Regulation of Health and Social Care Professions Etc. Bill [HL]
Friday 3rd February 2017
(7 years, 9 months ago)
Lords ChamberRead Hansard Text
Lord Hunt of Kings Heath
Lord Hunt of Kings Heath (Lab)
My Lords, I draw the House’s attention to my role as a trustee of the Royal College of Ophthalmologists. We are indeed fortunate in this country in the quality of our health and care professionals and the contribution they make to the NHS, social care and society generally. As demographic pressures grow and the potential of what can be achieved also grows, the challenges facing those professions should never be underestimated. That is why the way they are regulated is so important.
The Francis report on the tragic events at the Mid Staffordshire NHS Foundation Trust some years ago raised a number of challenges to the way that health and care professional regulation works in this country. Francis suggested that professional healthcare regulators need to be much more adept at analysing and using the information they have in order to take a proactive approach to risk to patients. The Francis inquiry also identified a number of barriers to overcoming the challenges. It describes restrictive and complex legislation and insufficient capacity and resources on the part of the regulatory bodies.
In the meantime, the Law Commission has been undertaking work on the legislation covering the regulation of health and care workers. This comprehensive review considered the legal framework for bodies responsible for 32 professions, covering approximately 1.44 million people. It looked at the whole process of the registration of these professionals, the standards that were set for professional conduct, the way in which disciplinary procedures were undertaken and the way those regulators were held accountable to Parliament. It published a report in April 2014 setting out its views, along with an extensive draft Bill, which would have brought all the legislation covering the various different professions together in one legislative framework.
At the time, the Government welcomed the Law Commission’s work. Indeed, in January 2015 they accepted its recommendations, particularly that there should be,
“a single, overarching objective of public protection placed on each regulator … wider powers and greater flexibility for the regulators to investigate and dispose of cases”,
and “greater consistency” in the way disciplinary panels were held in each of the regulatory bodies, whether relating to doctors, nurses, physiotherapists or the other professions. It also recommended,
“greater separation between the regulators’ investigation and adjudication functions”—
a necessary split—so that investigations should be undertaken by one part of the regulatory body, and judgments about whether a professional is still fit to practise should be done as a separate operation. It also made it clear that there should be,
“an overarching duty on the regulators to ensure the ongoing fitness to practice of registrants”.
That is a very important function, given that a practitioner who has been licensed to practise may well then practise for 30 or 40 years. Ensuring that as the years go by they are still absolutely ready to practise becomes very important.
It was very welcome when the Government accepted the principle of the Law Commission’s work in such forthright terms. However, since then there has been a long silence. Nothing has happened. No legislation has been brought forward. It has not even been put in for pre-legislative scrutiny. In my view, this was an ideal vehicle to deal with these issues because pre-legislative scrutiny could have ironed out some of the issues raised by the Law Commission and would have enabled the Government to come forward with a Bill in which there was very strong consensus. Alas, nothing has happened, despite the Government’s clear intent to ensure that the lessons of the Francis report were learned. My Bill is a nudge to the Government that it is about time they brought legislation forward, and tries to give them some confidence that that legislation would be welcome and that Parliament would take a constructive approach to any such proposals.
I do not agree with all of the Law Commission’s proposals. First, I do not agree with the recommendation to abolish the statutory Midwifery Committee within the Nursing and Midwifery Council, which is the subject of a debate on 28 February. Secondly, I do not agree with the Law Commission’s view that the Privy Council’s role in relation to health professionals should be removed entirely. We are currently debating a similar issue in the higher education Bill, and many of the arguments against the changes there would apply to the health professions as well. Thirdly, I have reservations about the Law Commission’s proposal that simply by an order, a Minister could abolish a regulatory body and replace it with another. For instance, under its proposals the General Medical Council could be abolished and the registration of doctors transferred to the Health and Care Professions Council. There are mixed views about whether that is a good thing; for myself, I do not think it should simply be done under an order-making power. Some things need to be reserved for primary legislation.
