Immunisation: RSV
Baroness Merron Excerpts(8 months ago)
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Lord Markham (Con)
I too add my thanks; the noble Baroness is very good at holding our feet to the fire, and it is very important and appreciated. Regarding the age group, we are being guided by the scientific advice on what is most cost-effective.
Baroness Merron (Lab)
My Lords, earlier this year we discussed the busy pipeline of new vaccines, including those for RSV, which, coupled with the concerning decline in the uptake of immunisation, does point to the need for a fresh look at delivery mechanisms. What steps are being taken to move beyond traditional arrangements, and when can we hope to see an improvement plan in place, in readiness for the RSV immunisation programme?
Lord Markham (Con)
Of course, the communication needed for each one is different, and that is a vital consideration. As I said, we found that, often, it is easier to put RSV in the infant rather than the pregnant mother. It is a question of considering which is the most effective way to get the best outcome and the highest take-up rate. That is one of the key criteria we are looking at. Regarding general communication, the noble Baroness will be aware that, on MMR, we have challenges in both London and the West Midlands. That has shown that you need other communication routes to get to some ethnic minority groups, using technology such as the app. There is no one silver bullet —you need a series of measures in place.
Children’s Cancer Services
Baroness Merron Excerpts(8 months, 4 weeks ago)
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Lord Markham (Con)
I want to be fair to the NHS here. It has done an extensive study, with a lot of professionals rating extensive criteria, and they really did believe that in certain areas, the Evelina scored higher than St. George’s and the Marsden. It is a balanced decision; all I can do is absolutely promise noble Lords that we will take all those factors into account.
Baroness Merron (Lab)
My Lords, I appreciate that the Minister is looking at all of this, but given the difficulties of achieving the number of clinical trials in the UK, what effect is anticipated on research because of the proposed relocation of paediatric cancer services? Is there an intention to factor into the final decision the need to expand research capacity for childhood and adult cancers?
Lord Markham (Con)
Among the criteria the NHS has taken into account are clinical services, the patient care experience and research, and it scored the Evelina higher on research. I want to understand that, because many noble Lords will be surprised by that finding. I assure the noble Baroness that research and the ability to do clinical trials, which is a vital component of our life sciences industry, is an important factor in this decision.
Sexual and Reproductive Healthcare
Baroness Merron Excerpts(8 months, 4 weeks ago)
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Baroness Merron (Lab)
My Lords, I start by congratulating the noble Baroness, Lady Barker, on securing this important debate, and on her thorough assessment of what is a very worrying state of affairs. As I am sure the Minister has heard, that assessment has been received with some unanimity of concern across the Chamber.
The Health Foundation estimates that sexual health services will have seen spend lowered by some 39% between 2015-16 and 2024-25, which is far in excess of the already problematic 27% cuts to the public health grant. However, the situation gets even worse as the reductions in the public health grant tend to be largest in the more deprived areas. In Blackpool, for example, ranked as the most deprived upper-tier local authority in England, the per-person cut to the grant has been one of the largest. Perhaps the Minister could address how this disparity in the provision of funding for sexual health services will be put right for people in the most disadvantaged areas. It would also be helpful to hear how we have got to this situation.
My noble friend Lord Hunt raised some key questions about the Office for Health Improvement and Disparities, which I certainly want to echo. I look forward to the Minister’s reply on that, as well as to an explanation about how these cuts, which are more extreme in disadvantaged areas, square with the Government’s levelling-up agenda.
I anticipate that the Minister will give your Lordships’ House a number of statistics to refute the negative impact of the reduced funding that I have referred to on sexual health services. However, a recent Written Question tabled in the other place by Rachael Maskell MP asked what recent assessment had been made of the quality and adequacy of the availability of sexual health services. Minister Leadsom replied:
“No formal assessment has been made of the quality and availability of sexual health services to meet demand nationally or locally”.
As this is the case, how can the Government assure themselves that they are satisfied with the impact of the funding that they provide? How can they address, therefore, the very real questions that have been put in the debate this evening?
