Professional Qualifications Bill [HL]

Lord Ribeiro Excerpts

2nd reading
Tuesday 25th May 2021 Lords Chamber

[Lord Ribeiro (Con) [V]]

My Lords, it is a pleasure to be able to speak at Second Reading. I declare my interests as listed on the register.

We are dealing with more than 160 professions regulated by legislation and surely cannot accept a one-size-fits-all approach to these professions. The General Medical Council, mentioned previously by the noble Lord, Lord Hunt, was founded in 1858 and produced its first registration of doctors in 1859. We established processes for registering doctors 160 years ago, so the process for assessment and registration of doctors is now well established. For such organisations, unlike in other sectors, there are existing powers within legislation to do the majority of what this Bill seeks. To the medical profession and its regulators, given the long-standing history of overseas recognition and registration, this Bill seems unnecessary and risks cutting across these established processes. One might ask: if it ain’t broke, why fix it?

The consultation on the Bill found evidence that, while the regulatory landscape can operate smoothly,

“there is considerable diversity of approaches and expectations, which can be difficult to navigate.”

The desire for enabling approaches to the recognition of professional qualifications that meet the needs of all parts of the UK should not be used as a means to achieve uniformity in the regulation of professional bodies. Medicine requires strict regulations and standards, because patients’ lives may be at risk without them. Any dilution in standards, in a mistaken attempt to achieve uniformity, may have unintended consequences.

For this reason, the GMC—as the noble Lord, Lord Hunt of Kings Heath, noted—and other medical bodies have concerns about Clause 1(4), which could force health profession regulators to accept professionals into the UK to practise, in a way that compromises patient safety. It also has implications for the workforce we need, as it would require medical regulators to assess thousands of applications to allow medical professionals to practise in the UK. This seems unnecessary, given the well-established methods we currently have through the Professional and Linguistic Assessments Board, which the noble Baroness, Lady Garden of Frognal, mentioned in her speech.

PLAB, as we know it, is taken in two parts. Part 1 is a multiple-choice examination with 180 single best answers, and it lasts for three hours. Part 2 consists of an objective structured clinical examination, OSCE. While part 1 may be taken in overseas centres, part 2 is undertaken in the UK and consists of 18 clinical stations, each lasting eight minutes, with two minutes of reading time added. This is a rigorous assessment and is set at the level of competence of a foundation year 2 doctor, so why is there a need for an assistance centre? Do the Government not trust the GMC to undertake this task, given its long track record, which I have detailed? Why is there a need for another layer of bureaucracy between the regulator and the applicant?

I am also concerned by the use of “substantially the same” in Clause 1(2)(b). Clause 1(1) gives international professionals an entitlement to practise on the basis of their overseas qualifications or experience that are “substantially the same” as or equivalent to UK qualifications or experience. In the interest of patient safety, the GMC quite rightly believes it has the obligation to assure itself that professionals seeking registration have the knowledge, skills, and experience to practise safely in the UK. So I ask: is “substantially” 95%, 85% or 75% of the same knowledge and skills in order to be “substantially the same standard”? How is this standard to be tested? What guarantees can be given that this equates to the standards required to practise in the UK at the present time?

For example, in my discipline of surgery, patients are potentially at risk every time they undergo a surgical operation. As president of the Confidential Reporting System in Surgery, CORESS, I see reports of near-misses in surgery in the UK by professionals trained in the UK. This may be more apparent in locum doctors who may be unfamiliar with equipment or hospital practices and occasionally may misinterpret the labelling on packages. Language matters, and merely accepting qualifications is no guarantee that the practitioner has the language skills to work in the UK.

What assurances can the Minister give that these professional standards will be maintained? We do not accept an ill-defined criterion of “substantially the same”. The GMC believes, and I agree, that the wording of Clause 1(2) could result in secondary legislation that would prevent the GMC from interpreting qualifications or experience in a way that enables it to assess knowledge and skills through robust written and clinical tests like the PLAB I described earlier.

Although this may not be the intention of the Bill, it is important to spell this out clearly and make explicit provision in the Bill that regulators may put processes in place to determine appropriate knowledge and skills over and above the qualification as a necessary step towards registration. Without these assurances, the implications for patient safety are great. Coupled with the inevitable workforce shortages after leaving the EU, this could lead to a lowering of standards to fulfil the workforce needs.

My questions for the Minister are these: first, can the Government insert an explicit provision in Clause (1)(2) of the Bill that regulators are able to determine appropriate knowledge, skills and experience in any way they see fit? Secondly, regarding the use of “substantially the same” as UK qualifications or experiences, can the Government insert a provision into Clause (1)(2) of the Bill to clarify that the nature of an assessment of an international qualification is to be determined by each regulator and does not supersede the assessment of knowledge, skills and experience?

This Bill covers over 160 professions. It is important that the healthcare professions are protected from any unintended consequences. Can my noble friend the Minister confirm that healthcare professional regulators with well-established routes to their registers will not have these compromised by the provisions of this Bill? I look forward to hearing the Minister’s replies.