Draft European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018 Draft European Qualifications (Pharmacists) (Amendment etc.) (EU Exit) Regulations (Northern Ireland) 2018

Justin Madders Excerpts

Tuesday 29th January 2019 General Committees

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Howarth.

I thank the Minister for introducing the regulations. As we have heard, current EU law sets out a reciprocal framework of rules for the recognition of health and social care professionals. That enables EEA and Swiss nationals to have their qualifications recognised, and to gain access to the regulated professions in which they are qualified to work in the UK on a temporary or permanent basis. Of course, in the event of a no-deal Brexit those rules will no longer apply.

As we have heard, the draft regulations on health and social care professions would amend the relevant legislation for the nine health and social care professional regulators in the UK. The other set of regulations would similarly amend the relevant legislation for regulation of pharmacists in Northern Ireland. The aim in both cases is to put in place new regulations for EEA and Swiss-qualified professionals to register to work in the UK in the event of a no-deal Brexit after 29 March.

As that date is fast approaching, the regulations are important. It is right to make arrangements, although it is a matter of regret that we are dealing with them at the last minute. Clearly they must be temporary. We accept the need in principle for some arrangements to be put in place, but we have several questions about their potential impact on the delivery of healthcare.

First, on registered professionals, an estimated 3,200 EEA and Swiss-qualified health and social care professionals join the relevant registers to practise in the UK each year. According to the General Medical Council, doctors from the 31 EEA countries and Switzerland currently make up about 9% of the UK’s medical workforce, rising to around 20% for some specialities, including surgery, with similar figures in other important areas. According to the Royal College of Nursing, the figure for nurses and midwives is between 5% and 6%.

We are therefore talking about a significant chunk of the workforce, in the context of a record number of vacancies, so there is clear potential for workforce disruption if EEA and Swiss nationals cannot register. We must do all we can to minimise the risk associated with that in a no-deal scenario. The NHS workforce is already in a precarious position, with 100,000-plus vacancies and more nurses and midwives leaving the register than joining. There is no doubt that the workforce challenge has been exacerbated since the referendum result, with 3,692 staff from the EEA leaving the Nursing and Midwifery Council register between 2017 and 2018, for example. At the same time, the number of EU nurses and midwives coming to work in the UK has fallen to its lowest level, with just 805 joining the register in 2017-18.

My first question to the Minister is this. Given the huge contribution of EEA and Swiss-qualified professionals to the NHS, which he was generous enough to acknowledge, what assurances can he give that the NHS will begin to stem the huge losses of these important staff that we currently see? Furthermore, future arrangements for EEA and Swiss applicants will be dependent on discussions with the EU. The costs attached to these future arrangements are unknown, but regulators are expected to continue to operate on a full cost recovery basis. The Government assume that any extra cost of assessing applicants with EEA and Swiss qualifications for registration will be recouped via the regulator’s setting and charging fees to recover those costs from the applicants, which has been confirmed by regulators including the General Medical Council.

At the same time, the Government have acknowledged that changes to the procedure for recognising qualifications could make access to health and care professions more difficult, which could affect the availability of professionals. Has the Minister carried out an impact assessment to determine whether additional costs will affect the number of applicants from EEA countries and Switzerland and what affect that will have on the health service?

There is also a potential impact on healthcare, because the draft regulations will remove the right of EEA and Swiss professionals to work in the UK on a temporary or occasional basis. Examples that we have been given include a Dutch-qualified paediatrician working in the UK full time but participating in European-funded international research projects, or a Portuguese-qualified doctor working in Lisbon but undertaking weekend locum work in the UK. In December, when the draft instrument came before the Secondary Legislation Scrutiny Committee in the other place, there were 134 EEA or Swiss professionals providing healthcare services in the UK on that basis. How will the Government ensure that the removal of this right will not have a detrimental effect on the NHS?

