All Lord Trees contributions to the Professional Qualifications Bill [HL] 2021-22

Tue 25th May 2021
3 interactions (851 words)

Professional Qualifications Bill [HL] Debate

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Department: Department for International Trade

Professional Qualifications Bill [HL]

(2nd reading)
Lord Trees Excerpts
Tuesday 25th May 2021

(5 months ago)

Lords Chamber

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Department for International Trade
Lord Ribeiro Portrait Lord Ribeiro (Con) [V]
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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.

Lord Trees Portrait Lord Trees (CB)
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My Lords, it is a pleasure to follow the noble Lord, Lord Ribeiro, and my remarks will chime closely with his. I speak as a veterinary surgeon and my remarks will apply to the regulation of and qualifications for veterinary medicine and practice, which is regulated by the Royal College of Veterinary Surgeons. I declare my interest as a fellow and former president of that college. I emphasise that I am speaking in a personal context. I would sum up the response of the Royal College of Veterinary Surgeons to this Bill as “concerned curiosity”. As one official at the college said to me, the Bill appears to be “a solution in search of a problem”.

The RCVS currently has full powers to enter into mutual recognition agreements, which it has done with Australia, New Zealand and South Africa. For countries with acceptable and comparable accreditation systems, it can accept graduates from vet schools which have satisfied those accreditation processes, such as certain vet schools in the USA and some EU countries. Finally, it has a process for all other graduates from any school in any country in the world, who must take and pass the royal college’s own exams.

Collectively, this ensures a level of competence in the individuals allowed to register as MRCVS and hence practise in the UK. Above all, it gives the public an assurance of professional competence and it ensures that our animals can be treated only by those who have satisfied the RCVS standards, which apply, of course, to those who graduate from the accredited UK vet schools. All of this means that this Bill adds nothing to the powers and capabilities that already exist for the veterinary profession. I realise that all regulators do not have the same powers, but, if not, why not just give all regulators such powers and leave it at that?

An underlying concern is the ability conferred on government by this Bill in Clause 3 to

“implement international agreements … that the UK strikes … so far as they relate to the recognition of professional qualifications.”

I confess I am not quite sure what that really means. But it is not unreasonable to fear that government pressure, as a result of commitments they make in a desire to achieve FTAs, will pressure regulators to relax standards.

In agreeing FTAs, the Minister is aware of concerns about relaxing standards regarding, for example, animal welfare on the importation of products of animal origin, or about relaxing environmental standards relating to the production of all manner of products. It is not unreasonable to ask if this is the thin end of the wedge to relax the standards of competence that we currently expect from professional personnel. This pressure will undoubtedly be exacerbated in professions where we have skill shortages, as are specifically included in this Bill. The vet profession is one such profession.

If we need more vets or more of any other profession, we should ask why we cannot produce more to our standards rather than trying to make up the numbers by imports—the standards of which it is, practically and realistically, impossible to assess without a great cost. How can a body like the RCVS, which charges a very modest retention fee to current members of £364 per year, possibly accredit or ensure appropriate in-country accreditation of, for instance, the 24 vets schools in Brazil, the 52 in India or the 20 in Mexico?

The reason we have a shortage of vets is not a lack of student applications but is, to a large extent, due to a shortfall in the recovery of the full cost of veterinary education. The income to vet schools comprises the maximum allowable student fee plus the government grant to universities for band A clinical subjects, which include medicine, dentistry and veterinary science, and is £10,990 per year for 2021-22. For clinical veterinary education, virtually all the clinical training—the hospitals, clinics and associated equipment and many of the clinical teaching staff—has to be provided from this total income. This is in marked contrast to clinical medical training, where there is a very substantial subsidy through the NHS budget.

The reality is that the real cost of the education of vet students, which has been estimated at around £27,000 per year per student, substantially exceeds the band A allocation plus the maximum student fee. The difference is about £7,000 per student per year. With a relatively modest uplift in band A grants for vet students, for what is in a national context a moderate number of students—currently about 1,000 graduates per year, this problem could be addressed. The schools could expand the intake of UK entrants to vet schools who would contribute as graduates to the UK market.

In conclusion, to return to my major concern in this Bill—namely that, as a result of trade negotiations involving international recognition agreements, regulators will be pressurised into relaxing professional standards—why is Clause 3 necessary? Will the Bill in effect debar a regulator, such as the RCBS, from requiring certain applicants where no regulator recognition agreement has been agreed, to sit that UK regulator’s own examination or assessment procedures?

Baroness Noakes Portrait Baroness Noakes (Con)
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My Lords, the Minister explained that the Bill applies only to professions regulated by law. At his helpful briefing meeting last week, he undertook to let me have a list of the bodies covered by the Bill as I found it a bit difficult to work out what was covered and what was not. I am most grateful that this list arrived over the weekend—at 5.30 pm on Sunday afternoon, to be precise, which demonstrates real commitment by the Bill team.

