Physiotherapy: Rehabilitation Services

Lord Allan of Hallam Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

I start by wishing the noble Baroness a happy birthday. I was pleased to read the three recommendations from the Chartered Society of Physiotherapy: return the rehab space to use; include physios in the long-term workforce plan; and give staff and space to the physio service. As I have said in my earlier responses, we are working on all three: we are working with the NHS trusts to return the rehabilitation space; we are putting physiotherapy in a very important part of the workforce plan; and we are providing the services. So we are making a lot of progress, but I welcome the involvement of the Chartered Society of Physiotherapy in that.

[Lord Allan of Hallam (LD)]

My Lords, it is pleasing to hear that physiotherapists are included in the proposed and long-awaited workforce strategies; there is clearly a shortage in this area. Can the Minister comment on today’s press reports that, while his department is persuaded that there needs to be a dramatic increase in training places across the medical professions, his friends in the Treasury are declining to support that essential expansion?

[Lord Markham (Con)]

As we are all aware, the Chancellor was very keen to kick this off in the first place. We have been participating in this by working very closely with the Treasury, and I am heartened by the work we are seeing on it all. There are some early reports, and, while they do not yet know the full picture, I am looking forward to being able to talk to the whole House about it in the not-too-distant future.

GP Appointments

Lord Allan of Hallam Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. One of the key benefits of the digital approach is the triage system. We all know that a lot of people who call at 8 am for an appointment could probably be well served by a pharmacy, a physio service or nursing. So proper triage through a digital-type system is a big step forward. It will end up with them being able to make an appointment with the pharmacy, physio—or the GP in this case. It will also free up resources so that those people who are not able to access digital services are able to get through at 8 am and speak to a person. So I really believe there is a win-win for both sides and personally I am very excited to take this through the House later in the year and see all the services that will be launched.

[Lord Allan of Hallam (LD)]

My Lords, following on from the Minister’s previous answer, what steps are the Government taking to develop the profession of care navigator? They are skilled staff who can make sure that people are directed to the right resource, whether a GP, nurse or pharmacist. Some people can use digital, but others need a personal contact for that direction process.

[Lord Markham (Con)]

Absolutely. I know that a lot of the best trusts that I have seen and visited have that right at their front door. It applies to A&E as well. One of the first comments I made when I joined the department was about expanding pharmacy services. That is brilliant and is part of the increase we are seeing but, if we are not telling people when they should go and under what circumstances, how is this going to help? So, yes, there will be both digital and analogue navigation.

Maternity Services

Lord Allan of Hallam Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

Yes, one of the Kirkup recommendations—recommendation 3, I believe—was about an improvement in teamwork, and that is what will be done under the guidance of national and regional maternity safety champions. I should say that while there is much improvement that we want to do, the overall context is a 19% decrease in stillbirth since 2010 and a 36% decrease in neonatal mortality over 24 weeks since 2010. So it is an improving picture, but it is something that we want to improve further.

[Lord Allan of Hallam (LD)]

My Lords, another day, another area of the NHS that is suffering from serious staff shortages, and these shortages are having a real impact on the willingness of midwives to stay in the profession, more than half of whom are considering leaving the NHS, according to surveys by the Royal College of Midwives. What is the Minister’s view on the proposals that have come from various groups that there should be nationally agreed minimum staffing levels for maternity and neonatal staff?

[Lord Markham (Con)]

Again, I think there are certain things that we are saying we want to see in place. Continuity of care is part of that, and the workforce plan is how we put teams around to do that. It will always be a feature that we then expect the local health trusts and ICBs to work out how best to do that in their own situations. I also say in this context that we are increasing our numbers but this is not like other demographics where we have an ageing population. The birth rate, as we all know, is actually constant/declining, so it is not like those other areas where we are talking about that. Notwithstanding that, as I mentioned before, we are increasing the number of graduate places.

Hospitals: Maintenance

Lord Allan of Hallam Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

We are actually making a lot of progress on them. A number of them, dare I say it, were introduced by Governments of a different colour and we are now working through and correcting those. At the same time, private capital can do a lot of good things. Many in the House will have heard me say just yesterday that if we put LED lightbulbs in every hospital, it would cost £400 million and save £100 million a year. That is the sort of thing private capital will fund every day of the week, probably at a 5% yield, giving us £95 million of savings a year. That is a good use of private capital, and the sort of thing I am looking at.

