Draft Wine (Amendment) (England) Regulations 2024
(11 months ago)
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The Minister for Food, Farming and Fisheries (Mark Spencer)
I beg to move,
That the Committee has considered the draft Wine (Amendment) (England) Regulations 2024.
It is a pleasure to serve under your chairmanship, Mr Gray. The regulations were laid before the House on 4 December. The Government are taking this necessary step to take account of obligations relating to the marketing of wine in the comprehensive and progressive agreement for trans-Pacific partnership—or the CPTPP, as Members will know it—following the UK’s signing of the protocol of accession.
The instrument introduces rules governing how products marketed as ice wine must be produced. Ice wine is a type of dessert wine produced from grapes that have been frozen while still on the vine. Currently, ice wine is not produced domestically, but it is imported. Annual global production is very small, but it can yield high-quality wines that sell at premium prices. Therefore, it is important to ensure that products marketed as ice wine are marketed correctly, to support consumers in their choices.
The instrument applies the relevant restriction in England only. Separate instruments applying to Scotland and Wales are being made for the purpose of continuity, so that the same restriction applies across Great Britain and enables CPTPP accession. This type of imported wine will continue to be able to move from Great Britain to Northern Ireland via the Northern Ireland retail movement scheme under the Windsor framework.
The instrument will also update the list of oenological practices, processes and restrictions that may be used in the production and conservation of wine in other wine products. The changes are highly technical in nature and relate, for example, to the use of discontinuous high-pressure processes, which reduce yeast contamination in wine and therefore the reliance on sulphites to preserve wine and help to improve its fermentation. I am told that reducing sulphites also means that you are less likely to have a headache the next morning.
The Scottish Government have made the same changes, and the Welsh Government are in the process of doing so. That will ensure that producers across Great Britain benefit from the latest technological developments and winemaking practices.
Grahame Morris (Easington) (Lab)
The legislation we are dealing with refers to marketing. In this post-Brexit period, will these things be marketed by the pint?
Mark Spencer
I actually think they will be marketed by the half-bottle—in my limited experience, dessert wines tend to come in half-bottles. If the hon. Gentleman reaches for the internet when he makes these purchases, I am sure there will be more information there.
The changes before us align with those adopted by the International Organisation of Vine and Wine since 2009 and approved by the UK through our membership of that organisation. The instrument was notified to the World Trade Organisation’s Committee on Technical Barriers to Trade, and no comments were received.
Ian Lavery (Wansbeck) (Lab)
Will the Minister give examples of the different oenological practices introduced by the IOVW? I am a bit stumped by that.
Mark Spencer
I can help the hon. Gentleman out. The regulations are about making sure, for consumers who buy ice wine, that the correct process has been followed, and that includes the grapes being frozen on the vine. It is possible to create dessert wine by harvesting the grapes and then freezing them mechanically to change the sugars so that the wine becomes sweeter. However, ice wine is produced only as a result of a natural frost while the grapes are on the vine, and the regulations are about protecting that process, although we do not use it in the UK, and it is quite uncommon in Europe as well. They are about protecting this product so that consumers buying ice wine know that the grapes have been frozen naturally rather than in a freezer.
Jesse Norman (Hereford and South Herefordshire) (Con)
I note the decline in standards in explanatory memoranda, in that my right hon. Friend—who has been a member of the Cabinet—is not acknowledged as such in the explanatory memorandum; however, I think that is a matter for his civil servants. Given that we do not have an ice wine industry in this country, why are we passing this legislation?
Mark Spencer
That is a very good question. It is quite simply because the ice wine brand, as it were, is not currently protected in the UK. In signing up to CPTPP, an obligation was placed on us to recognise this product and register it in the UK. Ice wine is mostly made in Canada, which is a signatory to that agreement. This is about protecting their ice wine producers’ brand, as it were.
Mrs Natalie Elphicke (Dover) (Con)
The Minister is very helpfully explaining this product. Will he say whether the change will be to the detriment of Eiswein produced in Germany, which is obviously a more popularly known product in the UK?
Mark Spencer
This is about ensuring that UK consumers, when choosing which wine to purchase, understand the process and the methodology by which it has been made and can make that choice for themselves. I commend the regulations to the Committee.
Daniel Zeichner (Cambridge) (Lab)
It is a pleasure to serve once again with you in the Chair, Mr Gray. I thank the Minister for his exemplary introduction. I had always pictured him with a pint of bitter in his hand, but perhaps I will now picture him with an ice wine chaser to go with it. Let me reassure the Minister and the Whips that, given the support that the industry has expressed for this SI, and given that it concerns a very niche product, we do not intend to press for a vote.
I note the important contribution made by the wine sector to this country’s economy. The vast majority of wine consumed here—some 99%—is imported. We recognise and accept the need for the rules inherited from the EU to be updated and streamlined to help the sector to operate even more efficiently. I appreciate that efforts have been made through this legislation to bring the UK’s wine regulations in line with the CPTPP as regards ice wine.
The Minister has explained that the instrument restricts the use of the term “ice wine” to products made exclusively from grapes naturally frozen on the vine, as opposed to those made from frozen grapes. In relation to the CPTPP, as the Minister has told us, Canada is the major producer of ice wine, but CPTPP’s progress puts us on a different parliamentary scrutiny and legislative path. We know that the economic benefits of the treaty appear to be small. The Government’s impact assessment indicated that the long-run increase in GDP would be worth only 0.06%.
As with so many of these trade deals, we need to watch with great care to see whether these small economic benefits are being achieved at the expense of our environmental or welfare standards. The Trade and Agriculture Commission report on the CPTPP notes that the Pesticide Action Network UK has reported that there are 119 pesticide products not permitted for use in the UK that are permitted to varying extents by one or more of the 11 parties to the CPTPP treaty. It needs to be made clear that the deal does not enable food and wine produced elsewhere to lower standards to compete unfairly with our own producers. In this case, of course, we do not have producers. In relation to unfair competition, the Trade and Agriculture Commission report on the CPTPP noted:
“This is important, as CPTPP is likely to lead to increased imports of products that have been produced at lower cost by using pesticides in…parties that would not be permitted in the UK.”
The Chair
Order. I am listening carefully to the hon. Gentleman. I think that what he is saying regarding the CPTPP in general is beyond the scope of our discussions. We are simply discussing whether or not these grapes can marketed here under a particular name.
Daniel Zeichner
I am grateful, Mr Gray, and I understand the point that you make. May I point out that our concern is that pesticides could have been used on vines that produce ice wine? It is about the changing circumstances for different parties and different rules.
Will the Minister explain what legislation is planned by the Department for Environment, Food and Rural Affairs on wine as a result of the CPTPP and when we can expect those changes to be introduced? Having taken heed of your warnings, Mr Gray, I shall not make the wider points that I was going to make about the concerns of the wine sector about additional bureaucracy, administrative burdens and rising costs. I have possibly made that point without raising those concerns.
A serious point was made by the Secondary Legislation Scrutiny Committee in the House of Lords—the measure was discussed in the other place last night—about parallel legislation in Scotland and Wales. The Committee pointed out that Northern Ireland would be subject to the different rules that apply in the EU. Given that we had a lengthy discussion in the Chamber on Monday evening about the export of live animals for slaughter and the implications for Northern Ireland, I suspect the Minister hopes that members of the Democratic Unionist party are not ardent ice wine drinkers, but is he completely satisfied that there will be no impediments to the movement of ice wine products between Northern Ireland and Great Britain? For instance, does he expect that the labelling of ice wine will be completely consistent across the UK? I leave him with that thought.
Mark Spencer
I shall address that final point first. The reforms apply only to England, Wales and Scotland, but they are progressing their own statutory instruments. There are no producers of ice wine in Northern Ireland, but imported ice wine can move from Great Britain via the Northern Ireland retail movement scheme and be sold in Northern Ireland, so there will be no restrictions there.
