I rise to support clause 13 on the regulation of health care professionals. In some ways, it falls into the same category as the one we described in relation to clause 12. The Calman commission looked at an issue, and in this instance it decided that the best interests of Scotland would be for the issue to be dealt with on a UK-wide basis. Dr Whiteford said that her response to the previous issue was not a knee-jerk one; I assume that she or one of her colleagues will now rise to explain that there will not be a knee-jerk response to this issue. There seems to be a pattern emerging: when the Calman commission recommends that things be done at a UK level, it must be wrong, and when it recommends that they be done at a devolved level, it must be right. I am afraid that that does not strike me as consistent with serious consideration of these issues.
Since the passage of the Scotland Act 1998, several new categories of health care professionals have come into existence. In some instances, their regulation has been less than complete, and when they require regulation, it is appropriate that it is done in the same place. That proposal has been supported by the Calman commission and by the Scotland Bill Committee, and it was reflected in the White Paper and in the draft Bill. The Health Professions Council, NHS Lothian and others have supported this as a sensible approach. In evidence to the Holyrood Bill Committee, the Health Professions Council observed that
“there is widespread consensus that a consistent UK-wide approach to the regulation of health professions is both appropriate and beneficial to professionals and the public.”
This is beneficial to the public and consistent for the professionals.
We support the clause instead of trying to find a reason to object to it simply because it reserves a power. That does not strike me as a sensible way of dealing with the issue. However, no doubt Pete Wishart will now try to enlighten me.
I rise to oppose the clause. This is part 2 of the great Calman clawback. Presumably we are going to see an attempt by the Tory-led Government to take powers away from the Scottish Parliament, once again with Labour complicity and support.
The Bill is characterised as one that gives powers away to the Scottish Parliament, but the previous clause and this clause demonstrate that one hand most definitely giveth, but the other most definitely taketh away. We oppose the clause, first, because it is anti-devolutionary, and secondly, and most importantly, because it is not necessary. The Scottish Parliament is totally in control of Scotland’s health services. Scottish Ministers are responsible to the Scottish Parliament and, in turn, to the Scottish people for the structure and delivery of health services. We have our own national health service in Scotland.
The Scottish Parliament has a direct interest in ensuring that Scotland’s particular needs and circumstances are taken into account in decisions made about the health service in Scotland, including the regulation of its work forces. Since 1999, we have developed a different NHS in Scotland—one based on the needs of the Scottish people.
The hon. Gentleman talks about the regulation of work forces. Does he therefore believe that we should have a separate Health and Safety Executive for Scotland?
There would probably be a strong case for that. The hon. Gentleman is entirely right. In Scotland, all the regulations for the regulation of health professionals that existed before the 1998 Act came into force are continuing to be regulated at a UK level from the Department of Health. That includes nearly all doctors, nurses and dentists. The Scottish Government have a little toehold into regulation as regards important new professions that have been designed since the 1998 Act came into force—for example, operating department practitioners, dental nurses, dental technicians, orthodontic therapists, pharmacy technicians and practitioner psychologists. It is incredibly important that we do not lose that toehold.
If the hon. Gentleman were consistent, he would be arguing that all the health professions should be regulated in Scotland. Surely it does not make sense for dentists to be regulated UK-wide and dental technicians to be regulated in Scotland, but for them all to be regulated in one place.
There is eminent logic in what the hon. Gentleman says, and there is very little of it that I could not support. Of course all these important health professionals should be regulated in the Scottish Parliament.
The hon. Gentleman confirms what I was saying. Of course they should all be regulated in one place, and that should be the Scottish Parliament. They should be under the direct control of Scottish
Ministers, because we have a Scottish national health service—perhaps the hon. Gentleman is not aware of this—that has been designed and structured by Scottish Ministers who are accountable to the Scottish people.
I do not wish to involve myself in the spat that has been entertaining us, but given that the hon. Gentleman seems to be saying that there is a different health service in Scotland that has different professions, will he explain which medical professions exist in Scotland that do not exist in England?
I am really pleased that the hon. Gentleman has asked that, because that is one of the things that I am most keen to come on to. If he is not satisfied by what I say, I ask him to come back on me, because I will list some very important professions that receive regulation from Scottish Ministers.
The most important point is that we have the toehold that I have described. All the UK devolved Administrations work together on these important issues to find innovative practices and new ways of doing things. That is important work. The current arrangements support and create dialogue and the sharing of ideas in reserved and devolved areas.