[Lord Allan of Hallam (LD)]

My Lords, I am surprised that more noble Lords have not dived into this report. It is fascinating, especially sheet 7 of the spreadsheet, which tells us that NHS England is spending £234 million a year on storing medical records. So while some parts of the NHS are working towards all-singing, all-dancing federated data platforms, in other places the height of modern technology is a new shopping trolley to move mouldering files in and out of a dingy basement. Will the Minister share with the House the Government’s plans to digitise or securely dispose of those paper records so that in future editions of this ERIC report, we will see that that £234 million has fallen close to zero?

[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.

NHS Staff: Food Banks

Lord Allan of Hallam Excerpts

Tuesday 7th February 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. The lowest paid, who are obviously most at risk in this category, we have sought to protect the most. They received a 9.3% pay increase. In all these circumstances, we have been looking to follow the guidance from the independent bodies, which we will continue to do.

[Lord Allan of Hallam (LD)]

My Lords, the Minister will be aware that food price inflation is now running at over 16%. This disproportionately affects lower-paid workers, including many health and social care staff, yet the Government’s approach seems to be, “Crisis? What crisis?” Does the Minister accept that nurses are seeing real-terms pay cuts at present? Is he worried about the effect of these cuts on his long-awaited workforce strategy?

[Lord Markham (Con)]

As has been mentioned many times, the workforce strategy is key; being able to recruit and retain staff, and pay, are vital elements of it, so I accept the challenges in this space. At the same time, I am mindful that we have sought to protect the lowest paid through these increases, as I mentioned. I am confident that the new pay review body, which is coming up, will seek to take the inflationary pressures into account to make sure that there is a fair settlement for everyone.

Urgent and Emergency Care Recovery Plan

Lord Allan of Hallam Excerpts

Thursday 2nd February 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, this plan, interesting in parts though it is, misses the point. We find ourselves in yet another debate over another short-term cash injection to deal with a continuing acute crisis in the health service. It would certainly be helpful if, in replying, the Minister could indicate to your Lordships’ House whether this is in fact new money and, if not, where it is coming from. Furthermore, can the Minister say in his response whether he feels, from his experience, that the better way forward would in fact have been to have a sustainable and long-term plan for the NHS and social care with a laser-like focus on having the necessary workforce in place? The absolutely core point here is this: do we have the staff with which to provide the right level of service? At present, we do not.

We know that more than 7 million people are waiting for NHS treatment; that the four-hour A&E waiting time target has not been met since 2015; and that heart attack and stroke victims and others are waiting inordinate amounts of time for an ambulance. Similarly, we know that those waiting for more than five hours in A&E are more likely to lose their lives, as are heart attack and stroke victims waiting more than 18 minutes for an ambulance.

I am concerned that this plan waters down standards for patients rather than trying to recover the baseline services that are needed to meet them. For example, while the target is for 95% of patients to be seen within four hours at A&E, the Secretary of State has said that the best that can be managed is 76%. Yet outcomes are poorer if patients wait longer than five hours, so can the Minister say what plan there is to return to this all-important target? More generally, can the Minister indicate when patients will see a return to safe waiting times throughout all services?

It is important to see this in the round because too many people find it impossible to get a GP appointment so they end up in A&E, putting more pressure on the service. At the same time, the right care is not available in the community; patients find themselves kept in hospitals, sometimes for months, when they should not be there. As I have said, the gaping hole in this Statement and the Government’s plans is the lack of any sustainable solution to having the right workforce in place, both now and in future. After all, good care in the community, in people’s homes or in hospital cannot be provided without the staff to care for people. As we have lost two in five district nurses since 2010, can the Minister say how more “hospital at home” services will be delivered for patients if there are not the staff to visit them?

As I raised this in a recent question to the Minister, I wonder whether he is now in a position to comment on why the Universities Minister wrote to medical schools telling them not to train any more doctors. It would be helpful to have some light shed on this action.

