New Clause 4 — Doctors’ language skills

Prayers – in the House of Commons at 10:30 am on 9 January 2015.

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The Secretary of State shall by order make regulations enabling the General Medical Council to ensure that all doctors holding a licence to practise medicine in the UK have appropriate language skills to communicate effectively with their colleagues and patients.”—(Sir William Cash.)

Brought up, and read the First time.

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee, Chair, European Scrutiny Committee

I beg to move, That the new clause be read a Second time.

It is terribly important to use opportunities of this kind to discuss matters of such importance properly on the Floor of the House. It does not mean that we always have the right answers—sometimes, we do not even have the right questions—but there are some really important issues that need to be given an airing so that people outside can hear the nature of the discussion, rather than having that discussion held by an agency on its own account or, alternatively, by the civil service and then put forward in a Government brief.

Basically, this is a new proposal that deals with doctors’ language skills. There are many people in this country who believe that this is an important issue. It is pretty obvious that ensuring that doctors have appropriate language skills is rather important, especially given what happened in a particular case. I do not remember the names of the individuals concerned, but I seem to recall that the case involved a father who died after being treated by somebody from Germany. It seemed to be pretty likely, if not certain, that the reasons that happened were to do with a lack of proper language skills and proper experience of the medical practices in this country. The doctor was effectively coming here as a locum without appropriate qualifications or sufficient skills to be able to give the kind of treatment that was needed, and the result was a tragedy. Other Members of Parliament may have other such examples.

This is a very important issue. Indeed in April last year, the Medical Act 1983 was amended to strengthen the arrangements to ensure that all doctors have sufficient knowledge of English before being able to work in the UK. My new clause would help to ensure that all doctors were able to communicate effectively with colleagues and patients, which would sufficiently reduce the risk to patient safety caused by a lack of understanding of the English language that could result in the misdiagnosis and mistreatment of conditions. Many people regard that as common sense.

Photo of Jacob Rees-Mogg Jacob Rees-Mogg Conservative, North East Somerset

I thank my hon. Friend for giving way. I am sorry to bring him on to familiar ground, but would this new clause be acceptable under European Union law?

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee, Chair, European Scrutiny Committee

My hon. Friend quite properly puts that question to me as I am Chairman of the European Scrutiny Committee of which he is a member. We always come across these questions of interpretation. The short answer is that in relation to the issue of having appropriate language skills, the parameters for the communication of information between the patient and the person giving the treatment would be described as being within the framework of public health and the importance of ensuring that the people concerned—the patient—had not only adequate treatment but the opportunity to ensure that they were not put in danger. I think that in those circumstances it would pass muster and that we could legislate on our own account. If there were ever a challenge, I would propose that we introduce a further provision reading “notwithstanding the European Communities Act 1972” and then legislate. If we did that, under sections 2 and 3 of the 1972 Act the notwithstanding formula would enable us to bypass the European Court of Justice and ensure that we could legislate on our own account in this House to ensure that language skills were needed in English to ensure that patients in this country were properly safeguarded. I hope that I have dealt with my hon. Friend’s point.

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee, Chair, European Scrutiny Committee

I see him nodding and I am glad that I managed to pass that test. I am always grateful to my hon. Friend, who ensures that we all keep up to the mark.

On this occasion, I think we would have the capacity to make the change in the first place, but, if not, perhaps we can take a belt and braces approach in the House of Lords and use the notwithstanding formula. We shall see.

Photo of Jeremy Lefroy Jeremy Lefroy Conservative, Stafford

Again, I am most grateful to my hon. Friend Sir William Cash for tabling this new clause, which covers an important subject—the language skills of doctors—although of course the language skills of all involved in clinical care are vital.

Clear and understandable communication is essential to safety and the quality of care of patients. Language skills are a necessary condition for good communication, but not a sufficient condition. They must be accompanied by good communication skills, with which not all of us are automatically blessed, however good our language skills. Communication skills teaching is now an essential part of training in medical and nursing schools and it is to the credit of the previous Government that they ensured that it was embedded in the curriculum of new medical schools and was taken forward in existing schools. I welcome the Government’s support for that important approach.

