Medical Profession (Responsible Officers) Regulations 2010

Lord Walton of Detchant Excerpts

Tuesday 23rd November 2010 Lords Chamber

[Lord Walton of Detchant]

My Lords, I declare an interest as having been president of the General Medical Council from 1982 to 1989. I know that the GMC is particularly anxious to see these regulations go ahead because the whole question has been smouldering away for very many years. Even during my presidency, we were aware that many doctors who came before the conduct committee of the council, or before that the disciplinary committee, were not so much erring or wicked as actually not practising, in some respects, to a standard of competency appropriate to today’s world. For that reason, we tried very hard to set up a mechanism within the GMC to establish what we called at first a competence committee. However, it was not successful because we could not persuade the profession and other bodies to approve some of the recommendations that we tried to put forward.

Subsequently, the GMC embarked on a programme of performance review. Mechanisms were established to identify doctors who were not performing to an adequate standard in the health service and other bodies, but that programme too did not succeed as well as it might. It was perfectly clear that it was crucial to the interests of the public at large and of patients themselves that there was a mechanism whereby doctors would be required every five years to subject their clinical performance and performance in their appointment to a process of validation. Revalidation then became one of the essential priorities for the General Medical Council. As the noble Earl said in his introduction, the GMC believes that implementing this process of revalidation is an essential step in advancing the quality of medical regulation, improving patient safety and providing patients with greater assurance that doctors are meeting the standards that we set for the medical profession.

I appreciate to the full some of the anxieties expressed by the noble Baroness. She has criticised the nature and content of these regulations. However, as I have said, this mechanism has been smouldering away for over 20 years and it is time to make progress. The statutory basis for the responsible officer is set out in the Health and Social Care Act 2008, which amends the Medical Act 1983. The GMC is now committed to the introduction of revalidation for doctors in order to change the way in which all doctors in the UK are regulated. Under this process, to retain their licence to practise, doctors need to demonstrate to the GMC every five years that they still meet the appropriate professional standards and are continuing to develop their skills and knowledge.

The responsible officer will be the link between the local healthcare organisation, whatever it is, and the GMC, and as such will be an essential component of implementing revalidation. The responsible officer will usually be based in and employed by the organisation for which the doctor works, or with which the doctor is contracted to provide services. The GMC will need to be confident that the recommendations it receives are robust, fair and consistent, but that the process leading to the recommendations and the recommendations themselves will be subject to quality assurance and to audit. The GMC will develop guidance to assist responsible officers in carrying out their role in relation to revalidation.

We have reached a stage at which it is crucial that responsible officers are in place before the rollout of full revalidation commences. This will have the advantage of enabling the GMC to identify gaps in the coverage of responsible officers, particularly of doctors working outside the National Health Service, and to make provision for them. In its response to the government White Paper, Equity and Excellence: Liberating the NHS, the GMC comments that the abolition of PCTs and strategic health authorities, which is not expected until 2013, leaves it unclear as to where the responsible officer role in primary care and sometimes in specialist care will sit, and how the role and functions of the medical directors will be exercised. As the noble Baroness said, this matter needs to be resolved, but it must not be a reason to delay the passage of these long-awaited regulations or to stall preparations more generally. The GMC has confirmed that it will work with the Department of Health to resolve this and other issues so that it can continue to make progress towards the implementation of revalidation. I trust that the regulations will be approved.

[Lord Patel]

My Lords, I concur with the comments of my noble friend Lord Walton of Detchant. It is important that we allow these regulations to pass. As he has said, the issue of revalidation has been smouldering away, to use his words, for many years. I recall from when I served on the GMC over eight years ago that the revalidation issue predates Shipman and has nothing to do with that issue. As my noble friend has said, this is a process and it is important that the regulations should be passed because we need the responsible officers to be appointed pretty soon so that the GMC can train them up and identify any issues before the process of revalidation begins. I understand that all the devolved Administrations have agreed that it should start by autumn 2012. If that deadline is to be met, we need the responsible officers long before that.

My conversations with officers of the GMC suggest that the council is well aware of the concerns raised. They know that when the legislation to reform the NHS is brought forward, the issue of what happens in primary care with doctors working as commissioners, and how they are to be revalidated, will have to be addressed. They are confident that they will be able to do so.

As for the other professional organisations that have also commented and to which the noble Baroness referred, it is interesting that only one has raised concerns; the others have not. All the other royal colleges have been involved in working with the GMC to identify how revalidation will be carried out in their own specialties and they are satisfied with the mechanisms that will be used. They are also satisfied that the pilots that are now being carried out will identify the issues.

It is important that we now approve these regulations and allow the responsible officers to be appointed. We will have other opportunities to debate the matter again during the next stages.

