The National Health Service

Andrew Selous Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

Thank you very much indeed, Madam Deputy Speaker. Although I wish the House were completing the necessary Brexit legislation today, it is always a particular pleasure and, indeed, a responsibility to speak on the important subject of the NHS.

I, too, start by thanking every member of NHS staff —including two members of my own family—for what they do. The pressures on them are unrelenting, day in, day out, as all of us in this House must acknowledge. I, too, have a personal reason to be grateful to the NHS: when I was 24, I had a haemopneumothorax in the middle of the night, and the NHS saved my life with an emergency operation carried out in the hospital just over the river. Had it not been for the brilliant care I got some 30 years ago, I would not be here today making this speech.

When I met a number of presidents of royal colleges last month, they told me that they thought we needed to double the number of medical students in training. It is brilliant news that we recently increased their number by a quarter, but the ongoing NHS people review shows that demand is such that a doubling is needed. Another area we need to consider is highlighted by evidence that one to three hours a day of a doctor’s work could be done by non-clinical healthcare staff. Are we using our staff as effectively and appropriately as possible? I am worried by how many medical students we lose: having trained in this country at public expense, too many then go off to Australia, Dubai or elsewhere. Are there perverse incentives in the system? Where is the value for money for the taxpayer?

I hear from staff that sometimes they work with computers that take half an hour to warm up. Yes, we want to get rid of the fax machines and to use the latest technology, but computers that are just turned on and then work are vital for NHS staff under pressure. We need to put more nurses into care homes to curb inappropriate calls on accident and emergency services for residents. We need to make sure there are enough practice nurse courses in rural areas, where there are gaps that lead to poaching. Perhaps we could use the apprenticeship route.

I understand that 27% of medical school students who graduate go into general practice, yet the Royal College of General Practitioners says the percentage needs to be nearer 50% to meet the acute need for doctors in GP practices up and down the country. There is also great variation in the proportion of medical school students who go into general practice. We need to learn how to increase the proportion going into general practice, so acute is the need. I am also concerned that we do not have a proper career path for associate specialists, particularly in surgery, in our hospitals. They are valuable members of staff, but they can drift around the system a bit, and I understand that about 20% of them are leaving. We need to look after them better and plan for them more appropriately.

We need to link our health visitors more closely with the new primary care networks. Health visitors do invaluable work, but their national child measurement data is not transferred to GPs. That leads to problems and to childhood obesity not being tackled. As co-chair of the all-party group on obesity, it is great that we have chapter three of the childhood obesity plan, but I would just remind the Minister that the actions from chapter two, on watershed promotions and point of sale, have not yet been implemented. We need them to be implemented.

We also have a very bizarre issue in that the equality and outcomes framework does not cover children’s weight. In fact, it specifically excludes it—it covers only adults. Come on! We need to vary the contract to make sure it measures children’s weight.

We must do better on foetal alcohol syndrome disorder. It needs to be included in personal, social, health and economic education, and we need a massive public campaign. I am awaiting a letter back from the Secretary of State on that. It is a huge and growing issue that we do not talk about enough in this House.

We live in an obesogenic polluted environment, with unacceptably low levels of active travel. We need to design the healthy environments of the future if we are to relieve the NHS of the pressures that are otherwise going to overwhelm it.

We also need to be aware of the opportunities that NHS staff have to spot incidents of modern slavery. I would like to commend a very alert healthcare worker who last week, on the eve of Anti-Slavery Day, spotted the first victim of modern slavery in her hospital. She was alert to the symptoms and had done the training. NHS staff have a unique opportunity to bear down on modern slavery, and that is so important.

I was staggered to hear from the Scottish National party’s spokesman that the taxpayer is paying out £80 billion for £30 billion-worth of hospitals.

[Dr Whitford]

The figure is £13 billion.

[Andrew Selous]

It is even worse, then. Some trusts are paying up to 16% of their income on PFI payments. We really must learn from that and do much better.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Matt Hancock]

We have recently announced that the way in which we are going to proceed with regard to sexual health services is co-commissioning between local authorities and the local NHS. This is the best way to ensure that we get the services on the ground. I would just slightly caution the hon. Gentleman; although he mentioned that some sexually transmitted diseases have been on the rise, others have been falling quite sharply. We have to ensure that we get the details of what we try to implement right, but I support the direction of travel that he proposes.

[Andrew Selous (South West Bedfordshire) (Con)]

What can we do to make the workload terms and conditions more attractive for salaried GPs and GP partners compared with locums? GPs in my constituency tell me that a great number want to be locums, but that not so many want to be salaried or GP partners because of the workload. What can we do about that?

[Matt Hancock]

My hon. Friend is dead right. This is an important part of the work that Baroness Dido Harding is leading in the NHS people plan to ensure that we can make careers in the NHS—whether as doctors, other clinicians or more broadly—the most attractive that they possibly can be. This week we announced a pay rise for doctors and earlier this month we announced a long-term agreement with junior doctors, which I am delighted they accepted in a referendum with over 80% support. But there is more work to do.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 18th June 2019 Commons Chamber

[Seema Kennedy]

I have set out to the hon. Member for Sheffield Central (Paul Blomfield) the measures we have taken. Through the childhood obesity trailblazer programme, we are working with local authorities—I am hoping to visit one in Blackburn later this week—that want to see how they can use their powers to best effect, doing things such as limiting new fast-food outlets. We have spent billions of pounds over the past five years. The public health grant will be subject to the spending review.

[Andrew Selous (South West Bedfordshire) (Con)]

Given that 46% of food and drink advertising is spent on unhealthy food—and unhealthy foods are three times cheaper than healthy food—will the Minister follow in the footsteps of her predecessor, and go to the Netherlands to look at the Marqt supermarket, which has 16 stores around Amsterdam and does not market any unhealthy food to children? It is a profitable business and a model for our supermarkets, so will she go and look at it?

[Seema Kennedy]

I thank my hon. Friend for his interest in this area. The Amsterdam model has been very successful, but it is not just about food—it is about place and culture. I would hope to be able to visit the model very shortly.

National Marriage and Mental Health Awareness Weeks

Andrew Selous Excerpts

Thursday 16th May 2019 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

It is a pleasure to serve under your chairmanship, Sir David. I congratulate my hon. Friends—they are my friends—the Members for Congleton (Fiona Bruce) and for Strangford (Jim Shannon) on two excellent speeches. It is very good to see the Minister, who I know takes this area seriously. She has responded to other debates of this nature in Westminster Hall, and is a deep and serious thinker on these issues. We are lucky to have her responding to today’s debate.

The debate quite properly has marriage in its title, because it is National Marriage Week, and mental health, but every single Member in the Chamber, myself included, is here for every type of family. We are here for every one of our constituents, whether they are married, single, cohabiting, widowed or divorced—whatever their state. It is important to put that on the record, because occasionally such debates, and this issue, can end up in an unnecessary culture war. That is not necessary. We have moved on. As MPs, we are for absolutely everyone. However, it is also right that at least once a year we come to the important issue of marriage.

On the cross-party consensus, I was really encouraged, as the vice-chair of the all-party parliamentary group for the prevention of adverse childhood experiences, that I, as a Conservative, could sit down recently with a Labour Front Bencher and a Liberal Democrat MP. The three of us, from different parties and traditions, were united in wanting to do more to promote couple stability, because we understand the links with inequality and poverty. I think all three of us would describe ourselves as true social justice warriors, as the hon. Member for Strangford mentioned. It is really important to put that on the record.

In 2016, 47% of all children in single-parent families were living in poverty. Frighteningly, the Resolution Foundation recently predicted that children in single-parent families will make up two thirds of all children living in poverty. Like every Member in the Chamber, I came into this House to eradicate poverty. That is the heart of what our politics are about. If children grow up in poverty, they do not have the life chances that we all want for them. They cannot make the most of their God-given gifts in terms of their education, career and contribution to their community.

I will focus on why this issue matters to Members in every party—the Scottish National party, the Democratic Unionist party, the Liberal Democrats, Labour and the Conservatives. I want us all to be united on this. We need to get behind the family/relationship aspect of poverty if we are serious about engaging with social justice issues and tackling poverty.

