restoration to the register of a name. In being permissive, it places no compunction whatsoever on the general council to take any action. The government amendment completely resolves the problem. Under the old wording, the general council could have got away with doing only half the job—although it has no intention of doing anything but the whole job, I am assured. I thank the Minister for her help in this matter, and her officials with whom I have been in correspondence.

Baroness Masham of Ilton

Amendment No. 7, which is grouped with Amendment No. 4, stands in my name and seeks to establish that a doctor's retraining and supervision will be provided for in regulations. I have already referred to the need for that and shall wait to see what happens. I do not intend to move my amendment—but we have not yet reached it.

Baroness Cumberlege

Indeed, Amendment No. 7 comes later. I thank all noble Lords who have spoken for their support for Amendment No. 4.

On Question, amendment agreed to.

[Amendment No. 5 not moved.]

Baroness Cumberlege moved Amendment No. 6:

Page 3, line 34, leave out ("subsection (1)") and insert ("paragraph (a)").

The noble Baroness said: I have already spoken to this amendment. I beg to move.

On Question, amendment agreed to.

[Amendment No. 7 not moved.]

Clause 2, as amended, agreed to.

Baroness Cumberlege moved Amendment No. 8: After Clause 2, insert the following new clause:

Preliminary proceedings: interim orders

(" .—(1) Section 42 (preliminary proceedings as to professional misconduct and unfitness to practise) shall be amended as follows.

(2) In subsection (3), in paragraph (c) for the word "two" there shall be substituted the word "six".

(3) In subsection (4), for the words "No order for interim suspension or for interim conditional registration shall be made by the Preliminary Proceedings Committee" there shall be substituted the words "No order under subsection (3) (b) or (c) above or (6A) (b) to (d) below shall be made by any Committee".

(4) In subsection (5), for the words "If the Committee decide" there shall be substituted the words "If the Preliminary Proceedings Committee decide".

(5) In subsection (6), for the word "two" there shall be substituted the word "six".

(6) After subsection (6) there shall be inserted— (6A) Where an order for interim suspension or for interim conditional registration has been made in relation to any person under any provision of this section (including this subsection) the Preliminary Proceedings Committee, the Professional Conduct Committee or the Health Committee may, subject to subsection (4) above—

1. (a) revoke the order or revoke any condition imposed by the order;
2. (b) vary any condition imposed by the order;
3. (c) if satisfied that to do so is necessary for the protection of members of the public, make an order for interim suspension; or
493
4. (d) if satisfied that to do so is necessary for the protection of members of the public or is in the interests of the person concerned, make an order that his registration shall be conditional on his compliance, during such period as is specified in the order, with such requirements so specified as the Committee think fit to impose for the protection of members of the public or in his interests.

(6B) An order under subsection (6A) (c) or (d) above—

1. (a) shall take effect as from a date not later than the date on which the interim suspension or interim conditional registration would otherwise come to an end; and
2. (b) shall specify a period not exceeding three months.

(6C) If an order is made under subsection (6A) (a) to (d) above the Registrar shall forthwith serve a notification of the order on the person to whose registration it relates. (6D) Where an order has been made under any provision of this section, the court (within the meaning of section 38 above) may—

1. (a) in the case of an order for interim suspension, terminate the suspension,
2. (b) in the case of an order for conditional registration, revoke or vary any condition imposed by the order,
3. (c) in either case, substitute for the period specified in the order some other period which could have been specified in the order when it was made;

and the decision of the court on any application under this subsection shall be final.".

(7) Subsection (7) shall cease to have effect.").

The noble Baroness said: I beg to move Amendment No. 8. In moving this amendment I will also speak to amendments consequential to this—that is, Amendments Nos. 9 to 13 and 18 to 26 inclusive.

My honourable friend the Parliamentary Under-Secretary of State for Health gave a commitment in another place that the Government would bring forward this amendment. It will give the General Medical Council's preliminary proceedings committee the power to impose interim suspension or interim conditions on a doctor for a period of up to six months pending the full hearing of his case by the health or professional conduct committee. These interim orders can be extended by those committees or the preliminary proceedings committee for further periods of up to three months. The preliminary proceedings committee's existing powers are currently limited to one, non-renewable period of two months. This has proved insufficient to cope with protracted hearings or adjournments.

The GMC issued a consultation document in February 1994 which proposed that the period of interim suspension or conditions should be extended from two to six months and that further periods should be imposed if necessary. The proposal received broad support from the profession and from patient groups.

While this power is not expected to be often used, it is needed in order to protect the interests of patients. However, the doctor also has rights. It seems fair that he should be given the opportunity to be heard by the health, professional conduct or preliminary proceedings committees at any time when they are considering imposing interim conditions or suspensions. A doctor would also be able to appeal to the High Court against interim suspension or imposition of interim conditions, or against their renewal.

