National Health Service Reform and Health Care Professions Bill
Baroness Northover (Liberal Democrat)
My Lords, in moving Amendment No. 62, I wish to speak also to Amendments Nos. 63 to 65 and 67 to 72. We are now moving on to consideration of the regulation of the medical professions. This is a major area in the Bill. It is here that we have the proposal of a lay dominated overarching committee with in effect control over the health professions. That is a change which should be made after full consideration of what we are doing, why and whether that is the best way to proceed.
When we considered this matter in Committee, we started at 10.45 p.m. on Thursday 11th April and we concluded our session at 12 minutes past midnight on Friday 12th April. That is not a recipe for careful and considered appraisal of what is a major change in the accountability and arrangements which have been in place for the health professions in some cases for well over a century and a half. I hope that we shall be better placed today to do this subject justice. We are again at the tail end of the Bill as before, but the hour is not quite so late.
The medical profession was the first to professionalise, with others following later. Self-regulation has always been part of that. There are pros and cons to that and I have no problem whatever with the notion that at the beginning of the 21st century we should reappraise that. Professor Kennedy's report on Bristol and his proposals for linking the professions have acted as a catalyst for that and must be seriously addressed. I welcome the fact that the various professions have played a full part in such discussions. Co-ordinating standards, spreading good practice and monitoring performance, as suggested by him, are all worthwhile objectives. It is clearly also vital that the various health professions should be more accountable and more transparent as well as better co-ordinated.
The Kennedy report proposed that an overarching council should report directly both to the Department of Health and to Parliament and should have a broadly-based membership, including representatives of the health professions of the NHS and the general public. It is now up to us to assess whether, with this blueprint, the Government have now come forward with a sensible proposal.
As I mentioned previously, there is a danger that the Government are proposing a quango to second-guess what the regulatory bodies are doing without the depth of knowledge and experience that they have. We are in serious danger of bogging down this council in looking at endless complaints against the profession by jaundiced patients even if the council then rules the complaints not worthy of further consideration.
However, we agree that in addition to co-ordination and a spread of good practice the time has come for greater accountability of the professions to the public and for there to be greater transparency. In that respect we agree with the Government although, conspicuously, the Minister trod very gently around the subject in Committee.
It is not enough for the Minister to argue, as he did in Committee, that Select Committees can call the various regulators before them. We need a more systematic way of ensuring accountability on a regular basis and not simply when things go wrong. We retain serious doubts about making the health profession accountable to yet another quango. The Government's proposal does not make each of the professions answerable to Parliament. As the noble Earl, Lord Howe, said, all is done at one remove via the council. Such accountability should surely be by the shortest route and enable each regulatory body to be cross-examined.
Therefore, we propose that those bodies which regulate the health professions should be accountable directly to Parliament. We propose that the health bodies should report each year to a Joint Select Committee appointed by the House of Commons and House of Lords. They should report in public and that is where they should answer and be scrutinised.
The Minister said that the Government have no power to request the establishment of such a committee. I thank him for the letter he sent me on the matter which unfortunately arrived after the deadline for amendments. However, he had made clear his views in Committee. I submitted the amendments, therefore, in the knowledge of where he stood. The Minister said that he can have no view on the idea of a Select Committee as he cannot dictate what Parliament does or does not do. That is true enough. But, as he knows, that is not the whole story. After all, the Government could bring forward such a proposal to be debated in both Houses which could decide to set up such a Joint Select Committee. Select Committees are set up through the usual channels. We all know what the usual channels are and they do not exist in isolation from the political parties or government. A "usual channel" is sitting on the Front Bench. I served on a Select Committee on stem cell research.