Professional Qualifications Bill [HL]

Baroness Randerson Excerpts

Committee stage
Wednesday 9th June 2021 Lords Chamber

[Baroness Garden of Frognal (LD)]

My Lords, I wondered if I had drawn the short straw for this set of amendments. It always feels slightly lonely when yours is the only name on an amendment, but I assure noble Lords that I have the support of all my Lib Dem colleagues. I beg to move Amendment 4 and speak to Amendments 5, 7, 8 and 33—there may be more to come later; I hope that this is not a spoiler alert—to remove “substantially” from the relevant clauses. It appears so often that it is obviously a favourite word of the Bill drafters, but it expresses a qualification, uncertainty and lack of conviction which we wish to challenge, and it surely threatens to undermine the authority of the regulators. If I were having an operation, or water were flooding through my roof, I am not sure that I would be reassured to know that the surgeon or the plumber had substantially the same knowledge and skills as those required by a UK surgeon or plumber, or substantially corresponded to the practice of a profession. Surely in legislation we need to be more assured. If we are genuinely looking at a level playing field between UK and overseas professionals, let us have the courage of our convictions and assure our citizens that they are in safe hands because the regulators have done their professional job and checked that qualifications and experience match across the countries, not just substantially but in their entirety.

[Baroness Randerson (LD)]

My Lords, I support these amendments. As my noble friend has excellently explained, we are probing the use of “substantially” and highlighting what we see as its inadequacy. The Minister’s own amendments start to tackle this problem. Both the British Dental Association and the British Medical Association have concerns that the proposals focus too heavily on simple qualifications and do not adequately recognise the importance of skills and experience, as well as the vital requirement to be of good character and to put patient safety first. This is fundamental in healthcare and being of good character is of course important in teaching-related professions.

The noble Baroness, Lady Finlay, earlier outlined the concerns of the Health and Care Professions Council. The Minister may argue that the BMA, the BDA and so on are not regulators, but they represent their profession. They have a stake in the respect in which that profession is held, and they pay substantial annual fees for the recognition of their qualifications. The impact assessment makes it clear that the proposals in the Bill will be likely to increase those fees.

In some measure, the amendment encapsulates the fundamental problem with the Bill. It tries to impose a simplistic solution on an endlessly complex and dynamic situation. The Government have grossly underestimated how long it will take to replace the current structure with an adequate and comprehensive alternative. The interim recognition of qualifications is swept away on enactment of the Bill, on the grounds that it gives preference to EEA and Swiss nationals before a replacement is necessarily ready. What will it be replaced with? Another set of recognition for qualifications from countries which will then be given preference as a result of international trade arrangements.

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[The Deputy Chairman of Committees (Lord McNicol of West Kilbride) (Lab)]

Just for clarification, if a Member wishes to speak after the Minister and is in the Chamber, they can message the clerk; if they are online, they can email the clerk. But all requests must come through the clerk to the Chair. I call the noble Baroness, Lady Randerson.

[Baroness Randerson (LD)]

My Lords, I wish to speak specifically to Amendments 42, 49 and 57, which I have co-signed. They all address issues related to the interaction of UK Government powers with those of the devolved Administrations and each of the three relates to different aspects of that issue.

Amendment 42 relates to the national assistance centre. The impact assessment makes it clear that this will be a centralised facility under the control of the Secretary of State, but it will also provide information and assistance in relation to devolved regulators and where the professional qualifications are different in the devolved nations. In preparation for this debate, I went online and explored the websites of a range of regulators. They all seem to provide comprehensive advice and information services, so I am puzzled as to what the problem is. Why is it necessary for the Government to overlay the well-established structure of regulators with this additional bureaucracy with—of course—its accompanying additional cost?

Because I am of a suspicious nature, I feel that the real purpose of the assistance centre is to enable to the UK Government to override the differences between the nations of the UK and, when making trade agreements, to take the opportunity to iron out those annoying differences in qualifications in one part of the UK and another. Hence my amendment, which simply requires consultation with the devolved Administrations on the function and operation of the assistance centre before it is established.

It should not be necessary to state this basic constitutional principle in terms of an amendment to a Bill, but the Government’s approach to this Bill has been woeful so far. It has been developed at speed—the noble Baroness, Lady Hayter, suggested it was on the back of an envelope—at a time when elections meant that there have been none of the usual opportunities to consult the devolved Administrations. In Wales, officials did not even see a draft of the Bill until the week before its introduction. They did not see the final version until we all saw it, when it was laid.

