Health and Social Care Bill
Public Bill Committee, 8 January 2008.
Written evidence to be reported to the House
Jimmy Hood (Labour, Lanark and Hamilton East)
Before we begin, I have a few preliminary announcements to make. If they wish, hon. Members may remove their jackets during the Committee sittings. Will they ensure that in Committee their mobile phones and pagers are turned off or are switched to silent mode? I remind them that copies of the money resolution in connection with the Bill are available in the room. Adequate notice should be given of amendments. As a general rule, I and my fellow Chairman do not intend to call starred amendments, including any that may be reached during an afternoon sitting.
We are still in the early days of taking oral evidence in Public Bill Committees so it might be helpful if I explain briefly what is proposed so that we can be clear about matters. The Committee will first be asked to consider the programme motion on the amendment paper for which debate is limited to half an hour. We will then proceed to a motion to report written evidence followed by a motion to permit the Committee to deliberate in private in advance of the oral evidence sessions. I hope that we can take the motions formally.
Assuming that the second of the motions is agreed, the Committee will move into private session. Once the Committee has deliberated, the witnesses and members of the public will be invited back into the room and the oral evidence session will commence. If the Committee agrees to the programme motion, it will hear oral evidence today and on Thursday morning before reverting on Thursday afternoon to the more familiar proceedings of clause-by-clause scrutiny. I call the Minister to move the programme motion.
Ben Bradshaw (Labour, Exeter)
I beg to move,
That—
(1) the Committee shall (in addition to its first meeting at 10.30 a.m. on Tuesday 8th January) meet—
(a) at 4.00 p.m. on Tuesday 8th January;
(b) at 9.00 a.m. and 1.00 p.m. on Thursday 10th January;
(c) at 10.30 a.m. and 4.00 p.m. on Tuesday 15th January;
(d) at 9.00 a.m. and 1.00 p.m. on Thursday 17th January;
(e) at 10.30 a.m. and 4.00 p.m. on Tuesday 22nd January;
(f) at 9.00 a.m. and 1.00 p.m. on Thursday 24th January;
(2) the Committee shall hear oral evidence in accordance with the following table:
TABLE
Stephen O'Brien (Conservative, Eddisbury)
I add my welcome to you, Mr. Hood, as Chairman of the Committee, and to Mr. Conway. We look forward to serving under your leadership of our proceedings. On behalf of the official Opposition, I, too, welcome all members of the Committee to the opportunity to scrutinise the Bill, which is important in terms of the health and social care of people in England and Wales, and which, at times, touches on other legislative areas and jurisdictions of the United Kingdom.
I reiterate that the Second Reading debate was a positive introduction to the Bill, and I am pleased to see the witnesses available to us in the first three sittings, negotiated between the two Front Benches, out of a total of 12 sittings for the scrutiny of the Bill. Three sittings for witness evidence seems to be appropriate and reflects the importance and seriousness that all of us across the House place on the views of those who have an interest in these matters. I am pleased to see that, as noted by a number of people, the negotiations successfully led to what is now proposed as the programme motion for the list of witnesses. That includes the National Childbirth Trust, which, crucially, will be available to us to discuss the issue of the health in pregnancy grant. I had hoped for opportunities to hear from Monitor, the National Institute for Health and Clinical Excellence and a number of others, not least the Patient’s Association. That did not prove possible, although we hope that their advice will be available to members of the Committee during the scrutiny of the Bill.
Jimmy Hood (Labour, Lanark and Hamilton East)
Copies of any memorandums that the Committee receives will be made available in the Committee Room.
Jimmy Hood (Labour, Lanark and Hamilton East)
I welcome witnesses to the Committee. It is nice of you to come here this morning.
It is an interesting new process that we are now engaged in and we are on a learning curve, I assume, in all parts of the Committee.
Could I ask our witnesses to say who they are and who they represent and then we will proceed.
Jimmy Hood (Labour, Lanark and Hamilton East)
Before I move on, a question to all means to each organisation, so please chose between yourselves who speaks and answers.
Sandra Gidley (Liberal Democrat, Romsey)
This is a question to all. Do you agree with the decision to create a single integrated inspectorate for health and social care? Perhaps we could start with the Healthcare Commission.
Sandra Gidley (Liberal Democrat, Romsey)
I think that we will be picking up on some of those concerns later, thank you. Commission for Social Care Inspection?
Sandra Gidley (Liberal Democrat, Romsey)
On the record.
Ben Bradshaw (Labour, Exeter)
It may be helpful for the Committee if all three organisations, particularly members of the Healthcare Commission, could clarify whether the views they have expressed now mean that they are departing from their principled welcome to the Bill when it was published on 24 October.
Ben Bradshaw (Labour, Exeter)
I am asking whether your view has changed since you welcomed the publication of the Bill in your press release on 24 October, or whether you are concerned about specific details of the Bill. On 24 October, all three organisations welcomed the creation of an integrated regulator. Has your view changed since then, and if so, why?
Ben Bradshaw (Labour, Exeter)
You said, “We broadly welcome the policy direction set out by the Government”.
Jimmy Hood (Labour, Lanark and Hamilton East)
Does anyone else want to answer the Minister’s supplementary question?
Stephen O'Brien (Conservative, Eddisbury)
Picking up on Dame Denise Platt’s point, all of us are dealing with a Bill that now exists and we cannot rewind the clock, despite the urging of the leader in today’s Financial Times, which seems to suggest that the Bill should be abandoned. I want to direct my questions to CSCI and the MHAC. They have both expressed concern that the new commission will be dominated by its health care responsibilities, and may neglect social care and its duties under the Mental Health Act. What changes to the Bill, now that we are presented with this, would you like to see to help prevent that from happening? At the same time as you are considering your answer to that, perhaps you can also ensure that we have an idea about where in your current work you have a fear that these will be lost in the merger.
Stephen O'Brien (Conservative, Eddisbury)
I am very grateful, and before the MHA replies I will ask a supplementary so that they can help to cover this. Is it both what is and is not in the Bill that causes you concern? Also, do you think the expected £60 million saving to the £140 million overall cost—the figures now being reported—are the sort of numbers that you expect to recognise in what we will see in future? The Healthcare Commission might also like to comment on that particular aspect.
Jimmy Hood (Labour, Lanark and Hamilton East)
Is it addressing Mr. O’Brien’s question?
