Medical (Professional Performance) Bill (Hansard, 1 November 1995)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, I beg to move that this Bill be now read a third time. Since there are no amendments, I have been advised that I should say a few choice words at this time and not later.
This has been an interesting Bill, not only of interest to us parliamentarians, but a Bill in the public's interest. The debate has been characterised by a common purpose: to give the General Medical Council the powers it needs to deal with doctors whose performance is, in the words of the Bill, "seriously deficient".
We know the famous quote of George Bernard Shaw that professions are a conspiracy against the laity, but he also said of the medical profession: Like other professions [the medical profession] consists of a small percentage of highly gifted persons at one end, and a small percentage of altogether disastrous duffers at the other".
I hope that with the introduction of these new procedures the few disastrous duffers will be quickly weeded out and that the profession's efforts can be concentrated on ways of ensuring that the vast majority of very competent and committed doctors are assisted and encouraged to maintain their medical excellence.
The NHS is the largest employer of doctors and it has a major role in ensuring that they are encouraged to keep up to date with the latest techniques, drug therapies and treatment protocols and that high standards are achieved and maintained. The NHS needs to develop a climate of 1489 opinion which is both sympathetic to doctors but is also able to take decisive action when practice is poor. It also needs to encourage other colleagues to be vigilant before patients suffer or extreme sanctions are needed.
I think we can detect the first signs of a global warming in the medical world and we should welcome and encourage the new impetus given by the GMC in dealing with problem doctors. The GMC's guidance Duties of a Doctor, issued in October, exhorts the medical profession: to treat every patient politely and considerately; … to keep professional knowledge and skills up to date; … [and] to recognise the limits of professional competence".
Those are three aspects of medical practice which are very pertinent to this Bill and I am sure that your Lordships will welcome the clear statement by the General Medical Council that doctors must protect patients when they believe that a colleague's conduct, performance or health is a threat to them. As the GMC says, The safety of patients must come first at all times".
Another sign of global warming is the Joint Consultants Committee which has recently recommended action when clinical audit has revealed unsatisfactory practice. It is important that poor performance is picked up early and at every opportunity. The Chief Medical Officer has recently published his contribution to the subject entitled Maintaining Medical Excellence. Despite the common purpose which we share in the Bill, we have vigorously debated important points of principle. The noble Baroness, Lady Jay, with her razor-sharp intellect, has pushed for clarity—as she so often does—on the meaning of "seriously deficient performance". I am aware that I have failed totally to satisfy her, but I am sure that she will recognise that clarity in legislation often emerges with time and usage. The decisions of the Committee on Professional Performance will be published and a body of case law developed. With time, the definition will be clearer to us all. The GMC and the NHS Executive will want to ensure that user-friendly guidance is provided both to the public and those in the NHS who deal with complaints and disciplinary matters. This guidance will need to be ready for the start of the new procedures in early 1997.
The noble Baroness, my noble friend Lord Pearson and the noble Lord, Lord Walton, quite rightly explored the reasons why the Bill provided for hearings of the Committee on Professional Performance to be held in private, unless the doctor wishes a public hearing—as, of course, he or she is entitled to do in the interests of open justice and under the European Convention on Human Rights. The General Medical Council has undertaken to review the position after the committee has been hearing cases for three years. Leaving this matter to rules approved by the Privy Council with the further scrutiny of Parliament allows for flexibility. But there should be no fear that embarrassing decisions will be hushed up. The GMC intends that all findings of seriously deficient performance will be made public.
1490 The noble Baroness, Lady Robson, in her usual decisive and probing way, and the noble Lord, Lord Rea, have both questioned the arrangements for cases to be transferred between the GMC's conduct, health and performance procedures. I hope I have been able to reassure them that these matters can be left to rules. The GMC has assured me that its rules will enable the swift passage of cases between the conduct and performance procedures.
