Moved by Baroness Hayter of Kentish Town
15: Clause 1, page 2, line 23, at end insert—“(5A) Regulations under this section relating to priority professions may not be made unless—(a) they have been published in draft form, and(b) the relevant regulators have been consulted on them for a period of three months beginning with the day on which they are published.(5B) In this section “priority professions” means—(a) healthcare professionals,(b) social workers,(c) teachers, and(d) veterinary surgeons and veterinary nurses.(5C) In this section, the relevant regulators are—(a) Nursing and Midwifery Council,(b) General Medical Council,(c) General Pharmaceutical Council,(d) Health and Care Professions Council,(e) General Optical Council,(f) General Dental Council,(g) Pharmaceutical Society of Northern Ireland,(h) General Osteopathic Council,(i) General Chiropractic Council,(j) Social Work England,(k) Scottish Social Services Council,(l) Social Care Wales,(m) Northern Ireland Social Care Council,(n) Teaching Regulation Agency,(o) General Teaching Council for Scotland,(p) Education Workforce Council,(q) General Teaching Council for Northern Ireland, and(r) Royal College of Veterinary Surgeons.”
My Lords, in moving Amendment 15 I will speak to Amendment 27, both of which are in my name and those of the noble Lord, Lord Patel, my noble friend Lord Hunt and the noble and learned Lord, Lord Hope.
These amendments are here for two reasons. One is that the regulators listed already have the power to recognise professionals from other jurisdictions, so they are somewhat at a loss as to why they should need to be covered at all. The other is that the maintenance of their standards is particularly crucial to the lives of patients—be they human or animal—pupils and clients. If there is any chance that they will be mandated to open up their approval system further than it is already—because they already have one—at the behest of the Government, then there must be the most thorough consultation and agreement. This really is too important to leave to chance. We need a legal commitment to consult in the Bill for the priority professions listed in the amendment.
In answer to the question posed by the noble Baroness, Lady McIntosh, during our debate on an earlier amendment, the Government had a list—the Minister sent it in a letter to the noble Baroness, Lady Noakes—of all the regulators covered, but this group of healthcare and personal care professionals already have the ability within their statutes to do the necessary for international. So there is this two-way reason why we put them in the amendment: their clients or patients are particularly vulnerable if standards fall, and they already seem to have this power. Therefore, for the Government to take a power to ask them to do something outwith what they want to do seems to require a particularly high level of consultation. I beg to move.
My Lords, I will be brief. The requirement in these amendments for regulations to be published in draft form and consulted on is sensible, for the reasons that the noble Baroness has given. I just do not see why they are confined to this so-called priority list, because any profession that could be brought within the ambit of Clause 1 or Clause 3 should be treated in the same way. While we can sympathise with the medical professions and vets being priority groups over such mundane things as auditors and farriers, in practice any profession that might be impacted by these sorts of regulations, and could therefore have its standards impacted, ought to be covered in a consultation process.
I do not think the consultation process, as drafted in these amendments, should be confined to the regulators, because it is not just the regulators themselves that would be impacted by any regulations made under these clauses; so would the professionals operating in those regulated professions and all the other groups affected by them. I support consultation being in the Bill because of the unusual nature of the powers the Bill is taking, but I do not think it should be confined to the so-called priority groups.
My Lords, I have added my name to Amendment 27, which is principally in the name of the noble Baroness, Lady Hayter of Kentish Town. There is a lot to be said in this particularly obscure Bill for the publication of regulations in advance of their being made, so that people can see them in draft and consider them before they take effect. Regulators themselves would of course be consulted if this amendment is passed, but publication gives the opportunity for the wider public to scrutinise them, and no doubt inform this House and the other place, before the crucial point comes when the regulations are made. So I support this particular amendment.
There is a lot of force in the point just made by the noble Baroness, Lady Noakes, that to confine this provision to the priority professions perhaps misses the point. Perhaps there should be a requirement across the board. There are other important professions that are not in this list. I am not claiming this particularly for the legal profession, as there are certainly other professions that are absent from this list, given the enormously long list of people who are within the purview of this Bill. The amendment may be a starting point but, for what it is worth, I support it.