Interim conditions or suspension will be extended when a hearing is pending. However, because at this point no case will have been proved this should be for only periods of three months at a time. This also ensures that the GMC is required to review the case regularly.

An unfortunate but unavoidable effect of this amendment is that it has spawned a number of minor consequential and technical amendments—14 in all. These are required to reflect the change in structure of Section 42 (as amended) and maintain the current position regarding such matters as the effect of interim suspension on employment.

Lord Walton of Detchant

I rise to support the amendment most warmly. When a doctor is reported to the General Medical Council as having been convicted of a criminal offence, when a report comes to the council suggesting or raising as an issue that the doctor may have been guilty of serious professional misconduct or that his or her health may be seriously impaired, and in the future when the Bill becomes law, as we all trust that it will, when a doctor is reported as perhaps performing below the standard that is required and defined in the Bill, after being considered by a preliminary screener, those reports go to the preliminary proceedings committee.

In the past there have been cases where the preliminary proceedings committee has felt that the offence of which the doctor was convicted or the offence of which the doctor stood charged in, for example, a disciplinary case was so serious that in order to protect the public it was essential that an order of suspension of that doctor's registration should be made immediately effective. However, under the present law, that period of two months has proved to be quite insufficient because collecting the evidence in order to mount a proper case to be heard by the professional conduct or health committees or perhaps in the future by the professional performance committee is a complicated matter. Therefore, extending the period from two to six months is important in the interests of the protection of the public. I warmly support the amendment and the consequential amendments which flow from it.

On Question, amendment agreed to.

Clause 3 [Supplementary and consequential amendments]:

Baroness Cumberlege moved Amendment No. 9:

Page 3, line 38, leave out ("and 2") and insert ("to (Preliminary proceedings: interim orders)").

The noble Baroness said: In moving Amendment No. 9, I should like to speak also to Amendments Nos. 10 to 13. When considering the previous amendment, I addressed the issue of extending the powers of interim suspension and the making of interim orders. Amendments Nos. 9 to 13 make minor consequential changes and flow from Amendment No. 8. I beg to move.

On Question, amendment agreed to.

Clause 3, as amended, agreed to.

Clauses 4 to 6 agreed to.

Schedule [Supplementary and Consequential Amendments]:

Baroness Cumberlege moved Amendments Nos. 10 to 13:

Page 5, line 17, at end insert: (" . In section 36(2) (professional misconduct and criminal offences)—

1. (a) for the word "42(3) (c)" there shall be substituted the word "42"; and
2. (b) after the words "the Preliminary Proceedings Committee" there shall be inserted the words "or the Professional Conduct Committee".").

Page 5, line 19, at end insert: ("( ) In subsection (2)—

1. (a) for the word "42(3) (c)" there shall be substituted the word "42"; and
2. (b) after the words "the Preliminary Proceedings Committee" there shall be inserted the words "or the Health Committee".").

Page 6, line 48, leave out ("and").

Page 7, line 2, at end insert ("; and (c) for the words "of the Preliminary Proceedings Committee under section 42(3) (b)" there shall be substituted the words "under section 42".").

On Question, amendments agreed to.

Baroness Cumberlege moved Amendment No. 14:

Page 7, line 2, at end insert: (" . In section 53(2) (proof of certain instruments), after the words "the Professional Conduct Committee" there shall be inserted the words ", the Committee on Professional Performance".").

The noble Baroness said: This is a consequential amendment which needs to be made for completeness. It ensures that copies of orders made by the Committee on Professional Performance under Section 38 of the Act, dealing with immediate suspension, can be admissible as evidence. That is already the case for immediate suspension orders of the Professional Conduct Committee and the Health Committee. The purpose of that is to enable a copy of the committee's order, rather than the original document, to be submitted in evidence in an appeal to the court. I beg to move.

On Question, amendment agreed to.

Baroness Jay of Paddington moved Amendment No. 15:

Page 8, line 23, after ("relate") insert ("or any person making a complaint to which the proceedings relate").

The noble Baroness said: The amendment seeks, like Amendment No. 3, to remove an anomaly from the Bill so that everyone involved in the proposed proceedings is treated equally. The amendment makes it possible for persons making a complaint to request that GMC proceedings be held in public—a privilege at the moment, as the schedule stands, given only to the person, to whose registration they relate"; that is, to the doctor concerned.

The spirit of the Bill is to create a greater openness in professional self-regulation and to increase patient confidence in the system. Many of the innovations achieve both those aims. Therefore it seems rather strange that when it comes to the proceedings of the Committee on Professional Performance itself the balance seems to swing back again to favour the professionals as against the complainants.

