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

Lord Coaker Excerpts

Tuesday 29th January 2019 General Committees

[Stephen Hammond]

It is a great pleasure to see you in the Chair, Mr Howarth.

The draft regulations aim to ensure continuity in the recognition of European economic area and Swiss health and care professional qualifications in the United Kingdom in a no-deal European exit scenario. The statutory instrument relating to Northern Ireland, which has been introduced here because the Northern Ireland Assembly is suspended, ensures that the approach to recognising health and care professional qualifications is consistent throughout the United Kingdom.

European health and care professionals make a major contribution to the national health service and the wider health and care system. Since 1997, more than 100,000 EEA and Swiss-qualified health and care professionals have applied to have their qualifications recognised in the United Kingdom, and more than 77,000 of them have been dentists, doctors, midwives, nurses and pharmacists. The Government have been clear that European health and care professionals will continue to be welcome after the UK leaves the EU, and the statutory instruments are part of ensuring that.

Arrangements for the recognition of professional qualifications within the EU is provided for by the directive on the recognition of professional qualifications, which will cease to apply if the UK leaves the EU without a deal. Changes to the domestic legislation that implements the directive are therefore needed to ensure that recognition of those EEA and Swiss qualifications can continue after EU exit, in the case of no deal. The directive provides for mutual recognition of EEA and Swiss professional qualifications within the EU and makes provision for harmonised education and training standards in seven professions, five of which are in health—doctors, dentists, nurses, midwives and pharmacists. The directive allows for recognition of listed qualifications that meet the harmonised education and training standards and provides for recognition under a general system for qualifications that do not meet those harmonised requirements. The directive also covers Switzerland and EEA nations.

It is worth noting, as I have said, that the UK has been a major beneficiary of the arrangements under the directive. Since 1997, the UK has recognised 77,000 EU qualifications in the automatically recognised professions. In contrast, fewer than 7,000 UK qualifications have been recognised in other EU states. The directive has helped with the recruitment of skilled professionals to the UK’s health and care sector and it is important that the arrangements that allow for continued recognition of health and care professional qualifications are in place if the UK leaves the EU in a no-deal scenario.

The two instruments that we are debating have three main effects. First, they put in place arrangements for the recognition of those EEA and Swiss professional qualifications that are currently recognised and provide for the continuation of recognition arrangements for those qualifications that are covered by the general system. Secondly, they ensure that applications for recognition that are ongoing at exit day can be completed under the current legal arrangements and, finally, they remove a number of provisions that would not be appropriate to maintain in the event of a no-deal Brexit.

I will set out the changes in a little more detail. The instruments put in place new arrangements for the recognition of professional qualifications that are currently automatically recognised. Such qualifications will become recognised overseas qualifications, or “relevant European qualifications” in the case of pharmacist qualifications in Northern Ireland. As such, they will continue to be recognised without additional testing, other than the checks for an applicant’s language skills and on whether there are concerns about their fitness to practise.

The regulations give UK regulators a new power to designate a qualification that is currently recognised automatically.

[Vernon Coaker (Gedling) (Lab)]

The Minister has just announced a major change, in that a UK regulator would determine whether qualifications were acceptable. Who sets the criteria for the regulator to determine that?

[Stephen Hammond]

I have said two things: that there will be new arrangements, so that professional qualifications that are currently automatically recognised will continue to be recognised without additional testing, other than checks for language; and that the regulations give powers to designate a qualification that is currently recognised. As yet, I have not said that there will be a new designation system.

[Vernon Coaker]

My understanding is that the regulator will determine whether a qualification is regarded as comparable. Is that the case? If so, who determines the criteria on which the regulator will make that decision?

[Stephen Hammond]

I will come to that a little later, if I may. The hon. Gentleman is right that we need to come on to that point, because some qualifications will be comparable and we need to ensure that the right regulatory system is in place.

As I was saying, designating a qualification will allow UK regulators to stop the automatic qualification, which is not possible under the directive. That is an important additional measure, which will enhance public protection. Such designation will be subject to Privy Council consent, or the agreement of the Department of Health in Northern Ireland in relation to pharmacists’ qualifications there.

The Secretary of State for Health and Social Care will review the arrangement for the continued recognition of automatic qualifications no later than two years after the regulations come into force. The review clause is important because it means that the arrangements put in place by the regulations will not remain indefinitely. It would be reasonable for hon. Members to ask what the review will cover. In short, it will cover whether it is appropriate for the near-automatic recognition of European qualifications to continue. It would not be right for me to predict what key factors there might be at that point in two years’ time, but I guess that hon. Members will make a judgement about which factors ought to be included in the review.

[Vernon Coaker]

The point I am trying to make is about the difference between automatic acceptance and the regulator determining that certain qualifications are not acceptable. I am trying to tease out from the Minister how that difference will be determined, between automatically accepted qualifications and those that are regarded as non-comparable. Who sets those criteria? That is the question for the Minister.

