Motion to Approve
That the draft Regulations laid before the House on 17 September be approved.
My Lords, these regulations relate to the recognition of professional healthcare qualifications in the UK and social work qualifications in England. They are part of the Government’s preparations for the end of the transition period. As noble Lords will be aware, the Government have signed agreements with the EU, the three EEA EFTA states and Switzerland in relation to the UK’s withdrawal from the EU. These agreements include provisions that protect the rights of EEA EFTA state professionals with qualifications covered by the directive, and Swiss nationals living and working in the UK, and vice versa.
European healthcare professionals have played, and will continue to play, an important role in the delivery of health and care services in the UK. We have been clear throughout the EU exit process how valued these professionals are and how we would like them to remain in the UK. It is for that reason that the previous SI, which we are amending today, maintains automatic recognition of relevant European healthcare qualifications for a limited time after the end of the transition period. It is also why a number of health professions, including doctors, nurses and social workers, are on the shortage occupation list.
These regulations specifically implement the agreements that we have signed with Switzerland and the EEA EFTA states, and as such affect a very small number of professionals. For example, on 30 June 2020 there were 80 doctors and 32 nurses and health visitors among a total of 134 Swiss healthcare professionals working in the UK. This legislation also makes some minor amendments to the provision for EEA EFTA-qualified professionals, of which there were 230 working in the UK on 30 June this year.
While the number of professionals impacted is very small, it is important that there is legislation in place to protect the rights of these healthcare workers wishing to come and play a part in the UK healthcare workforce. On 14 September 2020, the House considered legislation brought forward by the Department for Business, Energy and Industrial Strategy which set out arrangements for the recognition of professional qualifications from Switzerland and the EEA EFTA states. These regulations now cover a similar area. They implement the Swiss citizens’ rights agreement and the EEA EFTA separation agreement, in relation to the recognition of professional qualifications for healthcare in the UK, and social work in England.
Regarding the current framework, I will remind noble Lords of the background to the recognition of professional qualifications, or RPQ. The current system for this recognition is derived from EU law. It allows UK professionals to have their qualifications recognised in the EEA and Switzerland, and vice versa, with minimal barriers. There are seven professions where standards are harmonised under the relevant EU directive. This means that qualifications must comply with minimum agreed standards. Five of these harmonised professions are health professions: doctors, nurses, midwives, pharmacists and dentists. The recognition arrangements under the directive have supported the movement of European health and care professionals to the UK. Between 1997 and 2019, more than 77,000 EEA and Swiss qualifications in the professions of doctors, nurses, midwives, dentists and pharmacists have been recognised in the UK. At the end of the transition period, the EU directive will cease to apply to the UK and the mutual recognition of professional qualifications will end.
Last year, in preparation for the UK leaving the EU, Parliament passed regulations to amend the domestic law that implements the current EU system for RPQ. This included regulations in relation to recognition arrangements for health and care professional qualifications, namely SI 2019/593. These regulations, which come into force at the end of the transition period, include provisions which, first, ensure that healthcare qualifications which are currently recognised continue to be recognised automatically, for up to two years after the end of the transition period. Secondly, they protect previous recognition decisions. Thirdly, they allow applications for recognition submitted before the end of the transition period to be concluded. Fourthly, they remove the provision for healthcare professionals to deliver temporary and occasional services in the UK once such current registration comes to an end.
Since the passing of the previous regulations, the Government have secured agreements with Switzerland—the Swiss citizens’ rights agreement—and the EEA EFTA separation agreement. These agreements go further than the arrangements set out in the regulations that were passed last year. Therefore, the regulations before the House today amend the previous SI to implement the terms of the Swiss and EFTA agreements.
I will explain the main changes. First, they provide a four-year period of continuation of the automatic recognition system for Swiss nationals. Secondly, they allow Swiss healthcare professionals to continue to provide temporary and occasional services under certain conditions. Thirdly, these regulations will require UK regulators to co-operate with their EEA EFTA state and Swiss counterparts to ensure that EEA EFTA state EU-qualified professionals and Swiss nationals whose professional qualifications are recognised are treated on the same basis as UK nationals. These arrangements will be reciprocated by the EEA EFTA states and Switzerland respectively.
