Medical Profession (Responsible Officers) Regulations 2010

Lord Kakkar Excerpts

Tuesday 23rd November 2010 Lords Chamber

[Lord Kakkar]

My Lords, we have heard that the key priority of the General Medical Council for patient safety and ensuring continuing standards and confidence of the public in regulation is the process of revalidation. We have heard in the Chamber today very strong support for the regulations.

The early appointment of responsible officers is critical. It will ensure that the system can be tested. The noble Baroness, Lady Thornton, was absolutely right to raise the structure in which responsible officers in the area of primary care will eventually be able to operate, but this matter can be dealt with when the health Bill is laid before Parliament and the primary care structures in it can be appropriately scrutinised.

As we have heard, if the regulations are in any way derailed at this stage, there is a danger that the whole momentum of revalidation will be disrupted. It could cause anxiety in the profession and lead to unhelpful pockets of resistance. There is now an ideal opportunity for a mechanism and the early appointment of responsible officers to test potential systems and determine where the weaknesses are. This will occur before revalidation comes into force in its fullest form, and will therefore allow the General Medical Council to respond appropriately. I add my voice to those of many noble Lords in supporting the regulations.

[Lord Colwyn]

My Lords, although the principles behind revalidation, which aims to raise confidence in clinical standards, are welcomed, there are concerns over the ways in which the Department of Health plans to implement the process through the responsible officer regulations. There is also concern about the new regulations coming into force in January 2011, given the proposals in the recent health White Paper to abolish structures that were intended to support the role.

I agree with the noble Baroness, Lady Finlay, that the demands of the role outlined in the proposals will require a person of quite exceptional skills and competences. It is assumed that many medical directors will become responsible officers, which will significantly extend their role by extending their responsibility, powers and workload.

There is already a marked variation in the abilities of medical directors to investigate performance concerns and implement local disciplinary procedures. The additional duties are likely to be onerous. It is not certain that senior doctors with the necessary professional standing will be willing to take them on, or that it will be possible to find senior doctors with the necessary standing and experience to succeed in this role.

It is essential that adequate resource is allocated to support responsible officers and that they are appropriately equipped to carry out their responsibilities. The guidance to the draft regulations emphasises that there must be a “robust” medical management infrastructure to support the responsible officer and sufficient delegation of duties to enable the role to be delivered to a high standard. How will this work in practice and how will it be resourced?

The draft regulations do not reflect the changes proposed in the White Paper. Reference is made throughout to “designated bodies”. These include PCTs and SHAs, which are to be abolished by 2013. There is no detail on what structures will support responsible officers, revalidation and other aspects of performance management in primary care after 2013. This makes the decision to press ahead and appoint 975 responsible officers to strengthen systems in structures that are to be abolished difficult to understand. Surely, given the decision to delay revalidation and the uncertainty around the structures that will support performance management, more time is needed to pilot and evaluate the responsible officer system effectively before bringing these measures into force in January.

NHS: Prebiotics

Lord Kakkar Excerpts

Wednesday 17th November 2010 Lords Chamber

[Earl Howe]

My Lords, I merely meant to indicate that we would welcome good-quality proposals. On probiotics, I understand that one study using live yoghurt showed a patient benefit but my advice is that the study methodology was flawed and its findings were not generalisable. Probiotics are not therefore recommended, as studies have failed to show any convincing evidence that they either treat or prevent C. difficile infection.

[Lord Kakkar]

My Lords, is the noble Earl concerned about the presence of the potentially more aggressive and resistant forms of C. difficile that have been identified in our hospitals? What action is being taken to ensure that they do not spread more widely?

[Earl Howe]

My Lords, the noble Lord is absolutely right. It is appropriate for me to emphasise that, as he will well know, inappropriate prescribing of antibiotics is above all what has caused the high levels of infection that we have seen in recent years. The use of broad-spectrum antibiotics predisposes people to C. difficile infection, so it is important that those in the health service understand the cause and effect relationship involved.

