Under-age Vaping

Jerome Mayhew Excerpts

Wednesday 12th July 2023 Commons Chamber

[Jerome Mayhew (Broadland) (Con)]

One of the great pleasures of being tail-end Charlie in these debates is that one has the opportunity to sit through and listen to every contribution. The disadvantage is getting nudged to hurry up by those on the Front Bench. So, I have torn up my original speech, Madam Deputy Speaker, and will focus instead on the bits from the contributions of others that you did not have the opportunity to hear yourself.

There have been lots of interesting suggestions on how we can solve this problem, which we all agree needs to be addressed. I am a father of teenage children as well, and I share the concerns of my hon. Friend the Member for Winchester (Steve Brine). I have experience of my own children’s friends using vapes—their friends, I hasten to add.

[Kirsten Oswald]

That’s what they all say!

[Jerome Mayhew]

As the hon. Lady says, that is what they all say. Obviously that is wholly inappropriate, but part of the problem in reaching the correct solution to this shared concern has been demonstrated by the richness of the debate we have had today.

All sorts of suggestions have been made. My non-exhaustive list indicates that some hon. Members said that we should ban flavours. Some of them said that we should ban all flavours; others said that we should ban only flavours that are targeted directly at young palates. There have been suggestions that we should ban disposable vapes, or that we should require bland packaging for vapes, although others suggested that the issue is not so much the packaging as the fact that they should be hidden behind closed doors. There has been a suggestion that we should increase the cost of vapes, but that was controversial—the hon. Member for North Tyneside (Mary Glindon) rightly pointed out that for adults seeking to give up smoking who are on very limited means, the cost of vapes is a very relevant consideration.

[Dr Caroline Johnson]

The cost is indeed important, both in pricing children out of the pocket money market and in ensuring that smokers who are seeking to quit can do so. However, to a smoker who can afford a packet of cigarettes, even if £5 is put on the cost of a disposable vape, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) described, the vape is still cheaper.

[Jerome Mayhew]

I am grateful for that intervention. I do not have skin in the game about whether it is better to have a higher cost or a lower cost, but my hon. Friend’s intervention has highlighted my fundamental point, which is that this is a complex area where we need evidence to base our policy on.

It has been suggested that we should crack down on marketing. Others have suggested that we should increase education in schools, and there is a wider debate about schools policy and the use of loos in schools. There are other concerns, overriding all of these, about what impact our actions in relation to vapes—including single-use vapes—could have on the ability of adults to give up smoking, in order to continue the downward trend of smoking addiction in this country. These are serious and interrelated issues. If this debate were to result in a Division, there is no way that I could support the Labour motion, which focuses solely on banning branding and advertising for the young, because it may not go far enough. It may just focus on one little area, when the richness of the debate on both sides has highlighted how much wider and more complex the issue is.

As such, what we are really talking about is not so much our concerns about vaping, including by children: the main issue is, “How should we make our law?” It is a given on both sides of the Chamber that action should be taken, and the first speech on behalf of the Government, made by the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien) made it clear that the Government have already acted and are intending to go further. In fact, the Secretary of State said at Health questions yesterday that the Government were looking to go further, particularly on single-use disposables. It is not a question of whether we are going to act: the question is, on what basis do we act? For my money, we should act on the evidence and not solely on anecdote, important though that is.

[Kirsten Oswald]

Will the hon. Gentleman give way?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I would gently say that the hon. Lady has made a long contribution, and I do have two other speakers to get in. That is the only problem.

[Jerome Mayhew]

Thank you for that indication, Madam Deputy Speaker.

To wrap up my submissions, I will say that the Government are absolutely right to have put out a call for evidence. That evidence has now been obtained, last month, and the Government should take every second that is needed to assess it and come up with draft proposals, but not a second longer, because this is a very important issue. As a parent, I share the concerns that have been expressed across the House. We need to address this issue—we cannot waste time—but we should do so based on the evidence.

New Hospitals

Jerome Mayhew Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

My hon. Friend is right on both counts—first, that the Royal Berkshire is part of the rolling new hospital programme, and secondly, that there are complexities with that site. As she knows, part of the site is grade I listed, and there have been some specific issues with the existing site on which survey work has been undertaken. That is having an impact on the target date for work. We are funding a mental health crisis facility this year, along with the survey work, and I look forward to having further discussions with her as that progresses.

[Jerome Mayhew (Broadland) (Con)]

This announcement could not be better news for the people of Broadland. In the west of my constituency, they are going to be served by a brand new build at the Queen Elizabeth Hospital in King’s Lynn, and a brand new hospital at the James Paget will be serving constituents at the other end of my constituency, joining the work of the Norfolk and Norwich University Hospital in the centre. Can my right hon. Friend just confirm that the modular nature of the design will still provide the absolutely first-class facilities that the people of Norfolk deserve?

[Steve Barclay]

Today’s announcement is transformative for healthcare in Norfolk, for the reasons my hon. Friend has set out: a new hospital at the James Paget and a new hospital in King’s Lynn. Of course, there will be further work from Government on the diagnostic centres and surgical hubs, about which there will be further discussion. In terms of the quality of the modular design, we are bringing the country’s leading experts together, as well as engaging with the market to finalise those designs so that we can have the best inputs as we standardise the design, and then roll that out as the template for schemes at King’s Lynn and James Paget. The quality of the scheme should be of a very high order.

Dental Services: East of England

Jerome Mayhew Excerpts

Tuesday 16th May 2023 Westminster Hall

[Jerome Mayhew (Broadland) (Con)]

One of the unifying features of the speeches today is that we have heard them all before. Not only have we all heard it before, but we have all said it before, so I will try—I may fail—not to do that. However, I do have to highlight some elements of the problem, which has been ably covered by my hon. Friend the Member for Waveney (Peter Aldous).

