National Health Service (Dental Charges) (Amendment) Regulations 2023
Baroness Merron Excerpts(2 years, 11 months ago)
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Lord Allan of Hallam (LD)
My Lords, I am very grateful to the noble Lord, Lord Hunt of Kings Heath, for giving us the opportunity to have this debate. I think he is having an even busier day than the Minister, given his contribution to the Illegal Migration Bill debate that we just had.
There are two real questions that people are asking about access to NHS dental services. The first is whether they can get an NHS dentist. That is something that we have debated in the context of other regulations along similar lines discussing the way in which the remuneration scheme works. The second question is about how much will it cost if they do get one—if they are the lucky few who can navigate through the system and find an NHS dentist, and that is what we are primarily discussing today.
It is also important to touch on dental deserts, particularly in rural and coastal areas. I hope that the Minister may also have some to say on availability. He has assured us in this House previously that the Government have ideas to try to improve the ability of NHS dentists generally, and I know he had some creative ideas about attracting dentists into under-served areas.
Having got through the barrier of finding an NHS dentist, we now need to think about the question of charges—a question that is entirely academic if you are unable to get one in the first place. The Government are proposing in these regulations an uplift—in common language, an increase, but they prefer to use “uplift”, which I think is supposed to sound a little softer— of 8.5%. I find that curious language. When I go to supermarkets they do not tell me that they are applying an uplift value to their prices; they apply an increase to their prices, but here we are told it is an uplift value.
In paragraphs 7.8 and 7.9 of the Explanatory Memorandum we get a lengthy and quite convoluted explanation of where that money goes, which makes it clear that patient charges make no direct contribution to the remuneration that the dentist receives. People out there may think that the payment they are making to the NHS goes to the dentist, but it does not. Again the Explanatory Memorandum makes it clear that there is intentionally no link between the contract price paid to the dentist and the contribution that the individual pays. Paragraph 7.8 states that the money is essential to improve access challenges, and that current and future work to improve NHS dentistry would be undermined by the risk of reduced funding if the patient charge revenue was lower. Yet, as we heard from the noble Lord, Lord Hunt, it is reported that there was a £400 million underspend in the NHS dentistry budget for last year, so I have a couple of questions for the Minister, a maths question and a logic question. The maths question is: will he confirm that £400 million is approximately five times as much as the £78 million in extra revenue that we are told that this 8.5% increase will achieve? In other words, if we were not to have the increase but were simply to roll the underspend into dentistry, we could cover five years of that additional revenue-raising from the underspend that already exists. The logic question is simply: how can we say logically in this paragraph that these charges are essential to improve NHS dentistry when we are not spending the money that is already available? Perhaps the Minister is going to make us all happy by confirming that that £400 million underspend is all going to be spent on NHS dentistry, in addition to the extra £78 million, but I suspect that is not going to be the case. Listening to the noble Lord, Lord Hunt, I wondered whether one of the solutions might be that the new charges should not be allowed to be levied unless and until all the existing budget has been spent. If there is going to be a £400 million underspend, perhaps the patient should benefit from that if the money is not going to be rolled back into NHS dentistry.
The overriding concern is one that the noble Lord, Lord Hunt, also referred to: that the long-term commitment from this Government to provide dentistry within the National Health Service just is not there. The right words are being spoken, but the actions are telling us a different story.
The Government’s own impact assessment notes, at paragraph 37, tell us:
“There remains uncertainty about whether higher patient dental charges would lead to lower levels of patient access”.
They say that, although the research is not clear,
“it is very likely that higher charges will reduce the number of patients seeking NHS dentistry services, relative to there being no patient charge uplift.”.
So, again, the Government’s own notes tell us that it is likely there will be reduced demand for NHS dentistry as a result of the charges that we are discussing today.
Paragraph 32 very tellingly talks about the relationship between NHS and private dentistry, which, of course, is an alternative in most parts of the country. It says:
“There is also a risk that increases in NHS charges could mean that the cost of NHS dental treatment becomes closer to prices of private dental care. Some patients may choose to receive private care if the cost differential is lower”.