These regulations also make a minor amendment to ensure that the frameworks for RPQ will function as intended after the transition period. This makes sure that GP qualifications obtained before the reference date specified in the mutual recognition of professional qualifications directive are recognised in the same way as specialist medical qualifications obtained before that date, and are not eligible for automatic recognition.
UK regulators of healthcare professions have been consulted on an informal basis throughout the development of RPQ EU exit legislation, including these regulations. The devolved Governments were consulted regularly throughout the process. They are supportive of our approach and consent has been given by the Scottish Parliament to take this legislation forward.
These regulations are necessary to implement the Swiss citizens’ rights agreement and the EEA EFTA separation agreement, in respect of the recognition of professional qualifications. These agreements were signed after the passing of previous EU exit legislation on this matter. These regulations enable health and social care professionals and businesses to prepare for the end of the transition period. I commend them to the House.
My Lords, my understanding is that these regulations are a tidying-up exercise to continue to recognise existing Swiss and other EFTA health professionals with qualifications after the end of transition this year. This does not address plans for future pathways of recognition. However, I would like to focus on professionals of whom we need more to clear the backlog of treatments—that is, dentists, who are a bit different from other health professionals. Can the Minister confirm that, irrespective of any new agreement made with the European Union, the General Dental Council will be able to continue to recognise the qualifications of all graduates of dental schools within the EEA, without the need for candidates to sit the overseas registration exam?
Can the Minister also tell me what steps have been taken by the General Dental Council to resume overseas registration examinations for non-EEA overseas dentists, which have been halted due to Covid, and ensure a continuing pathway for recruitment of EEA and non-EEA dentists? In light of the backlog of 15 million treatments, surely we need all the dentists we can get.
As the Minister will know, the NHS dental service does not have a registration system like the medical services do. Each course of treatment is a separate contract. Even with the same dentist, there is no obligation for either party to continue the relationship after a course of treatment ends, except to sort out any issues relating to a recent course of treatment. The patient is free to go to another dentist, and the dentist is free to decline further NHS courses of treatment.
The result of the lack of any registration system is that after a course of treatment ends, nobody has any obligation to find another NHS dentist for any patient. This gives NHS patients no security whatever about continuity of treatment, either preventive or responsive. Given that this situation has been made worse by Covid-19, and given the shortage of NHS dentistry in some areas, does the Minister’s department have any plans to ensure we have enough dentists going forward after the end of the transition phase of exit from the EU?
My Lords, there is much to be welcomed in these regulations. It is essential that there are minimal disruptions in the NHS and social care workforce at the end of the transition period. The coronavirus pandemic has shown us that these workers are the most essential among us, and any measure that encourages workers to come to the NHS and our social care services is needed.
I am pleased the Government are going beyond the 2019 SIs to ensure that Swiss and other EEA workers have longer periods to apply for recognition and can continue to provide services. However, some detail is still in the dark. First, it is unclear what reciprocity there will be for UK nationals wanting to work in EEA countries. Will UK qualifications be recognised in EEA countries following the transition period?
Secondly, these are temporary measures, but individuals who wish to come and work in the UK need certainty for the long term. The health and social care sector needs sustainable and reliable immigration to fill posts with high-quality professionals. Can we get any indication today of what the long-term plan is for immigration from these countries?
There is a staffing crisis in our NHS and in social care. We are all well versed in the figures: 122,000 vacant posts in English trusts alone and a pledge of more than 50,000 nurses from this Government. Workforce issues that already existed have been exacerbated by the referendum result and the pandemic, meaning that wards are often understaffed as staff isolate. With the Government’s immigration Act receiving Royal Assent last week, I must use this debate as an opportunity to ask the Minister what steps the Government are taking beyond this legislation to encourage immigration within the health and social care sector.
As this legislation relates to Swiss nationals, it is worth remembering that in September, Swiss voters decisively rejected an accord that would end free movement. This is something our neighbours in Europe value, and we need to be shown to be making immigration as fluid and free of barriers as possible. That is not the current impression.