With regard to virtual wards, NHS providers have rightly pointed out that progress will be dependent on NHS staff continuing to go above and beyond. Does the Minister share my view that this is not what exhausted health and care staff need to hear? Rather, they will want to know when they can expect to have a more sustainable job to go to and when there will be further support from the extended workforce.

In the other place, the former Health Secretary, Sajid Javid, pointed out that successive Governments have not focused enough on prevention, which would take much of the pressure off more expensive emergency care. This intervention came in the context of the Government’s latest announcement that they will not be publishing individual cancer, dementia and mental health plans, which has troubled many patients and stakeholder groups. Can the Minister assure your Lordships’ House that the Government’s new major conditions strategy will give prevention the focus it deserves? When can we expect this strategy? Also, the plan does involve more mental health ambulances, but can the Minister say how we can look forward to a plan that will prevent those with mental ill-health needing an ambulance in the first place?

Lastly, on children, the Royal College of Paediatrics and Child Health has heard how footfall in paediatric emergency departments has doubled across the country, with some children waiting more than 10 hours to be seen by a doctor and surgeries cancelled to free up beds on paediatric wards. As children can deteriorate very quickly, a timely assessment and response is absolutely essential to providing safe and effective care. Will the Minister commit to ensuring that a proportion of the dedicated fund will be used for paediatric services? Will he also commit to writing to every local area to remind them of the solutions that are included in this plan in order to improve urgent and emergency paediatric care?

I look forward to hearing the Minister’s response, in particular with regard to the need for a workforce plan. Perhaps he might also be able to tell us today when we can look forward to the strategy being put before your Lordships’ House.

[Lord Allan of Hallam (LD)]

My Lords, as is usual for this kind of Statement, it is peppered with promises of more of everything. I hope the Minister will help us to dig into the numbers we have been given to see how much lies behind them. First, on the new hospital beds, this seems to come from a process of making winter surge beds permanent. For a real long-term increase in capacity, we need the promised 40 new hospitals. How many of these will be on stream by next winter?

The Statement also tells us that there will be 800 new ambulances, which I think most people would interpret as fully staffed, blue-light vehicles. Can the Minister offer a more detailed breakdown of the different types and capabilities of what is being offered here? The Statement itself said that, for example, 100 of these will be mental health emergency vehicles rather than classic blue-light ambulances.

Of course, staffing these beds and ambulances and the other measures in the Statement will depend on good workforce planning. Here, I echo the comments made by the noble Baroness, Lady Merron, and by these Benches over many months. The Statement tells us that the plan will come this year; can the Minister offer any more precision on when this year we might expect it?

The Statement also talks about data and transparency. We are told that integrated care boards will now have to focus much more on data about patient flow. Can the Minister commit to making more of those statistics public, as well as the ambulance wait time statistics?

Finally, the promised new care hubs can add value only if care services are actually there. This brings us back to workforce limitations. I end with three questions for the Minister: where is the staffing for the beds, where is the staffing for the ambulances, and where is the staffing for the care services?

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

First, I thank the noble Lords for their questions. To put the UEC recovery plan in the context of the three plans we will be announcing, there was last month’s elective recovery plan, which we spoke about, followed by this UEC recovery plan, and then, within the next month or so, we will also talk through the primary care recovery plan. That plan will seek to address exactly some of the points the noble Baroness, Lady Merron, rightly made about getting care in the right places, such as primary care.

I hope noble Lords agree that what we see today is a sensible and pragmatic plan. It has been welcomed by NHS Providers and described by the Royal College of Emergency Medicine as a

“significant step on the road to recovery”,

seeking to increase capacity in urgent and emergency care. The 5,000 beds that the noble Lord, Lord Allan, mentioned are a recognition that more capacity is needed in that space.

