§ 7.46 p.m.
§ Baroness Gardner of Parkes
My Lords, I beg to move that this Bill be now read a second time. I am pleased to sponsor this Bill brought from another place, where it was so ably dealt with by Sir Michael Shersby.
Pharmacy is a profession in which I have taken an interest for many years. As chairman of the Royal Free Hospital NHS Trust, I am very familiar with the excellent work that is done by pharmacists in the hospital service. I also know many community pharmacists. I am a great supporter of the valuable service which an effective community pharmacist provides to his local population. As a member of another healthcare profession, I am acutely aware in that capacity that all of us as prescribers or patients depend on the pharmacist to do his job carefully and accurately. (Throughout my speech whenever I refer to "his" I also include "hers".) Dispensing the wrong medicine to a patient can have very serious consequences. Errors in labelling or the giving of the wrong advice about how and when to take medicine, or whether it is safe to drive or to drink alcohol with the medicine, can also be crucial to the safe and effective care of the patient.
When one thinks about it, it is easy to appreciate that a pharmacist suffering from an illness that affects his ability to perform his critical tasks may need to refrain from practice or to practise only under conditions that ensure that any risk to the public is minimised. Of course, in many cases the pharmacist will take responsible action to deal with his health problem. He will stop work or restrict his work while he recovers. There are occasions when that does not happen. The Royal Pharmaceutical Society of Great Britain, which is the professional body for pharmacy, currently has no powers to act in the few cases where the competence of pharmacists is affected by physical or mental ill health or drink or drug-related illness and they do not voluntarily cease to practise. The society wishes to have 1511 these powers. This Bill seeks to create a new mechanism to enable the society to protect the public in these circumstances.
The most acute problems that have been brought to the attention of the society by colleagues, family or patients concern pharmacists who apparently have been suffering from mental illness but have been unable or unwilling to acknowledge any health problem. In addition to mental health problems, physical conditions can affect competence. For example, a pharmacist who suffers from poorly controlled diabetes which affects concentration can as a result make dispensing errors.
This Bill provides for a new committee of the society to be set up—a health committee—to hear cases where it appears that a pharmacist may not be fit to practise. I believe that the cases will be few in number, but the House will recognise the importance of having procedures to deal with these cases. It is essential that any action necessary to protect the public from error occurs as soon as possible and, whenever possible, before any harm occurs.
The Royal Pharmaceutical Society is under a duty to maintain a register of pharmaceutical chemists, and no person may act as a pharmacist in Great Britain unless his name is in the register. The health committee will therefore have jurisdiction over all registered pharmacists in Great Britain. Northern Ireland has its own pharmacy legislation and its own professional body, the Pharmaceutical Society of Northern Ireland, and that is why the Bill does not extend to the Province.
The profession of pharmacy in Great Britain is governed by the Pharmacy Act 1954. The Act establishes a disciplinary committee, the statutory committee, which has power to remove pharmacists from the register of pharmaceutical chemists, but only following a conviction or serious misconduct. The statutory committee has no jurisdiction in the case of a pharmacist before he has done wrong. For the society to be aware of a problem but not be able to act until the pharmacist has committed an offence is clearly unsatisfactory.
While commenting on this, I wish to pay regard to the excellent work that the husband of Baroness Flather has done as chairman of that committee over many years. She is here; I thought it would be a pity if she was not here, but as she will no doubt speak later, I will reply on that point then.
Health care professions which are governed by more recent legislation, including the medical, dental and nursing professions, have procedures in their governing statutes for dealing with ill health among their members. This Bill will do the same for pharmacy.
It may reassure Members of the House to learn that the society has in recent years established voluntary and benevolent schemes to help pharmacists suffering from ill health or stress. These will continue. Where a pharmacist who is too ill to practise recognises this and voluntarily ceases to practise while he recovers his health, there will be no need for the procedures provided in the Bill to take place.
1512 I hope I can explain briefly what this Bill will achieve. First, it will establish a committee of the Royal Pharmaceutical Society of Great Britain to consider allegations against pharmacists of unfitness to practise due to ill health. A case will be heard by a tribunal including a medically qualified chairman and a pharmacist. Allegations of unfitness brought to the attention of the council of the society will be investigated and where there appears to be substance to the allegation they will be referred to the health committee for hearing. In cases of urgency it will be possible for a case to be heard speedily, possibly even within a week.
The committee, if it decides that the pharmacist's fitness to practise is affected by ill health, will either make a conditions of practice order or a suspension order. A conditions of practice order may include any conditions which the health committee thinks necessary. Where it is essential to protect the public by suspending the pharmacist's right to practise, the committee will make a suspension order. The committee will specify the duration of the order, but the Bill provides that no order can be made for a period of more than three years, and the committee may review an order at any time. It may, on review, vary or revoke an order or substitute another order if it believes that is what is needed. Procedures for investigating allegations and for hearings and appeals will be specified in regulations.
