NHS Dentistry

John Glen Excerpts

Thursday 20th October 2022 Commons Chamber

[John Glen (Salisbury) (Con)]

I rise to speak on behalf of a number of dentists in my constituency. Nicola Jones, an oral surgeon at Salisbury District Hospital, contacted me to say that the lack of available NHS dentists is causing significant challenges in the constituency. I recognise that from my mailbox over recent weeks. I met Matthew Clover, a specialist orthodontic practitioner, in February. He took me through the challenges of the “units of dental activity” model: it does not discriminate properly when it comes to the classification of the different activities that he has to undertake.

The challenges derive primarily from the lockdown two years ago and the interruption to supply: 38 million appointments were lost. I welcome the Government intervention earlier this year to provide the additional £50 million and 350,000 additional dental appointments. I also welcome the Government’s statement in July, but this is an opportunity for the new Minister to challenge his officials and work with industry representatives to find a deeper and more enduring set of changes that address some of the ongoing challenges that have existed for a very long time.

I would not suggest that I have anything like the expertise of my hon. Friend the Member for Waveney (Peter Aldous), the hon. Member for Bradford South (Judith Cummins) or, particularly, my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who has a lifetime of experience at policy level and as a practitioner. But I am aware that since 1951 there has been a model of co-payments, in which dentists act as independently contracted professionals to the NHS but also typically receive an income from private practice work as well.

[Wera Hobhouse]

The hon. Gentleman makes a very good point that, basically, private patients have been cross-financing NHS patients, but that model is no longer sustainable.

[John Glen]

I respectfully say to the hon. Lady that my mother is a resident of Bath and has received excellent service from her NHS dentist. Although I recognise this problem exists in different spots of intensity across the country, it needs a comprehensive solution.

The fundamental point is this: how can the model of rewarding dentists incentivise the maximum amount of engagement? All dentists start their professional life wanting to help people and wanting to do as much good as they can. I totally embrace what my hon. Friends the Members for Mole Valley and for Gloucester (Richard Graham) said about the need to deal with the oral health and education of young people, including how to clean their teeth at an early age. There will need to be a focus on how those practices can be embedded in a funding model that has to pay some respect to the geographic coverage of a dentist, while ensuring that each cohort of the population has access to basic dentistry.

The proposed new dental contract goes some way towards dealing with some of the challenges of the UDA model, but it probably does not go far enough. I urge the Minister to go beyond what his officials may be suggesting to him, to think radically and to take this opportunity to ask, “How can we reset after the dislocations caused by covid?” I urge him to come up with something that incentivises dentists to offer an holistic service to people of all means and to help those communities that have cold spots of dentistry supply.

I would like to make a few observations about supply and, again, my hon. Friend the Member for Mole Valley made some very good points about streamlining bureaucracy to ensure more people qualify as dentists in this country. Of course, it is right that we have ongoing quality assessments through the CQC, but that organisation’s focus, as across all industries, needs to be on where there are vulnerabilities and risks. When we think about NHS medical and dental services, I feel we are continually trying to be perfect and to remove all the risk, which sometimes has a cost because it involves using resources to fill in bureaucratic processes that might not necessarily, in most cases, give us much return.

My message to the new Minister is to build on the good start made by his predecessor in the summer, but to consider a more radical and fundamental review of the UDA funding model, to consider the volume of patients and to consider the real dynamics of the choices a dentist makes about how to maximise the number of patients they see who cannot afford to make a contribution.

I feel hopeful that the enthusiasm to provide the service I saw from my dentist in Salisbury means there will be a solution. I wish the Minister well, and I acknowledge the contribution of my hon. Friend the Member for Waveney, who showed a mastery of this subject.

Procurement of Evusheld

John Glen Excerpts

Wednesday 12th October 2022 Westminster Hall

[Daisy Cooper]

The hon. Member is absolutely right. Many people are clinically vulnerable because they have a health condition, and their physical health is getting worse, as it would when someone is stuck at home for two and a half years, but the mental health impact is also incredibly profound. We know that many of our constituents have experienced suicidal thoughts.

I turn now to the advice of the RAPID C-19 oversight group, which has been mentioned. The Government refused to share this advice for some time, and many of us were asking for it. I was pleased to see that this advice was finally published last Thursday on 6 October. I was pretty shocked for two reasons. First, the report actually says that the group looked at real-world data and the impact on people and that data was very strong. Then it looked at the data in a non-clinical setting and decided not to roll it out. That seems absurd to me.

There is a second problem with the evidence that was published last week. It lists the evidence that the group reviewed, and it leaves out one very critical scientific study by the Francis Crick Institute—a study that I believe the Government commissioned themselves. That study was commissioned to look at the effectiveness of a different drug: sotrovimab. That report concluded that sotrovimab was effective, and the Government are using that report to justify why they continue to use sotrovimab. However, the report also concluded that Evusheld was even more effective. So why not buy Evusheld too? Perhaps the Minister can enlighten us.

