Clause 23 - the council for the regulation of health care professionals

NHS Reform and Health Care Professions Bill – in a Public Bill Committee at 10:30 am on 11th December 2001.

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Photo of Ann Widdecombe Ann Widdecombe Conservative, Maidstone and The Weald 10:30 am, 11th December 2001

I understand that the Opposition want a stand part debate on clause 23, so I ask the Committee—indeed, I insist—that the three groups of amendments be debated according to the narrow way in which they have been drawn.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I beg to move amendment No. 224, in page 28, line 31, leave out from 'bodies' to end of line 33.

This is a probing amendment concerned with the functions of the Council for the Regulation of Health Care Professionals as described in clause 23(2)(d). Under the clause, the council will promote co-operation between the eight regulatory bodies to which it refers, and I am happy for that principle to be extended to the further body that the Minister is seeking to add to the list through a later amendment. However, if the amendment were accepted the council would not promote wider

''co-operation between regulatory bodies; and between them, or any of them, and other bodies performing corresponding functions.''

It is worth bearing in mind that some of the bodies listed in subsection (3) contain more than one profession. For example, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting contains three professions, and the Council for Professions Supplementary to Medicine contains 12. In total, clause 23(3) lists about 20 bodies that will have a duty to work together, and between which the council will have a duty to promote co-operation.

Why is it necessary for a wider group of bodies to co-operate with such health bodies? If subsection (3) listed just one or two bodies, it might be reasonable to argue that such co-operation is necessary to ensure that matters are dealt with consistently across a range of professions. However, subsection (3) lists some 20 bodies, so why is it necessary to expand the list yet further? Moreover, what sort of bodies does the Minister have in mind? Although the Department of Health is responsible for the Bill's progress, I believe that the bodies listed in subsection (3) are the responsibility of the Privy Council Office. Bodies such as chartered institutes and bankers are also the responsibility of the Privy Council Office. With that in mind, what would be the point of trying to promote co-operation with, say, architects?

Will the professional regulatory bodies that we are discussing be required to co-operate with, and promote co-operation between, bodies that embrace a wide range of professions? I believe that a UK professional council exists that covers such a range. Will the Minister flesh out what he has in mind in terms of promoting co-operation? Will he also confirm that there is some point to the provision, and that it is not just a bureaucratic exercise involving people spending a lot of time discussing parameters and broad agreements to little effect?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I am grateful to the hon. Member for North-East Hertfordshire (Mr. Heald) for giving me the opportunity to explain the matters that he raised.

We do not envisage the UK council having any role in relation to the qualification of architects, bankers and chartered accountants. It is a council for the regulation of health care professionals, and all its functions must be seen and exercised in that context. The bodies with which it should be able to discuss matters are the quality standard-setting bodies that have an impact on the delivery of health care and health care services, not those that deal with bankers, architects or accountants. Those are all worthy professions, and I have nothing against them, but they will not fall within the remit of the council. The Bill has been constructed to ensure that that does not happen.

The hon. Gentleman asked why we wanted the council to have a wider remit. In essence, the answer lies in the Kennedy report. Professor Kennedy saw it as part of the council's rationale that it should be able to work closely with other quality-related bodies. As I understand it, that is the reasoning behind new clause 2, which we will debate later.

The amendment would make it harder for the council to promote co-operation between, for example, a regulatory body and the Quality Assurance Agency for Higher Education about the fitness of purpose of educational courses and qualifications in relation to health care professionals. It would make it harder for the General Medical Council and the specialist training authority or the joint committee on the post-graduate training of GPs or its planned successor, the medical education standards body, to have discussions and closer co-operation on the admission of doctors to the specialist register. It would make it harder for there to be discussions between the regulatory bodies and the General Social Care Council, or between the GMC, the General Dental Council and the national clinical assessment authority about the thresholds at which poor performance by a doctor or dentist could lead to referral to their regulatory body.

We regard this provision, as did Professor Kennedy, as a necessary adjunct to the proper discharge by the council of its new functions. It is not designed to extend its remit into professions that have nothing directly to do with health care professionals and their regulatory and educational requirements. As Professor Kennedy said, the overarching body that is established by clause 23 needs to have a broad co-ordinating function between the regulatory bodies and the bodies that are responsible for setting quality standards on education and training in relation to the relevant professional organisations.