Access to NHS dentistry in Norfolk, which is the worst in the east of England, was surveyed in 2020 to 2021, and of the 150 sub-regions of the country, Norfolk came 147th. As I said to the Minister in a previous speech, we have to follow the money. As my hon. Friend the Member for Waveney pointed out, the best areas spend nearly £80 per mouth per year on dentistry; in the east of England, the figure is £39—a full 50% less. Does the Minister have an explanation for that? I genuinely struggle to understand how spending on NHS dentistry in the east of England is so far below that in the rest of the country. It seems to be without explanation.

More locally still, in Broadland the lack of dentists of any description is profound. I was lucky enough to persuade the Department to advertise a new contract for NHS dentistry in Fakenham last year. The money was available and the contract was advertised; not a single organisation applied for the contract, and it is still vacant. In Sheringham, in the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker), who is unable to speak in this debate, there is a dental practice that is owned by an organisation that has an equivalent practice in London. The organisation has been advertising consistently for a new private dentist in Sheringham for 10 years, and it has yet to fill the role, whereas during the same time multiple positions in its London practice have been advertised and filled. It is therefore not just a regional issue; geography really matters.

I am sorry to say that just last week the latest in long and ignoble line of announcements came when Brundall Dental Practice, which is an NHS practice, contacted patients to say that it would no longer be accepting adult NHS patients from 1 September this year. People are being asked to move on to monthly subscriptions for dental care, which are between £150 and £400 a year. I struggle to know what to say to the many constituents who have contacted me, because not a single NHS practice in the county of Norfolk is currently accepting new patients under an NHS contract. The £11 a month is only for check-ups and hygienists; it is not for dental care, which is an extra charge.

People might say that many can afford to pay for dentistry if they have to, but we have to also consider those who are excluded from paying dental charges because of their financial circumstances. What are we asking of those constituents? Where are they to turn not a single provider in the county of Norfolk is accepting NHS dentistry? The answer, of course, is that they will go to the Norfolk and Norwich University Hospital when their dental problems become acute, and we merely transfer the problem from the dentistry budget to the NHS and acute budget. The problem will be so much worse, and so much harder and more expensive to treat, because we are not nipping things in the bud but dealing with acute emergencies. That cannot be the right answer.

The reason I do not want to prolong the agony of discussing the problem is that I know that the Minister gets it. If he was not educated before, he has certainly been educated on numerous occasions, either here or in the main Chamber, by many of the Members present—the problem has already been fed back. Government Members have great confidence in the Minister and in his grip, grasp and focus on the issue. We know that a dentistry plan is imminent—the sooner that it is published, the better, and more power to the Minister’s elbow—but there are a number of suggestions I hope will find their way into the plan.

In the short term, we need additional improvements to the current dentistry contract—other Members have spoken eloquently about that, and I would highlight it as being very important. As regards the medium term, we have had reference to centres for dental development. The University of Suffolk has progressed far in its application, and there is a necessity for a similar venture at the University of East Anglia, or at least similar work in Norwich. However, in the long term, we simply have to train more dentists. We have to open the market to allow people to access a lucrative and fulfilling career that is currently not being explored in the east of Anglia and in Norfolk, in particular.

We need to train people in the east of England. The University of East Anglia has put forward proposals for a dental school. The medical school it founded in Norwich about 10 years ago knows definitively, from surveying all its graduates each year, that about 40% go on to take their first job locally. The single act of setting up a dental school in Norwich, linked to the Quadram Institute and the research work at the Norwich Research Park on the human microbiome, is the long-term solution.

I hope the medical plan will look beyond the national numbers. I was told by the NHS that roughly the right number of dentists are being trained each year, but I dispute that. It has been seven years since it surveyed what those dentists are up to. It has no idea whether the dentists notionally on its books have retired, gone abroad, are working in the NHS, are working part-time in the NHS, are working privately, or none of the above.

[Andrew Selous]

My hon. Friend is making a powerful point about the link between where people train and where they work. I would gently make the point to the Minister that the east of England is quite a large area. Norfolk and Suffolk are deeply wonderful places, with which I have a great affiliation, but they are quite a long way from Bedfordshire, which is also in the east of England. If we were to think that it was job done because we had trained dentists in Norwich or wherever, I would want to know what that meant for the good people of Leighton Buzzard, Dunstable, Houghton Regis and the surrounding villages. I put that marker in the Minister’s mind.

--- Later in debate ---

[Jerome Mayhew]

That is fair enough. However, if someone grows up in the east of England, whether in Norfolk, Suffolk or even Bedfordshire, there are only two places where they can train: Birmingham and London. There is no other place in the entire east of England where they can train, so is it surprising that we have a dearth of dentists? Is it surprising, particularly in rural areas, that we do not attract dentists who are newly qualified and therefore likely to be in their early to mid-20s? Do they wish to relocate in large numbers at that stage to a rural location? Many do not, so we need to bring the beauties of East Anglia, including Bedfordshire, to trainees so that we can benefit from the stickiness of tertiary education and location.

Finally, my hon. Friend the Member for Waveney raised the issue of fluoridation, which I wish to develop. There is no fluoridation in Norfolk at the moment, and perhaps it shows. The data suggests that the level of decay across the teeth of Norfolk is not universal but is substantially located towards west Norfolk and King’s Lynn. All sorts of factors may account for that, but areas of higher dental decay correlate with those that have reduced natural levels of fluoridation in the water, with the lowest levels around King’s Lynn. I raise that as an issue that I hope the plan will address.