Given the fairly terrifying figures—currently, 47% of children in single-parent families are in poverty, which is predicted by the Resolution Foundation to rise to two thirds—we know that we want to try to keep mum and dad together in order to keep children out of poverty. Why, however, does marriage matter, and why have a debate on it? Is it not just another structure among many?

It matters for this reason: sadly, unmarried couples are six times more likely to break up before their child’s fifth birthday. If we are all on the same page in wanting to tackle poverty and reach a serious, evidence-based recognition of the fact that family breakdown, and the increasing numbers of children in single-parent families, is a major contributor to child poverty, we need to look at the type of relationships that will give our children the best chance of not growing up in poverty.

At this point, there is always a bit of challenge in the argument. “Okay, those are the facts,” people say, “but is that correlation or causation?” In other words, do a particular type of people decide to marry, which is why fewer of them are in poverty? I agree with my hon. Friend the Member for Congleton that we should dig into the data and compare like for like—people living in the same circumstances. I am absolutely assured by the researchers I have spoken to over the years that marriage still has a protective effect against child poverty in low-income communities, which many single-parent families live alongside.

That, in essence, is why marriage matters. If people accept my argument as I have laid it out so far, we need to be concerned about a number of facts. First, the marriage rate itself is in free fall; the figures show that it is really declining. As I said, I am genuinely delighted that today’s Minister will respond, because I know that she cares about this issue. I suspect that she was asked to reply to the debate because of the mental health part of the title. Had the debate been just on marriage, I wonder which Minister the Government would have put forward. I hope that it would have been her; perhaps it would have been someone else.

We might have had the new Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Colchester (Will Quince), as family policy is currently centred in that Department. However, if we are a Government and a Parliament that is four-square behind bearing down on child poverty, this issue needs to be at the heart of Government policy, not tucked away in one or two Departments. To my mind, it should be in the Cabinet Office, and there should be regular accountability through the Cabinet Office of all Government Departments on what they are doing in this area.

Statistics from the Office for National Statistics show that the marriage rate is in free fall. However, it is even worse than that because, as my hon. Friend the Member for Congleton said, marriage rates among the better-off are holding up quite well. A company director or university lecturer is 48% more likely to be married than a building worker or office cleaner, and that gap is growing. In 2000, the gap was only 22%. Basically, marriage is almost completely disappearing from low-income communities. We have to call a spade a spade and recognise that fact.

I am really pleased that there are Labour Front Benchers who understand that fact and are concerned about it, because if we are to bear down on child poverty, we have to use every tool in the kitbag. Certainly, the Government, the welfare system, schools, youth clubs, community groups, the voluntary sector, the health service and all manner of different central Government and local government institutions have a role. However, we cannot ignore what is happening in our families up and down the country if we are really serious about this issue. The Marriage Foundation tells us, in a similar statistic put another way, that 87% of mothers from high-income groups get married, as opposed to only 24% from the lowest-income groups. We have to do something about that.

I am grateful to Tavistock Relationships for the briefing that it gave me for the debate. Its representatives sent me some research from Paul Amato, who they say is generally recognised as one of

“the world’s leading researcher on marital quality, divorce, and other family related issues”.

His research has shown that common mental health problems are much

“more prevalent in people who are experiencing relationship distress than those who are happier in their relationships”.

He warned against viewing marriage and cohabitation as interchangeable, stating that

“we should consider the fact that cohabitations are less stable than marriages”,

as I pointed out a moment ago.

Tavistock Relationships has a particular ask of the Department of Health and Social Care, because it believes that the huge overlap between relationship distress and depression is being largely ignored by the NHS. It points out that within the excellent IAPT— improving access to psychological therapies—programme, only 49% of the relevant NHS services provide couples therapy for depression. It is calling for that figure to be increased to at least 90%, although it would be best if couples therapy were universally available. I ask the Minister to take that point back to her Department.

Like my hon. Friend the Member for Congleton and the hon. Member for Strangford, I pay tribute to the many organisations up and down the country that are working hard to strengthen relationship quality and provide relationship support and education. They should be much more prominent in our national life and much better known in Whitehall and Westminster.

In no particular order, let me mention the four organisations that make up the Relationships Alliance: Relate, which is perhaps the best known and the largest, Tavistock Relationships, which I have already mentioned, Marriage Care and OnePlusOne. They are fantastic organisations and are at the front and centre of dealing with these issues and providing support day in, day out. In my view, they need to play a more prominent role in our national life in the fight against child poverty, because they are absolutely part of the solution.

I would like to mention the work of Nicky and Sila Lee, who run the marriage preparation course and the marriage course. I will also namecheck Jonathan and Andrea Taylor-Cummings of Soulmates Academy, which my hon. Friend the Member for Congleton mentioned. I commend them for their recent TED talk on this important subject and for their excellent work, particularly with employers. Many employers are beginning to realise that there is not a watertight seal between what happens at home and at work. Relationship distress and emotional distress at home have an unquestionable impact on performance and productivity at work.

We need the private sector to get a bit more engaged in the issue, because it is not just about the Government. Everyone always asks the Government to do everything, and while the Government have a role, employers and those in the private sector need to get with the programme and realise that they have a role to play too, alongside the community and the voluntary sector.

I will make a silly analogy that some colleagues will have heard before. I would guess that most of us in this Chamber own a car. It is the law that every year we have to give that car an MOT. We spend time and money taking it to the garage and having someone check under the bonnet so that the car is serviceable to go back on the road for another safe year’s motoring, which is the object of the exercise—and quite right, too. Should not our relationships and marriages have the same treatment? Are they not just as important?

I use the phrase “marriage MOT” or “relationship MOT”. Some people may have done a little preparation before getting married, but will that last a lifetime? In my own marriage, I have got into bad habits and have had to be corrected by my wife or by good friends. I have gone on marriage MOTs from time to time with my wife and with other couples, and have found them helpful. We should try to make that more normal and mainstream. It is not just about therapy, but about something that all of us need: a little advice and assistance to get out of bad habits and maintain good ones. I am grateful to my hon. Friend the Member for Congleton for mentioning some of the practical things that are involved.

Research shows that the No. 1 reason why children present at child and adolescent mental health services is family relationship issues at home. The hon. Member for Strangford spoke about the huge growth—the epidemic—in children’s mental health issues, which can extend until they are university students. Recent studies have shown that a quarter of all young women at university and in their early 20s experience some form of mental health issue. Very often, family relationships are at the core of those issues.

I will conclude with a quotation from an excellent article by Ed West that appeared in The Spectator in December 2017. The Spectator is not a magazine that I read very regularly, but I commend the article to anyone who is interested. I will read out his final paragraph, because I found it so striking. On the subject of marriage, he writes:

“How much does the government care? The answer is not very much. About a decade ago, David Cameron said he’d be the most pro-marriage leader the Tories have had in his lifetime, but his enthusiasm cooled quickly.”

Actually, I think that the last Prime Minister did some good things in the area. I would have liked him to do more, but I think that that criticism is a little harsh. The article continues:

“Jeremy Corbyn is unlikely to be talking about family values, which is a shame because a true social justice warrior would be obsessed with this issue. Marriage is becoming a luxury item, a trend that is likely to cause ever-increasing inequality down the generations. Any government that is genuinely concerned about helping those at the bottom should think about what it could do to make marriage for the many, not the few”—

a phrase that perhaps the Labour party could think about. I think that those are powerful words on which to conclude my speech.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 26th March 2019 Commons Chamber

[Stephen Hammond]

My right hon. Friend the Secretary of State and I have both had conversations with the Treasury and the Chancellor, and there are ongoing discussions.

[Andrew Selous (South West Bedfordshire) (Con)]

The Government have done well to get more medical students into general practice, but we are not doing quite so well at retaining GPs later on. What more can we do to make sure that GPs stay in general practice, so that more of our constituents can go and see a doctor more easily?

[Stephen Hammond]

NHS Improvement has a number of retention schemes in place, for GPs and for nurses, to look at why some people are leaving. The interim plan being developed by Baroness Harding has an employer of excellence work stream, which will report on a number of potential issues.

