European Union Bill

Lord Kakkar Excerpts

Tuesday 22nd March 2011 Lords Chamber

[Lord Kakkar]

My Lords, from the outset I declare an interest as a practising surgeon and professor of surgery at University College. The matters that I wish to deal with are not as grand as the overall principles of this important Bill—I am grateful to the Minister for having outlined its important purpose in establishing an opportunity to reconnect our people with the European Union—but on matters of unintended consequences of past European legislation and regulation and how this or future legislation might better protect against these problems. I shall do so by giving examples from my own discipline and area of practice, that of medicine and healthcare.

We have heard mention of the European working time regulation, for instance. It is an important piece of legislation, designed to improve the safety of workers in the workplace and their rights overall by restricting working time to 48 hours. However, its application to the practice of medicine has led—in an unintended way, I believe—to detrimental effects on the training of our junior doctors. We hear stories continuously about the way, and I have experience of this, that it has eroded the training of those particularly in craft specialities, such as those like myself in general surgery, to the extent now that the training offered within a 48-hour week is quite inadequate and we are producing generations of doctors who potentially might not feel sufficiently confident in the structure of the way that we deliver healthcare in our country, compared with the delivery of healthcare in other European systems, to practise independently and provide the standard of service and care to patients in the National Health Service in future. That is clearly an unintended consequence but it could have serious implications.

Another example is the application of employment law, driven by the principles in legislation derived from Europe. It is good in many ways to ensure that there is a free movement of labour across the European Union, and that has brought many advantages to our country. However, it has created a serious and important problem regarding the end of medical school undergraduate education. By tradition, the first year of employment after graduating from medical school—the so-called “house job”, now known as the foundation 1 year—is a year where junior doctors take up a post under the continued supervision of the dean of their medical school. They have to complete that post before they can be fully registered with the General Medical Council and be in a position to practise independently in our country. However, because that first year is a year of employment, it must now be open to competition throughout the EU for applicant doctors from anywhere in Europe. As a result, we now run an increasing risk of our successful graduates being unable to find posts in their first foundation year because they have been taken by others. They will therefore not be able effectively to complete their undergraduate education, and will never be able to register with the General Medical Council and serve the people of our country. Again, this is an unintended consequence of previous legislation and regulation from Europe that has had a detrimental effect.

I turn now to the primacy of our regulatory body for medical practice in the United Kingdom—the General Medical Council. There is a European medical directive and it is a requirement that the Medical Act passed by this Parliament be consistent with the requirements of that directive. The directive covers several areas, such as defining what specialties exist in the European Union with regard to medicine, surgery and so on. It deals with the number of hours that are required for a recognised undergraduate medical course. It deals with the question of the duration of postgraduate training for doctors, surgeons and others. However, it also ensures that an EU national—a qualified doctor registered anywhere in the European Union—has the right to practise here, in the United Kingdom, by seeking registration with the General Medical Council. That, in itself, is fine. However, it also therefore prevents the General Medical Council determining the quality and content of the training schemes that those doctors have been subjected to. It prevents something that we all well recognise the importance of now—the ability to test the English language skills of those doctors before they come to practise in our country. As a result of that, there have been some serious problems—unfortunate events where our own citizens have died as a result of poor medical practice that could have been avoided if these unintended consequences had been foreseen. It is interesting that the General Medical Council is able to deal—

[Lord Teverson]

Can I just clarify that? Surely it is the responsibility of the employer to make sure that the person is competent to speak English and carry out their duty. They have the right to do that. It is surely a primary responsibility of any employer to make sure that the people they employ meet the standards of that organisation or business.

[Lord Kakkar]

Indeed it is but it is not always done. I was coming to the point that the General Medical Council has the obligation to do this for doctors who come from outside the European Union. It must ensure that they have the language skills, that they have sufficient competence in skills, and that their training programmes and undergraduate medical education are of a sufficient standard and quality.

[Baroness Nicholson of Winterbourne]

Will the noble Lord reinforce his point by endorsing the FAB exam, which has resulted in more than 2,000 Iraqi medical professionals staffing the National Health Service very successfully? Could the FAB exam be transferred to European Union member state applicants who come to the General Medical Council?

[Lord Kakkar]

Indeed it could. There should be consistency in the standards that are required for doctors to practise in our country. There is another point: if a practitioner registered in another European Union country is struck off, suspended or undergoing investigation by that country’s regulator, those regulatory authorities have no obligation to inform our own—the General Medical Council—that it has happened. A doctor from elsewhere in Europe, having qualified there and been registered here, could continue to practise while not being able to do so in their original member country. This, again, is unacceptable.

I make these points just to reiterate that, in trying to achieve the objective of reconnecting the people of our country with the European Union, the proposals outlined in the Bill are very important. However, it is also important to ensure that we protect the standing of the European Union in areas such as the practice of medicine and healthcare by ensuring that the problems we have experienced so far are not repeated in the future; and that, as a country, we overcome these problems so that the purpose of the General Medical Council—to protect our patients and ensure the highest standards—is not inadvertently frustrated by European legislation.