PPE Expenditure

Lord Harris of Haringey Excerpts

Wednesday 25th January 2023 Lords Chamber

Asked by

[Lord Harris of Haringey]

To ask His Majesty’s Government what is their latest estimate of expenditure incurred in purchasing faulty personal protective equipment (PPE) during the COVID-19 pandemic; how much had been recovered by 31 December 2022; and how much they forecast to recover by 31 December 2023.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The department’s Annual Report and Accounts 2020-21 confirm that 817 million items of PPE worth £673 million were not fit for any use. By December 2022, the department had reduced the number of contested PPE contracts from 176 to 60, with an associated recovery of value for the taxpayer of around £1 billion. Given commercial sensitivities, we cannot comment on our forecast for further recovery.

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to the Minister for that reply, but when I look at the National Audit Office report it produces some slightly different figures from those that he has given. It says that his department had identified 3.6 billion PPE items that were not suitable for use, at a cost of £2.9 billion. The point I want the Minister to comment on is that 53% of those suppliers who came through the VIP route provided materials which were not fit for use. Does that raise any questions about the procurement processes operated during the pandemic?

[Lord Markham (Con)]

I thank the noble Lord. Given the recent press, I want to start by setting out the position of Cignpost, the private sector Covid testing company in which, as many noble Lords will be aware, I own a stake. To be clear, Cignpost did not bid for any government PPE contracts and has only private sector clients. None the less, upon taking up the role as an unpaid Minister of Health, I resigned my directorships, made an undertaking to sell my stake, and in conjunction with the Permanent Secretary, ensured that I was not engaged in any areas where there could be perceived to be a conflict—I just wanted to make that clear.

Turning to the question, I was giving the most up-to-date figures. The £1 billion reflects the money that we have continued to recover. Right now, the only amount that has been written off is the £600-odd million that I have mentioned, and we are continuing to pursue the other amounts. When we close the accounts, we will have an update on where that will go. On the VIP lane, I think we accept that, given our time again, we would conduct that in a different way. I will check but I do not recognise those figures as to the level of faults.

Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022

Lord Harris of Haringey Excerpts

Monday 9th January 2023 Grand Committee

[Lord Harris of Haringey (Lab)]

My Lords, the noble Lord, Lord Hunt, has effectively declared my interest for me. However, just for the record, I declare that I am chair of the General Dental Council and have been for the last 15 months or so. I am grateful to the Minister for introducing and bringing forward this order. I think we will all benefit from the fact that he has some familial insight into the issues that we are looking at here and in other matters.

I hope that the Minister will accept that this order has been quite a long time coming. It was already long awaited when I was appointed 15 months ago, and the discussion has been going on since at least 2017. This particular order has been introduced twice in the past few months, before the present order; it had to be withdrawn and introduced again, for various technical reasons.

I start by saying clearly that the General Dental Council welcomes this order. However, I want to take this opportunity, in Grand Committee, to make it clear what this order does and does not do. As I think has been said by all noble Lords who have spoken so far, internationally qualified dental professionals make a vital contribution to the UK dental workforce. In recent years, more than one-third of newly registered dentists have qualified overseas, and current workforce pressures would be immeasurably greater without the contribution that they make. However, the current processes for international registration are cumbersome and inefficient. Existing legislation imposes considerable constraints on the GDC’s ability effectively and efficiently to assess the skill and knowledge of internationally qualified dental professionals. For dentists, there is an overseas registration examination with a very rigid structure and, because of the statutory framework, a very limited range of providers. This results in places not always being available for candidates who want to sit the exam.

Quite properly, nothing in this order reduces the high standards required of international candidates seeking to join the UK register. I am sure that the Minister will want to reaffirm that that remains the Government’s priority. Certainly, public protection is, and remains, central to the purpose of the General Dental Council. The standard applied to international candidates is, and should be, equivalent to that applied to people who register based on UK qualifications. Nobody will want to see those standards compromised, least of all the GDC, and the changes made by this order protect those standards but will enable modernised and more flexible approaches for assessing whether candidates have met them.

The order brings in some immediate changes, 21 days after it has been made—so we are probably talking about March this year. From that point, a number of changes will happen immediately. At the moment, the overseas registration examination is in two parts: the first is effectively a written process, and the second a practical test of skills. It is a requirement of the existing legislation that the second part must be concluded within five years of the first part. During the Covid pandemic, part 2 exams had to be suspended and, through no fault of their own, some candidates missed the opportunity to take part 2 because the five-year time limit had expired and therefore lost the opportunity to be registered, because you cannot simply start again. Those affected will now have restored to them the opportunity to sit the second part of the ORE. That is welcome, and it addresses an injustice for those affected as a consequence of the pandemic.