This is not a back-door route to bringing within the remit of the council a whole range of professional organisations that have nothing to do with the regulation of health care professionals. It is a sensible measure that will ensure, as Professor Kennedy argued, that the council can do its job properly.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Just so that we are clear about this, is the Minister ruling out the promotion of co-operation with regulatory bodies for architects, bankers and so on, and limiting it purely to the health context?

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

As my hon. Friend the Member for North-East Hertfordshire said, this is a probing amendment, and I want to probe the Minister a little further.

Subsection (2) lays down the general functions of the council, which include:

''to promote the interests of patients and other members of the public . . . to promote best practice in the performance of those functions . . . to formulate principles relating to good professional self-regulation . . . to promote co-operation between regulatory bodies''.

Those are all eminently sensible. However, given the importance of education, professional development and training, to which the Minister referred, why does the Bill include nothing specific about them in relation to the functions of the council? I am sure that the Minister would agree that all three of those areas are critically important, and unless there were good reasons to the contrary, they should be included in the functions under subsection (2).

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

As I understand it, the hon. for West Chelmsford (Mr. Burns) is arguing for the UK council to have some jurisdiction in relation to setting educational training standards for a variety of health care professions. It is an interesting argument, but I do not think that we want the UK council to discharge that role. We may come to this discussion when we look at some of the amendments about the composition of the council.

As we envisage it, the body will have a lay majority, and some perfectly reasonable concerns would be expressed about a body with a lay majority setting professional standards for doctors' qualifications and so on, and that would not be a sensible path to go down. I know that the amendments would equalise the balance, but even then I am not sure that that would be a sensible thing to do. Existing bodies have responsibilities in these areas, including the royal colleges. We intend to establish, I hope later next year, the medical education standards board to provide oversight and an overview of the work done by the Special Training Authority and the joint committee in relation to the education and training of GPs. It is important that they are professionally-led responsibilities. We certainly envisage that continuing in the future.

The UK council's role is different. We are setting it up partly in response to what Professor Kennedy said, and the reasoning in his report, which I am sure we will come to in the debate on stand part. We are also setting it up for reasons that we set out in the NHS plan last year. In both cases, certainly in the NHS plan, we tried to explain why we wanted to set up a council and why professional education training issues should be dealt with elsewhere.

The hon. Gentleman has an interesting point to make, but, in relation to some of the points that I have tried to address, it is better for the educational issues to be dealt with elsewhere, within professionally-led organisations, rather than within an organisation with a lay majority.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Having heard the Minister give a clear assurance that the promotion and co-operation is between regulatory bodies and other bodies within the health sphere, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Photo of Ann Widdecombe Ann Widdecombe Conservative, Maidstone and The Weald

With this it will be convenient to take Government amendments Nos. 199, 201 and 202.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The first amendment seeks to add the Pharmaceutical Society of Northern Ireland to the list of bodies within the scope of the Council for the Regulation of Health Care Professions. The second and third amendments together make the same provision for the hybrid status of the Pharmaceutical Society of Northern Ireland, as both a regulator and a professional body—as we have already made in clause 24(5) in relation to the Royal Pharmaceutical Society of Great Britain. The fourth amendment brings the Pharmaceutical Society of Northern Ireland within the scope of clause 27, which relates to the council's power of public interest appeals.

Essentially, the amendments are necessary to reflect the separate ways in which the pharmaceutical profession is regulated across Great Britain and Northern Ireland.

Part 2 of the Bill applies to Northern Ireland as each of the regulatory bodies covers the whole of the UK. In the case of pharmacy, there is a Royal Pharmaceutical Society of Great Britain and a separate Pharmaceutical Society of Northern Ireland. Therefore, in order to apply the Bill properly to pharmacy in Northern Ireland, there needs to be a reference to the Pharmaceutical Society of Northern Ireland wherever the Royal Pharmaceutical Society of Great Britain is mentioned.

As members of the Committee will probably be aware, the regulation of health care professions in Northern Ireland is a matter transferred to the Assembly under the terms of the Northern Ireland Act 1998. That means that the Bill can apply to Northern Ireland only with the consent of the devolved authorities there. However, we have secured that consent and the Northern Ireland executive is happy for us to proceed along the same lines as we are in England, Wales and Scotland.

Amendment No. 198 is self-explanatory and would add the Pharmaceutical Society of Northern Ireland to the list of bodies included in the council. As with the Royal Pharmaceutical Society, the PSNI is distinct from the other regulatory bodies covered by the council in that it is both a regulatory body and a professional organisation. The Bill reflects that unusual status for the RPS and amendments Nos. 199 and 201 simply mirror the provisions in relation to the Pharmaceutical Society for Northern Ireland.