Several organisations, including notably the Patients Association, have expressed concerns that even in that altered state the mechanics of investigations into professional performance will seem daunting to many potential 'complainants. The Patients Association has, like us all, welcomed the Bill in principle, but the organisation still feels that if people with a legitimate complaint against their doctor think that the scales are tipped against them within the GMC, they may be deterred from acting.

Of course I acknowledge that there will be many complainants who, like many of the doctors concerned, may well prefer the anonymity of a private hearing, but there are others who will expect their day in court to be public, and they should at least be given that choice. After all, the GMC and the Government clearly acknowledge that in certain circumstances it may be preferable to have an open hearing because the Bill allows for a doctor to opt for that procedure. That makes the new procedures different from health investigations, which, as I understand it, are always held in camera, and professional misconduct hearings, which are, by contrast, always held in public.

There is therefore presumably no objection in principle to the arrangement so that public hearings can be held. That makes the anomaly in the schedule even more objectionable, and it may not be surprising that the conspiracy theorists, or those who are merely alarmed by the prospect of taking on the medical establishment, see it as a last-ditch attempt to give a doctor who is being investigated a potentially unfair advantage over a complainant.

The Government and the GMC have given assurances that proceedings will be monitored and may be revised again after the new system has been operating for some time. The Minister repeated those assurances on Second Reading and stated that there was a commitment to review the operations of the Committee on Professional Performance three years after the first hearing. On that occasion the noble Baroness said (Hansard, col. 895.): I am sure that the issue will be addressed again".

Surely it is more sensible to address the issue again today and before the Bill leaves this place and remove the anomaly in the Bill by accepting this simple amendment which must improve general confidence in the equity of the new arrangements. I beg to move.

12.15 p.m.

Baroness Masham of Ilion

I support the amendment. Where there is choice there is generally much more satisfaction.

Lord Walton of Detchant

I can fully understand the reasons underlying the proposal in the amendment. The Professional Conduct Committee of the GMC invariably meets in public except that it may go into camera where there are circumstances such as the protection of the rights and confidentiality of a minor who may be giving evidence when the Committee may decide to protect that individual by going into camera. The Health Committee invariably meets in camera, if only because it is important to recognise that its procedures are intended to be rehabilitative, compassionate and, in the first instance, to prevent a doctor who may be so sick as to be a danger to the public from practising except under rigid conditions. Nevertheless, they are intended to help that doctor to recover from his or her illness.

That was an issue which gave the GMC and its advisers considerable difficulty before they decided to recommend to the Government that these proceedings should be held in private, save when the doctor requested that they be held in public. I can wholly understand the reasons why it may be felt that the interests of the patient who is the complainant may require them to be held in public. I am ambivalent about this position but, in general, feel that, after all the consideration that has been given to these procedures which are intended to be rehabilitative and not punitive, it would be better to leave the position as it stands in the Bill.

Baroness Cumberlege

The matter of whether a complainant in a case should be able to ask for hearings of the Committee on Professional Performance to be in public was touched upon as the noble Baroness, Lady Jay, said, on Second Reading. I made it clear then that our intention was that hearings of the Committee on Professional Performance will be held in private unless the doctor wishes otherwise. That intention remains. When the new procedures have been bedded in, the GMC will be better placed to see whether the difficulties of public hearings can be overcome.

The reason we have given the doctor a right to ask for a public hearing and not the complainant is that the case is about whether the doctor should continue in practice. It is his livelihood which is at stake. Under the European Convention on Human Rights the doctor is entitled to a fair and public hearing. Hence, when hearings are to be normally held in private that right must be reserved.

A complainant in a performance case will be party to any hearings of the Committee on Professional Performance on the case in question. The complainant will also be entitled to be heard by the committee and to be legally represented. Some people have compared the performance procedures with the conduct procedures, where hearings are held in public. Indeed, that has been done this morning. The two procedures are very different. The conduct proceedings address specific wilful acts and omissions by doctors and the Professional Conduct Committee operates very much like a court. Hearings of the Committee on Professional Performance will review the report of the assessment panel on the doctor's performance as a whole. It will not make a finding on any single complaint. The finding will relate to the doctor's standard of professional performance generally.

The GMC consulted specifically on the merits of public and private hearings. The result was generally in favour of private hearings. In Committee in the other place a clear commitment was given that the GMC would review the operation of the Committee on Professional Performance three years after the first hearing. I repeated that commitment, as the noble Baroness said, on Second Reading and make that commitment again today.

I hope that with those comments the noble Baroness will be reassured and will feel able to withdraw the amendment.

