Health and Social Care (Safety and Quality) Bill

Philip Davies Excerpts

Friday 9th January 2015 Commons Chamber

[Jacob Rees-Mogg]

My hon. Friend makes an interesting point. It is possible that that is taken care of by other parts of the Bill. Clause 1 contains the fundamental commitment that unreasonable risks should not be taken, and language could be seen to be part of that. The reason I like the new clause is that it makes it absolutely clear that language is fundamental.

It is very hard to think of a circumstance where a lack of communication could possibly be safe. There may be cases where a patient cannot speak, or absolutely dire emergencies where there is no alternative form of treatment, but in the ordinary course of events language skills must be essential for somebody who looks to work in this country for any length of time.

I hope that the Government will think about this new clause very seriously, and perhaps consider whether a “notwithstanding” aspect is necessary, and that if they do not accept it today, they will look at the matter again in another place.

[Philip Davies (Shipley) (Con)]

I apologise for not being here when my hon. Friend the Member for Stone (Sir William Cash) opened the batting on this new clause.

I very strongly support the sentiment behind the new clause. It should go without saying that people who are practising medicine should be able to communicate properly in English. It is a sad state of affairs when we have got to a point where we feel the need to introduce legislation in this regard. Whatever the rights and wrongs of the matter, sufficient examples have been reported around the country to indicate that we do have a problem. It may not be widespread—it may only occur in pockets—but it is perfectly clear that in some areas there is a problem that needs to be addressed. If the Government do not intend to accept the new clause, I would like to know what they intend to do about this genuine problem that people have identified.

My hon. Friend the Member for Stafford (Jeremy Lefroy) made a reasonable point about the measures that were put in place, partly by the previous Government, relating to new doctors and people who are currently going through training. The problem with that, however, is that it does not deal with the people who are already practising.

[Jeremy Lefroy]

My hon. Friend makes an extremely important point. Does he accept—perhaps the Minister will comment on this as well—that the revalidation process that doctors now have to go through should include, if it does not already, as I am sure that it must, language and, indeed, communication skills?

[Philip Davies]

I take my hon. Friend’s point. I am not entirely sure, though, how robust that process is or whether the same test is applied for people who are currently practising as for those who are starting out on their training. I suspect that there may well be a slight difference in the standard that is expected. I hope that I am wrong and he is right; it will be interesting to hear what the Minister says. I would be interested to know how many people have been struck off because they are unable to communicate effectively—if it is hardly any, or none, that would indicate that the current regime is not working effectively—and how often the measures that my hon. Friend mentions have been invoked.

As ever, my hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) made an interesting point about the European Union. I do not intend to get bogged down in that today, but it would be interesting to know what the Minister’s understanding of this is. If he will not accept the new clause, is my hon. Friend’s point a factor in that, or is it his position, and that of the Government, that nothing in EU law would prevent such a provision from being introduced?

Although I agree with the sentiment behind the new clause, I wonder whether its wording is deficient and could lead to some unintended consequences. My hon. Friend the Member for Stone made great play of the need for people to be able to communicate effectively in English, and he is absolutely right, but unfortunately there is no mention of English in his new clause. That seems to be a rather glaring omission that could lead to unintended consequences at a later date. The new clause merely says that people who practise medicine should

“have appropriate language skills to communicate effectively with their colleagues and patients.”

I think what he is really trying to say is that they should have appropriate English language skills to communicate effectively with their colleagues and patients. As drafted, the new clause would place an onus on people practising medicine to have appropriate language skills in general to communicate effectively with their patients. In the case of a patient who speaks no English whatsoever and speaks Urdu, for example, would the new clause insist, in effect, that their doctor must be able to communicate effectively with them in the only language that they are capable of speaking? That would seem to be a possibility, because the crucial word that has been omitted is “English”.

[Jacob Rees-Mogg]

I have just checked the territorial extent of the Bill, and parts of it apply to Wales as well, so we should not forget the need perhaps to be able to communicate in Welsh where appropriate.

[Philip Davies]

My hon. Friend makes a good point. That enhances the complication that could arise as an unintended consequence. I agree wholeheartedly with the sentiment of the new clause and the intention behind it, but I wonder whether its wording may lead to unintended consequences in relation to languages other than English that were not foreseen when it was tabled.

[Sir William Cash]

As my hon. Friend will appreciate, the new clause says:

“The Secretary of State shall by order make regulations enabling the General Medical Council to ensure that all doctors…have appropriate language skills to communicate effectively”.

I am not prejudging this—I will be interested to hear what the Minister says, if he can take advice on the matter, and of course there is the House of Lords to come—but it may well be that the regulations can identify how my hon. Friend’s points, which I completely understand, can be addressed.

[Philip Davies]

I am grateful to my hon. Friend. He may be right that the points I make can be overcome in one way or another, whether through his existing wording, which may well work, or perhaps a slightly amended version in another place. I just wanted to flag up this issue because I would not want any unintended consequences to come about as a result of the new clause. The whole point is that the onus should be on everybody to be able to speak English, and I would not want anything to allow for a loophole that prevented that from happening.

I wholeheartedly support the sentiment underlying the new clause. Integration is essential in this country and speaking the language is one of the key forms of integration. I do not see how it is possible to integrate into society if one is not competent in speaking English. I support the idea that people who come to this country should be able to speak English, whether they are patients or doctors—the requirement should apply to both equally. I shall be interested to hear the Minister’s view.