I will not attempt to explain in full the detailed structure of the procedures established in the Schedule to the Bill, but I would like to draw to your Lordships' attention just three more important points.
First, rights of appeal to an independent appeal body are provided as a right to any pharmacist who is the subject of an order made under the Bill's provisions, and the pharmacist will also have the right at intervals to have the order made in respect of him reviewed.
Secondly, in cases where the health committee considers it essential in the public interest to do so, it may, having heard the case, order the immediate suspension of the pharmacist; in other circumstances the pharmacist will have a period within which to appeal before the decision takes effect, and if he does appeal then (except in the case where interim suspension is ordered) the operation of any order made by the committee will await the outcome of the appeal.
Thirdly, the health committee is under a duty to ensure that any order it makes is the minimum necessary to protect members of the public.
I hope your Lordships will have no difficulty in accepting this Bill and I commend it to the House.
Moved, That the Bill be read a second time.—(Baroness Gardner of Parkes.)
§ 7.55 p.m.
§ Baroness Flather
My Lords, I rise to say a few words on this excellent Bill. My interest has already been declared to some extent by my noble friend Lady Gardner. My husband has served as the chairman of the statutory committee for seven years and therefore what I am about to say really reflects his views. I put these views to your Lordships because my husband is 1513 concerned that there are a few points which might cause difficulties later on, and it is probably much better for them to be looked at at this stage.
Unfortunately, there was not an opportunity for him to be consulted; whether that was due to the pressure of time or whether it just went by the by, I do not know; but he was not consulted as to the contents of the Bill and he is someone who has been asking for such a committee to be established throughout the time that he has served as the chairman of the statutory committee.
As your Lordships may imagine, he has been under great difficulty when faced by situations where there is danger to the public and he has had no alternative but to suspend the pharmacist under the heading of misconduct. Clearly, it has been grossly unfair to the pharmacist to be suspended under that heading when he or she has been suffering from health problems or an addiction of some kind. My husband is therefore absolutely delighted that the matter will now be handled properly and it will be much fairer to the pharmacist.
Some of the points that he has asked me to make to your Lordships are as follows. He feels that a pharmacist ought to be informed under new Section 13B(6) of the Pharmacy Act what steps are being taken to obtain information about him, as it is likely that it could be through a competitor and it would be much better if the pharmacist were informed; it would be much fairer.
In new Section 13C(2) of the Act the words "well-founded" are used, but a standard of proof should be stated and it should be at least on the balance of probabilities. He suggests that, after Section 13C(2)(b), the power to impose conditions which must be complied with before any review of the order is made under Section 13D should be added so that other conditions can be made, such as that the pharmacist keeps in touch with pharmaceutical practice; that he attends for medical treatment for example; that he remains drug free for one year, two years, and so on; or that he produces a medical report on any subsequent review about his condition. That would let the pharmacist know very clearly what was required of him.
As my noble friend has stated, the suspension cannot be for longer than three years. At the present time in the GMC the normal practice is to call in a case some months before the end of the three-year term, unless, of course, there has been reason to withdraw the order earlier, and then to review it to see whether the doctor would be fit to come back into practice after the three years. If there were a further three-year suspension in the case of a pharmacist or doctor, it would be difficult for that professional to return to practice without further qualifications. It is important that that point is clarified.
Under new Section 13G(3) hearsay evidence is excluded. My husband suggests that tribunals normally admit hearsay. It should be left to the legal assessor to decide what is admissible and what is not; or one might have to have the butcher, the baker and the candlestick maker in court to say what happened to them when they went to obtain their prescriptions. That is the current practice of the GMC and the GDC.
1514 Under Schedule 1B, paragraph 2, at least one, and preferably two, members of the committee should be lay members. Safety of the public is one of the criteria. The GMC and the GDC have that. It gives the public more confidence in the body's impartiality. In the procedure contained in paragraph 4(1), my husband suggests that at least one of the members should be a lay member.
The appeals tribunal panel excludes members of the statutory committee. My husband feels that those are the members who have had the most experience of evaluating evidence. He does not understand why the provision is stated in that way. If a case which starts out as a misconduct case turns out to be a health matter when the evidence is heard, it cannot be sent to the health committee. Equally if a case which has been heard by the health committee turns out to be a case of misconduct, it cannot be sent to the statutory committee. Those powers exist for the GMC and the GDC.
