Regulation of Health and Social Care Professions Etc. Bill [HL]

Baroness Goldie Excerpts

2nd reading (Hansard): House of Lords
Friday 3rd February 2017 Lords Chamber

[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.