I am grateful to hon. Members and the shadow Minister for their support. I do not want to be dragged into a debate on CPTPP—that is not the purpose of our discussions—but there are upsides to the agreement. In fact, only last week we signed an £18-million deal with Mexico to export pork offal, which is of great benefit to the UK economies. When it comes to pesticides and matters such as lowering the standards of imported products we are very much aware of the need to defend against that. In fact, sanitary and phytosanitary rules are relevant, and the ability of colleagues to challenge some of those things is something that we defend vigorously as well.
This is a good move forward, and it assists with getting the CPTPP agreement into place.
Question put and agreed to.
4.42 pm
Committee rose.
Draft Anaesthesia Associates and Physician Associates Order 2024
(11 months ago)
General CommitteesRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister for Health and Secondary Care (Andrew Stephenson)
I beg to move,
That the Committee has considered the draft Anaesthesia Associates and Physician Associates Order 2024.
It is a pleasure to serve under your chairmanship, Dame Caroline. I will begin by setting out the policy context behind the draft order. Strengthening the future of the NHS workforce remains one of the Government’s top priorities. Anaesthesia associates, AAs, and physician associates, PAs, are already a valued and integral part of the multidisciplinary healthcare team, but they have the potential to make an even greater contribution. Regulating those professions will increase the contribution that AAs and PAs can make to the UK healthcare sector, while improving patient safety and professional accountability.
As well as bringing AAs and PAs into regulation by the General Medical Council, the draft order paves the way for full-scale reform of the regulatory frameworks for all the healthcare professional regulators. This is a rare and significant opportunity to deliver a large-scale programme of reform that will implement improvements to patient and public safety, the system of professional regulation, and the health and care workforce. We are introducing the regulation of AAs and PAs under a new legislative framework without at this stage changing the GMC’s regulatory framework for doctors. That means that the GMC’s overall governance and its regulation of doctors will continue under the Medical Act 1983 after the order comes into effect.
The draft order will give the GMC powers to register AAs and PAs whom it assesses to be appropriately qualified and competent, and to set standards of practice, education and training, and requirements for continual professional development and the conduct of AAs and PAs. It gives the GMC the powers to approve AAs and PAs’ education and training programmes, to operate fitness-to-practice procedures, to investigate concerns and, if necessary, to prevent or restrict an associate from practising.
The legislation provides a high-level framework for the GMC to regulate AAs and PAs, and importantly gives the GMC autonomy to set out the details of its regulatory procedures in rules. The GMC has committed to developing rules and processes for regulating AAs and PAs, which will be subject to public consultation, to enable regulation to begin by the end of this year.
We recognise some concerns about the deployment and planned expansion of the AA and PA roles within the NHS. Let me be clear: the role of associates is to work with doctors and not to replace them. AAs and PAs are distinct, complementary and valued professionals who can enrich the workforce skills mix, freeing up doctors and consultants to spend more time using their specialist skills and training to focus on complex clinical duties and decisions on patient care.
It is important to note that the NHS long-term workforce plan sets out an aim to double the number of medical places in England to 15,000 a year by 2031-32, and to work towards expansion by increasing places by a third to 10,000 a year by 2028-29. We have accelerated that expansion by allocating 205 additional medical school places for the 2024-25 academic year, with the process for allocating 350 additional places for the 2025-26 academic year under way. That demonstrates our commitment to the medical profession and that we do not see PAs or AAs as replacements for doctors.
Currently, more than 139,200 full-time equivalent doctors work in the NHS in England. That is more than 42,100—or 43%—more than in 2010. There are fewer than 3,500 PAs and AAs. Patient safety remains of the utmost importance, and regulation will help to bring further clarity to patients and healthcare professionals on the nature of the roles and their respective remits. Regulation will give the GMC responsibility and oversight of AAs and PAs, in addition to doctors, allowing the council to take a holistic approach to education, training and standards. That will enable a more coherent and co-ordinated approach to regulation, and make it easier for employers, patients and the public to understand the relationship between the roles of associates and doctors. Each nation is considering the operational deployment of those roles within their respective workforces.
In England, the long-term workforce plan reaffirms the commitment to PAs and AAs, and commits to increase the PA workforce to 10,000, and the AA workforce to 2,000, by 2036-37. Over the same period of the long-term workforce plan, we will deliver an additional 60,000 doctors. That is a factor of 5:1 in favour of doctors, which I hope addresses the mistaken belief that PAs and AAs will replace doctors within our NHS. It is vital that this expansion is delivered safely. NHS England is working through partners, including the GMC, the Royal Colleges and other stakeholders, to ensure that associates can be effectively trained and integrated into teams across a range of specialities.
To summarise, the draft order will provide a standardised framework of governance and assurance for clinical practice and professional conduct to enhance patient safety and enable AAs and PAs to make a greater contribution to patient care. I commend the order to the Committee.
Karin Smyth (Bristol South) (Lab)
It is a pleasure to serve under your chairmanship, Dame Caroline. I thank the Minister and his officials for meeting me in advance of today’s sitting, and for the courtesy they showed to the Opposition in doing so.
When we are in need of care from the NHS, we are usually at our most vulnerable. We expect to be seen and treated by a professional who is competent in their role and regulated. It is vital that patients know who is undertaking their care, and can be confident in their competence. It is paramount to patient safety that those treating patients in the NHS are regulated. There has clearly been a delay in getting to that point with physician associates and anaesthesia associates, and regulation is long overdue. Those positions play an important role as part of a flexible and diverse workforce, but should never be seen as a replacement for doctors. I am pleased that the Minister has made that clear.
PAs and AAs were first introduced as assistants by the previous Labour Government because they are important in bringing people with different skills into the NHS and providing opportunities for those who do not take the traditional route into clinical roles. They exist in many systems around the world, and we thank them for their service. As part of a multidisciplinary team, they can provide much-needed capacity by supporting doctors and other frontline staff. So important are they that, as we have heard, their numbers are going to be increased as part of the Government’s workforce plan.
However, we must be clear that associates are not a panacea to 14 years of Conservative mismanagement of the NHS. The current crisis on the frontline, the workforce crisis, and record high waiting lists will not be solved by increasing the number of associates. The Government have cut 2,000 GPs, and many people now find it impossible to get an appointment when they need one. The failure to recruit, and particularly to retain, enough fully qualified staff should not be papered over by using alternatives. The Government’s inability to maintain relationships with frontline staff, including both junior doctors and GPs, is exacerbating worries about this legislation. The Government have already shattered morale among the health workforce. Many of us, as MPs, have heard from the people concerned most specifically in the run-up to this legislation. My first question for the Minister is: will he reassure me that the expansion of PAs and AAs will not impinge on medical specialty training expansion and, crucially, opportunities?
A number of concerns have been raised with me and other colleagues about the detail of this order and its implications for safety—concerns that really should have been addressed earlier if the Government had better relationships with key stakeholders. It is important for a Government to listen to and work with patients and professionals, and address their concerns. I ask the Minister to do that today, as this legislation goes through, and throughout the consultation process. That is my second question to the Minister: can he provide assurance that, going forward, all stakeholders will be fully consulted by the GMC on the details of the draft order? Patients need clarity about who is treating them and why. What measures will the Minister take to ensure that patients have that clarity, and improved awareness of who they could be speaking to in a GP surgery or other medical setting?
It is vital that people who are looking to become associates are properly supported and supervised to work within a defined scope in those roles. Addressing the workforce crisis in the NHS, so that staff have the time and, crucially, the capacity to support PAs and AAs, is crucial to ensure that those roles are successful. Can the Minister indicate what support would be available to PAs and AAs, what level of supervision will be suitable, and how the Government will ensure that that is in place, given that we all know how stretched the frontline already is? Has he had discussion with the GMC about defining the scope of PAs and AAs?
It will also be helpful to hear the Minister’s thoughts on how the draft order may impact on career progression in the NHS and help with retention, which we all want. Are there plans to define the core capabilities expected of PAs and AAs? What assurances can the Minster give us that the GMC is the best regulator to undertake that work? That point has been raised with many Members. Will the Minister explain how the order fits in with wider regulation reform, which is to be undertaken over the next year or so? Patient safety is and must always be our No. 1 priority. Can the Minister provide any assurances about the measures in place to review this legislation over the two-year transition period, particularly given the expansion of the role of PAs and AAs in the NHS?