I understand that regulations have been in place for a short while to ensure that all doctors, whether from within or from outside the European Union, have appropriate language skills before being granted a licence to practise. I want to hear from the Minister what the effect of those important regulations has been and whether he believes that new clause 4 is necessary. I would also like him to consider whether the assessment of language skills should include communication skills within that language.

Photo of Jacob Rees-Mogg Jacob Rees-Mogg Conservative, North East Somerset

I want to speak in support of my hon. Friend Sir William Cash. This is an important new clause on a matter that it would be wise to have clearly set forth in primary legislation.

The heart of the matter is, unfortunately, the European Union and the mutual recognition of qualifications within the EU, and there are good reasons for that. The only way to open up service industries generally is if mutual recognition of qualifications takes place, so if we are to have a single market in services that is an important basis for it. However, above and beyond that there must be a fundamental principle of patient safety, which is embodied in this excellent Bill, and a lack of good language skills and of understanding of a language is a danger in both directions. It is a danger for the doctor who is listening to the patient explain his or her symptoms and it is also a danger when the doctor explains to the patient what steps the patient needs to take for better health. If there is confusion, it can have a seriously deleterious effect on the patient’s health.

We must be clear that this is not about restrictive practice or protecting the market for British doctors but about ensuring that there can never be such confusion. As my hon. Friend the Member for Stone says, if this provision runs into trouble with the European Union, we need to state clearly that it is of such fundamental importance that it must override international treaty obligations. It was Disraeli who said in his speech in the Manchester free trade hall in 1872, “Sanitas sanitatum, omnia sanitas”—that the first duty of Minister is the health of his people. That statement has underlined and guided Conservative policy for nearly a century and a half.

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee, Chair, European Scrutiny Committee

I recall that Disraeli also said, “The Tory party is a national party or it is nothing.”

Photo of Jacob Rees-Mogg Jacob Rees-Mogg Conservative, North East Somerset

Indeed, although I am less clear on the relevance of that, and I was not intending to swap Disraeli quotations all morning. I just wanted to make that point about a fundamental principle that has guided our party since the 1870s and its relevance in defending health through ensuring that there is a proper standard of English-speaking—or in Wales, Welsh-speaking—physicians.

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee, Chair, European Scrutiny Committee

My hon. Friend used the word “ensuring”. That reminds me that insurance is a very important ingredient in the question of health and language skills—and, as my hon. Friend Jeremy Lefroy said, communication skills as well. If there were to be a failure of language, the consequence of which was to breach the terms on which an insurance contract was devised as between the patient and the national health service, as well as others involved in the contractual relationship, there would be massive financial consequences that could, in certain cases, run into millions of pounds.

Photo of Jacob Rees-Mogg Jacob Rees-Mogg Conservative, North East Somerset

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.

Photo of Philip Davies Philip Davies Conservative, Shipley

I apologise for not being here when my hon. Friend 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 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.

Photo of Jeremy Lefroy Jeremy Lefroy Conservative, Stafford

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?

Photo of Philip Davies Philip Davies Conservative, Shipley

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 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”.

Photo of Jacob Rees-Mogg Jacob Rees-Mogg Conservative, North East Somerset

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.

Photo of Philip Davies Philip Davies Conservative, Shipley

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.

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee, Chair, European Scrutiny Committee

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.

Photo of Philip Davies Philip Davies Conservative, Shipley

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.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health) 11:00, 9 January 2015

Thank you for calling me to speak, Madam Deputy Speaker, and happy new year.

I listened closely to Sir William Cash introducing his new clause 4 and to the other hon. Members who have spoken on it. They are correct to say that good communication between professionals and patients is crucial for ensuring positive health outcomes. I would go so far as to say that it is critical. One of the issues that we need to address in this regard is the needs of patients with sensory impairments, such as deafness and blindness. That is not covered by the new clause and it has no regard for nationality or language skills.