Since then, other organisations have commented on the original Law Commission report, including the Professional Standards Authority, which oversees the regulatory bodies, and the Nursing and Midwifery Council. They have all come up with some reservations about the Law Commission’s proposals—but that is exactly what you want and what pre-legislative scrutiny would have ironed out. We have to accept that we have moved on. We need to look afresh at the requirements of health and care regulation.
In the meantime, the Government have ploughed on with trying to make changes in a piecemeal way to individual regulatory bodies. These are called Section 60 orders and they plough through your Lordships’ House with monotonous regularity, the problem being that the amount of time officials at the Department of Health devote to these individual orders would be much better devoted to drafting a Bill to deal with all the professions together. They are also not dealing with the inconsistencies between different regulatory bodies. Thinking of Mid Staffordshire, where there was a collective failure, an incident involving a patient can often involve more than one profession. It seems illogical to me that if disciplinary proceedings are held, they should be dealt with in different processes for different professions.
The argument from the regulators, too, is that they overwhelmingly want to see new legislation. The NMC and the Royal College of Surgeons say that the current regulation is outdated and governed by conflicting legislation, and the college goes on to say that it thinks the current situation compromises the regulator’s ability to safeguard patient safety. The General Medical Council believes that we need legislation to “improve patient protection”.
Another example is the Opticians Act, which is hugely out of date. We had a debate in your Lordships’ House a year or so ago about a UK company called Adlens, a spin-off company from Oxford University, which has developed flexible and adjustable reading spectacles. It is exporting millions of these from the UK to Japan and the US but up to now, it has not been allowed to market them in the UK because of the outdated approach of the Opticians Act. We also have many professions which are not regulated but ought to be. For instance, there is a voluntary register for clinical physiologists but you can practise without being part of that register. The Royal College of Radiologists is concerned about tele-radiologists and sonographers who, again, are not regulated but are involved in patient procedures which, if done incorrectly, could cause them harm.
There have been other developments. I pay tribute to the PSA, which has published two reports making the case for change. I do not necessarily agree with all the proposals it has set out, but it has done immeasurably valuable work in pointing to the future direction.
The question then arises: what are the Government going to do? A consultation is promised in the next few months, but I put it to the Minister that it is one thing to have a consultation but quite another to bring proposals to Parliament. There remains a great deal of doubt within the health service and regulatory bodies as to whether the Government are really committed to bringing forward new legislation. I take your Lordships back to the Francis report, which clearly identified weaknesses in the way we regulate health and care professionals. The regulatory bodies themselves would acknowledge that; patient groups, too, are clear that we need reform. I very much hope that the Government can respond today by saying not only that they will introduce proposals but that they are committed to bringing legislation forward at the soonest possible moment. I beg to move.
The Senior Deputy Speaker (Lord McFall of Alcluith)
The Question is that the Bill be read a second time. As many as are of that opinion—
Lord Patel (CB)
My Lords, I was given clear instructions not to jump the gun before the Senior Deputy Speaker spoke.
I support the Bill and I am glad that the noble Lord, Lord Hunt of Kings Heath, has brought it to the House. If it does what he thinks it might, which is nudge the Government to bring forward some kind of draft regulatory Bill, that would be helpful. I declare my interests: I am a fellow of several medical royal colleges, most of which are freebies. I am overdue to pay my General Medical Council dues and if I do not pay them this week, I will no longer be on its register—but today I am, I hope, still on it.
I have been involved in such debates before. We had a debate on the Law Commission report and I have asked questions on two occasions related to this. On both occasions we were promised that the Government had the intention to bring in the legislation—which is, as the noble Lord, Lord Hunt of Kings Heath, said, very much needed. The Medical Act 1983 is outdated, bureaucratic and inflexible. It is not doing patients any good because the GMC, as we have heard, is not able to bring the regulatory regimes to bear on people who do not do what it expects them to do.