As drafted, this Bill confers a suite of regulation-making powers on the appropriate national authority. In Wales, the Welsh Ministers are that authority for the devolved areas, but the powers conferred on them are exercisable concurrently with the Secretary of State and the Lord Chancellor—hence the Secretary of State and Lord Chancellor could legislate in devolved areas and would not need to obtain Welsh Ministers’ consent.

As things stand, all the devolved Administrations appear to be opposed to this Bill in its current form. In Amendment 42, I offer just a modest solution to a very small part of the problem that the Government face. I would be grateful if the Minister could explain exactly how he sees the assistance centre working, how large it will be, what it will actually do and the estimated cost.

Amendment 49 relates to the interaction of this Bill with common frameworks, an issue that was raised by the noble Baroness, Lady McIntosh. Several noble Lords can boast that they have the T-shirt in relation to common frameworks and their interaction with government attempts to regain devolved powers. We fought several rounds with the Government on this issue during the passage of the internal market Bill. It is not at all clear how this Professional Qualifications Bill interacts with the well-established common frameworks programme.

There is a recognition of professional qualifications framework in preparation by BEIS, but it seems to have been delayed and there has been no explanation for that delay. Is this Bill designed to replace that common framework? If so, the Government need to tell the devolved Administrations, because they would much rather go ahead on the basis of a framework that involves non-legislative co-operation and a lot of working by consensus. This amendment is designed to ensure that the common framework on professional qualifications is not undermined or overtaken by any provisions in this Bill.

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[The Deputy Chairman of Committees (Baroness Fookes) (Con)]

My Lords, I have received requests to speak after the Minister from the noble Baroness, Lady Randerson, and the noble Lords, Lord Foulkes of Cumnock and Lord Purvis of Tweed. We will start with the noble Baroness.

[Baroness Randerson (LD)]

I thank the Minister for his response to several of the issues that I have raised. I welcome his assurances on the common framework on this issue and I look forward, along with colleagues across the Committee, to scrutinising it in due course. I also welcome the information that he has provided on the assistance centre. That is helpful, but it would have been even more helpful if it had been included in the impact assessment so that we would not have had to waste time today seeking that information.

Finally, I want to make an important point. To me, it sounds as if the Minister has been really surprised by this Bill and therefore it should not be unexpected that the devolved Administrations have been surprised by it too. Since the vast majority of the Bill touches on devolved powers, why were not the officials of the devolved Administrations, if not the Ministers, involved at an earlier stage in the development of this policy? That would have improved trust if that had happened. Perhaps I may urge the Minister to make up for lost time by having some fairly intensive discussions with the devolved Administrations over the coming days.

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[Baroness Randerson (LD)]

My Lords, I am very pleased to have the opportunity to speak on this group of amendments, and to reflect on the comments of the noble Lord, Lord Patel. He has reminded us of the complexity and sensitivity of these issues, with his example of medical practice in America. It is a country— the richest in the world— with the very highest medical standards, but it does not have the guarantees of high standards, perhaps, that we rightly want to take for granted in this country. I think he has pinpointed an important sensitivity on this issue.

I welcome these amendments, especially the emphasis on consultation, since I am very worried about the lack of awareness of this Bill beyond this Chamber. I think it is right to say that some of us in this Chamber have woken up only gradually to the huge complexity of the Bill. The Minister himself expressed some surprise at it, and the more that can be done to raise awareness among regulators and among the professions affected the better.

I have one very specific comment: I was struck, on reading the impact assessment, on how narrow the Government’s consultations with regulators were prior to the laying of this Bill. Out of 150 professions and 60 regulators, only a dozen were involved in some of the consultation. They were asked questions about the costs and, in one case, there were replies from only three of them. The costings we have been given on an expensive new policy are based, in some aspects, on replies from three regulators, and they could hardly be regarded as a representative cross-section. There is a real worry for us about a lack of understanding of the complexity of the Government’s policy.

[Lord Grimstone of Boscobel (Con)]

My Lords, I thank the noble Baroness, Lady Hayter of Kentish Town, for her amendments and I note that the noble Lords, Lord Patel and Lord Hunt of Kings Heath, and the noble and learned Lord, Lord Hope of Craighead, are supporting them. These amendments introduce a duty to publish, in draft form, any proposed regulations where they relate to the professions listed, and to consult on these regulations before they can be made under Clauses 1 and 3—the powers to provide for individuals to be treated as having UK qualifications and the implementation of international agreements respectively. I have spoken at some length about the commitment to engagement on both clauses but let me provide some further reassurance specific to these amendments.