In April 2010 the Health Committee conducted an inquiry called “The use of overseas doctors in providing out-of-hours services” following the tragic death, to which the hon. Gentleman referred, of David Gray in 2008 after receiving medical treatment from Dr Ubani from Germany, who was working his first shift as an out-of-hours doctor in the United Kingdom. The report recommended that the Government make the necessary changes

“to enable the GMC to test the clinical competence of doctors and undertake systematic testing of language skills so that everything possible is done to lessen . . . the risks of employing another unsuitably trained . . . doctor in out-of-hours services.”

Following this case, I understand that the Government have, with the support of Labour, worked to strengthen the powers of the General Medical Council in this regard. We welcome that.

Notwithstanding all this, I am unsure what the hon. Gentleman is trying to achieve. Given the existing practice of the GMC, the new clause, although agreeable in principle, is superfluous. The GMC conducts English language assessments already, and failure to undertake an assessment or failing such an assessment can result in fitness to practise hearings, which can lead to a loss of registration to practise.

These assessments can be triggered in a number of ways. A single complaint from a patient, a health professional or another party can result in an assessment, as can prescribing errors and poor record keeping. Overseas medical regulatory authorities can prompt an English language assessment if they believe that a doctor does not have sufficient knowledge to treat patients in an English-speaking context. Indeed, the GMC website tells international doctors that

“you must satisfy us you have the necessary knowledge of English to get registration with a licence to practise”.

So the GMC needs to be satisfied before a licence to practise is granted. These tests relate to all forms of communication—speaking, reading, writing and listening. It is right that the GMC continues to be vigilant in its oversight of this requirement. Good communication is central to patient safety, and the GMC does a great deal to ensure that those practising in the NHS have the skills required to do so safely.

I want to place on record an acknowledgement of the contribution made to our national health service, which I know nobody doubts, by the many overseas health care workers without whom the NHS would not be able to cope, including in my constituency. On Second Reading of the National Health Service (Amended Duties and Powers) Bill, my hon. Friend Mr Skinner commented that he had received a “United Nations heart by-pass” operation, by which he meant that people from all over the world had done a great deal for the health of this country, and we should all be thankful for that.

We have touched briefly on unintended consequences. Some politicians have recently sought outside the House to manipulate and inflame the issue with a view to creating an imaginary bygone Britain in the public consciousness as part of a long-standing flight from reality based on bizarre notions such as “gay rain”, the enforced segregation of breastfeeding mothers from public spaces and the right to use racist language. We must all be careful not to legitimise this abhorrent, detached, cultish behaviour or the perverted mindset which underpins it.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health

I am grateful to my hon. Friend Sir William Cash for tabling the new clause. We all agree that it is vital that doctors can speak and communicate effectively in English. My hon. Friends the Members for North East Somerset (Jacob Rees-Mogg) and for Shipley (Philip Davies) made a number of important points.

I hope I can bring some reassurance to hon. Members that there are already in place, thanks to changes introduced by this Government, a number of strong tests for language competency and the ability to communicate. It is not good enough for a medical professional to be able to speak English; it is important in all aspects of health care that we can communicate effectively with our patients. The ability not just of doctors from overseas when they work in and contribute to the NHS, but of doctors who have been working here for many years to communicate effectively is at the heart of good medicine. There are a number of steps that this Government have taken to strengthen the tests in place.

To echo the comments of the shadow Minister, I have worked alongside many doctors and many health care professionals from all over the world who have come here to contribute to our NHS and to the care of patients. Many of those doctors have been outstanding and continue to look after patients today as we debate the new clause. One of the strengths of our diverse NHS is that because we have a world-class health service, doctors want to come here and contribute as part of their careers, often for a short period, before they return to New Zealand, Australia or the many other countries from which they have come. The diversity of our NHS and the fact that we attract doctors—often the very best doctors—from all over the world is a great strength, but it is vital that all doctors can both speak English and communicate effectively in English. That is not controversial, and it is what good patient care is all about.