It seems logical that, if a patient is confronted with real difficulty in getting an NHS dentist compared with getting a private dentist and if they understand that there is no real price differential, those two forces combined will act to steer people away from NHS dentistry towards private dentistry.
As I know the Minister and I have heard him speak on these issues before, I suspect he will say that this is not the Government’s intention—but we need more than words. We need evidence that we are not seeing a succession of measures leading inexorably in one direction: a direction in which dentistry ceases to be available on the NHS at a fair NHS price for people in large swathes of this country.
Baroness Merron (Lab)
My Lords, I am grateful to my noble friend Lord Hunt for tabling this regret Motion and speaking so clearly to it, describing for your Lordships’ House what this actually means for people by its effect on NHS dentistry.
I am glad to follow the noble Lord, Lord Allan, and I absolutely associate myself with his remarks about the word “uplift”. It is a very positive way of describing an increase in costs to those who need NHS dentistry. We should remind ourselves that this is why we are having this debate, not only about the costs but about the sorry reality of the state of NHS dentistry at present—and bearing in mind that all this takes place in the context of a cost of living crisis.
It is incumbent on us this evening to remind ourselves that poor oral health—which is where we end up when people do not look after their teeth because they cannot afford and/or cannot access NHS dentistry—does not just affect the teeth. It impacts on our general health and well-being; it affects what we can eat, how we communicate, and how and whether we can work, study and socialise with ease, and it affects our self-confidence. Yet it is right to say that tooth decay is largely preventable.
There is also a significant public health problem linked with considerable regional variation and inequality. A three year-old living in Yorkshire and the Humber is more than twice as likely to have dental decay as a three year-old who lives in the east of England; and one in three five year-olds in the north-west has experience of dental decay, compared to nearly one in five in the south-east of England. It would be helpful if the Minister could tell us: what is the Government’s aspiration in respect of NHS dentistry? That aspiration and the practical means to achieve it seem to have got rather lost on the way.
As we heard from my noble friend Lord Hunt, the last 13 years have seen dentists quitting in very considerable numbers. In 2021 alone, 2,000 quit the NHS, which represents almost 10% of all dentists employed in England. An estimated 4 million people cannot access NHS care, with some parts of the country now described as dental deserts, where remaining NHS dentists are not taking on new patients.
To secure a future, we need staff, which I will refer to later, and the equipment, technology and access to ensure that patients get the treatment they need. This raises a number of wider questions. We are spending less on dentistry per head of the population in the areas with the highest levels of deprivation. Statistics from the British Dental Association suggest, for example, that 1 million new or expectant mothers have lost access to dental care since the start of the pandemic. Could the Minister say what the Government are doing to prevent those on low incomes or in more vulnerable groups being disproportionately impacted?
Tooth extraction in hospital due to tooth decay remains the most common reason for hospital admissions in the six to 10 year-old age group, with an estimated cost of hospital admissions for children aged between nought and 19 for this intervention being some £33 million per year. What steps are being taken on early preventive action to reduce what has become a shameful situation?
We know that 91% of dental practices are not able to accept new adult patients in England and 80% are not able to accept new child patients. Millions are having to face the unpalatable options of waiting for months in agony, resorting to their own DIY dentistry, or stumping up for private dental fees they simply cannot afford. My question to the Minister is not just about what the Government are doing to tackle this crisis, but how did they allow it to get to this situation? From inadequate support for the prevention of oral ill health in childhood to dental deserts, net government spend on general dental practices in England has been cut by over one-third over the past decade. Again, perhaps the Minister could explain how the situation has been allowed to deteriorate to this extent.
We know that not enough is being done to recruit and retain dentists and dental care professionals. A recent British Dental Association member survey showed that more than nine in 10 owners of dental practices with a high NHS commitment found it difficult to recruit a dentist, with 43% of vacancies unfilled for more than six months.
On the workforce, there is a point I want to underline following the points raised by my noble friend Lord Hunt. In June last year the House of Commons Health and Social Care Committee reported the findings of its inquiry into the health and social care workforce. It found that the headcount—to underline this—of primary care dentists in England providing NHS treatment or otherwise conducting NHS activity in 2020-21 was at its lowest level since 2013-14. While the register has the highest number of dentists, the number doing NHS work is decreasing. In 2021 alone there was a decrease of 951 dentists with NHS activity in England. That is the near equivalent of the whole intake target of dental students for the whole year. Perhaps the Minister could explain how this all stacks up.
