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

Lord Markham Excerpts

Thursday 13th July 2023 Lords Chamber

I am sure that the Minister has got the message that while there is no issue with the actual changes, there are many issues with the way in which the regulations have been dealt with. There are great concerns that they may not deliver the impact that the Government seek and, indeed, we all seek—that is, improvement to access to dental care.

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

I thank noble Lords for their contributions and the noble Lord, Lord Hunt, for bringing this topic before us today. As noble Lords know, I have an interest in this case in that my wife is an overseas dentist, which means I can trump the website search by the noble Lord, Lord Allan, and say that I have filled in these forms myself.

Overall, I am glad that there seem to be shared goals in that we all want to increase the supply base of doctors, dentists and opticians—in this case, the focus is particularly on dentists. Clearly, we all want to maintain high standards and remove unnecessary red tape. That is what we are trying to do here.

I do not think anyone is going to pretend that this alone will be a massive thing. I liken it to Team GB cycling—noble Lords have probably heard me use that example before—where you are looking at 1% and 2% changes and sensible things at the margin that will accumulate over time. The noble Baroness, Lady Merron, asked about some of the July 2022 changes. The noble Lord, Lord Hunt, mentioned the changes to the UDAs and those earlier changes. Each of those on its own will not make a massive change, but the accumulation of all those things will begin to have an impact. That is why it is so difficult to do an impact analysis on any one individual measure, because we are trying to combine all those things to make it into the right space for people to want to do this.

I think we all agree that it seems strange not to trust that the Scottish, Welsh or Northern Ireland NHS has gone through a process good enough that we would automatically use it. It is sensible that we trust them and their standards but have a case to verify afterwards if we need to. I do not know whether it will be reciprocal. I argue that we should do it regardless, because it has to be to our benefit that we are as inviting as possible. I would not be surprised if they follow suit. Funnily enough, if they do not, it might be to our advantage through a narrow NHS England lens and making sure that we have the easiest approach to work and practice.

The other main point is where I really have a personal interest. I hope it will add some colour to the thinking behind this, albeit with a sample size of one. Please take this as an anecdotal experience rather than as a massive data analysis. I have seen that you go through a very thorough GDC process. That is something that I filled out in the context of my wife when we did all this. She had practised and had her own practice in Madrid for about 15 years and was very experienced. She went through a very thorough GDC process to make sure that she was eligible to practise here. She then practised in Manchester and Liverpool at some very high-end private clinics.

We then decided to move to Surrey. She saw that there were a number of jobs on offer that wanted people with private registration, but that it would be helpful if they had NHS as well, because a number of clinics have a hybrid model whereby they will offer both NHS and private treatment. She went down that process and I was involved in it. Eventually, she came to the conclusion that she was doing a hell of a lot of hard work. There was a two-year process and all sorts of courses she needed to take—it was very much a checklist of things to do—so she thought, “Do I really need to do this? I have plenty of private practice anyway”. In the end, she concluded that there was no point. I grant that this is a sample size of one, but I think we can all see that, if someone has been practising for many years to a very high level and can continue doing that, but suddenly there is a load of red tape in the way of becoming an NHS dentist, eventually they would say that it is not worth it. That is what this approach is all about.

It is also about accepting that you need judgment; you cannot put down any hard and fast rules, as was questioned, because every case is going to be different. Part of the problem now is that it is almost a tick-box exercise when looking at their experience. That is what this is designed to do. If a dentist has worked in the private sector or overseas for 10 to 15 years and can show evidence of the different types of treatment they have done, you can be pretty confident—by all means, meet them and talk to them—that they can do that at the NHS level. Those are the judgment calls that they make, and that is where we are coming from.