My Lords, I am delighted that the noble Baroness, Lady Finlay, is supporting me. She is a clinician of distinction and a palliative doctor, but so much else besides. She will know as well as any of us—those of us who are not doctors—that one thing is at the heart of good, safe care: trust. As patients, we place our trust in our doctors. We trust them to use their skills and knowledge to treat us, to cure us and to keep us healthy to live our lives. We trust our doctors with our bodies, our minds and our lives. That brings great power and great responsibility. Doctors must make decisions and take actions in our interests; that is what we trust them to do. We know that trust is fragile. It is said that trust arrives on foot but leaves on horseback.
Noble Lords who were in the Chamber for the debate on Amendment 288 will know the context of the Independent Medicines and Medical Devices Safety Review, which I chaired. The people—the children—who were harmed placed their trust in their doctors and the wider healthcare system. They were let down. The lives of many have been turned upside down as a result of the harm they suffered. One woman who had been terribly harmed by a pelvic mesh implant told us:
“As patients, we allow the medical profession access to our bodies, our thoughts and our lifestyles. All manner of information to better assist them in reaching decisions about the best course of treatment for us. We, the patients deserve the same, we should be aware of clinicians’ allegiances or involvements whether they be financial or other. So we too can reach informed decisions about who is best to treat us, and how they should treat us.”
Doctors do wonderful work, often in extremely difficult circumstances. Decisions they make are not always perfect—they cannot be; we know and accept that—but must always be led by the best interests of the person who is their patient, not by external factors and commercial interests.
Amendment 283 would require the General Medical Council to expand its register of doctors to include their financial and non-pecuniary interests, as well as their particular clinical interests and their recognised unaccredited specialisms. In doing so, it would implement one of the nine major recommendations we made in our review.
The concept of declaring interests is hardly new, not least to all of us in this place. We know that it is important. It brings transparency and accountability, and the public have a right to know. Who in a position of responsibility can have a clearer, more significant
impact on someone’s life and well-being than a doctor or a surgeon? Maintaining information about doctors’ clinical interests and specialisms is a vital foundation of patient safety.
I was pleased that, in their response to the recommendations of the Paterson inquiry, the Government committed in principle to creating a single repository of the whole clinical practice of consultants across England, setting out their practising privileges and other clinical consultant performance data—for example, how many times a consultant has performed a particular procedure and how recently. This information should be accessible and understandable to the public. It should be mandated for use by managers and healthcare professionals in both the NHS and the independent sector. It would be a way of measuring outcomes and ensuring safety and quality. For all these reasons, we urgently need a register.
I have been extremely encouraged that the leading journal for doctors, the British Medical Journal, is in full support. It has written extensively about it. Its editor has spoken expertly on the subject at a meeting of the First Do No Harm All-Party Parliamentary Group. The BMJ found that current reporting of interests, which is meant to be done locally and held by employers, is at best patchy. Many hospitals do not keep the information and, when they do, it is hard to find and may be out of date.
We need a central register, one that is easily accessible and complete. The General Medical Council already holds the register of qualified doctors. Adding their financial interests to the register is not difficult; it can be done via the annual appraisal. Every doctor must undertake an annual appraisal to maintain their registration. I have spoken to the GMC about this, but it seems—shall we say—lukewarm.
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I am disappointed and surprised by that. The GMC does not have to shoulder the burden alone. Each year, at appraisal time, the doctor would complete a short form declaring their financial interests. That would be held by their employer or their contractor, private provider or clinic, whichever is the most appropriate. The information would be linked to the GMC register, so that the public could go to one place—the GMC—to see at a glance the interests of their doctor. As Sir Cyril Chantler says in his recent article in the BMJ,
“this arrangement would be an administratively simple, quick and effective way to improve transparency and begin to rebuild trust.”
Some, including the Department for Health and Social Care, have said that we should have a register not just for doctors’ interests but for all health workers. I do not disagree, but we must start somewhere.
Doctors are the primary decision-makers. They diagnose, prescribe, treat and operate. Of course, other health professionals should declare their interests, and I look to the professional regulators of nurses and allied health professionals, and others, to take that forward using a similar approach to that which I advocate for doctors. But we should not wait for that to happen before ensuring that there is transparency of doctors’ interests.
I hope that my noble friend will agree that those who have suffered so much through no fault of their own from harm that could and should have been avoided deserve the practical help and support that the amendment would deliver.