§ The Minister for Health (Dr. Gerard Vaughan)
I beg to move,That the draft European Communities (Medical, Dental and Nursing Professions) (Linguistic Knowledge) Order 1981, which was laid before this House on 11 February, be approved.This is an important order. I understand well why some hon. Members may wish to debate it. I shall do my best to answer any questions which may be raised.
The order provides safeguards for patients. It ensures that doctors, nurses and dentists coming from other parts of the Common Market cannot practise here, in the National Health Service, unless they speak English adequately for their job and unless they can communicate reasonably with their patients and their colleagues. All hon. Members will agree that it is essential for the safety of patients that they should be able to talk to, be understood by and understand the doctor they are seeing. We are talking not only about clinical doctors but about doctors working in laboratories who also need to be able to understand instructions and to communicate adequately with people.
I stress that the changes proposed in the order will not depart from the principle that people in health professions must be able to communicate accurately with each other and with their patients. We do not regard this as negotiable with any body, whether national or international. The order merely changes the point of application of language tests in respect of a very small number of practitioners from testing before registration to a need to satisfy an employer that the person is able to speak English sufficiently well to carry out his work. It applies only to professional people from the Common Market.
I shall well understand if the hon. Member for Crewe (Mrs. Dunwoody) asks why a change is necessary. The answer is that is legally necessary in order to comply with Community law. One aim of the Treaty of Rome is that workers should be free to move between member States. When it comes to professional people whose ability to practise depends on having a recognised qualification, directives have been issued providing for mutual recognition of qualifications. Two directives were approved in 1975. One concerned training, and the other, which is relevant here, asked member States to ensure that doctors had a sufficient knowledge of the language to carry out professional work in the host country.
The Medical Qualifications (EEC Recognition) Order 1977 was intended to implement that in the United Kingdom. Under that order the General Medical Council has to satisfy itself about the knowledge of English of European Community doctors at—and this is very important—or within six months of registering them to practise medicine in this country. However, in 1979, in a reasoned opinion, the European Commission asked that that be removed on the ground that it represented a restriction of movement of professionals in contravention of article 52 of the Treaty of Rome. Included in that were not only doctors but nurses and dentists
Essentially, the Commission's legal view is that under the Treaty language competence cannot be an absolute 836 condition of continuing registration. The directives in 1977 permit no more than the provision of advice or tuition. That is most unsatisfactory. However, the Community regulation on freedom of movement of workers, which has direct effect in member States, permits employers toimpose conditions, where appropriate, as to linguistic knowledge required by reason of the nature of the post to be filled".That is what the order sets out.
We accept that the measure before the House is necessary, but let us keep in proportion what is involved. The order will affect only a small minority of professional people who come here to work. The scale of migration from countries within the European Community is modest Since 1977, only 449 EEC doctors, other than those qualified in Ireland—and, incidentally, the order will apply equally to English and Irish doctors—have been registered in the United Kingdom. For nurses, in 1979-80, the number was 35 and for dentists, since June 1980, only seven. There is no reason to suppose that the order will lead to an increase in the numbers.
§ Mr. Teddy Taylor (Southend, East)
The hon. Gentleman is the Minister for Health. Can he tell us what the health justification is for applying standards to EEC doctors different from those perhaps for Austrian doctors?
§ Dr. Vaughan
I shall be coming to that, and I shall be glad to answer further questions from my hon. Friend.
We have consulted the health authorities. In general, they would prefer that language requirements should be linked to registration which I can understand. A standardised central procedure is always attractive.
The arrangements will continue to apply to the vast majority of overseas qualified doctors who wish to work in the National Health Service.
§ Mr. Tony Marlow (Northampton, North)
Is my hon. Friend saying that the linguistic requirements of European doctors in this country will be rather lower than they are for many other doctors?
§ Dr. Vaughan
No. In many instances they will be very much higher. I shall come to that in a moment.
I am pleased to tell the House that the General Medical Council has agreed to make its central testing facilities available to all health authorities. The cost of the tests will fall upon the people who wish to come here to practise. They will not be a charge upon the health authorities. I must emphasise again that the order will apply only to Community nationals. For other people from overseas, the registration link will continue as at present. This link was established under the Medical Act 1978 and a change would require primary legislation.
The new arrangements for EEC nationals will have the advantage that they will be more flexible. They can be made more appropriate to the particular job and, if necessary, they can be made very much tougher for a particular job. They will also be tighter in that a European practitioner will no longer have the six months' period of grace. There has always been an outside chance that an EEC doctor could enter the National Health Service in general practice in an open area during the six months' period of grace. That will stop, because he will now have to demonstrate his knowledge of English at the start.
I turn very briefly to the order itself. This is a United Kingdom measure made under section 2(2) of the 837 European Communities Act 1972. As I have said a number of times, its scope is restricted to Community nationals only.
Article 1 is purely formal. Article 2 repeals the legislative link between knowledge of English and registration. Article 3 makes knowledge of English a precondition of engagement or employment.
§ Mr. J. Enoch Powell (Down, South)
Is that engagement in the National Health Service, or is it employment or occupation as a doctor outside the National Health Service as well? Would a knowledge of English be required before a doctor from the EEC could practise outside the National Health Service?
§ Dr. Vaughan
That is a very important point. It is engagement in the National Health Service or employment in some other capacity as a doctor or a dentist in this country. But it does not cover private practice.
§ Mr. Douglas Jay (Battersea, North)
Will the Minister make this quite clear? Did the previous system of registration cover private practice?
§ Dr. Vaughan
The previous system covered entry to the medical register. I remind the right hon. Gentleman, however, that there are now agreements about the level of qualification and the interchange of qualifications between the various countries in the Community.
Articles 4 and 5 apply the provisions of Scotland and Northern Ireland.
I conclude by assuring the House that National Health Service authorities will be applying standards no less exacting than those which the registration bodies now apply. As I said earlier, they could be considerably tougher if the job required it. I hope that the House will see the necessity to make these changes. I commend the order to the House.
§ Mrs. Gwyneth Dunwoody (Crewe)
When a man speaks softly, carry a big stick. The Minister has sounded extraordinarily reasonable in the case that he has put tonight. Nevertheless, when I am sick, two requirements are absolutely basic for me. One is that the doctor, the nurse or the dentist with whom I am dealing knows what he or she is doing. The other is that he or she understands what I am saying. The word "bed-pan" in any language is a rather emotive word.