On the same day the Government published this RAPID group report, The Lancet—the world’s highest-impact general medical journal—carried an article by 19 experts calling on the World Health Organisation to update its guidance on Evusheld, based on the study the Government commissioned. In the article, those experts say that Evusheld should be used for not only preventative, prophylactic use, but treatment. The UK Government are really trailing behind. Can the Minister tell us why the RAPID study ignores this vital piece of research, which they must have known about?

Many of the people we are talking about have already had five or six vaccine jabs, even though they will mount very little, if any, response. The Government say it is important that these people get those vaccines, because they say some response is better than none. Why does that same test not apply to Evusheld? Why is it being singled out and held to an impossible standard?

Let us look at what the Government are proposing, instead of following the science. Ministers have referred Evusheld to NICE for further clinical and cost-effective assessment; apparently, we might hear back in April 2023. That is another delay—another six months of isolation—even though every other covid treatment and vaccine was urgently procured before being appraised. I ask again, why is the Government’s treatment of Evusheld so inconsistent?

[John Glen (Salisbury) (Con)]

My constituent Helen Nash asked me to be here to support the case that the hon. Lady is making. She makes the key point: while the Government did a lot of great work to accelerate the availability of vaccines for the population at large, this particular cohort seems to be subject to a very different set of criteria. That is the great concern. While we must rely on clinical advice, we must also have the same situation for all people, regardless of their status.

[Daisy Cooper]

I agree with the hon. Gentleman. One of the big concerns that has not been answered by the Government so far is why their approach to this drug is so inconsistent with their approach to others. As I say, Ministers have referred Evusheld to NICE, and it is not at all clear why their treatment of it is so different.

Meanwhile, the Department of Health has proposed that immunocompromised patients have an antibody test, and that those who do not respond well enough could join an Evusheld trial. Let us be clear what that trial would mean in real life. It would require some of the people who have been shielding to stay alive for two and a half years to come out of shielding like the rest of us, but without any protection from covid vaccines, knowing that they might only be given a placebo. It would be like taking lambs to the slaughter. I would be astonished and appalled if that proposal passed anyone’s ethics test. I do not know if the Minister would support one of his loved ones taking part in such a trial, but I certainly would not. Can the Minister therefore tell us why his Department wants to take this dangerous approach instead of the approach suggested by the Drug Safety Research Unit, which has called on the Secretary of State to roll out Evusheld now, for this winter, and to run an observational study of the impact?

Another question that has arisen is whether there are problems with supply. The answer is no. AstraZeneca has dismissed that claim.

Income tax (charge)

John Glen Excerpts

Monday 16th March 2020 Commons Chamber

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

I am pleased to have the opportunity to speak in this debate. Harold Wilson said that a week was a long time in politics. During Brexit we found out that a week was even longer, but the Budget, only last Wednesday, seems a lifetime ago. Even when listening to the Chancellor, I still harboured hopes of a long-planned personal visit to New York this weekend, but for all the reasons we see around us that is simply not able to happen. Three weeks ago, I was in Rome for the Scotland-Italy rugby match. At that point, the talk was of difficulties in the north. No one envisaged that instead of the crowds in St Peter’s Square or outside the Colosseum there would be nobody.

As a Member of Parliament, I am often asked about the most difficult issue and time I have had to deal with. For me, the answer is very straightforward: the 2001 foot and mouth crisis, which affected my constituency deeply. I want to be very clear that I am not making any comparison between that disease and coronavirus. The comparison relates to the impact of an event of that scale on businesses and their continued prosperity, and on the wider community. There was also, as a report from Strathclyde University and others identified, the impact of isolation. During that period, very stringent measures were taken and many farmers had to be isolated on their own properties and could not leave. The report, two years later, made very clear the long-term consequences of isolation. We need to take those findings on board and think about them. We need to learn the lessons of such events, with measures that might come into place. I am sure those issues will be debated when we have more focused debates on coronavirus.

The businesses most affected by those circumstances were the self-employed and contractors, so we need to give those groups the maximum possible support. The hospitality industry was also very badly affected. One lesson from that experience is that small businesses need grants not loans. I remember taking part in a demonstration—I know that that will surprise you, Mr Deputy Speaker—outside the offices of Scottish Enterprise Dumfries and Galloway with colleagues in small businesses to make just that point. Grants, not loans, were needed to see them through. Rates relief is to be welcomed and I welcome the package of measures the Scottish Government have announced, but it is capped and we need to look again at whether that is appropriate.

The other big players are the banks. From my perspective, the situation that we face will be easier to deal with because it affects the whole United Kingdom, so the banks that are based outwith the south of Scotland and that are being asked to support businesses understand what is happening on the ground. We need that unity of purpose from the banks. Hon. Members who have dealt with the banks know that they always say the right thing, but doing it is something else, especially when the computer says no. We need to make sure that they follow through on their commitments, and on the positive tone that the Chancellor set in the Budget.