Health: Spending Review 2010

Lord Walton of Detchant Excerpts

Tuesday 26th October 2010 Lords Chamber

[Lord Walton of Detchant]

My Lords, part of the Question refers to the exemption of prescription charges for people suffering from long-term conditions. In my professional capacity as a neurologist, I looked after many such patients. Is the noble Earl aware that, as a result of recent research in molecular biology and genetics, many people with previously incurable conditions which are genetically determined are facing the prospect of drugs becoming available to treat their condition—so-called orphan or ultra-orphan drugs? Because these drugs need to be taken on a long-term basis, can we have an assurance that, as they come on stream, they will be made available to patients who will then be exempted from prescription charges when receiving this kind of treatment?

[Earl Howe]

The noble Lord raises two issues: access to new medicines for sufferers from cancers, particularly rarer cancers; and prescription charges. On the first, he will know that we have already created a cancer drugs fund to enable those people who cannot access cancer drugs to apply for funding for those drugs. That was part of the spending review announcement made last week. On the issue of prescription charges, we are looking for ways to make the system fairer than it is at the moment. We have not implemented the previous Government's plan to exempt all people with chronic conditions. Frankly, it was not affordable in the current context. However, we are looking at other means of creating fairness in the system.

Health: Osteoporosis

Lord Walton of Detchant Excerpts

Tuesday 19th October 2010 Lords Chamber

[Earl Howe]

My Lords, my noble friend is right to say that the outcomes framework will be central to assessing the performance of the NHS and driving up quality generally. The framework is still in development, and my department is currently looking at the responses to the recent consultation and carrying out the necessary analysis to ensure that it is as balanced and robust as possible. Having said that, the consultation document contained a number of proposed indicators that relate to falls and fragility fractures which are candidates for inclusion in the framework, although the department cannot take any final decisions until we have digested all the consultation responses.

[Lord Walton of Detchant]

My Lords, is the Minister aware that drugs are now available that can halt the progression of osteoporosis? Is he satisfied that there are sufficient facilities in hospitals across the country to carry out bone density measurements, from which the position can be assessed at an early stage to allow those at risk to be given appropriate treatment?

[Earl Howe]

My Lords, the NHS in England has invested in additional diagnostic capacity over recent years, including the provision of more DEXA scanners, which are bone density scanners. The most recent data I have show that only 145 people in England waited for more than six weeks for a bone scan, and of those only seven had been waiting for over 13 weeks. That does not suggest that there is undercapacity. However, the noble Lord is right to say that several treatments are available, along with many messages put out by the department to promote a healthy lifestyle in order to prevent fractures.

NHS: White Paper

Lord Walton of Detchant Excerpts

Monday 12th July 2010 Lords Chamber

[Lord Walton of Detchant]

My Lords, does the Minister recall and accept that I have said on a number of occasions in the past few years that what the NHS needs least is another major reorganisation? We have been beset by too many reorganisations over the years, but, having made that point, I should say that there are many valuable things in this White Paper on which we shall all wish to reflect over the coming months before the legislation is laid before the House. The development of outcomes, measurement and framework is very important.

There is also a case to be made for making all trusts foundation trusts, but only if Monitor and the Care Quality Commission have the strength and improved ability to monitor behaviour so that we avoid the kind of disasters that have occurred in one or two foundation trusts in the past few months.

I have said on a number of occasions that the NHS is beset by the activities of an intolerable quangocracy. There are far too many quangos, which have the right to examine and assess the performance of health service bodies, and a reduction in the number of these will be very valuable. However, we wish to know which quangos the Government have in mind. Valuable, too, will be the reduction in bureaucracy.

Many of those who are so proud of the NHS have major concerns about the GP-commissioning element of the White Paper. No doubt the Minister will remember GP fund-holding under the previous Conservative Government, which was not a great success and had to be withdrawn in the end because it failed to fulfil the objectives. I know, and the Minister will agree, that a number of general practitioners are very enthusiastic about this idea, but many are deeply concerned and anxious about the new responsibilities that will be imposed on them. What administrative support will the GP consortia be given to enable them to fulfil this very arduous responsibility? Is it really right that every form of regional strategic planning should be abolished? What is to prevent overambitious foundation trusts embarking on programmes to bring in highly expensive—

[Lord Campbell-Savours]

My Lords, with all respect, could someone remind the House that we are discussing a Statement?

[Lord Walton of Detchant]

Will the Minister say whether he believes that abolishing all regional planning is absolutely right? I believe that it could be dangerous.

[Earl Howe]

My Lords, I am grateful to the noble Lord for his questions. He will know that our plans do not constitute reorganisation for its own sake. The only purpose of the reorganisations that we are proposing is to embed higher-quality practice and better outcomes for patients, and for no other reason.

The noble Lord asked several questions about GP commissioning. As he will know, the previous Administration introduced practice-based commissioning more than five years ago. Some consortia are doing an excellent job, but many GPs have been frustrated by not having clear responsibility and control. They find very often that PCTs get in their way rather than help them. I think that it will be music to their ears that they will be able to create structures and management systems for themselves that will help them rather than get in their way. We are going to enable them to learn from the past. We are engaged in talks with the profession about how we implement the change, which will, I emphasise, be bottom up.