There are fundamental requirements which lie at the heart of the directive. It is not, as the Government would have us believe, a simple administrative change, brought about to ensure that Britain does not once again cause unnecessary pain to her European partners. It goes much deeper than that. The business of communication is vital to the professional, and that is true whether the doctor or nurse is an EEC national or has come from the Commonwealth.
Some years ago, mainly because of doubts about the linguistic facility of some overseas personnel, a series of language tests were introduced by the professional bodies concerned as part of the registration process. All overseas doctors and nurses were continually required to demonstrate their fluency in the English language either by providing evidence that some part of their training had taken place in a university in the United Kingdom or 838 Ireland, or by taking a language test. That was a sensible and disciplined approach administered by the appropriate national bodies and suitably standardised. Indeed, one of those bodies, the Royal College of Nursing, made representations on this very point during the passage of the Nurses, Midwives and Health Visitors Act 1979. It said:The Royal College of Nursing would urge that the exclusion of EEC trained nurses from the language requirement be removed; or, alternatively, in accord with the Medical Act, all reference to the EEC position be excluded. In making these representations, the RCN would submit that an ability to communicate with patients is even more essential for the nurse than for the doctor, because of the 24 hour responsibility which the nurse accepts for the care of patients. Legislation should not inhibit the profession from seeking to achieve some degree of facility in the use of the English language on the part of EEC nurses who seek to become established in the United Kingdom. Indeed, the RCN would hope to see comparable provisions to those which apply to doctors as set out in HC(77)38 'Changes in Arrangements for the Registration of Doctors from other EEC countries.'Because of that, section 11 of that Act, part of which will be rescinded by this statutory instrument, was worded in the following way:In the case of an applicant within subsection 3(b) … the rules may either—(a) make it an additional condition of his being registered that he has the necessary knowledge of English; or (b) require him to have that knowledge within a period specified by the rules (failing which his registration will lapse at the end of the period)".Further, the Nursing Qualifications (EEC Recognition) Order 1979 states:A national of a member State who applies to be registered in the general part of the register shall be required, on or after registration in that part, to satisfy the Council that he has the necessary knowledge of English, that is, the knowledge which, in the interests of himself and his patients, is necessary to render nursing services in the United Kingdom.The new directive, however, removes that responsibility from the appropriate monitoring body, for example, the General Medical Council. It leaves it, in the wording of the order, to the health authority and, although the Minister has been careful to talk about the fact that the General Medical Council facilities will be available, he has not made clear what will happen in relation to nurses, dentists or midwives. What is more, he has not answered the point that part of the registration process is to monitor the overall training of personnel in the NHS.
§ Mr. Marlow
I apologise, but I did not pick up the hon. Lady's point properly. Is she saying that at present nurses from EEC countries who wish to practise in this country must have linguistic ability which is tested, whereas if the order is passed they will not be required to have that linguistic ability?
§ Mrs. Dunwoody
For a person to have his name entered on the register he had to satisfy certain tests, of which one was a linguistic test. Tonight we have been told that that will no longer be part of the responsibility of the relevant medical registration boards but that they will have an overseeing capacity. It is important that the House should understand this point. Presumably they will be required to register nurses, doctors or midwives and they will then check their ability to speak English. That is a major change. It carries considerable implications for the professions concerned, over and above the simple implications of the directive.
§ Dr. Vaughan
Perhaps the hon. Lady is not aware that the General Nursing Council has developed its own tests. The number of nurses involved is very small. Indeed, just over 30 are involved. Dentists have not thought it necessary to hold tests. The General Dental Council decided that it did not wish—at least for the moment—to use the General Medical Council's tests. It is relying on a simple, direct interview. Again the number involved is very small. At present, there are no European directives on midwives and they are not affected. They are considering what they should do.
§ Mrs. Dunwoody
With great respect to the Minister, he has not answered the vital point. Normally registration carried with it a certain guarantee of standards. For many years, the professions have operated in that way. In effect, the Minister is now saying that the professions may be required to register EEC nationals. He is saying that they can check whether those nationals comply with the tests that used to be de rigeur afterwards.
We are discussing the principle of registration. It is all very well for the Minister to say that only a few people are involved. It seems that if a person who cannot speak English wishes to undertake private practice he can do so. However, as soon as someone wishes to work in the National Health Service, he must satisfy a linguistic test. That seems a bit odd.
§ Dr. Vaughan
I understood the hon. Lady to say that all the professional groups felt a language test to be essential to registration. That is not so. They do not all feel that a central testing process is necessary. In many cases, the professions are content to rely on individual interviews with applicants.
§ Mrs. Dunwoody
The Minister still has not responded to my point. Far from comforting me, he has led me to believe that he has not considered the effects of his actions. If this responsibility is removed, and if the health authority is left to satisfy itself that the applicant has a knowledge of English—which, in the interests of himself and his patients, is necessary for the provision of general medical services—an anomaly will arise.
It has long been accepted that the relevant professional bodies in medicine, nursing and dentistry should check that people have the necessary qualifications for registration. They satisfy themselves about an applicant's standard of training in order to safeguard the patient. In future, are we to take it that that protection will be removed? No matter which discipline is concerned, professional bodies will be required to register any applicant who is an EEC national. They do not necessarily have to satisfy themselves about the qualifications that an applicant holds in one respect, namely, language. They simply have to assume that someone else will perform that task.
I turn to a fundamental point. Overseas doctors in the United Kingdom will still have to take the language tests, as will any nurses or dentists who come from Commonwealth countries. I should have thought that that was plainly divisive. Irrespective of the let-out clauses in the Race Relations Act, no provision comes close to enshrining openly discriminatory practices. Some might say that these provisions are openly racist because they apply to only one group of professional workers. After all, there is already an extraordinary anomaly in relation to British doctors, whose primary qualifications were 840 obtained outside the EEC. I am told by the Overseas Doctors Association that a doctor, even though he is fully registered in the United Kingdom and is a British national and may have a postgraduate qualification, cannot practise in other EEC countries if his primary qualification was obtained outside the United Kingdom.
Furthermore, the Government have so far not even taken up this matter with the Commission. They have a responsibility to all British nationals and they certainly have a responsibility—if they are to bring in the sort of directive that we have before us tonight—to consider the role of overseas and particularly Commonwealth doctors who provide a great many of the personnel in the National Health Service.