It is also worth mentioning that tomorrow is European Antibiotic Awareness Day, so it is appropriate that this Question has been asked today.

Healthcare: Costs

Lord Kakkar Excerpts

Monday 15th November 2010 Lords Chamber

[Earl Howe]

The noble Baroness is quite right, and I am well aware that she speaks from personal experience. Many hospital trusts, and indeed GPs’ surgeries where applicable, have devised inventive ways of reminding patients of their appointments, either on the day or on the day before, perhaps by text. Good practice in this area is something that we need to focus on.

[Lord Kakkar]

My Lords, clinical leadership is critical if we are to secure the greatest benefit for patients from NHS spending and the appropriate use of resources. What strategies do Her Majesty's Government have for developing clinical leadership in the NHS? I declare an interest as patron of UCL Partners’ NHS staff college.

[Earl Howe]

Again, my Lords, the noble Lord is absolutely right to focus on clinical leadership, which will be critical if we are to deliver the improvements in the quality of care that we wish to see, and also to roll out the vision laid out in the Government's White Paper. The department has a number of initiatives under way, as do deaneries in strategic health authority areas around the country, to promote clinical leadership. There are also active programmes in acute trusts. Without good clinical leadership, the programme cannot proceed as we all hope and wish.

Genomic Medicine: S&T Committee Report

Lord Kakkar Excerpts

Wednesday 9th June 2010 Lords Chamber

[Lord Kakkar]

My Lords, I, too, congratulate my noble friend Lord Patel and members of the Science and Technology Committee on this excellent report. I was not a Member of your Lordships’ House when the report was first published but I have had the opportunity to speak to my noble friend about its recommendations, and I agree with my noble friend Lord Sutherland of Houndwood that the implications of the report will be read throughout the world. It is a thorough, thoughtful and authoritative piece of work, and I am sure that many other Governments and authorities will wish to consider its recommendations as they consider an issue that will affect the provision of healthcare throughout the world.

The advances in genomic medicine that we have heard about in this debate are profound and, as we have heard, are starting to affect clinical practice today in the management of common diseases. There is no doubt as we move forward that the research that is being undertaken in this country and in other parts of the world will start to resonate, in terms of both what is available for our patients and what our patients and the general public hear about. This will drive patient and public expectation. We have heard that genetic testing and new diagnostic strategies will be available, not only through mechanisms provided through the National Health Service and other care institutions, but, as we have heard, will be available independent of healthcare institutions and systems. This will pose a considerable challenge for medical practice. Medical practitioners will be keen to do the very best for their patients and respond to their inquiries, but they will not be able to do that if they are not trained and educated in the new science of genomic medicine.

I shall concentrate on the issue of the recommendations in chapter 7 of the report—those related to education, training and workforce planning. If we do not get this right, many of the potential advantages and benefits that we could potentially provide to society will be lost in the medium term, and in fact there will be opportunities for misunderstanding as the available science is misunderstood and clinical practitioners are not able to respond.

Some important areas have been identified in the report regarding the question of primary education, subsequent training and continuing professional development. With regard to undergraduate medical education, the General Medical Council, in its publication Tomorrow’s Doctors, which was updated in 2009, has recognised the importance of including a requirement for the teaching of genetics in the curriculums offered by higher education institutions in the United Kingdom offering primary medical qualifications. There is no doubt that these will be adopted because the recommendations in Tomorrow’s Doctors will have to be applied by 2011-12, so we can feel certain that new generations of medical students moving into the next stage of their training will have knowledge about this important new science and will therefore be ready in their subsequent training to learn how to apply it.

