Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I beg to move amendment No. 137, in page 21, line 2, leave out `49M' and insert `49MA'.

Mr John Maxton (Glasgow, Cathcart, Labour)

With this it will be convenient to take Government amendment No. 162.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

The provisions of amendment No. 162 will prevent a practitioner who has been disqualified from a health board list by an NHS tribunal in Scotland or Northern Ireland from being included on any list in England or Wales. Specifically, it enables the Secretary of State to make provisions in regulations to recognise the decisions of Scottish and Northern Irish tribunals in England and Wales. It is essential to ensure that there are robust arrangements across the UK so that practitioners removed from lists in one area of the country do not appear in another area. Contractors who are unfit to practice in Scotland or Northern Ireland are likely to be unfit to practice in England or Wales. Indeed the FHSAA will not be able to overturn or review a decision of a Scottish or Northern Irish tribunal. I am sure that everyone will agree that this is an important provision to ensure patient safety. Amendment 137 makes a consequential change to the numerical reference in the clause to reflect the addition of the new section.

Mr Desmond Swayne (New Forest West, Conservative)

I could have dealt with this point in an intervention, but I failed to catch the Minister's eye. I was wondering about the degree of discretion that the amendment appears to give the Secretary of State. I refer specifically to the phrase in parentheses and ``whether or not exactly'' the two things may correspond to what has happened in a health board in Scotland, for example, as against the circumstances in England. Can the Minister give an example to bring that to life so that we can understand precisely what is meant?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I believe, and I will certainly write to the hon. Gentleman if I am wrong, that because the tests that we are introducing on suitability, efficiency and fraud into the English legislation do not mirror directly the tests applied by the NHS tribunals in Scotland and Wales, which currently have the test of efficiency, they do not map on to each other directly. It will be necessary to allow one to be translated into the other to achieve the same effect.

Amendment agreed to.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I beg to move amendment No. 138, in page 21, line 23, leave out from `they' to `with' in line 26 and insert

`so decide, they must impose such conditions as they may decide on his inclusion in the list'.

Mr John Maxton (Glasgow, Cathcart, Labour)

With this it will be convenient to take Government amendments Nos. 139 to 141 and 150.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

This group of technical amendments clarifies the provisions of the Bill in relation to the health authority's power to make a contingent removal from its main practitioner list when dealing with inefficiency or fraud. The most substantial changes are made by amendments Nos. 138 and 139, but they essentially clarify the policy intention rather than change direction or add a new function. Amendment No. 138 makes it clear that if a health authority makes a contingent removal it must apply conditions on the practitioner with a view to removing any prejudice to the efficiency of the NHS or preventing further fraud. Essentially, if one limits a person's scope to practise because of a particular problem, one must limit it in a way that deals with the problem.

Amendment No. 139 clarifies that where a practitioner fails to meet any such conditions, a health authority can vary them, apply new ones, or remove the practitioner from the list. Amendment No. 150 is a consequential drafting amendment. Amendments Nos. 140 and 141 are technical amendments to ensure clarity of the powers in the clause. I hope that that is sufficient for the Committee.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

I have a brief question. The Minister used the word ``contingently''. This may not be the place to ask, but could he tell me the difference between ``contingently'' and ``conditionally''? It seems a rather nice distinction.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I have a helpful note from my officials somewhere in my notes explaining that difference, but I will have to rely on my memory. Conditional has the sense that a practitioner should fulfil certain conditions, whereas contingent essentially means that he should not do certain things. I think that that is the underlying difference. Clearly it does not make sense to say that it will be conditional on someone who has been found guilty of fraud not to handle money. That would be an odd use of the English language; instead, it would be contingent on them not handling money. That is the difference in the English language. I bow to the superior wisdom of parliamentary counsel that this is the correct way of doing it.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

For the record, the Minister did that without the benefit of any notes, and we are all terribly impressed, but why did parliamentary counsel not have a look at the dictionary when drafting the original Bill?

Amendment agreed to.

Amendments made: No. 139, in page 21, line 30, at end insert—

`(3A) If the Health Authority determine that the practitioner has failed to comply with a condition, they may decide to—

(a) vary the conditions, or impose different conditions, or

(b) remove him from their list.'.

No. 140, in page 21, line 31, after `may' insert `decide to'.

No.141, in page 21, line 38, after `49G' insert

`(other than in circumstances falling within paragraph (b))'.

No.102, in page 21, line 40, leave out `Council' and insert `body'.—[Mr. John Denham.]