Stephen O'Brien (Conservative, Eddisbury)
I do not know whether it would be helpful to short-circuit slightly the very helpful set of points being made, but an amendment has been tabled which calls for a review to Parliament on a regular, and indeed annual, basis. Now it is a possibility that one could actually prescribe what should be contained within that review—which in itself would command what needs to be done—so I do not know if that helps in terms of whether that would be an appropriate mechanism by which your points could be delivered?
Stephen O'Brien (Conservative, Eddisbury)
So, if I fully understand your organisation’s view on this, it is that, while some of this is currently under regulations, you believe that without it appearing in a more upfront legislative manner—in primary legislation—it is not sufficient to get to where you think it ought to be?
Stephen O'Brien (Conservative, Eddisbury)
Just to round this off, I notice that the healthcare commissioner was nodding. Does he want to react to some of the points that were just raised, and also is there any help he can give us on this expected costs idea?
Stephen O'Brien (Conservative, Eddisbury)
Can you give me an example of what you mean by that distinction?
Stephen O'Brien (Conservative, Eddisbury)
I am sorry to pursue it, but just to be absolutely clear, do you believe that comes within the ambit of the clause 6 definitions?
Ben Bradshaw (Labour, Exeter)
Just a brief question that I think brings together the latest round of questions and answers, and that is whether the witnesses see that there may be an inconsistency between their desire for more prescriptiveness on the face of the Bill and their desire for the new commission to be flexible and independent and plough its own furrow. I will just leave that question hanging.
Jimmy Hood (Labour, Lanark and Hamilton East)
It would be unfair not to invite a response.
Stephen O'Brien (Conservative, Eddisbury)
Before that point, and I suspect that Dame Denise Platt might want to comment on this as well, is it the ambit—the scope—that you are seeking this clarification on, rather than the depth of the detail of process implementation?
Stephen O'Brien (Conservative, Eddisbury)
I notice that Anna Walker wanted to add one more point, Mr. Hood.
Jimmy Hood (Labour, Lanark and Hamilton East)
Mrs. Walker, you should not be invited to respond if you do not want to do so. The hon. Gentleman seems to be assuming that you want to ask questions.
Stephen O'Brien (Conservative, Eddisbury)
Mrs. Walker did indicate that she wished to do so, but I was conscious that I cut across her.
Jimmy Hood (Labour, Lanark and Hamilton East)
Sandra, did you want to come in?
Sandra Gidley (Liberal Democrat, Romsey)
I want to pick up on the Minister’s point about independence. In the CSCI submission, concerns were raised that the new body will not be as independent because ministerial approval is required for a range of matters. Will someone from the CSCI comment on whether the new body will have greater or lesser independence?
Sandra Gidley (Liberal Democrat, Romsey)
Do you have concerns that that will not happen?
Angela Browning (Conservative, Tiverton and Honiton)
Lord Patel and Chris Heginbotham have given us a very clear outline today of the work of the Mental Health Act Commission. Under the umbrella of the Care Quality Commission, would you envisage that mental health will be dealt with by a specific team of people or a separate department in order to maintain the expertise that is clearly essential? How in practice would you see this happening under the new umbrella organisation?
Angela Browning (Conservative, Tiverton and Honiton)
Further down, regarding the people who actually go to hospitals and carry out inspections. You emphasised very clearly in one of your answers how the process is about people and how they pick up from their experiences specific wards, specific conditions and so on. They start to identify, as opposed to someone who just goes in with a tick box and ticks it all off one way or the other. How do you envisage retaining that expertise at that level?
Angela Browning (Conservative, Tiverton and Honiton)
Could I now come to the next question I was to ask, which is about elderly people? Anna Walker touched on it, and I also ask Lord Patel and Chris Heginbotham to keep it at the back of their minds, because one of the advantages of the Care Quality Commission is that there are no glass walls. As we know, when we are dealing with people they do not necessarily have one condition, so there is this mix of learning disability and mental health.
Coming now to care and inspection of behalf of the elderly. Do you believe this is going to improve the quality of care for elderly people, given the demographics we face with an increasingly elderly population? I wonder whether you think having these different disciplines working more closely together is going to help, or are you concerned that things will become so generic that specific groups such as the elderly will not see the improvement in quality?
Angela Browning (Conservative, Tiverton and Honiton)
Do you all agree on the point made by Dame Denise? She mentioned a report that is being made about people who do not qualify for support through social care under social services regulations. Equally, we see with elderly people not just an increasing population, but a common mental health read-across. Elderly people who are admitted to trauma wards, for example, usually present not just with the trauma, but a multi-disciplinary set of concerns. Will the new Care Quality Commission really improve the lot of these complex cases, or will we see a more generic service that will not address the specifics of care for these people?
Angela Browning (Conservative, Tiverton and Honiton)
I do not want to leave the witnesses trapped, but my concern is behind this point.
Angela Browning (Conservative, Tiverton and Honiton)
Thank you.
Greg Mulholland (Liberal Democrat, Leeds North West)
I want to ask a few questions about the powers of the new Care Quality Commission. I know that Dame Denise Platt has made some comments on that, which she might like to expand upon. I would like to ask the other two organisations whether they are generally happy with the powers that the new commission will have. If not, are there any specific changes to those powers that they would suggest at this stage?
Stephen O'Brien (Conservative, Eddisbury)
Before we move on and particularly while we are on that point, I would like to ask a quick supplementary. From what I heard earlier, and particularly in relation to the Clause 41 point that has just been made, is there shared concern about the delays that have already been referred to? If the information in the data generated by the activities that you all currently carry out, and that will be carried out under the umbrella body, generates this vital information base—often quite generically through visiting and inspection—it is a very powerful tool for benchmarking and upgrading the standards that are applied in these specialist and often tough areas. Is the absence of being able to go straight to publication, which is often a powerful leverage tool to get these things understood in the public mind, as well as in the users’, rather than going, as it were, in house via the Minister, a worry in terms of the potential independent power that you have? Going back seven years, I recall the great debates we had when the community health councils were axed and the absence, therefore, of the ability for things such as bedwatch suddenly to be a major standard upgrader within the health service. I do not know whether brief comments would be possible from the three bodies.
Stephen O'Brien (Conservative, Eddisbury)
Indeed.
Angela Browning (Conservative, Tiverton and Honiton)
As a member of the Public Accounts Committee, I just wanted to observe that in recent months the National Audit Office has done in-depth studies into both dementia and stroke services and, although its focus is very much the use of public money, other advantages have come out of those two very detailed reports, which it was able to make without any permission needing to be granted. It seems ironic that we rely on the NAO for those reports and that you do not have the discretion to commission them yourselves.