[Stephen Hammond]

It is the question. There is a system currently in place, as the hon. Gentleman knows, in which the regulator has powers to automatically accept qualifications. There is also a system in place for professionals from outside the EU and the EEA, which looks at regulatory qualifications and ensures that they comply with UK standards, which, at the moment, is the EU directive. Therefore, there is already a regulatory system for non-EU/EEA/Swiss citizens that sets those standards. If we were considering different standards to the current automatic recognition, it would be appropriate to use that process of regulation to give the regulator his authority to decide whether a qualification was acceptable. I hope that answers the hon. Gentleman’s question.

What I can say about the two-year review period is that it is important to have a widespread and encompassing review of the arrangements for recognition of all international healthcare. That will ensure that the process of recognising all the qualifications is effective and proportionate. If and when the arrangements for the recognition of relevant EEA and Swiss qualifications come to an end, a parliamentary review to determine the time when that happens will be appropriate.

The regulations, as I hope I explained in more detail in answer to the hon. Gentleman’s question, enable qualifications that are not covered by the automatic system to be considered by the relevant UK regulator and compared with the equivalent UK qualifications standard, as currently happens. They allow applications made before exit date to be concluded under the current arrangements, as far as practically possible. They allow individuals practising under temporary and occasional status, or under the EU professional card, to continue to do so until such registration expires.

The regulations also remove obligations and administrative arrangements that will no longer apply to UK domestic regulators when the UK leaves the EU. Those changes include the removal of provisions relating to cross-border temporary provision of services, which currently allow professionals in a member state to practise in another member state on a temporary and occasional basis without having to register fully; the removal of the requirement to share information through the European Commission’s internal market information system, to which UK regulators will no longer have access; and the ending of arrangements that allow professionals to practise in the EU using the European professional card. That card is underpinned by European Commission systems that will no longer be available to UK regulators.

Finally, the regulations remove the requirement on UK regulators to set professional education and training standards that comply with the standards set out in the directive. That will provide UK regulators with greater flexibility to set education and training standards that meet the needs of the UK’s health and care professions.

In conclusion, the regulations put in place a system for the recognition of EEA and Swiss health and care professionals if the UK exits the EU without a deal. They also ensure that applications that are in progress at exit day will be concluded under current arrangements as far as practically possible.

As I said at the outset, the UK places enormous value on the contribution of the EEA and Swiss-qualified professionals who work in the UK health and care sector. The regulations will facilitate the continued recognition of EEA and Swiss professional qualifications after the UK leaves the EU. I look forward to hearing the contributions of other hon. Members. The effect of the regulations is to ensure continuity of recognition of qualifications in the event of a non-deal EU exit.

--- Later in debate ---

[Vernon Coaker]

It is a pleasure to serve under your chairmanship, Mr Howarth. I wish to reinforce a couple of important points made by my hon. Friend the Member for Ellesmere Port and Neston from the Front Bench in his excellent contribution.

The hon. Member for Linlithgow and East Falkirk, who speaks for the SNP, talked about this, but these SIs are incredibly important. Tucked away in these regulations are all sorts of policy changes that will have huge implications for our constituents and our country. I want to mention a couple. Hon. Members might not have read all these regulations—I have not read all of the pages, but I have read some—but if, in a few weeks’ or a few months’ time, a no deal happens, we will have people coming to our constituency offices asking what has happened to change their working arrangements in this country. We will have to say, “We’re not quite sure; we’ll go back and have a look and see where that happened.” And it will have happened in Committees such as this.

I say this as an aside—I know that we have all said it—but one of the problems with SIs is that we cannot amend them. Let me give one example. My hon. Friend the Member for Ellesmere Port and Neston mentioned this, but one really significant change tucked away in these regulations is the removal of the right of EU and Swiss nationals who are working here on a temporary or occasional basis to do so. My hon. Friend set out how many people that covers. What will we say when a Swiss or EEA national turns up at our surgeries and says, “I am working here on an occasional or temporary basis”—or says that they wish to do so—“and my local hospital needs me”? The figures are there: 42 General Medical Council registrants, 88 other professionals, and so on. If one of those people comes to us and says, “I am no longer able to work here,” it will be this Committee that agreed that regulation.

I agree with my hon. Friend that we will not vote this measure, but why on earth is the Minister doing this? Why on earth are we saying to EEA and Swiss nationals who are working here on an occasional or temporary basis that they cannot do so?

[Stephen Hammond]

rose—

[Vernon Coaker]

I will of course give way to the Minister, but the House of Lords Select Committee raised that point, so is he going to tell me that that has been changed?

[Stephen Hammond]

The hon. Gentleman is raising a number of serious and important points, as did the Opposition Front-Bench spokesperson—he was right to do so, and I will answer those points. However, the hon. Gentleman will be aware that at the moment the number of social and healthcare professionals working under the regime that he is describing is fewer than 160. Does he not agree that if people wish to work, or to continue to work, on a temporary or occasional basis, it might be more sensible, in the interests of public safety, for them to seek full registration? We are talking about a very small number. Surely full registration is the way forward.