On the matter of substance—we have heard much about this from the noble Lord, Lord Allan, as well as my noble friend Lord Hunt—at almost 500 practices across England the British Dental Association tells us that the amount paid by NHS patients was greater than the amount paid to that practice to provide NHS services. The analysis suggests that patients at those surgeries were topping up government funding by an estimated £2 million last year. It would be helpful to hear from the Minister how and in what way this makes sense.
NHS National Health Inequalities Improvement Programme
Baroness Merron Excerpts(2 years, 11 months ago)
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Lord Markham (Con)
Absolutely. We work very closely together. The Healthy Start programme gives seven fruits a day to kids up to the age of seven to make sure that they get fruit and vegetables, and that is very much a joint initiative. Clearly, we need to be joined at the hip on some things, but as regards school meals, the DfE takes the lead.
Baroness Merron (Lab)
My Lords, the levelling up White Paper promised to design and test a new approach to ensure compliance with school food standards. Although pilot schemes were meant to start last September, a recent Written Answer from the Schools Minister stated that
“standards are being kept under review”,
with no sign of the pilot scheme. Have the Government given up on their promise and does the Minister consider the existing standards for school meals and the means of compliance sufficient to tackle nutritional inequalities across the country?
Lord Markham (Con)
As mentioned previously, the review did not happen because of Covid, and it is very much within the plans that it is time to look at school standards again. Clearly, that is key to making sure that there is a healthy diet in schools, and of course that goes across the board.
Autism: Diagnosis Targets
Baroness Merron Excerpts(2 years, 11 months ago)
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Lord Markham (Con)
First, I totally agree with my noble friend’s sentiment about the power that AI, when done in the right way, can have in this space. Clearly, the stress is on the words “the right way”. I think it is fair to say that we are all on the nursery slopes as regards what it can do. I have seen how effective it can be in taking doctors’ notes, recording a meeting and drafting action points, which a doctor can then review. I am sure that we would all agree that that is very promising. There are future generations of AI being talked about that may be able to perform diagnosis. In the 10 to 15 years of looking ahead in the long-term workforce plan, these are some of the things that we will have to try to take into account. However, we are in the very early stages.
Baroness Merron (Lab)
My Lords, when it comes to autism services, we know that there are major disparities across the country which predate the pandemic but which were made much worse by it. The number of people waiting for an assessment has grown by 169% from pre-pandemic levels. How will the Minister ensure that the national framework and the standards for autism assessment within it are deliverable at a local level and in every part of the country?
Lord Markham (Con)
First, each ICB now has to have a lead for autism and learning difficulties. The noble Baroness is correct that there are some disparities— I am sure that she is aware of the two ICBs which have restricted their services quite significantly, although, thankfully, they are now rowing back on that. We need to make sure that we are on top of all of them. As the noble Baroness is aware, I and other Ministers are taking a personal interest in this. Clearly, there is a lot of work to be done.
NHS: Allocation of Financial Resources
Baroness Merron Excerpts(3 years ago)
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Lord Markham (Con)
Yes, and we are doing it. We have committed to an up to £7.5 billion increase in funding over the next two years. We announced last month a social care plan which is addressing this and reforming the sector, and we are starting to see the changes.
Baroness Merron (Lab)
My Lords, the Royal College of Emergency Medicine described as unambitious the Government’s plan to see 76% of A&E waits meeting the four-hour standard by 2024. As this target has not been achieved in the past two years, how does the Minister see it working to drive down waiting times? How will the Minister ensure that hospitals are not prioritising patients with minor conditions at the expense of those in greater need of admission simply to allow them to meet the target?
Lord Markham (Con)
Numbers out just this morning show that we are now at 75% of people being seen within four hours, so we are close to the 76% target. That is the best since September 2021. I am the first to admit that we want to go further, as the noble Baroness states. It is about making sure we have got the care in the right places. We are triaging to make sure that the most important cases are seen first and, as I mentioned in a previous answer, we have things such as fall services, which can avoid trips to A&E in the first place, and more primary care in place to avoid visits in the first place. That is what the primary care recovery plan is all about.