As has been mentioned many times, and as was raised by the noble Lords today, growing the workforce is crucial. This includes student places and getting to the bottom of whether there is a cap on those numbers, on which a written reply will be given soon. Again, the workforce plan is in draft and will be shown shortly—as I say, in weeks. I cannot give a date, but it will be soon. It is designed to tackle the whole question of how we are going to staff all of this and the points that have quite rightly been made. We need the staff: the nurses, the ambulance staff and all the others. There are 30,000 more nurses than three years ago, so we are on target to hit the 50,000 increase. There are 5,000 more doctors than a year ago, but that is not to say that we do not need more. That is what the workforce capacity plan should be all about.

This plan is looking to show those milestones and what we are trying to do to increase capacity, with the 5,000 new beds, growing the workforce, speeding up discharge, expanding and having better joined-up community services and making it easier to access the right care in the right places, such as primary care. I would say this, probably, because I am biased, but I feel that this is a useful and pragmatic plan because it is trying to build on the evidence of the things that we have seen work, which noble Lords have heard me talk about over the last few weeks. They include the Maidstone “mission control”, which really is making a difference there and we are now looking to roll out to all trusts and ICBs; the Watford virtual wards, which we are looking to roll out to 50,000 places; and, in all instances, using data-driven analysis to make sure we are making the right decisions.

The plan is backed up by funds and is part of a long-term plan. We are using the £1 billion of support for this year and the £500 million for social care capacity, but this is in the context of an increase of £14 billion over the next two years. It is part of a sizeable plan, but it is realistic action. I would love to be able to stand here today and give targets, but we are trying to be realistic about where we are coming from—for example, in setting the 30-minute category 2 ambulance wait time. Likewise, the target of 76% of patients being seen within four hours is not the limit of our ambition. That is the minimum, and from there we would look to increase it beyond that target. I would much rather come to your Lordships’ House with targets we think are realistic, with achievable plans behind them, as a statement of intent from which we can grow, rather than setting unrealistic expectations.

Of course, I say all of this in the context of what the House knows is an unprecedented challenge. It is not just England facing these challenges; I have spoken to colleagues across Europe, the US and Canada, and within the UK, in Wales and Scotland. Every health system is facing these problems off the back of Covid, and there are also the demands coming from flu coinciding with that this winter in particular.

I believe that this is a realistic plan. It is centred on the workforce; I agree on that. Prevention is also a key element of this. The five-year life expectancy improvement target is still key. We are looking at what we realistically need to do to make a difference on that—so, what are the causes of death, and what are the things we need to tackle? Again, the House has heard me speak many times about Chris Whitty’s concern about cardiovascular disease, and that it could be the next cohort of potential excess deaths among 50 to 65 year-olds, because they missed out on their blood pressure monitoring over the last couple of years. We all agree that rectifying those sorts of prevention actions is key.

When this plan is seen in the context of the primary care plan, which will also come out shortly, I hope it is understood that this is about treating people in the right place, which is not A&E. We all know that far too many people go to A&E who do not need to be there, and that is because we need more primary care spaces. We are on target to achieve the 50 million more primary care spaces, but, again, we need to do more. We really need to look to expand capacity in pharmacies, as I have mentioned before. We need to look at what some of our colleagues in Scotland are doing and the ability of pharmacists, for instance, to prescribe a lot more. Longer term, the new hospitals are a key part of this. Just this morning, I was going through the plans and some very good virtual reality examples, which we are going to bring to Westminster Hall for one day in the next few weeks. I look forward to showing colleagues exactly what is happening and how that will be the future.

I hope that noble Lords will see this plan in the context in which it is meant. I will, as ever, write in detail on the points I have not managed to cover in this quick reply. I hope noble Lords will see this as a down payment for the future, within the context of the elective care recovery plan and the primary care plan that we will see later, building on solid things that we know work and making sure that we are expanding those rapidly, so that we have learned the lessons from this winter and have them in place in time for next winter.

PPE Expenditure

Lord Allan of Hallam Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, as well as the financial cost of failures in the PPE procurement process, does the Minister agree that it is important to remember the human cost paid by care workers who became ill when looking after vulnerable and elderly people without adequate PPE? Does he understand how frustrated care workers must now feel to see this level of wastage when their services are crying out for more investment? We could buy a lot of care packages for “£600-odd million”.