[Matt Warman (Boston and Skegness) (Con)]

I congratulate my hon. Friend the Member for South Norfolk (Mr Bacon) on securing the debate. Although my constituents use the facilities of the east of England, I welcome his hospitality in the debate as well. This is a shared issue, especially for many in the southern part of my constituency.

I wanted to speak today because, as we have heard from many other hon. Members, this is not just a top issue, but the top issue, in the postbag and particularly on social media. We all feel the immense frustration of our constituents on this important issue. In Lincolnshire, nearly a quarter of five-year-olds are suspected to have tooth decay. Last year, a dozen Boston children had teeth removed. The problems we have heard about in the east of England are present in my part of the world too, and the burden of that partly falls on the services provided in the east of England, which is why it is relevant for me to speak today. These are real problems.

I asked my office to do what I called a secret shopping exercise because, like my hon. Friend the Member for South West Bedfordshire (Andrew Selous), I did not trust the data NHS England had provided. On that secret shopping exercise, we see that just a single NHS practice is offering access to new patients and, even then, only to children. There are huge problems with local provision. When I spoke to the ICB, which has recently taken on the responsibility, it said that there are particularly acute issues in coastal and rural areas and, as we have heard, that there are no silver bullets. However, it raised a few issues, which I will use to augment previous speakers’ excellent contributions.

First, there is the enormous backlog in the General Dental Council exams. I gather that 1,700 people are seeking to take the part 1 exam and that the GDC website does not even say when it plans to put another one on. When it does, it is likely to put just 150 people through it. I know that the GDC is an independent body, but will the Minister do all he can—I know he is already doing so—to encourage the GDC to pull its finger out?

Secondly, on the issue of having a dental school in the east of England, there is a medical school in Lincoln; if it were to train dentists, that would benefit the broader area. As we have heard, there is a clear need for many more dentists to be trained across the country, so perhaps we could do something for East Anglia and see benefits for the whole region from having Lincoln-trained dentists.

Thirdly, the issue of fluoridation affects my constituents as well. I do not think anyone, except those on the outer edges of the internet, could possibly argue against fluoridation, and we should encourage it as quickly as possible. On the outer edges of the internet, I give way to my hon. Friend the Member for Broadland (Jerome Mayhew).

[Jerome Mayhew]

I try not to inhabit that area. Does my hon. Friend not think that it is surprising that only 10% of the country’s drinking water is fluoridated?

[Matt Warman]

It is a surprising number. As I am sure my hon. Friend knows, the water companies have raised issues that are legitimate to some extent, but the overall public good from increasing that number is obvious and would pay real dividends relatively quickly. It would be public money well spent.

Reforms to NHS Dentistry

Jerome Mayhew Excerpts

Thursday 27th April 2023 Commons Chamber

[Jerome Mayhew (Broadland) (Con)]

We have had a full debate today. This is the third Backbench Business debate on the subject, but not the third debate on dentistry; I have had an Adjournment debate on dentistry, for example. The subject is well rehearsed. The reason why so many people are keen to speak today is that the issue affects areas right across the country. We all know that there is a problem with NHS dentistry, that the Government are focusing on it, and that they are coming up with a dental plan. We anxiously look forward to its publication in the next two to three months. In the few minutes available to me, I will not focus on the national problem so much as recognise that within the national difficulties, there are regional crises. In rural areas such as North Devon, but also in the east of England and Norfolk in particular, we can see that what is already a challenging picture nationally is exacerbated. To identify the issue, we have only to follow the money. I will look at funding for the east of England, then I will talk about recruitment and retention.

I know that funding has been impacted by covid, and the ability to undertake units of dental activity was restricted because of the covid pandemic and the aerosol activity of much of dentistry. I also know that funding has subsequently been increased because of the catch-up bid, so the numbers for the year 2018-19 give a more accurate reflection of the level of investment by the Government in dentistry in the region. The national average gross spending per mouth in England was £66 in that period. The best performing region was the midlands, which received £78 of expenditure per mouth. The figure for the east of England was £39 per mouth. That is exactly half the amount of money spent on dentistry per head of the population in the midlands. Now, there are many unconfirmed rumours about the number of fingers and toes that we have in Norfolk, but we do not have half as many teeth as those in the midlands—not yet, anyway.

My request to the Minister is to follow the numbers, to look at where the expenditure has been taking place and, more importantly, to look at the places where the expenditure has not taken place, and then to ask the question of his officials, “Why is that?” Why is it that even though in many parts of the east of England we have the worst dental health, the expenditure by the Government is fully half what it is in the midlands, and £20 less than the national average per person?

Looking to recruitment and retention, a potential answer to my first question is that there are physically not enough dentists in the east of England to carry out the work. The national average number of dentists per 100,000 of the population is 43. In the east of England, we have just 39. That compares to Devon, where there is a dental training school, which has 49. Why is it that people do not want to be dentists in Norfolk? The answer is because it is rural, and for those who grow up there, the nearest place they can train is Birmingham.

People cannot train to be a dental technician or a dentist anywhere in the east of England. It is the only region of the country, other than the south-east, which is next door to London, that has no dental school at all. People can go either to London or Birmingham. Is it surprising, then, that we do not have an indigenous population of would-be dentists growing up, training to be dentists in Norfolk and then staying there for their working life? We are reliant entirely on people relocating to the east, and to Norfolk in particular, to supply our dental needs.

When people qualify as a dentist in their mid-20s, the overwhelming majority do not wish to move to a rural location. Even though it is without question the best place in the country in which to live, to grow up, to learn and to bring up a family, it is not immediately attractive. A policy that relies on importing foreign-qualified dentists does not satisfy the need in rural locations either, because overwhelmingly the data tells us that when we import, say, South African or Australian dentists, they relocate to the cities. They set up their new life where there are already expat communities. They do not move to Fakenham, and the problem is very real in Fakenham. I persuaded the NHS to write a wholly new NHS dental contract for Fakenham. That contract went out, and not a single organisation bid for it. The money is there, but there is physically no supply of NHS dentists.

