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Lord Clement-Jones: The amendments are not directed at a UK citizen practising within the EU as regards PLAB but only as regards the IELTS.
Baroness Carnegy of Lour: But presumably a European Union citizen practising in this country would be affected by that directive.
Lord Clement-Jones: The two amendments only relate to UK citizens, not to cross-border working by EU citizens outside the UK.
Baroness Carnegy of Lour: I apologise. I misunderstood.
Lord Soulsby of Swaffham Prior: I support the noble Lord's two amendments. I declare an interest as a member of the academic board of St George's University.
The noble Lord clearly explained the intricacies of British graduates returning to this country from medical schools overseas. In the past, I have been associated with the University of the West Indies. Graduates from that university's medical schools on
three islands can come to this country without let or hindrance in many ways. It is anomalous that graduates of a school in Grenada of equal quality cannot do so.By virtue of the fact that we are short of medical graduates, one could at the stroke of a pen increase the number available and the number going for training. St George's is already set up. If the amendments were carried, it is likely that a greatly increased number of British graduates would take a medical degree at St George's University.
I remind the Committee that the medical programme at St George's is to take the pre-clinical and some of the para-clinical teaching in Grenada. Then the clinical students are farmed out to selected clinical departments in the United States and this country. There is of course a tendency for the United States students to go to the US and for the British students to come here. When graduation takes place, we have British graduates who have been trained at clinical level in British medical schools. Consequently, they are entirely familiar with medical issues, programmes and problems in this country. Such a development would certainly be convenient to the medical profession in terms of supplying well-trained graduates for our health service.
Baroness Howells of St Davids: I support the noble Lords, Lord Clement-Jones and Lord Soulsby. I am confident that my noble friend the Minister is aware of concerns that the provision in question exists for one purpose only—to discriminate unfairly against individuals who obtain their medical degrees outside the so-called white Commonwealth. I understand that the GMC is concerned about that distinction at a time when we freely speak about globalisation. I trust that my noble friend the Minister will undertake to look again at that suspect wording because I understand that the GMC would like the distinction abolished.
Lord Filkin: The amendments raise interesting and important issues in the context of the NHS seeking to ensure an adequate number of trained professionals.
It has been recognised in statute for some years as right and necessary that the GMC should satisfy itself about the English language ability of a person who qualifies in medicine overseas. The only exception is our treaty obligation to our European partners to allow freedom of movement by EU nationals. That does not mean that a French doctor would be able to practise in the UK if his English language skills were poor. He would have a right to register with the GMC but it would still be perfectly possible for a health authority or health trust seeking to employ such a person to satisfy itself that he was suitable by having adequate fluency in English. We need not be fearful that the measure is leading to something grossly inappropriate.
To be fair to all who apply for registration, it is right that the GMC must have a rule of some kind and that it should have as few exceptions as possible. For example, the rule should apply also to people who are British citizens. One can imagine cases where a British
citizen emigrated at a young age and may not have the facility in English needed to be a doctor in this country. The GMC wants to be as helpful as possible, both to be fair and because it appreciates the value to the UK of people with overseas qualifications who want to work here. While we do not think that the amendment is the right route, it may be helpful to get the GMC to reconsider how it satisfies itself under its obligations of English language ability. The standard test may not always be necessary, but that is a matter of GMC policy rather than law. I understand that the GMC will follow carefully today's debate and take from it lessons for consideration.The new clause is also wrong to confine itself to people wanting to work in the NHS. There should be one standard for registration, regardless of a person's intended employment in health professions. So while I cannot support the amendment, I understand the sentiments that motivate it and hope that a solution can be found as I have suggested. If the Government were persuaded in future, in the light of fuller consideration by the GMC, that a change in the law was necessary, an order under Section 60 of the Health Act 1999 would provide an appropriate vehicle.
The noble Lord, Lord Clement-Jones, is correct to say that there is no legal requirement for a British citizen to take a language test. The Act requires that the registrar of the GMC is satisfied that applicants—including British citizens, unless they have EU rights—have the necessary knowledge of English. The test itself is not a requirement of the Act.
The noble Baroness, Lady Carnegy, raised the issue of the directive. We think that it is probably the directive on the mutual recognition of medical qualifications. No, it is not. We shall keep searching.
Baroness Carnegy of Lour: I am sorry for raising the matter without having checked it. I thought that it might be helpful to ensure that the Government had considered that in replying to the amendment. I am sorry if I have wasted the Committee's time.
Lord Filkin: We shall have a further opportunity to reflect on that and, if appropriate, give a subsequent answer. We will of course need to check the specific relevance to the issues we are discussing today.
Amendment No. 89 is also unnecessary. It would compel the GMC to maintain a list of recognised overseas qualifications. As the Committee will know, the GMC already does so and I am unaware of any case in which people seeking a registration or wanting to check a doctor's registration have had any difficulty getting the GMC to share the list with them.
However, this is a good point at which to say something about the substantive issue of recognised overseas qualifications, which several Members of the Committee have raised. There have been concerns that provisions of the Medical Act 1983 discriminate unfairly against those who obtained their medical degrees outside the so-called white Commonwealth. My noble friend Lady Howells was clear on that point. The GMC would like that distinction abolished and,
broadly speaking, we share its view. It proposes—and we support it—to abolish the status of recognised overseas qualification that degrees from 22 universities currently hold. Graduates from those universities will then be in the same position as those from the hundreds of other institutions world-wide whose medical courses are recognised by the World Health Organisation. They would have to demonstrate their competence at the point of registration—as do graduates from the United States or, say, India, currently.The Government, in the light of the GMC's consideration, will use the next suitable Section 60 order to make the necessary amendments. Discussions with the GMC have already begun on that, and we plan to lay the order before Parliament later in 2002 after full consultation in the normal way.
Some important points were raised about St George's. My noble friend Lord Hunt recently met representatives of St George's Hospital and a group of hospital friends in the UK. He has asked departmental officials to consider the issues raised. He recognises the potential and quality of the medical education at St George's. While the Government's approach is not exactly the same as that proposed by the noble Lord, Lord Clement-Jones, in Amendment No. 89, we feel that it is an appropriate manner in which to proceed. It will ensure that there is no unfair discrimination and that suitably qualified medical people are able to practise in the UK. I urge the noble Lord to withdraw the amendment.
Baroness Masham of Ilton: Before the Minister sits down, perhaps I may ask him whether the provision includes doctors from South Africa.
7.15 p.m.
Lord Filkin: I am fairly certain that the system that I described would apply to doctors from all around the world, and would therefore include those from South Africa.
Lord Clement-Jones: I thank the Minister for his reply, which, as he said, was not entirely in line with what I want. I thank the noble Lord, Lord Soulsby, and the noble Baroness, Lady Howells, for their support for the amendments. They seek to ensure that we make the best of a potential pool of properly qualified, well-trained graduates and that there is no discrimination in favour of white Commonwealth universities—a phrase used by both the Minister and the noble Baroness. It is important that we are not in the business of levelling down. That is where the current GMC proposals and what the Minister had to say are unsatisfactory.
I understand the issue about the IELTS. It may well be possible to persuade the GMC not to apply it to UK citizens. I take the Minister's point about it being up to hospital trusts to vet their doctors, but there is considerable pressure on trusts to take on doctors. If they are already registered on the basis that they have a somewhat rudimentary knowledge of English, it is
difficult not to accept them. The essential check is on registration, and UK citizens are being required to take a language test at that point. That seems rather anomalous.
I agree with the Minister that it is perhaps not entirely appropriate to legislate on the matter, but he then went on to say that a change may be made by regulation under Section 60 of the Health Act 1999.
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