The right reverend Prelate the Bishop of St. Albans, on his last day in this House, reminded us that even the Church of England has much to learn in the field of discipline and adjudication and that there is a strong case for compassion in these new procedures. But the GMC's overriding concern must be the need to protect the public. My noble friend Lord Milverton, through his own telling experience, reminded us that even Peers may suffer poor treatment.
My noble friend Lord Harmsworth, in probing the voluntary removal procedures, focused our minds on the structure of Clause 2. With his intervention, we were able to improve the wording of the clause to make it clear that doctors cannot use it to frustrate an investigation into their conduct or performance.
The noble Baroness, Lady Masham, raised the problem of ensuring that doctors undertake remedial training when this is necessary. We do not consider that the Bill needed to include a power to make remedial training a condition on a doctor's registration. However, the Committee on Professional Performance will be able to impose such a condition where the doctor refuses to take remedial action and where there has been no improvement in performance.
The scope of the Bill has been widened with the co-operation and encouragement of all parties. We have been able to include two important measures: one to protect the interest of the public by extending the GMC's powers to impose interim suspension until the outcome of the case is decided; the second to aid the treatment of the doctor in the health procedures. At present a doctor is required to go before the health committee each year while under suspension. The Bill will enable the committee to suspend the doctor indefinitely while giving the doctor the right to a further hearing once every two years.
I should also particularly like to mention the very knowledgeable and wise contributions from the past presidents of the GMC—the noble Lords, Lord Richardson and Lord Walton. At times it has been difficult to find anything further to add to what they have said.
I hope that Sir Robert Kilpatrick will see the passing of this Bill as a fitting tribute to his presidency of the General Medical Council. I know that the work he has started will be ably taken forward by his successor, Sir Donald Irvine.
Finally, I should like to thank the officials who have helped me with this Bill and for the co-operation I know they have given to Members of this House seeking information. They have worked with diligence. They 1491 suffered the inconvenience of some of your Lordships' rather strange timekeeping—or, I should say, lack of timekeeping. I am grateful to them for their patience.
We have discussed this Bill thoroughly. I thank all noble Lords who have taken part. Your Lordships' scrutiny has again demonstrated the importance of this House as a revising Chamber. The Bill, although small, is important, in that it marks the determination of the General Medical Council to grasp thorny issues in the interests of patients and the good name of the medical profession. I commend the Bill to the House.

§ Baroness Jay of Paddington
My Lords, since this Bill was first introduced in another place, we on these Benches have supported its principles. We now wish it a smooth passage on to the statute book. The General Medical Council has rightly recognised the need to extend professional self-regulation so that an assessment can be made and, if necessary, sanctions be applied to a practitioner whose professional performance may be deficient. That is clearly appropriate today, when the increased use of medical technology and rapidly expanding scientific knowledge, together with rising levels in patients' expectations, place new demands on doctors.
We have been very grateful for the detailed and helpful briefings and background information that the GMC provided. We were particularly grateful for the way in which some of the points that we on this side of the House made in debate have been incorporated in its new guidance to the medical profession—even though none of our amendments was successful.
Noble Lords will be aware, as the Minister reminded us, that the General Medical Council has in the past few weeks fulfilled an earlier commitment to issue new professional standards of guidance. This comprehensive pack of booklets called Duties of a doctor replaces the old "blue book" which was discussed at length and in various contexts at earlier stages of the Bill.
The new guidance contains new duties. For example, one of the important issues that we on these Benches and other noble Lords raised at Second Reading and in Committee is the difficulty of regulating that area of a doctor's performance that relates to a doctor's personal behaviour, to his or her personal "bedside manner". It is something that may be of great significance to a patient. I am therefore very pleased indeed that the new guidelines strongly emphasise these matters. In fact, the headline principles included in every booklet and on the front cover of the folder containing them, include the following points: In particular as a doctor you must … respect patients' dignity and privacy; listen to patients and respect their views; give patients information in a way they can understand; respect the rights of patients to be fully involved in decisions about their care".
Although these principles are not enshrined in the legislation, the new guidance goes a long way towards meeting the concerns that we raised at earlier stages.