The issue goes further than that, because the lack of dentistry spreads out into the private sector as well. There are many examples right across the county of where private dental practices, whether in my constituency or in those of my hon. Friends the Members for North Norfolk (Duncan Baker) and for North West Norfolk (James Wild), have been advertising for years—in one case I am familiar with, for a decade—and are yet to fill the place. While the short-term answer to the national issue may well be to improve access to international dentists, the medium and longer-term solution for the east of England, and Norfolk in particular, surely is to establish dental training in the county. There are two ways to do that.

There are two ways to do that. In the short term—the very short term, I hope—there is a bid by the University of East Anglia to create a centre for dental development: a postgraduate training establishment that would help to draw in newly qualified dentists from other parts of the country. The hope is that if they do their postgraduate training in the east, a percentage of them will remain. There is also what I hope is not a competing but a complementary application from the University of Suffolk in Ipswich. Those bids should not be in competition; they should be working together to improve access in both Suffolk and Norfolk.

However, the real solution in the medium term is to unite with the University of East Anglia and its existing medical school to create a dental school at UEA, which already has the Quadram Institute—the world’s leading centre for the study of the gut biome, which of course begins with the mouth. The Norfolk and Norwich University Hospital is right next door. We would then have the ability to bring people in and train them in the city of Norwich; as evidence from the medical school demonstrates, a percentage of them would remain thereafter to develop their careers.

The hybrid nature of the UEA bid would mean that even in the first year of the five-year training period, people would be spending at least a day a week working in practices, helping work through the dentistry backlog, and developing community relationships that will make them more sticky to the region once they qualify. All that will go towards the long-term solution to the dental desert in Norfolk.

I very much look forward to the publication of the dental plan in the next few months, but it would be the most monumental wasted opportunity if that plan did not include training for dentistry in Norfolk.

[Mr Deputy Speaker (Mr Nigel Evans)]

Last but not least from the Back Benches, I call Robbie Moore.

NHS Industrial Action: Government Preparations

Jerome Mayhew Excerpts

Monday 12th December 2022 Commons Chamber

[Will Quince]

The hon. Lady talks about NHS staffing levels; we have 1.2 million staff within our NHS, and compared with last year, we have 3,700 more doctors and 9,100 more nurses, and compared with 2019, we have 29,000 more nurses and 2,200 more GPs, but we do have high vacancies. That is why it will not have escaped her notice that we have commissioned NHS England to publish a long-term workforce plan, and that will be independently verified as set out by the Chancellor in the autumn statement.

[Jerome Mayhew (Broadland) (Con)]

Inflation is the real enemy here, because it makes us all poorer. We have a political and economic choice: we either tackle it, or we give in to an inflation pay spiral. The Minister was right to mention that the Royal College of Nursing pay demands are in excess of three times greater than the average private sector payment at the moment. Does my hon. Friend agree that public sector pay demands of almost 20% would embed inflation for years to come and make us all poorer?

Dental Training College: East Anglia

Jerome Mayhew Excerpts

Tuesday 11th October 2022 Commons Chamber

[Jerome Mayhew (Broadland) (Con)]

It would be all too easy to focus any speech on dentistry on a call for the renegotiation of the NHS—[Interruption.]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. Could colleagues leave quietly? Otherwise we will not be able to hear what the hon. Gentleman is saying.

[Jerome Mayhew]

As I was saying, it would be all too easy to focus any speech on dentistry on a call for the renegotiation of the NHS dental contract. Every Member of Parliament will know from their postbag the suffering that ordinary people are experiencing every day because they are simply unable to see a dentist.

The pandemic has caused the loss of 40 million dental appointments—more than an entire year’s worth of standard pre-covid treatment—but covid is not the cause of our problems. Ever since Labour imposed its NHS dental contract on the profession back in 2006, trouble has been brewing. Dentists have been voting with their feet, moving in their thousands away from NHS treatment into private work.

That trend has only accelerated through covid. Between the start of the pandemic and May 2022, 3,000 dentists have stopped doing any NHS work. Three quarters of those who are left say that they are likely to reduce their coverage further over the next year, so we simply cannot ignore the problem any longer. The pain and suffering are too great. Labour may have created this bad system, which fails to pay for the cost of complex work, but our job is to fix it, and the sooner the better.

The purpose of this debate, however, is not to moan about the state of NHS dental provision, but to put forward a positive case for solving the long-term problems in Norfolk and the east. Put simply, we have a desperate shortage of dentists of any description. Too few dentists and too few dental technicians—whether NHS or private—are choosing to work in East Anglia.

Nationally, the General Dental Council says that we have more dentists than ever before, with a national average of 43 for every 100,000 of the population, but in Norfolk and Waveney, that figure is just 38. That is the fifth lowest ratio of the 106 clinical commissioning groups around the country. Dental practices are crying out for new staff, but they simply cannot get them.

In the town of Fakenham in my constituency, I lobbied successfully for the NHS to award a brand-new NHS dental contract to increase local NHS provision. That was the Government being prepared to pour new money into increasing NHS provision. However, when that contract was advertised, not a single company bid for the work. There simply was not the staff to supply the need.

That is not just an NHS issue. In the same town, a private dental practice has been advertising for a private dentist for two years, but without success. In the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker), there is a dentist in Sheringham who operates practices both in London and Norfolk. He has not had a newly qualified dentist come to work in his Sheringham practice for 10 years. Job vacancies in London are snapped up, but he simply cannot get them to take the jobs in Norfolk.