--- Later in debate ---

[Philip Davies]

I welcome what the Minister has said and commend him for that initiative. In order for us to be able to see how robust the revalidation process is, can he tell us how many people have been through it and how many have failed as a result?

[Dr Poulter]

The revalidation process is ongoing and is reviewing everybody on the medical register. It is very easy to revalidate someone who is training to be a specialist as a surgeon or in some other hospital position, because they are assessed annually as part of their specialist training. The revalidation process for the consultant and general practice work force—which kicked off as a five-year programme—is ongoing. Some people have volunteered to come off the medical register, including retired doctors who have not practised for some time. I would be happy to write to my hon. Friend to update him on the revalidation process. It will not be completed for another couple of years, but once we have gone through the first cycle of revalidation the process will be easily repeated. I stress that doctors will be revalidated on a maximum of a five-yearly basis. It is possible for the GMC to seek reassurance with regard to certain specialties by requesting more regular competency tests as part of the annual appraisals.

The revalidation process is an important new power that is being implemented effectively. We need to keep it under review because it is important that all doctors, regardless of the proposed new clause on language testing, are competent, keep up to date with medical practice, able to communicate effectively and empathetically with their patients, and work as part of a multidisciplinary team for the benefit of patients. That applies to general practitioners, hospital specialists and those working in mental and physical health. It is an important step for which the GMC has been asking for many years and in which other health care professions are taking an interest. The Nursing and Midwifery Council is considering revalidating nurses in a similar way in future. It is a welcome measure that will help protect patients and the public. It is making good progress and I will write to my hon. Friend with further details in due course.

Medical revalidation is the process by which the GMC evaluates whether doctors can keep their licence to practise in the UK. In addition, a doctor wanting to work in general practice in the UK must also be on the national medical performers list, which is managed by NHS England. To be included on the list, the doctor must hold a licence to practise from the GMC and, as a consequence of the revalidation programme, he or she must have effective communication skills.

As I outlined earlier, the key step to improving checks on language competency for EEA doctors was the Medical Act 1983 (Amendment) (Knowledge of English) Order 2014, which made changes to the Medical Act 1983. My hon. Friend the Member for Shipley will be pleased to hear that the title of the order refers to English. After all, the General Medical Council regulates doctors on their ability to speak primarily that language, and I hope that that reassures him.

The order gave the General Medical Council the power to refuse a licence to practise to a medical practitioner from within the EU who is unable to demonstrate the necessary knowledge of English. It created a new fitness to practise category of impairment relating to language competence to strengthen the General Medical Council’s ability to take fitness to practise action where concerns are identified.

For example, if I, as a doctor, worked with a doctor about whose language competency I had concerns, or if a doctor was not able to communicate effectively in their day-to-day work, I, fellow health care workers and patients could report the doctor to the GMC, which—in addition to the existing initial point-of-entry language testing powers and the revalidation process—now has new powers to take action specifically in relation to such language concerns. That is another important measure that the Government have introduced to strengthen the GMC’s powers on language testing.

The change enables the GMC to require evidence of English language capability as part of the licensing process in cases where language concerns are identified during registration. Just as doctors from outside the European economic area can be tested on their language competency, the same competency tests now apply to doctors coming to work in the UK from within the European economic area, thanks to the new regulations. We hope that the wrongs identified following the dreadful Daniel Ubani case and the tragic death of David Gray have now been righted through very strong legislation to ensure the competency and ability to communicate in English of all doctors coming to work in the United Kingdom. As I have outlined, additional measures are now in place to enable the GMC to take action if concerns are raised during the ongoing medical practice of any doctor about their ability to speak English and to communicate effectively with their patients.

The process for determining whether a person has the necessary knowledge of English is set out in the General Medical Council (Licence to Practise and Revalidation) Regulations Order of Council 2012. The GMC has published guidance setting out the evidence required to demonstrate that a person has the necessary knowledge of English. With regard to the fitness to practise changes that have been introduced, a new category of impairment relating to English language capability has been created, which allows the General Medical Council to request that a doctor about whom concerns have been raised undertakes an assessment of their knowledge of English during a fitness to practise investigation.

The changes have hugely strengthened the General Medical Council’s ability to take fitness to practise action where concerns about language competence are identified in relation to doctors already practising in the UK. We are in the process of bringing in similar powers for the Nursing and Midwifery Council, the Pharmaceutical Society of Northern Ireland, the General Pharmaceutical Council and the General Dental Council to ensure that the health care professionals they regulate—nurses, midwives, pharmacists, pharmacy technicians, dentists and dental care professionals—will also have appropriate language skills for the roles that they perform. The consultation on our proposed legislative changes for those four regulators closed on 15 December, and we will publish the outcome shortly with a view to immediate legislation.

I want to pick up the good point made by my hon. Friend the Member for North East Somerset about the need for primary legislation. I hope that he is reassured that the existing legislation, and the ability to bring in regulations underpinning that through section 60 orders underpinning the Medical Act 1983 and other Acts, provides the ability to bring in strong regulations to protect patients and the public in respect of language competency. The Government have done exactly that. There will be future opportunities to legislate in the form of a Law Commission Bill, which would make it possible to neaten up the already very robust and strong regulation on language testing that we have introduced. I am sure that we will consider doing so at the first opportunity.

I hope that such measures will reassure my hon. Friend the Member for Stone. Thanks to this Government, strong laws have been passed, and very strict new rules are now in place to ensure that doctors practising medicine in the UK can do so only if they can communicate with patients using a high standard of written and spoken English. With that reassurance, I hope that he will withdraw his new clause.