[Lord Markham (Con)]

In the circumstances at the time, I think we were all worried that we were going to run out of PPE. If the noble Lord remembers, it was the Wild West out there in terms of trying to purchase it, with planes gazumped literally on the runway and flying to other countries. That is why we stepped in. We bought to a worst-case projection, because we knew we could not afford for PPE to run out in our social care homes or our hospitals. We ended up buying 20% too much as a result, and that is what we are dealing with now. However, only 3% of everything that we bought ended up being faulty, which I think people will agree was a pretty good result.

Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Lord Allan of Hallam Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I am grateful to the noble Lord, Lord Hunt, for ensuring that we have an opportunity to debate this statutory instrument. I am also grateful to the Minister for both his initial response to the amendment and the time that he and his officials have spent responding to queries from me and my noble friends Lady Brinton and Lord Clement-Jones.

I revealed in yesterday’s debate how I started my tech career in the Avon Family Health Services Authority. From there, I moved to the FHS Computer Unit and worked on national NHS IT, so this reorganisation has a special interest for me. The subsequent path of the system that I worked with, which was called the Exeter system because the developer hub was in Exeter, is illustrative of the constant reorganisation of NHS IT, of which the latest example is in front of us today; I note in passing that early versions of the Exeter system were written in a language called MUMPS, like the disease but in capital letters, proving that geeks do have a sense of humour. The FHSCU was incorporated into something called the NHS Information Authority, which was then split between the National Programme for IT—NPfIT—and the Health and Social Care Information Centre. NPfIT was later rebadged as Connecting for Health, while the Health and Social Care Information Centre found its way, via a couple more name changes, into NHS Digital; this was referred to by the noble Baroness, Lady Finlay of Llandaff.

It can feel like the architects of these reorganisations have drawn inspiration from peristalsis, the process that moves food through the body by contracting and expanding the gut. The belief seems to be that we can make progress with NHS IT by pulling everything to the centre then pushing it out again to the edges in a cycle of rinse and repeat. I fully expect us to be back here in a few years’ time being told that we have lost focus by pulling everything into NHS England and that we need to create some kind of new stand-alone agency. We might call that new body the Unified Trust Operational Process Information Agency, or UTOPIA for short—there is some free branding advice for the Government.

The serious point here is that, in spite of—or perhaps because of—these reorganisations, the NHS still has information systems that fall well short of what is possible and desirable. There are many excellent people who work in NHS IT, and there are examples of great systems being developed, but we cannot say that there is consistent excellence, which is what the service needs and deserves, as noble Lords have said. I sincerely hope that we might get it right in the public interest this time, but experience suggests that we should remain cautious and test thoroughly what we are being offered.

An early test for this new structure will be the mega contract that has just been opened up for bids to provide a federated data platform, to which my noble friend Lady Brinton referred and which looks like it will cost the taxpayer at least £500 million; that is the number on the face of the contract, and God knows what else will need be spent by trusts on ancillary services. We will be asking searching questions of the Minister at all stages of the development of this project, as some elements are already triggering the spidey-sense of those of us who have seen too many big NHS IT projects go south—by which I do not mean going to Exeter but further than that.

As well as the structural questions about whether this reorganisation will achieve its core purpose of improving IT support for health and social care, there are concerns about what it will mean for the treatment of personal data. The noble Lord, Lord Hunt, and my noble friend Lady Brinton have done a thorough job in describing those concerns so I will not repeat their arguments in detail. However, I want to reinforce their emphasis on the importance of independent oversight. I have worked in technology organisations and have huge admiration for the way in which software engineers, researchers and data scientists tackle problems using data, but their deep focus on addressing problems is not always accompanied by the same level of interest in documenting and getting approvals for all of their uses of data. This is not usually because they are doing anything wrong but because they are in a hurry to explore a task that we have given them. Given this tendency, it is essential that we put in place good governance systems that do not get in the way of necessary uses of data but ensure both that these are properly considered and that any risks are surfaced and mitigated.