I turn to the current state of demand. The Local Government Association, using data from the Office for Health Improvement and Disparities, reports on a number of areas. For example, almost all council areas have seen an increase in the diagnosis rate of gonorrhoea, with 10 local authorities seeing rates triple, while nearly three-quarters of areas have seen an increase in cases of syphilis and more than one-third of local authority areas have seen increases in detections of chlamydia. It is interesting to note that councils, as well as other groups, have called on the Government to publish a new 10-year sexual and reproductive health strategy to address infections in the long term. Perhaps the Minister could advise the House what consideration the Government have given to that proposal.
An analysis by the Guardian just last month found that spending by English councils on sexual health services had reduced by one-third since 2013 despite a rise in the necessity for consultations for sexually transmitted infections. Advice, prevention and promotion services have had the largest cuts to funding, with net spending down some 44% since councils were made responsible for public health in 2013. Meanwhile, STI testing and treatment fell by one-third and contraceptive spending by nearly one-third. Yet we know it is costly for people to end up in hospital who could otherwise have been treated through sexual health and reproductive services. So could the Minister comment on how cuts such as these make sense in terms of value for money, when research shows that each additional year of good health achieved in the population by public health interventions costs £3,800, around three times lower than the costs resulting from the NHS interventions that become necessary in the absence of those preventative measures?
The noble Baroness, Lady Barker, was right to draw attention to the workforce that is necessary to provide these services. There have been many warnings that a large number of skilled medical staff have left the NHS and, even in the unlikely event of a major injection of resources, it would just not be possible to replace that loss of workforce overnight.
I think we in this Chamber all agree that long-term workforce planning is essential to ensure the sustainability of crucial sexual health services. There is currently a retirement cliff edge for all members of multidisciplinary teams. That has been exacerbated by difficulties in recruiting new staff into the specialty, as well as the experience of the pandemic, which saw more healthcare professionals leaving the sector. As we have heard today, there is an urgent need to recruit new trainees by addressing the low number of training posts in GUM and HIV and lower awareness of the specialty. A survey of RCN members reported that sexual and reproductive health is not regarded as attractive to new staff, while concerns were also raised about the diminishing options for education and training. That is borne out by the limited exposure to the specialty that we see in undergraduate training and in the core general training following medical school—something highlighted by the noble Baroness, Lady Barker.
In all this, the failure to plan and invest in a sexual and reproductive workforce only exacerbates pressures elsewhere in the healthcare system. People are being pushed into hospital now due to untreated STIs, with admissions to hospital for syphilis and chlamydia doubling between 2013-14 and 2022-23 while gonorrhoea admissions have tripled.
As the noble Lord, Lord Allan, said, the workforce plan refers to what I would describe as a hope—a hope that there will be benefits from improved joint working between ICBs and local authorities on workforce planning, development and training for public health areas, including sexual and reproductive health services. In answer to a Written Question that I tabled last month, the Minister confirmed that NHS England conducted an annual performance assessment of the ICBs for the 2022-23 financial year. Can the Minister indicate what assessment has been made of those promised improvements through joint working in respect of sexual and reproductive health services; in other words, is the joint working delivering in the way that the workforce plan hoped for?
Importantly, how will the Government address the very real issues that have been highlighted in this debate? They are real, they have been with us for years and they need resolution.
Cancer: Staffing
Baroness Merron Excerpts(9 months ago)
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Baroness Merron
To ask His Majesty’s Government, in the light of warnings by the Parliamentary and Health Service Ombudsman, what assessment they have made of the risk to cancer patients in England presented by the staffing levels, workloads and working conditions of healthcare professionals.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I express my regret about the cases referenced by the ombudsman. The department is taking steps to reduce cancer diagnosis and treatment waiting times across England and to improve survival rates across all cancer types. Through announcing the first ever NHS long-term workforce plan, we are taking meaningful steps to build the NHS workforce for the future. The Government are backing the plan, with over £2.4 billion of funding for additional education and training places.
Baroness Merron (Lab)
My Lords, the Minister will know that numerous complaints relating to patients with cancer that were investigated by the Parliamentary and Health Service Ombudsman included misdiagnosis, treatment delays, the mismanagement of conditions, poor communication and unsuitable end-of-life care. As the NHS is grappling with over 110,000 staff shortages, how is patient safety being compromised by the Government’s long delay in bringing forward the workforce plan? What immediate action will the Government take to deal with the continuing risk to cancer patients posed by a workforce that the ombudsman describes as “understaffed, under pressure and exhausted”?