Meanwhile, the Department has not hesitated to issue some rather bizarre press notices. One of them, dated 3 September 1980, seems to deal with the point that a doctor wishing to go into private practice will not necessarily have to speak English too fluently; it is only in the NHS that the doctor may be required to take the tests. Presumably in future the doctor concerned will simply display outside his door the reverse of the normal notice, so that it will read "No English is spoken here."
So if a doctor is white and European and has training inside the Community, he need expect no difficulty, but if he is a British national, a Commonwealth citizen or even a British national within the meaning of the nationality provisions, and has the wrong background in terms of where he took his medical training, he can expect to encounter very considerable difficulty.
We are the only country that will be faced with this sort of problem. As always happens in the Community, the British are openly debating the subject and playing according to the rules, while other countries are using other methods of coming to some back-door arrangement.
In the European Assembly my dear friend Ernest Glinne was very concerned about the British arrangements, and he put a number of questions to Viscount Davignon about it. He was told by Commissioner Davignon that in 1948 there were 48 migrant doctors in France, nine in Luxembourg and 470 in the United Kingdom. Viscount Davignon also made plain that, although the EEC was aware of similar difficulties with Luxembourg and with French law as with United Kingdom law, nevertheless it had looked at those countries and decided in its wisdom that there was no need whatever to ask them to bring about any changes.
The reasoning was very simple. It was that in each of those countries there was no formal language test. In other words, we were told that these matters could be dealt with by administrative changes. The Commissioner in that speech relied very heavily on the ethical responsibility of the doctor concerned. I was in the Community long enough to know exactly what is meant by reliance on administrative measures in real terms. Unlike the position in Great Britain, if there is a country in the Community that wishes to take action to bar nationals of another country it can find a number of ways of doing so. What is more, this is, unfortunately, only too common.
I know of cases where British nationals have been told, in effect, that it does not matter what it says in the treaties, they will not be given any kind of permission to work either in France or in other member States. If the Minister has doubts about that, I can quote to him several professional qualifications that are used to bar the free movement of nationals of other EEC countries.
§ Dr. Brian Mawhinney (Peterborough)
The hon. Lady has been making a comment about the sorts of practices that are used in the other member countries of the Community in terms which lead the House to believe that she does not approve of those practices, and that they are less to be valued than she would wish. Is she now saying that she would wish Her Majesty's Government to lower their standards and to stoop to adopt the practices which she has just so roundly condemned?
§ Mrs. Dunwoody
I am asking why Her Majesty's Government have not had the guts to stand up to the Commission and say "We shall not bring in a change of this kind until we are wholly satisfied that it is in the interests of our people." I do not regard that as an exceptional demand for the House of Commons to make. I regard it as a perfectly normal and straightforward approach.
§ Mr. Marlow
Is the hon. Lady saying of the paraphernalia before us this evening that the French are not introducing such measures, only Britain? Is that right?
§ Mrs. Dunwoody
The Commission looked at the French and Luxembourg laws, said that there were similar difficulties to those in the British law which could be dealt with by administrative means, and that it was its intention to take only Britain to the court. I regard it as extraordinary that the sponsoring health Department has not stood up for the Health Service workers and facilities. The Government should not have accepted the direction that they should simply change the laws without being prepared to go to the European Court of Justice. We have a good and defensible case. I want to see it argued at that level. Instead, the Government have simply issued an edict that because of other matters we should not cause any unnecessary difficulty for our Community partneres at any level and, therefore, we must accept all sorts of changes. That is unfortunate but apparently the price that we must pay for the arrangement reached by the Prime Minister.
§ Mr. Nigel Spearing (Newham, South)
My hon. Friend mentioned that other EEC countries overcame the problem by administrative arrangements that are compatible with the Treaty of Rome. Does she know whether those arrangements cover both public and private sectors in those countries? If they do, a further anomaly is created because it has not been found possible to apply them in Britain.
§ Mrs. Dunwoody
Part of the difficulty that has arisen is the usual one with EEC directives. It is noticeable that the House endeavours to discuss these matters openly, and to bring them to the attention of the British people. Unfortunately, that is not necessarily so in some other countries where edicts are simply handed down, and this sort of anomaly is only too easy to create between one member State and another. We have heard from the Minister the limp argument that it does not involve many people. If we are changing a number of standards in Britain, it does not matter whether it affects one person, 60 persons, or 600 persons. What matters is that we are seeking to change existing standards within the medical, nursing and dental professions without any excuse other than having been told that if we stand up for British interests we shall be taken to the European Court of Justice. That is not a sufficient defence.
If the Minister seriously expected the House to accept, without any questioning, the order that he has put forward, 842 he should have come here with a much better story than the one he has presented. On the whole, the Opposition are proud of the National Health Service. We expect it to maintain the highest standards. We are proud of the fact that the national registration bodies have always fulfilled their tasks with responsibility and understanding. The Minister has not yet explained either to my satisfaction or to that of other hon. Members why he thinks that that should be changed at the first sign of pressure from the Community. There has been no real effort to negotiate. There has been no attempt to say that we shall not go along with the change. The Minister is failing both himself and the House. I ask my hon. Friends to vote against the order.
§ Mr. Teddy Taylor (Southend, East)
Although the Minister introduced the order in his usual agreeable way, few who listened to his speech would not come to the conclusion that the position created by the order will be an outrageous nonsense. He sought to argue that what existed now was even more of an outrageous nonsense because of the original impact of the EEC Treaty and the various regulations. He rightly pointed out that under section 7B of the Medical Act 1956, which is being repealed by the order, a Common Market national is entitled to six months work in Britain without having to satisfy anyone that he can speak English. The Minister rightly said that that is unsatisfactory. On the other hand, I hope that he will accept that the proposition in the order is not satisfactory. If it is not satisfactory, and if it deals with medical qualifications and the treatment of individuals under the Health Service, surely we should not approve the order. We should look for a better solution.
The Minister must accept that linguistic ability—the ability to communicate with patients—is a medical qualification. If a doctor cannot communicate with a patient, it makes it far more difficult for him to be a good doctor. If there is a change in the assessment that we make of linguistic qualifications, that can have an effect on patient care.
I ask the Minister to respond to three basic questions when he replies. First, if we are talking about a medical qualification—that is what the linguistic qualification is—what on earth is the health justification for having standards applied to doctors who come from the Common Market that are different from those applied to doctors from other countries? It is not an issue of black doctors and white doctors. We are talking of comparing doctors from Austria with doctors from Germany.