We need to be certain that those training programmes both for primary and secondary care across the disciplines and sub-specialties have a requirement to ensure a core competency in the understanding of genomic medicine as it applies to that specific discipline. That has been agreed in terms of the Government’s response, but we need to make certain that it is applied. The coming together of the General Medical Council and the Postgraduate Medical Education and Training Board certainly suggests an opportunity for that to happen. I hope that the noble Earl will confirm that this will remain an area of focus so that the training we provide ensures the opportunity for practitioners to be able to respond not only to knowledge currently available but knowledge that will become available in the near and medium-term future. As we have heard in this debate, so much research is taking place in this particular area that advances will come thick and fast.

Then there is the issue of current practitioners—a very large proportion of the workforce—who were educated and undertook their training prior to the whole emergence of the field of genomic medicine. They will be seeing patients and members of the general public with the results of tests and inquiries about the implications of genetic and genomic medicine on their own health day in and day out, but they have not been trained to date. We need mechanisms for continuing professional development that ensure that as advances become available, and are being considered by our healthcare systems, they can be readily made available to practitioners so that they are able to respond to inquiries from their patients. That will be hugely important because large numbers of doctors and other healthcare professionals will be confronted with these challenges. We need to make sure that we have considered this and that we have appropriate mechanisms available to ensure that continuing professional development also provides opportunities as we go forward.

If we do not do that, the advances that come from all the excellent research and technology that we have heard about will not be readily available to patients as soon as we would hope. That will cause anxiety and unhappiness. It will miss opportunities in terms of protecting people and providing early opportunities for diagnosis and better treatment outcomes. Therefore, I urge the Government to look at this whole area of training and education in terms of taking forward the excellent recommendations in this report.

Queen's Speech

Lord Kakkar Excerpts

Thursday 3rd June 2010 Lords Chamber

[Lord Kakkar]

My Lords, it is with great humility that I beg your indulgence on this, the first occasion on which I address your Lordships’ House. In the few weeks since my introduction, interrupted by the general election, I have enjoyed the warmest of welcomes from so many noble Lords and Baronesses, for which I am most grateful—as I am for the courteous, kind and thoughtful help that I have received from numerous members of staff, including the Clerks and the dedicated Doorkeepers. My happiness in making this speech is tempered by thoughts for Black Rod, who was particularly kind to my family at my introduction and whom I have had the chance of seeing, most recently yesterday evening, in hospital. I know that all our thoughts are with him and his family.

I also express my particular thanks to my supporters: the noble Lords, Lord Higgins and Lord Patel, and the Convenor of the Cross Benches, the noble Baroness, Lady D’Souza.

I could not let this occasion pass without recognising the role of the House of Lords Appointments Commission in my being here. Its thorough interrogation to which I was subjected was without doubt the most demanding and insightful of my professional career to date.

My emotions always run high as I enter the House. I never cease to be amazed by the history that attends our deliberations and the vital role that your Lordships play in ensuring that potential legislation enjoys rigorous scrutiny, so that the best possible laws may join the statute book for the benefit of all our people. That this important work is conducted in such a decent, thoughtful and selfless fashion, calling upon a wide range of scholarship, expertise and, above all, experience, makes this House truly unique.

Nor do I cease to be amazed that I find myself among your Lordships, something I could never have imagined on 7 December 1977 when, as a schoolboy, I made my first visit to this House, on which occasion I was filled with awe, excitement and a passion for our nation’s democracy, debate and political discussion. The educational outreach programmes conducted by your Lordships are invaluable, and I hope to be able to contribute to these to help enthuse future generations of schoolchildren about the important work of your Lordships and about what is done in this House and how it forms a cornerstone of our much cherished democracy.

My professional life outside your Lordships’ House is as professor of surgical sciences at Barts and The London School of Medicine and Dentistry, part of Queen Mary College in the University of London, and consultant surgeon to University College Hospital. I also have the privilege to be director of the Thrombosis Research Institute in London, a world-leading centre dedicated to better understanding the problem of blood clots and how best they can be prevented and treated.