Finally, some have expressed concern about the safeguards around the fitness-to-practice decisions taken by regulators, including decisions to remove or reduce regulatory restrictions on a registrant who has been found to present a possibly serious risk to the public. What assurances can the Minister give on that point? If the legislation is deemed not suitable to improve patient safety, what measures will the Government take to remedy that and keep on top of the situation?
The draft order provides a framework for the regulation of associates. It is vital that all those treating patients in the NHS are regulated and safe, and for that reason we will not oppose the statutory instrument. We support regulation. However, I hope that my concerns and those of others—I know that other right hon. and hon. colleagues wish to speak—will be monitored closely. I look forward to hearing further assurances from the Minister as he works to ensure that the change is successful.
Several hon. Members rose —
The Chair
A number of colleagues have indicated that they would like to speak in the debate. I call Thérèse Coffey first.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
It is a pleasure to serve under your chairmanship, Dame Caroline. This may surprise Members, but I am not a member of the Committee. However, I care about this issue. I believe that the expansion in the number of associates is fully in the interests of patients. By virtue of this Order in Council—which has also been put forward by Scottish Government Ministers—there will be a necessary and rightful route by which physician associates and anaesthesia associates can be regulated by the General Medical Council, with all its professional elements. There will be a curriculum, continuous professional development, and a variety of other things that we expect of other professionals in the NHS and the wider health services.
This may all sound a bit odd. Why do we not just get more people to become doctors? The Government, however, have already addressed that, through the expansion in medical school places that is to happen. I will tell the Committee a personal story, through which I saw the issues at first hand. I will not pretend otherwise: when I was, for a brief time, Secretary of State for Health and Social Care, this event reinforced the reasons why I was keen to see this move make the progress that it is making.
About 18 months ago, Parliament was busy with a potential change in leadership, although Prime Minister Boris Johnson was still in post. I suffered an infection and went to a hospital in London, where I waited more than nine hours to see a doctor. I went home without any treatment, and then re-presented myself at a different London hospital, where I got the treatment that I needed within a much shorter time. This meant that I attended my last Cabinet meeting by phone from an NHS hospital bed.
The second hospital was quicker to deal with my situation, because it had a wider range of medical professionals, including a physician associate, who was able to do a lot of the work on the appropriate treatment, although of course that still needed sign-off by the doctor. Instead of patients waiting for hours for that one doctor, the hospital was using a full range of NHS professionals to the extent of their abilities. That is a sensible, practical way to ensure that patient care and safety is absolutely paramount.
Not all hospital trusts have associates, nor are they necessarily planning to have them, but I would strongly recommend that they do. When I think about the number of operations that could be happening, I really welcome the expansion of anaesthesia associates. The anaesthetist will be a key part of that, but imagine one anaesthetist helping with three operations at one time, along with appropriately trained and regulated anaesthesia associates. That is an approach that modernises the NHS’s capacity and capability to treat as many patients as possible.
In the past, there has been resistance to Pharmacy Direct, which is about to be launched, expanding the number of things that pharmacists can do. There has also been resistance to expanding what nurses can do without a doctor’s sign-off. There will be plenty of situations where people in community hospitals say, “Ah, yes, you’ve come in. We will try to treat that in the minor injuries unit, but we don’t have a prescribing nurse here, so you’ve got to either wait, or go to the doctor to get a prescription.” The modern NHS has to think about those situations, and be careful in how it deploys staff. This Order in Council is a key element of that. It brings associates into the same professional regulatory body and inspection regime as doctors—of course, people will know that there are other regulators for different professions.
I felt strongly about coming along to the Committee to support this order and see it progress. For me, patient safety will always be paramount, but I see this as a professional step forward, and I look forward to the change happening right across the United Kingdom.
Barbara Keeley (Worsley and Eccles South) (Lab)
It is a pleasure to serve on this Committee with you in the Chair, Dame Caroline. I am pleased to be able to speak in our discussion of this very important area of legislation, as the right hon. Member for Suffolk Coastal just called it. In my view, this issue is so important that we should be debating it in the Chamber; perhaps we could have found a way to do that.
Schedule 1(3)(a) to the order states that the regulator
“has the objective of promoting and maintaining—
(i) public confidence in, and
(ii) proper professional standards and conduct for members of, the anaesthesia associate and physician associate professions”.
I hope that the regulator takes those duties very seriously, because public trust in physician associates has already been damaged by the very sad death of Emily Chesterton, who died after being seen twice and diagnosed by a physician associate at a local GP practice. Emily was the daughter of my constituents, Marion and Brendan Chesterton, and I raised her case at an Adjournment debate on 6 July 2023. I would like to give details of Emily’s case, because it illustrates the need for the greatest clarity in the distinction between doctors and staff in the medical associate professions.
Emily Chesterton died in November 2022 after suffering a pulmonary embolism, after being seen twice by a physician associate, rather than a GP. She was just 30 years old when she died. Emily was a budding actor in musical theatre. She and her partner had moved to London from Boothstown, in my constituency, to pursue their careers in the arts. They registered with their local GP surgery, the Vale Practice in Crouch End, north London. Emily had been diagnosed with polycystic ovary syndrome and had also contracted covid-19 in late summer 2022. Marion Chesterton, her mother and my constituent, said that Emily had been feeling unwell for a few weeks before she made an appointment at the Vale Practice on 31 October 2022, as she had calf pain and was breathless. Emily believed that this appointment was to see a GP, but the person she was booked to see at the practice was a physician associate.
Physician associates and doctors have a very different depth of expertise. Physician associates have to complete just two years of clinical training, following a biosciences undergraduate degree. Doctors, on the other hand, must complete a five-year medical degree, as well as several years of foundation training and specialism training, interspersed with national exams. As both the Minister and my hon. Friend the Member for Bristol South on the Opposition Front Bench have said, physician associates are intended to support and assist more medically qualified staff, not replace them.
In Emily’s case, after a short appointment, the physician associate diagnosed Emily with a sprain and possibly long covid. Emily was told to rest and take paracetamol. At no point during the appointment at the GP surgery was Emily made aware that the person who had diagnosed her was not a doctor.
A week later, on 7 November, Emily began to feel very unwell. Her leg was swollen and hot, and she struggled to walk a few steps without becoming out of breath. She made another appointment at the Vale Practice and saw the same physician associate. It appears that this was a short appointment, and that Emily’s legs were not examined. The physician associate suggested that Emily’s breathlessness was due to anxiety and long covid. She prescribed propranolol. In messages that Emily sent to her family on that day, it appears that she described seeing “the doctor”, and that she was never told that the person she was consulting for medical assistance was not a fully qualified GP.
In its serious incident report after Emily’s death, the Vale Practice stated that patients should not see a physician associate twice for the same condition. The guidelines make it clear that physician associates cannot prescribe; any prescriptions need to be signed off by a supervising GP. It appears that the oversight of prescribing medication was missing, and the system failed in Emily’s case.
Later in the evening of that same day, 7 November, Emily’s health deteriorated, so she took a propranolol tablet, as advised by the physician associate. She then became drowsy, and then very ill. Her partner Keoni recalled to the inquest that she lost her pulse, and he had to perform CPR on her, which recovered the pulse. He then called an ambulance.
Emily suffered a cardiac arrest on the way to the hospital. Her family had to say their goodbyes to her while she was still on the machine that was pumping her heart for her. Keoni recalled that staff at the A&E department at Whittington Hospital, where Emily died, told him that the propranolol tablet “definitely would not have helped” Emily’s condition, and staff had to give her an antidote to the drug.
The circumstances that led to Emily Chesterton’s death were investigated by a coroner, and there was a hearing at St Pancras coroner’s court on 20 March 2023. Messages from Emily to her partner and family at the time of her appointments were shared at the inquest. These messages provide evidence that Emily believed that she was seeing a doctor. They also provide evidence that the appointments with the physician associate were short, and that Emily was not examined fully.