Services for People with Autism

Andrew Selous Excerpts

Thursday 21st March 2019 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

I beg to move,

That this House has considered services for people with autism.

Every year, my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan), in her role as chair of the all-party parliamentary group on autism, moves a motion along the lines:

“That this House notes that World Autism Awareness Week runs from 1 April to 7 April; observes that autistic people continue to face a number of barriers to full participation in society; notes that it is 10 years since the Autism Act became law; and calls on the Government to improve support for children and adults on the autism spectrum, and ensure that the Autism Act is fully implemented across the country.”

My right hon. Friend cannot be with us today. She has asked me to explain that a close family member is critically ill and that she cannot leave their side. Though you, Mr Deputy Speaker, I send the love of this House to our right hon. Friend. She is a formidable champion of this cause, and someone to whom many of us have turned in our own hour of need. The best tribute that I can pay to her is to deliver the speech that she prepared and would have made today. These are her words:

“I welcome the Minister to the Front Bench and look forward to hearing what she has to say. My thanks to the Backbench Business Committee for granting this debate as we look forward to World Autism Awareness Week, a full seven days when people across the UK take part in activities to raise awareness of autism. I also thank the National Autistic Society for its ongoing support for the all-party parliamentary group on autism.

Hon. Members will be aware of my long-standing commitment to improving the lives of people on the autism spectrum, most notably through my role in spearheading the introduction of the Autism Act 2009—which has now been on the statute book for 10 years.

I was proud to introduce that Bill that became the only Act—which is the only Act dedicated to improving support and services for one disability. It was a landmark in the battle to improve the lives of autistic adults and their families. As a result of the Act, there has been a fundamental shift in how policy is developed and delivered for adults on the autism spectrum. For the first time, legal duties were placed on councils and the NHS to provide support to autistic adults in their local areas. In addition, the Act placed a responsibility on the Government to produce the national autism strategy, to set out its vision—and, importantly, to keep that strategy under review.”

[Andrew Selous (South West Bedfordshire) (Con)]

Like my hon. Friend I pay huge tribute to our right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) and all that she has done on the issue for so long. I am listening carefully to my hon. Friend’s excellent speech, and I wonder what he would say to a constituent who wrote to me about her son. She writes:

“My son is 21 years old and since leaving education has had nothing to do. He is not disabled enough to qualify for benefits but he is not able to compete for a job. He is caught in the middle.”

What more does my hon. Friend think we can do to help people like that young man with their future?

[Huw Merriman]

I thank my hon. Friend for his words and for championing his constituents. As he rightly says, some autistic people tend to fall through the gaps. Of course, all local authorities have a responsibility to take note when it comes to autism. We see individuals who are on the autism spectrum but are not receiving help because they might be outside a defined period. The extension of plans up to the age of 25 will go some way towards addressing that, but we still see people falling through the gaps. I will touch on some of the other areas that might address his concerns, or I will at least make calls to those on the Front Bench.

My right hon. Friend the Member for Chesham and Amersham continues:

“This year, it falls on the Government once again to review its strategy and identify what more needs to be done.

Each of us has about 1,000 people on the autism spectrum in our constituencies and it affects one in 100 people. We each will have many autistic people and their family members contacting us to ask for our help on areas from education to adult support, diagnosis to employment...”

Dental Health: Older People

Andrew Selous Excerpts

Wednesday 27th February 2019 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

This Adjournment debate provides an opportunity to discuss a very important but often overlooked issue, which can have a major impact on the wellbeing of older people: their oral health. Many of us will have older relatives who have reached the stage where they need some extra support. It might be that they live in a residential care home, have a carer who visits them in their home a couple of times a week, or just require a bit of extra help from us personally to stay independent.

However, one issue that often slips under the radar when we think about an older relative’s needs is their oral health; it can often seem like a small issue, but in fact poor oral health can have much wider implications. Having a painful oral health problem can impact on someone’s ability to eat comfortably, to speak and to socialise with confidence, and on the ease with which they can take medication, something which may be a particular issue if an older person is living with other long-term health conditions. Maintaining good oral health can also become much more challenging for older people with reduced dexterity, who may for example have more difficulty with brushing their teeth. Furthermore, for the most vulnerable older people, such as those with dementia, who may have difficulty communicating where they are experiencing pain, an oral health problem can be especially distressing.

Ensuring that older people are supported to maintain good oral health, and have access to dental services when they need them, is therefore very important. However, while data on this issue is limited, the information that we do have suggests that these are areas in which we often fall short.

The Faculty of Dental Surgery of the Royal College of Surgeons published a report on “Improving older people’s oral health” in 2017, which estimated that 1.8 million people aged 65 and over in England, Wales and Northern Ireland could have an urgent dental condition such as dental pain, oral sepsis or extensive untreated decay. Moreover, the Faculty of Dental Surgery also highlighted that this number could increase to 2.7 million by 2040 as a result of several demographic factors, thereby increasing pressure on dental services in the future. As well as the ageing nature of Britain’s population, increasing numbers of people are also retaining their natural teeth into old age; while this is good news, it also means that dental professionals are facing new challenges as they have to provide increasingly complex treatment to teeth that may already have been heavily restored.

Separately, in 2014 Public Health England published the findings of research looking at oral health services for dependent older people in north-west England, which found that access to domiciliary and emergency dental care can often be very challenging for those living in residential care homes or receiving “care in your home” support services. More recently, Public Health England last year published the results of a national oral health survey of dependent older people living in supported housing. This revealed that nearly 70% of respondents had visible plaque and 61% had visible tartar, indicators of poor oral hygiene, and that in some parts of the country, such as County Durham and Ealing, over a quarter of dependent older people would be unable to visit a dentist and so required domiciliary care in their home.

It is difficult to get a complete up-to-date picture of the oral health needs of older people across the country, partly because there has not been an adult dental health survey for 10 years, an issue I will return to later. However, these figures, as well as anecdotal reports from dental professionals working on the frontline, suggest there is a real issue here which potentially impacts on large numbers of often vulnerable older people.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this important issue to the House. As he said, 1.8 million elderly people across the United Kingdom of Great Britain and Northern Ireland have problems, which is shocking. The hon. Gentleman outlined some of the solutions such as extra attention on domiciliary care and in residential homes, and for those at home and dependent on carers. Does he agree that older people’s confidence can also be diminished by not having their teeth correctly done? My mother went this week to have her teeth done; she is 87 years of age and she depends very much on her dentist. She has attended over the years, but many have not, and we need to have that care at all those different levels.

[Andrew Selous]

I am grateful to the hon. Gentleman for giving us his personal family experience of this issue.

There have been some welcome developments over the last few months, including the recently published NHS long-term plan highlighting oral health as one of the priorities for NHS England as it rolls out a new “Enhanced health in care homes” programme across the country. However, I would like to draw the Minister’s attention to five particular areas in which more could usefully be done: training for health and social care professionals; access to dental services; data; regulation; and the social care Green Paper.

First, on training, health and social care professionals regularly do a brilliant job of caring for older people, but as I have mentioned, oral health is one issue that can easily fall between the cracks, particularly if someone is living with a range of other health conditions that also require care and attention. One example of this is oral care plans. Ideally, whenever someone is admitted as a resident to a care home, their oral health needs should be considered as part of their initial health assessment. Those needs should then be reflected in an oral care plan that all their carers are aware of and that will, for example, set out whether the resident needs extra help brushing their teeth.

There is some good guidance from the National Institute for Health and Clinical Excellence, but this can often be overlooked. In Public Health England’s research in north-west England, 57% of residential care home managers said that they did not have an oral care policy, and one in 10 said that an oral health assessment was not undertaken at the start of care provision. Knowing how to provide good oral care is especially important when it comes to supporting those with more complex needs. For example, for those with dementia, electric toothbrushes can sometimes be quite intimidating, and it makes a big difference if a carer knows that they should use a manual toothbrush when helping with tooth brushing. More broadly, if someone who is living with dementia refuses oral care, this can become an obstacle to maintaining good oral health, so it is important that carers understand how to manage these situations, ideally with input from a dental care professional.

