Health and Social Care

Lord Colwyn Excerpts

Thursday 24th November 2016 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I am sure noble Lords will be grateful to the noble Baroness, Lady Finlay, for giving the House another opportunity to examine the reaction to the result of the referendum on the UK’s membership of the EU, particularly with regard to the health and social care workforce. I am looking forward to hearing from noble Lords, some of whom contributed to the debate introduced by the noble Baroness, Lady Watkins, on 21 July. I am not used to speaking at such a high position on the list and the noble Baroness is probably not used to speaking near the end, but I am sure we are all grateful to the noble Baroness, Lady Finlay, for securing this debate.

I will refer to the situation in the workforce and the implications the result of the EU referendum might have for doctors, nurses and other health professionals, as well as social care workers. I take this opportunity to highlight the fact that Britain’s exit from the EU is likely also to have a major impact on Britain’s fourth-largest healthcare workforce group: the dental professionals. My noble friend the Minister will be pleased that, like the noble Baroness, Lady Finlay, I have managed to refer to my own profession. I declare my interest as a fully retired dental surgeon, a fellow of the British Dental Association and vice-president of the British Fluoridation Society.

Of the 40,000 dentists registered to practise in the UK, close to 7,000 qualified in one of the EU countries outside Britain. Many of them relocated here in the early noughties in response to the well-publicised shortage of NHS dentists at the time, and there is absolutely no doubt that they make a crucial contribution to dentistry in the UK, both in the NHS and in private practice. These dentists’ ability to work in our country is based on the European principle of free movement and the professional qualifications directive. It is of utmost importance that their rights to live, work and have their qualifications recognised here is retained post-Brexit. The failure to do so could lead to a significant workforce shortage in general dental practice and create severe problems with access to dental care for patients in many areas.

Issues with recruitment of dentists for high street practices are already surfacing again in quite a few areas, and I am very concerned that this trend might be aggravated by Britain’s anticipated exit from the EU. It is crucial that EU dental health professionals receive firm and unequivocal assurances that they will be able to continue to practise in the UK following Brexit. We cannot afford to keep them guessing. In fact, the British Dental Association has informed me that it has been receiving inquiries from members who are considering leaving the UK as a consequence of the uncertainty of their status in the wake of the referendum result.

It is all too easy to think that if there is a serious shortage of staff in dental practices as a result of Brexit, we could just plug the gap with dental professionals from outside the EEA, but that is not as simple as it might sound. Any dentist coming to the UK whose qualifications are not recognised under the European professional qualifications directive must sit the General Dental Council’s overseas registration examination. This examination, at over £3,000, is not only incredibly costly but it does not have a particularly high pass rate. Due to the high cost of its administration, it is not held very often, which means that it could take a dentist applying to sit the exam—assuming that they are successful the first time round—more than a year to pass it. Add to this the necessary visas and the lengthy process of equivalence dentists need to undergo in order to be allowed to work in the NHS and it becomes very clear that relying on dentists from outside the European Union to fill the gaps in our dental workforce would not be wise.

Finally, we should not forget that while dentists are first and foremost health professionals, most high street practices are effectively also small independent businesses. This makes many dentists business owners, who invest in and develop their practices through their income and borrowing. Their business running costs are affected by inflation and given that a large proportion of their equipment and materials is imported, they will also be hit by the falling value of the pound.

A possible wider economic downturn that we might experience following Brexit could lead to a further drop in dental practices’ income. This is because many patients view oral healthcare as a discretionary cost—increasingly so in the context of ever-rising dental patient charges. If they need to tighten their belts, many will opt out of visiting their dentist, even if this is detrimental to their oral health. Any such drop in practice income could mean practice owners having to let go of some of their staff or possibly even compromise the financial viability of the entire practice and lead to its closure, leading to potential problems with access for patients who need dental help.

I would be very grateful for the Minister’s assurances that all dentists qualified in one of the countries of the European Economic Area will continue to have their qualifications recognised in the UK post-Brexit, and will be able to continue working in our dental services and serving British patients.