Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023
Lord Hunt of Kings Heath Excerpts(1 year, 3 months ago)
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Lord Hunt of Kings Heath
At end insert “but that this House regrets that (1) the consultation on the statutory guidance that will direct NHS England’s handling of the medical data under these Regulations is being conducted in a rushed and piecemeal manner, and (2) the results of that consultation are not available alongside the Regulations to reassure the House that patient data will be used properly”
Lord Hunt of Kings Heath (Lab)
My Lords, let me say at once that I support the digital transformation of the NHS and the use of information to enhance patient outcomes. I want to see the NHS move faster in a digital world, but it is essential that there are safeguards in place to protect the integrity and confidentiality of patient data. I say that as I look back into the history of NHS data, where we confronted a number of occasions when this did not happen. That is why this is such an important debate. I am grateful to the Minister for the assurances he has already given in his opening speech, and through him I thank his officials for the way in which they have been prepared to engage with us over the past few months, which has been very helpful.
I remain of the view that it was a mistake to bring NHS Digital, or the Health and Social Care Information Centre as it was formerly known, into NHS England, and feel that there are some inevitable tensions and conflicts in so doing. I think the review that led to this overlooked the issue of the integrity of patient information and public confidence when it suggested that the two functions should be brought together. That was legislated for; here we are now, examining some of the details.
The noble Lord has already referred to the Select Committee’s disappointment about the way in which it considered this had been done in a rushed and piecemeal manner. I have no doubt the House will want to take account of the Minister’s response. It is a pity that the full statutory guidance is not available as we debate these regulations. I think, as a matter of principle, it would have been much more sensible if that had occurred.
The core issue is that in the passage of the Bill, and a number of noble Lords who are here took part in that debate, the Government gave assurances that governance arrangements would protect NHS England from marking its own homework, with independent oversight of governance decisions under the new arrangements. The noble Lord, Lord Kamall, the then Minister, said that
“I can assure your Lordships that the proposed transfer of functions from NHS Digital to NHS England would not in any way weaken the safeguards. Indeed, when I spoke to the person responsible in the department, who the noble Lords met, he was very clear that in fact we want to strengthen the safeguards and take them further.”—[Official Report, 5/4/22; cols. 2005-06.]
Having said that, when one comes to look at the arrangements, there are still some questions and doubts that we would like to put forward tonight. I pay tribute to medConfidential, which has raised questions on how some types of data will be handled under the new regime and whether, in pursuit of efficiencies, NHS England’s handling of the data will be less transparent and subject to fewer checks and balances. I think that expresses the issue and the potential tension in a nutshell.
This was reinforced by the comments of the National Data Guardian, to whom I pay tribute for her strong involvement in these matters. In December, Dr Nicola Byrne expressed concern that, in the statutory instrument before us, there is no recognition of the need to have independent oversight. She noted that provisions to obtain independent advice from specialists and experts to advise on and scrutinise NHS England’s exercise of its data functions, which were originally included in a previous draft of the SI, had been removed. She reminded the Government that the commitments to putting the current, non-statutory provisions safeguards regarding oversight into regulations had been made by officials to the House of Commons Science and Technology Committee. I understand from the briefing we received last night that the advice received by the Minister’s officials was that it is not possible, due to the nature of the statutory instrument and the original primary legislation. It is, though, a pity.
In relation to the membership of the Data Advisory Group, the National Data Guardian referred to the arguments put forward by the department for having NHS England representatives on the group present in their capacity as senior individuals with responsibility for data access. I think they are not full members, but they will be present. The department’s argument is that that will support more efficient discussions regarding applications for data access. I can see that, clearly, officials may need to make presentations. I think it is a bit of grey area when they are members, albeit not full members, of the actual group. The National Data Guardian reiterated that moving from a completely independent group to a hybrid model could affect public trust, particularly when advice is given and decisions are made on the internal uses of data.
We need to be clear why NHS Digital had an entirely independent oversight group. It was for very good reasons; it was put in place following the 2014 Partridge review which was conducted due to concerns about the way that patient data had been shared with insurance companies. There was a huge furore at the time. It was interesting that one of the resulting proposals after Partridge was the disbanding of an oversight group which involved staff members for a new independent oversight group. A public consultation in 2015 found support for this change. This is now being reversed. My fear is that something may go wrong with patient data and the department will come back and say, “Actually, we should make this an independent function”.