Even if we were to interpret the provision in a racialist manner, as the hon. Member for Crewe (Mrs. Dunwoody) suggested, we should remember that unlike French, German and Italian doctors, many of our splendid Pakistani doctors were trained in English when they obtained their degrees and qualifications. We have many fine Pakistani doctors. I believe that they can communicate with patients more effectively than a Welshman can communicate with an Englishman.
The Government are saying "The standards that we want to apply for the Common Market doctors will be different from those applied to other doctors." The Minister says that he is confident that the health boards will ask for very high standards. They might even ask for higher standards than those that they require of Austrians, Australians and Americans, but that is not the point. What 843 is the justification for having different standards and different arrangements depending only on whether a doctor comes from the Common Market or elsewhere?
I have the greatest admiration for the Minister. I appreciate that he probably has to push forward this disreputable order, which I am sure he personally abhors. Surely it is difficult for a Minister for Health to say "We shall apply different medical standards depending on whether they come from the Common Market or from somewhere else."
Secondly, does the Minister appreciate that under this order he is replacing a national standard with a local qualification? When any standard was applied in the past it was applied by the registrar and it was a national qualification, whether it was high, low or anything else. That system will be replaced by health board assessment. We all know that some boards are splendid. My hon. Friend the Member for Aberdeenshire, West (Mr. Fairgrieve), the Under-Secretary of State for Scotland with responsibility for health matters, will, I am sure, have highly qualified boards in Scotland. I am sure that my hon. Friend will have equally highly qualified boards in England. However, boards can vary. The Minister is asking us to accept the replacement of a national standard with differing standards depending on the assessments of health boards and their medical services committees.
The Minister said "We shall ensure that we shall have facilities for learning whether someone can speak English", and these will be available to health boards. It seems that they will be able to say to a doctor "We shall send you to a splendid place to ascertain whether you can speak English." Even if these facilities are available, provision is not made in the order. These are facilities that may be offered and of which advantage may be taken.
§ Sir Anthony Meyer (Flint, West)
My hon. Friend is giving great pleasure to the House, which is hearing him defending so strongly Pakistani doctors. That makes a welcome change from the line that he sometimes takes.
§ Sir Anthony Meyer
Does he accept that there are many instances of people who have a primary language that is not English? For example, in the Bedford area there are many Italians Would it be so unreasonable for the regional health authority in that area to have the discretion to vary the standard, bearing in mind that the needs of the local population may be different from those elsewhere in the country?
§ Mr. Taylor
My hon. Friend is trying to introduce another factor to complicate the issue and to try to upset me. I am horrified, shocked and disgusted that he should suggest that I have attacked Pakistanis. He has no justification for saying that. I have not in any way tried to instil racial disagreement. What he said is totally unjustified and simply an attempt to divert us from an important issue.
§ Mr. Taylor
Certainly not. In no circumstances will I give way.
My hon. Friend the Member for Flint, West (Sir A. Meyer), who so well represents the Welshmen, said that there is a case for adopting a different standard of English application in parts of Wales or Scotland. There might be 844 a case for that, but there is no case for applying the local standard to Common Market doctors and a national standard to all other doctors. If the Minister wants to put forward a case for local determination and not national determination, that is fair enough. But we cannot have an argument for local determination for Common Market doctors and for national standards for doctors from elsewhere.
§ Mr. Taylor
That is so. How can we justify a national standard for private practice and a local standard for Health Service doctors? The proposal is for different standards for private practice and the Health Service.
The three basic anomalies create a nonsense. Even if the Minister has been threatened with being taken to the European Court, we should be prepared to argue our just case. I am sure that even fanatical supporters of the Common Market—or fanatical opponents of it—will accept that reasonable people will not want us, with our splendid medical services, to introduce administrative, medical and constitutional nonsense.
Far too readily do we do everything that the Common Market asks of us. The Minister must accept that the order is nonsense. Let us be taken to the European Court and convince just men that what we are being asked to do is nonsense. I am sure that our Ministers will be able to persuade the court that, although there may be a case for encouraging the free movement of labour, there is no case for European laws insisting that we accept nonsense.
The present situation is nonsense. Surely it is not right to replace one nonsense with another. We should go to the court and argue our case and persuade it that we want national medical standards in Britain, irrespective of whether a doctor comes from the Common Market or from elsewhere. We want to make the decisions about national or local standards ourselves. To turn down the order and go to the court instead would be the best answer. That does not mean that we reject the principle of the free movement of labour.
I hope that the Minister will accept that we should not accept the order but that we should argue our case in the court and persuade it that there is no justification for Common Market rules making us introduce nonsense which has no friends in the medical profession.
§ Sir Nicholas Bonsor (Nantwich)
With regret, I intervene in the debate without having had the opportunity to discuss the matter with the Minister. That is partly my fault and partly the fault of the system under which so many regulations come to the House with little notice and with no prior chance of consideration by hon. Members. They come from Europe and are imposed upon us. The order was laid last Thursday. We have to consider a mass of legislation without the opportunity to digest it first. For not having done so, I offer my apologies.
I listened with intense concentration to the remarks of my hon. Friend the Minister. I am left with a feeling of profound disquiet about the consequences of implementing the legislation before the House. I should like to put two distinct points, the first relating to the National Health Service and the second relating to private health practice.
845 In regard to the National Health Service, I agree with my hon. Friend the Member for Southend, East (Mr. Taylor). It is clearly unsatisfactory to have a national standard of linguistic ability for doctors practising in this country who do not come from European Community countries and a different and local standard for doctors from the European Community who do not speak our language. I must take issue with my hon. Friend the Member for Flint, West (Sir A. Meyer) who suggested that local language qualifications are legitimate. Were local qualifications to be universally applied, they might be legitimate. We are, however, dealing with a national position in which people who speak English and probably no other language will be going to a doctor who speaks any other language within the European Community but probably not English.
It is not acceptable in those circumstances to have different standards between doctors from one foreign country and doctors from another foreign country. I ask for the assurance that if this matter is to be left to local area health authorities some standard guidelines will be laid down enabling them to have minimum criteria of linguistic ability below which permission would not be given to practise.
