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The Health and Social Care Bill

11 December 2007

The Health and Social Care Bill, officially announced in the Queen’s Speech in November 2007, contains measures to modernise and integrate health and social care in the United Kingdom. The Bill is just one component of the legislation devised to implement the recommendations set-out in the White Paper Trust Assurance and Safety – the regulation of health professionals in the 21st century.

The Bill aims to:

  • Create the Care Quality Commission as a new integrated regulator for health and social care
  • Reform professional regulation to enhance public and professional confidence in the system of professional regulation and strengthen clinical governance
  • Create public health protection measures to strengthen the response to infectious disease and contamination
  • Establish the Health-in-Pregnancy grant to assist expectant mothers with the costs of a healthy lifestyle during pregnancy

Although revalidation is a key aspect of the White Paper, it is not specifically mentioned in the Bill.

The majority of the content of the Bill is technical in nature and serves as enabling legislation for future legislative projects. Despite this, there are some aspects of the Bill that are relevant to surgery.

Responsible Officers and Sharing Information

As discussed in the ‘Tackling Concerns Locally’ chapter of the White Paper, the Bill creates local oversight elements for sharing information on concerns about doctors and establishes the role of Responsible Officers.

Each regulatory body will appoint a local Responsible Officer to monitor the conduct and performance of its members. The Responsible Officer will ensure that appropriate action is taken when concerns are raised about a doctor, and will share this information with the appropriate authorities. The Officer will also have the responsibility to cooperate with the General Medical Council (GMC) in connection with its responsibilities for revalidation and fitness to practice. The College’s regional structures and representatives will be key stakeholders for these Responsible Offices on surgical matters.

Although it is not explicitly mentioned in the legislation, the explanatory notes to the Bill state that the Responsible Officer is closely related to the revalidation and appraisal processes.

Office of the Health Professions Adjudicator

The White Paper Trust, Assurance and Safety outlines the Government’s intention to separate the adjudication of fitness to practice cases from their investigation and prosecution. To this end, the Health and Social Care Bill introduces a new body, the Office of the Health Professionals Adjudicator (OHPA). The OHPA will appoint fitness to practice panels (with at least a parity of lay and professional members, as per the White Paper) to hear cases of alleged misconduct. The OHPA must consult with the public, patient groups, the GMC and other professional representation bodies (e.g. RCS Eng.) when making rules. In addition, the OHPA must seek guidance from the GMC with regard to appropriate sanctions, warnings, conditions for continuing practice and restoration to the medical register. This move has been welcomed by the GMC, subject to satisfactory agreement of the details.

Standard of Proof

Reflecting the intentions of the Government as set out in the White Paper, the Bill introduces the Civil Standard, rather than the Criminal Standard, of proof for adjudicating fitness to practice claims. This means that the party bearing the burden of proof must demonstrate that it is more probable than not that the medical professional is guilty of misconduct, and the evidence used must be proportionate to allegation made.

The College believes that the change to the civil standard of proof has the potential to benefit patient safety by focusing on earlier intervention and rehabilitation when concerns have been raised about a surgeon’s clinical practice.

Care Quality Commission

The Care Quality Commission is a new independent body with responsibilities for the registration, review and investigation of health care providers. The Commission will be responsible for reviewing the performance of care providers, and has the power to suspend or cancel the registration of a provider who is found guilty of a relevant offence.

The Commission is also tasked with reviewing the provision of NHS services and informing the Department of Health. It will conduct reviews of NHS and Foundation Trusts with reference to standards of quality set by the Department of Health. The service quality standards set by the Department of Health may have an affect on the College’s workforce planning work. In addition, the Commission’s periodic Trust reviews may complement the College’s Developing a Modern Surgical Workforce plan with regard to effective use of resources.

Next Steps

The College will follow the progress of the Bill as it moves through the Committee stage, including debates and proposed amendments. The College will also be looking out for future legislation, particularly that which may clarify where the statutory responsibility lies around revalidation.

A pan-specialty Project Board and sub-groups, composed of representatives from the Specialty Associations and managed by the College, has been established to take forward work on revalidation. The groups will be working over the next couple of years to determine:

  • the standards for recertification (the specialist element of revalidation);
  • the best forms of evidence to demonstrate those standards; and
  • how that evidence needs to be collected.