I tried to find out whether there was any example of where a jurisdiction similar to ours, with a single regulatory body for health professionals, works. There is one. It was set up about 80 years ago in Australia. It is very similar to ours. There are several different health professional bodies and a lot of the professions are not covered—which, as the noble Lord, Lord Hunt, mentioned, is the case with us. So I asked a question: in the light of your experience of the past six or seven years, what have been the key advantages? I got an extensive response. The key advantages are: being able to drive consistency in regulatory requirements across professions, such as common standards in areas including criminal history, English language and advertising requirements; a largely aligned code of conduct; and some degree of consistency in the jurisdiction side.
More importantly, there is better knowledge exchange between professions in embedding leading practice in regulation and a single piece of legislation for the regulation of all registered professions. There are 14 professions in Australia’s case; in our case, it would be 32 or more. There are potential efficiency benefits in having a single organisation to provide all the operational support and in being able to modernise that through a single effort, ranging from corporate services to include—importantly—legal and regulatory services.
There are significant wider benefits in having a single source of comprehensive workforce data in a single depository for wider workforce projections and planning. That is something we suffer from badly in this country. Our workforce planning for the NHS and social care is dreadful, as we will no doubt hear in forthcoming debates. One reason we are not able to do skills-mix training is because of the separate regulatory authorities.
There are also advantages for the community in a single, national online register in which all registered practitioners can be found. Common registration types make it easier to understand and allow increasingly greater consistency in how regulatory decision-making is applied across professions, particularly in fitness to practise. It also allows a national approach to raising community awareness and understanding of how to complain and of what registration means.
The community expects that all registered practitioners should be held to a similar level of accountability; that is, there should be a lower criminal history threshold for some professions. I think the noble Lord, Lord Hunt, mentioned that. There should also be a single front door for raising concerns about fitness to practise across professions. It will make health professionals work more closely together and therefore bring about better integration of the requirements for the accreditation of approved programmes of study. We badly need integrated common study modules. It would help with workforce planning and make for a better regulatory regime, which is badly needed. We will all ask the same question of the Minister: when will the Government bring in the legislation?
Lord Turnberg (Lab)
My Lords, I congratulate my noble friend Lord Hunt on securing this Second Reading debate. The Bill arises out of frustration, because we should have had legislation on this some years ago. I should express my interest as a former member of the GMC council when I was the dean of a medical school in the long-distant past. I am no longer a practising physician. Unlike the noble Lord, Lord Patel, I am no longer even on the GMC register. I have to say that that has not stopped the occasional unsuspecting Member of your Lordships’ House seeking my advice. Regretfully, I have to tell them where to go. Perhaps I should rephrase that: I have to tell them where to go to get the best medical advice.
As we have heard, it is almost three years since the Law Commission’s report, more than two years since the Government welcomed it and more than a year since they said that they would put it out to consultation. The glacial progress makes the decision on the third runway seem positively hasty, yet the caring professions and the regulators are desperate for the Government to act. It is pretty clear that we have an outdated system of regulation: it is too elaborate, it is inflexible and it is splintered into too many regulators, which often have inconsistences between them. Those who regulate are already frustrated, and far too many front-line clinical staff are not even officially regulated at all. Healthcare assistants, physician associates and clinical physiologists, to say nothing of carers in nursing homes, are not regulated; they merely have voluntary registers. These can work well but they, too, are frustrated by their lack of powers. Yet all these healthcare workers are on the front line dealing with patients every day, and they do an essential and important job. They could do more, given the confidence of safe and proportionate regulation. We need them now in the NHS.
Let me say a few words about the GMC, which I know best. I am grateful to it for its excellent briefing. Its major complaint is that it is hamstrung by the inflexibility under which it is forced by law to operate. For example, of the 9,000 complaints a year it has to examine in its fitness to practise committees, a very high proportion could, and should, be dealt with locally by the responsible officer in each trust. But the GMC has to examine every case that meets its criteria. Since the cost of doing so consumes about 60% of the GMC’s total budget, it is an enormous waste of money, to say nothing of the trauma to doctors who could easily have been returned to good, safe practice by strong local action.