Life Expectancy: Pensions, Health and Insurance
Baroness Merron Excerpts(3 years ago)
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Lord Markham (Con)
My noble friend is correct: it is a key issue. There have been successes such as the sugar tax levy, which has reduced sugar consumption by about 40%. But clearly, you need only to look at the statistics to see that all western nations, including the UK, are facing this problem. It is a challenge that we have to attack. We can learn a lot in this space from Japan, where employers and the whole society are very much involved in the healthy lifestyles of their workers and people.
Baroness Merron (Lab)
My Lords, life expectancy for those with a learning disability is particularly shocking: only four in 10 live to see their 65th birthday, nearly half of their reported deaths are avoidable, and those living in the north-west and the Midlands are at greater risk. What action are the Government taking to address the specific barriers faced by people with learning disabilities in getting access to the timely, quality healthcare which could perhaps extend their life expectancy?
Lord Markham (Con)
As noble Lords are aware, we have been putting significant investment into mental health; from memory, there has been a £2 billion-plus increase over the last year. In recognition that learning disability is an issue we particularly need to tackle, as the noble Baroness is aware, we are putting investment into schools so they can identify it early on. Some 35% of schools now have the right educational leads in this space, and the figure will rise to 50% next year. It is a big improvement, but do we need to do more? Absolutely.
Long Covid
Baroness Merron Excerpts(3 years ago)
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Lord Markham (Con)
I thank the noble Baroness. My understanding is that the 90 specialist adult centres and 14 specialist children’s centres have care pathways which they are supposed to adhere to. Therefore, I hope that the instances which the noble Baroness brings up are the exception, but I am happy to investigate because I think we all agree that a consistent care pathway is vital in this space.
Baroness Merron (Lab)
My Lords, despite the provisions that the Minister has outlined, the reality is that just a fraction of the people who have long Covid are seen and supported. What steps are being taken to ensure that GPs recognise long Covid in those who do not self-label as having the condition, and how will the Minister respond to the data that shows inadequate access to specialised health services?
Lord Markham (Con)
As I say, the data that I have been working with indicate that 80% are seen within eight weeks, which I think most noble Lords would agree is a pretty good statistic. My understanding is that GPs are fully briefed on referrals and disability types. It is clearly important that people who are suffering in the long term make sure that they get treatment.
Diphtheria
Baroness Merron Excerpts(3 years ago)
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Lord Markham (Con)
As I mentioned, we are doing the screening. We lead Europe on this; my understanding is that no other European country is taking the extensive measures that we are. I can also reassure the House—I was speaking to Susan Hopkins on this just yesterday—that UKHSA has deemed that there is a very low risk to the general population. The uptick in cases that we are talking about is in the migrant population, and the fact that we are vaccinating 88% of them against diphtheria shows that we are on top of the problem.
Baroness Merron (Lab)
My Lords, we know only too well from pandemics that diseases do not respect borders, and though, as the Minister says, we ought to be well protected against diphtheria in this country given the vaccination programme, recent increases in vaccine hesitancy have given cause for concern. On the steps that the Minister referred to that should be taken to maximise vaccination rates, can he indicate whether this will reflect regional variations, bearing in mind that the National Audit Office has reported a lower level of vaccine take-up in London?
Lord Markham (Con)
Absolutely. As the noble Baroness is aware, vaccination take-up is the responsibility of the ICBs in their areas. Like many other places, London has unique demographics. As I mentioned, our record is pretty good in this area, but it needs to be done nationally on a uniform scale.
Junior Doctors’ Strikes
Baroness Merron Excerpts(3 years ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
“Mr Speaker, the honourable gentleman seems to ignore the fact that we have actually negotiated a deal with the NHS Staff Council, and it is a deal that it has recommended to its members. Indeed, the largest health union has voted in favour of the deal—indeed, it is his own health union—yet he seems to think we should tear it up, even though other trade unions are still voting in response to that offer and their leadership had recommended it.