As other noble Lords have argued, the IGARD system, which worked for NHS Digital, has broad support. We need something equivalent in this new structure. I ask for the Minister also to consider additional forms of transparency that will help people have confidence that data is being used appropriately. The overriding principle here is that you do not want people to feel surprised that particular kinds of data are being collected or used for particular purposes. A healthy discipline that will help avoid surprises is to ensure that the data schema and software code are made public, as this allows third parties to see for themselves what is going on inside the black box. This is not about publishing all the data held in the databases, which needs to be managed separately; it is about showing the kinds of data that sit in different systems and informing us what the systems are doing with them.

There is a common trope that Governments like to trot out to reassure the public and show that something is safe: putting in place a triple lock. This is part of the Government’s rhetoric around the Online Safety Bill, for example. I invite the Minister tonight to commit to a quadruple lock in this case, given the importance and sensitivity of health and social care data. Lock 1 is the commitment to meeting fully all the data protection standards that are already in place for NHS Digital and in the general data protection regulation. Lock 2 is to ensure there is a truly independent body assessing and authorising requests to use data. Lock 3 is the publication of data schema so that we can see the full extent of what is being held, and where. Lock 4 is the publication of code that will allow people to check that what was authorised is what has actually happened.

I hope that this reorganisation will both lead to positive technology outcomes and avoid negative data outcomes. The NHS needs success in these areas more than ever. I also hope that the Minister will agree that our scepticism on these Benches is healthy and makes it more, not less, likely that we will see those outcomes. Onward to UTOPIA.

[Baroness Merron (Lab)]

My Lords, I thank the Minister for introducing these regulations and for the assurances he has given your Lordships’ House. I also express my appreciation to my noble friend Lord Hunt for what, as other noble Lords have said, was an extremely detailed and helpful examination of the challenges that these regulations present. I hope that the Minister will take his amendment and this debate in the spirit which I know is intended.

I share the view of all noble Lords who have spoken this evening that digital transformation of the NHS is a good thing; on that we are agreed. We all support the use of information to make things better for patients. However, this is about getting it right, and I hope that the debate this evening has contributed greatly to that. It is about confidence. As the noble Lord, Lord Allan, just said, people should not be surprised. They should also not find themselves compromised, uncertain or in any way undermined by the use or misuse of data. That is the challenge before us.

National Health Service (Primary Dental Services) (Amendment) Regulations 2022

Lord Allan of Hallam Excerpts

Tuesday 24th January 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Lord, Lord Hunt of Kings Heath. I thank him for securing this debate and for so clearly setting out the pressing issues around dental treatment. He set out the massive, chronic underfunding—a quarter down since 2010—and the workforce problems. As he said, the regulations we are debating are an extremely modest, if welcome, step to address that to a very small degree.

I will take this opportunity to take a somewhat broader view of dental health and raise a couple of issues that are arising from the crisis of the lack of NHS dental provision. My first point draws on the WHO Global Oral Health Status Report, which was published in November 2022. It stressed that most oral diseases are fundamentally preventable through addressing the social and behavioural determinants, with risk factors such as tobacco, alcohol and sugars that are shared with many other non-communicable diseases. So the first question I put to the Minister is: are the Government really taking seriously the issue of addressing good oral health and public health conditions, which would have so many other positives in terms of issues such as obesity, diabetes, et cetera? Are the Government looking at this in this kind of way?

Secondly, the WHO global strategy on oral health says:

“Achieving the highest attainable standard of oral health is a fundamental right of every human being.”


I will refer here to an article published in the Lancet Public Health on 11 December last year by Winkelmann and other authors, which looked around the world at the different classes of oral health coverage available. There are four: no coverage at all, limited coverage, partial coverage, and comprehensive coverage. The UK, I am afraid, falls in the second of those four increasing levels of coverage: limited coverage. We know that the Government like to claim to be world-leading in many contexts, so do they have an aspiration at least to reach the comprehensive or advanced level of coverage identified in that study, which would mean making dental treatment available to all and ensuing a high quality of preventive public health provision?

My third point is on the issue of dental health tourism. This was prompted to the front of my head again this morning by sitting in a Tube carriage in which I was facing adverts saying, “Get your teeth fixed—go to Turkey”. A couple of days ago, there were a number of horror stories about this across the tabloid newspapers. I am not picking on Turkey in particular, because I do not have the stats on how many people are going where and what problems are arising—but I do not believe that the Government have stats on what is happening with dental health tourism or those problems, either.

