Urgent need for medical watchdog reforms

The public rightly expects the Medical Council to uphold the highest professional and ethical standards among doctors in order to protect patients. That, after all, is its mission. But it is easier said than done, because the watchdog lacks the structure, independence and resources for credible self-regulation. It has been trying to get the government to do something about it for years. Now it is preparing fresh proposals for change. For the sake of maintaining confidence in the profession, the government should handle them with a sense of urgency.

Calls for overdue reform usually follow criticism of the way the council handles complaints. In the most memorable example the council cleared a surgeon of misconduct for holding a private mobile phone conversation during an operation. This sparked public outrage that led to the council's first reform proposal to the government in 2001. Amid opposition from some doctors and lawmakers and inaction by the government, the severe acute respiratory syndrome crisis finally knocked it off the public health agenda. More recent judicial reviews have found that the council has used unlawful procedures to reject complaints against doctors and been inconsistent in sentencing.

An outdated structure and lack of resources are part of the problem. The council is right to press the government to tackle them. On this occasion the council says a recent court ruling on the scope of its investigative powers strengthens its case for reform. A doctor launched a judicial review to challenge the council's power to obtain information from him unrelated to the original complaint. The court found in favour of the council.

As a result, the council intends to step up investigations of medical blunders without waiting for complaints, including those that happen at public hospitals. It may come as a surprise that it seldom deals with cases involving doctors at public hospitals. Complaints are usually lodged with and investigated by the Hospital Authority, and most complainants do not take it further with the Medical Council after reaching a settlement with the authority. Now council chairwoman Professor Felice Lieh Mak says its preliminary investigation committee, which advises whether a disciplinary hearing is justified, will look into inquest findings, reports of the authority's investigations and even media reports of medical blunders. The public can be forgiven for assuming that this was already happening. However, given that the committee is already overstretched in handling complaints, increasing its workload does raise some problems.

First, the law requires that a lay member join investigations and disciplinary hearings. The council has just four of them, out of 28 members, and unavailability already slows inquiries. It proposes doubling the number, and including people with legal backgrounds. Second, half the council's members are nominated by the government, the employer of public hospital doctors, which raises concerns about conflict of interest. True, the government funds the council, but such a representation raises questions about independence and falls well short of best practice overseas. Half of the members of Britain's medical council are lay members.

Reforms should not stop there if the medical profession is to have credible self-regulation, administered fairly and openly with the interests of patients put foremost. There is no reason that it should not have the same independence as the Bar Council and Law Society have in regulating the legal profession.