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Baroness Carnegy of Lour: I agree with the noble Baroness about that, but the point of the amendment is probably that it is very much easier to set up a quango than to close it. I do not know whether the noble Barones has ever chaired anything that the Secretary of State tried to close. I have, and the Secretary of State did not close it. It is really quite difficult to shut something down.
We cannot have an ever-expanding empire when some bodies have passed their sell-by date. Whether or not the amendment is the right way to do it, the point is that subsection (3)(f) would require the Secretary of State to say whether the body was still necessary and, if not, what he will do about it. He has to say it with the knowledge of Parliament because the matter will be laid before Parliament. That is the point of the amendment, and if some way could be found to keep that requirement, it would be very helpful. A mushrooming of quangos is not a good idea if some of them are no longer necessary.
6.45 p.m.
Lord Hunt of Kings Heath: Clearly we do not want unnecessary quangos. I accept that, and it is important that all the activities of non-departmental bodies are kept under close review. If evidence arises that the job can be done better by other means, or that certain
bodies are no longer required because life has moved on, I am all in favour of bringing their activities to an end.The Government have looked at many non-departmental public bodies and have made changes. For example, we debated the proposals of the Chief Medical Officer on Monday on the surveillance and public health arena. It is proposed that one agency should be established in place of four existing agencies. There are other examples of the Government looking at rationalising non-departmental public bodies.
It is also significant that a number of the bodies to which the noble Baroness, Lady Noakes, referred—the noble Baroness, Lady Masham, also mentioned the National Patient Safety Agency—carry out important functions in terms of national standard setting. I am thinking about NICE or the Commission for Health Improvement investigating the quality of services at local level, or the National Patient Safety Agency to which National Health Service organisations will report adverse events. From that reporting, we hope to learn ways of improving the quality and safety of healthcare services. Those are important matters that need to be dealt with.
I would also argue that, having established such national bodies, enabling us to develop national standards, to which the noble Lord, Lord Clement-Jones, referred in the previous amendment, we are then in a much better position to decentralise. We can allow, within that national framework setting, National Health Service organisations at local level to have a much greater ability to decide their own destiny. Throughout the Bill we shall continually debate the balance between national standard setting and local determination. I am convinced that the establishment of a number of agencies at national level will allow us to decentralise more decision-making to local level.
I also agree with the noble Baroness, Lady Noakes, that openness about the roles and responsibilities of non-departmental public bodies is desirable in health, as across government generally. The Government's wish to promote increased accountability and openness for all quangos led to the publication of the measures in Quangos: Opening the Doors. Considerable progress has been made in this area in the past four years.
As my noble friend Lady Pitkeathley suggested, there does not seem to be much point in publishing again, in another format, information about the Department's quangos that is already available from other sources. The noble Baroness, Lady Noakes, mentioned the Cabinet Office's annual publication, Public Bodies, which already contains the majority of information dealt with by the amendment, including that for all the Department of Health's non-departmental public bodies.
In addition, the bodies themselves publish their own annual reports, including on the Internet, which gives that much more detail than is contained in the Cabinet Office's publication. Ministers remain accountable to Parliament for non-departmental public bodies. That includes informing Parliament about decisions
relating to the reviewing and abolition of such bodies. It is notable that the Select Committees of your Lordships' House and in another place frequently examine the performance of those non-departmental public bodies. They frequently call in the chair and chief executive of those bodies for what can only be described as fairly searching examination. In addition, if the Secretary of State were to issue any written directions to these bodies, that fact would be published in the department's annual report. We would expect that the bodies concerned would wish to make a similar statement in their own annual reports.I am convinced from my own experience in dealing with a number of the bodies mentioned in the debate that each of those bodies is under no illusion that we consider it very important that they are open about their activities; that they constantly examine the work that they do; and that they are encouraged to ensure that reports about their activities are published and put into the public domain. On that basis, I do not think that the amendments, while I understand their thrust, are necessary.
Baroness Noakes: I thank the Minister for that response. I thank the noble Baroness, Lady Masham of Ilton, and my noble friend Lady Carnegy of Lour for their support for the amendment.
In tabling the amendment I was trying to draw attention to the multiplicity of the created bodies. The Minister referred to the 2001 publication, Public Bodies. It shows that the Department of Health had at that time 69 bodies. The number is sure to have increased since then. The empire is growing. I understand and do not dispute that having certain kinds of agencies could lead to the ability to support further decentralisation. Indeed, at this stage I am not seeking to dispute the merits of any one of the bodies that I have mentioned or any one of the 69. My point was to draw attention to the increasing number of bodies and the increased use of non-departmental public bodies to undertake functions at the core of the Department of Health.
I am grateful to the Minister. I shall think carefully about what he has said. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Clement-Jones moved Amendment No. 88:
- After Clause 22, insert the following new clause—
The noble Lord said: Amendments Nos. 88 and 89 are quite closely related amendments. They spring from a perception of the minefield that any UK citizen who qualifies in a medical school abroad has to step through before he or she can practise in this country.
