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.