National Health Service (Performers Lists) (England) (Amendment) Regulations 2023

Lord Hunt of Kings Heath Excerpts

Thursday 13th July 2023 Lords Chamber

Moved by

[Lord Hunt of Kings Heath]

That this House regrets the lack of an impact assessment and a full consultation exercise being undertaken in relation to the changes made through the National Health Service (Performers Lists) (England) (Amendment) Regulations 2023 to the National Health Service (Performers Lists) (England) Regulations 2013, given the wide-ranging effect of those regulations on NHS primary care dentistry in England.

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure once again to draw your Lordships’ attention to dentistry matters in relation to this statutory instrument. I declare an interest as president of the British Fluoridation Society and related bodies.

These regulations are important in themselves—more important than first meets the eye. They come within the context of wider issues around the problems that patients are having getting access to dentistry under the NHS. In our previous debate, a few weeks ago, I referred to the GP patient survey last year, in which 12.9% of those surveyed said that they had failed to get an NHS dental appointment in the last two years. If you count only those people who attempted to get an NHS appointment the first time, 24% failed to get an appointment in the last two years.

In the last few weeks, I have had urgent representation from the Shildon and Dene Valley branch of the Labour Party about the impact that the closure of BUPA Dental Care in Shildon and Bishop Auckland has had on providing NHS dental services. As the branch says, this is an area where only a minority of people can afford expensive private dental care. The closures will lead to an overall decline in dental health and to increases in related health problems. This is happening up and down the country.

When we debated this in June, the Minister referred to the July 2022 package of dental system improvements, which was aimed partly at improving patient information and at changes to the contract to provide some incentives. However, that is not sufficient to tackle the chronic access problems that patients have.

The announcement in the NHS workforce plan that the Government intend to

“Expand dentistry training places by 40%”

is, of course, very welcome indeed. However, the Minister will need to find some capital funds to help dentist schools expand, and I know the Minister will not be surprised if I mention that the

“tie-in period to encourage dentists to spend a minimum proportion of their time delivering NHS care”

has caused some eyebrows to be raised—although I actually sympathise with that proposition.

--- Later in debate ---

I have tried to answer as many of the questions as I can. At this point, as ever, I will send a detailed reply after this which will clear up anything else. I am glad that noble Lords generally understand what we are trying to do here and agree with the direction of travel on it all. I hope that we can agree to move forward on this.

[Lord Hunt of Kings Heath (Lab)]

I am very grateful to the Minister, and to my noble friend and the noble Lord, Lord Allan, for their comments on the statutory instrument. As ever, I think we have had a very interesting debate.

It was interesting to hear the insights of the noble Lord, Lord Allan, on the website, which I have just tried out. It is easy to use and, as long as you know the name of the dentist, it finds it just like that. If you do not, I am not sure where you are. The other thing is its peculiar language. Why “performer”? That is a very odd name to use for a serious dental professional. What does “status: included” mean? Yes, they are included on the register, but I suggest it needs refreshing, and surely more information can be given. In the GMC, of which I am a member of the board, we too are looking at our registration details for the public. There is an appetite for the public to know more about the professionals—some of them specialise in certain techniques. Picking up the question of Scotland, Wales and Northern Ireland as a whole, I suggest that this is worth having a look at.

The noble Lord, Lord Allan, made a very good point on fees. I understand the issue about unfunded pay increases—we as Ministers have all had to go through some of those tensions—but that seems to be spiting yourself when, let us be honest, we are absolutely desperate for overseas recruitment. Using GMC figures, of the 20,000 or so extra registrants last year, 39% were homegrown, 11% came from the EEA and 51% came from overseas. We need to be very careful about dissuading overseas professionals from coming in, particularly when we know that the expansion in the workforce will take, I do not know, maybe a decade before we see its fruition—certainly with doctors and dentists—on the front line.

I thought my noble friend Lady Merron’s point about the cutback in NHS work post Covid was very interesting. Access issues are getting really worrying in some parts of the country where people do not have the wherewithal to go private. Somehow or other, we desperately need to do something more about access.

On the issue of impact assessment and consultation, I thank the Minister for the apologies about the tie-in statement, but there comes a time for a reset of relationships with the BDA. When the announcement about the extra training places was made, that might have been the time when a short consultation—although I think two weeks is too short—was tactically a good thing to do. Relationships between the department and the BDA are always full of interest—they are sometimes warm; they are sometimes not so great—but you cannot ignore the representative of the profession.

I accept the point the Minister made about sensible incremental changes. Small changes put together can lead to improvements. That is why the SI is welcome overall, as are the measures that we saw and debated recently.

Ultimately, we also need Governments to show more interest in dentistry. They need to understand that the access issues are very serious indeed and that we should not regard dentistry as a kind of marginal addition to the core issue of NHS services. I am sure the Minister will agree that dentists are an essential part of health promotion and healthcare provision in this country. Having said that, I am very grateful and beg leave to withdraw my Motion.

Motion withdrawn.