Amendment No. 88 deals with the International English Language Testing System, the IELTS. Section 19(1)(b) of the Medical Act 1983 stipulates that an applicant for full and provisional registration must satisfy the registrar of the GMC,
The GMC admits that it would prefer to test EEA nationals but it is illegal to do so because EU laws prevent discrimination against EU citizens on the basis of language. Therefore, the people who have to take the test are by and large any UK citizen who qualified outside the EEA and any non-EU citizen who qualified outside the UK. That means that someone who is British but has trained outside the EEA—loosely speaking the EU, but slightly wider—has to take an English language test. That is rather an absurd anomaly that our amendment seeks to get rid of.
It should be noted that there is actually no legal requirement for a Briton who has trained outside the EEA to take the language test. It was the GMC's decision to adopt the language test. It is not mentioned as such in the Medical Act. All that is legally required is for the GMC registrar to be satisfied that a test would be a waste of time and money. So it would be possible for the GMC in these circumstances to get rid of the IELTS requirement.
I do not know whether the Minister has had the opportunity to look at the table produced by the GMC of the tests that are required. The table covers both the PLAB and the IELTS tests. It is almost completely incomprehensible to a lay person. Therefore, we have this absurd situation which I have outlined. We also have the potentially problematic situation of an EU national—no matter where in the world he or she qualified—who speaks no English at all, starting a job in a British hospital without taking any kind of language assessment. It is not possible to get rid of this because of the EU anti-discrimination aspect, but at least we can get rid of the situation where a UK citizen has to take the test even though English is his first language. The amendment would change that situation so that UK citizens would not have to take the language test no matter where they trained.
I move to the second amendment and turn to the PLAB exam. I want to use the example of a medical school that is well known to many Members of the Committee. I see that the noble Lord, Lord Soulsby, is in his place. I know that a number of noble Lords have connections with St George's University School of Medicine. I want to use it as an example of some of the problems that arise as a result of current requirements.
St George's University School of Medicine is 25 years old. This international school boasts an extremely high standard of education for medical
What then follows for students who have qualified at St George's University and who then want to practise in the UK? They are able to come and practise in the UK in two ways. First, they must pass what is called the UEB examination. That examination is set and examined by the Society of Apothecaries. Hitherto students who wished to take the examination were assessed by certain UK universities. Having been signed off by the local dean as satisfactory, students were permitted to take this examination. Passing it gave the students registration with the GMC to work in the UK.
The second method of being able to practise in this country is taking and passing what is called the PLAB exam. That examination is set and examined by the GMC and consists of a theoretical and practical examination. In addition, all doctors applying for limited registration with the GMC must have obtained a satisfactory score, as I described earlier, in the academic modules of the IELTS.
The UEB examination in its present form will be changed dramatically. It will not, it now seems, be applicable to St George's students. All students from St George's have been told that in future they will have to take the IELTS and PLAB examinations in order to practise medicine in the UK.
So the spotlight then turns on to PLAB and the requirements for taking that exam. Older, traditional Commonwealth universities whose students have automatically received full registration in the UK include countries like South Africa, Australia and New Zealand, and the University of the West Indies. They were not required to take the PLAB exam. But the GMC has intimated that it wishes to discontinue with this so-called "élite" group of universities to level the playing field, so that overseas applicants who wish to work in this country will all have to take the PLAB examination.
It seems rather topsy-turvy to get rid of this group. One may not think that it is appropriate to have a specific élite group of universities drawn from a very narrow group of traditional universities, but we on these Benches, together with St George's University, feel that the standard of medicine as taught by the medical school at St George's is such that it is at least equal to this élite group.
Instead of disbanding that group as giving automatic exemption from PLABs, it should be increased so that a number of international medical
Along with other medical schools world-wide, St George's University School of Medicine has the capacity and expertise to train UK students who are unable to start training, perhaps because of a lack of available slots in the United Kingdom. It seems sensible to bring some order to the process whereby UK students do not have to take the IELTS and the PLAB if their medical school is of a sufficient standard. I hope that the Minister will consider the amendments, perhaps discuss the subject with the GMC and look favourably on the principles involved. I beg to move.
Baroness Carnegy of Lour: I realise that the noble Lord was talking beyond the European Union but I recollect serving on an inquiry about an EU directive which determined that while member states may have to accept individuals working in a particular profession, they may set the standards required. The list of qualifications to which Amendment No. 89 refers would exist for that purpose. Speaking English is obviously a requirement for anyone working in this country. Did not the GMC bring that aspect into the consultation?
"NHS REGISTERED MEDICAL PRACTITIONERS
In respect of registration of persons proposing to practise in the National Health Service, section 19(3)(a) of the Medical Act 1983 (c. 54) (full registration of persons by virtue of recognised overseas qualifications) shall apply as though the words "other than the United Kingdom" are omitted."
"that he has the necessary knowledge of English".
IELTS was adopted as a means of assessing linguistic proficiency following a recommendation from a Department of Health working group. It assesses skills in reading, writing, speaking and listening to English. But nationals of the EEA member states, other than the United Kingdom and others with what are called "enforceable EC rights", are exempt from having to demonstrate proficiency in English as a result of amendments to the Medical Act 1983.
7 p.m.
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