The position in the private sector is substantially more difficult, because my hon. Friend is limited in what he can do to assist. As the order stands, it is clear that any doctor from a European Community country will be able to practise in this country without an adequate command of our language. There is nothing, I understand, that the Government will be able to do to prevent that. If that is so, it is surely unacceptable to the people of England, Scotland, Wales and Northern Ireland. We cannot allow a situation in which people go to a doctor, albeit one practising privately, but are totally unable to communicate. As the hon. Member for Crewe (Mrs. Dunwoody) has rightly stated, this applies equally to the nursing profession. There are already those within the nursing profession who do not fulfil all the qualifications that we would like to see.
I am sure that no hon. Member wishes to see additional difficulty put in the way of those who find themselves being nursed in the private sector by people whose language they cannot understand and to whom they cannot communicate their difficulties. I appreciate that I am talking about the private sector where people have voluntarily put themselves in the position to which I refer. None the less, we must surely accept that the National Health Service is, has been for many years, and is likely to remain under an unacceptable level of pressure. The pressure is so great that many people who would like to be treated under the National Health Service find that they have to wait for a period that they find unacceptable. At the moment, if they go outside the National Health Service sector, they are treated by doctors of competence and nursed by nurses of competence.
What will be the effect of this legislation on those people? I cannot conceive that it can be anything but disastrous. What competent doctor, say, from Italy will come to practise in this country if he does not speak English? The competent doctors from Italy who speak English are a great asset if they come to this country. The legislation will allow into this country those who are unable to have a successful practice in their own country 846 and see the backlog of National Health Service patients in this country as a potential source of income for themselves. I fear that if this legislation is passed they will come to this country, not in a vast flood but in sufficient numbers to ensure that many people suffer from their presence.
I can see nothing in the legislation before us this evening that can be said to be in the interests of the British people. I can see nothing in it either that can be said to be in the interests of the French, Germans or Italians or any other member of the European Community, because no British doctor worthy of his salt will leave this country unable to speak French, German or Italian and go to practise in those countries. If he did, he would be far from welcome by the Governments of those countries. The Government of this country should show equal reluctance to have foreign people here.
We should not pass this order unless my hon. Friend can give me the assurances—I fear he cannot—in relation to the private sector and the effects upon that of the legislation.
§ 11.1 pm
§ Mr. John Wells (Maidstone)
I am particularly interested in that sphere of medicine which deals with the homoeopathic principle. That principle is widely known and widely practised on the Continent of Europe. Due to the machinations of the medical profession, it has been in a steady state of decline in this country for many years. Due to, if I may use the phrase, the bloodymindedness of the medical establishment, the homoeopathic sector of medicine may well decline very much further. In a few years the only practitioners offering that treatment may be French or German speakers only. This would be a most deplorable situation and would lead to many difficulties.
Those of us who live in comparatively rural communities, even if they are quite near London, are aware that the vernacular about describing one's body is not exactly the Latin language in which my hon. Friend the Minister was trained at Guy's hospital, or wherever it may have been. There is a certain language difficulty between a well-trained young GP, recently from his Latinist training, and, if I may call it such, a peasant who talks the sort of vernacular that I talk. Therefore, even within the English language there are difficulties.
I am appalled at the prospect of the two-standard system that could arise under this order. Therefore, when my hon. Friend replies I hope that he will say something on the second point I have made about the language problem. When he reads my extremely wise and thoughtful speech, perhaps he will write to me about the homoeopathic problem. I do not look for an answer to it tonight.
§ 11.3 pm
§ Mr. Hugh Dykes (Harrow, East)
The speech of my hon. Friend the Member for Maidstone (Mr. Wells) was undoubtedly wise and thoughtful, and also brief. I ought to be brief, too, because of the passage of time. None the less, I am sure the hon. Member for Crewe (Mrs. Dunwoody) will wish to hear a few of the comments which should balance the picture more and put some of the other arguments in the face of the resounding hysteria tonight and absurd obsessions with a whole lot of myths which are self-imagined and not true at all. Perhaps my hon. Friend the Minister for Health, with his characteristic modesty, which we find very attractive, did not push hard enough 847 some of the arguments. I hope that he will do so in his reply. The right hon. Member for Down, South (Mr. Powell), who presumably is campaigning for £100 million of Commission money for Belfast, because it is all right to have EEC public money when it is for Northern Ireland, will be amused with this order.
It is true that there is an anomaly created as a result of its provisions. But it is a matter of degree and incidence, and the idea that a horde of foreign doctors, unable to speak a word of English, will suddenly invade the United Kingdom as a result of this modest order—which is the implication behind some speeches—is absurd. It is the usual parody that foreigners are doing us down and we have heroic standards and they have none.
§ Mr. Dykes
No. I listened with great patience to the hon. Lady's hysterical speech and I did not intervene. She can listen to my brief remarks without intervening. The other side of the picture needs to be given.
I accept that the order creates a difference in the treatment of doctors from EEC countries compared with the treatment of doctors from other overseas territories, but it will apply to such a tiny number of people, potentially and actually, as to be insignificant. It is another example of a country that joined the Community later than others finding that there are plenty of anomalies between its legislation, and the treatment that it affords to other foreigners, and the gradual and progressive harmonisation of all sorts of rules and regulations in the Community for those who are supposed to be part of one Community. As a modest defender of that Community, I get heartily sick and tired of the sinister recrudescence of evil chauvinism against our membership of the Community and against orders such as that under consideration. It is a pity that that attitude extends to such a tiny measure.
Many of those in NHS circles, and I have discussed the matter with some, would prefer to see the old system of registration preserved—that has been conceded by the Minister—but they accept that it is a change which is applicable to the European scene and will not cause any of the practical problems that have been raised in the scaremongering, for tactical as well as strategic reasons, of a number of hon. Members who should be deeply ashamed of their hysteria and exaggeration.
I was disappointed that my hon. Friend the Member for Southend, East (Mr. Taylor)—the Secretary of State for Southend—gave way to a Labour Member, but did not give way to me.
§ Mr. Dykes
I wanted to make a point that would have helped my hon. Friend's argument.
The order can be justified more easily than my hon. Friend the Minister justified it. I hope that he will explain the reasons for it with more confidence The main reason is to try to get a harmonised position in all the member States, because of the heed for the practice of acceptance by way of interview by the competent medical authorities to be universally introduced.
The canard that there is a deep, Gallic conspiratorial plot in that they need only administrative law and we need properly enacted legislation from the Chamber is ridiculous. That is the way that all subordinate legislation is made in France after the primary legislation, particularly on medical matters, has been passed.