I come to the examples that the hon. Gentleman is so keen to hear about. The first is practitioner psychologists. The Department of Health originally wanted all such professionals to be educated to doctorate level. That would have posed major problems for the NHS in Scotland, where the majority of them are trained to masters level. That is why we need separate regulation. NHS Scotland has also piloted the position of physician assistant, which is an assistant to medical practitioners. Unlike their equivalents in England, such people can prescribe and work across a variety of roles in the Scottish NHS. Those are not the only two examples. Health care scientists were identified as a priority for regulation in the 2007 White Paper, in which the Department of Health proposed that the new education and training arrangements envisaged for England should also apply in Scotland, where there are different needs and a different educational system. Perhaps it has escaped the hon. Gentleman that as well as having an NHS in Scotland, we also have our own devolved education service. The training of many such professionals requires different regulation and different standards.
I do not think that the hon. Gentleman has explained exactly why Scotland needs different regulation from the rest of the United Kingdom. Will he tell the Committee how many health care scientists are practising in Scotland and who currently regulates them?
I am disappointed in the right hon. Lady, because she usually does better than that. She has clearly not been listening to what I have said. I have given three examples of new professions that have emerged since 1999 and that have benefited from separate regulation in Scotland, but there are more. Why would anyone want to re-regulate those professions, which have given such key benefits to the NHS in Scotland?
Of course there are health care scientists in England, but they are trained differently. Scotland has different educational institutions that require different regulation from those in England. That is why we are saying that it is important that these responsibilities rest with Scottish Ministers and the Scottish Parliament.
The hon. Gentleman has not answered my first intervention yet. [ Interruption. ] If Mr MacNeil would just face the front and fold his arms, the world would be a better place. Pete Wishart argued that people are trained differently in Scotland and should therefore be regulated separately. Health care professionals such as doctors and nurses come from other countries where they have been trained differently, but we still regulate them in the same way when they practise in this country. His argument is therefore specious.
Doctors who come to the NHS in the rest of the UK are subject to UK regulation. The NHS in Scotland is a different beast from that in the rest of the UK. That is the point. The NHS has been developing for the past 10 years and we have to recognise that.
Will the hon. Gentleman clarify whether he is proposing a separate Scottish college of nursing, bearing in mind that the Royal College of Nursing certifies not only all nurses in the United Kingdom, but courses across the Commonwealth? Is he suggesting that Scottish nurses would not benefit from that level of certification?
Perhaps I will stick to the amendment and put the case for continuing to leave the matter in the hands of the Scottish Parliament.
I cannot believe that the hon. Gentleman has got me animated about the issue because it seems so clear-cut. What would the position be for someone who trains as a health scientist in Scotland? Could they work in England or would they be regulated to work only in Scotland?
Reciprocal arrangements work across a variety of jurisdictions. Of course a health scientist trained in Scotland could work in England. We have a separate NHS, which has developed differently from the NHS in the rest of the UK in the past 10 years—that seems to have escaped hon. Members in the debate. It has new professions that require different regulation.
I have given way enough—I did not want to spend so much time on this, but I have been generous in giving way to several Labour Members. [Hon. Members: “Give way!”] Go on, then.
I am very grateful to the hon. Gentleman for giving way, even at the second attempt. Does he agree with the NHS in Lothian, which covers my constituency, and the Health Professions Council, which gave written evidence to Holyrood when the Scotland Bill Committee sat? It stated:
“We observe that there is a widespread consensus that a consistent UK-wide approach to the regulation of health professions is both appropriate and beneficial to professionals and the public.”
Why does the SNP differ from that approach?
I have no doubt that that is exactly what was said, but the only evidence taken by the Calman commission was from two royal colleges, which talked only about doctors.
I have already given way to the hon. Lady. The UK Department of Health evidence to the commission concluded:
“The Department of Health is not seeking any change to the reservation of the health professions in the Scotland Act 1998. In practice, both the Government and the devolved administration have always sought to apply a UK-wide framework to the regulation of health”.
It is not interested in re-reserving the issue, and I do not know why we are.
We have a different NHS in Scotland, and it is recognised that the implementation of some policies would have to be different in Scotland. Given that the provision is clearly anti-devolutionary and not in the interests of the NHS in Scotland, we will not support it, not because of any knee-jerk response but because of the examples that I have mentioned and that I hope have been accepted by the Committee. We have a toehold in regulation across the UK, we will not give it up lightly and we will oppose the clause.
