Recognition of Professional Qualifications (Amendment etc.) (EU Exit) Regulations 2018

Debate between Baroness McIntosh of Pickering and Lord Hunt of Kings Heath

Monday 11th February 2019 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I welcome the regulations but I will ask a number of questions. The first is, obviously, what are the reciprocal arrangements for the rights of British professionals affected by the terms of these regulations in other EEA countries and Switzerland? Is that matter currently ongoing in the Minister’s department and the other relevant departments for those professions to which he has referred?

There is a reference on page 4 of the Explanatory Memorandum to the situation of lawyers. I must declare an interest because I practised in two separate firms in Brussels as an EU lawyer, as I would call it, with the qualification that I had then as a member of the Scottish Bar—I am now a non-practising lawyer. Could the Minister confirm that the Explanatory Memorandum refers on, I think, page 4 to the statutory instrument relating to lawyers that has already been adopted? What is the exact relationship between the SI that we have already adopted and the regulations before us? What is the position overall of European lawyers from EEA countries and Switzerland wishing to practise here and of British lawyers wishing to practise post Brexit in other EEA countries and Switzerland?

The position of teachers has long posed a particular problem in countries such as Germany. In the consultation that I am sure my noble friend and his department will have done, were any issues raised about reciprocal rights for teachers, and have any issues been raised by existing EEA-national or Swiss-national teachers currently practising their profession in this country? I think my noble friend has answered this question, but the Explanatory Memorandum says that such issues will be the duty of others—for example, paragraph 17.9 says that the Department of Health will look at EEA and Swiss doctors, nurses, midwives and dental practitioners who wish to come and work here. If I have understood that correctly, what will the position be regarding the recognition of EEA and Swiss professionals in Northern Ireland, with there currently being no devolved government there? Is that something his department will look at? For example, the Explanatory Memorandum says specifically that farriers in Northern Ireland will not be covered. I would be very grateful if he would help me to understand particularly how farriers will be dealt with in that regard.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I remind the House of my membership of the board of the General Medical Council. I want to follow the noble Baroness by focusing on doctors in discussing this SI. As far as the GMC is concerned, the SI provides welcome legal clarification and certainty on the supporting framework governing how EEA-qualified doctors will enter the UK medical register if the UK leaves the EU on these terms—in other words, under a no-deal Brexit. We hope it will help to manage any potential disruption to the NHS medical workforce in those circumstances.

However, can the Minister confirm—I think he did so by implication in his opening remarks—that the regulations will be of only limited application to the medical profession? They will apply only in so far as they make transitional provisions for applications made or actions taken before exit day and which have not been fully determined by then.

The Minister will be aware that there is continuing anxiety in the health service about the uncertainties caused by the current state of negotiations. Given the reaction of many EU nationals working in the NHS to the climate of opinion in this country, I think we have to be really concerned about future staffing and the workforce pressures that will come around the corner very quickly.

[Lord Fox (LD)]

My Lords, before going into detail, I acknowledge that the General Medical Council, the Law Society, the Institute of Chartered Accountants in England and Wales and the Engineering Council have welcomed these proposals. I suspect this is more in sorrow than anything else, since this is better than the uncertainty that would exist without them.

My understanding of secondary legislation and its role—I fear I am treading into Adonis country here—is that it should be about technical, non-controversial issues. When you consider that the 2005 directive paves the way for free movement, you realise that this is actually quite a controversial instrument. In essence, it is here to make up for the fact that, outside the EU, we can no longer treat the European Union as a most favoured nation under WTO rules and will have to strike out the movement opportunities of EU 27 citizens. I understand that; that is why I tabled Amendment 66 to the Trade Bill. I know the Minister was not the beneficiary of that debate or speech but, for the sake of completeness, I am sure he would like to consult Hansard from about this time last week. He will see that free movement has important benefits and this SI tries to mitigate their removal. For that reason, I would say that this is not non-controversial and it is not, strictly speaking, just a technical piece of legislation. Therefore, we should probably not be using this instrument to discuss it, but here we are again.

I am sure the Minister has had a chance to look through Hansard for the other place; his colleague Richard Harrington, the Under-Secretary of State, piloted the debate through that House. A number of issues came up, which have already been touched on. One of these was about the Internal Market Information System, or IMI, of which we will no longer be members after exit. This is an important registry of skills and the way they relate to each other. It is not clear what we will replace it with—an Excel spreadsheet, perhaps—or who will hold it and be accountable for its veracity. I suspect it will be the Minister’s department, but this is not clear.

Reciprocity was raised by the noble Baroness, Lady McIntosh. The debate in the other place seems to indicate that there is no guarantee of reciprocity or process by which it is being sought or managed. If that is the case—it seemed to be the view of the Under-Secretary of State—why not? What are the Government doing to protect the interests of British citizens?