848 There is no ground for the imagined conspiracy against Britain which has been built into many speeches. The order is fairly routine, even though it has not been considered by the Scrutiny Committee as I recall, and it is a pity that a whole host of exaggerations have been constructed, for reasons that transcend the terms of the order. We know why this happens, and that is a good reason why those who are sensible and wise will support the Minister and the order.
§ 11.9 pm
§ Mr. Terry Davis (Birmingham, Stechford)
It seems to be agreed between the Minister and the rest of the House that doctors, dentists and nurses who work in the National Health Service should be able to speak English and understand English. It is not agreed between us that there should be only one procedure for all doctors, dentists and nurses who come to this country, and that there should be only one procedure regardless of the country of origin of those doctors, dentists and nurses.
This difference in procedure is extremely important, even if, as the Minister says, in practice there will not be a difference in the standard required of doctors, dentists and nurses, depending on their country of origin. Some of us are not yet convinced that there will be no difference in the standard required. Nevertheless, the point is that there will be differences in the procedures which people must follow, according to their ethnic origin.
The Minister put great emphasis on the safeguards for patients. He said that it was essential for the safety of patients that they should be able to talk to their doctor. He said that it was essential that people in the health professions should be able to communicate effectively with their patients and with each other. However, it is also essential for a doctor in private practice to be able to communicate effectively with other people in the health professions. It is essential for a nurse to be able to communicate effectively with a doctor. It is essential for a doctor to be able to communicate effectively with a consultant. That is why we are entitled to insist that people should be able to speak and understand English if they are working in the National Health Service, and also if they are engaged in private practice. A doctor in private practice will also need to communicate effectively with a consultant in private practice. A nurse employed in a private hospital should be able to communicate effectively with a doctor whose only language is English.
As a result of this order, there is a great danger that there will be different standards in different parts of the country. We are glad to hear that the General Medical Council has offered to make its test available to health authorities. However, that does not prevent different standards in different parts of the country. The Minister himself said that the standards could be tougher for some jobs. Therefore, there will be different standards for different jobs, and if we have tougher standards for some jobs than for other jobs, there will probably be different standards for the same job in different parts of the country.
What will happen if a doctor, a dentist or a nurse moves to a similar job in a different part of the country? Will there be a different standard for the ability to communicate in the English language?
The Minister's defence is that only a few people will be affected by the order. He can hardly give us a guarantee that, as the EEC expands, there will be no increase in the numbers of people who come to this country from other 849 member States. When, for example, Spain becomes a member of the EEC, there can be no guarantee that many people will not come here from Spain to become doctors, dentists or nurses. None of us can know what will happen in the future.
I am willing to concede that there will still be a minority of overseas doctors, dentists and nurses coming from other countries in the EEC, but they will still come. The Minister's defence is that this is a privilege that will be enjoyed only by a few people. In the Opposition's experience, privileges are only ever enjoyed by a few people.
The hon. Member for Harrow, East (Mr. Dykes) says that it does not matter. He is so quick to fly to the defence of the EEC that he ignores the real point What matters is that the order will lead to discrimination between different doctors, dentists and nurses on the basis of their ethnic origins.
When my hon. Friend the Member for Crewe (Mrs. Dunwoody) said that Britain would be the only country to apply this sort of discriminatory procedure, the Minister shook his head. Let him tell the House which other member of the EEC discriminates in this way. Indeed, which other member State discriminates against its own citizens and in favour of citizens of other member States? It is not simply a matter of language tests for doctors from one foreign country compared with those for doctors from another foreign country. We are dealing also with tests for British doctors, British nurses and British dentists who have qualified abroad. They will be treated differently.
The debate is not about whether doctors, dentists and nurses should be able to communicate with their patients or about whether there should be language tests for people who come from other countries to work in the NHS. It is about whether we should incorporate yet another example of racial discrimination into British law and administrative procedures. That is why I ask my right hon. and hon. Friends to vote against the order.
§ Dr. Vaughan
With permission, I should like to answer some of the points raised.
I should not be human if I did not take comfort from the remarks of my hon. Friend the Member for Harrow, East (Mr. Dykes), who kindly supported me. However, he admonished me for not being a little tougher. Frankly, I do not see it as a matter for toughness. I am sad that so many Opposition Members have tried to turn this into an anti-Europe debate or, much more seriously, an anti-racial debate. That is rubbish and absurd. It shows the sparse information that they could muster to argue against the order.
My hon. Friend the Member for Harrow, East is right. Only a small number of people is involved. In opening I gave the number as 449 doctors since all this started, compared with the total of 22,000 doctors from overseas practising in this country.
§ Sir Anthony Meyer
Axe there not in the Health Service many thousands of excellent doctors of Asian origin whose English is extremely difficult to understand and who would not pass an objective test in knowledge of English but who carry out their duties to the satisfaction of all concerned? Is not the nonsense we have heard from both sides of the House a deliberate attempt to create mistrust, fear and ill will?
§ Dr. Vaughan
Those doctors also have to pass a language test. I am conscious of the thousands of doctors from overseas working in this country to whom we are deeply indebted. We should have great difficulty in running the NHS without them.
The hon. Member for Crewe (Mrs Dunwoody) spoke from a set speech. A good deal of her information was incorrect. She did not modify it when I tried to give her help. She did not consider my comment, that I was not at all surprised that hon. Members wanted to debate the order. It is important, although the change is only minor. Although, my hon. Friend the Member for Southend, East (Mr. Taylor) said that it was illogical, I believe that it is completely logical to say that when somebody is appointed to a job the employer should ensure that he is capable of carrying it out effectively.
§ Mr. Teddy Taylor
My hon. Friend missed the point. It may well be a good argument. Perhaps the employer is the chap who should do that. If so, surely the employer should do it for all doctors coming from overseas and not only for those coming from the Common Market.
§ Dr. Vaughan
The General Medical Council has agreed to make its test procedure available, as I said earlier. It costs £66 for the test to be carried out.
§ Mrs. Dunwoody
Will the Minister now confirm that the change is a change in the registration of medical personnel? The fact that the physical surroundings of the GMC are to be used for a test is not relevant to the point that the order says that we are changing the normal administrative procedure.
§ Dr. Vaughan
I must ask the hon. Lady to let me make my speech. Other than my helpful remarks, I did not try to intervene in hers. I realise that it is perhaps difficult for her, but she has once again failed to appreciate the difference between registration of professional competence in one's medical work and a language test on the ability to communicate that competence, which is a very different matter.