First, and perhaps most importantly, the Government, through this Bill, will not and cannot bring forward regulations that affect the autonomy of regulators or the standards that they set. With the greatest of respect to noble Lords, I sometimes feel that they think there is more to this Bill than meets the eye. There is not. This is a Bill which, at its heart, is about the mutual recognition of professional qualifications. It is not, and could not be, a Trojan horse for the Government to somehow choose to undermine the autonomy or the standards of regulators. It would be the height of foolishness for any Government, not just mine, to do so. I suggest that a little injection of reality about what this Bill is about should creep into some of our debates, and I say that with the greatest respect to noble Lords.

I turn first to Amendment 15 to Clause 1, which would mean that, if one of the listed professions were deemed to meet the demand condition in Clause 2, and regulations under Clause 1 were justified, there would be a three-month period of consultation with their regulators before regulations relating to those professions could be made.

I recognise that the professions and regulators specified by the noble Baroness are primarily those supporting our important public services. It is of course essential that any regulations made under the Bill support the delivery of public services and complement regulators’ existing practices. However, there seems little merit in listing, in primary legislation, a set of priority professions —my noble friend Lady Noakes put this very succinctly —which would be subject to change as demand changed. To do so could unduly restrict the ability of the Government, or the other national authorities, to respond quickly and efficiently to the needs of the professions on the list when they were deemed to have unmet demand.

Moreover, let us remind ourselves of what Clause 1 does. It requires regulators to have a route to consider applications from these people. It does not tell them that they have to accept these people or that there has to be a diminution of standards in relation to them; it requires regulators to have a route to consider them. This in no way undermines the carefully constructed architecture that our regulators have put in place to protect patients, consumers and other users of regulated services. Decisions under the Bill will be informed by careful engagement with professions and their regulators, and not introduced without warning. I agree that regulators will need to be involved from the outset, and have time to prepare for changes.

Amendment 27, which relates to Clause 3, seeks to make a similar requirement to publish and consult on draft regulations, with the same regulators and professions, in relation to implementing parts of international agreements on the recognition of professional qualifications. As I have explained previously—and will no doubt have to continue to do—a key concern for the Government in all negotiations is ensuring that the autonomy of regulators within these trade agreements protects UK standards. That applies to all regulators and professional bodies which may be within the scope of an international agreement, not just the ones specified in this amendment.

Through the Department for International Trade the Government engage with a range of stakeholders, including regulators, to understand their priorities and inform the UK’s approach to trade with future trade agreement partners. We have several forums to inform these negotiations, including the trade advisory groups, which hold strategic discussions to help shape our future trade policy and secure opportunities in every corner of the UK. We also hold many ad hoc consultations with interested parties. BEIS also organises regulator forums that provide updates on the negotiations and the terms of trade deals.

In addition, to consult before making regulations at the point at which the international agreement being implemented has already concluded would, frankly, be too late to meaningfully impact the substance of the agreement. That is why in May this year we launched a public call for input as we prepared for trade negotiations with India, Canada and Mexico. I encourage all those with an interest, and of course that includes all regulators and professions, to respond. Why would we not want to know what people think before we embark on the negotiations? To think that we should consult them after the agreement has been effectively finalised, when it is being prepared for parliamentary scrutiny, seems, with great respect, to be shutting the stable door after the horse has bolted.

On Clause 3, it is important for the UK Government to be able to meet our international obligations on professional qualifications, to support UK professionals and trade in professional services, and to do so in a timely fashion. I know that on a later group of amendments we will come back to further examination of this clause.

I trust that this gives reassurance to noble Lords on the engagement of professions, including the professions cited in the amendments but of course all others, before any changes are enacted through regulations through Clauses 1 and 3. I ask that the amendment be withdrawn.

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[Baroness Finlay of Llandaff (CB)]

My Lords, this is a very interesting group of amendments because, as far as I can see, it is about addressing the domestic skills shortage. I do not think anyone should be under any illusion about the extent to which there now is a skills shortage. I am going to address this purely across health and social care, which is the area that I know about. I am not going to touch on law and so on.

There is a skills shortage now, particularly among clinical scientists. These are not qualified doctors; they are scientists who are now working in the clinical arena, often carrying a great deal of clinical responsibility. As medicine progresses, and as clinical sciences progress, there will be more of these people coming forward who have very narrow but highly specialised skills. I have already mentioned the physician assistants and anaesthesia assistants. Anaesthesia—and I say this having trained for a time in anaesthetics myself—is not a straightforward discipline. Things can go wrong very rapidly, and the responsibility carried by somebody with this skill set is enormous, because somebody’s life depends on it. They need to know what they are doing all the time. Currently, this group of assistants are not registered. I use that as an example because there will be others, including people working in fields such as cardiology and radiology—in all kinds of interventional areas. Then there are those working in the diagnostic fields who are clinical scientists. If they get something wrong, the diagnostic label attached to a patient will be wrong, the treatment will be wrong, and that patient’s life may be not only damaged but lost. If that original diagnostic test is not properly conducted, the mistake is repeated all down the line. I have a major concern, therefore, about the domestic shortage of clinical scientists. We used to have a good supply of people who wanted to come here from Europe. Now, those from Europe have been returning to Europe, but people from Europe no longer want to apply to come to the UK. That is aggravating the existing gaps in the service.