In the practice of medicine and my interest in thrombosis, I follow my father, a professor of surgery, and my mother, an anaesthetist, who came to our country in 1961 to complete their medical training. They were part of a substantial wave of immigration from India made possible because of a national consensus, long held, that has ensured opportunities and advancement for immigrant communities willing to integrate and contribute broadly to British society. What excitement there must now be among all British citizens of Indian origin on learning in the gracious Speech about the Government’s desire for enhanced partnership with India, a wonderful opportunity for this vibrant community to contribute to securing broader opportunities for the entire nation.

In many ways, consensus and institutions define our national character. It is about one of our great national institutions, the one in which I continue to have the privilege to practise as a surgeon and about which I must therefore declare my interest—the National Health Service—that I would like to speak to your Lordships today. Like any great institution, the NHS cannot and must not be taken for granted. It needs to be nurtured, nourished and pruned thoughtfully and sensitively where necessary but, above all, respected.

The gracious Speech indicates the Government’s desire to enhance the voice of patients and strengthen the role of doctors in the National Health Service. These are indeed important ambitions, and are made recognising the nation’s serious fiscal challenge, a situation that will dominate the way that all public services can be delivered for years to come.

Time and again, Governments have felt an obligation to turn to the question of NHS reform. Why is this necessary despite substantial investment, a dedicated and talented workforce and its unique place in the nation’s affections? Why is it that the care received by patients, and their experience of it, varies so considerably; that patient safety and dignity can still regularly be jeopardised; that we have not been able to define models and pathways of care that successfully cross the barriers of the hospital and general practice environment; that we are still witness to some shocking inequalities in health, none more so than those experienced by the homeless; that we have failed to develop a sustainable public health strategy; and that we are often unable to successfully disseminate and rapidly adopt innovation and the findings of medical research for the benefit of our patients? So much has been achieved, yet there is so much more that we need to do if we are to retain a sustainable National Health Service for the benefit of all. The nation’s continuing commitment to the NHS offers both opportunities and important challenges to the medical profession.

All life is a journey, and in my own as a clinical practitioner and academic I have learnt so much about the dignity and resilience of human beings, but also about their frailty and insecurity. It is with this in mind that individual practitioners must deliver healthcare, at a time when both patients and relatives are at their most vulnerable. Beyond the delivery of care to our patients, however, clinicians will have to direct their current skills, and develop new ones, to help ensure that the very best possible gains in public health can be achieved, and that we facilitate the most effective use of the public funds available for healthcare to deliver maximum societal gain.

This is an impressive challenge, but one with which my own profession must fully engage, and I am sure it will, through providing clinical leadership. Indeed, in its report, Future Physician: Changing Doctors in Changing Times, the Royal College of Physicians of London recognises this to be a critical issue and an obligation for the medical profession. However, there is an important distinction between leadership and management in the NHS, a distinction that needs to be clearly understood so that the development of true leaders across both primary and secondary care can become enshrined in the way that we nurture the careers of our most able clinicians.

Leadership is never easy, and clinical leadership will require healthcare professionals to engage with difficult decisions. How can resources be most efficiently utilised? How can the delivery of care be safe and effective while always ensuring that patients are treated with dignity and humanity? How do we ensure that advances in medical research and innovation, once proven, are rapidly adopted for the benefit of our patients, communities and society more broadly?

To effect change, partnership will be essential—partnership between patient and doctor, academic and clinician, hospital doctor and general practitioner, and of course Government and healthcare professional—always focused on the best that we can achieve for our patients while working to ensure that the precious and generous funding available for healthcare provides maximum benefit.

Despite being one of our country’s most cherished and important institutions, the NHS, like all healthcare providers around the world, faces immense challenges. With ever increasing costs on the one hand, and both the delivery of care and the nation’s health failing to meet expectations on the other, courage will be required to secure a sustainable NHS for the benefit of our people. The forthcoming health Bill offers the opportunity to ensure clinical leadership and partnership within the NHS. The expertise of your Lordships’ House will play an important role in achieving that. I thank noble Lords for having given me the opportunity to speak.