We have dealt with the issue of timing, and tonight the Minister has given an assurance that the outcome of the internal review into how well the transfer has gone will be made public—that will be very welcome. I will go just one step further and say that I hope the Minister may be prepared to brief parliamentarians on this at the same time.
The noble Lord also answered a question about social care that was asked in our briefing. I think he said there would be a person from a social care field on the group, which is definitely welcome. I suggest that discussions take place with the Local Government Association and the Association of Directors of Adult Social Services to make sure that they are fully involved and supportive of this happening.
So I remain of the view, as I have made clear, that it has been a mistake to bring NHS Digital into the NHS executive. Whatever the structure, one has to build in rigorous safeguards. The key here is the integrity and confidentiality of patient data. It is pretty clear that if the NHS is to be at all sustainable, it has to embrace the digital revolution and it has a long way to go. So I am right behind the Minister in what I know he is personally seeking to do. It is just that if anything that goes wrong with patient confidentiality, the whole thing can fall down. That is why this is so important. I very much look to the noble Lord and NHS England officials to ensure that we recognise that the integrity of personal patient information is important. I beg to move.
Baroness Brinton (LD)
My Lords, I echo the thanks of the noble Lord, Lord Hunt of Kings Heath, for the helpful and detailed discussions that the Minister, his predecessors and officials have had with the small group of us who have been worried about this issue, even before the Health and Care Bill started its passage through your Lordships’ House. Although some of us were more expert than others, and I was definitely not one of the expert members of the group, I care greatly about the digital revolution and ensuring that patient data is kept confidential.
The noble Lord, Lord Hunt, said that he supports improving and transforming data in the NHS. That cannot come soon enough. I have said before in this House, and it is still true probably a decade on from when I first said it here, that for my monthly blood tests I have to print out, photocopy and send copies to my hospital consultant because the hospital that I go to and the hospital that processes my blood tests do not use the same data system. That is ridiculous. It needs to change.
It is a real problem, as the noble Lord, Lord Hunt, set out, that the consultation and draft statutory guidance have been rushed through. I want to set that in the same context as that to which he referred, about perhaps going at a slightly slower pace while wanting the revolution to start. That might have been helpful. Omitting organisations such as the BMA from seeing the original statutory guidance raises the question: who else has not seen it? The question is almost impossible to answer. However, the detail of how this is going to work in practice inside the NHS will be the business of all clinical and administrative staff at all levels. It is vital that it works.
The Minister will know that I have repeatedly raised concerns about patient data and how people were not consulted in the two previous patient data and care.data communications. Both had to be held back because there has been outrage from the public that they were not given the chance to understand how their data would be used. Earlier this week, the Mirror reported that Matt Hancock had talked about handing over private patient medical records and the Covid test results of millions of UK residents to US data company Palantir fairly early on in the pandemic. It had offered to hold its data in its Foundry system, clean it and send it back to the NHS. I spoke about this in the Procurement Bill because I am concerned about how data can be kept truly confidential. Regarding the GP data for planning and research, the NHS has already published its federated data platform details, which is called by the Mirror the Palantir procurement prospectus. Perhaps I may ask the Minister, as an example of transparency for the new NHS England digital processes set out, whether organisations such as Palantir that are handling data records will absolutely not be permitted to use that data—even anonymised or deidentified—outside the purposes of the NHS, other than for agreed research being used in what my noble friend Lord Clement-Jones would say, if he were able to be in his place today, was a safe haven, thereby ensuring that that patient data remains completely confidential. The Minister knows, because I have said it before, that the problem is that in the past it has been possible to identify patient data when it was pseudonymised. I want confirmation that deidentifying really means that individuals cannot be tracked down and, most importantly, that the data will not be used elsewhere or sold on.
Lord Hunt of Kings Heath (Lab)
My Lords, I am very grateful to the Minister and other noble Lords who have spoken in this debate. I should say that I am particularly grateful to the noble Baroness, Lady Brinton, as she and I have been working on this for quite some time, along with the noble Lord, Lord Clement-Jones, who unfortunately could not be here tonight.
I very much take the substantive point. If you look at care.data, essentially the people running it were very careless in terms of the confidentiality of patient information. That set back the whole programme for a number of years, and that is the lesson that we need to remember. The noble Baroness, Lady Finlay, raised some very important points, including about Wales, on which the Minister has responded in terms of the agreement that has been reached with the Welsh Assembly Government, but her point about the security of local NHS data is very relevant to the way we are going forward.