Clause 5 and the schedule will introduce a consistent overarching objective for the Professional Standards Authority and professional regulators—the General Dental Council, the General Optical Council, the General Osteopathic Council, the General Chiropractic Council, the Nursing and Midwifery Council, the Health and Care Professions Council and the General Pharmaceutical Council—to ensure that public protection is at the heart of what they do.

The clause introduces the term “well-being” into the objectives of a number of these regulators. This has been a long-standing and established feature of the legislation for the General Pharmaceutical Council, the Health and Care Professions Council and the Nursing and Midwifery Council. The term encompasses those aspects of a health orcare professional’s role that may have an impact on individuals but may not directly impact on their health or safety: dignity, compassion and respect are all vital aspects of delivering high-quality care. This was highlighted most starkly in the Francis inquiry report of February 2013, which put into focus the terrible and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust, which was the basis on which my hon. Friend Jeremy Lefroy introduced the Bill.

One specific area where real changes in the protection of patients are being made relates to the strengthening of arrangements to ensure that all health care workers have sufficient knowledge of English and the ability to communicate effectively with patients in English before being allowed to work in the UK. The General Medical

Council has always been able to check the language skills of doctors from outside the European Union who want to practise medicine in the UK. It does this through the international English language testing system, which covers all four language skills—listening, reading, writing and speaking—and it is widely accepted by employers, the other health care regulators and professional bodies as a means of assessing proficiency in English in a professional environment. The GMC continually assesses the effectiveness of this test to ensure its robustness.

In addition to this test of their language skills, the GMC conducts a professional and linguistic assessments board exam—often called the PLAB exam—for doctors from outside Europe. This tests their reactions to a number of clinical scenarios and their ability to apply their clinical knowledge to the treatment of patients and is the main route by which international medical graduates demonstrate that they have the necessary skills and knowledge to practise medicine in the UK.

However, following the death of a patient, David Gray, and the tragic circumstances surrounding that death in 2008 after he received medical treatment by Dr Ubani, a German national, where language skills were a strong component in the incident, a House of Commons Health Committee report recommended that the Government change the law to allow the GMC to extend language tests to doctors within the European economic area, providing consistency in how doctors from both within and outside the EEA are treated with regard to assessing their language skills, before being allowed to practise medicine in the UK.

The Government made a commitment in the 2010 coalition agreement, which the shadow Minister has mentioned, to stop foreign health care professionals working in the NHS unless they have passed robust language tests. We have fulfilled that commitment in respect of doctors, and we are now putting in place additional measures, through section 60 orders, to introduce language testing for other health care workers.

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee, Chair, European Scrutiny Committee

Is the Minister satisfied that the measure complies with European law and that we do not need a notwithstanding arrangement? He may hope that it will not fall foul of the European Court of Justice, but has he taken advice on that? If not, will he do so after we have finished our proceedings?

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health

I hope I can reassure my hon. Friend on that. I am absolutely sure that our measures are consistent with European law and I took advice consistently on that, although there was a difference of opinion in how the previous Government and this Government interpreted advice. I work very closely with the General Medical Council, which receives its own independent advice, and I worked with its former chair, Sir Peter Rubin, who has been a tireless campaigner for the measure. Together with the GMC, we introduced measures that are consistent with European law and mean that we are able to test the language competency of EU doctors. I am sure that there is consistency: a similar process is in place in Bavaria in Germany. Although there can be free movement of qualified health care professionals to different member states—their skills can benefit our NHS—it is also important that they can perform a doctor’s functions properly, and it is not possible for them to do that if they cannot speak English and communicate effectively with patients. Our measures are consistent with the advice I have received and, indeed, with the views of the GMC. This is the right thing to do and I am pleased that the coalition Government have put in place language tests.

Last April, I led through this House changes to the Medical Act 1983 to strengthen the arrangements to ensure that all doctors, including those from within the European economic area, must have sufficient knowledge of English before being able to work and look after patients in the UK.

