Health and Social Care (Safety and Quality) Bill

Debate between Dan Poulter and William Cash

Friday 9th January 2015 Commons Chamber

[Dr Poulter]

I am grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling the new clause. We all agree that it is vital that doctors can speak and communicate effectively in English. My hon. Friends the Members for North East Somerset (Jacob Rees-Mogg) and for Shipley (Philip Davies) made a number of important points.

I hope I can bring some reassurance to hon. Members that there are already in place, thanks to changes introduced by this Government, a number of strong tests for language competency and the ability to communicate. It is not good enough for a medical professional to be able to speak English; it is important in all aspects of health care that we can communicate effectively with our patients. The ability not just of doctors from overseas when they work in and contribute to the NHS, but of doctors who have been working here for many years to communicate effectively is at the heart of good medicine. There are a number of steps that this Government have taken to strengthen the tests in place.

To echo the comments of the shadow Minister, I have worked alongside many doctors and many health care professionals from all over the world who have come here to contribute to our NHS and to the care of patients. Many of those doctors have been outstanding and continue to look after patients today as we debate the new clause. One of the strengths of our diverse NHS is that because we have a world-class health service, doctors want to come here and contribute as part of their careers, often for a short period, before they return to New Zealand, Australia or the many other countries from which they have come. The diversity of our NHS and the fact that we attract doctors—often the very best doctors—from all over the world is a great strength, but it is vital that all doctors can both speak English and communicate effectively in English. That is not controversial, and it is what good patient care is all about.

Clause 5 and the schedule will introduce a consistent overarching objective for the Professional Standards Authority and professional regulators—the General Dental Council, the General Optical Council, the General Osteopathic Council, the General Chiropractic Council, the Nursing and Midwifery Council, the Health and Care Professions Council and the General Pharmaceutical Council—to ensure that public protection is at the heart of what they do.

The clause introduces the term “well-being” into the objectives of a number of these regulators. This has been a long-standing and established feature of the legislation for the General Pharmaceutical Council, the Health and Care Professions Council and the Nursing and Midwifery Council. The term encompasses those aspects of a health care professional’s role that may have an impact on individuals but may not directly impact on their health or safety: dignity, compassion and respect are all vital aspects of delivering high-quality care. This was highlighted most starkly in the Francis inquiry report of February 2013, which put into focus the terrible and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust, which was the basis on which my hon. Friend the Member for Stafford (Jeremy Lefroy) introduced the Bill.

One specific area where real changes in the protection of patients are being made relates to the strengthening of arrangements to ensure that all health care workers have sufficient knowledge of English and the ability to communicate effectively with patients in English before being allowed to work in the UK. The General Medical Council has always been able to check the language skills of doctors from outside the European Union who want to practise medicine in the UK. It does this through the international English language testing system, which covers all four language skills—listening, reading, writing and speaking—and it is widely accepted by employers, the other health care regulators and professional bodies as a means of assessing proficiency in English in a professional environment. The GMC continually assesses the effectiveness of this test to ensure its robustness.

In addition to this test of their language skills, the GMC conducts a professional and linguistic assessments board exam—often called the PLAB exam—for doctors from outside Europe. This tests their reactions to a number of clinical scenarios and their ability to apply their clinical knowledge to the treatment of patients and is the main route by which international medical graduates demonstrate that they have the necessary skills and knowledge to practise medicine in the UK.

However, following the death of a patient, David Gray, and the tragic circumstances surrounding that death in 2008 after he received medical treatment by Dr Ubani, a German national, where language skills were a strong component in the incident, a House of Commons Health Committee report recommended that the Government change the law to allow the GMC to extend language tests to doctors within the European economic area, providing consistency in how doctors from both within and outside the EEA are treated with regard to assessing their language skills, before being allowed to practise medicine in the UK.

The Government made a commitment in the 2010 coalition agreement, which the shadow Minister has mentioned, to stop foreign health care professionals working in the NHS unless they have passed robust language tests. We have fulfilled that commitment in respect of doctors, and we are now putting in place additional measures, through section 60 orders, to introduce language testing for other health care workers.

[Sir William Cash]

Is the Minister satisfied that the measure complies with European law and that we do not need a notwithstanding arrangement? He may hope that it will not fall foul of the European Court of Justice, but has he taken advice on that? If not, will he do so after we have finished our proceedings?