I have a particular interest in whether the Bill applies to the Institute of Chartered Accountants in England and Wales, of which I am a non-practising member. It is a body governed by royal charter and the noble Lord, Lord Bilimoria, might like to know that it is not on the Minister’s list. Many chartered accountants act as auditors and the ICAEW is a recognised professional body and a recognised supervisory body for those members who wish to practise as auditors. The Financial Reporting Council, which is on the Minister’s list, oversees the regulation of auditors rather than carrying it out itself. I believe a similar approach applies to insolvency practitioners. Hence the Bill is rather complicated in its scope, certainly for chartered accountants and, I imagine, for other professions as well.

To turn the Bill itself, there is one very good thing in it, one rather dodgy thing and some other things which I am on the whole puzzled about. The best things about the Bill are Clauses 5 and 6. As my noble friend explained, these clauses allow us to remove some more EU-retained law from our statute book and thereby remove the obligation to recognise EEA and Swiss professional qualifications. I support any legislation which allows us to frame our laws in a way which suits the UK. Even though I support Clauses 5 and 6, however, I am not convinced that the Henry VIII powers are accompanied by sufficient parliamentary oversight. The EU’s distinction between primary and secondary legislation is not necessarily a good guide to determining how our Parliament should be involved. This concern applies throughout the Bill and not just to Clauses 5 and 6. I believe we are still waiting for the report of the Delegated Powers and Regulatory Reform Committee, and I shall reserve final judgment until I see it.

The dodgy bit of the Bill is Clause 3, which allows the Government to override existing approaches and procedures for the recognition of non-UK qualifications if they have been covered in a trade treaty. This is explicitly presented in the Government’s policy paper as strengthening the UK’s ability to negotiate international trade treaties. It is some time since I was president of the ICAEW, but the recognition of overseas qualifications was a thorny issue then and I expect it still is. In addition, the landscape has changed and become more complicated since my day, with the arrival of the FRC to oversee the regulation of auditors.

Many countries have chartered accountancy qualifications which simply do not match the UK’s. Sometimes that is due to the technical coverage of the qualifications, at other times to the areas of practical experience and ethical training, and sometimes to all three. The Bill must not try to ignore that fact. Let us suppose that our enthusiastic and energetic Secretary of State for International Trade negotiated a trade treaty with one of those countries for which recognition had not been granted already in the UK. That might be in relation to chartered accountancy in general or for audit purposes. Clause 3 might allow the Government to tell the ICAEW or the FRC to recognise those qualifications, even if they would not be prepared to do so themselves because of the factors I mentioned. Clause 3 does not seem limited to telling the regulator of a regulated profession what to do; it seems capable of applying to both the ICAEW, which is not on the list, and the FRC, which is. This would drive a coach and horses through the ability of professions to guard the standards and quality of their qualifications, and I do not think that this concern will be confined to chartered accountants or auditors; I expect other professions will have similar issues.

My noble friend may say that we can rely on the CRaG processes to stop the Government doing stupid things in trade agreements, but he will know that CRaG is basically a rubber-stamping process, with only the blunderbuss of a weapon of the other place refusing to approve a whole agreement. Alternatively, either House might use the nuclear weapon of refusing to agree any regulations made under Clause 3. In the context of a major trade treaty, these are wholly unsatisfactory safeguards and unlikely to protect UK professions. That is why we need to look again at the power in Clause 3.

I shall briefly cover three puzzling areas. First, I am far from convinced that the new assistance centre set up by Clause 7, which is a reincarnation of an EU requirement, is necessary or that the costs are justified. The costs are borne by the taxpayer and we need to see a stronger case made for it than has appeared in the documents so far. Secondly, Clause 8 requires the regulator of regulated professions to publish a load of information. Not all professions are covered by the Bill, so it could create an unbalanced universe, with some but not all professions needing to comply. It also seems quite onerous on those bodies, such as the FRC, which oversee regulation but do not themselves do the detailed regulation. Why should the FRC gather and publish all the information already available at the ICAEW? That will serve only to increase costs. I have yet to see any explanation for the need for this clause. Are there any real concerns that regulated professions hide information about how to access membership? Who, if anyone, is policing this and what are the penalties for non-compliance? More profoundly, is this a solution in search of a problem, to which the noble Lord, Lord Trees, referred in the context of the veterinary profession?

Lastly, Clause 9 covers the exchange of information by regulators and seems a helpful provision underpinning the UK’s internal market in services, but I ask the Minister to reflect on whether its scope—largely excluding the chartered professions—makes it fit for purpose. In my specific example of the FRC and the ICAEW, it would seem largely ineffective, since the FRC will not hold data relating to individuals. A similar criticism appears to apply to Clause 10 as well.

I would like to be enthusiastic about the Bill, but I fear that it is creating a new division between professions covered by the Bill and those which are not. I also dislike its focus on a big government solution to a series of relatively minor problems in a few professions, which is all that the call for evidence actually revealed. On that basis, it is not a very Conservative Bill, and encouraging the Benches opposite to view it in that light may be the best help that I can give my noble friend in getting the Bill through.