Clause 22 - Unsuitability for inclusion in medical, dental,ophthalmic and pharmaceutical etc. lists
Health and Social Care Bill
2:30 pm
Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)
This is a lengthy group of amendments, so before speaking to the clause in general terms, I shall discuss the amendments themselves.
Clause 22 forms a key part of our package of measures to improve the quality of delivery of primary care services—a subject on which I touched in our discussions on Clause 19. Clauses 25 and 27 also deal with lists, and taken together clauses 22, 25 and 27 cover doctors, dentists, pharmacists and optometrists. They cover non-principals as well as principals, and practitioners under part I or part II of the National Health Service Act 1977. Between them, the clauses apply the same principles and procedures to each list, and any variations are those required by the circumstances of the particular group. Clause 22 deals with part II principals by amending the existing powers.
Clause 22 will also deliver more consistency to the provisions applying to each practitioner group. That is important, because although each practitioner group has distinct and different roles, in each case potential risks to patient safety can arise through the possibility of inappropriate or unscrupulous behaviour by a practitioner who is unsuitable for the role.
It might come as a surprise to some to learn that health authorities do not already have such powers. They have the power to refuse admission in some circumstances, but it has become clear that the powers are currently drawn too narrowly to be applied uniformly across the four practitioner groups. I should make it clear that, as now, the process of entry to the health authority list will be wholly separate from the processes through which a general practice selects new partners.
On the issue of unsuitability, to which Opposition amendments Nos. 170 to 174 relate, the clause will extend the grounds on which a health authority may refuse admission to its relevant practitioner list. Health authorities are already required to hold lists of all principal practitioners providing medical, dental, optical and pharmaceutical services. The new provisions will strengthen the power of health authorities to control the provision of family health services in their area. Crucially, they will allow health authorities to refuse a practitioner's entry to a list on the grounds of unsuitability or fraud. Unsuitability is capable of wide interpretation, so we will set out in regulations the criteria that health authorities must consider in reaching decisions on those grounds.
We intend that a health authority be able to consider a wide range of issues relating to the applicant, or, where relevant, to directors or other persons controlling a body corporate. They include criminal convictions, the adverse findings of a licensing or regulatory body, personal references, qualifications and previous career history—in other words, issues similar to those that any employer considers before engaging someone. We intend that barring from the list should be automatic where someone has been convicted for murder, is not on the relevant professional list—not quite as serious a matter, but a none the less suitable ground—or is subject to a national disqualification. In other cases, the decision would be at the health authority's discretion.
Before refusing a person's application on the grounds of unsuitability, we would expect a health authority always to consider criteria such as: the nature of any criminal offence or professional regulatory investigation; the length of time since any offence was committed or since the conviction or investigation; whether there are other offences to be considered; the penalty imposed on conviction or the outcome of the investigation; the relevance of the offence or investigation to his provision of family health services; the likely risk to patients or impact on the national health service or on confidence in it; and whether he has been refused admission to, removed from or suspended from other health authority lists, and the facts involved in such cases.
We intend to set those criteria in regulations. The list will not be exhaustive, in order to allow health authorities to apply other criteria that are relevant to each case. It will be for the authority to decide how much weight to attach to the criteria in the regulations and to other relevant factors.