The second immediate change, which my noble friend Lord Hunt of Kings Heath has referred to, is that new applications to the dental care professional register must be based on the primary qualification appropriate for the professional title being applied for. That stops a loophole whereby applicants who are qualified only as dentists have been seeking to register as a DCP. The Committee needs to know that there has been a flood of such applications in the last year: some 1,075 international candidates for registration as DCPs have been approved, which is more than the total number currently on the DCP register from any source. That enables them to practise in this country without going through the more appropriate ORE process for registration as a dentist. There is also now a considerable backlog of applications all seeking to make use of the loophole before it is closed to new applicants 21 days after the order is made. This change is important and overdue. The lack of clarity about what individuals are qualified to carry out in terms of their professional duties is not helpful, and therefore the loophole needs to be closed. The delays and the flood of applications to try to avoid the deadline are causing considerable operational issues for the GDC in managing all overseas registration, and indeed registrations of UK-qualified dentists.

At the same time, the order is going to give the GDC some new powers, although they will take some time to have practical effect. The requirement for assessments of international dentist applications to be conducted by a dental authority—effectively, a dental school—will be removed. Over time, that will give the GDC much greater flexibility in procuring providers and potentially in designing new assessment models. For example, it might be possible to look at the question of whether the first stage of the overseas registration examination has to be taken in this country or whether it could be taken overseas. That flexibility will be sensible, given the current problems in finding suitable providers. However, it is important to stress that this will not have an immediate effect while current contracts remain in place.

The GDC will also gain the power to make detailed rules about how applicants should be assessed. There will be a requirement to consult on these rules and, critically, the current requirement for Privy Council approval will be removed. The practical effect is that the rules can be more flexible and responsive to changing environments, not the least of which is that the fee can reflect the cost, which at the moment is not necessarily the case until it has received Privy Council approval.

The point is that the order is a vital enabler of reform but does not in itself deliver it. Removing the overly prescriptive constraints is a vital first step towards creating a more effective system but it does not and cannot provide an immediate increase in the dental workforce. The rule-making powers in the order do not come fully into effect for 12 months, and even then it will take time to develop new approaches, consult on new draft rules and procure the supply of the necessary services. Alongside that we have the continuing uncertainty about the different provisions that currently apply to people who can currently benefit from the continuing recognition of EU qualifications. If the Government choose to close that route as a result of the review that they are required to undertake this year, significant additional capacity will be required in the GDC’s assessment processes. Any indication today from the Minister as to whether the existing arrangements for applicants from the EEA will continue would be most welcome.

The order provides provisions for the GDC to explore alternative processes for the recognition of international qualifications. Incidentally, it should not be confused with the powers included in the Professional Qualifications Act that allow for the mutual recognition of qualifications through international agreements: they are outside the scope of this order.

Enabling the recognition of international qualifications is not as straightforward as it might at first appear—and there is certainly no quick solution. New processes for the quality assurance of education and training to secure public protection will be needed, alongside new fee structures. This type of recognition may need to be specific to an institution and qualification. It is not, therefore, a quick solution to workforce challenges. The approach taken would have to be fair to those who undertake the UK qualifications, and indeed to the institutions providing them. Also, any route to recognition would need to be applicable globally and take into account the very different standards and approaches to qualifications around the world.

The key point is that none of these changes will solve the wider problems of access to NHS dentistry. The role of the GDC is to register dentists and dental care professionals who are fit to practise in the UK. But there is a separate process before they can work in the NHS. They still need to go through the performers list validation by experience process to practise in the NHS for each UK nation in which they want to practise. So streamlining the ORE process does not in itself deliver more NHS dentistry. I appreciate that the Minister did not assert that that would be the case, but I have heard that view expressed in various quarters, perhaps by former Ministers, which makes it necessary to reinforce the point.

More significantly, if the NHS dental contract fails sufficiently to incentivise UK-qualified dentists to provide NHS dental services, it is not immediately obvious that overseas-qualified individuals faced with the same set of incentives will choose differently from their UK-qualified counterparts. The BDA in a recent briefing warned that

“NHS dentistry is facing existential threat”,

that even before the pandemic

“only enough dentistry was commissioned for half the population in England”

and that the proposed package of changes to the NHS contract announced by the Government in November was “modest” and “marginal” and would

“do little to arrest the exodus of dentists from the service, or address the crisis in patient access.”