On the issue of commercial companies, 20 years ago, I took through the legislation to allow the NHS or the Department of Health to agree with commercial companies a very legitimate use of patient information. We had in mind the research institutes and pharmaceutical companies, because we have such a rich information source in the NHS, and we wanted to do that to encourage new medicines and speed up their introduction to NHS patients. The problem is that as it has proceeded there has been a lack of transparency, and this wretched commercial incompetence has undermined confidence in what is happening. It is perfectly legitimate to seek to use this information, provided patient confidentiality is preserved, for the enhancement of our knowledge and understanding and future treatments. Clearly that is in everyone’s best interests.
On UTOPIA, mentioned by the noble Lord, Lord Allan, I could not help thinking of “Utopia, Limited”, the Gilbert and Sullivan opera. The alternative title is “The Flowers of Progress”. He went through the list: Avon FHSA, the Exeter system, NHS AI Lab, Connecting for Health. Such happy memories. The point that he raises is that the NHS and the Department of Health have a constant need and desire to restructure. We know this is displacement activity. Even now one hears that NHS England wants to reduce the number of regions and you think, “For goodness’ sake! Can you not understand that it’s completely hopeless thinking a restructure will have any impact whatever on the task in hand?”
This is the substantive point: we know that we are going to be back here debating an SI at some point which will take NHS Digital out of NHS England and establish a separate body. No one will take a bet on it, because we know it is going to happen, and I am afraid that this instability really detracts from the core purpose of what we are seeking to do. My noble friend Lady Merron raised some very pertinent points about the information, the lack of final guidance, the impact on staff and the big question about patients knowing whether their information is being used, which I believe from the advice I have received is possible. I hope that, as the work gets taken forward, this will be taken very seriously by NHS England. The Government will find that patients will have much greater confidence if they get that information, and that most of us will be absolutely supportive of why that information has been used.
Finally, I thank the Minister for his constructive response and the parliamentary briefing that he has offered on the 12-month review; I also think the information about Wales has been very helpful indeed. Having said that, we wish him and his officials the very best in taking this work forward, and I beg leave to withdraw my amendment.
National Health Service (Primary Dental Services) (Amendment) Regulations 2022
Lord Hunt of Kings Heath Excerpts(1 year, 3 months ago)
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Lord Hunt of Kings Heath
That this House regrets that the changes to dental contracts in the National Health Service (Primary Dental Services) (Amendment) Regulations 2022 (SI 2022/1132) will not have a significant impact on improving access to dental treatment whilst current workforce shortages persist.
Relevant document:18th Report from the Secondary Legislation Scrutiny Committee
Lord Hunt of Kings Heath (Lab)
My Lords, it is good as ever to know that dentistry excites such interest amongst your Lordships. I am very grateful for those noble Lords who are going to take part in what I think is a very important debate tonight.
Like many aspects of the NHS, our dental services are under great pressure at the moment. Indeed, there are reports that some patients are resorting to DIY dentistry and removing their own teeth because they cannot get access to an NHS dentist. In August 2022, the BBC reported that, based on a survey of 7,000 NHS practices, nine out of 10 NHS dental practices across the UK were not accepting new adult patients for treatment under the NHS. The BDA believes that NHS dentistry is facing, as it calls it,
“facing an existential crisis with the service hanging by a thread”.
The problem predates the pandemic, but it has now reached an unprecedented scale. The BDA estimates that over 40 million dental appointments have been lost since the start of the pandemic. Those from low-income or vulnerable groups are being disproportionately impacted, with 1 million new or expectant mothers having lost access to care since the start. Dentistry has been subject to cuts unparalleled in the NHS; in real terms, estimates suggest that net government spend on dentistry in England was cut by over a quarter between 2010 and 2020. The BDA argues that chronic underfunding and the current NHS dental contract are to blame for long-standing problems with burnout, recruitment and retention. We know morale among NHS dentists is very low, and we are facing an exodus of them from NHS practice.
The regulations before us today are welcome, but they will not turn this around. Under the regulations, subdividing band 2—putting more complex treatments into categories 2b and 2c—should hopefully reward dentists’ time and input more accurately. More generally on access, I understand the NHS has started commissioning “access sessions”, remunerated using a sessional fee in practices with an NHS contract in the north-east, using existing flexibilities within the current regulations. I hear that this scheme has worked very well, and I congratulate the commissioners and providers on this. Can the Minister confirm this and say whether it is to be rolled out across the country? I certainly think that this should be a priority. Because it can be done under existing regulations, and because of the protracted delay in moving from the long pilot scheme we have had to a new contract, this surely is an area where Ministers could make some progress in the short term, provided they provide resources to the health service to do so.