A doctor or dentist working in this country will still have to be registered. There is no question about that. There are now exchange arrangements between this country and other countries in the Common Market about standards of qualification. We have heard a little about the Italians, for example. At the moment, about 40 Italian doctors apply to come to this country each year. The Italians have proceeded very carefully in this, and we have indeed given them advice on standards of qualification and training. A great deal of discussion is taking place between the different countries on this.
The hon. Lady made some rather wild statements about other countries. I do not think that the House will wish me to go into detail about each one, but I have a list showing exactly what happens in each of the other countries. My information is that Ireland, Germany, the Netherlands, Belgium, Italy and Denmark impose no language tests but rely upon employers to check the adequacy of the people taken on. The Danish health service is empowered to satisfy itself as to the linguistic knowledge of prospective employees.
851 The hon. Lady keeps waving the example of France at me. Both France and Luxembourg have made legal provision for evidence of linguistic knowledge to be required at the point of registration, but in fact they do not carry out that practice. In the view of the Commission, because the practice is not enforced, it does not therefore conflict with Community law. Hon. Members may laugh, but at least I am endeavouring to give them a detailed comment on each of the countries. I can go into more detail if they wish.
About the only nice thing that my hon. Friend the Member for Southend, East did was to welcome the fact that the six months period of grace would no longer be available for the Common Market. As I mentioned earlier, a very important loophole will now be closed. Under the present arrangements, it would be possible for a doctor to come to this country, go to an area which is under-doctored and set up in general practice without any check on him whatever. Under the order, the family practitioner committee will have the power—indeed, it will have the statutory responsibility—to ensure that nobody practises at all without the linguistic ability. That is a very important aspect.
§ Dr. Vaughan
I shall come to that in a moment.
I am aware that there is a good deal of anxiety about the position of overseas doctors. I mentioned in opening the debate that it would require primary legislation to change the Medical Act. My information is that, in practice, overseas qualified doctors with British citizenship wishing to migrate to other States of the EEC experience no major difficulty in securing registration on the basis of qualifications acceptable to the General Medical Council.
I shall look into this matter again. I hope that the fears expressed today are unfounded, but I understand the desire of overseas doctors to be treated in the same way as other British citizens. I have therefore agreed to meet a delegation from the Overseas Doctors Association and the BMA to look into this yet again.
§ Mr. John Wells
Before my hon. Friend leaves the point about meeting the Overseas Doctors Association, can he give some specific assurance about British doctors seeking to practise in Spain in the holiday and retirement areas? Will there be reciprocity with Spanish doctors seeking to practise in the fruit-growing—
§ Dr. Vaughan
I am grateful to you, Mr. Deputy Speaker. We are not, of course, discussing Spain at present. My hon. Friend was kind enough to invite me to write to him on the question of homoeopathy, and I shall look into the Spanish situation.
A number of hon. Members referred to the problem of private practice. It would be possible for a doctor from another part of the Common Market, provided he had a qualification which was acceptable to the General Medical Council, to come here and to set up in private practice even though he was unable to speak English very fluently.
852 There is a difference here. In the NHS, the NHS is the employer. In private practice, it is the patient who is the employer. As a doctor, I find it inconceivable that any patient would want to go to a doctor who could not understand a word of what he was saying.
I have touched on a number of questions that were raised during the debate. I come back to what I said at the beginning—
§ Sir Nicholas Bonsor
May I again put the point that I attempted to make in my speech? Surely some patients will not be able to receive NHS treatment because of the enormous waiting lists which unfortunately exist in that sector. They will not be able to afford what I would describe as a reputable, English-speaking doctor to treat them. I entirely agree with my hon. Friend the Member for Harrow, East (Mr. Dykes) that we are not talking of millions of people. However, some people in desperation are likely to go to doctors who are not capable of fully understanding their problems.
§ Dr. Vaughan
I do not accept my hon. Friend's argument. In fact, Belgium and Holland have looked at this matter. They have no tests because they believe that it would be linguistically impossible for doctors to earn a living unless they were able to speak the local language. I should have thought that the same sort of common sense would apply to this country.
§ Mrs. Dunwoody
I am grateful to the Minister for giving way, and I apologise for interrupting him. I am afraid that he has still not answered the basic question, which is that this will bring into our legislation a discrimination between Commonwealth doctors and EEC nationals. Will he please address himself to that point before he sits down?
§ Dr. Vaughan
The hon. Lady persists in using emotive, aggressive words such as "discrimination". The essential point is that people should not practise in our Health Service unless they are able to carry out their job properly. This order puts the responsibility on the employer to ensure that no one, be it a doctor, nurse or dentist, is taken on unless he is able to do the job properly.
There are two different ways of setting about a common problem. The common problem is that we must ensure that people coming to this country to be employed, for example, in the National Health Service are able to speak sufficiently well to ensure the safety of patients, and I cannot see any objection to that.
I should say also to the hon. Lady that it is a question not of "whether" but of "when", because I am advised very strongly that we cannot defend the present practice before the European Court in relation to the freedom of movement of Community nationals. This order enables us to work out a very suitable alternative.
§ Mr. Marlow
Is my hon. Friend presenting this measure to the House on its merits or because he has been told to do it by Brussels? If it is the latter, I must tell him that hon. Members have not been sent to the House by their constituents to rubber-stamp bits of paper coming here from Brussels.
§ Dr. Vaughan
I should have thought that that was a gross reflection on a great deal of what I have been saying, and I am sure that my hon. Friend does not mean to imply that in what he has just said.
853 My hon. Friend the Member for Nantwich (Sir N. Bonsor) asked whether we should be issuing guidelines in order to ensure that there were not great differences from one part of the country to another. I do not see how that can possibly occur, if they are using the General Medical Council test—
§ Mr. Teddy Taylor
Is the Minister saying that they will have to use the General Medical Council tests?
§ Dr. Vaughan
I was asked whether we should be issuing guidelines, and the answer is unequivocally "Yes". We shall be following up the order with some very clear guidelines placing, as I have said several times, the responsibility on the employing authority.
I hope that we have between us explored the various uncertainties. I have done my best to answer them satisfactorily, and I hope that the House will now accept the order.
