Psychiatrists: Referral Fees

Lord O'Shaughnessy Excerpts

Thursday 7th June 2018 Lords Chamber

[Baroness Thornton]

To ask Her Majesty's Government what steps they will take to address concerns that psychiatrists treating patients suffering from addiction have been receiving referral fees from private clinics.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, the General Medical Council is the independent regulator of doctors in the United Kingdom. Its guidance is clear that doctors must not allow any financial interest to affect the way that they treat patients. The GMC is aware of the allegations in the media, will consider the evidence and, if it finds that doctors have breached its guidance, will take action. Serious or persistent failure to follow the GMC’s guidance may put a doctor’s registration at risk.

[Baroness Thornton (Lab)]

I thank the noble Lord for that Answer. Like many noble Lords, I am sure, I was alarmed to read allegations that people suffering from addiction were being used for what sounded like profiteering, which is absolutely against the rules. However, the wider issue seems to be that there is a shortage of mental health experts in the system at all levels and cuts in budgets, so there is vulnerability in the system that is being exploited. What are the Government doing to increase the number of psychiatrists and other physicians in mental health, and to increase funding given the amount lost in the mental health system?

[Lord O'Shaughnessy]

If these allegations are substantiated, there must obviously be serious consequences for the doctors concerned and clearly it is right that the GMC investigates that. In terms of the noble Baroness’s overall question, there is of course local authority-commissioned alcohol and drug treatment available; it does not need to be purchased privately. More generally, in terms of mental health support, she will know that there is a commitment to recruit 21,000 more mental health staff and that, through the new mental health investment standard, CCGs have to continue increasing their mental health spending year on year.

[Baroness Jolly (LD)]

My Lords, is there any evidence to suggest that these are isolated cases or more common practice?

[Lord O'Shaughnessy]

We do not have any detail on further cases at this point. Of course we would always welcome any evidence, as would the GMC, in order to investigate that. It is important to point out that doctors are revalidated medically every year and fully revalidated every five years. In that process, they are asked to demonstrate that they have stuck by the ethical guidelines in the GMC practice and, if any evidence alights contrary to that, it would put their registration at risk.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, as someone who has been in this area for quite some time, this exposure in the Sunday Times comes as no surprise whatever—it has been going on for many years. More importantly, is the Minister aware that there is a growing crisis in the private sector provision of alcohol and drug treatment centres? The numbers are declining and many are closing. The CQC produced a very critical report on the standards, which showed that 60% to 70% of them are failing to meet the appropriate level of performance, and that there is a distinct possibility that even less money will be available to provide for this kind of service in 2020, when the funding shifts to business rates. Is the Minister concerned about these kind of developments, and if so, would he be willing to talk to people who are equally concerned about it to try to find some way forward with better prospects for the future?

[Lord O'Shaughnessy]

I am as disturbed as the noble Lord is, not only by the stories we have seen in the press but by his view that this came as no surprise. If substantiated, from a professional perspective this is clearly a great cause of concern. I would be interested to meet him to talk about the overall support for the private sector. Clearly the CQC has a role in providing for patient safety and quality, but we need to make sure that publicly funded services are available for people recovering from alcohol and drug addiction.

[Lord Hamilton of Epsom (Con)]

My Lords, is it against the guidelines of the BMA for doctors to go to luxurious resorts on so-called conferences at places with plenty of golf courses, paid for by drugs companies?

[Lord O'Shaughnessy]

I do not know whether it is against the standards of the BMA. However, the General Medical Council is explicit in its guidance that doctors must not allow any financial interest—either the fact or the perception of it—to impact on the way they treat or refer patients, and they must declare any such conflicts or perceptions of conflicts to patients while treating them.

[The Earl of Sandwich (CB)]

Can the Minister confirm that Public Health England is now, finally, going ahead with its review of prescribed drugs and addiction to those drugs? Is he aware that the guidelines from NICE on this subject are very out of date, and will there be a parallel review of them?

[Lord O'Shaughnessy]

I can confirm that the PHE review is going ahead. I do not know whether there is a concomitant review on the NICE guidelines, and I will write to the noble Earl on that subject.