Anaesthesia Associates and Physician Associates Order 2024

Debate between Lord Markham and Lord Harris of Haringey

Monday 26th February 2024 Lords Chamber

[Lord Harris of Haringey (Lab)]

It is in your order.

[Lord Markham (Con)]

That is something I will pick up on. On the point raised by the noble Baroness, Lady Fox, I say that the GMC, with the CQC, should be able to give the ongoing quality assurance.

The noble Lord, Lord Hunt, said very well that the discussion on mistakes has not been useful. We are all aware that, regrettably, mistakes happen in all areas, and we need to make sure that we understand and learn from them, rather than using them to point fingers. Moving into the regulated space, where there is duty of candour, is useful.

I do not think anyone could be failed to be moved by the passion with which the noble Lord, Lord Winston, spoke about his experience. It was a very telling story. As reassurance I cite the noble Lord, Lord Patel, on the scope of the practice: it is one anaesthetist to two AAs, and the role of the AA is very much to maintain, as he explained well. In a similar way, the PAs really do need to work under GP supervision. The numbers are set out in the long-term workforce plan. We have a foot on the throttle for those training places, particularly in regulating them. We will make sure that things are properly managed so they cannot get out of control.

I absolutely agree with the points made by the noble Baronesses, Lady Watkins, Lady Harding and Lady Bloomfield, that this is a people management issue, and a lot of the heat from this debate is a feeling from junior doctors and others that they are unloved and uncared for. I freely admit that there is a wider issue that we need to look at, concerning things like hot meals; clearly, it is something trusts need to look at it as well.

I echo the points made by the noble Lord, Lord Hunt, that passing this order is the best way to ensure the safety of patients. As we develop, there is perhaps scope to be more ambitious, but let us try to do this step by step, to make sure we really are happy and that the scope of practice works. As ever in a debate as long as this—it has been a very thorough one—I will write to fill in any details that I have not managed to cover. At this point, I hope and trust I have provided sufficient answers to the questions, and have demonstrated—

NHS Dentistry: Recovery and Reform

Debate between Lord Markham and Lord Harris of Haringey

Wednesday 7th February 2024 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. He is absolutely correct that the benefits of water fluoridation are well proven. The consultation for the north-east of England, which will bring in 1.6 million people to this, is starting very shortly. The idea behind that is that we can really try to get moving quite quickly on that. I was surprised to learn that the level of water fluoridation in England today is only at about 6 million people. I know that a lot of people think that their water supply has fluoridation, but there is obviously a long way to go on that. The 1.6 million in the north-east is a good extension to that, but there is a lot more that we plan to do in this space.

[Lord Harris of Haringey (Lab)]

My Lords, I declare my interests as chair of the General Dental Council. I welcome the fact that this plan has now arrived—it has been a very long time coming. Of course, the council’s role is to maintain a register of dentists and ensure that all the dentists on that list are of an appropriate standard and fit to practise in this country. I am not going to comment on the level of investment, but I make the point that increasing the number of dentists on the register does not in itself increase the number of people who practise in the NHS. I think that the British Dental Association uses an analogy about a bucket with a hole in it. The point is that, if the situation is one in which dentists, whether they qualified here or abroad, feel that the rewards that they get from being an NHS dentist are insufficient, we will continue to see that drift away from NHS dentistry.

My specific point is about the question of overseas registration. The Statement highlighted the fact that 30% of those on the register are qualified from overseas. I should say that nearly 50% of those who joined the register in 2022 are from overseas, so that gives some idea of the direction of travel. To facilitate that, the GDC has trebled the number of places for people taking their ORE part 1 examinations. On the specific proposal about provisional registration, which the General Dental Council will welcome, I hope it is recognised that, if somebody is provisionally registered, they must be supervised. This will require a structure within both the NHS and private practice to make sure that there are adequate levels of supervision available and an adequate number of dentists to do that. Can the Minister tell us how that will happen?

[Lord Markham (Con)]

I thank the noble Lord, particularly for his great knowledge and work with the GDC. I absolutely accept the basic point about the leaky bucket, for want of a better phrase; we are losing a lot of dentists to private. At the end of the day it is about the economics, and clearly we need to make sure that doing NHS work pays. In part that is what the patient premium is designed to do, as is increasing the value of UDAs to £28. There is also an acceptance that we need to look at some of the more long-term measures to make sure that it is economic to do that. The salaried staff I mentioned earlier will help with that as well.

The noble Lord is absolutely correct—again, I have some personal experience of all this—about having that mentoring scheme. Even if a dentist has been operating overseas for a number of years, learning a lot of the techniques and methods here is very beneficial. It is absolutely recognised that such mentoring is required. On the detail of how that is being planned, I will set out in my letter to everyone how exactly that will be achieved.

NHS Long-term Workforce Plan

Debate between Lord Markham and Lord Harris of Haringey

Tuesday 4th July 2023 Lords Chamber

[Lord Markham (Con)]

As for the A-level point and those people not being able to go on to universities, that is what the different routes are about. The different pathways that we are talking about include nursing associate training places, which we want to see increased to 10,000, and similarly with physician associates. While we all understand that having a university education is a fantastic medical grounding, there are many other ways to get there. I am sure we all have very good examples of fantastic clinicians who did not have a degree.

[Lord Harris of Haringey (Lab)]

I refer to my interest as chair of the General Dental Council. I welcome not only the whole document but the specific commitment within it to increase the number of dental training places by 40% by the beginning of the next decade. Does the Minister accept that simply increasing the number of dentists will not solve the problems of NHS dentistry if dentists decide that it is more lucrative for them to practise privately rather than through the NHS? This is only part of the process. If the solution to dealing with the problems of NHS dentistry is to essentially create a tied class of dentists who have trained and are therefore expected to work in the NHS, I am not sure that this will be sufficient.