Lord Markham (Con)
As the noble Baroness says, we see increasing the workforce as a core component here. I was speaking to the president of the Royal College of Radiologists about this the other day, and we obviously need to make sure that the workforce can be as effective as possible at what it does. We are doing a lot of new diagnosis, and 80% of all the medical AI technologies are in the radiography space, which is making a huge difference to diagnosis and productivity. It is clearly fundamental that we get the treatment to these people as quickly as possible.
Prioritising Early Childhood: Academy of Medical Sciences Report
Baroness Merron Excerpts(9 months, 1 week ago)
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Lord Markham (Con)
One of the recommendations of the report is a cross-cutting approach of the kind the noble Lord mentioned to avoid silos. The family hubs we are investing in alongside the Department for Education are trying to do exactly that sort of thing to make sure the healthy start for life exists.
Baroness Merron (Lab)
My Lords, these Benches will greatly miss my noble friend Lord McAvoy. I had the pleasure and education of serving with him as a Whip in the other place. May his memory be for a blessing.
The Academy of Medical Sciences report highlights the importance of continuity of maternity care, which can reduce the likelihood of pre-term birth by 24%. Given that premature babies are more likely to have complications that affect vision, hearing, movement, learning and behaviour, which will all impact later life, what steps are the Government taking to increase the number of women receiving dedicated midwifery support throughout their pregnancies?
Lord Markham (Con)
I agree with the noble Baroness and my noble friend Lady Cumberlege about the importance of continuity of care in the maternity space. We are investing resources as part of the long-term workforce plan to increase the number of people trained in maternity and in this area generally. To give another example, we are investing in family nurses by increasing the number of training places by 74%, because it is understood that we need the workforce to provide all these services in an ever more complex world.
Mental Health Patients: Discharge
Baroness Merron Excerpts(9 months, 1 week ago)
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Baroness Merron
To ask His Majesty’s Government what assessment they have made of the current level of (1) safety, and (2) patient and carer involvement, where mental health patients are discharged from inpatient settings and emergency departments.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
In January, the Government published new statutory guidelines setting out how health and care systems can work effectively together to support a safe discharge process for mental health patients from hospital and ensure patient and carer involvement in discharge planning. This is particularly important given that the National Confidential Inquiry into Suicide and Safety in Mental Health has found that there is an increased risk of suicide within three days of discharge.
Baroness Merron (Lab)
My Lords, the Parliamentary and Health Service Ombudsman’s recent report found many failings in care around the discharge of mental health patients, with the most common being a lack of involvement of patients, their families and carers. With the pre-legislative scrutiny of the mental health Bill highlighting the need to address this preventable situation, and the Government still not bringing forward this crucial legislation, what immediate steps will the Government take to involve those who are essential to the care and safety of mental health patients?
Lord Markham (Con)
The noble Baroness is correct; the question is of the utmost importance. It is about putting more care into the community—that is why we have put £1 billion of extra spend into community support for mental health. Some 160 local mental health infrastructure schemes are being set up, with 19 in place already, and they are starting to work. The crisis cafés have resulted in an 8% decrease in admissions, while the telephone helpline has resulted in a 12% decrease.
Anaesthesia Associates and Physician Associates Order 2024
Baroness Merron Excerpts(9 months, 3 weeks ago)
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Lord Allan of Hallam (LD)
My Lords, this statutory instrument has triggered a debate that I think is happening on multiple levels. There are two meta questions around the structure of the medical professions, writ large, and the legislative process for establishing professional regulations and updating these over time. This is something on which the amendment from the noble Baroness, Lady Bennett, focuses, and around which the noble Lord, Lord Hunt, has helpfully provided some extra history.
There is one question, which I would call an adjacent question, around the treatment of junior doctors and their frustration at the moment, which they are expressing largely through industrial action. That has been mentioned, quite rightly, by a number of noble Lords, but I do not think that is core to the debate around associates; it is an adjacent question spilling over into this debate.