My Lords, it is a pleasure to follow the noble and learned Lord. I put my name to these amendments because I regard full and transparent consultation as very important. At its heart, the integrity and independence of our regulators is at stake. The problem is that the Bill gives far too many powers to Ministers. In the previous debate the Minister said that future trade agreements will not compromise standards. I wonder what our farmers and fishers think of that. We know that the Government are desperate for trade deals and that they have a track record of carelessness about their details. Clause 3 gives Ministers a completely free hand when it comes to trade agreements.
This debate is also set in the context of the independence of health regulators and fears that it may be compromised. Earlier, the noble Lord, Lord Purvis, made a cogent analysis of the interrelationship, or lack of it, between this Bill and the current extensive consultation by the Department of Health and Social Care on the reform of the health regulatory bodies. Those proposals are extensive and, as suggested by the noble Lord, Lord Purvis, give extensive powers to each regulator to streamline its own processes. I support that, because the public will benefit from more streamlined approaches to fitness to practise, which will deal with issues more quickly.
However, alongside this, it is widely expected that the forthcoming NHS Bill announced in the Queen’s Speech will contain extensive provisions on the very same regulatory bodies in health that we are talking about today. One provision will be to allow Ministers, by regulation, to abolish a regulator and establish others. I have huge reservations about this, because surely it puts their independence at risk if, on a whim, a Minister can get rid of a regulator that they do not like. When you put that prospect together with this Bill, alarm bells start to ring. Consultation is not everything, but it is a safeguard. My noble friend’s amendment would provide one such safeguard that I believe we need.
My Lords, I am delighted to speak in the right place in the right order on these two amendments and I apologise for what happened earlier. I congratulate the noble Baroness, Lady Hayter, on bringing forward these two amendments. I echo the concerns expressed by my noble friend Lady Noakes as to why they are limited to certain professions and not others. I am not entirely sure that all medical professions are represented here—the noble Baroness, Lady Hayter, can confirm whether this is the case.
The noble Baroness will know that I am wedded to statutory consultation, and she has clearly set out what the specific forms of the consultation would be. With that support, I look forward to hearing my noble friend the Minister say whether he can see merit in these or whether they should be extended to other professions as well.
My Lords, I agree with the comments of the noble Baroness, Lady Noakes, and my noble and learned friend Lord Hope of Craighead. The amendment could be extended to include all professions rather than just the health profession, but I will concentrate my comments on the health profession.
I support the amendment in the name of the noble Baroness, Lady Hayter of Kentish Town. Currently, the General Medical Council, as the regulator of doctors, has powers to regulate the training of doctors; to regulate clinical training following a degree course at university and the foundation years; and to regulate and approve specialist training conducted by the Royal Colleges. The curriculum is provided by the Royal Colleges but the General Medical Council approves it. The council then maintains a register of generalists and of specialists. In my case, it would be the specialism of obstetrics and gynaecology; I therefore could not practise cardiac surgery unless I was trained and approved by the regulator to be put on a specialist list of cardiac surgeons. The risk about not having consultation and producing regulation is that the regulator cannot then change the rules.
Amendment 27 is more to do with international agreements. There have been occasions when hospitals overseas have tried to open a branch for provision of specialist medical services with a view to their own people—their own doctors—delivering the care, until it was pointed out that that cannot be done.
It is possible—I have done it myself—to go to the United States and practise in a given hospital with a visa that allows you to do so, without having to go through any regulatory registering process or have experience and qualification approved. What we do not have, and quite rightly so, is a similar arrangement in the United Kingdom. It would therefore be wrong for any trade agreement to allow for that provision. Having the ability to guard, through consultation, against that is extremely important. Hence, I support Amendments 15 and 27.
My Lords, I am very pleased to have the opportunity to speak on this group of amendments, and to reflect on the comments of the noble Lord, Lord Patel. He has reminded us of the complexity and sensitivity of these issues, with his example of medical practice in America. It is a country— the richest in the world— with the very highest medical standards, but it does not have the guarantees of high standards, perhaps, that we rightly want to take for granted in this country. I think he has pinpointed an important sensitivity on this issue.
