Global Migration and Mobility (EUC Report)

Lord Kakkar Excerpts

Thursday 6th June 2013 Lords Chamber

[Lord Kakkar]

My Lords, I, too, join in congratulating the noble Lord, Lord Hannay, on having secured this important debate and on having led Sub-Committee F in the production of this exceedingly important report on migration.

I will confine my remarks to the dependence that we have in Europe on the migration of those professionals involved in the delivery of healthcare. In so doing, I declare my own interest as professor of surgery at University College London and a member of the General Medical Council, the regulator for medical professionals in the United Kingdom.

In our own country, it is clear that we have been absolutely dependent over the past four or five decades on the migration of skilled workers in healthcare—doctors, nurses and other healthcare professionals—to ensure the delivery of a successful National Health Service. I myself am the son of two medical practitioners who came to the United Kingdom in the 1960s to continue their own postgraduate education and were given the chance to develop their careers here, both as academics and clinical practitioners.

The ability of practitioners from other countries to come and settle in the United Kingdom before our accession to the European Union required their ability to demonstrate to the General Medical Council that they had a base of undergraduate medical education and training that justified their registration with the GMC. Similar requirements existed for nursing practitioners and others who decided to come and settle in the United Kingdom and contribute to the delivery of healthcare. Without that substantial contribution to our workforce, it is well recognised that we would not have been able to deliver a successful health service.

Many thousands of students from third countries have come, not only to the United Kingdom but to other member states in the European Union, to pursue their postgraduate education in medicine and other medical specialities. They make a tremendous contribution academically in many of the courses in which they participate. If they come for clinical training, they make a very important contribution to the delivery of healthcare to our fellow citizens. On completing their training, many of these postgraduate students will return to their own countries and go on to have substantial influence in their own healthcare systems, for example leading hospitals, leading academic institutions or developing services. They will rely on what they were able to learn during their period of training in our country to inform the decisions that they take. Those decisions will, very frequently, involve the procurement of technology, disposables or the products of our pharma industry, which are vitally important in driving exports from our country to those other nations.

We must not underestimate the vital importance that the participation of foreign medical graduates—both those who have decided to remain in our country and those who have decided to return to their own after a period of training—make to our vital life sciences industry, which is considered second only to the financial services industry in the impact it has in financial and economic terms and on the potential for growth in our country.

Recently, important questions have been raised about the requirements and, indeed, about the consistency of the requirements for registration in our country for medical practitioners and other healthcare professionals. This is a vital issue, where there is substantial opportunity for misunderstanding among the general public if they lose confidence in the consistency of registration requirements for all medical practitioners who they might come across, particularly in acute situations, when they are most vulnerable and most anxious.

At the moment, the General Medical Council is able to provide registration for all undergraduates—those graduating after receiving a primary medical qualification from any of the 32 recognised medical schools in our country. Those individuals have a right and entitlement to be registered by the GMC after completing their first year following qualification. There are about 160,000 such individuals on the GMC register at the moment.

The second category of doctors entitled to register are those who come from the European Economic Area. There are some 25,500 such individuals on the register at the moment. They must demonstrate that they have a qualification from a recognised institution in the European Union; they can then register without the General Medical Council testing their language skills or their professional competence. In general, that has worked reasonably well, although there have been incidents where language skills have been wanting and patient safety has been jeopardised. Her Majesty’s Government have agreed that under forthcoming legislation it will be possible in future for the General Medical Council to test the language skills of doctors who have qualified and who are registered in the European Economic Area if there are concerns at the time of registration, or afterwards, about their language skills—but not their other professional skills, which I still think is an area of concern.

The third category of registrants are known as international medical graduates, of which there are 67,000 on the General Medical Council register, and they come from outside the European Economic Area. They have to demonstrate to the council that their primary medical qualification is satisfactory and that the content of their postgraduate training meets requirements in the United Kingdom. The GMC is able to make very careful assessment of both their language skills and their professional skills with the PLAB examination.

However, concerns have been raised recently about this category of clinician, specifically those coming from a third nation outside the EEA who have settled in an EEA country and then choose to come and work in our country. There the situation is much more confused because it relates to enforceable community rights that exist for these individuals. They may have the right to remain in the European Economic Area but the ability of the General Medical Council to have clarity in terms of testing their language and professional skills with regard to registration if they wish to come and work in our own country is much less clear.

For those individuals from outside the European Union without an enforceable community right, the General Medical Council is still able to treat them as international medical graduates and look at both their language and professional skills. However, for those third-country nationals with an enforceable community right, where their qualification has been recognised elsewhere in the European Economic Area, that right for the General Medical Council to test language and professional skills no longer exists. For third-country nationals who have an enforceable community right but no recognition of their qualification, those individuals are still able to seek registration by the General Medical Council, and the GMC is not able to test language and professional skills.

As we have seen in this important report, the changing demographics in the European Union may require us to have to count upon larger numbers of healthcare professionals from third nations to come and work in the European Union and in our own country if our healthcare system is going to be able to continue to meet the demands of an ageing population with chronic disease. To ensure that the people of our country enjoy the confidence, at times of anxiety and vulnerability, that the medical practitioner in front of them, whoever it may be and from whatever background, has the same skills as any other doctor that they may come across, there needs to be a single and clear process for the registration of all doctors in our country and indeed in all other European nations. It will be important for all member states in the European Union to be able to satisfy these requirements for their own people, bearing in mind that the delivery of healthcare is as much a technical business as it is extremely sensitive to local culture and values.

Is the Minister in a position to provide some further information on how far discussions with European partners around the question of language and skills testing have progressed? In particular, how will the movement of individuals from third countries across European countries, and individual member states recognising their qualifications, be addressed?