Then there are the enormously expensive and elongated hearings, with the full panoply of lawyers, in cases against doctors when many could be dealt with much more quickly and cheaply when the doctor admits responsibility for his errors and accepts remedial action. At the moment, that is not allowed. Finally, when there is a problem with an underperforming postgraduate training and education unit in a hospital trust, the GMC has to withdraw all trainees instead of using some sort of proportionate response in which only the relevant bit of the training programme is dealt with. In short, a proportionate response is very difficult under the current rules.
I have one final point, which concerns Brexit—no debate is complete without a reference to Brexit. In this case there are clear advantages—some of the very few. Doctors from the EU can come to practise in the UK without any assessment of their training or level of competence. We have to accept their EU training, and we usually do not know too much about it—unlike doctors from, say, Australia, the USA or anywhere else in the world, who have to go through a thorough appraisal. Now that we are coming out of the EU, it should prove possible for the GMC to assess EU doctors in the same way. I hope that the GMC is prepared and that legislation will allow it to do it.
We have waited far too long for a correction to all the anomalies in regulation that we have heard about today. Let us just get on with it. I hope the Minister will agree.
Baroness Gardner of Parkes (Con)
My Lords, I intervene briefly because of my memories of problems with registration. I did advise the House that I was going to intervene in the gap. Listening to the noble Lord, Lord Patel, discussing whether he was on the register brought back to me very clearly the fact that if you are a dentist and you are past retirement age, you have no option to remain, even on a retired register. You are either actively practising or you are out. It was always considered very desirable to have names, on a voluntary basis, so that if there was a national emergency it might be very valuable to be able suddenly to find where lots of doctors, dentists and so on could be available. So I have always resented the fact that the General Dental Council—of which I was an elected member for some years—flatly refuses to have any such list, and yet the General Medical Council does have one. Something of that type is an example of how important it is to have a more overall pattern that we all follow.
Quite by chance, I think, the noble Lord, Lord Patel, quoted Australia as an example. I never really practised there, except for half a day a week before I came to England, whereas here I was in dental practice for 35 years and, as I say, was a member of the General Dental Council. I support the Bill.
Baroness Walmsley (LD)
My Lords, I am grateful to the noble Lord, Lord Hunt of Kings Heath, for producing this Private Member’s Bill and echo his praise for all the health professionals who look after us in this country. For the most part, they are highly trained, highly skilled, and extremely hard-working and conscientious. Indeed, so are the regulators, which do their very best, under some difficult circumstances, to fulfil their purpose of ensuring fitness to practise—right through a person’s career—and the safety of patients.
I support the noble Lord’s efforts to persuade the Government to get on with modernising the regulation of health and care professionals. There have been extreme delays, and the expression used by the noble Lord, Lord Turnberg—glacial—is very apt. Ministers commissioned the Law Commissions of the UK to review the mass of legislation, which has been put in place piecemeal over the years, that underpins the nine health and care regulators. The resulting UK report was published in April 2014, and the four Governments’ responses were published nine months later. In December 2015, a Health Minister confirmed that the Government intended to consult on how these matters would be taken forward. However, 13 months later, this still has not happened, and I am not surprised that the noble Lord and all the regulators are getting more than a little impatient. Will the Minister tell us exactly when the consultation will be launched? How long will it last? How soon will Ministers respond and when do the Government intend to legislate? Can we expect pre-legislative scrutiny, which would be most appropriate for this kind of legislation? I thought the Home Office was slow in implementing promised consultations, but this one takes the biscuit.