Secondly, he says that we should sit down and negotiate. We have made an offer of 10.75% for last year, compared with the Labour Government in Wales, who have offered just 7.75%. So the offer, in cash terms, in England is actually higher than the offer that is being put on the table by the Welsh Government, which I presume he supports. He says he does not support the junior doctors in their ask for 35%, and nor does the leadership there. We need to see meaningful movement from the junior doctors, but I recognise that doctors have been under significant pay and workforce pressures, which is why we want to sit down with them.
The bottom line is that the deal on the table is reasonable and fair. It means that just over £5,000 across last year and this year will be paid for a nurse at the top of band 5. The RCN recommended this deal to its members, but it was rejected by just under a third of its overall membership. It is hugely disappointing that the RCN has chosen not to wait for the other trade unions to complete their ballots and not to wait for the NHS Staff Council, of which it is a member, to meet to give its view on the deal. It has chosen to pre-empt that, not only with the strikes that come before that decision of the NHS Staff Council but by removing the derogations—the exemptions—that apply to key care, including emergency care, which is a risk to patient safety.
Trade unions are continuing to vote on this deal. The deal on the table is both fair and reasonable, including just over £5,000 across last year and this year for nurses at the top of band 5. It has been accepted by the largest union in the NHS, including, as I have said, the shadow Health Secretary’s own trade union. It pays more in cash to AfC members than the deal on the table from the Labour Government in Wales. It is a deal that the majority of the NHS Staff Council, including the RCN’s own leadership, recommended to its members. We have always worked in good faith to end the disruption that these strikes have caused and we will continue to do so, but it is right to respect the agreement that we have reached with the NHS Staff Council and to await its decision, which is due in the coming weeks.”
Baroness Merron (Lab)
My Lords, last week was the most disruptive in the history of the National Health Service, with some 350,000 patients seeing their operations and appointments cancelled due to industrial action. Does the Minister accept that the public remain supportive of doctors and nurses and also that the public want to see the Government reaching fair, negotiated settlements to bring disruption to an end? If Ministers remain unable to get agreements over the line, what other options are being pursued, including the involvement of ACAS?
Lord Markham (Con)
I think we all want fair outcomes and negotiated settlements, and I think we felt that the agreement reached with the Agenda for Change parties was fair and was something, as mentioned in the Statement, that the union leadership recommended to the union members. Of course, we need to wait to see the outcome of the staff council of all the Agenda for Change unions from 2 May to see where we end up on that. Our hope is that, across the majority of those, we will see support. As noted, this is a generous offer; it is higher than the offer made in Wales, for example, and we hope it will be a way forward after 2 May. If that is not the case, we need to sit down and think about next steps.
Junior Doctors’ Strikes
Baroness Merron Excerpts(3 years, 1 month ago)
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Baroness Merron (Lab)
My Lords, junior doctors are being asked to do the work of many. The NHS is short of more than 150,000 staff, yet the long-promised NHS work plan remains just that—long promised. We are still waiting for the general practice plan, the review of integrated care services and the social care update. Do the Government intend to get those plans out over the Recess when Parliament is unable to scrutinise them? With a quarter of a million appointments and operations potentially facing postponement because of the forthcoming strikes, when will the Health Secretary get back around the table with the BMA, this time to take talks seriously to stop the damage to patient care?
Lord Markham (Con)
We have taken the talks incredibly seriously. We have proven in other areas with the Agenda for Change unions that, with good will on all sides, we have managed to reach an agreement. I think most people would agree it is not a reasonable position to go in saying that, unless they get a 35% pay increase, they are not willing to have any further talks. That is not something that I believe many of us could support. We are always open to reasonable negotiation, as we have proved in the other cases, and we remain open to having that reasonable negotiation now.