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I beg to move amendment No.142, in page 22, line 5, after `case' insert—`(a)''.

Mr John Maxton (Glasgow, Cathcart, Labour)

With this it will be convenient to take Government amendment Nos. 143 and 144.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

The provisions in new section 49H in the Act provide that a health authority may suspend a practitioner while it decides whether he should be removed or contingently removed from a list. In such cases the health authority must specify the period. If the period has expired, amendment No. 143 enables the health authority to continue the suspension for a further specified period.

We do not propose the suspension of family health service contractors to continue indefinitely. We have no desire to recreate in the family health services some of the problems that have been encountered, for example, with the suspension of consultants in hospital services, which we are as Government anxious to deal with. It is in everyone's interest to ensure that the period of suspension is kept to a minimum, but there are cases in which it will be necessary to extend an initial period of suspension while further enquiries are made or a regulatory body considers the case.

Contractors need to be protected from the uncertainty of indefinite suspension. Amendment No. 144 clarifies that if a health authority imposes an initial period of suspension which is running out and then imposes a further period of suspension, the total period of suspension, including the initial period, may not normally exceed the six months set out in the Bill. If a health authority wishes to continue a suspension beyond six months it will be required to make representations to the appeal authority, just as it would have done had it made an initial suspension for a six-month period

Amendment agreed to.

Amendments made: No. 143, in page 22, line 7, at end insert

(b) if that period has expired, they may impose a further suspension, for a period which they must specify.'.

No.144, in page 22, line 9, after `case)' insert `,

including in both cases the period of any further suspension imposed under subsection(4)(b),'.

No.103 in page 22, line 28, leave out `(4)' and insert `(6)'.—[Mr. Denham.]

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I beg to move amendment No. 145 in page 22, line 37, after `and' insert `(except in prescribed cases.)'.

Mr John Maxton (Glasgow, Cathcart, Labour)

With this it will be convenient to take Government amendments Nos. 146, 148, 104 and 149.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

Amendment Nos. 145, 148 and 149 clarify the circumstances in which a health authority may or must carry out a review of contingent removal or suspension and the decisions they are able to reach as a result of the review. Amendment No. 146 prevents a health authority from being able to review—

Mr Desmond Swayne (New Forest West, Conservative)

Can the Minister explain what `except in prescribed cases' refers to? Presumably it is the same prescribed cases as are in subsection 5A but could he just explain what those might be?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

Amendment No. 146 prevents a health authority from reviewing a decision of the appeal authority to impose a contingent removal or suspension on a practitioner. It would be wholly inappropriate for a lower level body, the health authority, to be able change the decision of a higher level body, the appeal authority, hence the reference to ``except in prescribed circumstances'' in relation to a health authority's ability to review a decision. That is what is inserted by amendment No. 145. Amendment No. 104 removes the provision for a health authority to be able to shorten a period of suspension on review.

Amendment agreed to.

Amendments made: No. 146, in page 22, line 39, after 'than' insert

`a contingent removal or a suspension imposed by, or'.

No. 147, in page 22, line 44, leave out `conditionally' and insert `contingently'.

No. 148, in page 22, line 46, at end insert—

`( ) confirm the contingent removal or the suspension,'.

No. 104, in page 22, line 47, leave out 'or shorten its period'.

No. 105, in page 23, line 1, leave out `conditional' and insert `contingent'.

No. 149, in page 23, line 2, after `conditions,' insert `impose different conditions,'.

No. 106, in page 23, line 2, leave out `conditional' and insert `contingent'.—[Mr. Denham.]

Mr Desmond Swayne (New Forest West, Conservative)

I beg to move amendment No. 179, in page 23, line 7, leave out `21' and insert `28'.

The amendment would extend the time by seven days in which a general practitioner has the right of appeal to the Family Health Service Appeals Authority. The provision of an extra week is consistent with the period for an appeal to the General Medical Council. We regard those two appeal procedures as similar in their consequences for the practitioner if he were delisted. If his accreditation were removed by the health authority, it would be a career-threatening move. Therefore, we think it consistent to equalise the time period.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

We agree with the thrust of the amendment, for the reasons given. However, we have examined the drafting and found it flawed. If the hon. Gentleman withdraws the amendment, we will introduce amendments on Report.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

Will the Minister explain what is wrong with our amendment, as it simply changes the number 21 to 28? The Government may find it disagreeable to accept Opposition amendments, but the Minister is being a bit ingenuous in suggesting that we withdraw our 28 so that he can introduce his 28 on Report.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

If he wishes, the hon. Gentleman is welcome to take up Opposition time on Report in moving the necessary consequential amendment required on page 23, line 22 to proposed section 49J)(5)(a). However, I offer to use Government time on Report for that purpose.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

It was a perfectly simple question and, as it turned out, it has a relatively simple answer. I simply wanted to ascertain that the Minister was not simply being churlish in refusing to accept the Opposition amendment.