We are debating one element of a package that was announced by the Chief Dental Officer last year, designed to improve access. Two weeks ago, we agreed on one of those planks—regulations which gave dental care professionals the ability to open new courses of NHS dental treatment when they are trained and competent to do so. I do not want to go over the ground again; I think that this is a significant change that should be applauded, but there are still blockages in making it work effectively.
First, under previous regulations, a DCP would have needed a performer number to open a course of treatment, and with that would have come associated pension benefits. I understand that, under the recently issued guidance from the NHS, the DCP has to demonstrate competence by entering their GDC registration number, but the dentist whose performer number appears on the NHS form signing this off actually accrues the pension benefit. That does not seem to me to be fair, it is potentially discriminatory, and I wonder if the Minister could give me some justification for that, perhaps in writing.
Secondly, work has been going on for over a decade to allow DCPs to give local anaesthetics without having the direction of a dentist. Can I ask when that is going to be implemented?
Thirdly, given that the current system of remuneration of our dental schools means that it is much more attractive financially to train dentists, will they be incentivised to train more DCPs? If not, how are we going to see a substantial increase in DCPs? If I may just take the Minister back to our debate two weeks ago and the decision to exclude overseas dentists from working as DCPs, I still fail to see the justification for that.
The third plank of the package announced by the Chief Dental Officer to improve access was in relation to NICE guidance published in 2004. The concept of six-monthly recalls is embedded in our society and among patients, but it is not evidence-based and recall intervals need to be tailored to risk—in some cases, six months may be appropriate, but not all. The time taken up by unnecessary recalls could be used to grow access, and I would like to know how the Government intend to make sure this guidance is complied with.
Putting this all together, it is inevitable we come back to the issue of the critical shortage of workforce. Opening new dental schools is clearly one solution—I would like to see that—but we know that it takes up to 10 years from taking the decision to open a new school to clinicians entering the workforce. We clearly do not have 10 years, so we need to train more dentists, but in the near-term we have got to make NHS dentistry a more attractive option to improve retention of existing clinicians, while also making it easier for overseas dentists to work in the NHS.
The obvious way to make NHS dentistry more attractive to dentists in the UK is by increasing the budget for NHS dentistry. Given the real-terms cuts that we have seen—a quarter since 2010—this is essential.
In the short term, overseas dental professionals are one key to addressing the workforce pressures and ensuring access to NHS dentistry. One way that we can achieve this quickly is by streamlining the GDC processes for accepting individuals on to the register. This can be done by the UK striking more mutual recognition agreements for dental qualifications with countries of comparable standards and creating more places for the overseas registration exam. The GDC’s current mutual recognition of EEA-qualified dentists is also vital in boosting short-term applicant supply; this must not be removed.
Then there is the performers list validation by experience process, which all dentists not qualifying in the UK must go through to practise in the NHS—it needs standardising, simplifying, and streamlining. Does the Minister agree?
We also need to look at the work dentists do. I was briefed by BUPA that 24,272 dentists did some NHS work in England in 2021-22, but 15% of the workforce—almost 4,000 dentists—did no more than one patient course of NHS treatment a month on average; that seems quite extraordinary. How can that be justified? Can the Minister confirm that dentists do keep their performer number active by that process, which means that their historically earned NHS pension is dynamised on an annual basis? How can that possibly be justified?
Finally, we want to hear from the Government what priority they give to NHS dentistry. I put it to the Minister: is he content to see the dismantling of the service with access problems, piling up the misery of millions of people, and the frightening growth in self-treatment? Let me remind him of the BDA’s belief that
“NHS dentistry is facing an existential threat and patients face a growing crisis in access, with the service hanging by a thread.”
Are the Government essentially saying that they are content for this to happen? If not, then we need to see concrete plans to increase resources and the workforce to ensure that patients who want NHS treatment can get it in a timely way, confident in the quality of care they receive.
When I was Minister for Dentistry from 1999 to 2003, the then Prime Minister Tony Blair made a pledge that any patient who wanted to see an NHS dentist would be able to do so—and we achieved it. It can be done with strong leadership and the support of the profession. I hope the Minister will tell us whether the Government are going to go down that route tonight. I beg to move.