I have added my name to Amendments 20 and 21, and I fully support the requirement for others to be consulted. In all these fields, there is increasing interdisciplinary working. Although the registration of doctors is held separately to that of nurses, midwives, physios and so on, they must in fact work as a team and there must be cross-fertilisation of skills and competencies. We need to invest in UK training to upskill our own professionals—hence Amendment 21. Amendment 21 may lead the way to credentialling, which has been suggested as a way forward across the different healthcare disciplines, whereby people develop highly specialised skills and are credentialled in one particular area, rather than having to go back to their baseline qualification to apply for a post. I also wonder whether the Bill itself has been drafted as it has to push forward credentialling. I would be grateful if the Minister was able to clarify whether that has been behind some of the drafting, particularly in Clause 2.

Amendment 26 stresses the autonomy of the regulator. I would have thought, from the comments we have heard about the Government’s respect for the autonomy of the regulator, that they would wish to accept that amendment, although I do not have my name on it—it is in the name of other noble Lords.

On Amendment 28, again I would hope that the reciprocal arrangements between regulators would be in the Bill itself, to ensure that there is cross-disciplinary working and an interchange of standards. It would be a real mistake to have standards for a certain procedure, or way of doing things, that vary depending on the background—the initial qualification, possibly decades old—of that professional. That would mean that, if they came up through a nursing background they would somehow be expected to operate at a lower standard when they are, as a sole operator, doing a diagnostic procedure such as a gastrostomy, and that the skills and competencies required of them to do that procedure would be different from those required of someone with a medical degree. They should not be: there should be one standard for the procedure—for the patient—and, if it is complicated, it may well be that it gets handed on to the person with the medical degree.

This is, therefore, a very important set of amendments, and I am most interested to hear the Government’s response to them.

[Baroness Randerson (LD)]

My Lords, the Minister emphasised that the UK wanted to retain mutual recognition of EEA qualifications, and my noble friend Lord Purvis disputed some of that. Whatever led us to the current situation, shortages are a real problem. As the noble Baroness, Lady Finlay, just mentioned, the impact of the lack of recognition is very serious in some professions.

I shall give noble Lords an example: there are around 22,000 EEA-qualified doctors licensed to practise in the UK, although a significant number of them will have returned home, or at least left the UK, in recent months and years. Nurses, in particular, have gone home in large numbers. In contrast to those 22,000 doctors, only about 2,000 UK doctors are licensed to practise in the EEA, so the impact of that decision not to have mutual recognition falls much more heavily on the UK than on the EEA. We are one country with an impact of 22,000, versus 28 countries with an impact of only 2,000 UK-trained doctors.

However, I am pleased to have the opportunity as a result of these amendments to emphasise that the Government have to get a grip on workforce planning generally. There are amendments in this group that refer to the importance of working far beyond reliance on foreign-trained doctors and professionals generally. The Government have to fund an expansion of university and medical school places and increase the number of places on training courses in a wide range of professions where there are shortages.

Judging by statements in the impact assessment, the Government’s purposes seem to waiver. They seem not to have made up their mind about whether regulators can continue to operate independently and autonomously or should be part of a co-operative effort to address skills shortages. This will partly be addressed by international trade agreements. This group of amendments incorporates some ideas that offer the opportunity for greater clarity. Amendment 20, which I support, ensures consultation with regulators, so that it is not the job of the Government alone to decide whether there is a shortage.

One example is from the information that I received in preparation for these debates. The British Dental Association makes the point that in healthcare professions, patient protection must remain the overarching aim. It points out that the current barriers to work in the UK for overseas-qualified dentists include the need, once they are registered, to undertake up to one year of additional training in dental practices. I know this, in part, from my experience of regularly going to the trainee doing one year’s practice at my local dental practice. These opportunities are apparently very rare and difficult to obtain because they involve costs to the practice hosting the training dentist and costs to the new dentists themselves, so any supposed shortage of new dentists in this country would not be resolved by the simple measure of encouraging more registrants. That is the point of the BDA’s comments.