We have to recognise that the Government have got themselves into a mess over the junior doctor situation and that unhappiness is now having these knock-on consequences. The noble Lord, Lord Bethell, interestingly pointed out that the BMA was unable to come up with examples of the positive use of associates. I thank the Minister for bringing some associates here so that we could hear from them. I thank the consultants in emergency medicine at Leeds hospital who wrote to me and, I suspect, to other members, describing how associates work on the ground and full of praise for the work they do, which has rightly been echoed in the debate today.
There are three questions around the associate roles themselves, which are touched on more in the two regret amendments. The first is whether these roles represent a valuable innovation for the NHS and, importantly, for the patients of the NHS, and so have a long-term place in the system. I hear broad support for the answer to this question being yes, qualified by some questions around the name and the scope, which I will come to shortly. Broadly, I have not heard anybody say that they disagree with the development of these associate roles within the NHS.
The second question is whether they should be regulated by the GMC, as proposed in the statutory instrument. Here I hear a more grudging “Yes”, but still a broad acceptance that the GMC is the only game in town and that it will do a good job. I was interested to hear from the noble Lord, Lord Harris, about the role of the GDC; the comparisons between the GDC and GMC are helpful for us to consider. Certainly, there is a broad sense that the GMC will do a good job if it is the regulator; I am inclined to agree with that.
A particular benefit of the regulation is that it will provide a clear and well-established route for any issues to be investigated. Again, people have raised particular instances in the debate about where things have gone wrong. They will go wrong from time to time with any group of professionals—including politicians, dare I say? It does not matter which group of professionals it is, things will go wrong. What is important for a member of the public is that there is someone they can go to who has a clear and well-established procedure for getting to the bottom of what happened and finding a resolution. I have every confidence that the GMC will provide that for physician and anaesthetist associates and that this will add to any complaints mechanism that exists within individual trusts, which is all there is today so long as these professions are outside of a regulated entity.
Again, importantly, it has been mentioned in the debate that the GMC will provide for a regular review of these professionals to ensure that they continue to remain fit to practise. I think we all can welcome that. I hope the Minister will be able to commit to there being full transparency from the GMC about the activity that takes place on the new associates register so that we can understand how many are coming on and going off it and understand any issues that have arisen, such as the reasons they might have been taken off the register.
The Minister referred to annual reports to Parliament. In 2024, we expect a little more real-time information so I hope he will be able to commit to there being full transparency about associates coming on to that new GMC register and that we should be able to see that much more frequently than simply a report to Parliament.
The third question that has arisen and the one I want to spend the most time on—not too much given the lateness of the hour but enough to try to elaborate the point—is whether the roles are properly defined to avoid confusion and whether they are being used appropriately. Some of this is in the name, which we have discussed already, and I hope the Minister can point to some evidence about there being a lack of confusion.
It seems to me instinctively that there is confusion, partly because “physician” is not common parlance in British English—it is something we more typically associate with American TV shows. The noble Baroness, Lady Watkins, made the point about how we now talk about junior doctors. If you said to somebody, “Do you think a physician associate or a junior doctor is more highly qualified?”, I suspect a lot of people would opt for the physician associate because “physician” has a grandness.
We should be honest enough to test this with ordinary people, not people in the medical profession. That is the test we should apply and if it is true that people think that the physician associate is more highly qualified, we need either to help people understand that that is not the case or change the name. It is really important that we go out there and talk to ordinary people about how they experience those names to understand what is going on. I hope the Minister can commit to that.
More significant is the scope of the role as defined in national guidance and how that is exercised within health organisations in both the NHS and the private sector. The noble Lord, Lord Hunt, and others rightly raised the scope of practice. I think my most significant concern is not about individual physician associates presenting themselves wrongly but the decisions that will be made by their employers about how to deploy them. We need to look at general practices and large NHS trusts separately. With GPs, in many places we are already operating in a commercial market and in some cases physician associate roles have been growing quite significantly under the additional roles reimbursement scheme which has been operating over the last few years. I thank whoever in the department who is responsible for coming up with a scheme whose acronym is ARRS, which brought a smile to my face when reading the briefing notes late at night.