Those were the BDA’s words, but I hope that the Minister will be able to give us some assurance on the nature of the discussions that will take place on the future of NHS dentistry and the NHS contract.

To conclude, these changes in the international registrations order are welcome, but they will not address the fundamental issues.

[Lord Patel (CB)]

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.

Plastics: Health Research

Lord Harris of Haringey Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. Yes, the NHS is committed to a 10% reduction in clinical single usage by 2045, and these plans are set out in the NHS long-term plan document, Delivering a “Net Zero” National Health Service.

[Lord Harris of Haringey (Lab)]

My Lords, the Minister has said several times that there is no credible evidence that this is harmful. I just ask him to contemplate whether it really can be good for the human body to be pumped full of foreign material in this way. Would he have given the same answer in respect of smoking, which, when it was first promulgated and mass-marketed, was also seen as beneficial to health?

[Lord Markham (Con)]

The phrase I used was that there is “limited evidence” in this space. I reiterate that if a good research proposal is put forward, funds are available there. The only point of difference on this is that I do not believe we should ring-fence a definite amount each year when the evidence does not yet exist that it is a health risk.

Social Care Sector: Staff Shortages

Lord Harris of Haringey Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Harris of Haringey (Lab)]

My Lords, is it not the case that if the national minimum wage has gone up, therefore affecting the social care sector, it will also have gone up affecting those who stack shelves in supermarkets?

[Lord Markham (Con)]

I was referring in that answer to the visa scheme. That will allow us to recruit more people from overseas who will be eligible for a visa, in the fine traditions of the NHS. We have always recruited from around the world and I am pleased to say that we are recruiting in this space. This is a consequence of a full-employment economy, which I think we would all accept is a very good thing. But, clearly, that sometimes means we need help, in areas such as the NHS, to recruit from overseas.

Abuse and Deaths in Secure Mental Health Units

Lord Harris of Haringey Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

My noble friend raises a good point. My understanding is that the rapid review that we seek to put in place would involve an independent chair, because independence is key in this area. On the detail of whether that should be the case for every death, I will take back that point and respond to my noble friend.

[Lord Harris of Haringey (Lab)]

My Lords, following on from the noble Baroness, Lady Berridge, until 2015 I chaired the Independent Advisory Panel on Deaths in Custody. As she said, the largest number of deaths in custody were those in secure mental health units. There is no independent arrangement. It is all very well to talk about an independent chair, but, essentially, the assessment is being made by those in the same field—sometimes, indeed, in the same institution. The Government are failing their Article 2 obligations on the right to life. How frequently do the Minister and his colleagues in the department meet the Independent Advisory Panel on Deaths in Custody, and when did they last take note of, and act on, the recommendations it has made?

[Lord Markham (Con)]

I do not have the information to hand on when the last visit was, so I will write to the noble Lord on this. The substance of the question is good: clearly, we cannot have people marking their own homework—for want of a better phrase—in this situation, so I will take back this point. Again, I understand the importance of this; it is vital that these young people, and others in mental health institutes, are supported in the right way. We are spending about £400 million to eradicate dorms, which are often part of the problem, but that is not to say that more does not need to be done.

NHS Dental Services

Lord Harris of Haringey Excerpts

Tuesday 24th May 2022 Lords Chamber

[Lord Kamall (Con)]

I half-thank my noble friend for giving me advance notice of one of his questions. I will try to answer that one. Many dentists who provide NHS treatment also already work in a private care capacity, and all dentists who provide NHS care must be registered on the performers list. The NHS uses the list to ensure high quality and safety standards in NHS dentistry.

On the UDA and negotiations, NHS England is in conversations with the BDA concerning both short-term changes and longer-term changes given the concerns that have existed since they were introduced in 2006.

[Lord Harris of Haringey (Lab)]

My Lords, I declare my interest as chair of the General Dental Council. The noble Lord, Lord Young of Cookham, has correctly highlighted the importance of the negotiations on the NHS contract for dentists, but there is another element to the problem. That is the long-term expectation in terms of how many of each of the various dental professions and the various dental specialties we need in this country. What is the flow in people leaving and what is the flow in recruiting dentists, including those from overseas? Do we have enough places and enough experience coming in? Does the Minister agree that we should do a proper study of what the long-term requirements are for dentistry and how they are to be met?

