Charlotte Leslie is Member of Parliament for Bristol North West. Follow Charlotte on Twitter.
As EU Budget negotiations rage, then drag on in Brussels, the world sees the EU Commission drift even further from reality in its expectations over its own expenditure. Meanwhile, firmly back in reality, another dangerous and tragic side-effect of Planet EU is unfurling, in hospitals up and down the country, on a daily basis.
The sad irony is that health is not an EU competency – it was never supposed to have any remit over member states’ health services. However, through a seeping of side-effects, EU Directives are having a devastating effect on the training of our doctors, and the safety of our patients.
The two main culprits are the European Working Time Directive, limiting junior doctor training to 48 hours per week; and the ‘Recognition of Professional Qualifications Directive’ – which has prevented the General Medical Council from making the ability to speak English a requirement for medical registration for EU Doctors – unlike non-EU doctors who must pass a language test.
Each directive is beginning to reap its own grim headlines; There is the case of Dr. Daneil Ubani who caused the death of his patient David Gray by injecting ten times the recommended dose of diamorphine. He was able to treat patients despite having failed an English Language test. And earlier this year, after the tragic death of Kane Gorney who died from dehydration in hospital, the coroner identified the Working Time Directive as one of the key factors responsible.
These are two high profile cases, but doctors are warning that, beneath the headlines, there is ongoing cause for concern. The Working Time Directive is estimated to have wiped out 400,000 surgical hours per month. 81% of consultants are concerned about its impact on training. Almost a fifth of surgical trainees were aware of specific, formally reported adverse incidents resulting from reduced working hours or more handovers. No one wants a return to 100 hour weeks for junior doctors. But the irony of all this? 86% of surgical trainees report no improvement in their work-life balance at best.
At the same time, the EU Professional Qualifications directive intrudes into our healthcare system by insisting any professional with certain qualifications and registered in one member state must be recognised in any other member state. That means that the GMC can only test language after registration, and, even then, it is not allowed to test ‘systematically’ – only when a problem has already been flagged up. This seems a bit late.
It is then the employers (NHS Trusts) task to make sure the doctor has the right competencies and skills – but they tend to bow to the EU’s insistence that EU doctors are not ‘systematically’ language tested. What’s more, self-employed doctors and locums – who are being employed in increasing numbers to fill gaps in rotas caused by the working time directive-, can easily slip through the net. In 2010, a Pulse report found that despite calls for employers to test doctors, only 23% of EU doctors had their competency checked, only 17% tested for language skills. In 2012, only a further 4% of untested doctors have been tested.
A major part of the problem is that the UK does things differently from the rest of Europe. In the UK, recognition of qualifications, and ‘registration’ are one and the same, overseen by the GMC. In Germany they are separate, meaning that Germany can grant a theoretical ‘recognition’ of qualifications, a nod to the Euro-dream, but not grant them a licence to practice. It may be that we need to find a way to do the same.
These problems are urgent and real. But action so far has been slow, and seems timidly obsessed with obeying EU law to the letter, not on protecting vulnerable patients in the NHS. That has to change. In a new report for the 'Fresh Start' project, reshaping our relationship with Europe, Andrea Leadsom MP and I identify three areas we need to look at.
Firstly, what we can do here in the UK to make the rules work for us, not us work for the rules. The Government is looking at ways of policing language testing more effectively, and that is welcome. But we should not be afraid to be robust, fit the rules to what we want, and copy the German way of doing things on language testing. Patients, not protocol, must come first.
Second, work with other EU countries. It often seems like we are the only whinging man of Europe, but we are not. Other nations are fed up with language competency, and the Working Time Directive hitting their health service. Many are simply not complying with the rules. The EU Commission knows this and is looking again at the language testing issue, and is trying to negotiate a way through the working time directive. We should find allies and push that process as much as possible.
However, we have to be realistic. Waiting for EU agreement on the Working Time Directive is like waiting for Godot. Talks on The EU Budget negotiations show how inadequate and out of touch the EU commission has become in sorting out its own problems. If we really care for our patients, we should be prepared to simply disapply those elements of EU law that are damaging patient safety on a daily basis. It may not be popular, but we can always remind our critics that member states’ health systems were never supposed to be touched by the EU in the first place – and in applying the spirit of the law, we are simply being good Europeans.