I also raise a more general point which is nothing to do with dentistry specifically. Could the Minister tell the House what proportion in any one year of the number of people entering the workforce are expected to go into the NHS? My calculation suggests that they are expecting the figure to go up from 10% of those entering the workforce to 15%. What will incentivise that, and will it be addressed through the various pay processes that we have already referred to?

[Lord Markham (Con)]

I thank the noble Lord for the work he does as chair of the GDC. He will know that this is something that is quite close to my heart, given that my better half is a dentist. I completely agree that it is about far more than just the training places. I think the House has heard me discuss this before, but if we are serious about dentists who have been in practice for 10 years setting up their own clinic, maybe in an NHS Digital desert, we must give them guidance and support, as it is quite an ask to do that. We plan to produce and publish a dental plan in the not-too-distant future, in which I hope and trust that a lot of these points will be covered.

The noble Lord is correct; I do not know the exact maths behind it, but we spend roughly 12% of our economy on the health sector and so it is not surprising that roughly that number would be expected to go into the NHS workforce. In some ways, that shows the magnitude of everything we are talking about today. Probably one in eight of all people leaving school will end up in this sector—that really is a number worth thinking about and pondering over. As we all agree, it shows why this plan is timely and why it must be a living document that is continually adjusted as we go forward.

Mental Health In-patient Services: Improving Safety

Debate between Lord Markham and Lord Harris of Haringey

Monday 3rd July 2023 Lords Chamber

[Lord Markham (Con)]

As I am sure the noble Lord is aware, the second thing that the HSSIB is being asked to look at is exactly the point about how people are cared for as in-patients and how we can improve that approach. On staffing—again, we will debate this more tomorrow night following the Statement repeat—it is vital that there is a feedback loop in terms of the long-term workforce plan. That feedback loop, as I am sure noble Lords are aware, is built into it, so that when new data comes along, as will potentially be the case with the HSSIB, there is a way for that to feed back in again.

[Lord Harris of Haringey (Lab)]

My Lords, I will follow on from the point made by the noble Baroness, Lady Berridge. Until 2015, I chaired the Independent Advisory Panel on Deaths in Custody, which covered the more high-profile areas of deaths in police and prison custody. However, the largest number of deaths under the care of the state was in mental health institutions. The noble Baroness, Lady Berridge, asked about independent investigations and the Minister said that the review will look at what lessons can be drawn. The point is, however, that over the last 20 to 30 years, there have not been independent investigations into the individual deaths, so how will there be an evidence base to decide whether proper lessons were drawn at the time and whether those were acted on?

Secondly, my noble friend Lord Hunt of Kings Heath talked about the difficulties with CAMHS. There is a gulf at age 18 between people being treated under CAMHS and then going into adult mental health services. What are the Government doing to bridge that gap? People who may have received some support from CAMHS then lose it when they go into the adult sector.

Finally—I know I should not ask three questions, but I want to—one of the striking things about the number of deaths that occurred in mental health institutions is that many arose from physical causes. It was not about people committing suicide or their mental health crisis; it was the fact that in a hospital, a place of medical provision, they were not getting adequate physical healthcare. What are the Government doing about that?

[Lord Markham (Con)]

I thank the noble Lord for his commitment in this area over the years. With regard to the first question about past evidence, clearly the HSSIB will be looking at what evidence exists. As the noble Lord said, some investigations go back 30 years, so there will not always be circumstances where it can pick out that evidence, unfortunately. However, where there is that information, we are trying to make sure that we pull it out and learn from it. That is very much the direction of travel. Clearly, if part of the HSSIB’s findings is that we need to make sure that every death in such circumstances is investigated under a certain pathway, then I am sure that will come into its recommendations. In terms of the other questions, I think it is best that I write to the noble Lord, if I may.

Hospitals: Maintenance

Debate between Lord Markham and Lord Harris of Haringey

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord makes an excellent point. As he knows, we are investing heavily in a federated data platform, which is precisely about stopping storing paper and making such savings. Even more importantly, it is about improving patient care so that we can ensure that records are transferred instantaneously and really build on the knowledge that will bring.

[Lord Harris of Haringey (Lab)]

My Lords, I am not sure that the Minister really addressed the question my noble friend raised about the number of hospitals. He said that it was substantially more than three, then tailed off without giving us a number. He promised us a virtual reality opportunity to look at “the hospital of the future”, but I do not know whether that exhibition will show exactly which hospitals the 40 in question are, what is going to happen and how many of them a normal person in the street would regard as new. While he is on his feet, can he tell us what feedback Ministers have had from NHS staff working in hospitals about the physical state of those buildings and the extent to which that impedes their daily activities supporting patients?

[Lord Markham (Con)]

We have eight cohort 1 hospitals, which all have full planning permission and are in various stages of construction. We have 10 cohort 2 hospitals, of which two have full planning permission, seven have outline planning permission and one is awaiting approval of outline permission. All have had the preparation works done. So that is 17 where massive progress is being made. We then have cohort 3 schemes: the new hospital 2.0 projects, which are introducing modern methods of construction to standardise production and get cheaper and more efficient hospitals at a quicker rate of output. That is what I invite noble Lords to come and see for themselves over the coming weeks. This programme is very real and I will happily take people through whatever detail they want because, believe me, it is all there.

PPE Expenditure

Debate between Lord Markham and Lord Harris of Haringey

Wednesday 25th January 2023 Lords Chamber

[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.

Plastics: Health Research

Debate between Lord Markham and Lord Harris of Haringey

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

Debate between Lord Markham and Lord Harris of Haringey

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

Debate between Lord Markham and Lord Harris of Haringey

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.