I am fully behind the Government on the clause. If we listened to the advice of Pete Wishart, we would end up in a confused position. If we joined him in the Lobby tonight, some health professions would be regulated UK-wide and others would be regulated in Scotland. The hon. Gentleman referred to some dental professions that would be regulated in Scotland while dentists would be regulated UK-wide. That is clearly an anomalous situation.
Does the hon. Gentleman believe that the sky would fall in if we had an anomalous situation?
We would end up with a much worse situation than the position whereby all professions were regulated UK-wide. The latter makes much more sense. I understood from the answers that the hon. Member for Perth and North Perthshire gave to interventions that he wants all health care professions to be regulated separately in Scotland from the rest of the UK, although
I note that the SNP has not tabled an amendment to that effect. It would lead to a strange situation, which would not benefit patients.
Surely the hon. Gentleman is in error to suggest that SNP Members did not articulate the fact that they want all the professions to be separately registered in Scotland. The spokesman said that he wanted doctors and dentists to be regulated separately in Scotland—even more evidence that he is a bad man.
The hon. Gentleman is perfectly correct—[hon. Members: “Oh!”] I did not say in what he was correct. He was correct when he said that the hon. Member for Perth and North Perthshire stated that he wanted all professions regulated separately in Scotland. However, my point was that SNP Members have not tabled an amendment to that effect, which I suspect indicates that even they lack confidence in their case.
I suspect that if I respond to that intervention, Mr Hoyle, you will rule me out of order.
To go back in order, if as the SNP suggests all health care professions—doctors, dentists and so on—are regulated separately in Scotland, it would add more cost and bureaucracy. It would also mean that a doctor who is qualified in Scotland and who wants to move to England would have to get separate qualifications, and vice versa. That would not benefit patients, and nor would it assist professional development.
Does the hon. Gentleman find it strange that a nation would want to regulate its own health professionals?
I am listening closely to the hon. Gentleman. Do we not already reciprocally recognise qualifications within the EU, and is it not the case that doctors can come from other parts of the EU to practise in the UK? Therefore, what is the problem with the recognition of Scottish qualifications and Scottish regulation?
Simply put, those arrangements would add a new layer of bureaucracy and waste time. Currently, a doctor can move from Scotland to England or vice versa with no problem whatever. The hon. Gentleman simply wants to put bureaucracy in the way.
John Stevenson and the Minister, who represent the north-west of England and the south-west of Scotland respectively, are both in the Chamber. Mr Reid will probably be aware that many of their constituents, and the constituents of Members on both sides of the House, will travel to use services on both sides of the border. Does he not agree that this debate is another example of the tabling of Mickey Mouse amendments to slow down the process by a party that will come worse than sixth in the forthcoming elections?
I agree with the hon. Gentleman on cross-border traffic, which is important, but he gives SNP Members more credence than they deserve. They did not actually table an amendment—they did not put that amount of work in—and are simply opposing the Government. If the hon. Member for Perth and North Perthshire had been consistent, he would have tabled a new clause to the effect that all health professions would be regulated separately in Scotland, but he did not bother to do so. He is simply opposing a sensible Government measure.
I meant to speak for only a minute or two, but all those interventions took up quite a lot of time. I conclude by reminding Mr Davidson that in the Henley by-election, the Labour party were fifth with a lower share of the vote than the Liberal Democrats got last week.
Is it appropriate at this point to mention that fifth is actually higher than sixth? I have been approached by a number of Members in the Lobby who have told me that the Liberal Democrats came sixth only because the SNP did not stand—
Thank you, Mr Hoyle, and welcome to this debate, which I can see you are already enjoying.
I did not intend to speak for long. I was looking forward to the erudite contribution of Pete Wishart on why Antarctica should be the responsibility of the Scottish Parliament, and how after 12 years of devolution, Antarctica has been discovered to be an important matter for which the Scottish Parliament must have responsibility.
I am also disappointed about Antarctica. However, is the Minister pleased that Antarctica will now join time and outer space in schedule 5 of the Scotland Act?
I accept your ruling, Mr Hoyle, although it is sometimes important to point out to Opposition members that for the first eight years of the Scottish Parliament there was a Liberal Democrat-Labour coalition.
I would love to know why the Minister thinks that London rather than Edinburgh should have responsibility for whatever portion of Antarctica we are talking about. Is he ashamed of Scotland? Why should it be London? Why should Scotland not have that power? What is he ashamed of?