This issue was brought home starkly to me when I, along with thousands of other people, received a note from my practice telling me it is being sold by a large US corporation called Centene to a British private company, owned by private capital, called T20 Osprey Midco Ltd—very catchy. GP practices are bought and sold en masse between these corporations. I looked into the business of the Centene corporation and found that in 2022 “Panorama” did an investigation specifically into its use of physician associates and came up with some quite disturbing data around the preponderance of physician associates in practices being operated by this US corporation.
I am not a raging anti-capitalist but I do not think it is crazy to think that private businesses will try antod find whichever ways they can to reduce their costs and increase their margins. I would like the Minister to explain how the Government will make sure that these roles are not misused in general practice, especially where they are owned by corporates rather than being operated by some part of the NHS structure. In particular, I would like him to explain how we ensure that practices follow the Royal College of GPs’ position that the physician associates must work under the supervision of GPs and not be used as substitutes. That was something the Minister said in theory. I would like him to clarify in practice how he is going to make sure that happens in this multiplicity of individual contractors who are not NHS employees but operate independently of it.
There is a real concern that if there is a shortage in GP recruitment, that will clearly add to the pressure for practices to think, “I’ll hire the physician associates because I can’t get the GPs”. Again, if we follow the RCGP guidance—I hope the Minister will agree with this—if a practice cannot hire a GP, it has no one to supervise the associate so it should hire fewer physician associates, not more. The hiring of physician associates is contingent on practices hiring sufficient trained general practitioners.
When it comes to NHS trusts, the concerns relate to the decisions that the management may take. This is not intended to be NHS manager-bashing, particularly not with my noble friend Lord Scriven sat behind me; it is more a bit of Government-bashing. If the Government leave trusts with constrained budgets, managers will naturally look again at ways to keep the services running, including using less expensive staff where they can. The risk will be compounded again if the more expensive fully trained staff are not available because there is some shortfall in the Government’s training programme.
I know that the Minister will have to say, “The Government will meet their targets for training doctors and GPs”, but in the real world we have to imagine a scenario where, sadly, they fall short. Again, I want to hear assurances from him that where trusts start heading down the route of thinking that they can hire associates because they cannot get the doctors, the levers will be in place for the NHS centrally to stop that happening and to ensure that associates, who are valued and valuable members of teams, will not be left by their managers to do all of the job, rather than being part of a team with a trained medic leading it.
I hope the Minister can reassure us on the scope in both GP practices and NHS trusts. Again, the SI and this regulation are welcome but there are some questions to answer around how these measures present to people. However, the most significant questions that we may come back to in two, three or four years’ time will be around how individual trusts and general practices have decided to use these roles, rather than any questions around the professionalism or effectiveness of the individuals doing that work, whom we value.
Baroness Merron (Lab)
My Lords, the point that the noble Lord, Lord Allan, has just made about respect for the professionals we are speaking about is a very good one for me to follow on from, because I believe we are at our most vulnerable when we are in the care of the NHS. We have a right to expect to be seen and treated by a competent and regulated professional, in whom we have confidence. This debate has highlighted the sensitivities and practical challenges in trying to get that right. I am sure the Minister will take note of the many valid points that have been raised.
I start by associating myself and these Benches with thanking physician associates and anaesthesia associates for their professional and continued service. I feel particularly strongly about saying that in view of the points raised by my noble friend Lord Hunt and other noble Lords on the considerable toxicity that has been generated about this issue. That has brought bullying and intimidation to these very valued members of the NHS team. I am sure that all of us in your Lordships’ House believe that this is just not acceptable.
In the debate tonight, I feel that I have heard broad agreement that regulation is important—indeed, crucial —to maintaining high standards of patient safety and care, and providing clarity around the boundaries of the functions that can and cannot be performed. Yet, as we have heard, there has been significant delay in getting there when it comes to PAs and AAs, even though regulation needed to come alongside workforce planning. Can the Minister tell your Lordships why this regulation has taken so long?
NHS: Neurology Care
Baroness Merron Excerpts(9 months, 3 weeks ago)
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Lord Markham (Con)
Yes, absolutely. Of course, this is what the CDCs are about as well in trying to get that diagnosis capacity. At the Neurological Alliance forum I was just at, the main thing was needing help with early diagnosis, because getting treatment is key to it all and, also, seeing whether we can sometimes refer people directly to the CDCs so that the GP is not always the bottleneck.
