Health and Social Care (Safety and Quality) Bill

Jacob Rees-Mogg Excerpts

Friday 9th January 2015 Commons Chamber

[Sir William Cash]

I beg to move, That the new clause be read a Second time.

It is terribly important to use opportunities of this kind to discuss matters of such importance properly on the Floor of the House. It does not mean that we always have the right answers—sometimes, we do not even have the right questions—but there are some really important issues that need to be given an airing so that people outside can hear the nature of the discussion, rather than having that discussion held by an agency on its own account or, alternatively, by the civil service and then put forward in a Government brief.

Basically, this is a new proposal that deals with doctors’ language skills. There are many people in this country who believe that this is an important issue. It is pretty obvious that ensuring that doctors have appropriate language skills is rather important, especially given what happened in a particular case. I do not remember the names of the individuals concerned, but I seem to recall that the case involved a father who died after being treated by somebody from Germany. It seemed to be pretty likely, if not certain, that the reasons that happened were to do with a lack of proper language skills and proper experience of the medical practices in this country. The doctor was effectively coming here as a locum without appropriate qualifications or sufficient skills to be able to give the kind of treatment that was needed, and the result was a tragedy. Other Members of Parliament may have other such examples.

This is a very important issue. Indeed in April last year, the Medical Act 1983 was amended to strengthen the arrangements to ensure that all doctors have sufficient knowledge of English before being able to work in the UK. My new clause would help to ensure that all doctors were able to communicate effectively with colleagues and patients, which would sufficiently reduce the risk to patient safety caused by a lack of understanding of the English language that could result in the misdiagnosis and mistreatment of conditions. Many people regard that as common sense.

[Jacob Rees-Mogg (North East Somerset) (Con)]

I thank my hon. Friend for giving way. I am sorry to bring him on to familiar ground, but would this new clause be acceptable under European Union law?

[Sir William Cash]

My hon. Friend quite properly puts that question to me as I am Chairman of the European Scrutiny Committee of which he is a member. We always come across these questions of interpretation. The short answer is that in relation to the issue of having appropriate language skills, the parameters for the communication of information between the patient and the person giving the treatment would be described as being within the framework of public health and the importance of ensuring that the people concerned—the patient—had not only adequate treatment but the opportunity to ensure that they were not put in danger. I think that in those circumstances it would pass muster and that we could legislate on our own account. If there were ever a challenge, I would propose that we introduce a further provision reading “notwithstanding the European Communities Act 1972” and then legislate. If we did that, under sections 2 and 3 of the 1972 Act the notwithstanding formula would enable us to bypass the European Court of Justice and ensure that we could legislate on our own account in this House to ensure that language skills were needed in English to ensure that patients in this country were properly safeguarded. I hope that I have dealt with my hon. Friend’s point.

[Jacob Rees-Mogg]

indicated assent.

[Sir William Cash]

I see him nodding and I am glad that I managed to pass that test. I am always grateful to my hon. Friend, who ensures that we all keep up to the mark.

On this occasion, I think we would have the capacity to make the change in the first place, but, if not, perhaps we can take a belt-and-braces approach in the House of Lords and use the notwithstanding formula. We shall see.

[Jeremy Lefroy]

Again, I am most grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling this new clause, which covers an important subject—the language skills of doctors—although of course the language skills of all involved in clinical care are vital.

Clear and understandable communication is essential to safety and the quality of care of patients. Language skills are a necessary condition for good communication, but not a sufficient condition. They must be accompanied by good communication skills, with which not all of us are automatically blessed, however good our language skills. Communication skills teaching is now an essential part of training in medical and nursing schools and it is to the credit of the previous Government that they ensured that it was embedded in the curriculum of new medical schools and was taken forward in existing schools. I welcome the Government’s support for that important approach.

I understand that regulations have been in place for a short while to ensure that all doctors, whether from within or from outside the European Union, have appropriate language skills before being granted a licence to practise. I want to hear from the Minister what the effect of those important regulations has been and whether he believes that new clause 4 is necessary. I would also like him to consider whether the assessment of language skills should include communication skills within that language.

[Jacob Rees-Mogg]

I want to speak in support of my hon. Friend the Member for Stone (Sir William Cash). This is an important new clause on a matter that it would be wise to have clearly set forth in primary legislation.

The heart of the matter is, unfortunately, the European Union and the mutual recognition of qualifications within the EU, and there are good reasons for that. The only way to open up service industries generally is if mutual recognition of qualifications takes place, so if we are to have a single market in services that is an important basis for it. However, above and beyond that there must be a fundamental principle of patient safety, which is embodied in this excellent Bill, and a lack of good language skills and of understanding of a language is a danger in both directions. It is a danger for the doctor who is listening to the patient explain his or her symptoms and it is also a danger when the doctor explains to the patient what steps the patient needs to take for better health. If there is confusion, it can have a seriously deleterious effect on the patient’s health.

We must be clear that this is not about restrictive practice or protecting the market for British doctors but about ensuring that there can never be such confusion. As my hon. Friend the Member for Stone says, if this provision runs into trouble with the European Union, we need to state clearly that it is of such fundamental importance that it must override international treaty obligations. It was Disraeli who said in his speech in the Manchester free trade hall in 1872, “Sanitas sanitatum, omnia sanitas”—that the first duty of Minister is the health of his people. That statement has underlined and guided Conservative policy for nearly a century and a half.