Equally, for those with dentures, it is important that training and procedures are in place to minimise the risk of a denture getting lost, even if this is a simple thing such as ensuring that they are kept in a jar by the bedside when not in use. A lost denture takes weeks to replace, and this can be a devastating experience for an older person who relies on them to eat and speak. This is particularly sensitive if someone is coming to the end of their life, when it may not be possible to manufacture a replacement in time as they spend their remaining days with loved ones. An understanding of good denture care is particularly important in these situations.

Improving awareness of oral health among health and care professionals should therefore be a priority, and was a key recommendation in the Faculty of Dental Surgery’s 2017 report. This highlighted schemes such as the Mouth Care Matters programme, in which mouth care leads are recruited to provide oral care training to staff in hospitals and care homes, and I would be interested to know from the Minister whether there were any plans to replicate such initiatives nationwide.

Secondly, ensuring that older people can access dental services when they need them is essential. It is not uncommon for people to think that if someone has no teeth, they cannot be experiencing pain or other oral problems. Sadly, this is not the case and they should still have an oral check-up once a year, not least because the majority of cases of oral cancer occur in people over 50. There are all too many tragic instances of an older person being diagnosed with oral cancer too late—the saddest two words in the English language—simply because they had not seen a dentist in a number of years. Attending a dental appointment can be a particular challenge for those with reduced mobility—for example, if they are unable to climb stairs to reach a dental practice on the first floor—in which case, domiciliary visits are vital. However, evidence suggests that access to domiciliary dental care can be challenging, particularly for those living in care homes or supported housing, and I would appreciate the Minister’s thoughts on how we can address this.

In 2015, Healthwatch Bolton reported that it was easier for a local care home resident to get access to a hairdresser than to a dentist. In 2016, Healthwatch Kent reported that care homes had told it about accessibility problems for wheelchair users within dental practices. In 2016, Healthwatch Lancashire reported that care home staff said:

“The residents don’t get regular checks; they are only seen when there is a problem.”

Healthwatch Derby was concerned about the lack of information for social care providers about how to access dental services for their residents. While the commitment in the NHS long-term plan to

“ensure that individuals are supported to have good oral health”

in care homes under the “Enhanced health in care homes” section is welcome, there is no mention of a similar commitment for older people who use domiciliary care agencies. Those people should not be forgotten, so what do the Government intend to do about that for domiciliary care agency users under the NHS long-term plan?

Thirdly, the intelligence around older people’s oral health is quite limited, making it difficult to build a full picture of the level of need or assess the barriers that older people face in accessing dental care. The most immediate action that could be taken to address that would be for the Government to commission a new adult dental health survey. It is one of the few resources to provide detailed, national-level data on standards of oral health among older people, and it is a key reference for many commissioners, policy makers and dental professionals. The survey has been conducted every 10 years since 1968, but the last edition was published in 2009, so a new one is due. However, the Government have yet to give any indication of when or if a new survey will be taking place, which is causing increasing concern within the dental profession, so an update on that would be most welcome.

There are other steps that would help to improve our understanding of such issues. For example, NHS Digital publishes a regular set of NHS dental statistics for England, which reports on the proportion of children aged zero to 17 who attended an NHS dentist in the preceding 12 months, as well as the proportion of adults aged 18 and over who attended an NHS dentist in the past two years. That data provides a useful measure of access, and expanding the figures to include attendance rates for older people would help us to develop a clearer picture of whether there are particular groups or areas where access to an NHS dentist is a problem.

[Jim Shannon]

Many elderly people are independent and proud, and one of the things that puts them off attending the dentist—I see this in my constituency—is that they think they have to pay for the treatment, but they do not. Perhaps we need to put out a reminder about that.

[Andrew Selous]

I am grateful to the hon. Gentleman for putting that on the record.

Fourthly, in addition to health services, care home providers and dental professionals, regulators can play an essential role by monitoring standards of oral care and driving improvements. The Care Quality Commission in England does not explicitly look at oral health during its inspections of hospitals and care homes, although I understand that it is doing a lot of work behind the scenes to try and push that on to the agenda for care providers, which is obviously welcome. Health and care regulators in other parts of the UK can also make a valuable contribution to ensuring that the importance of oral health is recognised by those that they inspect.

Lastly, I continue to look forward to the publication of the Government’s long-awaited social care Green Paper. Given the importance of oral health to our wider health and wellbeing, an all-encompassing model of care for older people must include dental services, so it will be important that the Green Paper clearly sets out how social care and dental services can work together in the future and what more can be done to ensure that older people have access to dental services when they need them. As I have mentioned, one of the most valuable things we can do to improve older people’s oral health is to ensure that it is not overlooked amid the many other issues that we are dealing with, and I hope that the Government will show leadership on that in the Green Paper.

Oral health can sometimes seem like a small issue, but it has a significant impact on quality of life. The Minister will be aware that we have spoken a lot in recent years about the need to improve children’s oral health, and quite rightly so, but it is also essential that we do not take our eye off the other groups who need support. For an older person who is in pain because of an oral health problem, finding it difficult to eat or speak, or who may be distressed at the loss of a denture that will take weeks to replace, such issues are very real. We can all contribute to addressing them, including Members who care for older relatives in our everyday lives. Indeed, the Faculty of Dental Surgery published some useful advice over Christmas about using visits to older relatives as an opportunity to check their oral health and for how to spot the signs that they might have an oral health problem. That is something that Members could do over Easter when visiting elderly relatives, and we could encourage our constituents to do the same. However, I hope that the Minister will recognise that Government also have an important role to play and will look carefully at what can be done to help improve oral care for our older people.

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

I realise that a debate on older people’s dental health is merely of passing interest to you, Mr Deputy Speaker, as you are many years from it being of direct interest, but I hope you enjoy my response.

I congratulate my good friend, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), on securing time for this debate and on setting out his case so clearly. I will do my best to answer his points in the time available. As he knows, I will write to him on anything I do not answer.

Oral health has improved significantly over the 40 years that I have been alive. At the start of the NHS—it is worth noting this incredible statistic—40% of the population had no natural teeth. The figure is now—answers on a postcard—6%. These massive improvements are to be celebrated but, of course, with improvements come new challenges.

As we are all aware, older people—we categorise those aged over 65 as older people for the purpose of this conversation—make up an increasingly large proportion of the population. By 2032, we project there will be 13.5 million people aged 65 and over in our country. Older people are retaining far more teeth, often heavily filled, than previous generations. As people age, so do their fillings and all the other bits of their bodies, and ongoing restorative work is needed.

Many older people live independently and are in full charge of their oral health, as are working-age adults, but we recognise that frail older people—those with additional needs, often living in care homes or supported to remain at home, as my hon. Friend set out—can face real barriers to accessing the appropriate care and support they need to maintain good oral and dental health.

My hon. Friend set out some of the reasons why good oral health is an essential part of active ageing. We know that poor oral health can affect an individual’s ability to eat, which can lead to an acute episode and an encounter with the tertiary sector, or even to speak and socialise. Obviously, poor oral health hits their confidence and then it spirals. For older adults who are frail, good oral health is particularly important to maintaining hydration and the ability to eat comfortably and easily, which helps them to stay healthy and independent for as long as possible, and even to stay well in a care home setting.

As we set out in our 2017 manifesto, we are committed to improving the nation’s oral health, from children right the way through to older people. The NHS long-term plan, published last month, set out our plans specifically to ensure that individuals in care homes are supported to have good oral health. My hon. Friend raised that point.

The long-term plan national implementation framework, due to be published later this spring, and the national implementation plan, due to be published this autumn, will provide further information on how the LTP will be implemented, but I will now turn to the five specific issues raised by my hon. Friend.

[Andrew Selous]

The Royal College of Surgeons obviously raised concerns about people who use domiciliary care agencies. While there is still time, will it be possible for the NHS long-term plan to address that issue, too, so that we look after all older people whatever type of care they receive, not just those in care homes?