The draft regulations will give UK regulators the discretion to designate EEA and Swiss qualifications as not acceptable in the UK after exit, but they do not set out clearly the process for deciding what is or is not a comparable qualification. Two months from our exit, we do not know how healthcare professional regulators will operate their new powers to remove a qualification from automatic acceptance, should they have patient safety concerns; all we know is that the Privy Council will approve such a measure. It is unclear on what grounds a regulator will be able to make such a request and what information will be needed to satisfy the Privy Council. I am aware that at least one regulatory body, the General Medical Council, has been asking the Government for further clarification on that point. Will the Minister provide us and the regulators with guidance on what information will be requested to obtain Privy Council consent to remove a qualification from automatic acceptance where patient safety is a concern? How will he ensure consistency across the board when dealing with such applications and in the mechanism for reporting these issues to Parliament?

The impact on regulators also needs to be considered. The Department has said that there will be no additional administrative or resource burden on regulators. Given that UK regulators will have the additional function of having to assess whether qualifications are comparable, what assurances can the Minister give that UK administrators will have the administrative capacity and resources to deal with those burdens at no extra cost?

It is clear that these regulations are a stopgap to avoid an immediate cliff edge, should the UK exit without a deal. There is no clarity on plans to introduce more sustainable long-term arrangements for registering and licensing EEA and Swiss nationals beyond a review in two years. The Minister did not go into detail in his opening remarks, but it is legitimate to ask how the Government intend to approach the two-year review of the instrument and whether in the long run they will commit to reform of the legislation on professional regulators to allow for the registering of healthcare professionals regardless of where they qualified.

The Minister touched on this briefly, but what is most concerning is that the regulators will lose access to the internal market information system, or IMI, the online tool for sharing information. That will apply whether we leave with or without a deal. The IMI allows details about applicants and their qualifications to be shared and, crucially, provides an alert mechanism, which makes EEA and Swiss regulators aware of professionals with compromised fitness to practise or of restrictions on their practice. I appreciate that it is not in the Minister’s gift to commit to ensure continued access to the IMI, but as the instrument revokes provisions that require UK regulators to access and use the IMI as part of their mutual recognition procedures, it is fair to ask what plans he has to ensure that patient safety is not jeopardised by its removal. This is a very important point. What plans are in place in the short and long term to enable continued sharing of information relating to the fitness to practise of professionals across the EEA and Swiss area?

Finally, as is often the case with Brexit-related debates, we forget that there is movement both ways. The impact on UK professionals wishing to work in the EEA must not be forgotten. After exit day, professional qualifications awarded in the UK will no longer be covered by the directive. The EU has agreed that holders of UK qualifications that have been registered in EEA countries and Switzerland will continue to be registered. However, in the absence of an agreement with the EU, that will be a matter for individual EU member states to determine. Has the Minister had any discussions with his EU counterparts about the impact of no deal on UK professionals wishing to practise in the EU after exit day? Does he know, for example, how many UK professionals would be affected? Has there been any consideration of mutual qualification recognition for emerging roles such as nurse associates?

In conclusion, we do not oppose the regulations or what they seek to achieve. We recognise, as the Minister does, the valuable contribution to the NHS of staff from the EEA and Swiss areas. I hope that these regulations will not result, inadvertently or otherwise, in our deterring or losing more of them than we already have. I would welcome any reassurance from the Minister in response to my concerns.

--- Later in debate ---

[Stephen Hammond]

I would like to reassure hon. Members that, while it is essential to the public’s protection that we put in place this legislation, I recognise that a number of important and significant issues have been raised. I also recognise the potential impact on patients and citizens of the whole of the United Kingdom of not getting this right. There have been a lot of questions, which I shall try to address in some sort of order, perhaps lumping together some of the points put to me.

Initially there was a lot of talk about the impact on the numbers. From the overall number of EU, EEA and Swiss health and care professionals practising in the United Kingdom, the number working in NHS trusts in England increased by over 3,500 in the 12 months following the referendum. That includes an extra 600 doctors. As of June 2017, over 21,000 EEA doctors were registered with a licence to practise with the GMC. The number of joiners from the EEA has remained steady since 2016; therefore, these regulations would allow that to continue. The hon. Members for Ellesmere Port and Neston and for Gedling might like to point out that there has clearly been a decline in registered nurses. That is a significant concern to the Department, and we have looked not only at the number of current vacancies resulting from EU nationals not coming forward but, as importantly, at the need to train, recruit and retain UK nurses, which is why there are a number of routes into nursing.