We need a uniformity of approach from the Government at all levels—the UK Government, the Scottish Government and local government. The underlying philosophy of all those institutions must be that we want to keep our businesses going and that we are not jobsworths who want the returns in on the exact date. That is why I welcome what the Chancellor said about VAT holidays and flexibility with Her Majesty’s Revenue and Customs. I am sure, however, that hon. Members on both sides of the House have experience of HMRC not being particularly flexible, so we need that to be followed through. That unity of purpose from government will be vital.

As has already been said in an intervention, the hospitality and tourism industry is the most vulnerable in a constituency such as mine. Often, as I found out during the foot and mouth crisis, businesses that have done well and are planning for the future are the worst hit. For example, the Gretna Green Famous Blacksmiths shop in my constituency, one of the most visited tourist attractions in Scotland, has won numerous awards for its attempts to attract Chinese visitors. A large number of Chinese visitors go to that location, but not any more—there are none. Its business model has already been seriously disrupted by these events. It is a bigger business, not a small business, but it needs help and support too, if that sector of the economy is to survive after these events.

Hotels in my constituency were already in difficulty; many, such as the Moffat House hotel, have closed. One local hotelier told me that they were facing a perfect storm of events, of which, at that stage, coronavirus was not one. I appeal directly to the Scottish Government on that issue, because the way that our business rates system in Scotland works for the hospitality industry, and particularly hotels, is still not right.

As I indicated, there are lots of lessons to learn. I hope that there is still the institutional knowledge in the Scottish Parliament and the Scottish Government to learn lessons from 2001, and that the Government can take some of those lessons on board, particularly in relation to isolation, as I said.

I welcome the Budget as a whole for Scotland, in particular the £640 million of additional funding for Scotland, which was £172 million more than the Scottish Government had anticipated. By any analysis, the Scottish Government got extra money. In my experience, they have not always welcomed, or even acknowledged, extra money—indeed, sometimes it was the wrong kind of money, even if they did acknowledge it. I hope that on this occasion, and in these circumstances, they will acknowledge the extra money.

As I said, I am pleased with what the Scottish Government have had to say about spending on business support in relation to coronavirus, but I would also like the money that is coming forward to be spent on infrastructure. Back in the ’90s, before the Scottish National party was in power, and when it held the constituency of Galloway and Upper Nithsdale, as it then was, the A75 and A76 were described as the most important forgotten roads in Scotland that needed to be substantially upgraded. Of course, since 2007 there has been an SNP, or SNP minority, Scottish Government, but that investment has not been forthcoming. I use this occasion to plead for the needs of the A75 and A76. I am sure that there is somebody in the SNP who remembers those previous commitments.

Obviously coronavirus is significantly affecting today’s debate, and rightly so, because it is the issue that most affects our constituents at the moment, but I want to highlight one other issue on which I wrote to the Chancellor ahead of the Budget, together with 15 Conservative colleagues, the Association of Convenience Stores and the British Retail Consortium: access to cash. It is a big issue; in a crisis, many people like to have some cash available, so that they have flexibility in how they approach difficult circumstances. There is a crisis in access to cash, and it affects large rural constituencies such as mine in particular, but also many other communities.

Some of the most deprived communities in our country bear the hardest impact. I had not realised until relatively recently that the average withdrawal from a cash machine is around £10 or £20. A fee of up to £3 to take £10 out of a cash machine is a very significant mark-up. A report has indicated that about 8 million people in our country are not ready to cope with a cashless society. A cashless society may come; indeed, when I travel from my constituency to central London, I feel that central London is, in many ways, a cashless society—in which there are, ironically, hundreds of cash machines. We need to do something about this issue. I welcome the Chancellor’s promise in his statement to legislate to secure the long-term future of cash, but it is very important that the steps that he takes are the right ones.

[The Economic Secretary to the Treasury (John Glen)]

indicated assent.

[David Mundell]

I am pleased to see the Minister nodding; I hope that he will nod when I say that those steps should include reversing the arbitrary cuts to the LINK interchange rates paid by banks to fund the network; exempting free-to-use ATMs from business rates; and recognising that ATMs are the only infrastructure through which we can guarantee national access to cash. Of course, cashback at convenience stores and other places has a role to play, but it is very important that we have a sustainably funded network of cash machines throughout the whole country, given the many branch closures we have seen in our constituencies—particularly Royal Bank of Scotland branch closures in Scotland.

I agree with the hon. Member for Ellesmere Port and Neston (Justin Madders). The consequences of these events—such as the foot and mouth crisis that afflicted much of the south of Scotland 20 years ago—go on for years. They do not just end when someone declares that the crisis is over. They go on for a long, long time for the businesses, individuals and communities that have been affected. We do not just pledge support to those individuals and communities today; we pledge it to see them all the way through the consequences. I think that that will mean revisiting some of what was announced in the Budget and some of what was announced by the Scottish Government, and if that is necessary, so be it.