Baroness Merron (Lab)
My Lords, as Lord Cormack was a fellow of Lincoln, as I am, I pay tribute today to his considerable contribution to the City of Lincoln, as well as to this House and to the other place. May his memory be for a blessing.
The Neurological Alliance has expressed concern about the lack of clarity over whether new therapies for those affected by neurological conditions and their changing needs have been factored into the workforce plan. Can the Minister set out how the workforce plan will respond to these changing circumstances both for those with neurological conditions and those with other conditions?
Lord Markham (Con)
I echo the noble Baroness’s comments regarding Lord Cormack.
In terms of the long-term workforce plan, I was talking this morning to the national clinical lead in this area and to Professor Steve Powis. The next stage in terms of the detail is looking at the individual specialties and neuroscience experts are part of that. In the last five years, we have seen an increase of about 20% or so in this space but understanding that need going forward is the next stage in the long-term workforce plan.
NHS Dentistry
Baroness Merron Excerpts(9 months, 4 weeks ago)
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Lord Markham (Con)
Yes, it is all about outcomes and output. As I mentioned, there have been sensible moves recently in terms of the contract—the £50 for new patients; increasing minimum levels; and ensuring that dentists get more payment for doing, for example, three fillings versus one. I also agree that some fundamental work needs to be done in this space.
Baroness Merron (Lab)
My Lords, the Minister has previously suggested that the 15 mobile dental vans would be able to address emergency situations as well as scheduled appointments. How will this work in practice, particularly in view of the size of the areas each van will cover? How will the Government meet the immediate need for thousands more appointments for emergency dental treatment?
Lord Markham (Con)
There will be a schedule of when the mobile vehicles will visit each area, with the ability to pre-book so, if someone calls up with an issue, they will know that a truck will come to their area in a week or two’s time. That is the idea, or people can queue to receive those services as well. I hope this will be successful. It has worked quite well in some areas already. The case will prove itself and the 14 will be just the start. We can do much more from that, because we all agree that we need to expand supply.
NHS Dentistry: Recovery and Reform
Baroness Merron Excerpts(10 months, 1 week ago)
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Baroness Merron (Lab)
My Lords, I associate these Benches with the thoughts and prayers expressed for His Majesty the King. We wish him a full and speedy recovery.
I thank the Minister for this Statement at a time when NHS dentistry is at the most perilous point in its 75-year history. I found yesterday’s scenes in Bristol quite shocking, where the police were called to manage hundreds of people lined up outside a dentist. They had flocked to a newly opened practice, absolutely desperate to secure an NHS appointment. It is a raw illustration of the state of dentistry where more than eight in 10 dental surgeries are refusing to accept adult patients seeking NHS care and where more than seven out of 10 are not accepting under-18s. Tooth decay is the main reason for children between the ages of six and 10 being admitted to hospital.
It is noted that there is some proposed new investment in this plan, although previous funding has not kept pace with inflation. Good practice is to be deployed to improve access to dental care for those who have not seen a dentist for years, through the use of mobile clinics and some preventive measures. But this long-awaited plan which the British Dental Association has described as “sticking plaster” will not address the systemic problems that have led to today’s state of near terminal decline.
In addition to targeting recruitment of dentists to areas most in need and the preventive toothbrushing scheme for three to five year-olds, we have committed to 700,000 extra urgent and emergency appointments. There does not seem to be anything in the plan to address this latter need. This is key, because surveys have shown that 82% of dentists have treated patients who have had to take matters into their own hands since lockdown, by carrying out DIY dentistry. In 2022-23, across England, 52,000 patients were seen in A&E with a dental abscess caused by tooth decay, as well as 15,000 with dental caries. How will this plan work without the provision of more emergency and urgent appointments?
We know that immediate reform of the dental contract is needed. If in government, we will sit down with the British Dental Association in our first week. The Government’s 2010 manifesto made a promise to reform the NHS dental contract. Yet, this Statement confirms that reform will not be on the cards until 2025. Why was progress not made when it could have been? What assessment has been made of the impact of continued delay on dental health?
