NHS and Social Care: Impact of Brexit

Viscount Bridgeman Excerpts

Thursday 21st July 2016 Lords Chamber

[Viscount Bridgeman (Con)]

My Lords, I thank the noble Baroness, Lady Watkins, for securing the debate.

I draw your Lordships’ attention to a very interesting and concise blog from Miss Clare Marx, the president of the Royal College of Surgeons. She makes three important points. The first, already voiced in many quarters, is that losing non-UK staff would, in her words, be “cataclysmic”. I totally echo the words of the noble Baroness. Toughened migration rules often affect technicians, porters and cleaners. A clear message must be sent to the Government that the NHS needs to retain these vital staff.

Miss Marx’s second point is the opportunity that will be presented to the NHS to improve patient safety. Up till now, the UK has been required to accept the lowest common denominator of standards across Europe. An example is that some devices have found their way into the UK having been approved in European countries with lower safety standards. In many cases, these standards need to be toughened up, but at the same time the baby must not be thrown out with the bathwater. Care must be taken. The stricter regulations could make it harder to attract international innovators in healthcare. In other words, a sensible mean must be struck.

Ms Marx’s third point is a vital aspect of the changed climate in which healthcare in the UK will find itself post-Brexit—language testing. This is a subject not infrequently aired in your Lordships’ House. The law as it stood until 2012 was governed by directive 2005/36, which concerned mutual recognition of professional qualifications by all member states. Under this directive, healthcare was lumped in with professions such as engineering, surveying and so forth. It meant that English language testing could be made only following registration by the appropriate body, such as the General Medical Council and the Nursing and Midwifery Council.

The effect of this, particularly in the case of nurses, was that there were cases where a candidate could obtain registration and disappear, as far as the regulator was concerned, never to be seen again, with, of course, their English language ability untested. There were cases where the only evidence of English proficiency was a certificate obtained for a fee at a street corner in an eastern European capital. Representations were made, particularly from the UK, that healthcare differed from other professions, in that there was the additional consideration of patient safety and that it accordingly required special treatment. Thanks to the persistence of the Department of Health—I particularly mention my noble friend Lord Howe and my honourable friend Dan Poulter in another place, both at that time Ministers in the Department of Health—the Commission accepted the case for language testing of health professionals prior to registration. This can now be required not as a routine, but when the relevant regulator has reasonable grounds to believe that a candidate’s English language skills are not adequate.

This has been a step in the right direction, but it is not enough. At present the EU, within the constraints I have just mentioned, permits testing only on broad English language skills—effectively, conversational English—while to take the case of the GMC, candidates from outside the EU are required to show English language proficiency in, and I emphasise this, a clinical context. There is a huge difference between these levels. Note-taking is a particularly strong tradition in British medical practice. As one facetious journalist has written, the difference between a microgram and a milligram can be a coffin.

I urge the Minister to give priority to completing this mission, which is to require that all healthcare professionals coming to this country, from within and without the European Union, are subject to meaningful English medical language tests prior to registration. There is an urgency about this—patient safety is involved—and I hope this can be put in hand straightaway in the time remaining while the UK is still within the European Union, if not in the hopefully constructive environment post-Brexit, freed from any constraints imposed by Brussels.

The other matter that needs urgent review is the working time directive. Surgeons in particular have had long-standing concerns about the impact of the working time directive on time for training. In 2014 the task force on the EWTD concluded that we need greater flexibility for training hours while ensuring we never go back to a culture of excessive working hours that can only harm patient care. I understand the task force is due to report shortly. We await this with interest.

Finally, a brief word about research. It is essential that arising out of the Brexit negotiations there is sustained funding and continuing mobility of researchers and clinicians to ensure that the UK research industry can thrive and advance patient care.

I declare my record as a remainer at the referendum, but, as has been widely quoted, we are all Brexiteers now. I am confident that Brexit will provide a not-to-be-missed opportunity to rectify some of the anomalies and deficiencies in clinical practice that continuing membership of the European Union has involved.