Lord Hunt of Kings Heath (Lab)
My Lords, I am very grateful to noble Lords who have taken part in this short debate. As the Minister mentioned fluoridation, I should just remind the House that I am president of the British Fluoridation Society and patron of the National Water Fluoridation Alliance. I agreed with the noble Baroness, Lady Bennett, when she talked about the WHO and preventative measures. The single most important measure would be to introduce fluoridation where it is not present at the moment. I was delighted when the Government took powers back to themselves to do this. I know that progress is being made: I just urge the Government to speed it up.
I also say to the noble Baroness, Lady Bennett, that she is right to identify the levelling-up Bill. It is a long Bill, but there is room for more amendments in relation to health. There are some already, but I would encourage her to think about that. She and the noble Lord, Lord Allan, raised the issue of the south-west. I had a meeting today with Stonewater, a very large social housing provider, which is very concerned about the lack of housing in the south-west. I would definitely make the link between housing and health, which is a very important issue if we are serious about levelling up.
The noble Lord was right to identify that these problems started before the pandemic, and that we are now facing particular issues, but the underlying structural issues are still not being dealt with. I also agree with him about post-implementation evaluation. I hope that the Minister, when he responds in writing, might be able to say something about that.
My noble friend Lady Merron was absolutely right to hone in on retention and recruitment. Although there are various initiatives, at the moment I do not think enough is being done to retain the profession within NHS dentistry. We need to do very much more about that. Her point about practice information going on the NHS website is really important, and I hope that the Government will respond to it.
Ultimately, it comes back to prioritisation and money, and I was grateful for what the Minister said. I am delighted that his wife is present to hear our debate, and indeed that he is celebrating his father’s 80th birthday. It reminded me that I took my wife with me—for a romantic 50th birthday celebration—to address the Pharmaceutical Services Negotiating Committee dinner. She has never forgotten that or forgiven me for that great sin, nor has she forgiven Alan Milburn for making me do it.
Anyway, the point is that we come back to the workforce strategy, because without a properly funded workforce strategy, with numbers, we will not get anywhere. In the meantime, there is still a lot that can be done to streamline GDC processes, recruit dentists from overseas and, crucially, give dentists currently in the profession but not doing NHS work some confidence that it will be worth their while to do NHS dentistry.
I was very interested in the point the Minister made about the cost for dentists coming into NHS dentistry and starting a new practice. He will, of course, have been interested in what Wes Streeting had to say about the future of primary care. He came in for some criticism for suggesting that maybe the current model of GP partnerships might not always be the right one. He is absolutely right that we have to think rather radically about how we will develop primary care in the future.
The argument for a proper strategy for dental access for NHS patients is very persuasive indeed. Having said that, I thank noble Lords and beg leave to withdraw my Motion.
Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I thank noble Lords, and declare what is a kind of interest, in that my wife, as many noble Lords have heard me mention before, is an international dentist. For my sins, I had the joy of helping her to fill out one of these international GDC registrations—so I have a little bit of knowledge in this space. It was not the most riveting exercise of my life, but I do have some knowledge.
I beg to move that the order be approved. International dental care and nursing professionals form a vital part of the NHS workforce and make an important contribution to the delivery of healthcare in the UK. The GDC and the Nursing and Midwifery Council are the independent statutory regulators for the dental and nursing and midwifery professions in the UK, and nursing associate professionals in England, respectively. They set registration standards for healthcare professionals who wish to practise in the UK.
International professionals who wish to practise here must meet the same rigorous standards that we expect of UK-trained professionals. We believe that it is in everyone’s interests that such professionals can use registration processes that are a fair test of their professional competence and that provide them with a clear route to registration. We are reforming the legislative framework for the regulation of healthcare professionals to better protect patients, to support our health services and to help the workforce to meet future challenges. Ahead of this, action is required to provide the GDC and NMC with greater flexibility to amend their international registration processes. This will help the regulators ensure that future international registration pathways are proportionate and streamlined, while continuing to robustly protect patient safety.
We plan to take forward all the proposals we consulted on and have made one small amendment to the order in the interests of patient safety. This relates to the requirement that a qualification relied on by international applicants to the dental care professionals register can no longer be a diploma in dentistry. This change introduces fairness and consistency between the UK and international routes, as UK-qualified dentists cannot apply to join the DCP register using their dentistry qualification. The GDC also expects that increasing the capacity of the ORE exam will support international dentists applying to join the GDC’s register. The amendment will allow the GDC to process applications from dentists to join the register as DCPs that are received up to the day before the order comes into force. This guarantees that any live DCP title applications submitted before the legislation is passed will be processed.