The noble Lord also referred to GP fund-holding, which as the House will know was a policy introduced by the Conservative Government. There were good points and bad points about fund-holding. The good points were that it empowered GPs and, in many cases, delivered good quality care. But the criticisms revolved around high transaction costs, bureaucracy and, in many ways, inequalities that resulted. We want to avoid those pitfalls. The support that GPs will get will not be prescribed from the centre. A range of support is already available for commissioning, including PCT teams, local authorities and independent commissioning support organisations. There will be no shortage of help out there.

NHS: Pain Management Services

Lord Walton of Detchant Excerpts

Wednesday 7th July 2010 Lords Chamber

[Lord Walton of Detchant]

My Lords, I, too, am grateful to my noble friend Lord Luce for initiating this crucial debate because pain is one of the most distressing of human experiences. I shall concentrate on the importance of accurate diagnosis of the cause of pain before an appropriate programme of treatment can be initiated.

Everyone recognises chronic pain in osteoarthritis and multiple arthritis and in patients with cancer and terminal illness, but a number of chronic pains are recurrent and not continuous. The noble Baroness, Lady Gardner, referred to trigeminal neuralgia, which is a momentary acute lancinating pain in the face that may be precipitated by touching the face, by washing, by cold winds, by chewing. It is momentary and lancinating, and is a very severe and distressing pain that must be distinguished from the chronic low-grade continuous pain in the upper jaw that is not uncommon in middle-aged people and that has been shown to be a psychogenic regional pain that not infrequently responds to anti-depressive agents once dental causes have been excluded.

There is another form of pain called cluster headache in which people, every few months, may have every night—often at the same time, such as two in the morning—a hugely intense pain around the eye and in the face lasting for about half an hour, or a full hour, which wakes them from sleep time after time. It disappears after two or three months and then comes back again two or three months later. It is not migraine, but it, too, is a special headache syndrome that remarkably has been shown to respond to a drug called indomethacin. Accurate diagnosis is crucial, which is why the education of medical students, of young post-graduate doctors and of other healthcare professionals in the recognition of the different pain syndromes is so important.

Several speakers have stressed the importance of multi-disciplinary management. I, too, stress that because, in my experience, some people with chronic low-back pain have become so anxious and tense because of it that it builds up a kind of vicious circle in which the pain is accentuated by anxiety and tension. This can sometimes be helped enormously by the prescription of anxiolytic drugs and anti-depressives, alongside analgesics. That is why the multidisciplinary approach is crucial.

There are, of course, many physical methods of treating pain, including manipulation, injections, occasionally acupuncture and cutaneous nerve stimulation. There is a huge number: far too many to mention in this setting. However, at the same time, the recognition of the nature of the pain is crucial.

Another curious pain, proctalgia fugax, is an agonising pain in the anus that lasts for five to 10 minutes. It may recur completely out of the blue and for no reason at all. I have experienced it and so have two of my daughters. It is totally benign; it is alarming but of no serious significance. Its recognition is important.

I simply stress, as have others, the important work of the Chronic Pain Policy Coalition. It has highlighted five areas of action which I hope will be accepted in principle by the Government. I also hope that the vital report by the previous Chief Medical Officer, which contained so much invaluable material, will be accepted by the Government as a principle and will not only persuade local health authorities of all kinds—primary care trusts and so on—to embark on a programme of improving the establishment of pain clinics across the country, but will be used by educational bodies for the education of healthcare professionals.

NHS: Budget

Lord Walton of Detchant Excerpts

Wednesday 23rd June 2010 Lords Chamber

[Earl Howe]

My Lords, on an instinctive level, I completely understand the noble Lord’s concerns and I can tell him that the department has looked very carefully at this whole issue. The worry, based on research, is that labelling medicines with prices has a much more complex impact on patients’ attitudes towards their medicines than one might expect. A high or a low price on a medicine could lead to a patient doing the opposite of what one wants in terms of taking medication appropriately. Therefore, I am afraid that we have reached the conclusion that this is not something that should be pursued at the moment.

[Lord Walton of Detchant]

Does the Minister accept that for some years the National Health Service has been beset by the activities of an intolerable quangocracy? In fact, no fewer than 50 organisations have the right to inspect and assess the performance of health service bodies. In their proposed bonfire of the quangos, will the Government look first at whether it is necessary to continue with the mechanism of looking over the activities of the individual regulatory authorities? Is it necessary to continue with that supervisory body or with, for example, the National Clinical Assessment Authority? Have not these two bodies probably outlived their usefulness?

[Earl Howe]

My Lords, I am very much in tune with the noble Lord’s general theme. As I said in the House last week, it has to make sense for us to look at each and every arm’s-length body. We need to consider what it does and what it was designed to do, decide how critical those functions are and how well they are fulfilled and then decide whether we can achieve better value for money by doing things differently. I do not want to promise the noble Lord a bonfire, as I have not yet taken any decisions, but I assure him that I will be rigorous in my approach to this whole exercise.