The coroner’s conclusion was as follows:
“Emily Chesterton died from a pulmonary embolism, a natural cause of death. She attended her general practitioner surgery on the mornings of 31 October and 7 November 2022 with calf pain and shortness of breath, and was seen by the same physician associate on both occasions. She should have been immediately referred to a hospital emergency unit. If she had been on either occasion, the likelihood is that she would have been treated for pulmonary embolism and would have survived.”
That heartbreaking statement lays out clearly the failings in the health system, which should have supported Emily with appropriate care.
Sadly, further failings were evidenced in the incident report that the Vale Practice provided to the coroner. In particular, it was noted that the physician associate who saw Emily did not introduce herself and her role to Emily during the appointment. The practice said that the physician associate had failed to explore the causes of Emily’s symptoms, failed to refer Emily for clinical investigations, and failed to consult a doctor after seeing a patient who had presented twice in one week with significant risk factors for pulmonary embolism. The practice also raised concerns about the physician associate’s overconfidence and lack of insight into the limitations of her clinical knowledge and practice. Although the physician associate’s contract at that practice was later terminated, Mrs Chesterton was upset to learn that she was still practising in the NHS in London, but I understand that that changed after I raised concerns in the Adjournment debate.
I must add that Emily’s is not the only case like this. Sadly, Ben Peters, a previously healthy 25-year-old, died from a heart haemorrhage after being diagnosed with a panic attack by a physician associate. A freedom of information request sent to Scottish health boards found that there have been at least 12 “never events” linked to physician associates in Scottish health authority areas.
These cases demonstrate the urgent need for this profession to be regulated in a way that avoids further confusion among patients, their families and medical staff. To patients, associates and doctors may look the same—they appear to be doing a similar job—but the fact is that the associates do not have the same qualifications or expertise as doctors. I understand that it was originally envisaged that physician assistants would be vital members of multidisciplinary teams, assisting with the workload and contributing to a high quality of care, but the regulator must ensure that there are now clear guidelines for associates to make their role clear to patients when they introduce themselves. As I have described, that did not happen in the case of Emily Chesterton.
There is a bigger question around the titles of associate. At the time of my Adjournment debate, Marion Chesterton raised with me the point that the title sounds
“extremely grand, even grander than a General Practitioner”.
Some have suggested changing the title back to the original title of physician assistants and anaesthesia assistants to avoid that confusion. There may be other solutions that the Minister could consider.
Getting the approach to associates right will become even more urgent as the profession grows in line with the proposals set out in the NHS long-term workforce plan. There is certainly a need to tackle workforce shortages in the NHS, as my hon. Friend the Member for Bristol South said. A lack of qualified professionals is the root cause of many of the challenges that our health service faces. We must be careful that any adaptations to the workforce to fix those issues do not push existing professionals out.
I had many GPs write to me after my Adjournment debate about Emily’s case. One told me,
“There is much talk amongst GP locums of work drying up, possibly due to the increasing use of Additional Roles Reimbursement Scheme staff (including the associate roles) to fill vacancies (and these are much cheaper than employing locum GPs), and last week there was considerable disquiet about the Surrey practice that made its salaried GPs redundant due to ‘new ways of working’.”
He wrote on,
“For GPs—salarieds, locums, and trainees—who have been working in an over-stretched, high-stress system, and [who have] been told that there is a national shortage of GPs—this leaves many wondering about the security of their career and exploring other options. I am seriously concerned that the many intelligent, enthusiastic and valuable people in training and working as GPs are looking at options outside the NHS, outside medicine, and outside the country.”
I am sure the Minister would agree that this is deeply concerning when the UK already faces intense competition from other countries to retain our doctors. While multidisciplinary teams with a diversity of roles are vital, doctors must still be valued. Most importantly, patients and clinicians must have a clear understanding of the skills, qualifications and limitations of those providing care.
I want to acknowledge that there have been many tragic cases leading to avoidable deaths of patients that have involved other roles. We could look at the case of Connor Sparrowhawk, an epileptic teenager who had a seizure and drowned in a bath at a hospital unit run by Southern Health. Connor was just 18. Dame Caroline, you will know well the case of Oliver McGowan, who died in Southmead Hospital at the age of 18. Oliver was prescribed the anti-psychotic medication olanzapine by a consultant in the hospital, despite his notes saying that he had reacted badly to it previously. Oliver died as a result of the brain injury caused by the medication.
Those are tragic cases, but in neither of them was it the role and the limitations of an NHS professional that caused the problem. The issues I have raised are about the safety of patients and the accepted standards of knowledge, training and experience that we should expect from our medical professionals in order for them to provide a high quality of care. I hope that the Minister notes the points raised in this debate, and takes steps to ensure that the NHS workforce delivers for patient safety.
Rachael Maskell (York Central) (Lab/Co-op)
It is a pleasure to serve on the Committee, Dame Caroline. Before I begin, I declare that I was a registered professional with the Health and Care Professions Council, and worked in the NHS for 20 years before coming to this place. I was also the head of health at Unite, so I have a strong background in understanding the regulatory frameworks in the NHS.
I understand the issues that the Government are trying to resolve, given the changing nature of the NHS, the emergence of new professions, and the need to protect patients. I agree that all NHS professionals must be registered, and regulatory reform is long overdue, including for anaesthesia associates and physician associates. When Agenda for Change was piloted in 2003 and fully instituted in 2004, a job evaluation scheme was designed for this very purpose, and was overseen by the formidable Sue Hastings. However, emergent professions cannot just be add-ons to existing regulation. They required their own registers, governance and accountability, not least to ensure professional competence. The order is the first expression of that, 20 years on.
Also, the knowledge and skills framework enabled people to grow in their professional competencies and provide a higher level of care. That could lead to hybrid roles forming. I remember Alan Milburn saying at the time that the NHS career framework should enable someone to move from the role of porter to neurosurgeon—I do not know if that has ever been achieved. It is important that at every stage there is protection for the professional and, most importantly, the patient.
The reality behind the order is that the professional silos of the last 150 years or more are rapidly evolving and morphing in new ways, and the regulatory framework has to capture that and catch up. I agree that we urgently need a system of statutory regulation for anaesthesia associates and physician associates. They are working at a significant level of decision making, and they have a duty to uphold professional standards, their training must be of the highest standard, and there must be a fitness-to-practise process through which they can be called to account. I agree with my hon. Friend the Member for Bristol South that we need to ensure that that is rigorous and upholds standards, but I also welcome the fact that they may be expedited within the new system.
I have been asked whether the GMC is the right regulatory body. I understand the arguments for and against. This is where a lot of the concern comes from, which is why regulation is important. The challenge to this order is the lack of clarity about titles, roles and the competencies associated with each role. It could be argued that, for greater distinction, the HCPC, for example, is a more relevant registrant. I believe that that should have been examined further, not least as AAs and PAs are professionals allied to health and sit within the “Agenda for Change” family.
The public are nearly universally unaware of different roles in the NHS, let alone what they can or cannot do. In a clinical setting, if someone with a stethoscope around their neck calls themselves part of the medical team and they assess, diagnose and treat a patient, it will generally be assumed that they must be a doctor. I remember that when I started practising, if you were a woman, you were a nurse, and if you were a man, you were a doctor, so I certainly know that the distinctions are not always there. However, some use the title “Dr” because they hold a doctorate in another field, and that needs to be looked at. Further, there is a new lexicon of technicians, assistants, associates, advanced practitioners, and no doubt many more. I urge the Minister to find a common language so that there is simplicity and accuracy, and so the public understand the distinctions between these roles and those of the established professions.
In talking to the British Medical Association, I heard how people are now working above their competencies as AAs and PAs—carrying the consultant’s bleep, for example. That is deeply disturbing and just reinforces the public confusion over the distinct identity and purpose of each clinical role. Boundaries must be clear and distinct and, for the sake of safety, defined nationally rather than determined locally.