Amendment No. 202 adds the PSNI's fitness to practice decisions to the list of decisions against which the council may appeal in the public interest under clause 27.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health) 10:45 am, 11th December 2001

I welcome the amendments. The Royal Pharmaceutical Society of Great Britain contacted me to explain that its remit does not extend to Northern Ireland, which has its own pharmaceutical society, and that clarification is needed about inclusion of the sister body in Northern Ireland into the new structures. I am sure that it will also welcome the amendment.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I beg to move amendment No. 225, in page 29, line 15, after 'sections', insert

'save that the reference to the provision of general dental services in subparagraph 2(d) of paragraph 11(2) of Schedule 3 of the 1999 Act includes the performance of personal dental services,'.

This is a probing amendment to establish whether regulation of the qualifications or experience required to provide general dental services, as set out in paragraph 11(2)(d) of schedule 3 to the Health Act 1999, also covers personal dental services or, if not, whether that is covered in some other way in the Bill.

Clause 23(6) states:

''In this group of sections, references to regulation, in relation to a profession, are to be construed in accordance with paragraph 11(2) and (3) of Schedule 3 to the 1999 Act.''

Paragraph 11(2) of schedule 3 to the 1999 Act states:

''References to regulation, in relation to a profession, in that section and this Schedule include . . . (d) in the case of the profession of dental practitioner, the regulation of the qualifications or experience required for a dental practitioner to provide, or assist in the provision of, general dental services under the 1977 Act.''

We have dealt with personal dental services in various parts of the Bill and I seek the Minister's assurance.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

Once again, I am grateful to the hon. Gentleman who has drawn attention to what he believes is a gap in the provisions as they apply to the council. His amendment would cause references to regulation in the provisions to be read as including the regulation of the qualifications and experience required for the performance of personal dental services. It may be helpful if I explain the background because he has made a fair point and I want to explain why there is no gap.

The section 60 powers in the 1999 Act permit the creation, modification and amendment of legislation covering the regulation of health care professions to be carried out by order, subject to various limitations and procedural safeguards. We introduced those powers in that Act to make it simpler and more efficient to keep the relevant regulatory legislation up to date. Before the 1999 Act, there was always a problem finding legislative time on the Floor of the House to update and modify existing legislation, particularly against the background of a number of professional groups wanting their own new schemes of professional self-regulation.

This group of clauses uses the same definitions for the regulation of health professions set out in section 60 and schedule 3 of the 1999 Act. The schedule refers only to qualifications or experience required by a dental practitioner to provide, or assist in the provision of, general dental services. The amendment would include personal dental services in the scope of the UK council. The schedule relating to section 60 makes particular reference to personal medical services and so, as the hon. Gentleman said, there would appear to be an inconsistency. However, there is a difference between the regulation of qualifications or experience required for personal medical services and that required for personal dental services.

By virtue of primary legislation and European Union law, all doctors performing general medical services or personal medical services under a pilot must complete vocational training, which is period of employment after qualification during which the practicalities of general practice will be learned, including clinical learning, and learning about contractual matters. Dentists must also complete vocational training before becoming a principal on a health authority's list. To be able to perform personal dental services under a pilot scheme, there is no need to have completed that year of vocational training, although such a dentist would be fully qualified and required to work under supervision as part of personal dental services.

The hon. Gentleman's amendment is unnecessary because it does not recognise the distinction between the qualifications required to perform personal medical services and those needed to perform personal dental services. I hope that the hon. Gentleman feels reasonably reassured. Although there appears to be an inconsistency in the Bill, the differences can be explained in terms of the vocational and training qualifications required for a dentist to perform personal dental services.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

That is helpful because it explains the apparent gap in provisions under paragraph 11(2) of schedule 3. I fully accept that the Minister's explanation deals with that, but I will think about it again before Report. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed that, That the clause, as amended, stand part of the Bill.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

The setting up of the Council for the Regulation of Health Care Professionals is something that we are not minded to challenge directly by seeking to divide the Committee. However, we would like reassurance from the Minister that it is the correct approach.

The background to the council is that the Kennedy report suggested that an overarching body should deal with the regulation of health care professionals and the various bodies described in clause 23. However, some are asking whether it is the best way forward. The fact that Professor Kennedy suggested that such a mechanism should exist is powerful evidence, but the General Medical Council, which is probably the body to have received the most publicity in this area and has been criticised in many high profile cases, has taken steps to amend its procedures and make changes. The GMC's ability to regulate the profession has arguably changed since the Kennedy report.