As I understand it, there is no reliable source of data on all outbound UK medical tourism, whether it be dental or other forms, but the ONS has estimated that 248,000 UK residents went abroad for medical treatment in 2019. I assume that quite a number of those treatments were probably dental. Indeed, in a recent article the Guardian quoted the editor-in-chief of the International Medical Travel Journal—it is interesting that there is a journal on such a thing—saying that this was going up fast. Are the Government going to collect any stats on both dental tourism and other forms of medical tourism? Are they going to publish those? Are they going to look into whether this is an issue, in which case the stats would clearly be a starting point? Does the Minister agree with me that when these operations go wrong overseas, we will end up seeing the UK dental health system and general health system ultimately having to pick up the pieces?

I come now to my final point. Your Lordships’ House will shortly be engaging, I suspect at some considerable length, with the Levelling-up and Regeneration Bill. It is worth stressing how much dental health issues are a levelling-up issue. The south-west of England, Yorkshire and Humber and the north-west have the largest shortage of provision of NHS dental services, with 98% of practices in these areas refusing to accept new adult NHS patients, according to the latest figures I have been able to find.

I have raised a number of points, and I understand that the Minister may need to write to me on some of those. We sometimes have this sense that there is health, and then there is dental health. Indeed, the article I cited earlier stressed that the WHO is concerned that dental health is often seen as something that is done by private clinics in private places—but, of course, dental health is crucial to the health and well-being of a healthy population. We have, in so many different areas, a public health crisis in the UK. Dental health is one more of those areas, and it must not be left behind or neglected because of historic structural factors.

[Lord Allan of Hallam (LD)]

My Lords, I am grateful to the noble Lord, Lord Hunt, for ensuring that we have an opportunity to debate this important statutory instrument today. We benefit from his detailed analysis of problems in the dental sector.

The facts are laid bare in the Government’s own impact assessment, which says:

“NHS dentistry was a challenging area prior to the COVID-19 pandemic, with patient access proving difficult in some areas of the country … The COVID-19 pandemic exacerbated problems with patient access and created a backlog of patients seeking access to NHS dentistry.”


There is a recognition in that analysis that people being unable to access NHS dentistry is a long-standing problem. As other noble Lords have said, the statutory instrument is correctly aimed at addressing some aspects of that shortfall, and we would not oppose it as a contribution to solving the problem. However, we would ask the Minister, “Is this all you’ve got?”, given the clear and enormous gap between demand and supply.

The figures are dire. Again, the Government’s own impact assessment shows that the success rate for patients seeking an NHS dental appointment has fallen from 97% in 2012 to 82% in 2022 for people with an existing relationship with a dentist—so one in five of those who already have an NHS dentist relationship are not being seen. But for those trying to get their first NHS dental appointment, this has become almost impossible in many areas, with only 31% of those who had not been seen before successfully getting an appointment, compared with 77% of the same group in 2012. When we drill down into these national figures, we also see significant variation around the country, with some areas having become known as “dental deserts” because of the lack of dentists offering NHS treatments.

Turning again to the impact assessment, we see that it tells us that

“the North West has generally good access (but with pockets of poor access in rural areas), compared to the South West and East of England where access is generally poor, particularly in rural and coastal areas.”

This is a terrible indictment of what is supposed to be a nationally available essential service—one that is likely to have a disproportionate effect on deprived people who often need intensive dental care. The noble Baroness, Lady Bennett, also raised this point, quite rightly, in the context of the levelling-up agenda—or is it the gauging-up agenda? In any case, the agenda to deliver better services to people in historically deprived areas is critical to this understanding of the disparate access to dental care.

These changes are supposed to incentivise better provision of these intensive treatments but I note that again there is no statutory review clause in the instrument requiring the Government to produce data that will show their actual impact. I hope the Minister will want to commit to producing such a post-implementation evaluation in due course, even if that is not a statutory requirement. I am sure he will talk up the benefit of making these changes but the proof will be when we come back in a year or two and we can see whether there has been a change in the number of people able to access NHS dentistry and the number of treatments that were given.

