Health Inequalities

Derek Thomas Excerpts

Wednesday 4th March 2020 Commons Chamber

[Derek Thomas (St Ives) (Con)]

I am glad to be able to speak in this debate. Cornwall and the Isles of Scilly, which I represent, have a real issue with health inequalities, and I was glad recently to ask the Prime Minister to take a look at health inequalities in dental care. That has been touched on already this afternoon in relation to children. As I have said previously in this Chamber, 60% of adults in my constituency and across Cornwall and 40% of children have not seen a dentist in the past year. It is not so much a lack of funding—the funding actually gets returned to NHS England—as a lack of dentists prepared to work in the NHS. I am glad that the Government’s amendment states that they are

“committed to level up outcomes to reduce the health gap between wealthy and deprived areas, and supports the Government’s commitment to delivering long-term improvements for everyone no matter who they are, where they live or their social circumstances.”

[Dr Whitford]

Does the hon. Gentleman agree with me that part of the problem is the dental contract, whereby dentists are not rewarded for the amount of work they do and certainly not rewarded for preventive care?

[Derek Thomas]

I do agree with that. I did not want to get into party politics, but the Labour party gave the 2006 dental contract to dentists, and we have seen the decline in the availability of dental care in Cornwall from that point. I understand that it cannot be reviewed for another couple of years, but I believe there is work that can be done before then to respond to the challenge, and that is what I want to raise today.

Since I last raised this issue in the House, I have been asking my constituents about their experience. I have heard about disabled people who have to consider accessibility—they cannot get in to the dentist’s and therefore cannot get an appointment. Pensioners are unable to afford private treatment, and have been left stranded without provision for years. Some were getting NHS treatment, but then practices stopped offering it, as they are unable to keep up with demand. Pregnant women do not get access to NHS dental care for the entire pregnancy, but are offered it a long time afterwards, even though it is free during a pregnancy. People have ended up travelling further and further, and I heard of constituents travelling to Bristol and London to get the dentist care they need, which cannot be good for us as we try to reduce our carbon footprint. As I have said, there is also a lack of access for children.

In the time I have, let me share some of the comments that have been made. Mike left the Royal Navy and had a three-year wait for an NHS dentist. Then he got a dentist, but appointments have been constantly cancelled, so he is not seeing a dentist. He believes that the armed forces covenant should offer dental provision. Fred said that he has been waiting five years to get a dentist in Cornwall, so he is now registered at a London dentist, even though he lives in my constituency 300 miles away.

A gentleman who worked away a lot, but his family was in Cornwall, said that he, sadly, did not visit the dentist for two years so was “removed” from the dentist’s list. He had cracked his tooth, but was not able to see a dentist, despite his wife and children still being registered and able to get an appointment. Another gentleman who had been living in Penzance for eight years had to wait two years to be placed at a dentist’s. He got a dentist, but then found that they kept cancelling, so he had not seen a dentist in three years. There is story after story of this happening.

There is light at the end of the tunnel. A lot of work was done last summer by the former MP Sarah Newton and me and other colleagues in Cornwall, and a plan was put in place. NHS England said that it would engage with the national NHS England dental workforce team to look at a more innovative way to attract dental staff to Cornwall and put forward a plan by the end of the year—that was last year. It also said:

“Work is also under way at a national level to identify solutions to the dental recruitment and retention pressures in NHS dentist services, and to understand and address the constraints of current national NHS dentist contracts”,

which has been referred to. I would like the Minister to look at what has happened to the plan Cornwall was promised at the end of last year and what is happening to the review that is going on across the county.

We are doing work locally, but it needs the commitment of Government and others. There is an irony in that we train a lot of dentists in Truro but they do not seem to stay in Cornwall so this also needs the involvement and commitment of the Peninsula dental school, as well as NHS providers and NHS England, to get a grip of this and to ensure that children and adults, particularly vulnerable adults, are no longer discriminated against and no longer face these health inequalities.

We must come together quickly and creatively to ensure that dental care provision is addressed. As we have heard, if we get it right very early in life then we save ourselves a whole host of problems later on.

NHS Funding Bill

Derek Thomas Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Derek Thomas (St Ives) (Con)]

It is a great honour and privilege to speak about the NHS, which is a fantastic institution. There is no one in this building who has not had some experience of the NHS in some form or another. As I was particularly reminded during the election, the truth is that, in most cases, people’s experience is fantastic—they are treated in a timely, effective and caring way. It is always good to commend the work that many people do in our NHS. However, I heard about the experiences that my hon. Friend the Member for Dover (Mrs Elphicke) referred to; in Cornwall, we have had similar experiences, which cause considerable strain on families and the NHS in the area.