I turn to some specific points. Dentists are covering costs out of their own pockets, particularly for treatments that require lab work, such as dentures and crowns. This needs to be addressed. What assessment has been made of this situation and what impact does the Minister expect the plan to have in resolving it?
To what extent do the Government expect the new patient premium to make a dent in the scale of the problem of improving access for new patients? As the plan for around a million new patients is time-limited, there are concerns that this risks disincentivising the long-term treatment of the new patients being brought into the NHS. What reassurance can the Government give that this will not happen? The Government state that the plan will deliver care to 2.5 million, but their own data show that 12 million people in England have an unmet need for NHS dentistry. What about the rest?
The plan also includes “golden hellos” to around 240 dentists to work in underserved areas for up to three years. I hope this will help. Across the UK, 90% of dentists are not taking on new, adult NHS patients. In huge parts of the country, new patients are not being taken on at all, while, in others, dentists are refusing to see a child unless a parent is signed up as a private patient. What sort of a dent will 240 dentists make in this? How will these payments be distributed and in what areas? Perhaps the Minister can clarify whether the payments are for new dentists or are they to be used to get existing, qualified ones to move?
The absence of essential NHS dentistry is to the detriment of the health of the nation. As the Nuffield Trust says, this plan appears to be,
“a much-needed scale and polish when what NHS dentistry needs is root canal treatment”.
I look forward to the Minister’s response.
Lord Allan of Hallam (LD)
My Lords, from these Benches, I also echo our best wishes to His Majesty the King. We hope that he makes a speedy recovery.
In responding to this Statement, I also reach for that familiar phrase of it being a sticking plaster, before heading in the direction of dental metaphors. Rather than a scale and polish, it seems to me that this is something of a temporary filling when, as the noble Baroness, Lady Merron, says, NHS dentistry needs serious root canal work.
I feel for the Minister because I know he cares about dentistry and understands the scale of the problem. He has to sell the temporary filling hard in the hope that we will trust the Government to deliver on the more comprehensive course of treatment that is in the consulting on and exploring part of the document.
There are three elements in that long-term part of the plan on which I hope the Minister can comment further today or later in writing. First, we are told that the Government will ring-fence the £3 billion of NHS dentistry budgets from 2024-25 which have been underspent because of the lack of dentists willing to work at NHS rates. We cannot see this changing overnight, even with what is announced today. How will this ring-fencing work if an integrated care board has still not been able to get the take-up of the contracts that it wants? What kinds of things could they use these underspends for? Will these include additional local financial incentives on top of the ones we are discussing at a national level today?
Secondly, it is important to realise the benefits of people with dental qualifications moving to the UK. I know that the Minister would wholeheartedly agree. The policy document promotes the idea of a provisional registration of overseas qualified dentists while they are waiting for their full GDC registration. The phrasing in the Statement and in the document is quite hesitant. It talks about the Government working towards introducing legislation. Can the Minister give us more information about the complexity of the legislative changes that will be required and their likely timescale?
Thirdly, failures in emergency care both cause severe patient distress and additional work for NHS hospitals. The noble Baroness, Lady Merron, has already pointed out that many children are referred to hospital for emergency treatment. I looked at the description on the Smile Together website—a good service in Cornwall cited in the plan. It says that:
“Smile Together is commissioned by NHS England to provide urgent and emergency dental care to patients who would otherwise be unable to access treatment. Demand for this service is very high and the criteria set by our commissioners is very strict. We therefore offer emergency appointments that are independent of our NHS service”,
and people who call in who are unable to get an NHS appointment and do not wish to wait and try again the next day can basically go private. I am not sure we want to be in a situation where people needing emergency care are left hanging on the phone day in, day out, or face having to go for the private option. I hope the Minister can explain what the Government intend to do around emergency care. I hope he will agree that making sure people can get NHS emergency care will be better for both the patient and the NHS.
A temporary filling is designed to last a few weeks—or months at most—or perhaps until an election. We are grateful for the temporary relief it provides, but we know that more work is needed, and this has to be done urgently if we are to fix NHS for the long term.