While the Government are very much focused on vertical integration, which can exacerbate things such as skill mix, I urge the Minister to further consider the power of horizontal integration. We have seen some, for example with advanced practitioners reaching across professional silos, and in developing a focus on primary care it could bring strong benefits. We need to ensure that new regulatory frameworks address that. The blueprint for a future professional regulation framework must account for this opportunity.
As with all professions, medicine must not be exempt from looking at how it can be reshaped. However, when someone who has had two years’ training is paid more —ironically, 35% more; Members might recall that number—and assumes more authority than a doctor of seven years’ training with a higher level of competency, there is clearly a problem in the design of the role and cause for concern. We need to look at how we can move beyond traditional silos and create skills pathways that honour professions and the level of their skills, so that competencies can be gathered, tested and examined along the way. I believe that there needs to be a full job evaluation to understand the challenges between the professions—yes, across the two core NHS pay structures—and then a clear delineation of roles. For example, senior doctors in training in anaesthetics are now in a logjam, unable to progress to a consultant post due to the rise in the redeployment of anaesthetist competencies to AAs.
The same could be said of the Government’s prioritisation of PAs over, for instance, traditional senior house officers. There is serious concern about the diagnostic skills of PAs; there have been examples of failure, as we heard so powerfully about Emily Chesterton, the daughter of the constituent of my hon. Friend the Member for Worsley and Eccles South.
These functions need serious reconsideration and tight regulation. The GMC must ensure that their scope is clearly defined and that, before further role reforms occur, there are assurances that there will be no further scope creep. Clarity of role is really important in prescribing too. Some AAs and PAs may have transitioned from professions where they were already prescribers. We need to hear from the Minister how that situation will be managed, with clear delineation.
I want to touch on the issue of liability—where responsibility lies. With registration, AAs and PAs will be autonomous practitioners, liable for their own conduct and practice. How will the regulator ensure that liability is apportioned in the right way between them and those who provide supervision? Will they receive one-to-one supervision, and how far will liability carry on to, say, the consultant or senior registrar? That is a really important issue to consider in the immediate future, not only for AAs and PAs, but for doctors and doctors in training, who must receive supervision too. We need to ensure that a new generation of doctors in training are able to receive the support that they need, and that it is not all dedicated to AAs and PAs.
Furthermore, with the envisaged rapid expansion in the number of AAs and PAs, the GMC needs to determine that supervision is safe and appropriate, and at the level required to enable people to mature into highly skilled professionals. It must also ensure that there is not a spike in fitness-to-practise cases due to lack of investment. The call from the medical profession is for us to slow down and properly evaluate and understand the consequences, seen and unforeseen.
On part 3 of the order, which concerns the register, can the Minister clarify that the associates will be on a separate register to doctors at the GMC, and that they will have their own register, as identified in article 5(2)(a)? I note that AAs and PAs will be on one register, but in separate parts. Will he explain to the Committee exactly how that will operate? Holding information separately would enable greater access for the public to the information they seek with respect to the new associate roles. The register must be robust and easy to navigate and, like the register for doctors, provide the public with all the information that they require. I know that the GMC has agreed to put a simple prefix ahead of registration numbers, but the professions are calling for more distinction so that there can be no confusion.
I am mindful of the higher proportion of cases generated from AAs and PAs. Will the Minister ensure that the registration fees reflect that? It is vital that the Government and the GMC, in formally setting up the statutory register over the coming three years, work closely with the professionals to ensure that they are engaged in the process and that their concerns are picked up and addressed along the way. I am asking the Minister to commit to that today, as I know my hon. Friend the Member for Bristol South will when she has the opportunity later in the year.
Patients, the wider public and fellow clinicians need to understand these fine lines and distinctions for their safety and safe practice across the NHS. The culture of “get it right first time” must be central to this debate and all that flows from it. If regulation lands in the wrong place, the Minister and the GMC need to be candid and ensure that it is changed so that it is fit for purpose. I trust that Parliament will have further opportunity to scrutinise these developments.
Claudia Webbe (Leicester East) (Ind)
It is a pleasure to serve under your chairship, Dame Caroline. I am concerned, however, that this matter is not being debated in the main Chamber.
The renaming of NHS medical assistant roles to physician associate and anaesthesia associate is confusing the public by blurring the clear distinction between doctors and other professionals who do not have medical physician qualifications and training. In response to a British Medical Association survey last month, 30% of patients said that they had no idea that they were not seeing a doctor, and 90% of doctors believe that the shift has been dangerous for patients.
According to at least two coroners, including the Chief Coroner, and the British Medical Association, the use of associates instead of fully qualified physicians has contributed to the avoidable deaths of patients who were misdiagnosed. Emily Chesterton from Salford, who was 30 years old, and 25-year-old Ben Peters both died after being sent home by physician associates who diagnosed emergency health issues as a calf strain and a panic attack, respectively—in Mr Peters’s case, despite a history of heart problems. Ms Chesterton’s family said that she was never aware that she had not been seen by a doctor.
The use of associates has been the subject of dangerous scope creep. One physician associate told a podcast that he was performing basic brain surgery and “learning on the job”. Another hospital—in Leicester, as it happens —congratulated a nurse practitioner on being the first to perform a heart operation unsupervised. According to NHS campaigners, such non-medical roles are being used and expanded to cut staff costs and to fill vacant places as part of overall cost-cutting in the so-called integrated care service programme, which is the US accountable care system under a different name. A deliberate system of incentives ensures that the NHS and its regional providers will keep cutting the corners of what used to be a comprehensive, state-funded service, turning it into something that business can profitably provide.
The plan to regulate these non-medical roles through the General Medical Council adds to the dangerous confusion. It has been opposed by both the Royal College of General Practitioners and the British Medical Association. For the safety of patients and the proper functioning of the NHS, I urge the Committee to oppose the draft order. Instead, the titles of these roles should revert immediately to the previous titles, physician assistant and anaesthesia assistant. The NHS workforce plan must put doctors into doctor roles and unambiguously distinguish between medically qualified roles and other roles. As the British Medical Association has recommended, the Government must regulate those assistant roles through the Health and Care Professions Council, so that patients and their families are fully aware of who is treating them and how qualified they are.
Margaret Greenwood (Wirral West) (Lab)
It is a pleasure to serve under your chairmanship, Dame Caroline. Regulation of the roles of physician associates and anaesthesia associates is long overdue. Let me say first that physician associates and anaesthesia associates have a valuable contribution to make to the NHS workforce.
I want to highlight some concerns that doctors in my constituency have raised with me about the fact that the responsibility for regulation will rest with the General Medical Council, the same body that regulates doctors. Their concern is that patients often do not understand that physician associates are not actually doctors and do not have the same medical training as them. The British Medical Association is among those that have highlighted that the deployment of those roles can be problematic, and that when patients have been seen by a physician associate, they are
“often unaware they have not been seen or assessed by a doctor”.
That is extremely important because, in the treatment of illness, diagnosis is key. We have heard some harrowing examples this afternoon showing why this is so important.
A recent survey by the BMA found that 86% of the doctors who took part felt that patients were not aware of the difference between these roles and the roles of fully qualified doctors. They are concerned that the General Medical Council regulating responsibilities with a single register for doctors, physician associates and anaesthesia associates will only exacerbate the confusion. Further cause for concern is that 87% of doctors who took part in the same survey revealed that the way that physician associates and anaesthesia associates currently work in the NHS is always or sometimes a risk to patient safety. That is a matter of extreme concern.
A number of my constituents, many of whom are medical professionals, have contacted me about this legislation. A consultant wrote to me to say that
“the professional titles used for these roles—‘physician associate’ and ‘anaesthesia associate’—are highly misleading and only add to patient confusion, because it is clear that patients often think they are being treated by a doctor, when they are not.”
My constituent suggested that the titles revert to what they were—namely, “physician assistant” and “physician assistant (anaesthesia)” or “anaesthesia assistant”. I would go further and suggest that the name “doctor’s assistant” be used. That is much clearer and everybody would be able to understand it.
Another Wirral West resident, a retired consultant, said that doctors are
“increasingly concerned about the expansion of medical associate roles in the NHS while significant confusion remains about the scope of the roles, supervision and expertise.”