I welcome the NHS funding commitment in the Bill, and the fact that it is here to deliver our NHS 10-year plan. It provides the certainty that the NHS and all who work in it need in order to make their own plans. However, as others have already said, it is essential for us to get this right. I hear of countless instances in which NHS care and treatment have been excellent, beyond expectations and timely, but there are two areas in which patients in Cornwall—particularly children and vulnerable people—are being failed by the current provision. Those areas, which are especially relevant to the NHS workforce plan, are the diagnosis and treatment of children, young people and adults with autism, and the shortage of NHS dental appointments.

My heart goes out to the parents and families of children who have autism. They love and care for their children with every ounce of their bodies, but they often have to fight, fight, fight for a diagnosis, for access to adequate support and therapies, and for an understanding of what autism is and what impact a lack of that understanding has on their children’s development. In the past few weeks I have met several parents who are in crisis because they cannot obtain a diagnosis, an education, health and care plan, or adequate support for their children at school, and have little or no access to child and adolescent mental health services.

As I prepared for the debate, I was encouraged to read that the National Autistic Society was looking to the NHS 10-year plan to address, finally, the fact that people wait for many months—even years—for an autism diagnosis, the poor support for autistic people’s mental health, and the insufficient understanding of that learning disability or condition. It is great that the long-term plan recognises the autism diagnosis crisis and announces the NHS’s intention to reduce waiting times, but it would be good to hear from the Minister how the NHS plans to achieve that, and what progress is being made.

[Elliot Colburn (Carshalton and Wallington) (Con)]

In my local borough of Sutton, the council has received a damning Ofsted report on its services for children with special educational needs, and parents have formed a crisis education, health and care plan group. Does my hon. Friend agree that councils should work with their local NHS trusts to ensure that there is early diagnosis and that problems do not develop into something far worse?

[Derek Thomas]

That is exactly the commitment made by the NHS plan: early diagnosis, followed by proper, wraparound support from not only the NHS but local authorities. The potential gains are significant. The opportunity to transform thousands of lives, reduce pressure on our schools and unlock the potential of people who have autism is there to be had, and I urge the Department to step up its work in that regard.

The response to a question that I asked last March was that NHS England had a legal duty to commission national health service primary care dental services to meet local needs, but the truth—and NHS England accepts it—is that that is not the case in Cornwall. The six of us who represent Cornwall constituencies have worked closely on this. We have been told that NHS England is working with local commissioners to investigate how widespread the problem is and is keeping it under active review, but there is a shortage of NHS dentists in west Cornwall—indeed, throughout Cornwall—and it is not a new problem. The waiting list was two years on average in 2015, and remains roughly the same now. The number of units of dental activity has increased from roughly 80,000 to roughly 90,000, but the average number of people having to wait is lower than the national average. About 50% of adults are not seeing an NHS dentist, and about 60% of children have not seen one in the last 12 months.

Having spoken to NHS dentists, I know that children and their families are likely to take better care of their teeth and to have healthier diets if they have a regular relationship with their dentists. My primary concern, which I believe is becoming a critical problem in Cornwall and other rural areas, is the inability of children, from a very early age, and vulnerable adults to obtain NHS dental appointments, which both groups have reported to me.

When my colleagues and I met representatives of NHS England last year, they explained the difficulties that were being experienced, describing recruitment and retention in areas such as west Cornwall as a key concern. The NHS has made it clear that dentists in Devon and Cornwall are increasingly unable to meet their contracts. Funding for NHS dentistry in Devon and Cornwall was being returned to NHS England. That suggests that commissioned capacity is sufficient, and that funding is not the primary issue. The key difficulty reported by practices is the recruitment and retention of dentists.

We in Cornwall are fortunate to have a dental college in Truro where residents can have access to treatment. It is based at the Peninsula Dentist School, part of Plymouth University, where graduates learn their skills for careers in dentistry. However, students who are training to be dentists often return to their home towns afterwards, citing poor transport, high housing costs and a lack of opportunities in the south-west as reasons for not staying in the area.

As I have said, the Cornwall MPs have been working together closely, and I pay particular credit to our former colleague Sarah Newton, who led the way. However, it is unclear what progress is being made in ensuring that we care for the teeth of our young and vulnerable people so that they can avoid the many problems that would otherwise have to be picked up by the NHS in the future. May I take this opportunity to request a review of NHS dental provision, and an urgent exploration of what is needed to recruit and retain dentists, especially in rural areas such as west Cornwall?

The 10-year plan clearly sets out, among other things, its intention to integrate care and prevent healthcare problems from arising later. Getting diagnosis and care for people with autism right, and providing the dental treatment that people need, would help to deliver in that respect, and to reduce demand both now and in the future.