For example, the new interim orders committee has been effected and further initiatives amount to a radical constitutional change in the GMC. The Minister will recognise measures such as periodic revalidation for all registered doctors and we welcome further changes to the fitness to practice procedures. The Medical Protection Society is an important body that provides indemnity, particularly for general practitioners, and it has made it clear that it is supportive of the changes that the GMC is making—we all are, in broad terms. The MPS states:

''A new Council for the Regulation of Health Care Professionals will add a further layer of bureaucracy which, in our submission, is likely to prove superfluous. A better way of improving accountability of the GMC would be to make it directly accountable to Parliament through the Health Select Committee. The proposed Council with powers to the extent set out in the Bill effectively brings to an end the concept of self-regulation. Individual regulatory bodies may be forced to make changes which they consider inappropriate for their own profession. If the Council is to be established, it should be advisory only, with no powers to require or impose change on individual regulators. The concept of an integrated approach is misconceived given the different clinical and professional responsibilities and working environments of each profession. Self-regulation may be imperfect, but is still the best means of regulating the professions. A body comprising doctors or dentists, together with lay representatives, is the ideal way of ensuring the rights of patients and practitioners are protected and the regulatory procedures are fair, transparent and efficient.''

In a later new clause we shall examine whether there is a case for bringing together the four main regulatory and inspecting bodies that the Government have recently created. Would one way in which to deal with that without setting up another council be to build on the procedures that we have in this place by making the General Medical Council and other bodies directly accountable to the Select Committee on Health? That would boost Parliament and play into the current arguments in this place about the way in which our procedures could be developed to make the legislature stronger to provide a greater counterbalance to the Executive.

One criticism of the Government's proposals is that there is an area of weakness when it comes to the independence of the Council for the Regulation of Health Care Professionals. Many provisions will be made by the Secretary of State, although it is good that the Minister is accepting one amendment, who will be able to mould and fashion the Council for the Regulation of Health Care Professionals—his appointees; his direction; his council. It might be more inclusive if it were our job as parliamentarians to be the responsible body to which these various professional regulatory bodies report.

The responsibility falls under the remit of the Leader of the House, who is also the Lord President of the Council. The Privy Council Office is the administration that deals with regulatory bodies, and it is only because these are health bodies that the Department of Health is taking this part of the Bill through the House. The overall responsibility in government for such work rests with the Privy Council Office. A search for reform by the Leader of the House helps the legislature gain prominence and authority. This is his area of responsibility, and he is giving ground to the Secretary of State for Health. In short, Parliament is giving ground to the Executive.

I should be interested to hear the Minister fashion an argument for this further layer of bureaucracy. I am not saying that we shall seek to divide the Committee on the clause, but I should be interested to hear the Minister justify that. As I said to him when we were debating the order that dealt with the Health Professions Council, it is not enough simply to say that because Professor Kennedy thought that something was a good idea, therefore it is a good idea. The Government need to justify and fill out the argument.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury 11:00 am, 11th December 2001

I should declare an interest, as I am a subscriber to the GMC, the main body being considered. That does not mean that I am necessarily arguing for it; quite the reverse. Having suffered over many years from an increasing subscription, I must say that the GMC, even now, sends shivers down my spine.

The Government have some catching up to do. The GMC has done a great deal to put in place measures to prevent tragedies such as those that we have recently seen, especially in the light of the Kennedy report. We must not lose sight of the fact that much of what we are considering today would not have a material effect in preventing some of those tragedies. Some things that we discussed earlier in the Bill might do that, but I do not think that this will.

I believe that this part of the proposal is ill-conceived. It treats the various professional groups under discussion equally, when they are not equal numerically or in terms of their professional responsibility and accountability. That might be acceptable, but we need to bear it in mind. We should not assume that because the clause deals with the bodies equally, they are equal in numbers or responsibility. The professions allied to medicine are especially concerned with the proposal and the representation that they would have on the council, were the clause enacted.