They also suggest clearly defining the roles of physician associates and anaesthesia associates because there is currently such little definition of what the roles entail and what their limits are.
It is vital that the scope and limits of the roles of physician associates and anaesthesia associates are clearly set out, not just for people taking up those roles, but for their patients. That needs to be clearly communicated. Many constituents have also suggested, as has the BMA, that these roles would be better regulated by the Health and Care Professions Council. Will the Minister share with us what consideration has been given to whether that body might be better as a regulator?
This SI concerns regulation. It comes about following the Health and Care Act 2022, which made provision for taking health professions out of regulation. This SI shows the need for the exact opposite. It is important that the high standards that we enjoy in the NHS are protected, so it is vital that the roles are clearly defined, as well as regulated.
I hope the Minister will take on board and respond to the concerns that have been raised in this debate. Concerns are likely to persist that the Government see the training and deployment of medical associate professionals as simply a cheaper alternative to training doctors. To take GPs, for instance, as of November 2023, there were 2.3% fewer fully qualified full-time equivalent GPs in England than in 2019 and 6.8% less than in 2015. In 2023, there were 7% fewer GP practices than in 2019.
Meanwhile, the number of patients per GP has increased considerably. There are now 2,290 patients per GP, an increase of 6.9% since 2019. We can see that our GPs are doing more work than they had been required to do and they are clearly working under increased pressure. Added to that, those who have physician associates in their practice also have to oversee them. The expansion of the number of physician associates and anaesthesia associates should not be used as a solution to the shortage of hospital doctors and GPs.
Andrew Stephenson
I thank my right hon. Friend the Member for Suffolk Coastal and the hon. Members for Bristol South, for Leicester East, for Worsley and Eccles South, for York Central, and for Wirral West for their contributions to today’s debate.
I would like to turn first to the contribution by the hon. Member for Worsley and Eccles South, who spoke movingly on behalf of her constituents Marion and Brendan Chesterton about the death of their daughter, Emily. I know that the hon. Lady also did so in a very moving fashion during an Adjournment debate, which was responded to by my predecessor, my hon. Friend the Member for Colchester (Will Quince). Ahead of today’s debate, I was very keen to listen to that debate, so I watched it back and I am keen to see what more we can do to learn lessons.
No family should ever have to endure the loss of a child, and no words from me will assuage the family’s grief. However, I hope that by passing this order we are helping to ensure that some lessons have been learned and that we can deliver improved patient safety through better regulation of these roles. I recognise that there have been delays to the previously published timescale for the regulation of AAs and PAs. Although that is in part due to the pandemic, it is important to reiterate that this work is being taken forward as part of a broader package of reforms of regulators, governing a whole range of medical professions. That work is significant and complex. On that basis, a huge amount of work and input from all the regulators and a range of stakeholders has contributed to the draft legislation for AAs and PAs, which will be used as a template for reforms to other regulatory bodies.
Throughout this process, officials from my Department have met the BMA and other stakeholders to develop the policy behind this legislation. On the basis of feedback received through public consultation and additional targeted engagement, officials have made a number of amendments to the draft order to ensure that the legislation is fit for purpose and delivers the flexibility and autonomy required to empower regulators to be able to introduce new regulatory processes that would better serve patients and their registrants. That engagement has been crucial in shaping both our policy intention and the resultant legislation to ensure that it remains a practical piece of legislation that can be used by regulators.
The forthcoming GMC rules consultation, which will follow the passage of this order, represents a further opportunity for the BMA and others to have input into the regulation of these roles. When I met the GMC, I was assured that they were confident that they could bring forward this consultation quickly so that there are no further delays to the timetable of implementing these regulations.
Turning to the AA and PA titles, which quite a few Members have raised today, the physician associate title has been well established in the UK since 2014, and the Government have no plans to change the titles of PAs or AAs. As set out in the National Institute for Health and Care Excellence guidelines, all healthcare professionals directly involved in patient care should introduce themselves and explain their role to the patient. AAs and PAs are not and should never be referred to as medical practitioners, doctors or consultants.
The GMC has published interim standards for AAs and PAs in advance of regulation that make it clear that professionals should always introduce their role to patients and set out their responsibilities in the team. Ahead of regulation by the GMC, the Faculty of Physician Associates has issued guidance for PAs, supervisors, employers and organisations that helps to provide a structured and standardised way of using the title. In addition, NHS England has produced patient-facing materials that have been shared widely with GP practices to support patient awareness and understanding of the PA role.
Barbara Keeley
I thank the Minister for his words of sympathy; I will pass them on to Mr and Mrs Chesterton. On patient-facing advertising, I think a couple of months ago, I raised with the previous Secretary of State for Health, the right hon. Member for North East Cambridgeshire (Steve Barclay), a post from Norfolk and Waveney integrated care system that read, “Got abdominal pain that isn’t going away? A Physician Associate based in your GP practice can help…They are highly skilled at diagnosing conditions”. That was marketing material related to the role, which does not help. We have had tragic cases like Emily’s, and it does not help to have over-egged advertising like that. Can the Minister can say anything about that?
Andrew Stephenson
I completely agree. Things like that do not help, and that is why bringing forward these regulations will help. The GMC is obviously very keen to start its consultation and have the regulations introduced. As soon as this is set out in statute, it will be very helpful, not just for PAs but everybody, particularly employers and others, in ensuring that they never oversell the abilities of a PA and are clear about the role of a PA or AA in an integrated health team.
Turning to the shadow Minister, the hon. Member for Bristol South, I thank her for her contribution and join her in paying tribute to the PAs and AAs already working in our NHS. She asked about the impact on training opportunities for junior doctors, which leads me on to addressing quite a few of the points about why we have decided to go with the GMC as the regulator. The assessment of the most appropriate regulatory body for AAs and PAs was completed in 2019 following a public consultation. The majority of respondents were in favour of the GMC taking on regulation, including the professional bodies representing the two roles and the medical royal colleges. For the record, from a total of over 3,000 responses, 59% of respondents felt that the GMC was the most appropriate, while 20% thought it should be the HCPC.
Regulation of the associate roles by the GMC will allow it to take a holistic approach to the education, training and standards of associate and doctor roles. That will enable a more coherent and co-ordinated approach to regulation, hopefully ensuring that concerns around training places for junior doctors, for example, are addressed appropriately. I am happy to reassure the shadow Minister that I will continue to work with all stakeholders to ensure that we get the regulations right.
I thank the hon. Member for York Central, who spoke knowledgeably about these roles. We would all agree that it has been long recognised that we need to reform the legislative framework for the regulation of healthcare professionals to make things faster and more flexible. The current UK model needs to change to better protect patients, support our health service and help the workforce to meet future challenges.
Successive Governments have considered such reforms, but they have never come to fruition until now. While it is our intention to work as swiftly as possible to deliver reform for each regulator and profession, we will prioritise delivery based on criteria including the size of the registrant base, the need for reform, and our assessment of regulators’ readiness to implement the changes. Based on those criteria, we intend to start working with the regulators to develop reform legislation for their professions over the next couple of years.
The hon. Lady asked about fee levels. I believe the GMC’s current plan is to charge AAs and PAs a fee of £221 per annum, adjusted for inflation. That is what PAs are currently paying the FPA—of course, AAs do not currently pay a fee. The GMC, like the NMC and other regulators, works on the basis of their activities being funded by the fees from registrants, which is an important way of keeping them independent from Government.
This draft order represents a vital step forward to improve patient safety by ensuring that PAs and AAs meet the standards that we expect of all regulated professionals and that they can be held to account if serious concerns are raised. I hope that I have addressed as many of the points raised by the Committee as I can, but I am more than happy to continue dialogue with the Opposition Front-Bench team and others to ensure we get the changes right. I commend the draft order to the Committee.
The Chair
Order. Before I put the question, I have a reminder. We have heard from Members from both sides of the House who are not formal members of this Committee, but only members of the Committee are allowed to vote.
Question put and agreed to.