[Steve Brine]

I will touch on that, but I take my hon. Friend’s point. I will make sure it is flagged up in writing as a note from me, the Minister, to the relevant officials as a response to this debate.

In 2016, the National Institute for Health and Care Excellence published its “Oral health in care homes” report, which was an important piece of work. As we know, it set out a number of recommendations for care homes to help maintain and improve oral health and ensure timely access to dental treatment for their residents. In dental health, as in every other part of health, prevention is better than cure.

I completely agree that we expect care homes to follow NICE guidance and NICE recommendations in this area, as in every other. Alongside the importance of appropriately trained staff, my hon. Friend makes an important point about the role regulators can play in this area.

The Care Quality Commission is responsible for this area, as it is for many other areas of policy, and it is currently looking in depth at oral health for older people in residential care settings, and much needed that is, too. So last autumn, the CQC’s dental inspection teams joined adult social care inspectors on visits to about 100 care homes to gain a better understanding of the oral health care support for residents. I know that the CQC intends to publish the findings later this year. I have asked to be kept updated on the progress of this work and to have early sight of its findings. I will update the House and my hon. Friend in particular on this, given his interest and the fact he is a member of the Health and Social Care Committee. I will make sure the rest of the Committee are aware of this as well.

We should also recognise and highlight the ongoing work of NHS England and Public Health England, which I sponsor within my portfolio, to improve the oral health of vulnerable older people. As is referred to in the long-term plan, NHS England considers oral health for older people, particularly those in care homes who may be vulnerable, an important issue. I have asked also to be kept updated on progress as NHS England takes forward action on this and other areas highlighted in the plan.

Public Health England has published “Commissioning better oral health for vulnerable older people”—a snappy title—which is designed to support commissioners of services to improve the oral health of vulnerable older adults so that they can lead a healthy, long and meaningful life outside the acute sector. My hon. Friend highlighted the Mouth Care Matters programme, which, as he says, is a local training initiative from Health Education England offering support and training in oral healthcare for the elderly and for hospital staff looking after patients who may need help with mouth care. I know the programme has been very successful locally in Kent, Surrey and Sussex. Decisions on whether to extend the training more widely are for HEE, but I would hope the success of the programme to date means that HEE is able to take it forward to new areas in the longer term, including to his county. I cannot give the nationwide answer that he asked for in his speech, but I suggest that the early signs are positive.

On access to dental services currently, NHS England is legally responsible for commissioning services to meet local identified need, and that includes the commissioning of domiciliary care services, where appropriate. However, it is important to say that where residents can, the care home and the local NHS work together, often very successfully, to ensure that dental services are provided in the most appropriate setting for those residents, whether that is within the care home itself or in a dental practice, or provided by the community dental service. Often people in care home settings will enjoy the trip out to the dentist; it is part of their socialisation and their routine, and we should not overlook that.

I note my hon. Friend’s concerns about the availability of oral health data, particularly for the older age groups. I agree that the adult dental health survey is an important tool for understanding oral health changes over time. I can reassure him that although there is not yet a date set for the next survey, no decision has been taken to discontinue this important source of information. I take this debate as a bit of a nudge to ask more questions about this. If my hon. Friend looks at my track record, for example, on the cancer patient experience survey, which I was clear was an important tool to give me information about cancer patients’ experience, he will see that I place value on such patient health surveys. In the shorter term, I agree that the regularly published NHS dental statistics on numbers of people seeing an NHS dentist could provide more helpful information by analysing the data by age. I am going to ask my officials to work with NHS England and NHS Digital to pursue this further, and I will ensure that my hon. Friend is kept informed on that point.

My hon. Friend made a point about the social care Green Paper, which remains very much a priority but is not yet in reach. The Green Paper will cover a range of issues that are common to all adults with care and support needs, and will bring forward proposals to ensure that we have a social care system in which people know that the care they receive will help them to maintain their independence and wellbeing, and that we have a social care system that we can be proud of. We will publish the document shortly, and it will set out proposals to reform the adult care system. I take the points made by my hon. Friend about the importance of including dental and oral health in the Green Paper. I will make sure that a copy of this remarks is sent to the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage).

In the remaining few minutes, I wish to touch on the prevention Green Paper. We set out our prevention strategy last year, and it is one of the Secretary of State’s three priorities. We are now in the process of developing the prevention Green Paper, which is an exciting piece of work with which to be involved. It will be called “Prevention is better than cure” and will do exactly what it says on the tin. I will engage with key dental stakeholders—including the British Dental Association, Mr Deputy Speaker, so there is no need to tweet me—in the coming weeks. I look forward to those engagements.

In conclusion, although I am disappointed not to have heard from the hon. Member for Strangford (Jim Shannon) during my speech, I know he has already intervened, and I am pleased that we have had the opportunity to discuss these issues. I think this is the first time I have responded to an Adjournment debate on this subject, and I have responded to quite a few. I hope I have been able to demonstrate the Government’s commitment to improving oral health. Of course there is more to do, and that commitment absolutely includes work on the oral health of older people in care homes, as set out in the long-term plan, and in domiciliary care settings. Our plans to engage in the coming weeks with key dental stakeholders on the development of the prevention Green Paper are honest and sincerely meant. I will continue to watch the work of the CQC and the outputs of its report with interest, and I will follow up on the dental survey so that we have the key data we need to improve services for the people we are here for—our constituents.

Question put and agreed to.

Early Parenthood: Supporting Fathers

Andrew Selous Excerpts

Wednesday 30th January 2019 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

It is a pleasure to speak in this debate. I begin in the same way as my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) did, by saying that we are all here for mums as well, including single mums. In fact, the last debate of this nature that I shared with the Minister was on maternal perinatal mental health. A number of men led that debate, so it goes without saying that we are all 100% behind mums and single mums, just as we are behind dads.

Mums need support, so an important issue is involving fathers and helping them to play their role in equal parenting, which is a really important phrase—I am glad it has been introduced several times in this debate. We know from the research that we are not getting this right at the moment, because 69% of fathers feel like a spare part. If fathers are supported and helped to be involved, as the vast majority of them want to be, they have the ability to offer round-the-clock support to new mums.

There are some worrying figures on what is going on at the moment. Looking at income groups, less than 31% of people earning under £20,000 turn up to antenatal classes; among those earning more than £70,000, more than 71% turn up. We are not managing to reach really important groups of fathers who need that support. The inspection framework does not look hard enough at what areas are doing to help fathers—indeed, fathers are absent from a lot of the inspection frameworks.

From Government research in 2012, we know that if fathers are involved in the care of a young child, parents are a third less likely to split up. When the Minister was recently before the Select Committee on Health and Social Care to discuss suicide prevention, she said that debt and relationship breakdown are the two major causes of suicide. That is a really powerful reason, with a number of important outcomes, as to why we should help fathers to be involved in the care of their new-born children.

In 2016, we set up a £39 million fund at the Department for Work and Pensions to reduce parental conflict in workless families, which was an excellent initiative that I really support. We need a second fund to improve the quality of relationships between couples who are at risk of separation when they have new children. There is evidence to support that, and I think there is an overwhelming need. It would be really helpful for mothers. I ask the Minister to take it back to the Department and to the inter-ministerial working group on the first 1,000 days, with which she is fully engaged. That would be a really good development.

I want to give a plug for a little programme called “Let’s Stick Together”. I am not allowed visual aids, so I better not hold it up, but the course reading material could fit into a purse or wallet very easily. I have personally handed a copy to our last two Prime Ministers and encouraged them to take it up across Government. It contains some really simple tips to help the quality of a couple’s relationship when they have a new child. I commend the work of the charity Dads 2 Be, which is active in a number of hospitals in south London. It focuses on antenatal work for groups of dads and helps them with the changes to their life, and also focuses on improving relationship quality. My question to the Minister is very simple, and it is my overriding plea to her: given that we are doing this in some NHS hospitals, can we please do it everywhere, throughout these islands, across the whole of our United Kingdom? It is sensible and a no-brainer. Dads want it, and we know there would be better outcomes for mums and children.