I draw the Committee’s attention to an issue raised by the Secondary Legislation Scrutiny Committee, which noted that the Committee may wish to seek reassurance on how appropriate safety standards will be maintained. The primary purpose of professional regulation is to protect patients and the public from harm. Any new or amended registration pathways will be based on applicants meeting the same standards of training and knowledge as UK-trained professionals. These standards are set by the independent regulators in consultation with the professions, the public and education providers.
The order provides the GDC with greater flexibility to apply a range of assessment options for international dentists and dental care professionals. The GDC will have much greater freedom to update its overseas assessment fee, content and structure, now and in the future, as these will no longer be set in legislation that requires Privy Council approval to be changed. The requirement that dental authorities provide the ORE is removed, allowing the GDC to explore alternative providers. Candidates who were affected by the suspension of the exam during the Covid pandemic will be provided with extra time to sit it.
I understand that the GDC will first consult on the new rules in its international registration processes, which will come into force 12 months after this order is in force. It plans to increase the capacity of the ORE exam and support greater numbers of international dentists to join the register more quickly.
The order also includes a charging power, so that fees can be charged to international institutions for the cost of recognising their qualifications. This will support the GDC in registering individuals either based on an assessment of their qualifications, skills and training or by recognising the qualifications they hold.
On changes to the Nursing and Midwifery Order 2001, the NMC will have the flexibility to use two pathways in addition to its test of competence, which will remain its primary registration assessment. The first is recognition of an international programme of education. The second is qualification comparison, whereby the NMC may ascertain whether an international qualification is of a comparable standard to a UK one. The draft order also clarifies the NMC good health and good character declaration requirements. I commend this order to the Committee.
Lord Hunt of Kings Heath (Lab)
My Lords, I first declare an interest as a member of the General Medical Council. I welcome this order and pay tribute to the NMC and the General Dental Council for their work—and particularly to my noble friend Lord Harris, who so eminently chairs the GDC.
As the Explanatory Memorandum makes clear, this is in a sense an overture for a suite of orders that the Minister will bring in relation to all the registering bodies, essentially to streamline the fitness-to-practise processes—in the case of the GMC, to enable the statutory registration of physician associates and anaesthetist associates—and to update the governance of these bodies.
I noted in paragraph 10.4 of the Explanatory Memorandum the statement:
“The Department’s view is that it is for the regulators as independent bodies”.
I ask the Minister to assure me that in those new arrangements and governance processes the Government are as committed to these bodies continuing as independent entities as they have said during the consultation process.
I also raise with the Minister the one area in which I think the consultation produced disagreement in relation to the proposals, which is in regard to the DCP register and the fact that, as I understand it, dentists qualifying overseas are not to be allowed to come on to the DCP register. This was raised in Committee in the Commons. The Minister said:
“The change introduces fairness and consistency between UK and international routes because UK dentists cannot qualify or apply to join the DCP register using their dentistry qualification in other countries.”—[Official Report, Commons, Delegated Legislation Committee, 6/12/22; cols. 7-8.]
The point I want to put, which has been put to me by a dental practitioner, is that we are biting off our nose. We are disallowing future working by dentists from overseas in the professions covered by the DPC. The dentist said to me:
“I am working alongside four experienced dentists, three in the UK under the Homes for Ukraine scheme and one under the Afghan resettlement scheme.”
If this change occurs in the future, I think that they may be covered by the current grandparenting provisions. However, if this were to happen in the future,
“their livelihoods and contributions that they could make to our society would be severely constrained. Even with excellent English, overseas dentists are waiting some time … to sit the overseas registration exam”,
which allows them to practise as dentists, although I know that the GDC is considerably improving their performance to allow them to. The dentist went on to say:
“In the meantime, if the GDC implements this restrictive measure, overseas dentists could then take employment only as trainee dental nurses”,
which is really wasteful of their abilities.
I would like further clarification from the Minister about why this is taking place. Given the workforce challenges in the dental profession at the moment, I question whether this is the time to implement a new provision simply because dentists in the UK cannot be recognised in other countries. Perhaps the Minister would be prepared to look at this again.
Children in Care: CAMHS Waiting Times
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Lord Markham (Con)
Generally, we need to try to assess as many people as we can. I remember in my school there was a child in our class who we just thought was naughty and got into all sorts of trouble, but now, having had my own personal experience later on, I know that he had an autistic spectrum disorder. Clearly, he needed help and he was not assessed, so, as a statement, I agree that we need to increase assessment as much as we can for all these cases.