Most of the points that have been made are based on GMC and GDC practice rather than that of the osteopaths, which is probably the model for the Bill. Finally, in the next Session I hope to table a Private Member's Bill to give the statutory committee the power to order interim suspension in line with this Bill. For the protection of the public, it is essential—in some cases at least—that the pharmacist should not be allowed to continue practising for at least a further three months.
§ 8.3 p.m.
§ Lord Hacking
My Lords, I intervene briefly, and apologise for not having heard the opening words of my noble friend Lady Gardner of Parkes. I ask for her confirmation that there are provisions allowing for suspension of a professional person on the grounds of unfitness to practise for doctors, dentists, and veterinary surgeons. I receive acknowledgement of that from my noble friend.
It would be helpful to know how far that list extends in relation to health services. It may not occur to your Lordships—I noticed a distinguished Member of your Lordships' House who is a chartered accountant sitting on the steps of the Throne—that lawyers or chartered accountants are in the business of looking after the health of the nation, but these provisions do not exist for lawyers or chartered accountants, who can continue to practise when unfit to do so owing to health problems.
§ 8.4 p.m.
§ Lord Rea
My Lords, we on these Benches welcome the Bill. The only question I have to ask is: why was it not before both Houses a long time ago? I thought that we were aware of all the ramifications and implications of the Bill, but the noble Baroness, Lady Flather, came up with some useful details, obviously emanating from an expert source. I hope that the Minister will be able to answer her noble friend to her satisfaction.
Apart from protecting the public, one of the good things about the Bill is that it will result—perhaps under a certain amount of duress—in sick pharmacists obtaining the treatment which they would probably not have done before when they were denying or unaware of the fact that they were ill.
1515 The noble Baroness, Lady Gardner, said that the Bill had been ably conducted through another place. However, when I looked at Hansard of another place for 17th January, when the Bill came before that place, nothing was said about it except that it was presented, read a second time, went through the Report stage, Third Reading and was passed. Not one word went into Hansard about the Bill's contents. Two cheers for democracy, I say on that one, and in this case three cheers for your Lordships' House, because we have debated the Bill as it should be debated, and it is now on the public record. We have no objection to the Bill, and I hope that it goes through all its stages quickly now that we have aired the various points. I hope that the Minister will be able to satisfy her noble friend about the detailed points that she raised.
§ 8.7 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, I am grateful to my noble friend Lady Gardner for bringing the Bill before your Lordships' House and explaining its contents so clearly. Her experience of the health service, both as a former practitioner and now as one of the most influential trust chairmen in the country, is extensive and her knowledge prodigious. Her fitness to propose the Bill is beyond question.
As my noble friend has said, pharmacists practising in the community and in hospitals play a crucial role in promoting health, and in delivering care. As a profession they have been progressive in taking pharmacy forward. The Royal Society has sought to involve the profession through its document Pharmacy In a New Age, which has resulted in some clear and positive initiatives. It is committed to improving the accessibility and availability of pharmacy services, guaranteeing high standards in the profession, and to ensuring that all pharmacists participate in continuing professional development.
When it comes to dispensing medicines, pharmacists are the experts. Dispensing requires a high level of accuracy—supplying the wrong drug or failing to notice a dose that is too high can be fatal. For general health and medication in particular, patients frequently seek the advice of their pharmacist who may suggest appropriate self-medication.
Increasingly, doctors and pharmacists work closely together. Both in hospital and in the community they have sought to compile agreed formularies and thereby promote effective prescribing patterns and value for money. The pilot schemes for nurse-prescribing have also shown how nurses appreciate the knowledge and advice of community pharmacists, and we welcome these approaches which use all the skills within primary care.
The Government have made clear in their proposals for the NHS and in particular in the National Health Service (Primary Care) Bill (which noble Lords will only be too well aware has just completed its passage through your Lordships' House) their intention to employ pharmacy skills more flexibly and to make the 1516 most of new opportunities. Among other things, the Bill enables pharmacists to provide services such as advice to residential and nursing homes situated in a neighbouring health authority.
Last year, we ran some successful pilot projects which showed how pharmacists can help GPs improve the quality and cost-effectiveness of prescribing. Those ideas are now being adopted right across the country. This year we are running pilot studies into the value of repeat dispensing; supporting patients with compliance problems; and "pharmaceutical care packages" which involve in-depth assessment of patients' needs, carrying out a review of their medication and monitoring their progress.
These roles will build on the services which many pharmacists are already undertaking, such as domiciliary visits to help patients manage their medicines properly or advising residential homes on the storage and administration of medicines.
So the pharmacists' contribution is an essential element in the totality of healthcare; but we know it can be a stressful job and on occasions pharmacists can feel professionally isolated. It is in all our interests that they should be both physically and mentally well, and when this is not the case, it is right that there is a formal system for remedial action. That is the purpose of the Bill.