Stephen Crabb (Conservative, Preseli Pembrokeshire)
Thinking specifically about the powers of the new commission to issue penalty notices and suspend registration, it might be helpful for the Committee if members of the three organisations could outline the circumstances in which they would expect the new powers to be used.
Stephen Crabb (Conservative, Preseli Pembrokeshire)
Is there no other mechanism that would currently work in such a situation?
Richard Burden (Labour, Birmingham, Northfield)
My questions are related to the Healthcare Commission, specifically on the enforcement issues relating to infection control. I understand the points that you were making earlier about your wish to have oversight over commissioners as well as providers. I have got that point, but it is really about the issue of providers.
Richard Burden (Labour, Birmingham, Northfield)
The new commission will have tougher powers, as the Secretary of State made clear at Second Reading—for example, by closing hospital wards. I am just trying to clarify whether the Healthcare Commission thinks that those additional powers are necessary. Did you ask for those powers, because you, Anna, have just said that you see your current powers as being sufficient? However, I am also conscious that in your response to the Bill, Sir Ian, you said that the vision set out by the Department offers a sound basis for the regulator’s function, and means that the regulator would have additional powers while continuing to maintain a modern, risk-based, information-driven approach to regulation. We will come on to your concerns in a minute but, first, are those additional powers necessary? I am not sure exactly what you were saying about them.
Richard Burden (Labour, Birmingham, Northfield)
Are you saying you think that the powers are not necessary, but that if they are in the Bill they are an additional item in the armoury, or are you saying that you think they should be removed?
Richard Burden (Labour, Birmingham, Northfield)
So, if I understand it correctly, what you are saying does fit with what Sir Ian said in his response. You would not wish the powers to be used just at the drop of a hat, but to be a discipline that the regulator would need. You would want to encourage an escalation approach but, whether or not you would have brought them in, you are not necessarily saying that you want the powers removed.
Anne Milton (Conservative, Guildford)
Mrs. Walker, could I just bring you back to an example you mentioned earlier, which was that of Maidstone and Tunbridge Wells? Do you think that these powers would have helped the outbreaks of infection there? Would they have altered the outcome?
Anne Milton (Conservative, Guildford)
And you did not have the power that you needed?
Anne Milton (Conservative, Guildford)
But you did not have enough enforcement powers, penalties and that sort of thing.
Anne Milton (Conservative, Guildford)
And the public will look to this new body to be able to stop incidents such as those that happened at Tunbridge Wells?
Kelvin Hopkins (Labour, Luton North)
My question is about inspection. A view seems to have emerged already from what has been said, but the Bill does not appear to specify a minimum period between reviews of health and social care organisations by the commission. Do you envisage any change in the frequency of inspections?
Jimmy Hood (Labour, Lanark and Hamilton East)
Let me remind witnesses that the guillotine falls in four minutes, so please keep replies brief.
Kelvin Hopkins (Labour, Luton North)
I wish to ask a supplementary question about residential care for the elderly, much of which has been privatised. In the past, it was regulated by local democratic control and the ethics of public service, but it is now driven much more by the profit motive. Is it right that there should be lighter-touch regulation of such care homes? I understand that there is the possibility that, instead of being inspected twice a year, there might be inspections once every three years. Is that sufficient?
Jimmy Hood (Labour, Lanark and Hamilton East)
Mr. Kennedy, you have ten seconds.
Jimmy Hood (Labour, Lanark and Hamilton East)
Order. I thank you.
I welcome Professor Troop to the Committee. We are now eating into the time for questions.
Laura Moffatt (Labour, Crawley)
Good afternoon, it is great to see you, Professor Troop. This morning there was, rightly, emphasis from those who gave evidence not just on the inspection and regulations, but the health of those involved in the process. My first question is, do you feel that the measures that are outlined, particularly under clause 45, are sufficient for the Health Protection Agency to support the Bill, or would you like to see further measures or deletions?
Laura Moffatt (Labour, Crawley)
That is very helpful, thank you.
Anne Milton (Conservative, Guildford)
The new health protection information has set out that the measures can be used only in response to a serious and imminent threat to public health. Who will advise the Secretary of State about what is a serious and imminent threat to public health?
Anne Milton (Conservative, Guildford)
You would be well-placed to do that?
Anne Milton (Conservative, Guildford)
Do you think that there is any concern about the interpretation of a serious and imminent threat?
Anne Milton (Conservative, Guildford)
And you are comfortable with those words and the interpretation of them?
Anne Milton (Conservative, Guildford)
If I could just move on, the Local Government Association has argued that passing local health protection power from local authorities to the judiciary will possibly slow down the response to threats to public health. I would be interested in your views on that.
Anne Milton (Conservative, Guildford)
The witnesses are nodding in vigorous agreement, so I assume you are of accord. There is a balance to be found between responding quickly enough and, as you rightly say, getting a proper person to adjudicate on the matter, and a JP would obviously have the confidence of the public.
Anne Milton (Conservative, Guildford)
Thank you.
Jimmy Hood (Labour, Lanark and Hamilton East)
Professor, because of the speedy handover of the baton, I will now be able to welcome your two colleagues, who we were not expecting, according to our agenda, but we are delighted to have them here. If you would just introduce them.
Stephen O'Brien (Conservative, Eddisbury)
I would like to ask a specific question which relates to the subject under discussion. By way of introduction, could you give a view as to whether, as the Health Protection Agency, you think the current Bill we are about to look at line by line, both overall and in the detail you have read so far, has sufficient reference to and powers for public health generally as an emphatic part of our overall provision of health and care to the people of this nation? Then I might come on to a more specific point.
Stephen O'Brien (Conservative, Eddisbury)
I am very grateful that you have given us an opportunity to understand the principle that lies behind your point of view. Picking up now on the thread of discussion, are you happy that it is actually JPs who are going to be the people that can force individual citizens of this country to submit to medical treatment? Obviously you might not want to pass a judgment as to how draconian or not you think that is, and on the broad consent of and contract with people whom, after all, public health is done for and on behalf of—rather than done to, one hopes. Could you give a view both on the use of JPs and whether that is a proportionate part of the approach?