[Dr Poulter]

I hope I can reassure my hon. Friend on that. I am absolutely sure that our measures are consistent with European law and I took advice consistently on that, although there was a difference of opinion in how the previous Government and this Government interpreted advice. I work very closely with the General Medical Council, which receives its own independent advice, and I worked with its former chair, Sir Peter Rubin, who has been a tireless campaigner for the measure. Together with the GMC, we introduced measures that are consistent with European law and mean that we are able to test the language competency of EU doctors. I am sure that there is consistency: a similar process is in place in Bavaria in Germany. Although there can be free movement of qualified health care professionals to different member states—their skills can benefit our NHS—it is also important that they can perform a doctor’s functions properly, and it is not possible for them to do that if they cannot speak English and communicate effectively with patients. Our measures are consistent with the advice I have received and, indeed, with the views of the GMC. This is the right thing to do and I am pleased that the coalition Government have put in place language tests.

Last April, I led through this House changes to the Medical Act 1983 to strengthen the arrangements to ensure that all doctors, including those from within the European economic area, must have sufficient knowledge of English before being able to work and look after patients in the UK.

I hope my hon. Friend will agree that patients are much better protected by the new powers the Government have given to the GMC. When the GMC implemented language checks for European doctors in June 2014, it also raised the pass mark for its language tests. The GMC has vigorously used the powers given to it by the Government. Since the Government changed the legislation last April to strengthen the language test arrangements, 128 EEA doctors have been refused a licence to practise medicine in the UK owing to inadequate language skills. That shows that the measure is working to protect patients in the UK from EU doctors who cannot speak English effectively. It is having an effect—it is biting—and making sure that patients are being properly protected. I will write to hon. Members to outline the measure further, and I will perhaps ask the GMC to contribute to that letter. The measure was long overdue and I am proud that we introduced it. It is protecting patients in the UK from doctors who cannot communicate effectively.

As part of a belt-and-braces approach to ensure that all doctors looking after patients can speak a good standard of English and communicate effectively with them, in 2013 responsible officers in England—senior doctors in health care organisations who oversee the employment of other doctors—were given additional statutory responsibility for ensuring that doctors

“have sufficient knowledge of English language necessary for the work to be performed in a safe and competent manner”.

In addition, on medical revalidation, which was raised by my hon. Friend the Member for Shipley, the Government have taken the important step of ensuring that all doctors must show evidence of competency on a maximum of a five-yearly basis in order to maintain their medical licence. That has improved checks on all aspects of a doctor’s work, including how well they work as part of a multidisciplinary team, how well they communicate with their patients and whether they are keeping up to date with medical practice.

--- Later in debate ---

[Dr Poulter]

The revalidation process is ongoing and is reviewing everybody on the medical register. It is very easy to revalidate someone who is training to be a specialist as a surgeon or in some other hospital position, because they are assessed annually as part of their specialist training. The revalidation process for the consultant and general practice work force—which kicked off as a five-year programme—is ongoing. Some people have volunteered to come off the medical register, including retired doctors who have not practised for some time. I would be happy to write to my hon. Friend to update him on the revalidation process. It will not be completed for another couple of years, but once we have gone through the first cycle of revalidation the process will be easily repeated. I stress that doctors will be revalidated on a maximum of a five-yearly basis. It is possible for the GMC to seek reassurance with regard to certain specialties by requesting more regular competency tests as part of the annual appraisals.

The revalidation process is an important new power that is being implemented effectively. We need to keep it under review because it is important that all doctors, regardless of the proposed new clause on language testing, are competent, keep up to date with medical practice, able to communicate effectively and empathetically with their patients, and work as part of a multidisciplinary team for the benefit of patients. That applies to general practitioners, hospital specialists and those working in mental and physical health. It is an important step for which the GMC has been asking for many years and in which other health care professions are taking an interest. The Nursing and Midwifery Council is considering revalidating nurses in a similar way in future. It is a welcome measure that will help protect patients and the public. It is making good progress and I will write to my hon. Friend with further details in due course.

Medical revalidation is the process by which the GMC evaluates whether doctors can keep their licence to practise in the UK. In addition, a doctor wanting to work in general practice in the UK must also be on the national medical performers list, which is managed by NHS England. To be included on the list, the doctor must hold a licence to practise from the GMC and, as a consequence of the revalidation programme, he or she must have effective communication skills.

