Medical Act 1983 (Amendment) (Knowledge of English) Order 2014

Lord Hunt of Kings Heath Excerpts

Tuesday 11th March 2014 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, welcome the order. It comes, of course, from a report which followed the death of David Gray in 2008 after he received medical treatment from Doctor Ubani, a German national working his first shift as an out-of-hours doctor. Doctor Ubani gave David Gray an overdose of diamorphine which was 10 times the recommended maximum dose. A Select Committee investigation followed, looking at the use of overseas doctors in providing out-of-hours services, which was published on 8 April 2010. This recommended that the Government make the necessary changes to legislation that would allow the GMC to language-test those applying for registration. The order follows that and we welcome it. I commend the GMC and the noble Earl’s officials for their work in this area.

A number of points have been raised. I was interested in the BMA briefing on this matter which encapsulates some of the issues to which noble Lords have referred. It particularly concerns the area of fitness to practise. I agree with the noble Lord, Lord Kakkar, that the fact that the order covers the fitness to practise of doctors who are practising rather than those who are wishing to practise is a significant advance.

The BMA is right to ask for safeguards to ensure that testing for language competency is not abused. As it points out, a doctor’s language competence may not be a cause for concern but may be used as a conduit to prevent a doctor working where an employer may have more general concerns. One can recognise the circumstances in which this could be used. I would be interested to know what safeguards the GMC proposes in this area. Clearly, careful differentiation is required between situations when language is the main cause of concern and when there are other underlying problems such as professional or personal issues.

The BMA also states that an assumption has been made in these proposals that if someone is found not to hold a sufficient standard of English following a fitness-to-practise investigation, the situation is remedial and language competence could then be improved sufficiently over time to allow the doctor to continue to work in the UK. The BMA points out that while this may indeed be the case, it is concerned that the quality of English tuition may be very variable and that some responsibility might need to be taken by the GMC to signpost doctors to expert language training.

My next point was raised by both the noble Baroness, Lady Finlay, and the noble Baroness, Lady Brinton—namely that language competence is not the sole area which determines the likelihood of a doctor not trained in the UK experiencing difficulties. Effective communication is far broader and, indeed, has been highlighted by the GMC’s programme for doctors new to the UK, which looks at professional and ethical standards along with the importance of effective communication. I agree that it is essential that those new to the UK understand and apply the ethical and professional standards expected of them. That reinforces the point made by my noble friend Lord Turnberg that in the case of specialists from other countries, we sometimes do not know what we are getting.

I refer the noble Earl to a further briefing from the General Medical Council which stated that, by January 2016, the Government will have the opportunity to implement into UK law the new language requirements in directive 2013/55/EU on the recognition of professional qualifications. These clarify that competent authorities throughout Europe, such as the GMC, should have explicit powers to assess the language competence of all health professionals after their qualifications have been recognised but before they are allowed to practise.

The GMC considers that at that point we should be able to produce a more comprehensive scheme for language controls before doctors are given a licence to practise in the UK. Will the noble Earl confirm the GMC’s interpretation and can he say anything more about the timelines for this country implementing directive 2013/55/EU in the UK? Will he also confirm that, in so doing, we will be able to meet the point raised by the noble Viscount, Lord Bridgeman, in relation to other health professions? The point he raised about nurses is very well taken, particularly in view of the fact that they are very mobile in terms of where they work. It would be good if the noble Earl could confirm that as well.