Baroness Jay of Paddington

I am grateful to the Minister for that response. Of course I accept her assurance that the GMC will review these proceedings in three years' time. That is an important commitment. There remains an anomaly in the position in which one party to the proceedings can opt for an open hearing while the other cannot.

I understand the points made by the noble Lord, Lord Walton of Detchant. I am sorry that once again on this amendment we are on slightly different sides, but there is a much closer equation between this type of proceeding, as it has been explained—of course at the moment we are talking only of theory rather than practice as there have been no hearings under these arrangements so far—which I expect will be under the Professional Performance Committee and the Professional Conduct Committee than between the Professional Performance Committee and the Health Committee.

The Minister repeated the words that she used on Second Reading when she spoke of wilful acts in relation to the Professional Conduct Committee. Of course, one is not saying that a doctor who is brought before the professional performance committee has been acting wilfully for many years. That is not the assumption, but it is the assumption that there may have been a conscious dereliction of duty, or at least a failure to involve himself or herself in the continuing medical education programmes which we have discussed today.

It is not fair to say that the committee is equivalent to the Health Committee. However, as we have said in relation to several other amendments, there is an anxiety that the proceedings related to the outcome of these hearings should be remedial rather than punitive. The basis of my anxiety is the differential between the complainant and the complained against. My additional anxiety, which I outlined when I moved the amendment, has been expressed to me by various organisations involved in advocacy on behalf of patients; that, if only the doctor is allowed to ask for the proceedings to be held in public, it may be seen to be, even though it is not in practice, loaded against the patient who is complaining.

However, I accept the Minister's assurances and the assurances and commitments that have been given by the General Medical Council that the procedure will be reviewed and that the issue will be addressed again after a limited time period. On that basis, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Cumberlege moved Amendment No. 16:

Page 9, line 2, leave out ("regulations") and insert ("rules").

The noble Baroness said: This amendment is needed to remedy a technical error in the drafting of the Bill. The reference should have been to the "rules", which are mentioned in new paragraph 5A(1), five lines above in the Bill. I beg to move.

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 17:

Page 9, line 24, at end insert (", and on an appeal under this sub-paragraph the court may—

1. (a) quash the direction,
2. (b) substitute for the direction any other direction which the Committee could have made, or
3. (c) remit a case to the Committee to be disposed of in accordance with the court's directions;

and the decision of the court on any appeal under this sub-paragraph shall be final.").

The noble Baroness said: This amendment is a consequential amendment which brings into line the effects of a decision on appeal to the court against imposition of suspension or conditions by the Committee on Professional Performance for non-co-operation with an assessment with arrangements for appeal to the court in other parts of the Bill. It also provides for which decisions the court may make on such an appeal. I beg to move.

On Question, amendment agreed to.

Baroness Cumberlege moved Amendments Nos. 18 to 25:

Page 10, line 20, at end insert ("— (a)")

Page 10, line 21, at end insert ("; and (b) after the word "42(5)" there shall be inserted the words "or (6C)".").

Page 11, line 15, leave out ("and").

Page 11 line 17, at end insert ("; and"). (c) in paragraph (c), for the words "of the Preliminary Proceedings Committee of the Council under section 42(3) (b)" there shall be substituted the words "under section 42".").

Page 11, line 30, leave out ("and").

Page 11, line 32, at end insert ("; and (c) in paragraph (c), for the words "of the Preliminary Proceedings Committee of the Council under section 42(3) (b)" there shall be substituted the words "under section 42".").

Page 11, line 45, leave out ("and").

Page 11, line 47, at end insert ("; and (c) in sub-paragraph (c), for the words "of the Preliminary Proceedings Committee of the Council under section 42(3) (b)" there shall be substituted the words "under section 42".").

The noble Baroness said: I have already spoken about the new clause in the Bill which extends the powers of interim suspension and the making of interim orders. These amendments make minor and consequential changes flowing from Amendment No. 8. I beg to move.

Lord Walton of Detchant

The Bill has been long awaited. The initiative for it came from the General Medical Council. There has been a long period of consultation with the medical profession and the public leading to the Bill becoming a reality and being brought before another place and this Chamber.

I wish to put on record the debt which the public and the professions at large owe to the noble Baroness, her officers and to the Parliamentary Counsel for the time and effort that they have devoted to introducing these amendments and to ensuring that the Bill passes to this stage in the Chamber. I should like that to be on the record and I support the amendments.

On Question, amendments agreed to.

Schedule, as amended, agreed to.

In the title:

Baroness Cumberlege moved Amendment No. 26: Line 4, after ("practitioners;") insert ("to amend section 42 of that Act;").

On Question, amendment agreed to.

Title, as amended, agreed to.

House resumed: Bill reported with amendments.