Stephen O'Brien (Conservative, Eddisbury)
I understand the use, and perhaps you could draw a distinction between those things that are a collective hazard, such as pandemic flu—and you therefore have, if I can put this brutally, a herd issue—and an individual issue whereby somebody whom you might describe as having a chaotic lifestyle has taken it upon themselves, if they happen to be HIV-positive, perhaps, that it is important to go around biting people if they can, and they therefore present a serious individual hazard that must impact closely on the criminal law. So one can try to draw a distinction between herd issues and individual issues, and how your enforcement powers and the use of JPs might have application there. Also, who is going to advise the judiciary as to the appropriate use of its powers once, in effect, you call upon it to be part of your process?
Stephen O'Brien (Conservative, Eddisbury)
Would there be any difference between the herd and the individual?
Stephen O'Brien (Conservative, Eddisbury)
Has some study been done on the way that interacts with other recent legislation on civil contingencies and taking civil powers, which I think is what Laura Moffatt’s question initially hinted at?
Stephen O'Brien (Conservative, Eddisbury)
Would or would not?
Stephen O'Brien (Conservative, Eddisbury)
So, it would be more likely to be a herd issue than an individual one?
Laura Moffatt (Labour, Crawley)
Could I ask you to offer us a hypothetical case where these powers may be used? It would be helpful to Committee members to have an illustration.
Laura Moffatt (Labour, Crawley)
One of each would be great.
Laura Moffatt (Labour, Crawley)
That is very helpful. Thank you.
Stephen O'Brien (Conservative, Eddisbury)
For instance, would the increasingly worrying instances of TB, which are not proving amenable to known controls, be an example?
Brian Jenkins (Labour, Tamworth)
I am very glad to have the opportunity to speak to you on this issue because the break between local authorities as a health protection originally was, I thought, brought about because local authorities provided the sewerage system and because that was one of the big public health issues, so there was an incentive for a close tie-up there. Now, they no longer provide the sewerage system, which is provided mostly by companies, and they no longer provide the water system; they do not have that basic requirement. The world and the structures have changed.
Now we see, as was mentioned in relation to public transport, dangerous materials transported up and down the country on road and rail, and the tremendous churn of all-day traffic. While we are looking at the issue of the break and the realignment, are there any other areas where we should consider realigning because over time, there has been insufficient change and the power to run something is no longer in the most appropriate place regarding public health?
Sandra Gidley (Liberal Democrat, Romsey)
You envisage the personal restrictions being used only very rarely, I gather. You mentioned human rights. I would like to explore a little further something suggested by the hon. Member for Eddisbury. He suggested someone who is HIV positive and has a chaotic lifestyle. If we rewind 20 years to when HIV was new, there were no drug cures and there was a lot of hysteria, including among health professionals, would you envisage that, if the powers proposed in the Bill were available then, they could have been used in a very restrictive way on a lot of people’s behaviour at the time? Obviously, that would be quite controversial. In theory, the Bill could do that. It is hypothetical, but I am trying to work out what would tip the balance into using those powers.
Sandra Gidley (Liberal Democrat, Romsey)
I agree, and that is the sensible and balanced view, but there was a lot of public hysteria at that time, so could you envisage a situation in which Ministers might feel under public pressure to be seen to be doing something and not follow your advice? Is there a risk of that?
Jimmy Hood (Labour, Lanark and Hamilton East)
Thank you for coming along. I am pleased that we have had time to say thank you, as we have not with other witnesses. I hope that you found it useful to meet the Committee; I am sure that the Committee has found it very useful to question you and to receive your answers.
Further consideration adjourned—[Steve McCabe.]
Further written evidence to be reported to the House
Derek Conway (Conservative, Old Bexley and Sidcup)
It is now four o’clock and we have a fairly tight timetable to get through. Obviously, Jimmy was chairing the Committee this morning. Before we begin, does anyone have any preliminary points to make?
Angela Browning (Conservative, Tiverton and Honiton)
How long before our proceedings today will be available to read?
Derek Conway (Conservative, Old Bexley and Sidcup)
I am advised that it should be within two days.
Angela Browning (Conservative, Tiverton and Honiton)
So will we be able to read and quote from today’s proceedings during Thursday’s debate?
Derek Conway (Conservative, Old Bexley and Sidcup)
I am advised that you should be able to do so.
Lady Justice Smith, thank you very much for coming to the Committee to answer my colleagues’ questions. As you know, we are on a fairly tight time scale and our session must end at 4.40 pm, whoever is speaking, and whatever stage they are at in their sentence.
Derek Conway (Conservative, Old Bexley and Sidcup)
Forgive our rudeness if that occurs. Before I invite my colleagues to put any questions, perhaps you would tell the Committee a little about yourself and say a few words. We shall then move straight to questions.
Derek Conway (Conservative, Old Bexley and Sidcup)
Thank you for that. My colleagues understand that there are certain questions that you cannot answer because of your position. If, at any stage, you feel that the questions are not appropriate, feel free to say.
Sandra Gidley (Liberal Democrat, Romsey)
The Bill makes a number of changes to the regulation of health care professionals, particularly in medicine. Are the changes proposed in the Bill broadly in line with your findings and recommendations?
Sandra Gidley (Liberal Democrat, Romsey)
Thank you for that. I believe that you also made some recommendations about the proportion of lay members. Will you elaborate on them? Did they just seem like a good idea, or did you have any evidence to back them up?
Sandra Gidley (Liberal Democrat, Romsey)
So was the motivation behind that coming more from a public perception angle?
Sandra Gidley (Liberal Democrat, Romsey)
Okay. I have a final question. Would you like to see any other changes to the Bill? Are we missing an opportunity here?
Derek Conway (Conservative, Old Bexley and Sidcup)
Let us stick with this matter for a moment. I bring in the Minister.
Ben Bradshaw (Labour, Exeter)
May I return to something that you said earlier, Lady Justice Smith, about the status of the independent adjudicator? You kindly acknowledged that your recommendation stressed the influence of independence from the GMC, but you now say that you have some sympathy with the position of the GMC, which is arguing that it should not be the proposed model that is an Executive, non-departmental public body along the lines of the Independent Police Complaints Commission. I wondered what your reasons were for that and whether you had an alternative model in mind that would satisfy the need for democratic and public accountability.
Stephen O'Brien (Conservative, Eddisbury)
Slightly moving on, thank you very much for your observations on clauses 93 and 94. I will be very surprised if there is not a Government amendment—if not, I assure you that there will be another amendment from somebody else—that will help to give some clarification.
The regulations that have just been sent to us as members of the Committee who support this include the phrase “in the wake of a number of high profile inquiries”. Clearly that refers to what was I think in the end six inquiries into doctors who had harmed their patients. The Office of the Health Professions Adjudicator is being created as a new body able to make adjudications and decisions. Are you happy with that declaration of provenance?