§ Question put:—
§ The House divided: Ayes 123, Noes 90.
|Division No. 82]||[11.31 pm|
|Alexander,Richard||Hogg, Hon Douglas(Gr'th'm)|
|Alton, David||Howell, Ralph (NNorfolk)|
|Ancram, Michael||Howells, Geraint|
|Atkins, Robert(PrestonN)||Hunt, John(Ravensbourne)|
|Atkinson, David (B'm'th,E)||Hurd, Hon Douglas|
|Baker, Nicholas(NDorset)||Jopling, Rt Hon Michael|
|Banks, Robert||Kershaw, SirAnthony|
|Beaumont-Dark, Anthony||LeMarchant, Spencer|
|Beith, A. J.||Lester Jim(Beeston)|
|Bendall, Vivian||Lloyd, Peter (Fareham)|
|Berry, Hon Anthony||Luce, Richard|
|Best, Keith||Lyell, Nicholas|
|Bevan, DavidGilroy||MacGregor, John|
|Blackburn, John||MacKay, John (Argyll)|
|Boscawen, HonRobert||Major, John|
|Bottomley, Peter (W'wich W)||Marland, Paul|
|Bowden, Andrew||Mather, Carol|
|Bright, Graham||Maxwell-Hyslop, Robin|
|Brinton, Tim||Mayhew, Patrick|
|Brooke, Hon Peter||Mellor, David|
|Brown, M.(BriggandScun)||Meyer, Sir Anthony|
|Bruce-Gardyne, John||Mills, lain (Meriden)|
|Bryan, Sir Paul||Moate, Roger|
|Buck, Antony||Morgan, Geraint|
|Butcher, John||Myles, David|
|Carlisle, Kenneth (Lincoln)||Needham, Richard|
|Chapman, Sydney||Nelson, Anthony|
|Clarke, Kenneth (Rushcliffe)||Neubert, Michael|
|Colvin, Michael||Newton, Tony|
|Cope, John||Page, John (Harrow, West)|
|Corrie, John||Page, Rt Hon Sir G. (Crosby)|
|Cranborne, Viscount||Patten, Christopher (Bath)|
|Douglas-Hamilton,LordJ.||Percival, Sir Ian|
|Dykes, Hugh||Price, SirDavid (Eastieigh)|
|Elliott, SirWilliam||Proctor, K. Harvey|
|Faith, Mrs Sheila||Renton,Tim|
|Fenner, Mrs Peggy||Rhodes James, Robert|
|Fisher, Sir Nigel||Ridsdale,Julian|
|Fookes, Miss Janet||Roberts, M. (Cardiff NW)|
|Fraser, Peter (South Angus)||Ross, Stephen (Isle of Wight)|
|Gower,SirRaymond||Shaw, Giles (Pudsey)|
|Griffiths, E.(B'ySt.Edm'ds)||Shepherd, Colin(Hereford)|
|Squire, Robin||Ward, John|
|Stanbrook, lvor||Watson, John|
|Steel, Rt Hon David||Wells, John(Maidstone)|
|Stevens, Martin||Wells, Bowen|
|Stewart, A.(ERenfrewshire)||Wheeler, John|
|Stradling Thomas, J.||Wickenden, Keith|
|Tebbit, Norman||Wolfson, Mark|
|Thompson, Donald||Young, SirGeorge (Acton)|
|Vaughan, DrGerard||Tellers for the Ayes:|
|Viggers, Peter||Mr. Alastair Goodlad and|
|Waddington, David||Mr. Selwyn Gummer.|
|Ashton, Joe||Janner, HonGreville|
|Atkinson, N.(H'gey,)||Jay, Rt Hon Douglas|
|Bennett, Andrew('St'kp'tN)||John, Brynmor|
|Bonsor, Sir Nicholas||Jones, Dan (Burnley)|
|Booth, Rt Hon Albert||Lamond, James|
|Brotherton, Michael||Leighton, Ronald|
|Callaghan,Jim(Midd't'n&P)||Lestor, Miss Joan|
|Campbell-Savours,Dale||Lyons, Edward (Bradf'dW)|
|Carlisle, John (Luton West)||McElhone, Frank|
|Clark, Dr David (S Shields)||Magee,Bryan|
|Cocks, Rt Hon M. (B'stol S)||Marlow,Tony|
|Concannon, Rt Hon J.D.||Marshall,D(G'gowS'ton)|
|Cowans, Harry||Marshall, Dr Edmund (Goole)|
|Craigen, J.M.||Maxton, John|
|Cryer, Bob||Millan, Rt Hon Bruce|
|Davies, Rt Hon Denzil (L'lli)||Mitchell,Austin(Grimsby)|
|Davies, Ifor (Gower)||Molyneaux,James|
|Davis, T.(B'ham,Stechf'd)||Morris, Rt Hon J. (Aberavon)|
|Dixon, Donald||Parry, Robert|
|Dobson, Frank||Powell, Rt Hon J.E. (S Down)|
|Dormand, Jack||Powell, Raymond(Ogmore)|
|Dubs, Alfred||Prescott, John|
|Duffy, A. E. P.||Roberts, Ernest (Hackney N)|
|Dunwoody, Hon Mrs G.||Robinson, G. (Coventry NW)|
|Eastham, Ken||Rowlands, Ted|
|Ellis, R. (NE D'bysh're)||Shore, Rt Hon Peter|
|Evans, John (Newton)||Silverman,Julius|
|Fitch,Alan||Smith, Rt Hon J. (N Lanark)|
|Fletcher, Ted (Darlington)||Soley,Clive|
|Foot, Rt Hon Michael||Spearing, Nigel|
|Foulkes, George||Stewart, Rt Hon D. (W Isles)|
|Fraser, J.(Lamb'th,N'w'd)||Taylor, Teddy (S'end E)|
|Grant, John (Islington C)||Thomas, Jeffrey(Abertillery)|
|Hamilton, James(Bothwell)||Tinn, James|
|Hamilton, W.W.(C'tral Fife)||Welsh, Michael|
|Hardy, Peter||Whitehead, Phillip|
|Harrison, Rt Hon Walter||Woolmer, Kenneth|
|Haynes, Frank||Young, David (Bolton E)|
|Hogg, N. (EDunb't'nshire)|
|HomeRobertson, John||Tellers for the Noes:|
|Homewood, William||Mr. Allen McKay and|
|Hudson Davies, Gwilym E.||Mr. George Morton.|
§ Question accordingly agreed to.
§ That the draft European Communities (Medical, Dental and Nursing Professions) (Linguistic Knowledge) Order 1981, which was laid before this House on 11 February, be approved.