I hope my hon. Friend will agree that patients are much better protected by the new powers the Government have given to the GMC. When the GMC implemented language checks for European doctors in June 2014, it also raised the pass mark for its language tests. The GMC has vigorously used the powers given to it by the Government. Since the Government changed the legislation last April to strengthen the language test arrangements, 128 EEA doctors have been refused a licence to practise medicine in the UK owing to inadequate language skills. That shows that the measure is working to protect patients in the UK from EU doctors who cannot speak English effectively. It is having an effect—it is biting—and making sure that patients are being properly protected. I will write to hon. Members to outline the measure further, and I will perhaps ask the GMC to contribute to that letter. The measure was long overdue and I am proud that we introduced it. It is protecting patients in the UK from doctors who cannot communicate effectively.

As part of a belt-and-braces approach to ensure that all doctors looking after patients can speak a good standard of English and communicate effectively with them, in 2013 responsible officers in England—senior doctors in health care organisations who oversee the employment of other doctors—were given addition statutory responsibility for ensuring that doctors

“have sufficient knowledge of English language necessary for the work to be performed in a safe and competent manner”.

In addition, on medical revalidation, which was raised by my hon. Friend the Member for Shipley, the Government have taken the important step of ensuring that all doctors must show evidence of competency on a maximum of a five-yearly basis in order to maintain their medical licence. That has improved checks on all aspects of a doctor’s work, including how well they work as part of a multidisciplinary team, how well they communicate with their patients and whether they are keeping up do date with medical practice.

Doctors must now provide evidence at their appraisals that they are communicating effectively in line with the standards set out in the GMC guidelines, “Good medical practice”. Effective communication skills include treating patients with compassion and sensitivity. That is just as important as having technical knowledge of the English language and goes to the heart of the Bill promoted by my hon. Friend the Member for Stafford, which addresses some of the problems flagged up by the Francis inquiry, including the need for all patients always to be treated with dignity and compassion. Those values are at the very core of our revalidation process, which is overseen by the GMC.

Photo of Philip Davies Philip Davies Conservative, Shipley 11:15, 9 January 2015

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?

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health

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, keeping 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 practice 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.

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee, Chair, European Scrutiny Committee

I have listened to the Minister with great care and interest on the question of language skills. Despite his comprehensive description of the measures brought in, I feel that one or two areas might yet be usefully considered in the other place. I would be extremely glad if somebody raised them, just to test those measures further. This is the first time that we have heard such an excellent and comprehensive analysis on the Floor of the House in relation to a Bill of such importance. We are talking about situations in which there should be zero harm, so we do not want any doubts on the question of English language skills. In practice, I am prepared to withdraw the new clause, with the proviso that the matter should be looked at again in the other place at a future date. I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

Third Reading

Photo of Jeremy Lefroy Jeremy Lefroy Conservative, Stafford 11:26, 9 January 2015

I beg to move, That the Bill be now read the Third time.

I thank all those who have worked with and supported me in bringing the Bill to this stage. I especially thank my hon. Friend Sir William Cash, who, as I mentioned on Report, has been an inspiration, as have Julie Bailey, Ken Lownds and many others who campaigned for the Francis inquiry. My hon. Friend George Freeman, who is now a Minister, was also a driving force—clauses 2 and 3 are substantially based on a Bill that he had previously introduced—and I thank him for his work and support. I also thank all hon. and right hon. Members who served in Committee and who sponsored the Bill.

I thank the Clerks in the Public Bill Office for all their help, advice and skill, as well as the Bill team and others in the Department of Health, who worked extremely hard, for all their skill and advice. Finally, I thank Mr Reed and his Front-Bench colleagues, and my hon. Friend the Minister and his Front-Bench colleagues for supporting measures that I believe will assist us to get what we all want—higher-quality, safer and more integrated health and social care.