We must recognise that the proposal would sound the death knell of self-regulation. It will give us an over-arching body, able to direct closely the functions of the professional bodies. That will have a knock-on effect on the ability to attract the best in the professions to take part. At the moment, I can speak only for the GMC because it is the body about which I know most, but there is a great deal of status in becoming a member of that organisation, and much competition to do so. It attracts some of the very best in the profession. I fear that, with the degrading that we are discussing today, it will be increasingly difficult to attract some of the top people from my profession—and, I suspect, from the other professions under consideration—to take part in the crucial matter of regulating. Regulating one another is important and sensitive, and needs the best minds in those professions. I fear that the quality of the bodies will be diminished by the proposals.

The cost of the council is rather opaque. The Minister must make clear whether the regulatory bodies themselves will fund it, or whether the money will be found centrally in some way.

The independence of the new body is very important. I am sure that we will hear much from hon. Members about their concerns that the body be independent of ministerial control. That will require some parity in ministerial and non-ministerial appointments. It is important for regulatory bodies to be accountable to Parliament, as is currently the case. The Bill does not seem to establish any proper lines of accountability. We need a little more clarity on the lines of accountability of the regulatory bodies and the council.

The council will be able to intervene at the conclusion of a case by referring it to the High Court if it feels that that is desirable for the protection of members of the public. That will be of real concern if the power is not used very sparingly indeed. It could quickly become the norm for cases to be appealed, in effect, to the High Court. That would diminish the responsibility of the GMC in particular. In this context, we are really talking about the GMC. Various other bodies that have written to me have been keen to point out that they hear only a very small number of cases of professional matters such as negligence. It is principally the medical profession that is in the firing line.

In the light of the Kennedy report's recommendations, one welcomes the measure. However, there appear to be many gaps and matters that require explanation, and I should be grateful if the Minister clarified the issues that I have highlighted.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

I have two questions for the Minister, the first of which concerns health visitors. The national body and many local health visitors have expressed distress about the fact that their title is missing from the Nursing and Midwifery Council. Can the Minister advise me on how to convince health visitors that they are not being neglected and cut out? The second point concern chiropodists in the independent sector, who carry out well in excess of 50 per cent. of routine basic foot care. Given that only a single, state-registered representative will be on the council, what measures will be put in place to protect those chiropodists who provide a vital role in the independent sector?

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

It is difficult to do anything other than welcome clause 23, which, in establishing the Council for the Regulation of Health Care Professionals, implements a recommendation of the Kennedy report, even though it was foreshadowed, under a different title, in the NHS plan. Liberal Democrats have always made it clear that we support mechanisms to improve quality, and the co-ordination of quality assurance is an important factor in that regard. In general, we support the thrust and the recommendations of the Kennedy report, but we must not lose our critical faculties. We must recognise that it is an important source of advice and contribution to the debate. It is appropriate to look at what the report said about the council, and to flag up some questions that the Government must answer in future discussions. Page 435 of the report sets out the recommendations' desired effects, including that central Government

''create independent mechanisms for regulating the quality of healthcare and the competence of healthcare professionals.''

Will the Government confirm that that is indeed the purpose? If there are subsidiary purposes, they should be spelled out. Recommendation 39 of the report mentions the need for ''overarching organisations'', and states:

''A Council for the Quality of Healthcare should be created''.

However, the Bill does not establish one. Recommendation 39 also states:

''A Council for the Regulation of Healthcare Professionals should be created to bring together those bodies which regulate healthcare professionals (including, for example, the General Medical Council . . . and the Nursing and Midwifery Council); in effect, this is the body currently referred to in 'The NHS Plan' as the Council of Healthcare Regulators. These overarching organisations''—

the report is talking about quality organisations—

''must ensure that there is an integrated and co-ordinated approach to setting standards, monitoring performance, and inspection and validation. Issues of overlap and of gaps between the various bodies must be addressed and resolved.''

That is a clear and effective summary of what we believe the council should do. I hope that, in subsequent discussions, the Government will stick to those principles, or clarify the areas in which they wish to go further.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Paragraph 75 of the report, on page 349, states:

''An effective system . . . needs an independence from the professions and from government''.

Does the hon. Gentleman agree that that is a very important point? [Interruption.] I was quoting from page 349, paragraph 75.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I do not doubt the hon. Gentleman's source.

Photo of Ann Widdecombe Ann Widdecombe Conservative, Maidstone and The Weald

Order. We cannot have two hon. Members on their feet at the same time. Has the hon. Member for North-East Hertfordshire finished his intervention? It was a long one.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I accept that the hon. Gentleman was being helpful in giving me time to find the reference.

Recommendation 72 of the Kennedy report is explicit:

''The Council for the Regulation of Health Care Professionals should be established as a matter of priority.''