As I outlined earlier, the key step to improving checks on language competency for EEA doctors was the Medical Act 1983 (Amendment) (Knowledge of English) Order 2014, which made changes to the Medical Act 1983. My hon. Friend the Member for Shipley will be pleased to hear that the title of the order refers to English. After all, the General Medical Council regulates doctors on their ability to speak primarily that language, and I hope that that reassures him.

The order gave the General Medical Council the power to refuse a licence to practise to a medical practitioner from within the EU who is unable to demonstrate the necessary knowledge of English. It created a new fitness to practise category of impairment relating to language competence to strengthen the General Medical Council’s ability to take fitness to practise action where concerns are identified.

For example, if I, as a doctor, worked with a doctor about whose language competency I had concerns, or if a doctor was not able to communicate effectively in their day-to-day work, I, fellow health care workers and patients could report the doctor to the GMC, which—in addition to the existing initial point-of-entry language testing powers and the revalidation process—now has new powers to take action specifically in relation to such language concerns. That is another important measure that the Government have introduced to strengthen the GMC’s powers on language testing.

The change enables the GMC to require evidence of English language capability as part of the licensing process in cases where language concerns are identified during registration. Just as doctors from outside the European economic area can be tested on their language competency, the same competency tests now apply to doctors coming to work in the UK from within the European economic area, thanks to the new regulations. We hope that the wrongs identified following the dreadful Daniel Ubani case and the tragic death of David Gray have now been righted through very strong legislation to ensure the competency and ability to communicate in English of all doctors coming to work in the United Kingdom. As I have outlined, additional measures are now in place to enable the GMC to take action if concerns are raised during the ongoing medical practice of any doctor about their ability to speak English and to communicate effectively with their patients.

The process for determining whether a person has the necessary knowledge of English is set out in the General Medical Council (Licence to Practise and Revalidation) Regulations Order of Council 2012. The GMC has published guidance setting out the evidence required to demonstrate that a person has the necessary knowledge of English. With regard to the fitness to practise changes that have been introduced, a new category of impairment relating to English language capability has been created, which allows the General Medical Council to request that a doctor about whom concerns have been raised undertakes an assessment of their knowledge of English during a fitness to practise investigation.

The changes have hugely strengthened the General Medical Council’s ability to take fitness to practise action where concerns about language competence are identified in relation to doctors already practising in the UK. We are in the process of bringing in similar powers for the Nursing and Midwifery Council, the Pharmaceutical Society of Northern Ireland, the General Pharmaceutical Council and the General Dental Council to ensure that the health care professionals they regulate—nurses, midwives, pharmacists, pharmacy technicians, dentists and dental care professionals—will also have appropriate language skills for the roles that they perform. The consultation on our proposed legislative changes for those four regulators closed on 15 December, and we will publish the outcome shortly with a view to immediate legislation.

I want to pick up the good point made by my hon. Friend the Member for North East Somerset about the need for primary legislation. I hope that he is reassured that the existing legislation, and the ability to bring in regulations underpinning that through section 60 orders underpinning the Medical Act 1983 and other Acts, provides the ability to bring in strong regulations to protect patients and the public in respect of language competency. The Government have done exactly that. There will be future opportunities to legislate in the form of a Law Commission Bill, which would make it possible to neaten up the already very robust and strong regulation on language testing that we have introduced. I am sure that we will consider doing so at the first opportunity.

I hope that such measures will reassure my hon. Friend the Member for Stone. Thanks to this Government, strong laws have been passed, and very strict new rules are now in place to ensure that doctors practising medicine in the UK can do so only if they can communicate with patients using a high standard of written and spoken English. With that reassurance, I hope that he will withdraw his new clause.

[Sir William Cash]

I have listened to the Minister with great care and interest on the question of language skills. Despite his comprehensive description of the measures brought in, I feel that one or two areas might yet be usefully considered in the other place. I would be extremely glad if somebody raised them, just to test those measures further. This is the first time that we have heard such an excellent and comprehensive analysis on the Floor of the House in relation to a Bill of such importance. We are talking about situations in which there should be zero harm, so we do not want any doubts on the question of English language skills. In practice, I am prepared to withdraw the new clause, with the proviso that the matter should be looked at again in the other place at a future date. I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

Third Reading

Mid Staffordshire NHS Foundation Trust

Debate between Dan Poulter and William Cash

Tuesday 7th January 2014 Westminster Hall

[Dr Poulter]

I will of course respond to those that I can, but as the hon. Lady will be aware and as I will set out later, the TSAs’ report is currently with Monitor—I would expect it to be recommended to the Secretary of State by the end of this month—so it would be inappropriate for me to comment on it at this stage. I hope she understands that it would be wrong for me to make assumptions about a report that has not yet been submitted to the Secretary of State.