Lord Markham (Con)
As I have mentioned many a time and am happy to mention again, the workforce plan will be announced shortly—soon. I wish I could give an exact date, but it is there. However, I am sorry to say that I do not believe that can be used as an excuse for the strike action that we are talking about now, which puts patients at risk. I know that, in other areas, the Agenda for Change unions have worked constructively with NHS trusts on derogations to protect patients, but I regret to inform the House that that is not the case now. There is lots that we need to do in the workforce space, and there is lots that we want to do around recruitment, motivation and making it a good place to work, but I would like to think that none of that means that the delay of a report is a reason to take this sort of action and put patients’ lives in danger. I do not think any of us would agree that that is a suitable reason.
Baroness Merron (Lab)
My Lords, perhaps I could invite the Minister to respond to my first question, building on the points made by the right reverend Prelate. In addition to the NHS workforce plan, which we await, I remind the Minister that we are also waiting for the general practice plan, the review of integrated care services and the social care update. Could the Minister take this repeated opportunity to say whether the Government will be publishing these over the Recess? If this is so, it is obviously of concern that Parliament will not have the chance to scrutinise the plans.
Lord Markham (Con)
Like all noble Lords, I absolutely agree that Parliament has to have every opportunity to fully assess, discuss, debate and scrutinise the plans. As noble Lords know, I cannot say when the report will be released, so I cannot say with all honesty whether it will be over the Recess or afterwards. I can only repeat the words “soon” and “shortly”, and say that there is not a definite plan to announce it over the Recess. What we fundamentally agree on is that these plans are being produced with stakeholders and a lot of consultation, and they will absolutely be subject to a lot of scrutiny, as we would expect. I expect to answer on the plans in this House, as I expect my ministerial colleagues in the other place to have to do as well.
Health Education England (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023
Baroness Merron Excerpts(3 years, 1 month ago)
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Baroness Merron
At end insert “but that this House regrets that the explanatory memorandum to the Health Education England (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023 does not offer sufficient evidence to support the change; that the information provided on the potential costs and savings from this reorganisation are unspecified and vague; that the Regulations have not been published alongside His Majesty’s Government’s promised NHS Workforce Plan; and that they do not guarantee that NHS England will give long-term workforce issues sufficient priority”.
Baroness Merron (Lab)
My Lords, I am grateful to the Minister for introducing this draft statutory instrument, which facilitates the merger of the body responsible for the education and training of the health workforce, Health Education England, with NHS England, with the purpose of improving long-term workforce planning and strategy for the recruitment of NHS staff. I would also like to express my appreciation of the work of Health Education England and acknowledge the contribution of staff who have worked within that organisation. I am also grateful to the Minister for his initial response to the points raised in the amendment standing in my name on the Order Paper.
As noble Lords will know, on these Benches we are very committed to long-term workforce planning for the NHS and for social care, which requires independent workforce projections. Once again, I have to say, it is staggering that the NHS has not had a workforce plan since 2003—and still we wait. In answer to the much-asked question about the publication of the workforce plan, your Lordships’ House and the other place have been told that it would be “soon”. The meaning of the word “soon”, I do feel, has been somewhat overstretched, and I know the Minister understands that point. So, to repeat the question: when will the workforce plan be published? And can the Minister indicate what will be the role of NHS England within the workforce plan?
In earlier debates about the merger of NHS Digital and NHS England, the point was rightly made that talented expertise has to be retained. Given that, in this case, we are looking at an estimated cut of up to 40% in workforce numbers, this point bears repeating. Could the Minister provide an update on how the work on retaining talent and expertise is progressing? What assurances can he give to your Lordships’ House that the staff are being treated fairly throughout this process? Could the Minister also set out what specific service improvements are anticipated because of the merger and what metrics the department will use to judge NHS England’s performance, given its new remit?
I am grateful to the BMA for its contribution, which highlights areas of concern it has picked up from practitioners. I hope the Minister can assist with allaying those concerns, which I will now set out. Doctors are anxious that these changes could devalue the importance of supporting education and training, compared with the desire to increase service delivery during an ongoing workforce crisis. How will this be guarded against?
There are also concerns that the reduced size of the new NHS England will damage its ability to deliver support to junior doctors and negatively affect the day-to-day running of postgraduate training programmes, which are currently supported by the local offices of Health Education England. Can the Minister give reassurance on this point?
Finally, there is a question about NHS England’s ability to adhere to the minimum standards set out in the code of practice on the provision of information for postgraduate training. I hope the Minister can also assist by responding on this point.