I accept that the Government are establishing the body as a matter of urgency. Indeed, they are doing so before we have had their formal response to the Kennedy report, which means either that the Bill is an urgent response to the issue or that they are taking their time over their response to the report. The report continues:

''It should have a statutory basis. It should report to Parliament. It should have a broadly-based membership, consisting of representatives of the bodies that regulate the various groups of healthcare professionals, of the NHS and of the general public.''

In so far as the clause goes, we want to give it our full support. Of course, the clause refers to schedule 7, which concerns the balance of that body's membership. Nevertheless, the Government should be commended on the relative speed with which they have brought forward the proposal. They have sought to stick relatively closely to the Kennedy prescription, rather than their original prescription in the NHS plan, and we warmly welcome the clause.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I thank those hon. Members who support clause 23. The hon. Member for North-East Hertfordshire is concerned about some of the details, and I shall respond to his points in a moment.

Out of all the hon. Members who spoke, the only one who indicated a lack of support was the hon. Member for Westbury (Dr. Murrison), and he prefaced his remarks by drawing attention to the fact that he is a member of the BMA.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

I subscribe to the GMC because I am obliged to; I am not a member of the BMA.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I understand that the hon. Gentleman feels that this is needless bureaucracy that would not advance the issues that we are trying to address. That is probably the minority view in relation to the proposals, which we sent out for consultation in the autumn.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

Just to clarify, the Minister is putting words into my mouth. I said that I broadly support the clause.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I am grateful to the hon. Gentleman for pointing that out. I missed that part of his remarks, but I am sure that he said that. However, the general tone of his remarks was less supportive than that of the other hon. Members who spoke in relation to the clause. We must address whether existing arrangements are satisfactory. In my view they are unsatisfactory, which is why we have brought forward these provisions.

Turning to the remarks made by the hon. Member for North-East Hertfordshire, it is not the case that because Professor Kennedy recommended that we establish this council we simply accepted his recommendation. We have looked carefully at Professor Kennedy's arguments, which have been the subject of detailed quotation between the hon. Members for Oxford, West and Abingdon and for North-East Hertfordshire. I shall also be selectively quoting parts of the report in a moment. The arguments why a body with the powers that we are recommending should be established are carefully set out in Professor Kennedy's report. If we want to avoid the trap of establishing a pointless extra tier of bureaucracy, we must be clear that the council should have a range of reserve powers to use in certain situations.

It is to avoid the suggestion that this is a pointless tier of bureaucracy that we have brought forward these proposals. We do not want the council to become a talking shop, and it must fulfil a range of specific and valuable functions that will enhance the concept of professionally led self-regulation. Indeed, it must increase public support and confidence in the system of professional self-regulation. I would be the first to acknowledge that the professions have recently made significant steps forward in their approach to professionally led self-regulation, which is to be welcomed, but it does not subtract from the logic of Professor Kennedy's arguments.

He was mindful of those changes in preparing his report. We strongly support the Kennedy report's conclusions in that respect. I will return to those arguments in favour of the council in a second.

Several hon. Members spoke effectively about important principles that should underpin the work of the council, and I agree with them in general. The hon. Member for North-East Hertfordshire mentioned the need for independence from Government and I strongly agree with that. As he knows, we have been examining ways to strengthen and support further the independence that all Committee members, I think, want. We have tabled several amendments that are designed to do that, and we will come on to them later. We are at one with the hon. Gentleman on that matter, although we will have some difference of opinion about the details. That is to be expected, but I do not think that the principle separates the two sides of the Committee.

The hon. Gentleman also mentioned accountability and the role of Parliament. That is an interesting area. I should make it clear to the Committee that the UK council will not supersede existing lines of accountability for regulatory bodies. Those will remain in place. The council will be given an overarching responsibility for co-ordination and for promoting patients' and the public's interests in self-regulation. Those are important functions. The lines of accountability of the new UK council will be to Parliament, because it will be to Parliament that it submits its report.