Lord Hunt of Kings Heath (Lab)
My Lords, the Minister has mentioned the provision of services in schools, which is very welcome, but does he accept that thousands of young people are now being home educated? Will he ensure that there is parallel support for those children in terms of mental health provision?
Lord Markham (Con)
I agree. Arguably, if you are being home schooled, you probably need a lot of help. As the noble Lord will be aware, a lot of the services are related to social prescribing, where often people with mental disorders can be helped by involving them more in community activities. Clearly, those who are home schooled are much more likely to be isolated.
Invasive Group A Streptococcus and Scarlet Fever
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Lord Markham (Con)
I know that the health agencies in each country work very closely together. I do not yet have the specific details, so I will happily follow up on this. I know that they are working very closely because it is clearly an area of concern. Right now, we have not seen any evidence of a new strain, so we think that we are looking at existing strains. We are seeing this number of cases because of a general situation where there is less immunity in the population because of the isolation related to Covid.
Lord Hunt of Kings Heath (Lab)
My Lords, the Minister will be aware that, on social media, there have been a number of recommendations by health professionals that concerned parents should go to their GP to seek advice. Yet he will know that GPs are under considerable pressure. The GP patients survey showed that over a third of people did not see or speak to anyone when they could not get an appointment at their GP practice. What special arrangements are being made to ensure that parents can get through the system to get advice?
NHS Waiting Times
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Lord Hunt of Kings Heath
To ask His Majesty’s Government what steps they are taking to improve NHS waiting time performance.
The Lord Speaker (Lord McFall of Alcluith)
For the second time in a week or so, I do not notice the noble Lord in his place but I believe that the noble Baroness, Lady Merron, will kindly step in again.
Ambulance Delays
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Lord Hunt of Kings Heath
To ask His Majesty’s Government what steps they are taking in response to reports of long ambulance waits for serious conditions, including heart attacks and strokes.
British Heart Foundation: Tipping Point Report
Lord Hunt of Kings Heath Excerpts(1 year, 5 months ago)
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Lord Markham (Con)
I am afraid I do not have information on the number of deaths. I will investigate this. I can say that I am sure that we have all seen a great increase in the number of defibrillators and we very much encourage this.
Lord Hunt of Kings Heath (Lab)
My Lords, that is very kind of the Minister. May I take him back to his response to his noble friend about vaccination? Would he, none the less, tell the House that the Government are absolutely convinced that the Covid and flu vaccinations have brought huge benefits?
Lord Markham (Con)
I thank the noble Lord for giving me the opportunity to state this. I should have done so the first time around, so that is appreciated. As he says, vaccinations have brought huge benefits. We can all be proud to be the leading country on rolling them out, seeing the benefits that have come from it all.
Water Fluoridation (Consultation) (England) Regulations 2022
Lord Hunt of Kings Heath Excerpts(1 year, 6 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, it is a great pleasure to follow the noble Lord, although I do not agree with him; we debated this during the passage of the Health and Care Act through your Lordships’ House only a few months ago. I must declare that I am president of the British Fluoridation Society.
I have form, because I remember when I was secretary of the Edgware/Hendon Community Health Council in the mid-1970s, taking part in an extensive consultation exercise in the London Borough of Barnet when the then Government were encouraging the introduction of fluoridation. We had two very well attended meetings in the borough where there was a clear view in favour of fluoridating water. Unfortunately, virtually no progress has been made since then. That is why I am very glad that the Government have brought forward primary legislation, and I was very glad to hear what the Minister had to say about the intention to move ahead in the north-east. That is very encouraging and I hope that that will be the first of many such schemes.
It seems that the consultation progress that the Government have set out is entirely reasonable. We must remember that the principle is decided—it has been decided by primary legislation. The local consultations that will take place are not a reason for reopening arguments about the effectiveness of fluoridation; they are about the detailed proposals, making sure that the areas are covered correctly and that individuals can have a say about that. However, I have to say that I noted in paragraph 7.3 that in the consultation a higher weight is to be given to individuals affected by the proposals
“who reside or work in the area.”
I am sure that that is right, but I ask the Minister to agree that the highest weight has to be given to the statement by the Chief Medical Officers of all four UK countries last year that water fluoridation is both safe and effective as well as being the most cost-effective way to reduce inequalities in dental caries prevalence. That must be the principle that lies behind any consultation process. I wish these regulations all speed ahead and very much hope that the foundations for a second wave of fluoridation schemes can now be laid in the north-east.
