Queen’s Speech

Lord Patel Excerpts

Monday 9th June 2014 Lords Chamber

[Lord Patel (CB)]

My Lords, I am pleased to be taking part in this debate following the gracious Speech, and I am particularly encouraged to speak more freely when I see the noble Earl, Lord Howe, in his place and know that he cannot answer me back or reply to my comments—at least not today. So if I do speak freely, I hope that he will understand.

Before doing that, I shall speak on two of the issues that are in the gracious Speech and in the notes accompanying it. The first relates to redundancy payments, particularly for public sector workers. We know that current statistics show that a quarter of the managers who have been given redundancy payments come back to some post or other, either as NHS employees or contractors. These are highly paid individuals and some of them were found not to be performing well. It is time that that was stopped.

My other comment relates to education. I welcome the fact that GCSE A-levels are to be reformed. Both the Royal Society of Chemistry and the Royal Society have produced reports. The Royal Society report, which will come out on 26 June, alludes to the need for science and mathematics teaching in both primary and secondary schools. It also refers to the lack of appropriately qualified specialists in chemistry and other science subjects in both primary and secondary schools. Unless we tackle the issue, the comments we have heard from universities and employers about the lack of appropriately skilled people in science and mathematics and the lack of economic competitiveness as against our competitors will not be addressed. I hope we will have an opportunity to debate that.

I turn to the issues about which I can speak freely that were not in the gracious Speech. These represent missed opportunities. We have had draft Bills, and consultations and reviews conducted by the Department of Health, and yet nothing has come to legislation. Perhaps I may just list some of these issues because I do not have the time to go through them in detail.

First, the Law Commission report on the regulation of the nine regulators in health and social care. The Government asked the Law Commission to look at this in 2011 and it produced a clear report earlier this year which will be of benefit to both the regulators and, in the case of medicine, to improved patient care. The Government said that they were committed to bringing this in and yet there is no draft regulation or legislation and we do not know when we will get it. This will stop any further development or improvement in patient care, certainly as far as medicine regulation is concerned, because the current medical Act is draconian, bureaucratic and not fit for purpose. I do not know whether the Government can change this situation but I hope that they will at least produce a draft Bill before the next election.

My next point concerns caring, to which the Minister referred. Yes, we now have draft regulation and guidance, produced last week on 6 June, relating to Part 1 of the Care Act. Again, however, the legislation, guidance and regulation do not address the key issue—the vulnerability of old people who are abused through being provided with poor care and the lack of accountability of those who provide it. We need legislation to introduce a criminal offence and a penalty for those who do not treat old people properly. Some 500,000 elderly people are abused per year—50 per hour—and so, by the time we finish the debate, 250 more elderly people will have been abused. Regulation is required to fix this situation and I am sorry that I do not see it.

Parliament has said that it would like to see the plain packaging of tobacco products. There has been consultation and the Government produced draft regulation. I now realise that there has to be consultation time and, after that, the EU will have to have a consultation period. Therefore, the timescale is so prolonged that there is a risk that the issue will be kicked into the long grass if the Government do not produce something before the next election.

We have debated folic acid—I notice that the noble Lord, Lord Rooker, is in his place—and it is clear now that the folic levels in the general population of this country are low. One-third of pregnant women do not take the precaution of having adequate folic acid pre-pregnancy. This results in more than 300 babies being born with serious neural tube defects, spina bifida being one of them. However, several hundred others have their pregnancies terminated because of such defects. It is time now to address the issue by putting small quantities of folic acid in flour. However, there is no legislation to enable this.

We have also debated mitochondrial disease. About 3,500 women in this country probably carry mutant genes of mitochondrial DNA, which accounts for less than 1% of total DNA. Diseases related to mutations in mitochondrial genes are severe and affect mostly the brain, heart, liver, kidney and nervous system. One of the ways to help those who carry a CBL gene mutation is to replace the mitochondrial DNA.

Three reviews that the Government asked an expert committee of the HFEA to produce, and the report from the Nuffield Foundation ethics committee, all said that there was no reason why mitochondrial replacement techniques should not be given the go-ahead. However, legislation will be required before this can occur in humans, even for the purposes of research. These are five missed opportunities on issues that we have already discussed.

I turn finally in one minute to—

[Baroness Northover (LD)]

My Lords, there is an advisory speaking time of five minutes. Obviously the noble Lord could go beyond it, but in terms of courtesy to others, given the number of speakers in the debate, he might want to bear the time in mind.

[Lord Patel]

As a courtesy, I will not go any further. However, I have to say that NHS reforms have not worked so far and we should take the opportunity to look at the issues again. I hope that we will be able to discuss them further.

Law Commission

Lord Patel Excerpts

Monday 12th May 2014 Grand Committee

[Lord Patel (CB)]

My Lords, I am delighted to take part in this debate, initiated by the noble Lord, Lord Hodgson of Astley Abbotts. Although much of what I was going to say has already been said by the noble Lord, Lord Kirkwood of Kirkhope, I will re-emphasise it because it just goes to show why the medical profession feels that this particular part of the Law Commission’s report is so important. As the noble Lord said, it is not about health but about the protection of patients and the public, for better healthcare.

