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

Baroness Walmsley Excerpts

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

[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?