I welcome these amendments, especially the emphasis on consultation, since I am very worried about the lack of awareness of this Bill beyond this Chamber. I think it is right to say that some of us in this Chamber have woken up only gradually to the huge complexity of the Bill. The Minister himself expressed some surprise at it, and the more that can be done to raise awareness among regulators and among the professions affected the better.
I have one very specific comment: I was struck, on reading the impact assessment, on how narrow the Government’s consultations with regulators were prior to the laying of this Bill. Out of 150 professions and 60 regulators, only a dozen were involved in some of the consultation. They were asked questions about the costs and, in one case, there were replies from only three of them. The costings we have been given on an expensive new policy are based, in some aspects, on replies from three regulators, and they could hardly be regarded as a representative cross-section. There is a real worry for us about a lack of understanding of the complexity of the Government’s policy.
My Lords, I thank the noble Baroness, Lady Hayter of Kentish Town, for her amendments and I note that the noble Lords, Lord Patel and Lord Hunt of Kings Heath, and the noble and learned Lord, Lord Hope of Craighead, are supporting them. These amendments introduce a duty to publish, in draft form, any proposed regulations where they relate to the professions listed, and to consult on these regulations before they can be made under Clauses 1 and 3—the powers to provide for individuals to be treated as having UK qualifications and the implementation of international agreements respectively. I have spoken at some length about the commitment to engagement on both clauses but let me provide some further reassurance specific to these amendments.
First, and perhaps most importantly, the Government, through this Bill, will not and cannot bring forward regulations that affect the autonomy of regulators or the standards that they set. With the greatest of respect to noble Lords, I sometimes feel that they think there is more to this Bill than meets the eye. There is not. This is a Bill which, at its heart, is about the mutual recognition of professional qualifications. It is not, and could not be, a Trojan horse for the Government to somehow choose to undermine the autonomy or the standards of regulators. It would be the height of foolishness for any Government, not just mine, to do so. I suggest that a little injection of reality about what this Bill is about should creep into some of our debates, and I say that with the greatest respect to noble Lords.
I turn first to Amendment 15 to Clause 1, which would mean that, if one of the listed professions were deemed to meet the demand condition in Clause 2, and regulations under Clause 1 were justified, there would be a three-month period of consultation with their regulators before regulations relating to those professions could be made.
I recognise that the professions and regulators specified by the noble Baroness are primarily those supporting our important public services. It is of course essential that any regulations made under the Bill support the delivery of public services and complement regulators’ existing practices. However, there seems little merit in listing, in primary legislation, a set of priority professions —my noble friend Lady Noakes put this very succinctly —which would be subject to change as demand changed. To do so could unduly restrict the ability of the Government, or the other national authorities, to respond quickly and efficiently to the needs of the professions on the list when they were deemed to have unmet demand.
Moreover, let us remind ourselves of what Clause 1 does. It requires regulators to have a route to consider applications from these people. It does not tell them that they have to accept these people or that there has to be a diminution of standards in relation to them; it requires regulators to have a route to consider them. This in no way undermines the carefully constructed architecture that our regulators have put in place to protect patients, consumers and other users of regulated services. Decisions under the Bill will be informed by careful engagement with professions and their regulators, and not introduced without warning. I agree that regulators will need to be involved from the outset, and have time to prepare for changes.
Amendment 27, which relates to Clause 3, seeks to make a similar requirement to publish and consult on draft regulations, with the same regulators and professions, in relation to implementing parts of international agreements on the recognition of professional qualifications. As I have explained previously—and will no doubt have to continue to do—a key concern for the Government in all negotiations is ensuring that the autonomy of regulators within these trade agreements protects UK standards. That applies to all regulators and professional bodies which may be within the scope of an international agreement, not just the ones specified in this amendment.
Through the Department for International Trade the Government engage with a range of stakeholders, including regulators, to understand their priorities and inform the UK’s approach to trade with future trade agreement partners. We have several forums to inform these negotiations, including the trade advisory groups, which hold strategic discussions to help shape our future trade policy and secure opportunities in every corner of the UK. We also hold many ad hoc consultations with interested parties. BEIS also organises regulator forums that provide updates on the negotiations and the terms of trade deals.