The hon. Member for North-East Hertfordshire raised interesting arguments about how that accountability would be expressed in terms of the arrangements that we make in this place. Opposition Members will be glad to know that I am not about to legislate in that area. I do not think that that would be appropriate for Government. As the hon. Gentleman rightly said, such matters are for the House to consider, in the light of how the new council wants to discharge its responsibility of oversight.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health) 11:15 am, 11th December 2001

Is the Minister worried that the Secretary of State's power to appoint members of the council might compromise its independence?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

Yes, and that is why we have tabled amendments to make it clear that the NHS Appointments Commission, a special health authority, will be responsible for making the appointments that relate to the Secretary of State's role. The devolved administrations will appoint their members directly, but they will be only three out of 10 lay members. The seven for England will be appointed independently, at arm's length from the Secretary of State. We have listened to the regulatory bodies' concerns about that, and agree with them that the last thing that we want to do is to place a question mark, right at the beginning, over the independence and accountability of the new UK council.

Wherever possible, we must maximise consensus on the UK council's role. We are giving it important tasks to discharge on our behalf. I do not agree with the view that has been expressed that the UK council is something of a sideshow or irrelevance. It will have a central role in shaping and developing future regulatory arrangements in co-operation with the regulatory bodies themselves. The point about independence was well made but I thought that I had addressed it in terms of other amendments. Perhaps we can clarify those issues when we come to them.

On the role of Parliament, matters should be addressed by the House itself. It would not be appropriate for a Minister to tell the House: ''This is how I think that this responsibility should be discharged.'' Ultimately, it has nothing to do with me. My responsibility to the House relates to how I discharge my role as a Minister of State in the Department of Health. It is not to tell the House of Commons how it should organise its scrutiny of the work of the UK council.

The Select Committee on Health, which has been mentioned, already has the power, opportunity and right to ask the GMC and any regulatory bodies to give evidence before it. On occasion, it has invited the GMC to do precisely that. That Committee will be able to continue to develop those lines of accountability. It is right to say that opportunities need to be explored in relation to how the House discharges those responsibilities, but that cannot be done effectively in legislation. We are opening up the council to an accountability relationship with Parliament. That is important and, I hope, generally welcome.

The two issues raised by the hon. Member for Wyre Forest (Dr. Taylor) will largely be dealt with by the orders that establish the new regulatory arrangements, rather than by the Bill. The Bill simply ensures that if those orders were approved in another place, the new nursing and midwifery council and health professionals council will fall within the remit of the UK council.

The health visiting profession will be fully regulated by the nursing and midwifery council, so there is no question of it being spirited away from the jurisdiction and competence of the UK council. If the order establishing the nursing and midwifery council were not to be approved, health visiting would remain subject to full regulation by the UK Central Council for Nursing, Midwifery and Health Visiting. There is no question of any potential gap or loophole in that respect.

In relation to chiropody, the hon. Member for Wyre Forest argued for chiropodists to be directly represented on the UK council. However, it is not for Ministers to determine which members of the regulatory bodies can serve on the council, because the Bill stipulates that that should be decided by the regulatory bodies themselves. I should hope that that would be welcomed on both sides of the Committee in the spirit of encouraging professionally led self-regulation.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

The difficulty centres on the notion of having a representative from the group of professions allied to medicine, which covers a vast array of professions within the health care sector. Chiropodists are worried that they will not have a voice because, numerically, their membership is dwarfed by that of other groups. Physiotherapists—my wife is one, so I must be careful what I say—are so large in number that they will almost certainly dominate the group, and others may not get a look-in.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I understand the hon. Gentleman's argument, and we have designed amendments that try to address the issue. However, we must be clear about the underlying purpose of the proposals. Representatives of the regulatory bodies will be on the council not to represent professional interests, but the regulatory system to which their profession or group of professions is subject. As the Council for Professions Allied to Medicine regulates 12 separate professions, I assume that the hon. Gentleman would argue for one of each to be represented on the council.

Dr. Murrison indicated dissent.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

He would not. To be fair to him, we are not in the business of trying to arrange for every professional group of health care workers to have a representative on the UK council. The point is to have representatives from each of the regulatory bodies who can draw on their experiences of regulation in their professional sectors.

The Council for Professions Allied to Medicine currently includes 12 bodies and may include many more in future, depending on how the council discharges its responsibilities in advising Ministers about sectors that may introduce professional self-regulation, such as psychology, operating department practitioners, perfusionists and others in the queue of those who recognise its benefits. The logic behind the proposals is not to try to identify and represent on the council every separate professional group, but to ensure that it includes a representative from each of the regulatory bodies. I accept that that raises an issue in relation to the CPSM because it is the largest regulatory body representing health care workers in the NHS, and eventually, I am sure, the private sector. The matter requires further exploration, but we shall do so more fully at a later stage.