Mr Desmond Swayne (New Forest West, Conservative)

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendments made: No. 150, in page 23, line 11, after `49F' insert `or 49G(3A)'.

No. 107, in page 23, line 12, leave out `conditionally' and insert `contingently'.—[Mr. Denham.]

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I beg to move amendment No. 151, in page 23, line 14, after '49G' insert

`, or to vary any condition or to impose any different condition under that section'.

Mr John Maxton (Glasgow, Cathcart, Labour)

With this it will be convenient to discuss the following amendments: No. 180, in page 23, line 14, after '49G', insert

', or to vary the terms of service of the person concerned for the purpose of or in connection with the imposition of any such conditions.'.

Government amendments Nos. 152 to 154 and 161.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

The amendments deal with contingent removals and appeals to the Family Health Service Appeals Authority; they clarify the precise nature of the practitioner's appeal rights. Amendment No. 151 makes it clear that a practitioner can appeal to the FHSAA, against not only the health authority's original decision contingently to remove him but any further health authority decision to vary or change the conditions imposed on the practitioner in pursuance of a contingent removal.

Amendment No. 180, tabled in the names of the hon. Members for Woodspring and for Runnymede and Weybridge, and Government amendment No. 152 are designed clarify that a practitioner would have the right to appeal to the FHSAA against any health authority decision to vary his terms of service in pursuance of a contingent removal. That is an essential safeguard, so I am pleased that it has support from both sides of the Committee. I propose that amendment No. 152 is accepted, which I hope will meet the Opposition's concerns.

Amendments Nos. 153 and 161 clarify the position on the rights of appeal. As we have already discussed, the policy intention is that there should be no right of appeal against the decision to suspend. That will be a statutory, time-limited, neutral act, and we want efforts to be focused on addressing concerns and not on legal process. A right of appeal will be available against a decision to remove or contingently remove. The amendments tighten the drafting of the clause, so that it cannot be read in a way that infers a right to appeal against a decision to suspend.

Amendment 154 provides for the practitioner or health authority concerned to apply to the FHSAA for the conditions of a contingent removal imposed by that body to be varied, replaced or revoked.

Mr Desmond Swayne (New Forest West, Conservative)

I acknowledge that the purpose of amendment No. 180 is achieved by Government amendment No. 152. Before I ask leave to withdraw the amendment, I want to put it in on the record that we tabled our amendment first.

Mr John Maxton (Glasgow, Cathcart, Labour)

Order. The only amendment moved in a group is the first on the list. The hon. Gentleman's amendment was not moved.

Amendment agreed to.

Amendments made: No. 152, page 23, line 14, at end insert—

`( ) to vary his terms of service (under section 49G(4)),'.

No. 153, in page 23, line 15 after `review' insert `of a contingent removal'.

No. 154, page 23, line 19, at end insert—

`( ) If the FHSAA decides to remove the practitioner contingently, the Health Authority and the practitioner may each apply to the FHSAA for the conditions imposed on the practitioner to be varied, for different conditions to be imposed, or for the contingent removal to be revoked.'.

No. 108, in page 23, line 21, leave out `conditional' and insert `contingent'.—[Mr. Denham.]

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I beg to move amendment No. 155, in page 23, line 31, leave out `and'.

Mr John Maxton (Glasgow, Cathcart, Labour)

With this we may take Government amendments Nos. 156 and 157.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

In new section 49K in clause 26, there is already provision for the appeals authority to decide to nationally disqualify a practitioner from the principal and supplementary lists of all health authorities; it was referred to earlier as national disqualification. However, in the Bill as drafted there is no reference to national disqualification from the PMS or PDS lists, which we shall discuss in clause 27. Amendment No. 157 inserts a reference to those services lists that correct that anomaly and therefore enables the FHSAA to disqualify a practitioner from all lists. Amendment No. 155 is a consequential amendment that corrects the grammar and amendment No. 156 is similarly a drafting amendment.

Amendment agreed to.

Amendments made: No. 156, in page 23, line 32, leave out `practitioners' and insert `individuals.'