Why can we not produce dentists in East Anglia? The answer is that there is nowhere for them to train. If someone who lives in East Anglia wants to become a dentist, the nearest place they can train is Birmingham or London. None of the 10 training facilities around England is in the east of England.

That has to change. We know from our experience with the University of East Anglia that graduates tend to stay and build their lives close to where they have studied. Each year, the UEA does a survey of its graduates to see where they go to accept their first employment. If we look at that survey for doctors coming through the medical school of the University of East Anglia, we see that more than 40% end up taking jobs locally every year. That is great for us in relation to doctors and particularly for the Norfolk and Norwich University Hospital, which is based in Norwich. Unfortunately, however, the same problem is true in dentistry.

Let us look at the number of dentists working near existing dental training schools. As I said, Norfolk has 38 dentists per 100,000 of the population. Devon is a broadly similar county—it is largely rural, with coastal communities and one major conurbation, Plymouth—but there is a big difference: Plymouth has a dental school, which was installed in 2005, and Devon’s ratio of dentists per 100,000 of the population is not 38, but 49.6. If we look at the north-east, where there is a school in Newcastle, we see that its ratio of dentists to the general public is 56 per 100,000 of the population. In Cheshire and Merseyside, there is a school in Liverpool, so the whole area benefits from 58 dentists per 100,000 of the population. We can see from the hard data that people tend to settle down where they have trained.

So if that is the data, surely the solution to East Anglia’s problems is obvious: first, we need to open a dental school in East Anglia. I raised that need directly with the University of East Anglia some months ago and I have been enormously encouraged and impressed by their response, strongly supported by the NNUH, the region’s training hospital. The University of East Anglia has developed an innovative solution to our dental training problems that would minimise cost and get students out into the workplace from the start of their training, helping with capacity in the short term and dealing with the training deficit in the long run.

[Tom Hunt (Ipswich) (Con)]

As a Suffolk MP, I welcome the idea of an East Anglian training centre. I also want the University of Suffolk to play a role. It recently outlined its plans for a Suffolk centre for dental development. Does my hon. Friend agree that, actually, a dental training college in Norwich could work hand in glove with the new centre in Ipswich to make sure that people are trained locally but, when needed, they are pooled to provide services on the NHS for our constituents?

[Jerome Mayhew]

I am grateful to my hon. Friend for that intervention, and I agree entirely. There can be collaboration between the university in Norwich and the University of Suffolk, which is based in Ipswich. People can start training in Norwich and, once they are qualified, have career and professional development taken care of by the proposed unit in Ipswich. I will come on to that in further detail.

To return to the plans of the University of East Anglia, its idea is that students would work in the community for at least one day a week throughout their five-year training course. In that way, dental students will increase the capacity of associated NHS practices right from the get-go. Too often, it is suggested that a dental training school is too long term to solve the problems now. In a sense, it is, of course, but under this plan, we would have increased capacity right from the first year of the students’ five-year course.

There are more benefits, too: students would not only increase the capacity, but develop employment relationships locally, increasing their stickiness, and provide training income to stretched NHS practices. For that reason, MPs from North Norfolk, North West Norfolk, Mid Norfolk, South Norfolk and Norwich North all support the proposal. If there were an East Norfolk constituency, I am sure that that Member would support it as well.

[Peter Aldous (Waveney) (Con)]

I speak as an MP with a foot in both camps: I am a Suffolk MP but I also represent the Norfolk and Waveney integrated care system area. Does my hon. Friend agree, as my hon. Friend the Member for Ipswich (Tom Hunt) said, that it is very important that the two proposals being put together by the University of Suffolk and the University of East Anglia are collaborative and worked on together, so that they come through with a solution for the whole of East Anglia?

[Jerome Mayhew]

I am grateful to my hon. Friend. The only phrase that I would pick him up on is that he has “a foot in both camps”. I do not think there should be two camps. This is an East Anglian solution, whereby the proposals are complementary and, in time, they should both be implemented.

[George Freeman (Mid Norfolk) (Con)]

I commend my hon. Friend and constituency neighbour for raising this issue and highlighting the huge pressures that the dental service in his area and mine is experiencing on the ground. Many of our constituents are struggling and this proposal would not only make our region a leader in the science and technology of dentistry, but help to meet that demand and need on the ground. With new housing, the pressure will only get more acute in the next few years.

[Jerome Mayhew]

My hon. Friend is entirely right. There is a further point to be made about the collaboration between the University of East Anglia and the Norfolk and Norwich University Hospital, because they also have the Norwich research park co-located. I am thinking particularly of the Quadram Institute, the sole focus of which is world-leading research on the gut microbiota. I cannot pretend to know exactly what the gut microbiota are, but I know that they start with the mouth. There is huge capacity for proper, hard research in the area, and it could be assisted by a dental training school in Norwich. That is the first solution.

The second solution, which is also needed, is for the dental school in Norwich to complement the University of Suffolk’s plans to build a centre for dental development in Ipswich to support further career development in the region, attracting and retaining newly qualified dentists. My hon. Friends the Members for Bury St Edmunds (Jo Churchill), for Waveney (Peter Aldous) and for Ipswich (Tom Hunt) and others have all pushed for that.

The truth is that we need both to attract qualified dentists in the short term and to find a long-term solution to the wider training problem. It may be that an assessment is made nationally that there is no need for additional dental training seats, but people are human. We have to look beyond the empirical analysis and recognise that training needs to be offered in a location of real shortage. That location is East Anglia, and Norfolk in particular.

As a Conservative, I believe that people should have power over their own lives and that communities should not be dictated to by national Government. Rather, they should be empowered to come up with their own solutions to their local needs. We know what the problem is, and we have a solution to fix it locally; we just need the Government to trust the people to let us get on and do it.

