My Lords, I support these amendments. As my noble friend has excellently explained, we are probing the use of “substantially” and highlighting what we see as its inadequacy. The Minister’s own amendments start to tackle this problem. Both the British Dental Association and the British Medical Association have concerns that the proposals focus too heavily on simple qualifications and do not adequately recognise the importance of skills and experience, as well as the vital requirement to be of good character and to put patient safety first. This is fundamental in healthcare and being of good character is of course important in teaching-related professions.
The noble Baroness, Lady Finlay, earlier outlined the concerns of the Health and Care Professions Council. The Minister may argue that the BMA, the BDA and so on are not regulators, but they represent their profession. They have a stake in the respect in which that profession is held, and they pay substantial annual fees for the recognition of their qualifications. The impact assessment makes it clear that the proposals in the Bill will be likely to increase those fees.
In some measure, the amendment encapsulates the fundamental problem with the Bill. It tries to impose a simplistic solution on an endlessly complex and dynamic situation. The Government have grossly underestimated how long it will take to replace the current structure with an adequate and comprehensive alternative. The interim recognition of qualifications is swept away on enactment of the Bill, on the grounds that it gives preference to EEA and Swiss nationals before a replacement is necessarily ready. What will it be replaced with? Another set of recognition for qualifications from countries which will then be given preference as a result of international trade arrangements.
3.15 pm
The impact assessment goes into pages of tortuous argument about the considerable costs and lengthy processes by which the current structure will be replaced by individual regulators, including the potential reinstatement, either for individual EU countries or for the block of 27 countries as a whole. I confess that I felt an element of farce creep in when I read that. Given that background, I can be forgiven for thinking that there will be interruptions in the market and therefore a temptation to cut corners, and thus “substantially” is not an adequate insurance. A medical qualification obtained abroad may be substantially the same as the one in the UK, but if the small
variation was that students were not given the same understanding of the meaning of the Hippocratic oath, that would be a fundamental problem, hence the importance of incorporating both skills and experience, and, for healthcare professions generally, of recognising patient protection as an overarching guideline.
I would have greater faith in all this if there were any reference to universities. I declare an interest as chancellor of Cardiff University. There is no reference in the Bill to universities, other higher education institutions or other training providers. They are not even listed in the impact assessment as stakeholders, so presumably they have not been consulted. In practice, the quality of all these qualifications depends on the education and training that these organisations provide, and regulators are to a large extent simply relying on the outcome of their work. Two students coming out of two different universities with degrees in biology may have studied a different range of knowledge or may have studied it to a different level of detail, so regulators have to work closely with HEIs to ensure that both scope and depth of knowledge are maintained in whatever field they need, so they need a mention in the Bill.
It is possible to imagine that, as a result of a trade deal, a UK regulator may seek an agreement with a regulator in another country where not all educational institutions or qualifications are fully accredited by that regulator. Therefore, it is essential that recognition of qualifications is only ever agreed with the regulator in each country, and the Bill must specify this too. I will take a different example: the teaching regulators. Teachers qualified and registered to teach in England are not recognised as qualified to teach in Wales. One could argue that the learning and knowledge involved is substantially the same, but the requirements on skills and experience are somewhat higher and different in Wales.
This is all so much more complex than “substantially”, and the Bill needs a significant amendment to reflect this.