We have learned tonight that London SNP has control over Edinburgh SNP, because it is the Westminster SNP Members who determine the response to the Scotland Bill, and not their colleagues in the Scottish Parliament, who have a completely different point of view on a number of these measures.
The Scotland Act 1998 provides that the regulation of certain health professions is a subject matter reserved to the Westminster Parliament. Clause 13 implements the Calman recommendation to reserve the regulation of all health professions, not just those specified in the Scotland Act. The clause re-reserves the regulation of health professions, and I can confirm that the Scottish Parliament’s Scotland Bill Committee has stated that it is not opposed to the re-reservation of powers to the UK Parliament. The Scottish Parliament will vote on the Scotland Bill on Thursday, and we await the outcome of that vote, as I have said previously. Further, devolution is not a one-way street, and the Scotland Bill, like Calman, is about delivering a balanced package that works for the people of Scotland, as Tom Greatrex said. The Scotland Bill does just that: it updates the Scotland Act with a two-way transfer of powers.
Since Royal Assent of the Scotland Act, the regulation of any health professions not regulated by the legislation listed in section G2 of schedule 5 has been a matter that falls within the legislative competence of the Scottish Parliament. The Westminster Parliament was, therefore, unable to introduce legislation to regulate such professions without such legislation also being approved by resolution of the Scottish Parliament. Although the Scottish Parliament has had the power to introduce for Scotland separate legislation in respect of the regulation of these health professions and any other health professions not included within section G2, it has chosen not to do so and instead has approved the use of the existing, reserved machinery orders made under section 60 of the Health Act 1999 to regulate new groups of health care professionals.
The Calman commission criticised this mixed economy and considered that the current situation was unnecessarily time-consuming and cumbersome owing to the need to obtain agreement from the Scottish Parliament. The commission also pointed out that the current mixed economy presented risks in terms of consistency that could lead to the fragmentation of standards across the UK and threaten the mobility of practitioners across all four countries, which is a point that Members have raised. The Government agree that there are risks with the current situation. The Calman commission also noted that the current processes gave the Scottish Parliament some influence over the regulation of reserved professions—for instance, where there are orders and regulations relating to the regulation of professions that cover both devolved and reserved matters. The commission also took the view that there should be a common approach to the regulation of the health professions.
The Government have accepted the arguments made by the Calman commission, so the clause re-reserves the regulation of all health care professions currently regulated by legislation. It also has the practical effect of reserving to the Westminster Parliament the subject matter of the regulation of any new health professions in the future.
Notwithstanding the reservation that the clause will deliver, the UK Government will continue to agree policy in relation to the regulation of the health professions with the Scottish Government. The UK Government, through the Department of Health in England, will continue to engage closely with officials in the Scottish Government—and, for that matter, with the Administrations in Northern Ireland and Wales—to develop future policy proposals concerning the regulation of health care professionals. This will ensure that the views of the Scottish people will be taken into consideration as we go forwards, but in a manner that will deliver a consistent approach to regulation that works for the whole of the UK.
If in future a certain type of health profession develops that exists only in Scotland, is the Minister saying that regulation of it should be done in London?
Pete Wishart was challenged to identify health professions that could exist only in Scotland—and failed to do so. The regulation will be dealt with in accordance with schedule 5. When we have had some identification of a health profession that could exist only in Scotland, we will be able to look at what the hon. Gentleman and his colleagues have to say about it.
It would be good practice in shaping and making law to prepare for any eventuality. I put a particular type of eventuality to the Minister, but he has not provided an answer. If there is a certain type of medical profession that exists only in Scotland, what will happen?
I am afraid that that represents the level of debate on re-reservation that we have witnessed tonight. The SNP’s opposition to re-reservation is based entirely on dogma and political viewpoints rather than on the interests of the people of Scotland. The Calman commission looked very closely at these issues and considered that the balance lay with re-reserving the powers. The Government support that re-reservation and nothing we have heard in this debate or the previous one—or, I suspect, that we would have heard if we had had a debate on Antarctica—would convince any Member who looked at these matters either objectively or with the interests of the people of Scotland at heart to support the SNP position. I hope that SNP Members will withdraw their frivolous opposition so that the Committee will not have to divide on the issue.
Question accordingly agreed to.
Clause 13 ordered to stand part of the Bill.
Proceedings interrupted (Programme Order,
The Chair put forthwith the Questions necessary for the disposal of the business to be concluded at that time (
Clauses 14 to 20 ordered to stand part of the Bill.