Eating Disorders

Lord Harris of Haringey Excerpts

Tuesday 1st March 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness’s suggestions are reasonable, and I think that many noble Lords would agree that it is important that we tackle this on a number of levels. For example, under the NHS long-term plan, extra funding has been going to children and young people’s community eating disorder services every year, with £53 million per year invested in 2021-22. That will increase the capacity of 70 new or improved community eating disorder teams covering the whole of the country. In response to Covid and to help meet the waiting time standard, we have invested an extra £79 million in 2021-22 to significantly expand children’s mental health services. In addition, as part of the additional £500 million that we announced in 2021-22, some of this is also being done via the mental health recovery action plan. NHS England and NHS Improvement have announced a further £40 million in 2021-22 to address the impact of Covid on children’s and young people’s mental health. These are some of the different ways in which we are addressing this very serious issue that a number of noble Lords have quite rightly raised.

[Lord Harris of Haringey (Lab)]

My Lords, adolescence has been referred to repeatedly, but does the Minister recognise that there is a gulf between adolescent mental health services and those for adults? A young person reaches the age of 18, ceases to be dealt with through child and adolescent mental health services and is very lucky to get any sort of appointment thereafter. What are the Government going to do about that gulf?

[Lord Kamall (Con)]

There are number of areas—not only eating disorders but elsewhere—where people are often concerned about that transition from children’s services to adult services. We are looking at that holistically to make sure that healthcare is patient centred. It is one of the reasons why we want to make sure that the Health and Care Bill is completely integrated. It will be healthcare whereby the patient is looked after right from their birth all the way through their life, including that transition from children’s services to adult services.

Covid-19: PCR and Lateral Flow Test Providers

Lord Harris of Haringey Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

When I was discussing this with the people responsible for accreditation, they said that often a number of companies are reported to them and they look into them. Quite often companies will then be removed, but they can come back. The issue is that companies sometimes get provisional approval at the first stage while they are going through the full approval process. That will be reviewed in time.

[Lord Harris of Haringey (Lab)]

My Lords, in answering the noble Lord, Lord Scriven, the Minister referred to the fact that 100 companies had been removed from the list, presumably by his department or NHS Test and Trace. He presumably monitors all of this, so could he tell us exactly how many complaints there have been and how many of such complaints are necessary before a company is removed?

[Lord Kamall (Con)]

I am sorry to disappoint the noble Lord; I do not personally monitor this, but I will get the figures and write to him.

Covid-19: Plan B

Lord Harris of Haringey Excerpts

Wednesday 20th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that very important question. Some of the data suggests that there has been a slower uptake for the booster. I do not have the exact information and data available on the uptake of the booster, but I will make sure I write to my noble friend.

[Lord Harris of Haringey (Lab)]

My Lords, the Minister keeps referring to plan B, but he has not answered the fundamental question that my noble friend Lord Rooker raised. This Government have too often in the past been slow to respond, and as a result has had to introduce far harsher measures as a consequence. Does he accept that that has been the case in the past, and what assurances can he give us, as we go forward, that that will not happen later this year?

[Lord Kamall (Con)]

I am afraid I disagree with the noble Lord on that particular question. In fact, the UK is seen as a leader in the speed and efficiency with which it adopted vaccines. Countries that criticised the UK were, only a year later, saying “How did you do it? How did you manage to roll out your vaccines so quickly?” Of course, things change, and it is very important that we balance all the factors when considering whether to move to plan B.

Covid-19: Proof of Vaccination

Lord Harris of Haringey Excerpts

Monday 14th June 2021 Lords Chamber

[Lord Harris of Haringey (Lab)]

My Lords, I refer to my interests in the register. It sounds as though what you really need is a secure card that proves your identity and has important information uploaded to it, such as your vaccination status—something my noble friend was introducing, only to have it scrapped by an incoming Conservative Government. We have had 10 wasted years. If there is to be a vaccination app or some other certification, can we be assured that it will not contain data that purports to show that holders are safe to travel because they have had a negative test under the absurd test and trace scheme? The BMJ has reported that the level of false negatives is of the order of 30%. Such negative tests have no probative value, despite the Government, according to the Public Accounts Committee, wasting £37 billion on them.

[Lord Bethell (Con)]

My Lords, that is not our approach. Our approach is to try to use whatever technologies work in order to open up our borders. The idea that 30% of tests are not correct is an unhelpful suggestion by the noble Lord. We will be using testing in the validation app.