That is the purpose of the Bill: if it does not help in some important ways to achieve that, it will serve no purpose. I believe that it will do so for several reasons. First, it will ensure that every Secretary of State makes patient safety a priority at all times. Would that have prevented the tragic events at Mid Staffordshire or in other hospitals, surgeries or care homes? It would certainly not have done so in every case, but I am convinced that the attention given to safety would have done precisely that—prevented much avoidable harm to patients. In the important words of the Prime Minister in response to the Francis report on 6 February 2013:

“Quality of care means not accepting that bed sores and hospital infections are somehow occupational hazards—that a little bit of these things is somehow okay. It is not okay; they are unacceptable—full stop, end of story. That is what zero harm—the jargon for this—means.—[Hansard, 6 February 2013; Vol. 558, c. 281.]

Secondly, the Bill will put in place another of the necessary building blocks for the integration of health and social care that we all desire. A consistent identifier is not sufficient to bring about integration, but it is most certainly necessary and will help in some way.

Thirdly, the Bill will help the sharing of information, which is vital for a person’s care. Almost everyone with whom I have discussed this matter has told me of times when they or their loved ones have had to repeat information about their care on several occasions, or found that vital information—perhaps regarding medication or allergies—was simply not available to the person caring for them.

Finally, the Bill will bring consistency to the objectives of the regulation of the health and social care professions under the overarching objective of the protection of the public.

During the passage of the Bill, a number of important questions have been raised, both within and without the House. I am grateful to those who have raised them, because it is vital that a Bill such as this receives strict scrutiny.

A fear was expressed that the consistent identifier would become an ID card by the backdoor. The identifier could never become an ID card because it will be used only to facilitate the provision of health services or adult social care, and it must only be used in the individual’s best interests.

It has been asserted that there is no need for the duty to share information because the sharing of information is already required as part of the professional duties of health and care professionals. However, Dame Fiona Caldicott’s review in 2013 concluded that such sharing was not always happening as it should as a result of a “culture of anxiety”. The legislative landscape was found to be a contributory factor and a risk-averse attitude to information sharing was cited as a barrier to sharing by staff who deliver care directly to individuals. The Bill seeks to provide a remedy, while setting clear limits on the information that can be shared and the circumstances under which it can be shared.

Others have concerns about the Bill’s introduction of

“public confidence in the professions” to the objectives of the regulatory bodies. The Law Commission’s report of April 2014 noted:

“It was argued that maintaining confidence in the profession was being used to punish professionals who pose no threat to the public for something which incurred the profession’s, or the public’s, disapproval. Specific examples included a nurse who was disciplined for publishing a work of fiction about euthanasia and an investigation into a doctor’s behaviour at a Parent-Teacher Association meeting. Some argued that the concept of maintaining confidence in the profession was too subjective and difficult to quantify to form the basis of a statutory duty.”

The report concludes that in constructing the draft Bill on which the provisions of the Bill are based, the Law Commission was

“not seeking to change the current legal position or disrupt the relevant case law. The clause restates the existing legislative position that public protection is the regulators’ ‘main’ objective, and recognises that the public interest also consists of promoting and maintaining public confidence and proper standards of conduct and behaviour.”

I have no doubt that, should the Bill receive its Third Reading today, all the matters that I and others have raised will receive further scrutiny in the other place by experts.

No legislation can guarantee that there will be safe, high-quality care. Such care is founded on the capability, commitment and compassion of those who work day and night in our health and care services; no law can bring it about. What legislation can do, and what this Bill seeks in some small way to achieve, is to ensure that the framework within which those people work is sound—that the systems, resources, training and regulation that they need to provide safe, high-quality care are in place. In doing so, this is a Bill for both patients and professionals; for avoidable harm and poor care hurt both, while safe, high-quality care is a blessing for all.

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee, Chair, European Scrutiny Committee 11:33, 9 January 2015

I simply want to say how glad I am that the Bill has reached its Third Reading and to congratulate my hon. Friend Jeremy Lefroy on piloting it through, with the conspicuous help of the Minister and the Government. As I have said before, Ken Lownds and others have also been involved. Over the many years that I have been involved in the Mid Staffordshire situation, Ken Lownds has been a tower of strength, and we are all very grateful to him.