Although we on these Benches will not oppose these regulations, I now turn to the substance of my amendment and draw the attention of your Lordships’ House to the report of the Secondary Legislation Scrutiny Committee, which says:
“The Explanatory Memorandum describes what the instrument does in quite legal terms but does not offer evidence to support the policy by setting out the costs and benefits anticipated from this transition. We have received further information from the Department … which is published in Appendix 1 but despite our enquiries the information on the costs and savings from this reorganisation remains quite vague.”
In addition to these points, my amendment notes that
“the Regulations have not been published alongside His Majesty’s Government’s promised NHS Workforce Plan; and that they do not guarantee that NHS England will give long-term workforce issues sufficient priority”.
I heard the Minister’s initial response, but I feel he has spoken of promises of delivery in the future, so could he explain how the shortcomings, which have been criticised by the committee and in the context of the amendment, have arisen and how he will seek to address them in full?
Although there is no fundamental problem with the general policy of abolishing Health Education England and transferring its responsibilities to NHS England, once again the presentation, content and communication has been somewhat lacking. The SLSC has been damning of the regulations’ Explanatory Memorandum, which, as the committee says, does not provide sufficient evidence to support the policy, or set out the costs or savings clearly enough. This is clearly unacceptable, so could the Minister—this, again, is a repeat question for him—confirm what steps he has taken to ensure that important regulations such as these are properly and thoroughly brought before the House?
More broadly, and to return to where I started, these regulations are before us without reference to the broader NHS workforce plan, and it is this for which we still wait. Absorbing Health Education England into NHS England before knowing the number of health workers it will need to educate and train really does feel like putting the cart before the horse. The NHS is nothing without its workforce, yet we are still unsighted on how many doctors, nurses, care staff and allied health professionals we will need in five, 10 or 20 years’ time. Can the Minister set out the reasons behind this delay? Is it a matter of cost, or is it some kind of disagreement within government as to what the NHS needs and what the Government are prepared to commit to? I beg to move.
Lord Markham (Con)
I think that is probably one element I need to come back to the noble Lord on in writing.
As I said, I will try to follow up the questions in detail. I welcome the contributions of various noble Lords and their understanding of what we are trying to do here. I understand the arguments, as an ex-management consultant, regarding centralisation versus decentralisation and how they go in and out of fashion. This is a slightly different case because it is about bringing a core function in house. To me, that is the key change and the key thing we will be seeking to measure. As well as setting out clinical needs, the key role of the NHS at its centre is making sure that it is recruiting, training and retaining talent to meet the workforce plan needs. On that note, I thank noble Lords for their contributions and hope that my follow-up answers any questions that I missed.
Baroness Merron (Lab)
My Lords, I am grateful to the Minister for his response, and to the noble Lords who have spoken in this debate: the noble Lords, Lord Scriven and Lord Allan, and the noble Baroness, Lady Watkins. I did smile when the noble Baroness gave us an update on the workforce plan, which I am sure was helpful to the Minister, and I also wish her well in her new role.
As the Minister and your Lordships’ House will have equally understood, this is not about the actual steps that are being taken. We have had a useful debate to pull out some aspects, but the regret Motion is about the workforce and, in particular, the failure to have produced a workforce plan. This is not something recent from the last year or so. We have to remind ourselves that this Government have been in government for 13 years, and still we wait. For every day we wait, we lose an opportunity—as noble Lords have said—to plan for the future, as well as to deal with the immediate, and that is what motivated me to put forward this amendment.
We are all in agreement today that a workforce plan has to be for health and social care, which are inextricably linked, and has to not sit on the fence—well, it may; we will see. The plan has to not sit on a shelf but be fully resourced and do the job it is intended to do. We will look forward to holding the Minister to account on that point, as I know he expects.
Regrettably, I do not believe that in this debate the Minister has addressed the shortcomings of the regulations before us. Those shortcomings are somewhat unnecessary, which is a great shame because overall the statutory instrument is one that will be beneficial. It is a shame that we have had to debate it in this fashion. With that, I beg leave to withdraw the amendment.