Stephen O'Brien (Conservative, Eddisbury)
That is clear, thank you. It strikes us that there will be an opportunity to discuss the element of independence that has been focused on in some of the questions and your replies. That will probably take place early on Thursday afternoon in the amendment that is tabled to clause 2(4), which in relation to the Bill performing its functions of looking at the commission, would insert what the Secretary of State may “direct” instead of what the Secretary of State may “advise”. That may be a turning point in deciding who we look to for independence in that area. There will be an opportunity during the discussions to focus on that.
Stephen O'Brien (Conservative, Eddisbury)
That is helpful. Thank you very much indeed. On the role of the OHPA, in the various recommendations that you made— and there were many—are you concerned about how the appeal process might operate?
Stephen O'Brien (Conservative, Eddisbury)
Indeed.
Stephen O'Brien (Conservative, Eddisbury)
Yes, there is as I read it. Although I am waiting to scrutinise the Bill.
Stephen O'Brien (Conservative, Eddisbury)
I do not wish to get into how we will need to scrutinise the Bill in later stages because we are taking your evidence rather than mine, but I am concerned that when the powers of adjudication come into being, we will be dealing with a person’s livelihood as well as the overriding concern of patient care and safety. We need to strike that balance. Someone else will ask you about the burden of proof—
Stephen O'Brien (Conservative, Eddisbury)
Sorry, standard of proof.
Stephen O'Brien (Conservative, Eddisbury)
Looking at the standard of proof, I see that it is to be a graded approach depending on the outcome, and I have difficulty with that. How can you know what standard of proof you need until you have heard what is at stake and the evidence? Often, the standard that you would expect to apply would probably have to be set at the beginning. Otherwise, everyone would be moving at the same time, and I am struggling with that.
Stephen O'Brien (Conservative, Eddisbury)
Yes, I have moved on.
Stephen O'Brien (Conservative, Eddisbury)
Well, it is not in the Bill. I do not want to over-pursue my line, but that is not in the Bill—
Stephen O'Brien (Conservative, Eddisbury)
Exactly, so things will have to be developed by experience and understanding.
Stephen O'Brien (Conservative, Eddisbury)
Does the variable standard have a precedent in civil law?
Derek Conway (Conservative, Old Bexley and Sidcup)
Angela Browning, I was going to come to you next but we have moved into an area on which Anne Milton would like to ask some questions, so it makes more sense if we pursue the standard of proof issue.
Anne Milton (Conservative, Guildford)
Thank you, Chairman. To some extent, you have covered what I was going to ask. For clarity, you recommended and approved of the move to a single standard of proof, and you would like to see legally qualified chairs?
Anne Milton (Conservative, Guildford)
If there were not legally qualified chairs, would you then have your doubts about the single standard of proof?
Anne Milton (Conservative, Guildford)
Irrespectively?
Anne Milton (Conservative, Guildford)
There is also the competence of the profession.
Anne Milton (Conservative, Guildford)
The medical profession. There would be more competence in the system with a legally qualified person.
Anne Milton (Conservative, Guildford)
I would have thought so, but I dare say we will have an opportunity to ask them.
Anne Milton (Conservative, Guildford)
Thank you very much.
Angela Browning (Conservative, Tiverton and Honiton)
I will be brief because you have covered a lot of what I was going to ask you. During your initial remarks you said you felt that the OHPA should be independent of Government and you mentioned that the GMC had provided you with the briefing that it has also sent to us.
Angela Browning (Conservative, Tiverton and Honiton)
I do. Looking through the case that the GMC makes, it says that it believes that the Bill extends the ambit of the state quite considerably. It prays in aid in its document, for example, the requirement to keep accounts as specified by the Secretary of State.
Angela Browning (Conservative, Tiverton and Honiton)
Perhaps not so much. I understand that one of the GMC’s grievances is that this has not gone out to proper consultation and that the measures were not recommended in your report or other similar reports. Would a consultation resolve that problem and make the case?
Angela Browning (Conservative, Tiverton and Honiton)
Thank you.
Derek Conway (Conservative, Old Bexley and Sidcup)
Would any other Members like to ask a question?
Ben Bradshaw (Labour, Exeter)
As we have a few minutes left, the following question might be helpful for me and other members of the Committee. The Bill deals with a number of other issues. I think that I am right in saying that if they were not direct recommendations that you made, they were things that you would approve of: lay parity; responsible officers; appointments not elections.
Ben Bradshaw (Labour, Exeter)
Finally, what is your view on appointments vis-Ã -vis elections?
Ben Bradshaw (Labour, Exeter)
To the professional bodies
Derek Conway (Conservative, Old Bexley and Sidcup)
Are there any other questions?
Stephen O'Brien (Conservative, Eddisbury)
Just one. I am looking now at the part of the fifth report where you highlighted the role of the Healthcare Commission in complaints handling. Are you concerned that the private sector patients in the NHS and self-funders in the social care sector do not have adequate access to complaints procedures, and that this legislation removes the Healthcare Commission’s complaints-handling remit?
Stephen O'Brien (Conservative, Eddisbury)
Well, we are still looking.
Derek Conway (Conservative, Old Bexley and Sidcup)
May I thank you for coming before the Committee this afternoon and giving evidence? It is much appreciated. Thank you very much for your time.
We were due to start this next section at 4.40 pm, so we are well in hand. Before we do that, Anne Milton, do you want to make an observation?
Anne Milton (Conservative, Guildford)
Yes, just to declare that my husband is a qualified doctor and a public health physician, and therefore—[Interruption.] I am sorry?
Sandra Gidley (Liberal Democrat, Romsey)
Sorry, I was being flippant. I said, “Is there such a thing as an unqualified one?”
Derek Conway (Conservative, Old Bexley and Sidcup)
Let us have this properly for the record.
Anne Milton (Conservative, Guildford)
For the record, my husband is a qualified medical doctor and a public health physician, and therefore his job might be implicated by this legislation.
Derek Conway (Conservative, Old Bexley and Sidcup)
Thank you for clearing that up; it will be duly recorded.
Although it is not exactly 4.40 pm, we can move on if our witnesses and the Committee are ready. I think that we shall do so to make some progress. Thank you for coming before us. Would you first like to introduce yourselves to the Committee? My colleagues have some questions that they would like to put to you when you have had your say.