This is a Bill of national importance on a scale way beyond that of many private Members’ Bills. My hon. Friend deserves congratulations from all parts of the House on bringing it forward. I am glad that the Opposition are giving it a fair wind because it has a truly national purpose. It is in the interests of everybody that we achieve the kind of zero-harm care to which we should aspire.

I am extremely glad that the Bill will now go to another place, where, as my hon. Friend said, there are many experts who will no doubt say quite a lot about it. There may well be further amendments that will come back to this place. I urge their lordships to have regard to the importance of the Bill and the principles that lie behind it, and to seek amendments in the light of the fact that it is about our constituents. We, as an elected House, know—certainly my hon. Friend and I know—of the hard experience and tragedy that have been experienced by our constituents. Our constituents—the people of this country—deserve to have the improved health care that the Bill will help to achieve.

After those few words, I simply reiterate my thanks to my hon. Friend.

Photo of Jacob Rees-Mogg Jacob Rees-Mogg Conservative, North East Somerset 11:36, 9 January 2015

I follow my hon. Friend Sir William Cash in congratulating my hon. Friend Jeremy Lefroy on piloting the Bill so safely through the House. It is not necessarily easy to get private Members’ Bills through—and nor should it be—given the Scylla of the Back-Bench Tories who are not keen on new Bills coming through and the Charybdis of the Opposition, who sometimes suck Bills down to the bottom of the sea. I therefore congratulate him warmly on having achieved it.

My hon. Friend has done something that rather surprisingly was not done in the first place. The explanatory notes state that clause 1

“has the effect of removing the Secretary of State’s discretion around whether the requirements for registration with CQC should cover safety of care.”

It is amazing that the Secretary of State had that discretion. Why on earth would anyone want the Secretary of State to be able to think, “It doesn’t really matter if the safety of care is implemented or not. I think on this occasion I won’t bother with it.”? How reassuring it is that somebody has had the sense and wisdom to bring forward a Bill to close that extraordinary loophole, drawing on the experiences that are well known, particularly to the Members of Parliament from Staffordshire.

I take great comfort from what my hon. Friend said about the identifiers not being—to carry on with my Greek mythology—a Trojan horse to bring in an identity card system. It really would have set trouble alight if he had been trying to do that, but it seems perfectly reasonable to have a system that sees efficiently who people are within it and has a consistent form of identifying them. Having a notional go at an identity card system does not seem reasonable, so I am glad that he has stated so clearly that the Bill is not intended to do that. I am sure that their lordships will take careful note of that.

It is a tremendously important Bill that is being passed today, and one that I am sure that the other place will want to expedite because there is little time left between now and the end of the Session. The Bill will ensure that the primary duty of not doing harm to patients is established in law. As I said, it is extraordinary that it was not there before. I commend my hon. Friend for his discovery of that lacuna and his closing thereof.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health) 11:38, 9 January 2015

I, too, pay tribute to the work of Jeremy Lefroy. The diligence and tenacity with which he has pursued the Bill, and the collegiate nature in which he has done so, are to his eternal credit.

Members across the House, many professional bodies outside this place and others support the principles and aims of the Bill. Harm-free care is something to which everybody in our NHS aspires. Although it is something that, frankly, we should take for granted, it is something that any health care system in any part of the world must work tirelessly to achieve. Credit must go to the NHS staff, both clinical and non-clinical, who work tirelessly, often in very trying circumstances, to deliver high-quality care. I am sure that Members from all parties will echo that sentiment.

I do not wish to repeat what I said on Second Reading, in Committee or on Report, so I will keep my remarks relatively brief. The key principles of harm-free care, data sharing, and consistent objectives for regulatory authorities have been welcomed by the Opposition, and I will touch briefly on the why those things are important.

I have already mentioned harm-free care, and the Bill will give power to the Secretary of State to bring forward regulations to ensure that high-quality, safe care can be delivered. A wide-ranging power is being granted to the Secretary of State, and I welcome the Government’s assurances that any measures introduced will be subject to full parliamentary scrutiny, as is proper with such issues.