It is on that basis that I wish to speak about the Law Commission’s Regulation of Health and Care Professions Bill, which sets out the framework that will cover all nine health and social care regulators—not just the medical regulator but the medical councils. I declare no current interest regarding the General Medical Council, although of course I am a doctor and have been a member of the GMC and, as the noble Lord said, I produced a report on medical education in recent times.

In 2011, the Department of Health published a Command Paper called Enabling Excellence, which set out the Government’s position on the regulation of healthcare professionals, so there is no doubt that as long as three years ago they intended to do something about healthcare regulation. The Command Paper announced that the Law Commissions of the UK would review the legislation underpinning each of the professional regulators. They wanted the commissions to address four key areas: first, the independence of the regulators, with emphasis on addressing the current dependence on government for legislation; secondly, the simplification of the legislative framework, giving regulators greater autonomy to decide how to meet their regulatory duties; thirdly, reducing the cost of regulation, with emphasis on the scope for mergers, the consolidation of functions, the reduction of registration and fitness-to-practice costs and co-operation on quality assurance of education; and, fourthly, accountability—the greater independence granted to the regulators would be matched by a commensurate strengthening of their public and parliamentary accountability for their performance, including widening the role of the Professional Standards Authority.

As recently as April 2014, following the conclusion of the review, the Law Commissions of the UK published the draft Regulation of Health and Social Care Professions Bill, to which noble Lords have already referred. It is now the Government who need to take the next step, and it may well be for the Department of Health in England—with the assistance, I hope, of the Ministry of Justice—to decide how it wishes to take the Law Commission’s Bill forward. I hope, as do other noble Lords, that it will be in the Queen’s Speech on 4 June.

For its part, the GMC strongly supports the introduction of the Bill, which provides a once-in-a-generation opportunity to provide a long-term legislative framework that would enable the GMC and other regulators to innovate and respond quickly and efficiently as society’s expectations change in the years to come, as the noble Lord, Lord Kirkwood, referred to. The Bill would allow the implementation of a range of long-awaited reforms that are not possible under our current legislation, and would enable greater opportunities for collaboration between the different regulators.

Let me give some background. The Medical Act 1983, which provides the GMC with its statutory powers, was designed for a different era. Like the legislation underpinning other professional regulators, it is outdated, complex, highly prescriptive and difficult to change. The regulation of healthcare professionals Bill, on the other hand, would ensure that the GMC and other professional regulators were much less reliant on government lawyers and archaic procedures to modernise professional regulation. Currently, rules and regulations made by the General Medical Council are in the form of statutory instruments and require the involvement of the Department of Health in England, the Privy Council and Parliament. The process is interminably slow. This Bill proposes wide-ranging powers with its own rules, subject to a duty to consult, which would allow for more efficient and modern practices by the regulators.

There are a number of reforms that the General Medical Council and other health professionals would look to implement as quickly as possible if the Bill were taken forward. I will give examples. There are a range of reforms that the council and other regulators would implement to improve their fitness-to-practice procedures for the benefit of patients and employers. Currently, they are cumbersome and lengthy. Many of these reforms have been consulted on already and received widespread support but cannot be implemented without new legislation. There is a need to speed up fitness-to-practice processes and to be able to appeal panel decisions when the General Medical Council feels that they do not protect the public—and the key role for the GMC is to protect the public. It also needs to be able to strike off automatically any doctor who has committed a serious crime such as rape without the need to refer to a panel, whereas now there is a need to do so.

The GMC would also be in a better position in having management with legal chairs and requiring doctors who have restrictions on their practice to undergo checks on their performance before a full return to work. The legislation does not now allow for that. The draft Bill goes some way to implementing a number of these reforms. Clearly, despite its many clauses, it will require a great deal of scrutiny and improvement, but I am sure that we are up to it.

The regulation of healthcare professionals Bill will provide the flexibility to approve education and training obtained in a range of programmes. Let me briefly refer to why this is essential. It will enable the General Medical Council and other regulators to address the current problem of having to recognise or derecognise an entire institution because one part of the programme offered by that institution fails to meet standards, even though other programmes may be acceptable. Because of that difficulty, we often find that the GMC is reluctant to take that action. These changes will enable the GMC better to support the efforts of UK universities and other educational institutions to deliver UK education and training overseas, which would be of enormous benefit to the United Kingdom and its reputation worldwide as a centre for education in healthcare.

In addition, the Bill will provide a way to introduce the more nuanced suite of regulatory sanctions recommended by the recent review of quality assurance in medical education—even though I might have had some say in that. The Bill could also enable greater efficiency among regulators, with more opportunities for co-operation. The regulators would have a new duty to co-operate with each other, which they currently do not, as well as being able to delegate any of their functions to another regulatory authority.

In conclusion, simplified legislation would allow the professional regulators to be much more flexible and innovative in using regulation to support and promote safe, compassionate patient care for patients. All eight of the professional regulators agree that:

“This will be a once in a generation opportunity to bring long awaited reform to ensure that the health professionals who treat us are properly trained, competent and up to date”.

The Minister may not feel that it is for the justice department to bring such a Bill forward, but I am sure that he and the department are in a highly respected position to influence other departments in addressing this issue, and at least to indicate that they will bring this Bill to Parliament in the next Queen’s Speech.