Baroness Brinton (LD)
My Lords, I welcome the Minister to consequential SIs from the passage of the Health and Care Act. Some of those present will remember the long debates we had during the passage of that legislation, some of which the noble Lord, Lord Reay, has returned us to today.
I will start on water fluoridation. My points were actually about consultation, and I will return to those, but the noble Lord has a point: there are now scientific records to show that excess levels of fluoride do cause damage. There is a very good academic article entitled “Assessment of fluoride levels during pregnancy and its association with early adverse pregnancy outcomes”. It concludes that this happens mainly in developing countries where the level of fluoride is not managed. I echo the point that the noble Lord, Lord Hunt, just made, that if the four Chief Medical Officers for the four countries of the United Kingdom believe that it is safe, that should be enough for us.
Of course all care must be taken and monitoring must continue, but the other point I want to make is from a dentist in Australia, who was very supportive of Australia’s move to fluoridation a while ago. He said that the region where he lives was one of the last to add fluoride. He talks about the experience of having to give very small children repeated anaesthetics and pain relief, and the effect on them. He says:
“Since fluoridation was introduced to Geelong in 2009, my colleagues are much happier, as severe dental abscesses requiring tricky anaesthetic techniques are much less common, and tend to mainly come from areas in the region which still aren’t fluoridated.”
He goes on to say:
“The other anecdote … was that one of my colleagues who had worked in Europe for a few years went away with 3 children under the age of 6, who were the same age and social demographic as our own children. When they returned … 2 of his 3 children had needed dental treatment”
under general anaesthetic. The key point is that they went to unfluoridated places. Although I hear the concerns of the noble Lord, Lord Reay, I hope we can be reassured that everything we debated during the passage of the Health and Care Bill shows that this is being done very carefully.
During the passage of that Bill, my noble friend Lady Pinnock made a very important series of points about how to decide where to consult about fluoridation of water, given that we have so many reservoirs where water goes in lots of different directions. Often, you cannot identify each of those areas. Although it was good to hear the Minister talk about the way that consultation will happen, and it is good news that there has been broad consultation in the north-east and that there are some resources there, might the Minister comment on how it is possible for civil servants to identify the relevant areas for consultation? This was one of the reasons why we said during the passage of the Bill that there needed to be very broad consultation.
Moving on to the other statutory instrument on training on learning disabilities and autism, and on virginity testing and hymenoplasty, I signed both of those amendments during the Bill’s passage. Each time it came back I spoke to both of them. It was wonderful that the Government listened and accepted the amendments on training for health staff working with people with learning disabilities and autism. I know that this is only a technical amendment to remove the CQC, but this is a moment to thank the Government for listening to the concern of those of us who work with and know many in the learning disabled and the autistic communities, who have often found that they have been treated by people who do not understand their conditions, which makes it that much harder to communicate with them.
I will now move on to virginity testing and hymenoplasty—I welcome the Minister to the language that we have all had to learn. We were very pleased that the Government decided to support measures on this. I have one question for the Minister. He mentioned that this was about the suitability of foster parents or of their household. It is not clear how wide that household is regarded; is it literally the people who live in that house, or, as in other safeguarding issues, would it also include a member of the foster parents’ family who might be visiting that house on a regular basis and who, in any other safeguarding terms, would have to be notified? If the Minister cannot answer that today, I would completely understand, but I look forward to the answer because I have a particular interest in safeguarding. Apart from that, I support all three elements in front of us today.
Childhood Obesity
Lord Hunt of Kings Heath Excerpts(1 year, 6 months ago)
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Lord Markham (Con)
My Lords, as the House will be aware, the tax on sugar in drinks has reduced consumption of sugar by 44%, so I totally agree with the sentiment. We have been successful in this. We are looking to improve in the area of sugary food, where we have managed to reduce some of that content by as much as 13%.
Lord Hunt of Kings Heath (Lab)
My Lords, has the Minister seen the startling statistics showing the number of economically inactive people aged 50 and over, much of which is caused by ill health, with obesity thought to play a major role. Given that, why on earth do the Government need to fudge around and review? Why do they not get on with an assertive campaign to tackle obesity?
Lord Markham (Con)
I do not believe that we are fudging around. Noble Lords will see some very firm action. If the noble Lord goes into the supermarkets today, he will see a very big difference in how you see the food. There are big changes. I totally agree on the importance of this. I was the lead NED of the DWP, so I know how many inactive people there are in the workforce and how much better it will be for them and the economy if we can get them active and into work. I completely agree with the sentiment and the action that we are taking to drive it forward.