The Long-term Sustainability of the NHS and Adult Social Care

Debate between Baroness McIntosh of Pickering and Lord Hunt of Kings Heath

Thursday 26th April 2018 Lords Chamber

[Lord Hunt of Kings Heath]

It came from a paper from the Office for Budgetary Responsibility. I believe that it is to be a general rise of around 1% across the board, but I will check that out and place a copy of any letter that I send to the noble Lord in the Library.

The point is this: clearly considerations would need to be given if there were to be a rise in national insurance, such as to its impact on employees and employers. Would it be a tax on jobs? Would it be an increase in taxes on working people, when the main beneficiaries of the NHS are older people who do not pay national insurance? Although national insurance contributions are mostly progressive, they become much less so when you hit the upper earnings limit, where employee contributions decrease from 12% to 2% on incomes over £805 per week. I know some noble Lords believe passionately that this is the way forward, and it is an idea worth exploring, but we have to be realistic about some of the drawbacks.

[Baroness McIntosh of Pickering (Con)]

If 1% were added to national insurance contributions, what would the cost be to the health service, being the largest employer in the land?

[Lord Hunt of Kings Heath]

I do not know the answer to that but clearly it is another point that has to be factored in, as it would in the care sector more generally. We have already seen this: clearly, it is welcome that the living wage has been introduced, but it has had a knock-on impact when the funding for those services has not gone up at the same time.

I also caution about the desire to create a cross-party approach, as the noble Lord, Lord Patel, asked. Last month, Dr Sarah Wollaston, chair of the Health Select Committee, wrote to the Prime Minister asking for a parliamentary commission on health and care to be established to report on the long-term future funding of the NHS. Today, my noble friend Lord Darzi announced his independent review.

All this is welcome. The more we can debate the pressing need to fund health and social care properly, the more likely it is that the public will support a rise in taxes, which is what I believe this debate is essentially about. But the decision cannot be offshored. In the end, you need a Government with the political will to make the investment necessary, put in place a plan to fix staffing and properly support people to manage their own health care and conditions for the long term. Labour did it. We increased the amount of money going into the health service, reduced waiting times dramatically and invested in the infrastructure. It can be done, but it takes a Government with the political will to do it.

Alongside the issue of funding, we surely have to get on with redesigning the current regulatory and structural mess that the Government have got the NHS into. As the Select Committee report said:

“A culture of short termism seems to prevail in the NHS and … social care”,


with the department,

“unable or unwilling to think beyond the next few years”,

so there is no long-term funding plan and no national long-term strategy on workforce planning. The NHS is seemingly incapable of driving up productivity, using data effectively or adopting new technology quickly, as the Select Committee concluded.

The Health and Social Care Act 2012 has much to answer for. Its conflicting threads have led to fragmentation, friction and confusion. The Act is dominated by obeisance to a competitive market, with economic regulation to the fore. It established lighter touch oversight from the Government, with NHS England created as an arms-length organisation, subject only to an annual mandate, and GPs were supposedly put at the heart of decision-making through their dominance of clinical commissioning groups.

What has been the reality? Competition has proved a very expensive foible. It reached its ultimate folly with the competition authorities intervening in a sensible reconfiguration of service proposals at a cost of millions of pounds. Large parts of the competition regime have now been ditched but, as the Act has not been repealed, NHS bodies are endlessly at risk of legal challenge. As for light-touch oversight, the reality is that NHS England behaves in the way of all state bureaucracies: heavy-handed and highly interventionist. As for GPs being in control, so frustrated have CCG leaders become at their impotence and unwanted role as rationers of services that many have gone back to their surgeries or even retired.

Ministers preside over this with glorious ambiguity, consistently washing their hands of the shambles and performance failures that they and their colleagues created. The Secretary of State humiliatingly calls in the bosses of the so-called independent NHS Improvement, NHS England and CQC for a weekly berating and demand that ever more chief executives be sacked.

When the Sainsbury chief, Roy Griffiths, was asked to look into NHS management in 1983, he said that if Florence Nightingale were to come back to inspect NHS hospitals, she would find no one in charge. I wonder, if that great man were asked to come back to do a report, what he would say about the current arrangement. Actually, I think we have a pretty good idea. The noble Lord, Lord Rose, was asked by the Secretary of State in 2014 to recommend how leadership in NHS trusts could be transformed. By the time he finished, I think the Secretary of State regretted asking the question, because in his report he talked about the level and pace of change being unsustainably high, with the administrative, bureaucratic and regulatory burden fast becoming unstoppable. He talked about a lack of stability and a deep-rooted concern over the many and varied messages sent from the centre of government. Indeed, not surprisingly, the report died the death. We continue with a huge system that is under huge pressure, underfunded, under-resourced with people, and yet it is having to cope with one of the most complex, conflicting administrative systems ever seen.

One thing I particularly welcome in the report of the noble Lord, Lord Patel, is that he did not confine himself just to funding. He talked about the culture and some of the other issues that need to be tackled. The report is excellent, and we have an excellent debate ahead of us. I hope that the Government will listen. It is a great pleasure to follow the noble Lord, Lord Patel, who has shown such leadership in chairing the Select Committee and presenting his report so well this morning.