We simply need more dentists and dental technicians in East Anglia. We recognise that budgets are tight and that timings may have to be stretched. We accept that short-term fixes are sometimes more powerful arguments in politics than long-term solutions. We simply ask the Minister to agree to meet the University of East Anglia team to learn at first hand how we can make East Anglian dentistry better, and to be inspired by their practical vision.

[Peter Aldous]

rose—

--- Later in debate ---

[Peter Aldous (Waveney) (Con)]

I will contribute very quickly, Madam Deputy Speaker, if you will give me the opportunity.

My hon. Friend the Member for Broadland (Jerome Mayhew) has set out a great vision of a future in which East Anglia, Norfolk and Suffolk have high-quality dentistry schools. That is great, but we need a bridge to get to that future, because two dentistry schools will take some time to set up. Does he agree that we need to look at other strands to address the crisis in NHS dentistry in East Anglia, including recruitment and retention in the short term, making it easier for people from overseas to come and work in local dentistry; contract reform, which I think my hon. Friend referred to; a fair, long-term funding settlement; a focus on prevention; and improved local accountability through the fledgling integrated care systems?

[Jerome Mayhew]

I am grateful—

[Madam Deputy Speaker]

Order. Perhaps I am confused, but I thought that the hon. Member for Broadland (Jerome Mayhew) had finished. [Interruption.] Ah, so now he is intervening on the hon. Member for Waveney (Peter Aldous). That is absolutely fine.

--- Later in debate ---

[Jerome Mayhew]

Thank you for that clarification, Madam Deputy Speaker.

Does my hon. Friend agree that all those aspects are very important, but that perhaps there is another proposed solution that he has not mentioned? As we have learned today, there are inducement payments for teachers in special areas that are struggling to recruit. Perhaps we could apply the same approach to dentists in special areas that are struggling to recruit.

[Peter Aldous]

I thank my hon. Friend for that intervention and apologise for hijacking his debate. Yes, I agree wholeheartedly. This is a multifaceted challenge; there is no one solution and no one golden bullet. We need to address all the points, and he is right to raise that one.

Ambulance and Emergency Department Waiting Times

Jerome Mayhew Excerpts

Wednesday 6th July 2022 Westminster Hall

[Jerome Mayhew (Broadland) (Con)]

I congratulate the hon. Member for Bath (Wera Hobhouse) on securing a debate that, as a number of speakers have said, affects politicians of whatever party right across the country. I am lucky enough to represent a Norfolk seat, so my Broadland constituency is served by the Norfolk and Norwich University Hospital and, to a slightly lesser extent, by the James Paget Hospital and the Queen Elizabeth Hospital. All three have been mentioned in the debate.

The problems for ambulance waiting times are multifaceted and have been well rehearsed by other speakers, so I will not go through them all. I will focus on one area: hospital handover delays. The national standard is that handover should take no longer than 15 minutes, but 60% of all handovers nationally fail to meet that standard. I will focus on the Norfolk and Norwich, the most recent statistics for which show that in June the average handover time was not 15 minutes or less, but 57 minutes—almost an hour.

When we look at ambulance times, we think it is surely the front door of the hospital that is the problem—getting people into A&E—but when I spoke to the leadership of the Norfolk and Norwich, they told me that it is overwhelmingly the back door that is the problem, by which I mean people leaving the hospital. People are medically fit to be discharged but there are not appropriate intermediate care spaces for them to be discharged into, or their care packages have not been agreed or put in place. We should focus on that more than any of the other important aspects.

If we look at the data, we see that in April this year, across the nation, 20,155 people who were medically fit for discharge were still retained in hospital beds. During the covid pandemic I learned that we have around 100,000 beds in the NHS. More than 20,000 of them are bed-blocked—a deeply unfair term because it implies that the people in the beds are refusing to leave when, of course, nothing could be further from the truth—which means that fully a fifth of hospital beds are out of use for no medical reason. That is crucial to solving this problem. How many extra hospitals that we are building is equivalent to those 20,000 beds? It is an enormous change.

We need to look at why medically fit patients are not being discharged. In my submission, a key reason is the disparity of funding and where funding comes from in respect of the move from NHS beds to care. Everyone in this room knows that one provision is funded by the NHS and the other by county councils. There is often an unedifying dispute about who should pick up the bill and how to transfer responsibility for a patient, so there is no such thing as continuity of care in the discharge process.

If we can do one thing radically to improve not only ambulance times but the service that is provided in our hospitals more generally, as well as act on the burnout that hon. Members have described—the pressures on staff and the number of staff required—it is to solve the problem of continuity of care between the back door of the hospital and the front door of intermediate care and care in the community.

My question to the Minister is: am I wrong in that basic analysis? If I am, perhaps he will tell me where I have gone wrong. If I am right, or even substantially right, I would be grateful if he set out his views on how we could take the bold step from siloed funding and responsibility between the NHS and secondary care to the transition to what we desperately need, which is continuity of care for the patient, thereby solving all the other problems we are discussing today.

Health and Social Care Leadership Review

Jerome Mayhew Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

My hon. Friend will not be surprised to learn, I hope, that as Health Secretary I think an individual’s biological sex is incredibly important when trying to meet their health needs. I have seen the reports. In fact, I do not think they are just reports. With regard to the NHS website on ovarian cancer, I think it is actually has been, as she puts it, de-sexed. That is not something that I agree with. Of course, issues of gender, rather than sex—I distinguish the two—should be approached with compassion and sensitivity, but it is right that when it comes to healthcare, where there are health issues that impact only people of a particular biological sex, such as ovarian cancer and prostate cancer, the health service recognises that.