As well as amending the payment scheme, this regulation places new requirements on dental practices to update information about their services for publication on the NHS website. This may seem weird, but I experienced a twinge of fond nostalgia as I read up on this section. It took me back to my first technology job, where I was responsible for producing the directories of primary care practitioners for what was then the Avon Family Health Services Authority. These consisted of papers in ring binders that listed each dental practice and its services for distribution to libraries and other public information points.

That was in the mid-1990s before the massive growth of the public internet, but I managed to get hold of some software called the NCSA HTTPd, an early web server, and I produced an HTML version of our directory for people in the local authority. All of those products are now long discontinued, as indeed is the country of Avon itself, so this is of historical rather than current interest. However, that may have been version 0.001 of the public directory that we now have on the NHS website.

Fast-forwarding to the present day, it will be no surprise that we support improvements to provision of information to the public such as those in the statutory instrument. However, that has to be complemented by improvements to the availability of services or we will simply see increased frustration as people are given better information about what they cannot have. Does the Minister have a response to people who will go to the NHS website and find that there are no dentists taking on NHS patients in their area?

I hope that the Minister will not think it churlish if we say, “Thanks but not enough” in response to this instrument, and that he may have some additional remarks to make about what more the Government plan to do, especially in respect of creating the NHS dental workforce. I emphasise “NHS”; there are many areas where there is no shortage of dentists, but there is a shortage of dentists who are willing to work for the rates that the NHS is prepared to offer them. I hope that by making those improvements, we will be able to move on from where we are today, where seven out of 10 people in this country who try to get into the NHS dentistry system for the first time cannot find anyone to take them on.

[Baroness Merron (Lab)]

My Lords, I commend my noble friend Lord Hunt for such a thorough analysis and for bringing this debate before your Lordships’ House this evening. As ever, he brings his expertise, knowledge and incisive approach to this important subject: the provision, or lack of provision, of dentistry.

As we have heard, we have seen a quarter of the budget cut since 2010 and with dentistry, a complete failure to provide a proper service to the population of this country. We know that dentists suffer burnout and that there is difficulty in retaining and recruiting the dentists that we need, while insufficient numbers are in training. This is a toxic mix. We also know that even under the existing budget, even if it was utilised fully, funding is available to provide NHS dental services for only around half the population. We find ourselves in considerable difficulty.

Let us remind ourselves about this statutory instrument. It was drawn to the special attention of the House by the Joint Committee on Statutory Instruments in its report because the regulations are

“defectively drafted in two related respects.”

To look at the specifics of those, as the noble Lord, Lord Allan, also raised, I ask the Minister why it was not felt necessary in respect of primary dental service agreement changes to give a timeframe for dental practice profiles to be provided for the NHS website. Does this not, as the Joint Committee on Statutory Instruments criticised, insert a somewhat unacceptable level of uncertainty into the statute book? I look forward to the Minister’s comments on that point. Furthermore, in respect of the criticisms of this statutory instrument, can the Minister say why NHS England has received no steer within this as to what a “reasonable timeframe” is to take action against non-compliant contractors, which the JCSI concludes

“leaves this law unacceptably uncertain”?

Respiratory Syncytial Virus

Lord Allan of Hallam Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

I know that this, like all those areas that were unfortunately missed out during the pandemic, is something the department is working on. There are catch-up activities. I have seen it personally with my four year-old, who of course was two and three during this time. I will happily provide the detail in writing.

[Lord Allan of Hallam (LD)]

My Lords, does the Minister agree that it is wise for the UK to maintain a good level of baseline PCR testing so that we can ramp it up when confronted with novel viruses such as Covid-19? In that respect, does he agree that it is important to consider this resiliency benefit when looking at the business case for PCR testing for other viruses, such as RSV?

[Lord Markham (Con)]

Yes. I should probably declare an interest, having set up a PCR business—in the private sector, I might add. I know at first hand from that how versatile these PCR machines are. They can be used to diagnose all these sorts of treatments, so we absolutely have to make sure we keep that strategic capacity alive.