Queen’s Speech

Lord Kakkar Excerpts

Thursday 28th May 2015 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I congratulate the Minister on the very thoughtful way in which he introduced this debate following the gracious Speech. I intend to focus principally on the impact of our relationship with the European Union on the delivery of healthcare in our country. In so doing, I declare an interest as professor of surgery at University College London and a member of the General Medical Council.

Before turning to that important issue, I will just touch on the interesting issue of the forthcoming referendum on our membership of the European Union and what the basis of the franchise for that referendum might be. Her Majesty’s Government have announced in the last few days that the franchise should be the same as that for elections to the Westminster Parliament, which seems an intuitive place to be. Since we are a parliamentary democracy, it is for the representatives of citizens—constituents—to come to the other place, represent the views of those constituents and exercise their judgment in determining how to vote on the vast majority of issues. Seldom in our parliamentary system do those representatives of their constituents feel the need not to exercise their own judgment but to return to those who have sent them to the other place to seek the views of those electors. Under the circumstances, therefore, it seems appropriate that those who voted for Members of the other place should be those providing their views about how the House of Commons should respond to the question of our future relationship with Europe. Therefore, seeking the opinion of constituents able to vote in national elections seems an appropriate course.

That appears to be the approach taken by the 27 other European member states. Each of them restricts participation in national referendums to those citizens who are entitled to vote in national elections. The only other European nation that addresses the issue of participation in national referendums on a case-by-case basis, as is the habit in our own country, is the Netherlands. It is not identical but in a similar situation in 2005, when the Netherlands put to its own people the question of whether the European Union constitution should be adopted, it chose to proceed with a franchise restricting participation in that referendum to the citizens of its own country eligible to vote in national parliamentary elections.

Indeed, when we have had national referendums in our own country—such as in 1975 when the question of our ongoing membership of the European Economic Community was put to the people of our country—the franchise chosen was the national electoral franchise for Westminster constituencies. Indeed, when we had the referendum on whether we should change the voting system in our country—the AV referendum in 2011—once again the Westminster franchise was chosen, with the addition, of course, that Members of your Lordships’ House were able to participate in that vote.

Although there are to be vital major treaty negotiations in the coming two years with regard to our future relationship with the European Union, very important issues remain to be addressed, with regard not to major treaty change but important potential regulations that could have a profound impact on the delivery of healthcare in our country. It is vital that those important discussions about more minor areas rather than major treaty changes continue to be addressed in the most robust fashion.

There is no doubt that there have been and continue to be very important advantages through the opportunity for our country to participate actively in the European Union, both in the delivery of healthcare and in biomedical research. Only last week my noble friend Lord Rees of Ludlow, with a number of other very distinguished scientists, pointed out in a letter published in the Times the important opportunities afforded for research generally and biomedical research in particular by our relationship with the European Union. At this stage, I reiterate my interest as professor of surgery at University College London. My institution is eligible to apply for European Union research funding and, indeed, is very successful at doing so. I also served in the previous Parliament on your Lordships’ European Union Sub-Committee B, which undertook an investigation into research and innovation funding—the Horizon 2020 programme—from Europe.

In the previous funding round—2007 to 2014—our country was second only to Germany in the funding it received for research from Europe, with some €7 billion, and was the largest recipient nation in funding to academic institutions, with some €5 billion. In the area of healthcare, some €560 million came to our medical research programmes, making us the largest recipient among European Union member states. But in parallel with that, we have seen proposals around the European data protection regulations. The former proposal put by the Commission seemed reasonably sensible but, as modified by the European Parliament, is now a matter of further negotiation. Those regulations, if imposed as a result of qualified majority voting, would have a detrimental impact on medical research in our country. They would make it practically impossible to undertake cancer registries or to fully exploit the UK Biobank—a massive programme involving some 500,000 of our citizens donating biological materials and their personal data to allow us to have long-term longitudinal research studies—and of course the 100,000 Genomes Project would also be severely undermined. I wonder what progress Her Majesty’s Government have made in ensuring that the application of the data protection regulations does not undermine the future of biomedical research in our country.

There is also the very serious concern about the decision taken by the President of the European Commission to dismiss the independent scientific adviser. This is a very serious matter that was raised in your Lordships’ House in the previous Session of Parliament. There was an independent scientific adviser available to ensure the appropriate assessment—or the mechanism for the appropriate assessment—of applications for European Union funding. That was vital. What progress have Her Majesty’s Government made with ensuring that independent scientific advice continues to inform decisions taken by the European Union in science, technology and medical research?

There is no doubt that we have become increasingly dependent in our National Health Service on the large numbers of doctors, nurses and other healthcare professionals who have come to work in our country. However, we have also seen detrimental impacts with regard to the European working time regulation on the delivery of healthcare in our hospitals and, increasingly now, beyond them in community care as well. It is now well recognised that the working time regulation, originally a measure on health and safety at work, has had a detrimental impact when applied to those working in the health service. It is now seen to have had a detrimental role in ensuring continuity of care in our hospitals, and therefore a detrimental impact on patient safety. Where it was thought that it might not impact on the training of junior doctors, increasingly it is seen to have been detrimental—particularly in the training of those in craft specialties, such as my own as a surgeon. There is also the cost element associated with the need to pay more and more locum agency doctors to help our hospitals ensure that rotas for 24-hour cover are European working time regulation-compliant. Have Her Majesty’s Government made an assessment of what proportion of the £3.2 billion spent last year on agency staff in the National Health Service can be attributed to the fact that the working time regulation continues to be applied, and therefore that we need to employ many more locum and agency staff to ensure that hospitals have compliant rotas?

Finally, there is the question of how those from Europe wishing to practice medicine or undertake their professional obligations as healthcare professionals in our country should join the various regulatory registers. I again remind noble Lords of my declaration of interest as a member of the General Medical Council but I do not speak for the council on this occasion. In the last Parliament it finally became possible, where there were concerns about doctors coming from the European Union, for the General Medical Council to test their language skills. That was not previously the case, although the council was able to test the language skills of those doctors coming from outside the European Union. Last September, the council announced its aspiration to introduce a single national licensing exam, which every person wishing to join the general medical register would have to sit. It would apply to our own UK medical graduates as well as those coming from around the world—from the United States, Australia, Canada and many other countries. However, there is some doubt whether the national licensing exam could be placed before those coming from European member states and wishing to join the general medical register. If that turned out to be the case and if the council were to come forward with a proposal for the introduction of a national licensing exam, are Her Majesty’s Government able to confirm that their position would be to ensure that all doctors joining a register, including those from the European Union, were subject to that examination?