rose to move, That the draft order laid before the House on 4 June be approved.
The noble Baroness said: My Lords, this draft order is the second in a series of affirmative resolution orders. These form part of the Government’s reform and modernisation of the regulation of the healthcare professions. Noble Lords will be familiar with this and may recall that we debated similar reforms in respect of the Nursing and Midwifery Council early last month.
The aim of the reforms is to enhance public confidence in the ability of the healthcare regulatory bodies to protect the public interest and to deal with poor performance and professional standards. Public concerns and doubts based on perceived partiality of the regulators have threatened to undermine patient, public and professional trust in the system of professional regulation. These concerns have been highlighted by a number of high-profile inquiries, with which, by now, the House will be familiar.
The order is part of the process of implementing the recommendations of those inquiries. It makes various amendments to the framework legislation for the regulation of doctors, opticians, osteopaths and chiropractors. The main changes relate to the governance arrangements of the General Medical Council, the General Optical Council, the General Osteopathic Council and the General Chiropractic Council. Those changes include: moving each of those bodies from a partially elected to a fully appointed council, in response to the recommendation from Dame Janet Smith that professional interests should not unduly influence council members; members to be appointed by the independent Appointments Commission against specified skills and competences; provision for a separate constitution order to specify the numbers of lay and professional members and their terms of office; and provisions with respect to the suspension and removal of members, which will make it easier to remove council members who do not come up to the standards that we would expect of professional regulators. Each council has put forward proposals that will ensure parity between lay and professional members. The councils will all be smaller than at present, making them more board-like and strategic. There will also be changes to the provisions relating to the regulators’ committee structures to make them less prescriptive.
The order makes a number of other miscellaneous amendments. I will outline those most worth noting. For the first time, each council’s annual report will have to include a description of the arrangements that the council has put in place to ensure that it adheres to good practice in relation to equality and diversity. Each regulatory body will be able to strike off registrants who are barred from working with children or vulnerable adults when the new independent barring board is established. Finally, the GMC will be able to register anyone whom it considers suitably experienced as a doctor—such as recently retired doctors—in an emergency such as pandemic flu.
There are special arrangements for the registration of osteopaths and chiropractors with older UK qualifications that are not recognised under current legislation. This change is made at the request of the two regulators concerned and will enable them to make rules to deal with some practitioners who did not benefit from the original transitional provisions that enabled such people to register at the time their registers were first opened. All these measures are supported by each of the regulatory bodies covered by the order and I commend them to the House. I beg to move.
Moved, That the draft order laid before the House on 4 June be approved. 21st Report from the Joint Committee on Statutory Instruments.—(Baroness Thornton.)
My Lords, I thank the Minister for introducing this order, which for us on these Benches is not a matter of controversy, as its content has been the subject of extensive consultation and debate outside this Chamber as well as within it. As the Minister has helpfully explained, the order covers four or five main subject areas, as well as a number of subsidiary ones, which I will not repeat.
I welcome in particular the changes to the powers of the GMC in relation to medical education. This is not something that we have debated previously. Up to now, the Medical Act has contained a list of bodies entitled to hold qualifying examinations. Any changes to that list have needed an amendment to the Act, which is extremely cumbersome, as well as approval by the Privy Council. The order removes the list from the Act and gives responsibility to the GMC to maintain and publish the list of recognised institutions. I welcome that change. We should, of course, note that it will not in any way affect the standards that medical schools are required to meet or indeed the standing of the education committee of the GMC. I do not personally believe that anything has been lost by removing the Privy Council from the approvals process. The whole thrust of this and related legislation is to make medical regulation more independent but at the same time more accountable. This change runs with the grain of that approach.
Perhaps I could conclude briefly with some questions. The order provides for the GMC to keep an emergency powers doctors list, which will allow for suitably experienced people to help as doctors during an emergency. It would be helpful to hear from the Minister what “suitably qualified” means here and whether it has been defined in any detail. I understand that this provision is part of a package of measures that would enable the Government to respond flexibly in an emergency, but I wonder whether the Minister could say something about the safeguards governing the use of such powers.