Derek Conway (Conservative, Old Bexley and Sidcup)
Is there anything that you would like to say to the Committee before we put questions to you?
Derek Conway (Conservative, Old Bexley and Sidcup)
Mr. Scott?
Derek Conway (Conservative, Old Bexley and Sidcup)
All right. Laura, I wonder whether I can ask you to lead the batting for the Committee.
Laura Moffatt (Labour, Crawley)
Professor Sir Graeme, you kindly gave us a briefing note, and it was very helpful to us that you clearly said that the general direction of travel is exactly what you would like to see. You touched on your area of concern. If the Bill were to change, in what direction would you like it to change, and what specific measures would you put in place to promote so-called independence, about which you are concerned?
Laura Moffatt (Labour, Crawley)
Thank you.
Stephen Crabb (Conservative, Preseli Pembrokeshire)
On the office of the health professions adjudicator, perhaps we can take a step backwards. Will you tell the Committee why we need a new and separate body to take over from yourselves?
Stephen Crabb (Conservative, Preseli Pembrokeshire)
So, just to be clear, the problem of perception notwithstanding, you do not believe that there are any substantive deficiencies or problems with your processes?
Angela Browning (Conservative, Tiverton and Honiton)
You said that apart from the briefing that you sent us, you are generally content with the Bill. In clause 92, the GMC will still be able to publish guidance telling the OHPA what sanctions to impose on professionals found unfit to practise, but it will lose responsibility for conducting the work itself. I assume from what you have said that you are happy, because that is a classic example of judge and jury. Do you agree?
Angela Browning (Conservative, Tiverton and Honiton)
May I follow up with a supplementary question? Can you update us as to the GMC’s position on the question of doctors who are deemed to be fit to practise, but who offer themselves as expert witnesses in disciplines in which they clearly do not have the sort of experience that one would expect from somebody who puts themselves forward in that position? How does the GMC address that matter?
Angela Browning (Conservative, Tiverton and Honiton)
Thank you.
Stephen O'Brien (Conservative, Eddisbury)
We kicked off with Laura Moffatt moving into the question of independence, and we have heard from Lady Justice Smith and yourselves. You talked about seeking to secure a guarantee of independence for the Office of the Health Professionals Adjudicator, and to ensure that it delivers value for money. As we scrutinise the Bill, it is important for us to understand how it will impact on specific amendments in order to establish that. General information, unfortunately, has now got to reach the detail, and there are a number of amendments tabled that we will look at in order to tease this out.
One of the areas that I feel very un-briefed on, as we move toward a line-by-line discussion of the legislation on Thursday afternoon, is the argument about independence. I would like to know what point the GMC has reached, either with the Department or in its own understanding in discussions, in securing the OHPA’s operational effectiveness. What will be the financial arrangements for the cost of the OHPA? Will they eventually fall back as a burden on the profession? Will they be met from central funds? Where is the understanding? As an Opposition Member who has looked at this carefully, I am at the moment feeling somewhat unsighted, so I would grateful if you helped me out.
Stephen O'Brien (Conservative, Eddisbury)
It is a distinct thing from an arm’s length body from our point of view.
Stephen O'Brien (Conservative, Eddisbury)
Absolutely.
Stephen O'Brien (Conservative, Eddisbury)
I would like to follow that up, briefly; perhaps the Minister will speak about this, as well. From my point of view, therefore, trying to understand our role in scrutinising the Bill, it seems a bit unsatisfactory that there are unresolved matters. As you rightly said, the point that I raised is both separate and linked, and a lot of what we will find ourselves discussing may centre around what we truly mean by establishing the principle, as well as the practice, of independence. Unless those unresolved issues are resolved before we get to that point in the Bill, we will have a cart-and-horse situation. Do you feel the same, or do you think that I am perhaps being a little too pedantic?
Stephen O'Brien (Conservative, Eddisbury)
That is why I used the expression “arm’s length”. What one would want to achieve as we go through the detail is possibly to move away from a non-departmental body, however it is defined, to an arm’s length body. That should be set in the Bill as a matter of principle rather than a question of perception, which I think will be rather important.
Ben Bradshaw (Labour, Exeter)
Sir Graeme has partly answered the question that I was going to begin with—that is, what exactly is not independent enough about an NDPB? I was going to use the IPCC model, but there are others. I think that members of the Committee need a little more clarity about exactly which alternative model you prefer, or whether you would simply be looking for special guarantees about independence within an NDPB model.
There are a couple of follow-on questions from that. Is it not the case that the more distant and the more independent, the less power there is for any financial control or control of costs, which I know is of great concern to the GMC? Also, how does one ensure democratic—that is, public—accountability the more distant an independent body is from any governmental oversight or control?
Ben Bradshaw (Labour, Exeter)
What about the issue of cost control?
Ben Bradshaw (Labour, Exeter)
Would it be fair to say that the GMC has moved a considerable distance on a number of issues over the recent years, and that that has not always be easy for your council?
Ben Bradshaw (Labour, Exeter)
So you have not had any lively debates?
Ben Bradshaw (Labour, Exeter)
The British Medical Association does not like the way that you have shifted your position, does it?
Richard Burden (Labour, Birmingham, Northfield)
May I ask a couple of questions about the standard of proof in medical malpractice cases? In your public affairs briefing of 30 November you described the suggestion to change the burden of proof from the criminal to the civil standard in medical malpractice cases. You said that you saw the application of a civil standard of proof as
“consistent with protecting patients and the public interest”,
and at the same time “fair to doctors”. Is that still your view?
Richard Burden (Labour, Birmingham, Northfield)
There are some who have suggested that to move to a civil standard would be unfair to the medical profession. What is your answer to that?
Richard Burden (Labour, Birmingham, Northfield)
Do you have any idea, or would you speculate at all, on whether, if the standard of proof was changed to the civil standard, you would expect any change in the number of doctors who may be found guilty of malpractice or misconduct?
Richard Burden (Labour, Birmingham, Northfield)
Thank you.
Greg Mulholland (Liberal Democrat, Leeds North West)
May I ask a quick question about evaluation of the impact of the Bill? First, will the GMC be involved in evaluating the effect on professional regulation, which is fairly key to the GMC? If so, could you give us some more detail about how the GMC intends to do that?
Sandra Gidley (Liberal Democrat, Romsey)
I want to move on to responsible officers. We heard some concerns raised in the earlier session. How do you see the concept of responsible officers working in practice?
Sandra Gidley (Liberal Democrat, Romsey)
So is this a way of shifting the workload?
