Queen's speech heralds health bills in Britain

BMJ 1994; 309 doi: (Published 26 November 1994) Cite this as: BMJ 1994;309:1390
  1. John Warden
  1. Parliamentary Correspondent, BMJ.

    New powers for the General Medical Council to discipline doctors whose performance is seriously deficient are included in the legislative programme of the British parliament for the 1994-5 session, which opened last week (see also Focus on p1394). A bill extending the Medical Act was one of three health measures in the Queen's speech. Of the others, one will streamline the administration of the NHS in England and a second will introduce supervised discharge for mentally ill patients. Though it is the heaviest agenda of health legislation for some years, all the bills seek to amend existing provisions rather than to innovate.

    The bill to enable the General Medical Council to deal with doctors whose professional performance is found to be seriously deficient will set up two statutory committees to investigate complaints and, when necessary, arrange remedial training. The committees will be known as the assessment referral panel and the professional performance committee and will deal mainly with doctors who refuse to submit to local screening and assessment. The new procedures, which could lead to a doctor's registration being suspended, will meet longstanding concern that the disciplinary remit of the council covers only serious professional misconduct and that the council has no jurisdiction where it is evident that a doctor's performance is consistently poor. An estimated 150 cases a year could be referred to a performance screener, who would decide whether to investigate further.

    The main item of legislation, the Health Authorities Bill, will underpin the devolved NHS management structure for England. The bill will abolish all regional, district, and family health services authorities from April 1996. The eight existing regional health authorities will become regional offices of the NHS Executive to monitor the performance of NHS trusts.

    At local level about 100 all purpose authorities will replace the present 111 district and 92 family health services authorities. The new authorities will purchase health services to meet local needs and ensure the provision of primary care. The bill is expected to produce substantial management savings in addition to economies worth pounds sterling30m so far. The eight regional offices will employ a maximum of 1110 staff, compared with 3900 working for the regions two years ago.

    A mental health bill will strengthen the powers to supervise patients with a serious mental disorder who need special support after discharge from hospital. A new power of supervised discharge will require a patient to comply with a care plan under a named key worker. Failure to cooperate would lead to an immediate review of the case, with the possibility of recall to hospital under the existing provisions of the 1983 Mental Health Act. The bill will extend from six months to one year the “long leash” of extended leave, during which patients can be recalled to hospital. It will also correct the anomaly whereby a detained patient who absconds for 28 days cannot be returned to hospital.

    It is estimated that up to 3000 patients may be subject to supervised discharge in the community. They are mainly schizophrenic patients who relapse after failing to continue their treatment and may become a danger to themselves and others. Public concern was heightened by the killing of Jonathan Zito at a London underground station by Christopher Clunis, a newly discharged patient. In another incident a man climbed into the lions' den at London Zoo.

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