Resolved,
That the Committee has considered the draft Anaesthesia Associates and Physician Associates Order 2024.
Draft Public Offers and Admissions to Trading Regulations 2023
Draft Securitisation Regulations 2023
Draft Financial Services Act 2021 (Overseas Funds Regime and Recognition of Parts of Schemes) (Amendment and Modification) Regulations 2024
Draft Data Reporting Services Regulations 2023
(11 months ago)
General CommitteesRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Economic Secretary to the Treasury (Bim Afolami)
I beg to move,
That the Committee has considered the draft Data Reporting Services Regulations 2023.
The Chair
With this, it will be convenient to consider the draft Public Offers and Admissions to Trading Regulations 2023, the draft Securitisation Regulations 2023 and the draft Financial Services Act 2021 (Overseas Funds Regime and Recognition of Parts of Schemes) (Amendment and Modification) Regulations 2024.
Bim Afolami
It is a pleasure to serve under your chairmanship, Mr Vickers.
The draft Securitisation Regulations 2023, the draft Public Offers and Admissions to Trading Regulations 2023, and the draft Financial Services Act 2021 (Overseas Funds Regime and Recognition of Parts of Schemes) (Amendment and Modification) Regulations 2024 are made under powers in the Financial Services and Markets Act 2023, which I shall refer to as FSMA. They form part of the Government’s ambitious programme to deliver a smarter regulatory framework for financial services by replacing assimilated law, formerly known as retained EU law, with an approach to regulation that is tailored to the United Kingdom. As the House will know, they are a key part of the Edinburgh reforms, which are a key part of the programme of the Treasury, the Chancellor and my office. The third of those instruments makes technical changes across the statute book to support the effective implementation of the overseas funds regime and functioning of fund recognition.
The draft Data Reporting Services Regulations 2023 establish a new legislative framework for the regulation of data reporting service providers, or DRSPs, replacing the framework inherited from the European Union. DRSPs report trade data—that is, data relating to trades that happen on financial markets—to either the public or the Financial Conduct Authority. That is essential to ensure that markets are supervised effectively and for them to operate and function properly.
Sir Greg Knight (East Yorkshire) (Con)
The explanatory memorandum states that the FCA will need to make new rules under the new regime, and that the new regime will not come into force until the FCA has consulted on changes to its rules as part of the rule-making process. Can the Minister give us some idea of the timescale involved here?
Bim Afolami
I thank my right hon. Friend for that point, and I shall respond in the following way. Under the smarter regulatory framework, the broad approach is that Parliament—in this instance, this Committee—passes secondary legislation under the auspices of FSMA. Then, the detailed rulebook—which is, believe it or not, more detailed than this statutory instrument—comes in through the operation of the FCA. My right hon. Friend made a point about the consultation process. The consultation process can be long or short. I would expect that, as with various other measures under the Edinburgh reforms, the consultation process for statutory instruments as detailed as these will be quite short. We are looking for it to happen this calendar year. I do not want to be more precise than that, but I expect it to happen this calendar year.
Richard Fuller (North East Bedfordshire) (Con)
I want to follow up on the comment from my right hon. Friend the Member for East Yorkshire on the role of the FCA. The Minister will be aware of the concerns of Members on the Government Back Benches about the speed with which regulators perform their duties, how much we pass on to them, and how much we trust them to fulfil the will not just of Parliament but of our representatives. That applies to the FCA. I do not expect the Minister to comment on that directly, but can he assure the Committee that he will use his position to ensure that the FCA is kept on track in implementing the reforms at pace?
Bim Afolami
I will surprise my hon. Friend by commenting directly on what he has said. Like him, I have spent a long time thinking carefully about the role of the FCA and other regulators and the speed with which they discharge their duties. We give them a lot of work to do, but we also hope that that work is conducted as quickly as possible. The FCA has made improvements in that regard, but it is my job to ensure that it works as quickly as possible. When it comes to the Edinburgh reforms, under which these reforms sit, the Chancellor has been very clear that one of my key jobs is to deliver: not just to say that we are doing things, but to ensure that those things come into practice. I am very focused on that.
There are three types of DRSPs: first, approved reporting mechanisms, which report details about transactions in financial markets to the FCA on behalf of investment firms; secondly, approved publication arrangements, which publish trade reports to the public; and, thirdly, consolidated tape providers, which collate trading data from a variety of sources and publish it in a single live data stream. The draft regulations establish a new framework for the regulation of DRSPs, under which the FCA will make the detailed requirements in its rulebook, as we have discussed.
The instrument also delivers the Edinburgh reforms’ commitment to establish a regulatory framework for a UK consolidated tape. Currently, there are no consolidated tapes in this country, which means that market participants must go to various sources to get a cross-market view of trade data. That makes it expensive, burdensome and difficult for investors to access the data they need to make informed investment decisions in the UK. That is why, as part of the wholesale markets review, the Government consulted on legislative changes to facilitate the emergence of a consolidated tape in this country. There was broad support for the Government’s proposals, which this instrument delivers. A tape that collates data from multiple sources into one continuous live stream will make it easier for market participants to meet best execution requirements and manage risk. That will make UK markets more attractive and competitive.
The draft Securitisation Regulations 2023 establish a new legislative framework that replaces inherited EU law on securitisation. The introduction of the securitisation regulation in 2019 directly addressed financial stability deficiencies that arose after the global financial crisis. The Treasury conducted a review of the securitisation regulation in 2021. The review aimed to bolster securitisation standards, to increase investor protections, and to develop securitisation markets to facilitate real economy lending. The new framework established by the draft regulations will allow the financial services regulators—the FCA and the Prudential Regulation Authority—to make and further reform the firm-facing rules for securitisation with more agility and proportionality. The regulators will consider taking forward reforms in line with the outcomes of their own consultations and the 2021 Treasury securitisation review, which were received positively by industry.
The instrument also takes forward other reforms identified by the 2021 review. Those reforms include boosting the UK securitisation market’s competitiveness by no longer subjecting certain overseas firms to UK requirements when investing in UK securitisation. That will make overseas firms’ requirements more proportionate and increase their incentives to invest in UK securitisations, while also removing extraterritorial supervision issues for the regulators. I want the Committee to be clear on that point. The instrument also facilitates UK firms’ participation in international securitisation markets, which should benefit our industry.
The draft Public Offers and Admissions to Trading Regulations 2023 deliver a key recommendation—perhaps the key recommendation—from Lord Hill’s listings review to fundamentally overhaul the prospectus regime, and they mark a significant step in the Government’s reforms to make our capital markets more competitive. The current prospectus regulation, as outlined by Lord Hill and industry at length in his review, is inflexible and slows the raising of capital, which is the purpose of our capital markets. The instrument creates a new framework that requires companies raising capital to publish information that is relevant and useful for investors, while removing unnecessary barriers to such information. The new regime will mean that companies raising capital are required to publish a prospectus, except where they meet a series of exceptions—for example, where a security is traded on an exchange, or where the offer of securities is fewer than 150 investors. That means that, in practice, we are removing the need for a prospectus to be published in many situations. Just so that colleagues appreciate this, the purpose of that is absolutely not to reduce information for investors but to ensure that the right level of information is appropriate for the right type of investors for the right businesses.
The instrument also establishes a new regime for securities “admitted to trading’” on a regulated market or a multilateral trading facility, and creates a new regulated activity of operating an electronic system for public offers of certain securities that are above £5 million. By removing the €8 million threshold for a prospectus, which effectively acted as a blockage for certain private-capital raising, firms can raise larger amounts of capital more easily and more quickly.
That will allow firms raising money outside of capital markets—for example, through crowdfunding platforms, which has grown in popularity over recent years—to continue to do so, but do so in a more targeted way. The FCA will be given new rule-making responsibilities to set rules that apply directly to firms, such as when a prospectus is required. That will create a simpler and more effective regime.
I will now turn to the final instrument, the draft Financial Services Act 2021 (Overseas Funds Regime and Recognition of Parts of Schemes) (Amendment and Modification) Regulations 2024—I will take away from this the need to perhaps shorten the length of the names of such regulations.