I commend some quite simple changes. A health visiting team in Lincolnshire managed to increase the participation rate of fathers in the primary birth visit from 20% to 70% by addressing their letter, “Dear new mum and dad” rather than just, “Dear parent”. That is a really simple thing and did not cost any money. It said very clearly to fathers, “We want you. You’re important and welcome. We expect and want you to turn up, and we’re here to help.” We can do some simple things that do not cost a lot of money; they just cost some political will. They are really needed, and I ask the Minister to do them.

--- Later in debate ---

[Eddie Hughes (Walsall North) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies.

I thank my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) for securing this excellent debate. As I have tweeted, what a great group of Conservative dads are supporting the debate, although I feel slightly unhappy about speaking after three people who are young enough to be my children. That makes me feel a little bit old. I wanted to contribute because my early career highlights the difficulty that dads can have. I thank my first wife for being kind enough to have our children on a Saturday evening, which meant I was dismissed from the hospital, and about an hour after my children were born I was in the pub with about 30 friends and family celebrating the birth. It all turned out damned convenient for me, although having heard stories from others, I appreciate it can turn out differently.

I started life as a civil engineer, working on a building site in an obviously male dominated environment. I will not make excuses for that, but construction, particularly the very large-scale construction I was involved in, has a particular nature. The idea that I might have gone to work one day and suggested to my boss that flexible working would be a good idea, and asked whether I could come in a bit later, is incredibly difficult. By the time I was 25, I was running a building site with a gang of up to 50 blokes who would have thought I was crazy. We were on site at 7 o’clock in the morning in a process that meant that if someone did not turn up and do their job at a particular time, other people would not be able to do theirs.

Fortunately for me, I decided that working outside was too cold, and joined an American company called Cartus, where I was responsible for maintenance of the properties in its portfolio nationally. I found the world to be a completely different place. It was a much more welcoming environment with regard to flexibility in the workplace, but I may not have appreciated at the time the majority female workforce. I mention that because, in preparation for this debate, I read documents and papers from around the world, and I had not realised how difficult legislation is in America. I read a paper from the National Bureau of Economic Research, published in 2015, when a form of parental leave was just being introduced in California. The early research from that paper showed that if parental leave was introduced, fathers were more likely to be engaged in parental support, and that, interestingly, fathers are more likely to take up that parental leave for their first child or if the child is a boy.

Clearly, there is some work to be done to ensure that men do not lose interest after the first child and that they take equal interest in daughters and sons. I have one of each, and I appreciate the stress that goes with having a daughter. She seemed considerably more difficult for me to manage and look after than my son did. It is interesting that research suggests that there might be a difference in the way they are treated.

Government have a role to play, and that does not always have to cost money. We need to show intent; we need to show men that they have a role to play and that it is important in the 21st century that they play it to their fullest ability. For that not to be the case seems counterintuitive. I loved my role as a dad; in fact, I told colleagues earlier that I am ready to be a grandparent and I have made sure my children are aware of that. There is no rush, but I will be ready when they come. Indeed, the hon. Member for Hampstead and Kilburn (Tulip Siddiq), who recently gave birth, sent me a photo, which made me immediately feel paternal.

We have a role to play, but what will we do to play it? Documents have been mentioned, and “A Manifesto to Strengthen Families”, published more than a year ago, has some excellent ideas for Government to follow. As has been mentioned, we have a more significant male population in prison, so it is very important to ensure that men do not lose contact with their families. To reduce reoffending rates, we need to maintain that bond.

[Andrew Selous]

My hon. Friend may not be aware that the Ministry of Justice commissioned the Farmer review, which offered 21 recommendations to strengthen the family relationships of prisoners, because there is evidence that that leads to less reoffending and keeps us all safe. The Ministry of Justice has adopted those 21 recommendations, so there has been some progress made in that area.

[Eddie Hughes]

It is excellent and reassuring to hear of that progress. The point was also made about the amount of paternity pay—£145.18. When I started work on a building site, I earned £50 a day, so £250 a week. Even 30 years ago, it would have been very difficult for me, as a young man starting off with a young family, to cope on a reduced income of £145, for a couple of weeks. It is great that the opportunity is there for men to take two weeks of leave, but it is important to try to make sure that is not financially difficult.

This is a complicated area, so I conclude by referring my constituents in particular to the website of the Share the Joy campaign, where they can find more details of their rights with regard to maternity and paternity leave. They can get more details about sharing parental leave up to 50 weeks, so they can take leave together and share the parenting experience very early on in their children’s lives.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 15th January 2019 Commons Chamber

[Stephen Hammond]

The hon. Lady asks about GPs. As she would want to acknowledge, a record number of doctors are being recruited into GP training. We are determined to deliver an extra 5,000 doctors into general practice. NHS England and Health Education England have a number of schemes in place to recruit more GPs and to boost retention—the GP retention scheme and the GP retention fund—and she will know, as I have said it twice this morning, that the workforce implementation plan, which is part of the long-term plan, will be published in the spring.

[Andrew Selous (South West Bedfordshire) (Con)]

9. What steps he is taking to reduce obesity.

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

This Government are taking bold, world-leading action on child obesity that meets the scale of the challenge that we face. We have a soft drinks industry levy, a sugar reduction programme already working, measures on banning energy drinks, calorie labelling consulted on, and a consultation on restricting price and location promotions of sugary and fatty foods which I launched on Saturday.

[Andrew Selous]

The introduction of a 9 pm watershed on the marketing of junk food to children is the No. 1 ask of the Obesity Health Alliance, supported by Cancer Research UK, Diabetes UK and many of the royal colleges. When will we see that consultation launched?

[Steve Brine]

I am glad that my hon. Friend mentions CRUK, which has launched a powerful new marketing campaign that Members will see around Westminster and in the media over the rest of this month. We will launch the consultation on further advertising that was in chapter 2 of the child obesity plan, including the 9 pm watershed, very shortly. We are working hard to ensure that the remaining consultations announced in the second chapter are right. I want to get them right and, when they are ready and we are satisfied that they are the right tools to do the job that we want to face this enormous challenge, we will publish them.

Diabetes

Andrew Selous Excerpts

Wednesday 9th January 2019 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

It is a pleasure to speak in this important debate, because diabetes is so significant in the UK. There are 4.6 million people with diabetes and on current projections we are on track to have more than 5 million people suffering from it by 2025. Ninety per cent. of people with diabetes have type 2, and being overweight or obese accounts for 80% to 85% of a person’s risk of developing the condition, so I shall focus my remarks on what is causing the hugely unwelcome surge in diabetes across the UK and, more importantly, what we need to do about it.

The shocking fact is that a quarter of children go into primary school reception overweight or obese. By the time that they leave, one third are overweight or obese. They are being educated, but overall they are becoming less healthy, which has worrying implications for their future life chances. In the UK at the moment, 30% of all children and 60% of adults are overweight or obese. The worry is that that has become almost normalised. People do not notice it and do not think it is a problem. To me, that is a huge social justice issue. Obesity rates are twice as high in the most deprived communities as in the least deprived. My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) made that point eloquently in his opening remarks.

I was particularly impressed by the remarks of our wonderful chief medical officer, Dame Sally Davies, just before Christmas. She hit hard at a number of targets and came out with some important truths. She had the food industry in her sights—she said that it benefits from selling unhealthy food, that it does not pay for the harm it does, and that it clearly has not done enough. She raised the fact there is added sugar in baby milk and baby foods, for goodness’ sake. What is the justification for that, other than to put babies and very young children towards a life of sugar addiction? That is scandalous and we should call it out. Frankly, the Government should ban it as soon as they are able, and if we have to leave the European Union to do so it should be an early priority at the beginning of April.

I did not come into public life just to ban things. The corollary, of course, is that we need to make the healthy choice the easy choice, and to be all about promoting wonderful, healthy, delicious, nutritious—often British—food. My right hon. Friend the Member for South Holland and The Deepings made that point well, too. Dame Sally Davies discussed whether there might be a need for price subsidies for fruit and vegetables. Let us make fruit and vegetables—good food that will not cause obesity and diabetes—more accessible, available and affordable to our constituents. That could be done through the taxation system. Dame Sally also called for sugary milk drinks to come within the soft drinks industry levy, which is entirely sensible.