[Jerome Mayhew (Broadland) (Con)]

I am very concerned that the review found evidence of a blame culture and responsibility avoidance. We have to be clear that this culture is not just damaging but actually kills patients, because lessons are not learned from mistakes that are actively hidden. What can we learn from the airline industry, which adopted a no-blame culture and, through that, dramatically reduced airline-related deaths?

[Sajid Javid]

It was precisely because of that important point raised by my hon. Friend that when we had the recent Bill before Parliament—now the Health and Care Act 2022, thanks to the will of this House—we accepted the safe space amendment.

Queen Elizabeth Hospital, King’s Lynn

Jerome Mayhew Excerpts

Wednesday 23rd March 2022 Westminster Hall

[James Wild]

I am grateful to my hon. Friend for his support and words. He is absolutely right; I think his constituency has the oldest average age in the country, and that poses particular needs. My constituency and that of my hon. Friend the Member for Broadland (Jerome Mayhew), who has joined to support the debate, also have challenges, so we need to ensure that the care is in place. There is also a lot of planned housing growth in the area. The demand is strong across our constituencies, and in Lincolnshire and Cambridgeshire, which is why it is important to show the strength of support for the hospital across Norfolk and beyond.

When compared with the turnover, the level of capital programme is significant, and it is important to acknowledge that the programme is being managed well. QEH has submitted a further bid for £18 million for an orthopaedic centre, as part of the funding to tackle the backlog. Given that it is the area with one of the longest waiting lists for QEH, I strongly endorse that bid, and encourage the Minister to approve it when it comes to his desk. Seeing is believing. When the Secretary of State visits QEH—which he has agreed to and I hope will happen soon—he will see those improvements, but he will also see the props and the very real need for investment. My hon. Friend the Member for North Norfolk (Duncan Baker) will be able to join him on that occasion or another, as he will be very welcome.

As well as the structural issues, the hospital has outgrown its footprint. The emergency department sees 70,000 patients a year—more than double what it was designed for. The layout of the hospital does not meet modern care pathways, with too few consulting rooms, and wards well below the recommended size.

[Jerome Mayhew (Broadland) (Con)]

I am grateful to my hon. Friend for giving way. I wish to add my voice to the support he received from my hon. Friend the Member for North Norfolk (Duncan Baker), and to highlight the importance of this hospital as a regional centre of excellence. It does not support only the constituency of my hon. Friend the Member for North West Norfolk (James Wild), but also those of North Norfolk, Broadland and further afield.

I pose this question: what impact does receiving care in a building where the ceiling is maintained by acrow props have on the patient’s confidence in the care received?

[James Wild]

My hon. Friend gets to the nub of the issue, which is the impact of this situation on patients. The previous Secretary of State for Health came to the hospital, saw that and spoke to patients in those beds. They made light-hearted remarks, but they were concerned about the safety of the building after seeing props and timber supports. Of course, the trust is doing all that it can to manage that risk, but the risk of catastrophic failure remains, which is why it is rated red on the risk register.

The hospital cannot cope with the current demand. NHS modelling shows a 64% increase in overall floor space is needed to maintain services and meet future demand, with lots of housing planned in the area. In short, QEH needs to be replaced. The case is compelling to take this once-in-a-generation opportunity to have a hospital fit for the future. QEH has submitted proposals to the new hospitals programme for a single-phase new build on the existing site to meet current and future demand. The plans put forward would eliminate RAAC, and transform and modernise local healthcare, integrating primary, community, mental health, acute, social care and the third sector in a health and wellbeing village.

However, this is not about having shiny new buildings for their own sake; it is about delivering better health outcomes in some of the most deprived areas in the country that the Government have recognised as priority 1 areas for levelling up. It is also about an anchor institution—the QEH in west Norfolk—combining with the new school of nursing studies, which will be funded through the Government’s town deal, to help the NHS workforce by boosting local opportunities to develop skills and careers in our healthcare sector. It is also about promoting sustainability by using modern methods of construction and net zero principles, and maximising the use of digital technology.

It is important to recognise that the trust going from inadequate to good in the well-led domain in this inspection is a significant achievement, which provides confidence that this is a trust capable of delivering the new hospital that the patients and staff in west Norfolk need. A lot of hard work and engagement has gone into developing the plans and the scheme is highly deliverable, with a strategic outline case well advanced and on track to go to the June board meeting.

QEH’s bid is backed by 4,000 staff at the hospital. Stuart Dark—the leader of West Norfolk Borough Council—as well as all the councillors and the county council are supportive, as is the Norfolk and Waveney integrated care system, and at least seven right hon. and hon. Members, including my hon. Friends the Members for North Norfolk and for Broadland. The Prime Minister’s Chief of Staff—the Chancellor of the Duchy of Lancaster, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay)—and the Foreign Secretary also back the bid, and it enjoys local support, with more than 15,000 people having signed a petition backing a new hospital. It is essential that we have an acute hospital in this geographic area. The plans that have been put forward would deliver major improvements to care, patient outcomes and staff experiences. An alternative multi-phase approach has also been put forward. It would, of course, be an improvement on the status quo, but it would not deliver the same benefits or value for money as a single-phase build and would not be delivered in the required timeframe.

My constituents in North West Norfolk are frustrated by the delays in the timelines for the new hospital selection process, as am I. That will not come as any surprise to my hon. Friend the Minister; I confess publicly to bugging him and my right hon. Friend the Secretary of State repeatedly for decisions on the shortlisting of these hospitals. I press the Minister today: when can we expect to hear a decision on the hospitals that will go through to the next phase of the programme? What implications does the delay have for the final decision on the eight schemes to be selected, and for getting design and construction under way? I encourage him to do all he can to move this process forward as rapidly as possible.