Noble Lords will no doubt, like me, have received a number of briefings—most of them, I am afraid to say, only 24 hours ago—about this attempt to put a bomb under the Department of Health. I hope its imminent move to Victoria Street to make way for the Commons will not delay matters further. Noble Lords may also, like me, have been lobbied over probably the past two or three years about the shortcomings of the current legislation and the need to improve it. However, here we are and I hope the Minister will give the matter some priority because it is very important for the safety of patients.
I was struck by the level of agreement among the organisations that have briefed me about the problems with the current rules, although they disagreed about whether this Bill’s attempt to simply get the Law Commissions’ proposals implemented is the right thing to do. Clearly, it is much better than no change, but the problem is that time has passed since that work was done and things do not stand still in health and care. The situation has moved on very quickly. However, there is a consensus about the sorts of improvements that need to be made.
One of the common themes is the lack of flexibility in the current legislation. This is preventing regulators responding to the vastly increased workloads by streamlining inquiries. For example, the GMC tells us that when the Medical Act was passed in 1983, it had about 350 complaints per year. As we heard from the noble Lord, Lord Turnberg, we now have about 9,000, and the reasons for that are probably pretty obvious. The GMC closes thousands of cases every year without further action and yet it is obliged to consider all of them. Apparently, very many of them do not reach the thresholds set by Parliament, whereby a doctor has to be considered such a risk to patients that it should take action to restrict his or her ability to practise. A recent development is the local responsible officer who, according to the GMC, would be a much more appropriate person to deal with many more minor concerns. So the GMC would like the power to decide when a full investigation is appropriate and when it could be handled more appropriately by the RO. This would reduce the number of unnecessary investigations, reduce the stress on doctors—my goodness, we need to do that—and cut costs so that more resources can be diverted to where there is a need for serious action.
Another item on the GMC’s wish list is to be allowed not to have a public hearing in situations where the doctor accepts what has happened and is willing to accept the sanction. Finally, it would like a more nuanced suite of regulatory sanctions in relation to education and training concerns rather than just the nuclear options it has at the moment. All this seems to me to be sensible, and I am not sure why it is taking the Government so long to do anything about it.
The Royal College of Surgeons has raised an issue that emanates from the changes to the qualifications of members of surgical teams. A number of new roles in the extended surgical teams are not yet regulated, including physician assistants and surgical care practitioners. The college gives an example of the problem with this, in that physician associates cannot prescribe or order X-rays and CT scans. Statutory regulation of these roles to allow suitably qualified people to carry them out would free up surgeons to do other vital work, while at the same time reassuring the public. It is also anxious to see Sir Bruce Keogh’s recommendations on cosmetic surgery implemented, and the GMC supports this. It raised other matters such as ability to use medical titles and the testing of language skills, which we may be able to do in future.
The Optical Confederation highlights the rapid advances that have been made in eye care interventions by the use of digital technology—the noble Lord, Lord Hunt, mentioned one of them in a debate a few months ago. In addition, our ageing population has of course added greatly to the demand for eye care. The confederation supports the proposals of the Law Commission on the whole, but warns that the inevitable disruption and organisational change could interfere with its current work on transferring a lot of services from hospital into primary care or the community. That of course is what we are encouraging all hospitals to do. I think its conclusion is that this may not be the right time to change regulation. It did not mention the effect of the turmoil of Brexit, but I read that between the lines. What a pity this was not all done two years ago.
The NMC was the organisation most outspoken in its view that the draft legislation proposed by the Law Commissions is no longer the best way forward because of the passage of time. Its view is that its own founding legislation is too complex and prescriptive, and contains an unnecessary amount of overprescriptive detail, preventing it from adapting and modernising. It would like to be able to follow the more cost-effective approaches adopted by some other professional regulators, within its rules, but is prevented from doing so by its own particular rules. Clearly, there have been some minor but welcome changes to its regulation—we have heard about those that have gone through Parliament—but these make the whole package very bitty, and more is in the pipeline and will, as we have heard, come before your Lordships’ House very soon. But the NMC emphasises the need for further consultation before implementing the 2014 proposals because of the effect of the inordinate passage of time. Even the Health Secretary has asked the NMC to regulate the new nursing associate role. It is willing to do so but cannot do it without changes to the legislation.