The order also proposes the reconstitution of the GMC, the General Osteopathic Council, the General Optical Council and the General Chiropractic Council as fully appointed bodies, with all councils having parity of membership between lay and professional members. Can the Minister say how the Appointments Commission will be advised about the professionals who are to be appointed? How exactly will that nomination process work and to what extent will the GMC be able to set the criteria on which potential appointees are chosen?
Finally, when will the order be reviewed to establish whether it is having the desired effects? It is quite important that such a review should take place after a suitable interval, although I do not doubt that any problems with the order’s implementation will come to the surface naturally. However, we need to assess in a formal way the costs and benefits of implementing it. Some of the provisions are likely to show a welcome saving in terms of costs, but others may result in the opposite, and we need to take stock of those.
My Lords, like the noble Earl, Lord Howe, I do not wish to repeat debates that have been held in this House extensively over the past two years in the light of Dame Janet Smith’s major report. It is worth noting that these orders reflect a high degree of consensus among the professions about how they need and wish to change to ensure that the standards of practitioners within their different professions are not only maintained but extended.
I agree with most of what the noble Earl, Lord Howe, has said. I do not wish to repeat it. I simply wanted to ask three questions. First, under the GMC’s powers to approve doctors, who will be able to practise in times of emergency? Will there be a fitness-to-practise process through which they will have to pass to be on a list in advance of an emergency? Secondly, will those powers deal with qualified doctors who are asylum seekers in this country—an issue that has been raised in your Lordships’ House on different occasions—and with whether they would be allowed to practise in a time of emergency? I very much welcome the requirement of the councils to reflect diversity in their make-up.
Finally, I echo a point made by the noble Earl, Lord Howe. We are going through a major change in the regulation of professionals. Welcome though that is, the momentum behind it was a terrible scandal, in which hundreds of people died. The process of review is important. We never again want to be in a position where a scandal of that magnitude is required to make revisions that are deemed necessary. It is also the case that, whenever there is major change, there will be unintended consequences. The enthusiasm of the professions may wane when these orders are enacted. Can the Minister be a bit more definite than she was on the last order about the timescale of a review? It would be advisable to have a review within three years of these arrangements.
My Lords, I am feeling rather left out of this order. I am probably the only person in the Chamber who does not know the answer, but can the Minister tell me why the Dentists Act is not involved at this stage? I had a useful conversation with the Department of Health about 10 minutes ago and I gather that similar changes are subject to another Section 60 order, which will be laid at a later date. It is something to do with the Scottish Parliament and the devolution settlement. Can the Minister tell me when that is likely to happen and why amendments to the Dentists Act are different?
My Lords, I thank the noble Earl and the noble Baroness for their welcome for this order and their constructive comments. I hope that I can answer some of their questions more definitively than on the previous order. Who will be on the panel making the new appointments is a matter for the Appointments Commission and the regulatory body to determine. The usual practice will be for a panel of three members, although in some circumstances there may be more—for example, when they are appointing a chair. The panel will consist of the Appointments Commission, an independent assessor and someone nominated by the regulatory body. It will make appointments in consultation with the regulatory body.
In 2011, there will be a review of the governance arrangements of all these regulators. The noble Baroness, Lady Barker, was quite correct in her remarks.
The temporary registration of suitably experienced doctors in an emergency is an issue that we will take forward with a protocol. It will be developed by the GMC and there will be no statutory definition. In relation to asylum seekers, it has not yet been decided who will be registered under these provisions, although recently retired doctors are the most obvious candidates. It has not been decided to rule out doctors from overseas who have not yet been through the registration process, but neither has it been decided to rule them in. That is still a matter for discussion.
A variety of other questions is also being discussed, including whether the GMC will be looking at part of the protocol and how it will develop this in terms of gaining EU practices to operate elsewhere. All those things still have to be discussed as part of that protocol.
There will be a separate order covering the General Dental Council, the Health Professions Council and the Royal Pharmaceutical Society. They are in a separate order—I am coming to know and love Section 60—because, as the noble Lord said, these provisions have to go before the Scottish Parliament. There are devolution issues to be resolved, but I am sure that I will be here in due course talking about dentists and pharmacists. I think that that covers most of the points about fitness to practise. The White Paper makes a commitment to cover the system of regulation in 2011. The order covering dentists will come forward before the end of the year.
On Question, Motion agreed to.