In addition, to consult before making regulations at the point at which the international agreement being implemented has already concluded would, frankly, be too late to meaningfully impact the substance of the agreement. That is why in May this year we launched a public call for input as we prepared for trade negotiations with India, Canada and Mexico. I encourage all those with an interest, and of course that includes all regulators and professions, to respond. Why would we not want to know what people think before we embark on the negotiations? To think that we should consult them after the agreement has been effectively finalised, when it is being prepared for parliamentary scrutiny, seems, with great respect, to be shutting the stable door after the horse has bolted.
On Clause 3, it is important for the UK Government to be able to meet our international obligations on professional qualifications, to support UK professionals and trade in professional services, and to do so in a timely fashion. I know that on a later group of amendments we will come back to further examination of this clause.
I trust that this gives reassurance to noble Lords on the engagement of professions, including the professions cited in the amendments but of course all others, before any changes are enacted through regulations through Clauses 1 and 3. I ask that the amendment be withdrawn.
My Lords, there is a problem in what the Minister said. He talked about consultation and a call for input, but that is very passive. As I mentioned on an earlier group, unless you know that the Government are going to be looking at your profession, who would think to input at the beginning? On a later group we will come to the need to have a negotiating mandate, because at that stage that might stimulate people to think, “Oh gosh, that’s my profession.” If the Government would like architects, surveyors or whatever to be covered then they may start talking about it, but just putting out a call does not actually tickle the trout; people do not know that they should be involved. What the noble Baroness, Lady Randerson, said was interesting: people do not even know that the Bill exists, so the idea that they are following the situation and will keep looking at websites just in case their profession is affected is not going to happen.
There is an issue, not just about the Bill but about all sorts of measures, of the Government’s consultations consisting of, “We hope you’ll hear what we’re doing and will come and tell us about it.” The Minister has talked about the trade advisory groups. I am sorry to go on about this again, but there are no consumers on any of those groups. Again, the users of those professional services, be they clients of City lawyers or whoever, will not actually sit on those trade advisory groups so are not part of that inner circle that is kept close.
The Minister has basically said, “You can trust us. The Government wouldn’t bring forward regulations that affected the independence of regulators. We would never think to abolish a regulator.” The problem is that he was not in this House—quite a few of us who are here today were, including my noble friends Lord McAvoy and Lord Foulkes—when we had the Public Bodies Act. Do noble Lords remember that? It abolished 32 public bodies with a skeleton Bill and then by statutory instrument. The poor noble Baroness, Lady Noakes, has to put up with me all the time because the National Consumer Council was abolished under that Bill; had it not been, I probably would not have had so much cause to be here because there would have been a statutory body on the formal list that the Government have to consult, and a lot of the stuff that I come in on at a very late date probably would have been dealt with before. So we have previously had a Bill on the basis of “Trust us, we won’t go round abolishing things”, and now here we are: we have no National Consumer Council any more. There is history here that predates the Minister, and that is why we would like a little more evidence in the Bill.
These principles have had clear support from everyone who has spoken. It is interesting to be accused by the noble Baroness, Lady Noakes, and other noble Lords, of being too modest and to be told that I should have gone further than just this group. But take it from me, the amendment that we will bring back on Report will be much broader and will require prior publication of the draft regulations in good time.
I am slightly worried when things have to be hurried through. The noble Lord talked about setting up a process. If you had asked the regulator to set up a process, they would probably have done it, so you would not need the regulation. Where the regulator does not want to do this and a regulation has to be brought in in order to get them to do it, it is absolutely essential that there is plenty of time for consultation.
So I thank noble Lords for supporting the amendment. Obviously I give notice that it will be in broader form on Report. It might be better, however, if we could come to an arrangement so that there is a form of words that the Government can live with. If there is going to be consultation, there is no harm in having that in the Bill. It would be good if we could work together to make that happen, so that we do not have to divide the House. For the moment, I beg leave to withdraw the amendment.
Amendment 15 withdrawn.