We have already debated the benefits and risks of data-sharing, and Third Reading is not the place to do so again. I have been clear about the benefits that can be realised through effective data-sharing, although there are still concerns, many of which I raised on Second Reading. It is important that the national data guardian is put on a legal footing to ensure that any issues that arise can be dealt with effectively and swiftly.

On the regulation of health and social care professions, it is logical to have a consistent overarching objective for regulatory bodies, and right that that objective is patient safety. A number of bodies continue to express concerns about a possible conflict between the practical implications of a number of those objectives, and I ask the Government to keep that under review to ensure that the Bill is effective.

The issue of public confidence runs through the entire Bill, and the hon. Member for Stafford touched on that in some detail. We all want to have confidence that the care we receive is of the highest quality, and to have confidence in the integrity and security of the data and private information that the NHS holds about us. We need to know that our data are used only with our permission and for the betterment of health and social care provision. Finally, we want confidence that doctors, nurses and others are properly supported and regulated to ensure that best practice is always followed. The Bill should help to ensure public confidence in those areas, which is why Labour will support it today.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health 11:41, 9 January 2015

We have had a productive debate, and I thank hon. Members on both sides of the House for their contributions. I put on record my appreciation for the consensual way that the Bill has been approached by all parties, and I thank Mr Reed for his constructive attitude. Few private Members’ Bills make it beyond Second Reading, and there is determination across the House to improve patient safety. I hope we can get the Bill on to the statute book as soon as possible.

I commend my hon. Friend Jeremy Lefroy who, with tireless effort, is doing his best to ensure that the terrible experiences at his local hospital never happen again. The Government have thrown their full support behind this important Bill, which will do much to improve the safety of patients and protect the public. I also commend my hon. Friend Sir William Cash on his dedication to raising some of the issues that led to the Francis inquiry and to this Bill, and for his tireless advocacy on behalf of his constituents in Stone and its surrounding areas.

We would not be where we are with this Bill without my hon. Friend the Member for Stafford. All MPs can learn from his example of outstanding public service and putting the interests of his constituents and local patients first. I congratulate him on his dedication and hard work on the Bill. I also thank my officials in the Department of Health, the Clerks of the House, and everybody who has contributed and put a lot of work into the Bill. It is rare for a Bill to get past Second Reading, and a lot of work has been done. I thank everyone who has supported my hon. Friend’s efforts to make these important changes.

I will not dwell on the importance of the Bill because we had that debate on Second Reading, in Committee and on Report. I am sure we all agree that ensuring that the CQC is operationally independent from the Secretary of State and free from political interference is vital. Not Whitehall nor the Secretary of State, but independent, professional inspectors on the ground who understand what good care looks like must carry out hospital inspections, and the Bill will further support the independence of the CQC.

The Bill will also ensure that we improve the use of information for the purposes of direct care. In Committee we discussed the importance of joined-up care, so that a doctor who receives a vulnerable patient with dementia from a care home is better able to care for them because they have access to care records for the immediate purpose of delivering care to that patient. That saves doctors and nurses time and means they can understand their patient better, and the patient will therefore be cared for in a better way. These important measures will help health care professionals to look after their patients more effectively. As Fiona Caldicott said, there is a duty on professionals to share information for the provision of direct care. That is what the Bill is about and it will hugely benefit patients. I reiterate the Government’s commitment to consulting on the role of the national data guardian in the future.

In conclusion, the Bill is about patient care and safety, which should be at the heart of everything our NHS does. This is what everyone engaged in the delivery of health care is primarily concerned about, and that is why many people—including myself—became health care professionals. We care about patients and want to do our best for them. The Bill will do much to improve the safety of patients and protect the public. It is a welcome Bill, and patients in Stafford and across the country will be grateful to the hon. Member for Stafford for introducing it. I thank him for that and urge hon. Members across the House to give the Bill their full support.

Question put and agreed to.

Bill accordingly read the Third time and passed.