1492 I am less happy that the specific issues we raised about methods of financing the remedial retraining for defaulting doctors have not been resolved. Noble Lords will remember that I, together with the noble Baroness, Lady Robson of Kiddington, introduced amendments in Committee to try to ensure that no doctor should have to pay personally for retraining, and that the cost should be borne by public funds. Even at this very late stage, there still seems to he an anomaly in the Bill; namely, a hospital doctor can have his or her retraining fees paid by the employing NHS trust, but a general practitioner may have to pay up to £20,000 from his or her own budget for the retraining. I understand, from a conversation today, that the British Medical Association and the Department of Health are still in discussion regarding this situation. I hope that it can he satisfactorily resolved before the Act comes into operation.
It is also disappointing that the attempts of my noble friend Lord Rea at Report stage to try to rationalise the somewhat cumbersome procedures of the General Medical Council committee structure was resisted; although I must say on my noble friend's behalf that he is grateful for the Minister's replies to his queries which she was kind enough to pass to him in correspondence. Unfortunately, my noble friend cannot be present tonight. He feels that many of the points he raised were covered in the correspondence from the Minister. I thank my noble friend Lord Rea for his support during the passage of the Bill. He is certainly not at the disastrous end of the spectrum of medical practitioners but he does have longstanding experience in general practice and wide connections in the medical profession. These provided a useful touchstone against which we could evaluate some of the proposals.
I also thank the Minister for her very clear explanations at every stage of the sometimes complex procedures for which the GMC provided and which clearly govern all the instances that might arise. I thank her, too, for her helpful response to our amendments. It was noticeable that in several of her replies—indeed, the noble Baroness herself mentioned this in her remarks this evening—the Minister emphasised that she and the Department of Health are relying on the General Medical Council to fulfil informal understandings about some of the necessary regulation that must he complied with; for example, as the noble Baroness mentioned, to review the "in camera" committee proceedings after three years.
We must all have confidence that the GMC will be able to make the new law effective, in spirit as well as in practice. There is every chance that the Bill will improve the regulation and, indirectly, the performance of the medical profession, as well as improving patients' confidence in their ability successfully to protest at inadequate treatment. The front cover of Duties of a doctor has the following noble aspiration: Patients must be able to trust doctors with their lives and wellbeing. To justify that trust, we as a profession have a duty to maintain a good standard of practice and care and to show respect for human life". 1493 Those are very welcome sentiments. We hope that the Bill will ensure that they are put into practice. I wish it every success.

§ Baroness Robson of Kiddington
My Lords, on behalf of these Benches, I welcome the passing of this Bill. It has been of great comfort to all of us who are interested in it that it has support on all sides of the House, and also that it originated from the General Medical Council itself. I add my congratulations to Sir Robert Kilpatrick for the great work that he did in getting this Bill placed before the House.
I agree with the noble Baroness, Lady Jay: we are sad that we were not able to resolve the problem of who pays for a general practitioner's retraining. However, you cannot win all the time. I thank the Minister particularly for the way in which she guided the Bill through this House. She is always patient, even when she cannot give us what we want.
I should particularly like to thank her for the long letter that she wrote to me in reply to the point that I raised on Report about the interval that ensues after a doctor has been in front of the Professional Conduct Committee and before he can be brought before the Professional Performance Committee. I quite understand what she says—that the matter would then have to go back to the assessment committee and the doctor would have to be given another 28 days' notice of a meeting. I understand from her letter that the rules of the GMC will make certain that he can go from the Professional Conduct Committee direct to the screener for the Professional Performance Committee. That ought to make the hiatus between the two hearings shorter. When there is something wrong with a doctor's performance, I was concerned that he should be allowed to practise for a fairly lengthy time before coming before the Professional Performance Committee. So I am pleased that the time has been shortened.
I should like to join in thanking the noble Baroness the Minister very much for the way in which she has conducted the passage of the Bill. I wish it well.