Sandra Gidley (Liberal Democrat, Romsey)
The Medical Protection Society has argued that medical directors will not have enough time to act as effective responsible officers, a view with which Lady Justice Smith went along to a certain extent. Does the GMC have a view on that?
Sandra Gidley (Liberal Democrat, Romsey)
You talk about being resourced adequately, but it seems that we are talking about the time factor as much as finance. How do you find more time in the day for the average medical director? That is a challenge, is it not?
Sandra Gidley (Liberal Democrat, Romsey)
Do you concur with the view expressed by Dame Janet that there is almost inevitably a tension between having such a responsibility and wanting to keep your trained work force? On the other side of the equation, you might be required to push people through a procedure whereby they might lose their job.
Ben Bradshaw (Labour, Exeter)
The supply of doctors, which has changed significantly, would also make a difference to a responsible officer’s reluctance or otherwise to get rid of a qualified doctor.
Anne Milton (Conservative, Guildford)
Moving back to the time needed to do the job, do you share my concern that the danger for an organisation is that it ticks the box marked “We have appointed a responsible officer” and considers the job done, but there is no resourcing—money and time are the same thing in the NHS—or no additional resources are put in, or resources are diverted because there is no new money coming in to fund the set-up. The new set-up is ideal; as you rightly say, it is evident to most people that resolving issues locally prevents bigger mistakes further down the line, but it is enormously time consuming if done properly. It is not something that can be squashed in on a job description. Perhaps you are not as cynical as I am, but I am concerned that there will be no additional funds to support the change, and that it will therefore not be done adequately.
Angela Browning (Conservative, Tiverton and Honiton)
May I return to the question before that one, where you were talking about the changes you felt had been brought about in the past few years, in terms of doctors turning a blind eye at one time when they knew colleagues perhaps had some problems and questions to answer? Could you just clarify for me where we are now? This applies particularly to very senior doctors at consultant level—the Minister will be only too familiar with this, as we both share a general hospital in Devon, where some years ago a consultant was suspended after an investigation and it turned out that the problems we experienced in our hospital had been experienced in his previous hospital. I would like you to talk us through how you sorted the problem of one colleague—a senior colleague perhaps—giving references to another senior colleague. Would the medical directors be involved in that part of the process when people move, at senior level, from one hospital to another?
Angela Browning (Conservative, Tiverton and Honiton)
But within the hospital system, would you see the medical director having a role in terms of new senior people coming to work in the hospital?
Angela Browning (Conservative, Tiverton and Honiton)
Exactly.
Angela Browning (Conservative, Tiverton and Honiton)
What would the situation be with GPs?
Stephen O'Brien (Conservative, Eddisbury)
Immediately following on that discussion, and one other issue: who will train—and have responsibility for training—these responsible officers?
Stephen O'Brien (Conservative, Eddisbury)
That is something we could usefully seek to ensure is properly articulated during the course of the Bill. It is no good inventing a concept without having the practical ability to deliver, and training is going to be key to this—particularly because, as I read it, these are not going to be full-time equivalent posts. They will be part-time responsibilities within other very serious responsibilities, in all likelihood, and the process is not going to work if we have very sharp variability across the country. I am glad we have clarified that issue.
The other point I wanted to raise, as we have a few minutes left, is that I presume—contradict me if I am presuming wrongly—that you were with Lady Justice Smith when she talked about clauses 93 and 94, about the need for a legal chair?
Stephen O'Brien (Conservative, Eddisbury)
And on the need for us to either look for a Government amendment or to put one down to resolve that issue on the OHPA? Also, could I ask your views on the balance between lay and professional members, assuming there is a legal chair of the adjudication panel? To have your views on that would be helpful.
Stephen O'Brien (Conservative, Eddisbury)
I declare an interest, being a qualified solicitor who was in practice for a few years before becoming non-practising 19 years ago.
I found Lady Justice Smith’s train of thought as to the merits of a legally qualified chair very persuasive, as one might expect somebody of her calibre to be. That said, perhaps as we take that issue forward—it clearly is an issue that has been left on the table for this afternoon’s proceedings—we may consider whether, if one has a presumption or even provision for a legally qualified chair, one would then dispense with the legal assessor or assistance.
In terms of the balance of lay members, currently an Order in Council cannot impose a lay majority on the council of a regulatory body. The question I had was whether we ought to be considering whether that needs to be a consequence of what we are looking at. That might need to be reviewed. If there were a lay majority, what would the GMC’s reaction be to that?
Stephen O'Brien (Conservative, Eddisbury)
We are.
Kelvin Hopkins (Labour, Luton North)
I would like to reinforce the point that Stephen O’Brien was making. I must say I found the arguments of Lady Justice Smith very persuasive, compelling indeed, about a legally qualified chair. One of the points she made was that it would shorten proceedings because the chair would know what to do, know the full legal implications of decisions being made and there would be less need for a legal assessor if that were the case. No doubt there are many other arguments but you sounded neutral; it sounded like a lack of enthusiasm.
Derek Conway (Conservative, Old Bexley and Sidcup)
Sir Graeme and Mr. Scott, thank you. We have sadly run out of our allotted time, but I think most people have made the points they wanted to make and we are most grateful to you for coming before the Committee. Your evidence was very much appreciated. We invite the British Medical Association representatives to take the chair.
If you are comfortable and ready to go, can I thank you both for coming before the Committee this afternoon? As you know, our session cannot go beyond 6 pm and my colleagues have a number of questions, but if you would like to introduce yourselves for the record, that would be helpful.
Derek Conway (Conservative, Old Bexley and Sidcup)
I watched you with the Minister on “Newsnight” last night, but I will not sneer like Mr. Paxman, I promise. Anne Milton, would you like to put the first question?
Anne Milton (Conservative, Guildford)
Thank you very much. This is the BMA’s opportunity to give full vent to your opposition to the move from the criminal to the civil standard of proof, unless you have changed your mind?
Anne Milton (Conservative, Guildford)
So please feel free to go for it in every respect.
Anne Milton (Conservative, Guildford)
Dr. Buckman, do you want to add anything to that from a GP perspective?
Anne Milton (Conservative, Guildford)
Thank you. You would take it out of the Bill, then?
Richard Burden (Labour, Birmingham, Northfield)
Perhaps I could explore that a little further. Is the point you have put there that the standard of proof for a doctor should generally be higher than one would expect in other sorts of employment relationships?