Over the last three years, there have been real changes at QEH and patients are getting better care. The leadership has demonstrated that it can drive sustained improvements, and move to a position where staff feel supported and valued, and where there is a strong focus on improved patient care and outcomes. Now we have an opportunity to build—literally—on that progress, to provide the major investment to modernise the hospital, to improve care further and to support the trust’s strategy to be the best rural district general hospital.

The Government and the Department of Health have already committed to removing deficient RAAC from the estate by 2035. However, experts on RAAC have said that for QEH the end-of-life deadline is 2030 and that the risk will only worsen. There comes a point where it no longer makes sense or represents value for money to keep propping up the roof. I would contend that we are past that point. Indeed, in the report that set out the significant improvements needed to QEH, the CQC said that

“The trust’s most substantial risk was the safety of the roof structure”

and that there is a

“need for long term solutions to the estate problems.”

As well as having serious structural issues, the current hospital cannot meet the current or future demand. The only long-term solution is a new hospital to deal with the RAAC issues, meet demand and serve patients. By selecting QEH as one of the eight new hospital schemes, that inevitable need for replacement will become part of a funded programme, rather than an unplanned demand requiring repeated emergency funding. I urge the Government to include QEH as one of the schemes. The people of North West Norfolk and beyond deserve nothing less.

Access to NHS Dentistry

Jerome Mayhew Excerpts

Thursday 10th February 2022 Westminster Hall

[Jerome Mayhew (Broadland) (Con)]

It is a pleasure to speak in this debate. I, too, want to give my congratulations to the hon. Member for Bradford South (Judith Cummins) as well as my hon. Friend the Member for Waveney (Peter Aldous). One of the great advantages to speaking late on in a debate is that we can jettison all the interesting facts and figures we have carefully researched in preparation for a speech like this, because they have all been mentioned several times already. I want to focus instead on providing the Minister with some local feedback from my constituency of Broadland, so that she, when deliberating on how best to improve the dental contract and provision for all our constituents, can hear from the horse’s mouth the nuances that are experienced in Broadland and Norfolk and Waveney more widely.

Of all healthcare issues, dentistry is the most prominent in my inbox week after week. It is not just about the ability to register to get initial access, it is about getting dental work completed. I have a huge list of constituents’ casework, which I am not going to bring to Members’ attention, save for one, which gives a flavour of the seriousness of the missing treatment. A constituent of mine had two fillings fall out, which is a fairly common experience. She was unable to get any dental treatment to deal with that, so she ended up having to ring 111. She was told that, because of the lack of dental provision in the county of Norfolk, she was encouraged to do a DIY filling—that was by 111.

Every day is a school day in this job. I now understand that using the wax from Babybel cheeses is the way to perform a DIY filling recovery. Should we be in that sort of position? I, for one, think we should not. There are all sorts of examples I could have shared with Members. I want to drive home the real impact. For whatever reason, we are in the position we are now; some of it is covid, but a lot of it is not. We must, as a Government, address it in support of all of our constituents, however they voted.

I also have feedback from dentists. I have the honour of representing a fantastic town called Fakenham, which has been referred to already. One of the two NHS dentists announced a few months ago that she was no longer accepting NHS patients and that she was going private. I rang her up to find out what was the reason behind it. She is a very decent woman, who has worked tirelessly for the community of Fakenham for many years. What she said to me was not primarily about money. It was actually about the way she was treated by her NHS managers, which caused her frustration that reached such a pitch that she thought, “Stuff it. I am not putting up with this any longer.”

One thing that the dentist referred to that particularly stuck in my mind was that even a year ago, she had a person she could talk to directly as part of her management team; when there was a problem, she could ring up and talk to someone. That call was replaced by an email. She said that she had emailed every week for the previous 12 weeks about a really serious issue and she had not even had a reply. If we treat professional providers in that offhand way, can we be surprised that they decide to move to private provision? That is an option that every single NHS dentist has, and they have been voting with their feet.

I have already mentioned that this is not primarily about money—at least not in this instance—but I welcome the £50 million of additional spending that the Department has announced, and the 350,000 further treatments that that is apparently going to provide. I also very much welcome the decision by the Department to award a new contract for dentistry for Fakenham, because it is the largest town in my constituency and we were down to a single NHS provider. However, as has already been mentioned, I think by my hon. Friend the Member for North West Norfolk (James Wild), we have not been able to entice any dentist to take up that contract, even though the money is available.

Why is that? Why is it that a fantastic town such as Fakenham, which is a brilliant place to live, 5 miles from the gorgeous north Norfolk coast, with a really lovely quality of life and relatively low housing costs—it is a great place; it has its own racecourse—

[Duncan Baker]

And a good golf course.

[Jerome Mayhew]

It also has a good golf course—I thank my hon. Friend and neighbour. It is genuinely a really gorgeous town, so why is it that it cannot attract anyone to take on the NHS dentistry contract that is available? As my hon. Friends have pointed out, one of the reasons is that we have no training facility—not just in Norfolk or Suffolk, or even in Cambridgeshire or Bedfordshire; the nearest is in London. People have to go up to Birmingham or to London.

When we are trying to persuade young dentists to set out on their professional life in a certain place, moving to a rural or small town is not automatically attractive to them. We have to encourage people via training, and we know from our experience with the medical provision at the University of East Anglia and the Norfolk medical training in Norwich that someone is much more likely to stick around afterwards in the place where they train, because they have established relationships, they have contacts in the community—and, frankly, they know what great places Fakenham and other parts of Broadland are. One of the primary reasons I wanted to speak today was to encourage the Minister to consider the provision of a dental training facility in the east of England.

I will leave it to others who are much more professional than I am to comment on how we properly reform the 2006 NHS contract, save for saying that we need to treat dentists with respect. It is not all about money; it is about how we treat people. And please can we have some training in Norfolk?