My Lords, I will be very brief, because many of the points I might have made were more eloquently made by the noble Lord who just spoke.
The only thing I will say is that, from my experience when I chaired the previous assessor of postgraduate medical training, the Specialist Training Authority, which was established following the EU rules, the same problems occur in recognising equivalence of training. It is easier to recognise a qualification, but when you recognise equivalence of training, it has to take into account, as already elucidated, not just the knowledge but the experience and skills that practitioners can have.
It is even more difficult when you try to certify somebody or accredit somebody with a qualification that is highly specialised—including in dentistry. For
instance, they might not be a general dentist but you might want to recruit them because they have specific, high-quality training in a very specialised area. Assessing their equivalence is then made that much more difficult. So the points are well made about an order that I welcome for its simplicity—but it does have drawbacks that need to be addressed, and one way to do that would be to give the General Dental Council more authority to implement its own processes to assess qualifications, experience and training.
I turn now to the nursing and midwifery side, which is a slightly different issue. We should distinguish between qualifications and certifications. While we train nurses as graduate nurses—and that applies to midwives too—not all countries have graduate programmes in nursing and midwifery. They are trained and certified to be fully trained midwives, and having the Nursing and Midwifery Council to assess qualifications, experience and training makes it that much more difficult.
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There is another issue, which happens in other parts of medicine too. We do not have to assess that these people are culturally trained to work in our NHS, which has produced problems in the past. In EU situations, for instance, there was a language issue, because we had to recognise all EU qualifications and then we would find that they could not actually work because they did not have the language skills, a requirement that has latterly been introduced.
There is only one way to overcome this, but the order says nothing about providing post-registration training to be put on a register to be able to work in our NHS or, for that matter, in the private sector. I am sorry that we do not have that, because employers should have a role before allowing people to work, whether they are dentists, nurses or midwives, and particularly in clinical professions, in providing the training necessary to work in our culture. That is very important because, at the end of the day, they have to deal with the patients—particularly so, I might say as an obstetrician, for midwives. They have to be highly skilled and have the ability to cope with pregnant mothers when dealing with midwifery issues.