There are language issues. One reason for the nursing staff shortage in respect of EEA applications is down to the language controls introduced by the NMC, which took full effect in July 2016. Although some people might concentrate on the referendum as the contributory factor, the language testing is also judged to have had an impact. Therefore, since November 2017 the NMC has introduced a number of changes to the language requirements for nurses and midwives trained outside the UK, which has increased the options available to such applicants to demonstrate their language ability. The changes appear to be having a positive effect on international recruitment, with 2,500 more overseas joiners to the register between January and December 2018.

The hon. Member for Gedling asked about a slightly different language issue. I will confirm this in writing, but it is my understanding that we do not intend to change the language tests.

The temporary permissions argument is clearly of concern, and I have tried to address the hon. Gentleman’s questions about that. The numbers currently working under the regime are relatively small; however, that does not mean that they do not have a positive impact. It is right that under a new regulatory system people should seek full registration. However, over the EU exit day period and the period post that, the regime will continue. As temporary and occasional permissions last for up to 18 months, there will be plenty of time for those working under the regime to decide to apply for full registration.

The hon. Member for Ellesmere Port and Neston asked about the impact on UK professionals wishing to practise in the EU after exit day. I said in my opening remarks that it is the UK that is the main beneficiary of mutual recognitions. After exit day, professional qualifications awarded in the UK will no longer be covered by the directive, and the EU has agreed that holders of UK qualifications who have been registered in EEA countries and Switzerland will continue to be registered. However, in the absence of an agreement with the EU, recognition of UK qualifications after exit day will be determined by the national policy of the individual member state.

The hon. Gentleman and I have discussed reciprocal international healthcare arrangements on several occasions, both on the Floor of the House and in Committee, and he will recognise that the Government hope that a widespread and encompassing international healthcare reciprocal agreement will be in place with the whole EU after exit day—that is our ambition. In the event of a deal, during the implementation period the current arrangements will pertain and we can look to put in place such a treaty.

[Justin Madders]

Will the Minister give way?

[Stephen Hammond]

One moment, and then I will. As the hon. Gentleman rightly knows, in the event of a no-deal EU exit—which is a lot of what we are talking about this morning—it is the Government’s ambition first to put memorandums of understanding in place and then hopefully to have a widespread agreement with the whole EU or, if not, individual arrangements with member states.

[Justin Madders]

We all hope that arrangements will be in place, but my question was: have any discussions been entered into yet with individual member states about the arrangements in a no-deal scenario?

[Stephen Hammond]

There are ongoing and widespread discussions with the Commission and with member states. A number of member states are of high priority because the numbers of UK nationals currently living there make reciprocal international healthcare arrangements particularly important. A number of issues are being discussed. Given the nature of the discussions, I hope the hon. Gentleman will accept that reassurance.

[Stephen Hammond]

The hon. Gentleman is correct. That is why we discussed in depth the reciprocal healthcare arrangements under the Healthcare (International Arrangements) Bill. Although it is absolutely the Government’s intention, in either a deal or no-deal scenario, to ensure continuity of international arrangements, at the moment that cannot be absolutely guaranteed. I hope the hon. Gentleman heard me say to the hon. Member for Ellesmere Port and Neston that it is the Government’s intention to ensure that, in the event of a no-deal scenario, memorandums of understanding will be put in place. We have already stated that anyone seeking emergency medical care, from wherever they come, will be treated by the NHS. We hope to ensure the continuity of current arrangements in a deal or a no-deal scenario.

To give Members a bit more flavour and depth, let me say, in response to both the initial inquiry, from the hon. Member for Ellesmere Port and Neston, and the inquiry from the hon. Member for Stockton South, that there is understandably a widespread agreement in this area that the current arrangements are to the mutual benefit of the healthcare systems of both the UK and the whole EU and should continue. In that light, very positive discussions are taking place, particularly with the countries where most UK nationals currently reside.

I do not need to write to the hon. Member for Gedling; I can confirm that the regulators will continue to apply the language tests as currently set out.