[Sir William Cash]

I recall that Disraeli also said, “The Tory party is a national party or it is nothing.”

[Jacob Rees-Mogg]

Indeed, although I am less clear on the relevance of that, and I was not intending to swap Disraeli quotations all morning. I just wanted to make that point about a fundamental principle that has guided our party since the 1870s and its relevance in defending health through ensuring that there is a proper standard of English-speaking—or in Wales, Welsh-speaking—physicians.

[Sir William Cash]

My hon. Friend used the word “ensuring”. That reminds me that insurance is a very important ingredient in the question of health and language skills—and, as my hon. Friend the Member for Stafford (Jeremy Lefroy) said, communication skills as well. If there were to be a failure of language, the consequence of which was to breach the terms on which an insurance contract was devised as between the patient and the national health service, as well as others involved in the contractual relationship, there would be massive financial consequences that could, in certain cases, run into millions of pounds.

[Jacob Rees-Mogg]

My hon. Friend makes an interesting point. It is possible that that is taken care of by other parts of the Bill. Clause 1 contains the fundamental commitment that unreasonable risks should not be taken, and language could be seen to be part of that. The reason I like the new clause is that it makes it absolutely clear that language is fundamental.

It is very hard to think of a circumstance where a lack of communication could possibly be safe. There may be cases where a patient cannot speak, or absolutely dire emergencies where there is no alternative form of treatment, but in the ordinary course of events language skills must be essential for somebody who looks to work in this country for any length of time.

I hope that the Government will think about this new clause very seriously, and perhaps consider whether a “notwithstanding” aspect is necessary, and that if they do not accept it today, they will look at the matter again in another place.

[Philip Davies (Shipley) (Con)]

I apologise for not being here when my hon. Friend the Member for Stone (Sir William Cash) opened the batting on this new clause.

I very strongly support the sentiment behind the new clause. It should go without saying that people who are practising medicine should be able to communicate properly in English. It is a sad state of affairs when we have got to a point where we feel the need to introduce legislation in this regard. Whatever the rights and wrongs of the matter, sufficient examples have been reported around the country to indicate that we do have a problem. It may not be widespread—it may only occur in pockets—but it is perfectly clear that in some areas there is a problem that needs to be addressed. If the Government do not intend to accept the new clause, I would like to know what they intend to do about this genuine problem that people have identified.

My hon. Friend the Member for Stafford (Jeremy Lefroy) made a reasonable point about the measures that were put in place, partly by the previous Government, relating to new doctors and people who are currently going through training. The problem with that, however, is that it does not deal with the people who are already practising.

--- Later in debate ---

[Jacob Rees-Mogg]

I have just checked the territorial extent of the Bill, and parts of it apply to Wales as well, so we should not forget the need perhaps to be able to communicate in Welsh where appropriate.

[Philip Davies]

My hon. Friend makes a good point. That enhances the complication that could arise as an unintended consequence. I agree wholeheartedly with the sentiment of the new clause and the intention behind it, but I wonder whether its wording may lead to unintended consequences in relation to languages other than English that were not foreseen when it was tabled.

--- Later in debate ---

[Jacob Rees-Mogg]

I follow my hon. Friend the Member for Stone (Sir William Cash) in congratulating my hon. Friend the Member for Stafford (Jeremy Lefroy) on piloting the Bill so safely through the House. It is not necessarily easy to get private Members’ Bills through—and nor should it be—given the Scylla of the Back-Bench Tories who are not keen on new Bills coming through and the Charybdis of the Opposition, who sometimes suck Bills down to the bottom of the sea. I therefore congratulate him warmly on having achieved it.

My hon. Friend has done something that rather surprisingly was not done in the first place. The explanatory notes state that clause 1

“has the effect of removing the Secretary of State’s discretion around whether the requirements for registration with CQC should cover safety of care.”

It is amazing that the Secretary of State had that discretion. Why on earth would anyone want the Secretary of State to be able to think, “It doesn’t really matter if the safety of care is implemented or not. I think on this occasion I won’t bother with it.”? How reassuring it is that somebody has had the sense and wisdom to bring forward a Bill to close that extraordinary loophole, drawing on the experiences that are well known, particularly to the Members of Parliament from Staffordshire.

I take great comfort from what my hon. Friend said about the identifiers not being—to carry on with my Greek mythology—a Trojan horse to bring in an identity card system. It really would have set trouble alight if he had been trying to do that, but it seems perfectly reasonable to have a system that sees efficiently who people are within it and has a consistent form of identifying them. Having a notional go at an identity card system does not seem reasonable, so I am glad that he has stated so clearly that the Bill is not intended to do that. I am sure that their lordships will take careful note of that.

It is a tremendously important Bill that is being passed today, and one that I am sure that the other place will want to expedite because there is little time left between now and the end of the Session. The Bill will ensure that the primary duty of not doing harm to patients is established in law. As I said, it is extraordinary that it was not there before. I commend my hon. Friend for his discovery of that lacuna and his closing thereof.