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

Baroness Merron Excerpts

Monday 9th January 2023 Grand Committee

[Lord Allan of Hallam (LD)]

My Lords, I do not have any direct professional interest in the subject at hand, but as somebody who lives in London and needs dental care, and as a parent, I am grateful to those dentists and midwives from all over the world who have provided me with excellent service through the years. We should be grateful to them all.

From these Benches we also broadly welcome the order the Minister is putting forward. It is clear that we should make it possible for all suitably qualified healthcare professionals to practise in the UK and it is, frankly, a waste of an individual’s talent and a detriment to public interest if there are unnecessary delays or barriers to registration. The noble Lord, Lord Hunt of Kings Heath, described dentists coming here from countries such as Ukraine and Afghanistan who can make a significant contribution, and we need to enable them to do so rather than disabling them from doing so.

Of course, there are necessary checks to protect patient safety, but what we are saying with this statutory instrument is that we believe that the professional bodies, such as the General Dental Council and the Nursing and Midwifery Council, are the bodies most competent to determine what those checks should be and to set out the right testing and assessment processes to allow applicants with overseas training and experience to apply their skills here. In this debate I have learned a lot from the detailed experiences of the noble Lords, Lord Hunt of Kings Heath, Lord Harris of Haringey and Lord Patel, about what this means in practice. It seems to me to be the right decision that we should empower those bodies even further and give them the flexibility that they need to be able to adapt over time as circumstances allow, balancing out the need for safety but also the need to get people on to the register as quickly and reasonably as possible. We agree with the Government on the broad thrust of these provisions and that the additional flexibility is important.

I raise one question with the Minister. Do the Government have any criteria in mind for assessing whether this change has been successful? For example, have they looked at the cost and speed of applying to register before and after the additional flexibility is granted and after the new processes are brought in? The noble Lord, Lord Harris, correctly reminds us that this will not be immediately, but certainly over this multiyear process, if we are to make this change, it would make sense to look at the situation before and after. I note that paragraph 14.1 of the Explanatory Memorandum points out that the instrument itself has no monitoring provisions, but with any legislative change it is helpful for that to be the case, and I hope that the Minister will be able to describe some criteria that the Government have internally for deciding whether this has been successful.

Finally, I end on a note of caution about the safety standards. Sadly, something will go wrong; somebody will be registered in future who should not be registered. When that happens, the fact that we are all supportive of this today means that we will all own that decision, and we should not say that this is wrong because of a single bad case. Overall, we are making the correct decision. The correct risk assessment is that we trust bodies such as the General Dental Council and the Nursing and Midwifery Council to make decisions.

As the noble Lord, Lord Hunt, correctly pointed out, this is part of a process; we will be going further, and other professional bodies will be given similar flexibility. That is the right decision now and will be the right decision in future. Even if and when something sadly goes wrong under the new procedures, as I said, we will need to remember that, overall, we took this decision because we wanted to see more of those people—the kinds of people from whom I have certainly benefited—on the registers in the UK providing the professional services that they can.

[Baroness Merron (Lab)]

My Lords, I thank the Minister for bringing this order before us. On these Benches, as across your Lordships’ House, these changes are welcomed as sensible and as part of a suite of measures that we will continue to consider. Certainly, the increased flexibility that they bring to the work of the General Dental Council and the Nursing and Midwifery Council by amending the registration and examination processes and procedures so that they are as effective and practical as possible is very welcome. This is about harnessing the capacity and meeting the standards that are needed so that we can ensure that we have the right professionals in place. The noble Lord, Lord Patel, raised important points that I hope the Minister will consider on how the practicalities of this need to be done.

I am grateful to my noble friend Lord Harris, who laid out what the order does but also what it does not do—in our deliberations it is important that we understand that. I noted his comment that there was no ministerial claim that this will solve a workforce crisis, but, as my noble friend Lord Hunt said, we have a challenge in getting a workforce in place to provide the services that we need. In that regard, it is important that we consider the changes today in the current context of the health system in the United Kingdom.

It is important to say that, sadly, in 2021 alone, 2,000 dentists and over 7,000 nurses quit the NHS. There are more than 46,000 empty nursing posts across hospitals, mental health, community care and other services, which means that one in 10 nursing roles is unfilled across the service overall. As we have spoken about many times in your Lordships’ House, the number of NHS dental practices fell by more than 1,200 in the five years before the pandemic, and there are 800 fewer midwives than just three years ago. That is the context in which we are discussing this.

I turn specifically to the order. If, as expected, the GDC begins recouping costs incurred around international registration, including charging applicants more to take the overseas registration exam, could the Minister give an indication of what effect this might have on the number of dentists operating in the UK? I am sure he understands that, given the number of dental deserts that we already face, we cannot afford to lose the capacity of any further dental professionals.

As well as the overseas registration exam, non-EEA dentists also have to go through the performers list validation by experience process to practise here. The Minister will be aware that stakeholders expressed concern about dentists’ PLVEs being disrupted—for example, by being endlessly rearranged or cancelled—and that that is acting as something of a deterrent to working here. Can the Minister confirm whether there is recognition of that difficulty, and whether the department is looking at what needs to be done to make the process as coherent and smoothly run as possible?

In the other place, the Minister of State committed to write further on the breakdown of positive and negative responses to the consultation that was carried out. Can the Minister of State’s response be made available to Members of your Lordships’ House so that we might also better know what stakeholders were thinking when they responded to the consultation on these changes?

The Government’s Explanatory Memorandum states that policy changes that the regulations make following this order

“may potentially impact international applicants and existing registrants with different protected characteristics, particularly with regards to age, sex and race”

but does not provide detail on what that impact might be. Can the Minister offer any insight into this, if the department has correctly forecast what the regulators are planning?

As we have discussed today, the intent of the order is that there will be changes to application processes and so on. Can the Minister indicate what plans there are to review and audit changes to ensure that there is consistency of decision-making, fair treatment of all applicants and the achievement of the right standards?

In conclusion, while we all support the substance of the order, I hope the Minister can give an assurance that its impact and implementation will not be beset with logistical hitches and unforeseen consequences, because we are keen to ensure that changes are made to deliver the right result to get the workforce more into place than it has been hitherto. I look forward to hearing what the Minister has to say about how the order may assist that, if not entirely cure it.

[Lord Markham (Con)]

I thank noble Lords for their contributions to the debate. I shall attempt to answer the questions set. As ever, I will happily follow up in detail afterwards.

I accept the premise that no one believes that this is a silver bullet that answers all the issues around recruitment and workforce needs. At the same time, I think there is a belief that this is one of many things that can, hopefully, help increase access at the end of the day. I reiterate our commitment to independence, in answer to the question from the noble Lord, Lord Hunt. That is fundamental to this issue and, hopefully, something that the noble Lord, Lord Harris, has recognised through this process.

Probably the point I would like to devote most time to is the one about the DCP register. I must admit that it is something I brought up specifically and wanted to go around the houses on. I absolutely understand the issue: are we cutting off our nose to spite our face? On the equivalence argument—our dentists cannot apply overseas—part of that, as it was described to me, was also the feeling that even in the UK our dentists cannot use the DCP route, so to speak, in that they might be a qualified dentist but want to use some other qualifications, rather than be a dentist. So it was felt that there was no consistency there either.