It is worth looking at some of the foods currently on supermarket shelves. Taking children’s breakfast cereals as an example, 37 grams out of 100 grams of Kellogg’s Frosties are sugar. The figure for Kellogg’s Crunchy Nut cornflakes is 35.3 grams per 100 grams. For Kellogg’s Coco Pops it has come down a little bit, but there are still 30.9 grams of sugar per 100 grams. Those are pretty appalling figures, when we think how much sugar that is.

In 2017, some own brands were not much better. Lidl Golden Balls had 36 grams of sugar per 100 grams. Aldi Sugar Frosted Flakes had 35 grams per 100 grams. Tesco Frosted Flakes had 34.9 grams. Those are Public Health England figures and some relate to August 2017, while some, such as the Kellogg’s ones, are current. We need to call that out. Not enough progress is being made, and unless healthier food is available for our constituents we shall not turn the supertanker around. We know from Public Health England that chocolate confectionery and biscuits between them account for more than 300,000 tonnes of sugar going into our diet every year. That is more than from all the other food categories put together.

My first plea is that we should do more with food manufacturers. They need to get with the programme and to know that many of us in the House have them in our sights. I am a Conservative and believe in the free market. I do not want the state to produce our food. However, there is a serious challenge, because we all pay for the NHS through our taxes and the food industry is causing a large part of the problem. Dr Chris Marshall, one of my best local GPs, had to defend the diabetes prevalence in his area and what was happening about it, but it is not fair to blame GPs when so much is stacked against them because of the food industry, among other things. The food industry needs to raise its game. It has been getting away with too much for too long and the Government need to play hard ball with it.

Active travel is another area I want to consider. I came to the House of Commons on a bicycle this morning, because I could. For our children, when we design new housing estates, let us make sure they can bicycle or walk to school. Let us get more cycling and walking in cities. That is a design and planning issue. Officials and a Minister from the Department of Health and Social Care are here for the debate. We need a cross-Government strategy to build in active and healthy travel for children and adults to help the situation.

Calorie information is also relevant. Public Health England tells us that women should eat up to 2,000 calories a day and that men should eat up to 2,500. I wonder whether anyone here knows how many calories they had for breakfast, or how many they will have for lunch or supper. What is the point of giving us that daily total if none of us has a clue how much we eat? Here is a suggestion. For people who are waiting 10 minutes to see the doctor, why not have on the surgery wall examples of the different meals that the British public mainly eat, with a rough idea of how many calories there are in them? Would not that be a start to education? It would be free, easy, and a good use of the surgery wall in a public space where we all sit and wait. Why do not we try to get some of that public information out there so that we can do something and know what we are doing?

We have talked about schools. I do not blame teachers, who have more than enough to do trying to teach children, but they have a public education role. Given that we have gone from one quarter of children to one third being overweight or obese, there should be much more emphasis on providing proper education to children on food when they are taught to cook.

We must also look to Parliament. There has rightly been a move, which I am sure you approve of, Mr Robertson, to make this a more plastic-free Parliament. I approve of that and it is right, but the information in our catering outlets about their offerings is not as good. Let us set an example on our own doorstep.

--- Later in debate ---

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing the debate, for his very knowledgeable introduction and for the consensual nature of the debate that has taken place.

We have had a number of contributions; I will just touch briefly on the main speakers. The right hon. Member for Knowsley (Mr Howarth) reminded us of the importance of recognising the two different types of diabetes, which cannot be emphasised enough. I was also interested in his comments on the artificial pancreas. The hon. Member for South West Bedfordshire (Andrew Selous) raised the risk of diabetes being normalised and the impact of obesity, and the food industry’s contribution to exacerbating the problem. The figures he quoted on sugar intakes were genuinely frightening and should be a lesson to us all. The hon. Member for Rochford and Southend East (James Duddridge) gave his personal experience of his diabetes being under control. The very interesting thought of what we would say to our younger selves is one that we need to take out to our constituents in order to make an impact on the problem.

Health, of course, is a devolved matter. Consequently, it seldom features in my casework as a Member of this Parliament. That said, many of my friends have diabetes, either type 1 or type 2. It is the fastest growing health threat of our time and a critical public health matter. Diabetes is increasing rapidly, and one person in 20 in Scotland is now diagnosed with the condition—I stress diagnosed, because there will be many others who are undiagnosed. The latest figures published by Diabetes UK show that more than 3.5 million people in the UK were living with a diagnosis of diabetes in 2016-17, with just less than 290,000 of them in Scotland. Diabetes UK also reported that if nothing changes, more than 5 million people in the UK will have it by 2025. That is a figure that a number of people have used, and it is worth repeating to emphasise the impact of this health crisis.

In the Forth Valley area, which covers part of my constituency, more than 14,500 people are living with diabetes and there are more than 9,000 people with diabetes in West Lothian, which covers the other part. That helps to put the issue into perspective across a number of constituencies.

It is estimated that more than one person in 16 across the UK has diabetes, either diagnosed or undiagnosed, and it is worth remembering that around 80% of diabetes complications are preventable. I believe that in Scotland around 10% of NHS spending goes on diabetes—I think the English figure is fairly similar. If 80% of that is preventable, think how much we could save by tackling this problem, in addition to the benefit to people’s lifestyles that could be achieved. Many of those complications are preventable or can at least be significantly delayed through early detection, good care and access to appropriate self-management tools and resources, of which access to diabetes technologies is a fundamental part.

When I last spoke about diabetes, a couple of years ago, we talked about technologies. I confess that at that time I had not really witnessed much of them first hand, so I was pleased over the festive break when I saw one of my friends, Paul Kingsley, who has lived with diabetes for some time. He has a Libre patch sensor and an insulin pump. He showed me how that worked, which was interesting to see. It has made a real change to his life. I can remember when he had to do the prick tests and take his needles with him everywhere he went. Technology is making a big difference to people’s lives.

With the challenge of the increasing numbers of people with diabetes, access to the technology to help those living with the disease becomes ever more important. There are 19,000 new cases of diabetes diagnosed every year in Scotland and numbers are set to increase year on year, particularly with rising levels of obesity. Early results from ongoing research, led by Mike Lean at the University of Glasgow and Roy Taylor at Newcastle University, showed that it is possible for some people to put their type 2 diabetes into remission using a low-calorie, diet-based, weight management programme, delivered by their GP. I believe that, as a result of those promising results, NHS England has committed to piloting a remission programme for 5,000 people with type 2 diabetes in 2019, and the Scottish Government, through their “A Healthier Future” plan, pledged £42 million to the prevention, early detection and early intervention of type 2 diabetes. There is a lot we can learn from each other from these processes and as the results of these tests come out.

NHS boards in Scotland will be able use that funding to deliver programmes to prevent type 2 diabetes and to put it into remission. One such programme that receives funding from NHS Forth Valley is the Braveheart Association, a Scottish charitable incorporated organisation based at Falkirk Community Hospital. The Braveheart programmes have been designed to provide resources to support and improve the health and wellbeing of Falkirk communities. They create community-led activities and outreach health services to improve the health of local people. One of the initiatives is Braveheart Plus peer support groups, which focus on those living with type 2 diabetes and coronary heart disease. One beneficiary of Braveheart’s walking project is a lad called Ali, a sufferer of heart disease and diabetes, who was initially reluctant to take part. Through participation, he now leads his own bi-weekly group, enjoys meeting new people and is able to manage his health conditions much better.

There is little doubt that eating a poor diet and being overweight or obese cause serious health problems, such as type 2 diabetes, cancer and heart disease, and it is clear that we must take decisive action. The SNP has an ambition to halve childhood obesity in Scotland by 2030, which is one reason the Scottish Government are consulting with the public, and food and retail industries on restricting in-store marketing and promotion of foods high in fat, sugar or salt, with little or no nutritional benefit. That is very important; I think we have all been tempted.

[Andrew Selous]

On that point, does the hon. Gentleman agree that it would be good to hear from the Minister about when we will get the consultation on the 9 pm watershed and on promotions? Both are promised, but we do not yet have a date for them.