It all boils down to a need for rapid consultation and rapid response from the Government. We on these Benches will happily work with the Government to ensure that the legislation that is so badly needed is properly and speedily scrutinised. Can the Minister tell me when we will get that opportunity?
Baroness Goldie (Con)
My Lords, I congratulate the noble Lord, Lord Hunt, on bringing forward this Bill. His expertise in these matters is acknowledged. I thank all noble Lords for their contributions to this helpful and constructive debate. At its heart, the noble Lord’s Bill addresses important patient protection issues, and we are all in sympathy with that objective. However, I have to say at the outset that we have reservations about the implementation of such a Bill. I shall explain why, because there is a context to all this.
The White Paper, Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers, published in February 2011, signalled the Government’s intention to ask the law commissions of England and Wales, Scotland and Northern Ireland to review UK law relating to the regulation of healthcare professionals. The review aimed to establish a simple, consistent, transparent and modern framework that would give greater autonomy to the professional regulatory bodies to decide how best to meet their statutory duties, balanced by clear lines of accountability.
The law commissions then reviewed the legislative framework in detail, consulted widely with stakeholders and published the findings of their review, alongside a draft Bill, in April 2014. I make clear that the Government accepted the vast majority of the recommendations of the four law commissions, either in full or in part. A small number of areas caused concern because the recommendations were not accepted, either because the Government wished to vary their approach or to consider further how best to deliver the policy intention. I was interested to note that the noble Lord, Lord Hunt, expressed reservations about some of the recommendations from the commissions.
I take this opportunity to thank and pay tribute to all the law commissions for their dedicated work during the review, which involved considering an extremely complex legislative model. The results are a solid foundation on which the Government wish to build. We continue to support and pursue the law commissions’ aspirations of removing the antiquated and rigid processes embedded in the current legislative framework and of seeking to progress toward a more flexible, clear and coherent model of regulation that delivers better public protection.
Valuable as the law commissions’ work and recommendations are, we believe we need to go further to make the regulation of health professionals in the UK fit for the future. We therefore intend to bring forward additional policy proposals for public consultation that not only build on but go beyond the recommendations of the law commissions. As noble Lords are aware, it has not yet been possible to secure parliamentary time to bring forward primary legislation to enable this. However, I reassure the noble Lord, Lord Hunt, who asked whether the Government are serious about reform, and the noble Baroness, Lady Walmsley, who also aired this concern, that the Government remain committed to these important reforms.
I think it was the noble Lord, Lord Hunt, who raised the issue of whether the current arrangements are compromising safety. That is an important question to ask. I do not agree with the suggestion that the current legislation compromises safety, but clearly improvements can be made, and these will be considered in the forthcoming consultation.
In the meantime, it is not as though nothing has been happening. We have made improvements to priority areas to secure improved public protection. For example, changes have been made to the General Dental Council’s investigation-stage fitness-to-practise processes and the Nursing and Midwifery Council’s governing legislation. These have made the NMC’s and GDC’s processes more effective, ensuring greater consistency in decision-making and improving efficiency in handling fitness-to-practise concerns. This has speeded up the complaints-handling process in order to improve public protection while simultaneously improving efficiency.
Changes have been made to amend the Medical Act 1983 to establish the Medical Practitioners Tribunal Service in statute and to improve the General Medical Council’s fitness-to-practise procedures. The GMC has also been given an overarching objective of public protection. These changes strengthen the separation of the GMC’s investigation and adjudication functions, improving the timeliness and effectiveness of its processes.
In addition, the Health and Social Care (Safety and Quality) Act 2015, presented by my honourable friend the member for Stafford, Jeremy Lefroy, and supported by the Government, introduced a consistent overarching objective of public protection for the Professional Standards Authority and all the regulatory bodies.
