Scotland: Independence Referendum

Lord Kakkar Excerpts

Thursday 30th January 2014 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I, too, join in thanking the noble Lord, Lord Lang of Monkton, for the very thoughtful way in which he has introduced this important debate. In so doing, I declare my own interest as professor of surgery at University College London and a member of the General Medical Council because I wish to confine my comments to two very important and practical areas which I think will be profoundly affected if Scotland were to be separated from the United Kingdom. Those are the regulation of the medical profession and the conduct of biomedical research. I do that building on the comments made by the noble Lord, Lord Lyell.

First, I reflect on something that the noble Lord, Lord Forsyth of Drumlean, said earlier, when he recounted a long list of those of Scottish descent who have made a profound impact on the life of the United Kingdom. I would add to that some names of people who have made a profound impact on the way that we practise medicine—for instance, Sir John Hunter, a famous Scottish surgeon who came to England and who is considered the father of modern surgery. He described a methodical and scientific approach to the practice of surgery that still defines how surgery is practised globally and has resulted in the profession of surgery in the United Kingdom having made so many contributions to global surgery as well as being so highly regarded.

We have Sir Alexander Fleming, who discovered penicillin—a discovery that profoundly changed our ability to impact on human health, for which he received the Nobel Prize. Another Nobel laureate, Sir James Black, developed through new pharmaceutical entities beta blockers, which have profoundly changed the way in which we treat heart disease and high blood pressure, and H2 antagonists, which helped us to improve the management of ulcers, avoiding the need for major surgery and treating most ulcers of the stomach and duodenum with drug therapy. From among your Lordships, we have my noble friend Lord Patel, who was formerly a famous and distinguished professor of obstetrics and gynaecology in the University of Dundee and, more broadly in the United Kingdom, a highly regarded chairman of the Academy of Medical Royal Colleges and president of the Royal College of Obstetricians and Gynaecologists. Therefore, the links across medicine in the United Kingdom are profound and have existed for many centuries.

In the White Paper that attended the more formal announcement of the Scottish Government’s proposals for the referendum and for independence, there is in the question-and-answer section a statement about the wish of the Scottish Government that medical regulation continue across the entire United Kingdom as it does at the moment. But I do not think that that is going to be necessarily and easily possible.

At the moment, the Medical Act 1983 governs the way in which the General Medical Council operates. That Act is influenced by the professional qualifications directive of the European Union—which I shall come to in a moment. The situation for medical regulation is that three categories of doctor appear on the medical register. The first is graduates of UK medical schools, including the four schools in Scotland that are recognised as part of that Act as being able to award primary medical qualifications in the United Kingdom. Graduates of those universities, including Edinburgh, Glasgow, Dundee and Aberdeen, will immediately upon successful achievement of their examination and their first year of practice become full members of the register. A second category is those who hold a recognised European primary qualification in medicine. They have registered elsewhere in the European Union and will automatically have registration on the general medical register. The third category is for those who come not from UK medical schools or appear on European registers but are graduates from elsewhere in the world; for example, the United States, Canada and Australia. They are considered international medical graduates and have to take a separate examination to demonstrate their skills before they can apply for registration. Indeed, if they come with specialist skills from elsewhere in the world, they may well have to undertake further specialist training in the United Kingdom before they are able to appear on the register.

That would be the situation for those graduating from Scottish medical schools if Scotland were to separate from the United Kingdom—some 850 students due to graduate in 2016 and some 800 in 2017. Of course, the situation might be solved if Scotland were to become part of the European Union, but, as we have heard in today’s informative debate, that may take many years. In the intervening period, it may not be as simple as to say that we could have some form of legislation in the Westminster Parliament to allow those graduating from Scottish medical schools or those undertaking Scottish training programmes for specialist practice to be uniquely recognised in the remaining United Kingdom, because that will be affected by the professional qualifications directive of the European Union.

It is a very serious problem. Forty per cent of those who have qualified with a primary medical qualification from a Scottish university reside in England. This means that a large number of potential practitioners in the intervening years could be affected by our inability to offer registration and recognition of their degrees. Indeed, if they are not part of the European Union, it is not clear where they will be able to practise apart from in Scotland.

The second area to be affected if Scotland were to be separated from the United Kingdom is medical research. We have heard already in this debate that some 13% of research council funding from the United Kingdom research councils is spent in Scotland with only 8% or thereabouts of the GDP for our country coming from Scotland, so Scotland does disproportionately well. When we look at spending by the Medical Research Council in Scotland, we see that it is close to 17% of its budget, including the many important medical research facilities and units that exist there. It would be unprecedented for a research council to be able to spend its taxpayer-funded opportunities in a foreign country. The infrastructure across the United Kingdom that has put us at the forefront of biomedical research—some 12% of all citations in biomedicine come from the United Kingdom; it is a remarkable intensity of research effort that we are able to contribute globally—would be undermined if the important links between Scottish biomedical research institutions and the rest of the United Kingdom, designed in such a strategic fashion to exploit the most important research opportunities for our country, were to be broken through the separation of Scotland.

Scotland Act 1998 (Modification of Schedule 5) Order 2013

Lord Kakkar Excerpts

Wednesday 16th January 2013 Lords Chamber

[Lord Wallace of Tankerness]

My Lords, the key thing is that the Electoral Commission makes that judgment. I have heard the points made—with considerable conviction—by the noble Lord, Lord Foulkes, and others, but at the end of the day it is for the Electoral Commission to make that assessment. What it thinks about it, having done the testing on it, is far more important than what Ministers in the United Kingdom Government think.

Until relatively recently, I was the spokesperson for the Wales Office in your Lordships’ House and therefore during the referendum on the extension of powers for the Welsh Assembly. I could see at pretty close quarters the work done by the Electoral Commission in framing the question for that referendum—the noble Lord, Lord Wigley, will recall it. I was very impressed—not least because it faced the additional issue of the question being in Welsh as well as in English—by the thoroughness with which the Electoral Commission dealt with that. I was also impressed by the way in which my right honourable friend the then Secretary of State for Wales responded to the terms of the Electoral Commission’s report.

[Lord Kakkar]

Was it not the case both that the Electoral Commission looked at the specific question for that referendum and that legislation was brought before this Parliament? Therefore, this Parliament also had the opportunity to look at the question. The question for the referendum in Scotland will not be brought before this Parliament and we will not have an opportunity to look at it. Is it not still the responsibility of this Parliament to take care and to discharge its obligations to the citizens of the entire union?

[Lord Wallace of Tankerness]

The noble Lord is right about the Welsh referendum: the question was brought before this Parliament and was determined by it. However, as I sought to explain to my noble friends Lord Forsyth and Lord Cormack, this order seeks to put the Scottish Parliament in exactly the same position as this Parliament would be vis-à-vis a question for a United Kingdom referendum or a referendum that came under the responsibility of this Parliament. We want to put the Scottish Parliament in that position for the referendum on independence. If we are going to devolve power to do that, it is important that that is on the same basis as if this Parliament were responsible for the referendum. If this order is approved, it is up to the Scottish Parliament to make that judgment, and political consequences will flow from it if it is felt that the wrong judgment is made. We look forward with confidence to the Electoral Commission testing the question thoroughly—as it is indeed currently doing—and to make a report, and we will all be well aware of what the content of that report is. Perhaps I might make progress after I have answered the noble Lord, Lord Williamson.