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Proposed Directive on recognition of professional qualifications (COM(2002) 119 final of 07.03.2002 ) A response by the Alliance of UK Health Regulators on Europe (AURE) This paper has been produced by the Alliance of UK Health Regulators on Europe (AURE) in response to the European Commission's proposal for a Directive on the recognition of professional qualifications. As Regulators we are responsible for the protection of patients and service users and are required to register for practice only those with the appropriate training and qualifications and who are able to communicate effectively with patients and service users. This paper highlights the Alliance's serious concerns regarding the Directive and its drive toward free movement at the expense of patient safety, and proposes amendments that would remedy the shortcomings in the draft. I. Introduction We have several concerns relating to protection of the public and the safety of patients. The Directive proposes replacing the existing sectoral and general Directives to increase the free movement of professionals. Although the Alliance supports facilitating the freedom of movement of health professionals, we believe that the proposal, as drafted, does this at the expense of patient and service user protection. The draft disregards Article 152 of the Treaty of Rome, which provides that a high level of human health protection shall be enshrined in all Community policies. The loose provisions of the proposed Directive will endanger patient safety. We suggest that a reference to Article 152 of the Treaty of Rome is included in the first paragraph of the preamble of the proposed Directive and further reflected throughout the proposal and especially with regards to the following points. II. Specific Concerns We recommend consideration of the following points on the content of the proposed Directive: 1. Practice without registration (Articles 5-9 of the proposal) The proposal, in its current form, would allow individuals who are established in one Member State to practise in another Member State for up to 16 weeks per year without being registered in the host State (or even informing the host State of their activities). As a result, not only would patients in the host Member State be unable to recognise the professional status of the service provider, they would also be unable to pursue any complaint in their home State concerning the conduct or competence of the service provider. There would also be no means of preventing a professional found guilty of misconduct or poor performance in one Member State from practising in other Member States since, as the proposal is currently drafted, the host State regulatory body would be unaware of the service provider's intentions within its jurisdiction. The effect of this specific provision of the proposed Directive is that regulators would not be able to ensure sufficient patient protection at all times. This is unacceptable. We would therefore wish a clause to be included in Title II: Free movement of services, to exempt health professionals from this provision. We propose the following wording for an additional article.
2. The abolition of the Advisory Committees and CSOPH (Article 54 of the proposal) The sectoral Directives have, in the past, been supported by Advisory Committees on Training (ACTs) - one for each profession. The remit of the ACTS has been:
The Commission has also received regular advice from a group of national officials - one from each Member State - known as the Committee of Senior Officials on Public Health (CSOPH). The current Commission proposal seeks to abolish the ACTs and CSOPH and instead establish a single Committee on the recognition of professional qualifications. The proposed role of the new Committee will apparently include monitoring the implementation, as well as regular and appropriate updating, of the Directive in relation to the individual study programmes of all the professions covered by the Directive. A single committee of this kind cannot possibly incorporate the professional expertise and range of knowledge necessary to oversee and manage issues relating to practice across all the health professions. The description in the proposed Directive of study programmes for some of the professions (described in Annexes of the proposal) are up to 24 years old and ignore subsequent amendments proposed by the ACTs and published by the Commission. This undermines our confidence that proper importance is attached to modern healthcare systems. The Alliance requires a guarantee of a clearly established mechanism, with legal status in relation to the Commission, to ensure appropriate and updated programmes of training for entry to a health profession's register. That mechanism must ensure appropriate input from each of the practising professions, the regulators and the universities, and that it is reflected in the text of the Directive. Without such a guarantee it would be essential for the regulator to have the power to make an assessment of each migrant's capability for practice at the point of registration so that they may properly fulfil their role in public protection. 3. General system for the recognition of evidence of training (Articles 10-19) These articles impact differently on different health professions. The articles define a hierarchy of different levels of training and establish rules of recognition. They require host Member States to allow access to their professions where the level of training in the home Member State corresponds to at least the level immediately below that required in the host Member State. In some cases this could mean the host Member State being obliged to recognise training which falls significantly short of its own domestic requirements. Although the Directive permits the host Member State to apply compensation measures where there are substantial differences in training, in practice these are limited. In the absence of either common minimum standards to underpin the recognition of qualifications, or the ability of regulators to apply adequate compensation measures, public protection risks being jeopardised in the interests of free movement. Article 15 refers to the establishment of common platforms between individual States. It also enables the Commission formally to recognise such platforms, thereby giving automatic recognition to those qualifications across the EU. We are concerned that without common minimum standards to underpin these platforms, the ability of individual States to maintain standards of practice would only be as strong as the weakest member. 4. Language requirements (Article 49 of the proposal) Article 49 of the Commission's proposal provides: "The Member States shall ensure that, where appropriate, the beneficiaries acquire the language knowledge necessary for performing their professional activity in the host member state". It is unclear whether the article enables regulators to test the language proficiency of migrants at the point of registration. In order to guarantee patient and service user safety, the Alliance believes that the ability to communicate effectively in the language(s) of the Host State must be a pre-requisite to registration. We seek clarification of the intentions of this article, and recommend the following wording: "The Member States shall ensure that the migrant acquires the language knowledge necessary for performing their professional activity in the host Member State. The host Member State may require a migrant to demonstrate language proficiency prior to awarding registration." III. The Alliance The regulatory bodies in the UK have legal powers designed to establish and maintain the standards of health and social care professionals. We have been established to safeguard the health and well-being of patients and service users to ensure that members of the public have access to and are treated by adequately qualified and competent professionals. We hope that, in the interests of public protection, you will give these concerns and recommendations serious and urgent consideration. Should you have any questions or comments on the Alliance's position, do not hesitate to contact Mr. Matthew Ball, Public Affairs Manager, General Medical Council, on behalf of the Alliance on +44 (207) 344 4750, by fax on +44 (207) 153 685 or by email (mball@gmc-uk.org) Members of AURE: General Medical Council http://www.gmc-uk.org
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