This instrument amends the statute book to support the implementation of the overseas funds regime, which is a new route allowing overseas funds from equivalent countries or territories to be recognised for the purposes of marketing participation in such funds to UK retail investors. This instrument ensures that, where appropriate, funds recognised under the overseas funds regime are treated in the same way as other recognised funds. These changes are technical, but they are necessary to allow the overseas funds regime to operate as policy intends, ahead of the first funds being recognised under it. This will be critical to continue to support a competitive funds sector for UK investors.
In closing, the first three of these SIs replace key parts of assimilated EU law, putting in place new frameworks tailored to the UK as the Government deliver a smarter regulatory framework in financial services. The final instrument, as I have outlined, makes technical changes across the statute book to support the effective implementation of the overseas funds regime and the functioning of fund recognition. I hope that the Committee will join me in supporting these regulations, and I commend them to the House.
Tulip Siddiq (Hampstead and Kilburn) (Lab)
It is a pleasure to serve under you, Mr Vickers. I thank the Minister for setting out the four statutory instruments under debate today, and I agree with him about shortening the names of such instruments.
As the Minister will know, I did give my full support to the Financial Services and Markets Act, and I am wholly committed to protecting the international competitiveness of the sector. That is why we will be supporting the secondary legislation today.
The draft Public Offers and Admissions to Trading Regulations 2023 are a positive development, in my opinion. The UK’s attractiveness as a listing destination will benefit from a more flexible approach to prospectus rules. Likewise, the draft Securitisation Regulations 2023 are an important step forward in developing a securitisation market in the UK that contributes to growth in the real economy.
We also support the aims of the draft Financial Services Act 2021 (Overseas Funds Regime and Recognition of Parts of Schemes) (Amendment and Modification) Regulations 2024, as they will provide smoother market access for overseas funds that have been determined to be equivalent to the UK’s in relation to consumer protection.
Finally, I welcome the long-overdue establishment of a UK consolidated tape under the draft Data Reporting Services Regulations 2023. That will hopefully boost the international competitiveness of UK capital markets by improving efficiency and transparency, reducing trading costs and attracting more investment.
However, of course, the Minister will know that I have some questions for him on all of the legislation before us today, and I hope that he will be able to address some of my concerns. First, while the draft regulations will replace the prospectus regulation and create a new framework, the new prospectus regime is not expected to come into effect until 2025. In the meantime, the competitiveness of the UK’s public markets will continue to suffer.
In addition, in the Treasury’s initial review of the prospectus regime, the Government committed to introducing a new regime of regulatory deference for offers in the UK of securities listed on certain designated overseas stock markets. Despite that review being published almost two years ago, this draft statutory instrument fails to introduce a deference mechanism for prospectuses. Will the Minister please confirm whether such a regime remains under consideration and, if so, how it will be delivered and in what timescale?
I also have a question about the draft Securitisation Regulations 2023. This SI recognises simple, transparent and standardised—STS—equivalent securitisations from the EU and elsewhere. However, the EU does not recognise UK STS securitisations. What assessment has the Minister made of the impact of that? What steps is he taking to get an arrangement with the EU in the light of what I have said? Also, during the consultation on that SI, the Association for Financial Markets in Europe expressed concern regarding the lack of clarity of transitional provisions for legacy transactions. Is the Minister confident that the provisions for historical securitisations in the SI as drafted address such concerns?
On the draft Financial Services Act 2021 (Overseas Funds Regime and Recognition of Parts of Schemes) (Amendment and Modification) Regulations 2024, it is important to note that this SI is part of a wider set of measures to bring the overseas funds regime, or OFR, online. The regime will apply to funds from jurisdictions that the Treasury has deemed “equivalent”, so the OFR will only become operational once those decisions by the Treasury have been made. In the light of that, will the Minister set out when he expects the Treasury to take the equivalence decisions that would enable overseas funds to utilise the streamlined approach envisioned under the new overseas funds regime?
Finally, the draft Data Reporting Services Regulations 2023 will bring us into line with the EU, as the Minister said, but it is also consulting on a consolidated tape, or CT, so I have concerns that the UK is at risk of falling behind competitor jurisdictions. The FCA has consulted on a CT for bonds, but that is unlikely to be operational before mid-2025. It has not even begun consultations for an equities CT, and the UK does not have a pre or post-trade equities CT. By contrast, as the Minister will know, the EU is racing ahead on an equities CT, so the longer that change takes to deliver, the more that key public market listings will be lost to our competitors. The UK’s status as a global financial centre will be put at risk. Will the Minister talk a bit about how he will ensure that swifter progress is made on CT reform to support the UK’s international competitiveness?
I look forward to the Minister’s response. We will not oppose any of the draft SIs, but I would like some answers.
Bim Afolami
It will be a pleasure to answer the questions of the hon. Member for Hampstead and Kilburn. I will take them in turn, but before I get to them I will say that I have very much noted the comments of the hon. Lady and those of my right hon. and hon. Friends about the speed of implementation and that being key to what the House and the Committee want to see so that we get the changes we all need.
On the prospectus rules coming into force in 2025, the hon. Member for Hampstead and Kilburn will appreciate that this is a complicated set of changes. The Treasury and industry needed to ensure that what we are doing, when that is such a comprehensive piece of work, was the right thing and had the broad support of industry. We have got that, but I repeat that I will be working very hard to make sure that we implement these as quickly as possible. We are closely engaging with the FCA while it is beginning the complex process of reviewing its rules and changing them. The FCA is committed to completing this by the first half of 2025—not just completing the work but actually having new rules published. I will increase the speed of that if humanly possible.
On the point from the hon. Member for Hampstead and Kilburn about securitisation, I am always keen to talk with European Union friends and colleagues across a range of matters. Indeed, I will be visiting Brussels soon in order to discuss these issues and a range of others. I am happy to continue to do that. She also mentioned the legacy transactions point that was brought up by the Association for Financial Markets. We are confident that the regulations are appropriate, but I am very happy to meet with the Association if it would like to discuss any of its concerns.
On the OFR and the equivalence judgments, the answer is: very soon, I hope. I will be updating the hon. Lady and the House as soon as I possibly can, because I recognise that this is important. In relation to the consolidated tape, lots of different competitor jurisdictions are trying to do this work, which is part of the evidence that we are doing the right thing. I am confident that we are going to do this faster and more effectively than our competitors.
Tulip Siddiq
I appreciate the Minister’s responses, but the EU does not recognise the UK STS securitisations. Has the Minister made an assessment of that? He says that he is going to Brussels to speak to them, but has he not already started speaking to them, or is this the first time? That is quite an oversight, considering that they do not recognise those securitisations.
Bim Afolami
The hon. Lady will appreciate that across a range of different issues there are often political reasons why the European Union may or may not do things. We are committed to making sure that it operates in a sensible way when it comes to the UK, because we know that the UK’s financial services ecosystem, regulatory regime and market make it the leading financial services centre. But I will continue to engage with the EU on that basis. To her precise point, there are a range of different issues we are talking to the European Union about at all levels of Government. Financial services is included in that, and I will continue to have those conversations.
Tulip Siddiq
Can I ask the Minister to write to me after his visit to Brussels?
Bim Afolami
Of course.
Question put and agreed to.
DRAFT SECURITISATION REGULATIONS 2023
Resolved,
That the Committee has considered the draft Securitisation Regulations 2023.—(Bim Afolami.)
DRAFT FINANCIAL SERVICES ACT 2021 (OVERSEAS FUNDS REGIME AND RECOGNITION OF PARTS OF SCHEMES) (AMENDMENT AND MODIFICATION) REGULATIONS 2024
Resolved,
That the Committee has considered the draft Financial Services Act 2021 (Overseas Funds Regime and Recognition of Parts of Schemes) (Amendment and Modification) Regulations 2024.—(Bim Afolami.)
dRAFT DATA REPORTING SERVICES REGULATIONS 2023
Resolved,
That the Committee has considered the draft Data Reporting Services Regulations 2023.—(Bim Afolami)