As my noble friend has said, other professions have provision for health committees with powers to deal with these situations. Doctors, dentists and nurses have health committees quite separate from their disciplinary bodies. In recent years your Lordships have supported Private Members' Bills making statutory provision for the regulation of chiropractors and osteopaths. Both these Acts include provision for separate committees to deal with practitioners who are unfit to practise due to ill-health. Last month the General Osteopathic Council formally came into being; and only last week I announced the designate membership of the first General Chiropractic Council.
The Royal Pharmaceutical Society is anxious that it should have similar powers so that it can deal with the cases which arise. Every profession will include members who, sadly, become ill and the need to protect patients is paramount. That is what this Bill seeks to do. As my noble friend has said, the procedures established by the Bill provide arrangements for the investigation of allegations and the consideration of cases. This should ensure that the health committee will impose only the minimum restrictions necessary to protect the public.
I am very pleased that my noble friends Lady Flather and Lord Hacking support the Bill. Indeed, I thank both my noble friends and the noble Lord, Lord Rea, for making a number of telling points which I am sure my noble friend Lady Gardner will address as appropriate. As it is a Private Member's Bill, it is right that she should do that. The Government strongly support the Bill and commend it to your Lordships.
§ 8.12 p.m.
§ Baroness Gardner of Parkes
My Lords, I thank the noble Lords who have taken part in the debate. In introducing the Bill, I paid tribute to Mr. Flather for his work over seven years and I said that I thought my noble friend Lady Flather was not in the Chamber. Having listened to her speech, perhaps it would have been better if she had not been in the Chamber!
My noble friend pointed out many material improvements which could be made to the Bill. I accept the points that she has made. However, this is a Private Member's Bill and in order for the Bill to become law, it cannot be amended in any way in this House. If it were amended, it would have no hope of achieving Royal Assent. I understand that all these Bills must go through in a matter of minutes in the other place.
The noble Lord, Lord Rea, pointed out that there was no debate on the Bill when it was introduced in the other place and I understand that when it returns there, there is even less time available. Therefore, we must either have the Bill as it is or no Bill at all. That is a very difficult decision. It is true that faults have been pointed out. However, I believe that the Bill still answers a need and I believe that it is appropriate that it should become law.
I take a number of points which my noble friend made; for example, that hearsay is usually admissible in tribunals. That is absolutely true and is an interesting point.
I am pleased that my noble friend's husband is asking for this committee to be established and that he appreciates the difficulty of health cases. I understand that in the past my noble friend's husband will have had to deal with the sort of cases to which she referred under the heading of misconduct when really they were health cases. I am sure that he has handled those matters very sensitively and well, but that has not been an easy process. Therefore, it is important that there should be the change to a health committee and I am glad to hear that my noble friend's husband supports that.
The point was raised as regards what investigations should be carried out. I believe that the pharmaceutical committee should have the right to inform someone of what investigations it is carrying out, if it wishes to do so. That might be something that the Royal Pharmaceutical Society could look at, to see whether there would be any greater fairness if that could be done. That society is a highly reputable body which would want to do whatever was best.
It is probably deliberate in the Bill that disciplinary committee members cannot serve on the health committee. I believe that there is a deliberate separation of discipline from health matters. I do not believe that that is in the Bill by accident. The Bill has been drafted deliberately in that way. However, as I said, because it is a Private Member's Bill we cannot alter it in this House if we wish it to become law. I thank my noble friend Lady Flather for the issues which she has brought before the House. I hope that she will explain to her husband that we are in a procedural difficulty in relation to this matter and we wish to ensure that at least some powers exist.
1518 I support strongly the point she made that there should be a Bill to give interim suspension orders to the disciplinary committee. That leads me to the point made by my noble friend Lord Hacking that dentists and doctors have that power. I was involved in that legislation, which was brought forward about a year ago. I understand that those provisions are working quite well. My noble friend asked me about veterinary surgeons and I am afraid that I do not know anything at all about them. I do not know whether they come into the accountants' and solicitors' category or that of doctors and dentists. Therefore, I am unable to help him on that. But I know that we have dealt with interim powers of suspension for doctors and dentists. There is a need for the disciplinary committee to have those powers. My noble friend Lady Flather and I have discussed that point often in general conversation. It has been recognised only in recent years how important it is to give immediate teeth to the professional bodies so that they can protect the public.
I hope that your Lordships will give this Bill a Second Reading and I thank all noble Lords who have taken part in the debate.
§ On Question, Bill read a second time, and committed to a Committee of the Whole House.