Finally, I would like to make a remark about parliamentary scrutiny. In 2019, we saw a huge number of SIs come through this House preparing for the worst-case scenario—leaving the EU with no deal. Debating the 2019 SIs was seen as almost pointless, since crashing out of the EU seemed so unlikely and, as the Prime Minister said, would be a case of failed statesmanship. However, we are now in mid-November and no deal is appearing more and more likely, with little news from Brussels or this Government about the progress of negotiations. Has adequate thought been given to what was initially seen as contingency planning? And was there enough parliamentary scrutiny of the 2019 SIs? I sincerely hope so.
Many of the issues I wanted to raise with the Minister have been raised by the noble Baroness, Lady Jolly. I accept that we will be supporting this regulation and that it is necessary as a tidying-up exercise.
As we know, nationals of the EU and other countries make up 9.1% of doctors in England’s hospitals and community services. They account for 6% of all nurses and 5.8% of scientific, therapeutic and technical staff. As the noble Baroness, Lady Jolly, says, we have 106,000 vacancies across the NHS, including—according to my figures—44,000 nursing vacancies. And we have about 120,000 vacancies in social care. My question, echoing that of the noble Baroness, Lady Jolly, is: what will happen if we have no deal? What will happen to the ability of people to come to this country and work?
When we debated the previous regulations more than 18 months ago, we asked the then Minister what assurances could be given that the NHS would be able to stem the huge losses of those important health and social care staff. Given the numbers I have mentioned, can the Minister confirm whether any study has been made of the costs and barriers that might prevent applicants from the EEA and Switzerland entering the country and the possible impact on the health service? This might be a good opportunity to ask for progress and an update on the issue of the social care workers with which the Government agreed during the course of the immigration Bill.
It is clear that the regulations are temporary, but there is no clarity about the plans to introduce sustainable, long-term arrangements for registering and licensing EEA and Swiss nationals. Will the Minister give us some further information about what longer-term plans there are in the current timeframe and the four-year period provided by this statutory instrument?
My Lords, I am enormously grateful for the searching questions of the noble Baronesses. They have covered an enormous amount of ground, and I am not sure whether I can cover it all in my remarks. I will endeavour to write to them on some of their specific questions.
The noble Baroness, Lady Walmsley, asked a large number of pertinent, relevant and searching questions on dentists. We are extremely conscious of the provision of dentists during Covid, the ongoing commitment to improving Britain’s dentistry and the significant contribution of those from overseas to the dentistry practice. Provisions such as this SI and many others like it are there to ensure that dentists from overseas continue to be welcome in the UK and that we can meet the needs of the British public. I would be happy to write to the noble Baroness with some detailed answers to her questions.
The noble Baroness, Lady Jolly, rightly referred to the challenge of recruitment in health and social care, which we take extremely seriously. We have put in place an enormous marketing campaign to build the substantial and important NHS brand. We are recruiting more than ever before, and rather than reducing numbers, Covid has led to an increase in people stepping forward.
As I said in my opening remarks, we remain committed to workers from overseas. They make an invaluable contribution to health and social care, and nothing that we are doing through these provisions, the immigration Bill or any of our other provisions in any way diminishes that enormous contribution. As reciprocal arrangements will be subject to negotiated outcomes, I cannot make the commitments that the noble Baroness requested. However, I assure her that the regulations put in place in these statutory instruments and the others like it ensure that registration is possible and is part of our commitment to those who come to Britain from overseas to work.
I emphasise that the changes contained in these regulations are essential to ensuring that the UK meets its commitments, not only to overseas workers in general, but also, specifically, under the Swiss citizens’ rights agreement and the EEA-EFTA separation agreement. In response to the noble Baroness, Lady Thornton, that is part of a general commitment to those who come to Britain from overseas to work in health and social care. The UK Government are committed to protecting citizens who benefit from rights under the Swiss and EEFA agreements, many of whom make valuable contributions to the UK workforce. These regulations maintain existing rights for EEA, EFTA and EU-qualified workers and Swiss nationals beyond the end of the transition period and ensure that the UK’s existing EU exit regulatory frameworks for RPQ will function effectively at the end of the transition period.
I am enormously grateful for the support shown by many noble Lords for these measures, and I commend these draft regulations to the House.