No. 157, in page 23, line 34, at end insert—

`and

( ) any services list of individuals of the practitioner's description prepared by any Health Authority under section 28DA above or under section 8ZA of the National Health Service (Primary Care) Act 1997,

or any such list (or lists) of a description (or descriptions) specified by the FHSAA in its decision'.—[Mr. Denham.]

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I beg to move amendment No. 158, in page 24, line 4, leave out from beginning to end of line 7.

Subsection 49K(5) provides that if following an appeal by a practitioner the appeals authority decides to revoke its decision nationally to disqualify that practitioner, the FHSAA must also confirm or revoke the original health authority decision to move the practitioner from its list or to substitute a contingent removal. There is no reason to revoke the original decision and the amendment therefore deletes the unnecessary wording.

Amendment agreed to.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I beg to move amendment No. 32, in page 24, line 8, leave out `may' and insert `shall'.

Mr John Maxton (Glasgow, Cathcart, Labour)

With this we may take Government amendment No. 159 and amendment No. 33, in page 24, line 9, after `profession', insert

`and all other Health Authorities'.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I apologise to the Committee as the amendment seems to have gained something in translation. It should have read—I realise it makes the amendment slightly incompetent—

delete `or in prescribed cases may'.

I am anxious that even using all the safeguards built into the clause, it may take up to six months before a suspension is resolved. It would be against natural justice if that practitioner does not continue to receive remuneration in that time. I should be grateful if the Minister would explain in what prescribed cases the payments were not to be made.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I listened with care to what the hon. Member for Isle of Wight said and to the questions he asked, but I thought that his amendment was about something entirely different. I shall deal with my interpretation of what it would do, and I shall briefly talk about the question that he has raised, which will save us dealing with it in the stand part debate.

The issue that I thought we were dealing with is that of notification of health authority decisions to remove and suspend practitioners from their main list. It is obviously important, in the system that we are setting up, that robust mechanisms are in place to inform all health authorities of the removal or suspension of practitioners, so that people cannot be moved from one list simply to re-enter the NHS in another part of the country without anyone knowing anything about it.

We intend to put in place a comprehensive alert letter system ensuring that health authorities, regulatory bodies and the Department of Health are fully appraised of the removal and suspension of primary care practitioners. We also intend—and this is what I understood to be the import of the amendment—to introduce regulations to underpin an alert letter system. The provision in amendment No. 159 will go further than that proposed in amendment No. 32 in ensuring that all relevant bodies are properly informed of these key decisions.

The hon. Gentleman raised an important issue, which we may be able to debate at greater length on stand part. Provision will be made to protect the financial position of a suspended principal or a member--for example a GP--of the practice. We will also need to make provision for locums who are under suspension, which will require a different route to be constructed because clearly they are not directly on a payroll—if I can use that expression.

The importance of appropriately protecting the financial position of somebody who has been suspended has been recognised, and I can reassure the hon. Gentleman on that point. I am sure that these amendments are not the place to discuss the matter in detail.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdraw.

Amendments made: No. 159, in page 24, line 9, leave out

`the body which regulates the practitioner's profession' and insert `prescribed persons, or persons of prescribed descriptions,'

No. 160, in page 24, line 10, at end insert—

`Withdrawal from lists

. Regulations may provide for circumstances in which a practitioner—

(a) whom a Health Authority are investigating in order to see whether there are grounds for exercising their powers under section 49F, 49G or 49H, or

(b) who has been suspended under section 49H,

may not withdraw from a list in which he is included.'.

No. 161, in page 24, leave out line 22 and insert

`any right of appeal which he may have'.

No. 162, in page 24, line 25, at end insert—

`Corresponding provision in Scotland and Northern Ireland

49MA.—(1) This section applies where it appears to the Secretary of State that there is provision in Scotland or Northern Ireland under which a person corresponding to a practitioner may be dealt with in any way which corresponds (whether or not exactly) with a way in which a practitioner may be dealt with under this group of sections.

(2) A decision in Scotland or Northern Ireland to deal with such a person in such a way is referred to in this section as a ``corresponding decision''.

(3) If this section applies, the Secretary of State may make regulations providing for the effect to be given in England and Wales to a corresponding decision.

(4) That effect need not be the same as the effect of the decision in the place where it was made.

(5) The regulations may not provide for a corresponding decision to be reviewed or revoked in England and Wales.'.—[Mr. Denham.]

Clause 26, as amended, ordered to stand part of the Bill.