[Vernon Coaker]

The implication of what the Minister has just said is that those people have been working in the NHS at the present time with sub-standard qualifications.

[Stephen Hammond]

indicated dissent.

[Vernon Coaker]

That is exactly the implication of what the Minister has just said.

[Stephen Hammond]

It is not. The hon. Gentleman was citing the example of someone who wanted to work here on a more permanent basis and to use that regime to achieve that. If someone wishes to work under that regime, would it not be sensible to have full UK regulatory recognition?

[Vernon Coaker]

The Minister will give his answer, but this question has been raised by NHS professionals and by the cross-party House of Lords Select Committee that looks into these matters. Indeed, that Committee specifically said that the Minister should be questioned about the change, because it has serious concerns about the detriment to the NHS from removing the right of those people to work in this country under the occasional and temporary arrangements. The Minister may say it is only a small number, but if there is a no-deal scenario, let us see whether that small number start appearing at our surgeries and whether we have to explain why the current arrangements no longer apply.

I think the change is unnecessary. The system works very well now and allows people to move backwards and forwards. As my hon. Friend the Member for Ellesmere Port and Neston pointed out, this is a reciprocal arrangement. People from this country benefit from exactly the same arrangements when they go to other countries across Europe. It will be interesting to hear the Minister’s answer to my hon. Friend’s question about what he expects the reciprocal arrangements to be and how other European countries will respond to our doctors, nurses and other healthcare professionals seeking to broaden and extend their experience by working in other countries in Europe.

The Minister started to answer my earlier questions about qualifications that are not regarded as comparable. In his response to the House of Lords Committee, he said it would be a matter to be determined by the regulator. My hon. Friend has already raised this point, but given that different regulators will determine which qualifications are not comparable, will they all have different criteria? How on earth will there be any consistency? The bureaucracy will be enormous. What are the costs of that? What will the staffing arrangements be? Again, the House of Lords Committee, in response to what the Minister said, raised serious concerns about how that will be done. My hon. Friend is right: the Minister needs to lay out more clearly how he believes the NHS will not be detrimentally affected by the changes introduced by these regulations, should that be necessary in a no-deal scenario, given the numbers he pointed to—3,200 people being automatically registered and 1,500 being registered under the general system. Will the Minister also confirm, as I think he said earlier, that the language tests will remain exactly the same?

My final point refers to Northern Ireland. It is a general point for the Minister to take away and one that he should perhaps ask the Secretary of State to discuss in Cabinet. There is no Assembly in Northern Ireland. The explanatory memorandum says that, under the legislation passed by this House, the Government talk with officials in Northern Ireland to determine whether these or other regulations are acceptable. Without getting into the arguments about why that is occurring or not, the democratic deficit is quite significant. I wonder whether there might be a better, more informative way of proceeding than just to include a few lines saying, “We’ve consulted with Northern Ireland officials about whether these regulations will apply appropriately in Northern Ireland,” given the responsibility on us all, in the absence of a Northern Ireland legislature, to consider the impact of regulations on that part of the United Kingdom in a more appropriate way.

These are significant changes. The Minister says that a small number of people will be affected, but those receiving treatment from someone who will no longer be able to register under the temporary or occasional scheme will be asking how this Parliament passed legislation that is potentially detrimental to their healthcare. That is not the Minister’s intention, but these are appropriate questions for this Committee and the House to ask the Minister as we move into the unknown.

--- Later in debate ---

[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—

[Vernon Coaker]

Will the Minister give way? I think he misunderstood what I asked.

[Stephen Hammond]

I will give way but I think I might be about to predict that as well.

[Vernon Coaker]

To clarify, I was not talking about the cross-border arrangements. I was making the point about whether, in the absence of the legislative Assembly in Northern Ireland, instead of having two or three lines saying, “We’ve discussed this with Northern Ireland officials and that’s fine,” we need to give more detail to our discussions about that.

[Stephen Hammond]

The hon. Gentleman predicts what I was about to say.

[Vernon Coaker]

Apologies.

[Stephen Hammond]

Not at all. The hon. Gentleman is right to ask whether, in the absence of an Assembly in Northern Ireland, the Pharmaceutical Society of Northern Ireland can assess EEA and Swiss pharmacist qualifications that are not covered by automatic recognition—he recognises, of course, that the automatic recognition system is there. These regulations will ensure there should be little change in those. The PSNI will continue to recognise pharmacist qualifications that are within the scope of the automatic system at exit day. Those who do not hold a qualification currently within that scope will be registered with the General Pharmaceutical Council before registering with the PSNI. That is a continuation of the current practice. I am happy to keep this issue under review and to make it part of the discussion with Northern Ireland officials.

With those remarks, I hope that I have managed to satisfy hon. Members’ inquiries, and I commend both sets of regulations to the Committee.

Question put.