Richard Burden (Labour, Birmingham, Northfield)
Would you be aware that the standard of proof based on the balance of probability would of itself be a significantly higher burden than in virtually any other employment relationship, where if someone were to lose their livelihood from, say, alleged gross misconduct, all that an employer would have to demonstrate to a tribunal would be a reasonable belief that the employee had committed the offence of which he or she was accused. They would not even need a presumption of guilt, just a reasonable belief.
I do not know whether you were in here earlier for Lady Justice Smith’s evidence—
Richard Burden (Labour, Birmingham, Northfield)
Well, would I be right that a balance of probabilities standard of proof is actually of itself quite a high standard of proof, or do I have that one wrong?
Stephen Crabb (Conservative, Preseli Pembrokeshire)
Dr. Meldrum, you say that you are not here to talk about other areas of employment, but perhaps there could be something about other areas of health care professions. Our Committee was told that most other health professions use the civil standard of proof. What makes medicine so different?
Stephen Crabb (Conservative, Preseli Pembrokeshire)
Dr. Buckman, could I follow up on one comment that you made about potential changes in the way that a doctor might behave if there is a move to a civil standard of proof? Again, looking sideways at other health professions, have those fears been borne out in other professions where they use a civil standard of proof?
Steve McCabe (Labour, Birmingham, Hall Green)
I am trying to understand something. I might have missed the point here: you said that doctors will be more careful and cautious. What is the opposite of that? Would they be cavalier and less cautious? What is it that you are currently doing that will change if you are to become more careful and cautious? How are you operating currently?
Steve McCabe (Labour, Birmingham, Hall Green)
And being more careful and cautious would not be in the best interests of your patients? I am struggling to understand.
Laura Moffatt (Labour, Crawley)
May we continue this point, because I, like Mr. McCabe, am intrigued? I doubt that any of the cases that we know about, in which doctors have sadly run into trouble, were about over-investigation; they were about a cavalier attitude and not investigating properly. For me, that is where the risk lies. Did Steve’s question not touch on the real problem, which is quite the reverse of what you are saying?
Stephen Hesford (Labour, Wirral West)
If I may say so, I am frankly worried, Dr. Buckman, that you seem to personalise your answers—“I was doing that”, and “I was doing this”. Can you furnish the Committee with survey evidence that would persuade us, if we were persuadable, that your colleagues have told you, in huge numbers, that they have this fear about defensive medicine? Personally, I am not convinced that you represent what you colleagues would really be saying.
Stephen Hesford (Labour, Wirral West)
You have given your personal view, which is useful to some extent, but I am talking about the rest of the profession.
Stephen Hesford (Labour, Wirral West)
I understand the opposition, but that was not my point. I was talking about defensive medicine.
Judy Mallaber (Labour, Amber Valley)
I, too, am very puzzled by this attitude. My worst case in recent years concerned a child in my constituency who died of meningitis. There was a great cry for a full local inquiry, and a number of changes in practice took place in both the ambulance service and the children’s hospital. How would you explain to my constituents whose child died why the signs of meningitis that they thought were there were not investigated—we are talking about a good competent doctor here? How could you justify the idea about a more defensive attitude when that defensive attitude might have ensured that that child was investigated? Those are the sorts of cases that you will have to answer. You will have to explain to my constituents, and others in similar situations, why you do not believe that it is reasonable to have this burden of standard of proof.
Judy Mallaber (Labour, Amber Valley)
It still does not fully explain why the standard of proof for doctors should be different from that of other employees. I still do not understand exactly what makes you special.
Derek Conway (Conservative, Old Bexley and Sidcup)
I am conscious that we have other areas to cover, and two other members of the Committee want to come in.
Angela Browning (Conservative, Tiverton and Honiton)
I do not know whether I am in order here, but would it be helpful if the BMA or the GMC provided the Committee with recent statistics about the nature of the inquiries that doctors have been subjected to in disciplinary matters? I am beginning to find this a rather bizarre conversation. I would be interested to know how many patients have taken action against doctors for things such as over-exposure to scans. The Committee needs to consider the classifications of complaints against doctors and the outcomes of those different classifications. Before we consider the Bill line by line, I as a Committee member would find that information very helpful, wherever it comes from, so that we can focus on what, in the main, doctors are being asked to account for and the outcome of disciplinary action against them for those types of complaint.
Derek Conway (Conservative, Old Bexley and Sidcup)
We must not discuss the merits of the Bill just yet, but obviously if the witnesses want to comment on that, they can. If there is evidence that you wish to give, not necessarily now but subsequently—
Derek Conway (Conservative, Old Bexley and Sidcup)
That would be welcome.
Kelvin Hopkins (Labour, Luton North)
I just wish to pursue the point, if I may. I shall paint a scenario that is not so distant in reality. An elderly, single-hander GP in a poor inner-city area, who does not have a high reputation with the primary care trust, will not retire and has a long list because the more patients they took, the more money they received. They have a lack of confidence in their own ability and therefore refer a very large number of patients to the hospital, which upsets the hospital. The logical thing to do in those circumstances would be to persuade that elderly doctor to retire, yet because of the shortage of GPs, particularly in unpopular areas, they do not retire. Of course, they have many of the type of patients who do not complain, because they do not have the skills that some of us here might have to make complaints. What would you recommend for dealing with that situation, other than what is proposed in the Bill?
Sandra Gidley (Liberal Democrat, Romsey)
Is it not the reality that most doctors will carry on practising in pretty much the same way, because the difference is going to be very small? If GPs suddenly started referring people for a lot of tests, the referrals committee at the local PCT would be on to them like a shot.
Sandra Gidley (Liberal Democrat, Romsey)
Dr. Meldrum, you mentioned that there should be an evidence base for changing. Is it not also up to the BMA to provide some sort of evidence base for staying as you are? Is there any evidence from other countries that have changed the system that there has been any change in practice?
Sandra Gidley (Liberal Democrat, Romsey)
You mentioned the sliding scale, and Dr. Buckman seemed to intimate earlier that on an alleged offence, the committee might think you needed 60 per cent. probability, but the evidence would emerge and you would have to change it. I do not think that it would be like that; we must trust the people’s judgment, as the case develops, about whether more or less evidence is needed to make an ultimate sanction. Let us say you lost the case for a change in the standard of proof, is there anything that you would like the Bill to firm up—on the lines of a sliding scale or some such?
Sandra Gidley (Liberal Democrat, Romsey)
Is it just about the training of the panels, or does something more need to be written in stone?