The hon. Member for Ellesmere Port and Neston talked about the loss of the internal market information system. If the UK exits the EU without a deal, it will no longer have automatic access to the EU systems, including the internal market information system, which regulators across the EU use to exchange information. We hope that the discussion about international healthcare arrangements will continue, but it may well be the case that UK regulators have to seek information from their European counterparts directly, rather than from the Commission. UK regulators are aware of that and are preparing for it, although, as I have said, that may well be part of the discussions about international arrangements and encompassed in a future bilateral or EU-wide international healthcare arrangements agreement. However, the regulations mean that UK regulators will not be required to carry out more assessments of European qualifications than they do now and they will allow bilateral applications for information.

[Justin Madders]

The Minister has been very generous in giving way. We should be clear that, as things stand, the early warning system will not be in operation. It is important to express our concern about that and our sincere wish to put in place an arrangement to avoid it.

[Stephen Hammond]

The hon. Gentleman is absolutely right to raise that concern, but as I have sought to reassure him, it will be perfectly possible for UK regulators and EU regulators, either in whole or individually, to exchange information. It will be possible under this arrangement for UK regulators to seek that information from their individual European counterparts, should they need to do so.

The hon. Gentleman asked about the capacity of regulators to check qualifications. Although it is not the Government’s intention or desire to have a no-deal outcome, regulators have been preparing for that possible scenario. These regulations will ensure that there will be little additional work for regulators in recognising EEA and Swiss qualifications at exit date. Under the regulations, the regulator can choose to review automatic qualifications that it was previously obliged to accept and to designate those qualifications where there are patient and public safety concerns. An applicant will be obliged to supply the regulator with the relevant documents, and if the regulator is not satisfied, it can reject the application. My point is that there is no extra administrative burden on regulators.

On the potential for an additional financial burden, the UK and the regulators have been preparing for a possible no-deal outcome. As the regulations seek to maintain the current systems as far as possible, for at least two years from their coming into force after the expected exit day until the review, there should be little extra cost or impact. There is, as the hon. Gentleman pointed out, the potential for regulators to recover those costs through additional fees, and that is true of current regulatory systems, in many cases.

The hon. Members for Ellesmere Port and Neston and for Linlithgow and East Falkirk asked whether the regulations reduce the ability to safeguard public and patient safety, making the health service less safe. At the heart of these instruments is the recognition that public protection and patient safety must be the foremost ambition; therefore, public protection is the key purpose of regulating health and care professionals. The instruments provide the regulators with the necessary powers to protect the public by introducing the power to designate EEA and Swiss professionals, who they are currently obliged to accept automatically. In addition, they will still be able to check applicants’ language skills and, as I confirmed to the hon. Member for Gedling a moment ago, the language tests will not change.

I was asked about the review process. It is appropriate that a two-year review of the regulations is put in place, which will potentially be wide-ranging and encompassing. The regulations are intended to be subject to review two years after they come into force. As I said earlier, it would be wrong of me either to limit the scope of the review or to predict the factors that may be in place at the time. I am often asked by the hon. Member for Ellesmere Port and Neston and others to commit to reviews of regulations and other legislation, and, as we are committing to a review after two years, I hope that he will accept my assurance on that.

Several hon. Members, including the hon. Member for Linlithgow and East Falkirk, asked me about the impact assessment. There is no significant impact. The impact for the instrument falls below the £5 million threshold of the annual net direct cost to business, as detailed by the business impact target. There is no significant impact on business, and no significant direct impacts have been identified as a result of the changes. Hon. Members have asked about the potential impact regarding allowing recognition so that EEA and Swiss professionals who are valued in the health service can continue to practise in the UK post-EU exit day in a no-deal scenario. That is the impact, and the regulations seek to minimise it. They put in place sensible measures to ensure that that recognition can happen.

Finally, I was asked about whether the regulations support cross-border co-operation between Northern Ireland and the Republic of Ireland. The regulations ensure the continued recognition of Irish professional qualifications in the UK for at least two years after exit day. They allow professionals practising under an existing and temporary or occasional status to continue until the end of that—