Changes have also been made to introduce language controls for EEA citizens who seek or are registered as doctors, nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians. This has reduced the risk to patients of professionals practising without the right English language skills.
Legislation is currently before your Lordships’ House that will remove the statutory supervision of midwives and the NMC’s statutory midwifery committee. This legislation will also make a series of improvements to the NMC’s fitness-to-practise procedures. I am aware that the noble Lord, Lord Hunt, has some concerns about this order, which he has highlighted through his regret Motion. I reassure him that the department will respond to these concerns in the forthcoming debate on the order.
I am sure the noble Lord will agree that the Government have acted to make improvements to professional regulation since the law commissions’ reports. However, there needs to be more systematic reform in this area. We recognise that for patients and the public the current system of regulation can be confusing, inconsistent and slow. It is not always clear to the public which professionals are regulated by which regulatory body or against which standards. Staff working side by side in teams might be accountable to different bodies and work to different sets of standards. Different regulators might impose different sanctions for similar professional failings, and employers need to interact with numerous different professional regulators. Further, the regulators are hampered by an outdated and restrictive framework that struggles to keep pace with a constantly evolving healthcare system.
For those reasons, we plan to consult soon on radical reform of professional regulation across the UK. I realise that the word of critical interest to your Lordships in that sentence is the word “soon”. I cannot be prescriptive but we hope to launch the consultation within the next couple of months. It will not only build on but go beyond the law commissions’ work on simplification and consistency. We have developed our reform proposals in collaboration with interested parties including patients, the public, professional bodies, health and care regulators, trade unions, representative bodies, employers and the regulated professions.
Over the summer of 2016, the four UK Governments jointly held a series of engagement events. These identified the key objectives for the reform of professional regulation. These are to improve the protection of the public from the risk of harm from poor professional practice; to support the development of a flexible workforce that is better able to meet the challenges of delivering healthcare in the future; to deal with concerns about the performance of professionals in a more proportionate and responsive fashion; to provide greater support to regulated professionals in delivering high quality care; and to increase the efficiency of the system.
As part of the consultation we will seek views on: a more responsive model of professional regulation that can swiftly adapt to changing patterns of healthcare, and develop new roles and new ways of working without the need for frequent legislative change; establishing clear criteria to assess which level of professional regulatory oversight is appropriate for different professional groups; and whether the current number and set-up of healthcare regulatory bodies is delivering effective and efficient public protection. We want to ensure that the regulatory bodies have a consistent and flexible range of powers that allow them to take a prompt and proportionate approach to concerns about an individual’s fitness to practise. We are also concerned with enabling regulators, working with professional bodies and others, to better support professionalism among registered groups and to provide assurance on an ongoing basis that practitioners are competent and that their skills are up to date. We also want to ensure that we increase joint working, sharing functions and services between the regulators.
I think it was the noble Lord, Lord Patel, who asked about having one regulatory body. Having fewer regulators would make it clearer to patients and the public who to contact, and I reassure my noble friend that views will be sought on whether there should be a reduction in the number of regulatory bodies and whether a single body should be looked at. That will all be embraced in the forthcoming consultation.
I think it was the noble Lord, Lord Turnberg, who said that groups of healthcare professionals should be brought into statutory regulation. The Government’s position is that statutory regulation should be used only where it is warranted by risk. To inform decisions about whether groups should be regulated by statute, we have asked the Professional Standards Authority to develop criteria to assess whether and how such groups should be regulated. I hope that to some extent addresses the noble Lord’s concern.
The noble Lord, Lord Turnberg, and the noble Baroness, Lady Walmsley, raised the issue of Brexit—as the noble Lord said, no debate is complete without such a reference. The decision to leave the EU provides an opportunity to work with healthcare regulatory bodies and professional and patient groups across the UK to consider whether tougher checks are required, and we will consider all that alongside the Brexit negotiations.