[Mr Cash]

Will the Minister give way briefly on that point?

[Dr Poulter]

I will, but I am conscious of the time.

[Mr Cash]

I have asked nearly 10 times for a report to be debated on the Floor of the House in Government time, but it has not happened yet. Nobody can understand why it has not happened yet. Can we please have an assurance that a debate will take place and within a matter of weeks?

[Dr Poulter]

My hon. Friend makes an important point. The Secretary of State has previously given that assurance, and I give my hon. Friend that assurance again today. It is obviously for the Leader of the House to organise Government time, but I will have conversations with and write to him following this debate to ask him to expedite the issue.

Returning to the report, the TSAs have also highlighted the serious clinical implications of failing to act. They predict that services operating below the recommended consultant level, such as A and E, would need to be reduced. Low-volume services would risk being closed altogether, forcing patients to travel further for treatment. Throughout the process, the TSAs have stressed the fragility of the trust and emphasised the huge importance of agreeing to and implementing the changes required as soon as possible.

I will now move on to the next steps, about which all hon. Members are concerned. I know that it is frustrating for hon. Members wanting answers that I cannot provide them all today. The report is currently with Monitor, so it is for Monitor to make recommendations to the Secretary of State on the basis of that report. That will be the appropriate time for the Secretary of State and Ministers to comment. That may be frustrating for hon. Members, but that is the way that things need to be. We cannot comment on the matter until Monitor has made its recommendations. If Monitor is satisfied with the TSAs’ final proposals, the Secretary of State will have a maximum of 30 working days to consider them against a set of requirements defined in legislation. These aim to secure services for patients that are of a sufficient level of safety and quality and that offer good value for money. The Secretary of State will consider each requirement carefully before coming to his final decision.

As I have said, it would be inappropriate for me to pass further comment today on the TSAs’ final report because its final version has not yet been submitted. It is clear from the debate, however, that there is widespread interest from around the region and from local Members who are concerned about the wider impacts of the report on the health care economy and on services for other local patients. I am confident, however, given the interest from Members and the support provided to the trust from other health care trusts and hospitals in the area, that we will come to the right conclusion. We all want to see a strong and viable health care service for patients in Stafford and the surrounding areas, and I am confident that that is what we will have delivered once the Secretary of State has considered the report.

health

Debate between Dan Poulter and William Cash

Tuesday 18th September 2012 Commons Chamber

[Dr Poulter]

As my hon. Friend is aware, there is a process for scrutinising all decisions and, as I have outlined, if the correct procedure has not been followed, decisions are open to judicial review. To reassure hon. Members, we have accepted, from a medical perspective, the principle that fewer units deliver better care for patients and better surgical results for children. Therefore, this review is not about closing units in any particular hospital, but about specialist surgical services. Day-to-day care of patients and paediatric care for those who have had surgery will continue locally even after this review, and that should reassure local patients.

[Mr William Cash (Stone) (Con)]

Will the Minister give way?

[Dr Poulter]

I will give way again, but I am mindful of the time.

[Mr Cash]

On that point, and in the light of the way this legislation has been redressed over the past year and half, does the Minister accept that before the legislation was introduced, and now, ultimate responsibility and accountability for all matters affecting the health service turned on the duties, accountability and statutory responsibilities of the Secretary of State? That is why the Minister is now at the Dispatch Box, just as the Secretary of State would be in other circumstances.

[Dr Poulter]

I accept that the Secretary of State has always had responsibility for the health service, and that was implicitly made clear in the Health and Social Care Act 2012. It is, however, important that we no longer have a system in this country that micro-manages the delivery of local health care services. We must listen to local doctors and nurses, and put them in charge of the configuration of local services because they are often the best advocates for the needs of local patients. Reconfiguring local services should be led—as per the four tests I outlined previously—on good clinical grounds where there is a clinical case for reconfiguration and where local communities have been consulted. That is something we should listen to and we must move away from the Whitehall micro-management of local health care delivery.