In relation to chiropody, it is difficult for me to give the assurance that the hon. Gentleman wants because that would cut across the spirit and the letter of the clause. We are not proposing a separate representative on the UK council from each professional group of health care workers. I hope that I have dealt with some of the hon. Gentleman's concerns.

Clause 23 will broadly do four things. First, it will establish the council. Secondly, it will give the council its functions, which are

''(a) to promote the interests of patients and . . . the public in relation to the . . . ('regulatory bodies') . . .

(b) to promote best practice . . .

(c) to formulate principles relating to good professional self-regulation, and to encourage regulatory bodies to conform to them, and

(d) to promote co-operation between the regulatory bodies; and between them . . . and other bodies performing corresponding functions.''

Thirdly, the clause specifies which bodies come within its remit; there should be no ambiguity about that. Finally, it will give effect to schedule 7.

The new council will strengthen public confidence in professional self-regulation by acting as an independent defender of patients' interests. It is important to make it clear that the council is not, and should never be seen as, a substitute for professionally led self-regulation. Our system of regulation will be enhanced by greater co-ordination, consistency and accountability, and that is what clause 23 seeks to provide.

The proposals take their cue from Professor Kennedy's report, which states:

''The regulatory bodies, embracing . . . matters to do with safety, quality and standards as well as the competence of healthcare professionals, must themselves be co-ordinated and their efforts aligned by some overarching system.''

As the Consumers Association and the National Consumers Council have said, the regulators' accountability needs to be clearer and more consistent. The GMC said that its accountability was largely implicit and that that was unsatisfactory. The clause will remedy that by requiring regulators to conform to principles of good regulation and providing for effective scrutiny where necessary. As well as greater accountability, the new council will promote greater consistency. Professor Kennedy was keen for that and strongly argued for it. In the report, he said:

''Duplication must be reduced. Equally, holes in the system must be stopped. Only in this way will the fragmentation and lack of clarity about responsibility for regulating the quality of healthcare, which was such a feature of Bristol, be addressed.''

The BMA also supports the creation of the council and have argued that it will give consistency of action across the professional regulatory bodies.

To sum up our intentions in the words of the Kennedy report, we believe that

''regulation of the healthcare professions must be seen in the round and organised accordingly.''

That is what clause 23 seeks to do. I am glad to say that regulatory bodies in general have given the new council their support. We are aware of some of their concerns, particularly on clause 25, but they have been generally supportive and have said that, as regulators of the health professions, they welcome steps to promote best practice and common principles in the interests of patients. They also said that they support the proposed function of the new council as set out in clause 23(2) and want to be held clearly to account for what they do.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

It would be inappropriate to seek a debate at this point because we will have one under clause 25. However, paragraph 23(2)(a), (b) and (d) includes the word ''promote''—that was presumably chosen for a purpose—as opposed to choosing the expression, ''seek to ensure''. Is that to make sure that clause does not appear to have a directional function, or is it taken from the Kennedy report, or another general framework with which it is consistent?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The wording in the 23(2)(a) is consistent with the recommendations of the Kennedy report. The council's powers of direction which appear under clause 25 are separate matters. The exercise of such powers and the circumstances in which they can be used are defined in clause 25. When I described why we have decided to establish the new council, I said that it is important that those interests that we have identified in 23(2)(a) are promoted because that is the purpose and rationale of an effective system of professional self-regulation. That paragraphs states:

''interests of patients and other member of the public''

It is difficult to imagine any other set of underlying principles on which we could rest a system of professionally-led self-regulation.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon 11:30 am, 11th December 2001

That is a helpful answer. Is the Minister's view that one can only adequately promote the interests of patients and other members of the public through this body with a non-professional majority, however slim? The corollary is that when there is a professional majority, there may be tension between the promotion of the interests of patients and other members of the public, and the promotion of the interests of the profession.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The hon. Gentleman tabled an amendment to explore these issues, but Kennedy was clear that the best people to represent the views of patients and the public are the patients and the public, not members of professional groups or regulatory bodies. There is an inescapable logic behind that argument and we shall return to the matter later this morning when we discuss another amendment tabled by the hon. Gentleman.

I am grateful for the general support that Committee members have expressed for establishing the council. I understand fully that the regulatory bodies and Conservative Members are concerned about the way in which the council will discharge its functions and we shall debate that shortly. However, I am encouraged by the strength and support that has been expressed today for the principle behind the establishment of the council.

Question put and agreed to.

Clause 23, as amended, ordered to stand part of the Bill.