[Martyn Day]

I fully agree; that would be very useful to have.

I think we have all been guilty of impulse purchases when out shopping. It is always worse if we shop when hungry and there is a temptation to get fast food and a quick fix. We are all more than capable of cooking good quality meals, but convenience and lifestyle often get in the way of that. There is a lot we could do if there was a better marketing regime. The consultation in Scotland is part of the diet and healthy weight delivery plan, which will inform an assessment of impact and possible legislation.

No debate these days can be complete without some reference to Brexit, and why should this one be any exception?

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

It is nice to see you in the Chair, Mr Robertson. I thank all Members for their contributions and my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) for securing the debate. He introduced it with his usual flourish, and I know that people watching will have been interested in what he said and the issues that he raised.

We have to keep these issues high on the agenda. They affect a lot of people and we talk about them a lot in Parliament; I cannot think of a Health oral questions that I have been involved in as a Minister when diabetes has not come up. There is a reason for that: because it affects so many of us and our constituents. We must keep raising it.

This is a timely debate. We published the long-term plan for the NHS on Monday. Diabetes features prominently in the plan, which is no accident. We would expect it to, and if it did not, we would have a debate on why not. However, more than that, the plan has a strong focus on prevention and on building a health service for the needs of the 21st century that supports people to manage their own health—not only for diabetes but across the piece—and wellbeing.

We really support that agenda in this Department and with this Secretary of State. That matters for patients—our constituents—with diabetes and others. Chris Askew is a very good man and chief executive of Diabetes UK, and his welcome for the long-term plan and the diabetes sections within it greatly attests to that.

We have heard some excellent contributions. I very much enjoyed listening to the intervention from my right hon. Friend the Member for Wantage (Mr Vaizey) and his suggestion about Brine labelling; my right hon. Friend the Member for Ludlow (Mr Dunne), who gave us insights about his two-year-old daughter; and my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who talked about the food industry and child obesity. We also heard speeches from the right hon. Member for Knowsley (Mr Howarth), who talked about an artificial pancreas, which was very interesting, and from the hon. Member for Workington (Sue Hayman). I should be able to cover all those items. If I do not cover everyone’s points, I will of course write to them, as is my usual practice.

I have to say that I particularly enjoyed the contribution from my hon. Friend the Member for Rochford and Southend East (James Duddridge). It was a very powerful and insightful speech, as it always is from him, and it was delivered from the heart. He made the very good point that we are all different. That is one of the challenges not just for diabetes care, but for healthcare generally. Healthcare is not an exact science. I say that not as a doctor, but as someone who spends a lot of time with doctors.

My hon. Friend also made a point about the complexity of diabetes. In reality, it is a spectrum. We have heard a lot of talk this morning about type 1 diabetes—from the right hon. Member for Knowsley, for instance—and about type 2 diabetes from many others. But increasingly we hear about—it is not a new term—type 1.5 diabetes, otherwise known as LADA, or latent autoimmune diabetes in adults. As I understand it, that is not a clinical definition, but is generally used to describe a slow-onset form of type 1 diabetes that is often mistaken for type 2 diabetes. There are many support services for that condition, and people are increasingly talking to their doctors about it. There is lots of clinical debate around it, but the topic has been around since the 1970s. That goes to the heart of my hon. Friend’s point. Diabetes is a complex condition. There is a spectrum for diabetes, as there is for many other conditions.

I, too, pay tribute to the NHS staff, to the diabetes nurses and the doctors, but also to the support groups. My constituency has the Winchester and Eastleigh diabetes support group, which I spoke to recently. We will all have those groups in our constituencies. As MPs, we are very used to having in front of us people who are far more expert on the subject that they have come to talk to us about than we are—every single one of my constituency surgeries is an example of that—but never is that more true than when we talk to people with diabetes, who have a great and expert knowledge of their condition and the management of it. If they do not, we need to help them to have better, expert knowledge of their condition, because that is as much in our interest as it is in theirs.

There are a couple of points to touch on. My right hon. Friend the Member for South Holland and The Deepings, in introducing the debate, and my hon. Friend the Member for South West Bedfordshire touched on the food and drink industry and healthier eating. It is important that we build on the world-leading action set out in both chapters of our childhood obesity plan. We have already seen real success. More than half of all drinks in the scope of the soft drinks industry levy are being reformulated. That is equivalent to removing some 45 million kg of sugar every year, as a result of the so-called sugar tax. And some products in the sugar reduction programme are exceeding their first-year targets. For example, a 6% reduction is being achieved for yoghurts.

We will consider further use of the tax system to promote healthy food—the challenge that my hon. Friend put to me. He mentioned sugary milky drinks. The Treasury was very clear, when former Chancellor of the Exchequer George Osborne launched the sugar tax, that in 2020—next year—we would review the sugar levy and whether to extend it to milky drinks. As the Minister, I for one will certainly be welcoming that.

As part of chapter 2, we have already held consultations on ending the sale of energy drinks to children and on calorie labelling in restaurants. We are reviewing the feedback and will formally respond in due course. We will very shortly be launching consultations on restricting promotions of fatty and sugary products by location and price, and we will be consulting on further restrictions, including a 9 pm watershed, at the earliest opportunity, with the aim of limiting children’s exposure to sugary and fatty food advertising and driving further reformulation. What I will say, in answer to the challenge that I have been given on those products, is that not everyone agrees that we should do this. Let us be honest: there are people in our party who do not. I challenge them to look at the challenge that we have in our country with obesity and what it is costing our country and our health service. If we believe in a publicly funded health service, we believe in a public health system that challenges these kinds of condition, so I say to my hon. Friends: keep raising the issue in the House. Next Tuesday they will have an opportunity to do so.

Alongside that, we are committed to exploring what can be done on food labelling when we leave the European Union. My hon. Friend the Member for Ochil and South Perthshire (Luke Graham), who is no longer in his place, raised traffic light labelling. We cannot do that as a member state, but we will soon be free. Some companies have decided to take it on themselves. Kellogg’s, the cereal manufacturer, which has been mentioned this morning, announced just before Christmas that it intends to do that. I welcome that and give credit to Kellogg’s for doing it.

Wherever possible, the aim is of course to prevent type 2 diabetes from developing in the first place, which is emphasised in the NHS long-term plan. I am very pleased that NHS England and Public Health England, for which I have responsibility, and Diabetes UK, working hand in glove, have had great success in working on what is the first diabetes prevention programme to be delivered at scale nationwide anywhere in the world.

[Andrew Selous]

Will the Minister give way?

[Steve Brine]

Very briefly—be quick.

[Andrew Selous]

I, too, am very pleased that Kellogg’s has brought in traffic light labelling, but does the Minister agree that, with Kellogg’s Frosties at 37 grams of sugar per 100 grams, there is much more to do as far as Kellogg’s is concerned?

[Steve Brine]

Not only do I agree with my hon. Friend, but the company would agree with him. It is very aware of how much pressure that I and the Government are putting on it to change its products. I would say that it is top of my Christmas card list. Many other manufacturers have not yet made it on to my list, and I ask them to step up and raise their game to the level of the best. I am sure that they can.

In 2018-19, the diabetes prevention programme achieved full national roll-out, making England the first country in the world to achieve full geographical coverage. That is a great achievement, and the figures are good. As set out in the long-term plan, NHS England intends to double the capacity of the programme up to 200,000 people per annum by 2023-24. As my right hon. Friend the Member for South Holland and The Deepings said, it is a modest number in context, but it is also a big number. This is still the largest diabetes prevention programme of its kind. He asked whether we keep these things under constant review and whether we have the ambition to go further. You bet we do, and I think we need to.

There has been much talk this morning about technology. We are also developing an online, self-management support tool called HeLP, comprising a structured education course that has content focused on maintaining a healthy lifestyle for people with type 2 diabetes. That includes content on weight management and alcohol reduction—that can of course help with many health challenges—and cognitive behavioural therapy related to diabetes-related distress. NHSE hopes, once the tool has been developed, to roll it out in the summer of this year.