Our ambition for reform of professional regulation starts with, but goes beyond, the recommendations of the law commissions. While I share the aim of the noble Lord, Lord Hunt, of a more effective system of professional regulation, I cannot support the Bill at this time. I am confident that there will be widespread support for our proposals for reform of professional regulation when the consultation is launched shortly—I hope I have reassured your Lordships that that is not an intangible aspiration; something is happening and there is a timeframe. I hope that in this House and in the other place we can have a constructive and positive debate about these matters. They are extremely important and, as I said at the outset, I am very grateful to the noble Lord for continuing to focus attention on them.
In conclusion, I look forward to working with your Lordships to take forward much-needed reform of professional regulation within the United Kingdom.
Lord Hunt of Kings Heath
My Lords, I am very grateful to the Minister and all noble Lords who spoke in the debate. The noble Lord, Lord Patel, who was of course a distinguished president of the Royal College of Obstetricians and Gynaecologists, put it absolutely right when he described the outdated nature of current legislation. He referred to the Australian experience. If we are to look afresh at regulation, we should look at whether one regulator is the answer. There could be arguments against, not least the disruption that is likely to be caused. So many current cases on the books would have to be dealt with according to existing legislation that there might need to be enormous structural changes. None the less, surely it is right to look at that. It is very interesting that he put that on the table.
My noble friend Lord Turnberg, who was an equally distinguished president of the Royal College of Physicians, gave some examples of why the current regulatory approach is not working. The most telling point of his speech was that regulators are unable to make a proportionate response. If a practitioner, having had a complaint made against him or her, acknowledges that it is justified and is prepared to respond in accordance with the regulator’s wishes, it still has to go through a hearing. That seems unnecessary.
My noble friend also raised the problem of when a regulator is concerned about how trainees are being trained in an NHS institution. The only sanction the regulator seems to have is to withdraw training recognition, but that can have a devastating impact. If you withdraw training from a whole hospital department, not only is that department likely to be unable to run, it can have a knock-on effect on the integrity of the whole general hospital and could lead to its closure. There have been instances where the threat to withdraw training has threatened the viability of a whole institution. From the GMC’s point of view, pondering the public interest, that places it in an impossible position, which is why we need a more proportionate regulatory system.
It is always a delight when the noble Baroness, Lady Gardner, intervenes in our debates. She raised the knotty issue of the retired lists, which have been around for many years. Your Lordships’ House has good examples to offer of how to deal with retired lists and, if the noble Baroness, Lady Jones, has her way later today, we may have to have a very large retired list indeed.
The noble Baroness, Lady Walmsley, asked some very pertinent questions about the Government’s progress, and argued strongly for pre-legislative scrutiny, which I, too, think is a very good thing. She mentioned cosmetic surgery. It would be good to know where the Government are going on the need to regulate cosmetic surgery. We need to act. She raised the comments of the Nursing and Midwifery Council and the fact that current procedures based on legislation are simply too complex and prescriptive.
I am very grateful to the Minister for her response. Essentially, she said that the Government are serious about regulatory reform and the consultation is due very shortly. Although she challenged my assertion that current legislation compromises safety, I refer her back to the Francis report and to what the Royal College of Surgeons says: outdated legislation compromises the regulatory bodies’ ability to safeguard patient safety. As she said, the current arrangements are confusing, inconsistent and slow.
The Government are to consult very shortly. That is very welcome. Of course, the Minister cannot say from the Dispatch Box when or whether they will then produce legislation—they will have to see the outcome of the consultation—but I make a plea to her and her colleagues that this matter is important. The Government would find Parliament sympathetic to improving the regulatory procedures, and I strongly encourage them to bring forward legislation. We know that the Secretary of State is very interested in the establishment of an investigatory safety board, on the lines of that in the airline industry, which I understand will require legislation. I should have thought that a safety Bill which encompassed both the investigation board and reform of the functions of regulators would fit nicely together and make an excellent Bill for, if not the next Session, the one after that. I very much hope that we will see progress.