NHS Dentistry: Lincolnshire

John Hayes Excerpts

Wednesday 20th October 2021 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Smiles are very important. When we smile, it makes us happier and it makes those around us happier, but unfortunately many of my constituents are struggling to smile because they have problems with their teeth and just cannot get an NHS dental appointment. That has left some of them in very significant pain and discomfort.

Many constituents have contacted me to share their experiences: people waiting years to access NHS dental care; children unable to access NHS orthodontic care, with a choice between hugely expensive private treatment and doing without; service families posted to Lincolnshire struggling to get an appointment. Figures show that just 41% of adults in Lincolnshire have accessed NHS dental care in the past two years, and less than a third of children have accessed it in the last year.

Access to specialist treatment is even more limited. Lincolnshire has gone from having three full-time consultants in orthodontics, based in Boston, Grantham and Lincoln, to just one permanent consultant two days a week, based in Lincoln. Unlike neighbouring counties in the east midlands, Lincolnshire has no specialist dental services either in paediatrics or in restorative dentistry, which means significant travel out of county for patients who require more specialist help.

It is therefore perhaps not surprising that 80% of Healthwatch complaints in Lincolnshire relate to problems with access to NHS dental services. I would like to speak about how we could improve the situation for my constituents.

[Sir John Hayes (South Holland and The Deepings) (Con)]

The circumstances are just as bad as my hon. Friend suggests. Indeed, Lincolnshire is the worst served of any midlands county, with the lowest proportion of dentists in the population. There are detrimental effects on children, as she said, and it is the poor who tend to suffer most. Finally, given her professional expertise, I wonder whether she could comment on those who have undiagnosed conditions that a visit to the dentist might reveal, notably oral cancer.

[Dr Johnson]

My right hon. Friend is a big champion for his constituents and for ensuring that they have good dental care. My hon. Friend the Member for Louth and Horncastle (Victoria Atkins), who cannot be here this evening, is also vigorously campaigning to improve access to dental care in rural areas such as her constituency, particularly in Mablethorpe, where urgent care has now been restored and where she is committed to seeing non-urgent care renewed.

The journey to being a dentist begins at university dental schools, which are heavily over-subscribed. The Government trained 21% more dentists in 2018-19 than in 2008-09. It was forward-thinking of them to increase the number of dentists; given the increase of only 7% in population, one would have expected it to result in more dental care. However, that has not happened in practice, for two reasons: partly the increase in part-time working and flexible working, but particularly the dramatic increase in the number of dentists working in the private sector as opposed to the NHS. What is the Minister doing to increase the number of dental students still further? What is she doing to ensure that they are trained particularly in areas of low provision?

I note that there is currently no university dental school in the east midlands—or in East Anglia either, in fact. It is well known that people often stay where they train; it is therefore perhaps not surprising that there are fewer dentists in Lincolnshire. Does the Minister agree that, building on the success of the Government’s investment in opening a new medical school in Lincoln to train more doctors, we should build an east midlands dental school in Lincoln, creating a centre of excellence locally for specialist services and thereby increasing the number of local dentists being trained?

There is already a precedent for opening dental schools in under-served areas: the last school was opened in Plymouth to serve a deficit in the south-west. Following the establishment of Lincoln Medical School, the addition of an adjunct dental school would be a welcome addition to Lincolnshire and the surrounding area. It would boost training and skills opportunities for young people in Lincolnshire and the wider east midlands and increase the retention of new local dentists, while helping to address access to routine NHS dental care and specialist care for patients. I also ask the Minister what efforts are being made to increase local specialist provision for paediatrics and restorative dentistry.

Following their university careers, graduates become foundation trainees, and we need to look at where we place our foundation trainers and trainees. Newly qualified dentists need to work in a foundation job to get an NHS provider number, but they can work in a private practice without one. That is something of a disincentive for people to work as NHS dentists. We also need to consider where the postgraduate training takes place. For example, there are currently six full-time training places at Grantham Hospital, just outside my constituency, but this year it has been given only two new graduates to fill those places. That is creating a reliance on temporary and overseas staff to deliver services, but it also means that there will be fewer dentists trained locally and therefore fewer dentists for the population.

Does the Minister agree that all new dentists should work their foundation year in the NHS, as doctors do, and does she agree that, given that trainees often stay where they train, the foundation places in areas of low provision should be filled first? Would she consider “golden hellos”, such as those provided in some medical specialties in areas with low provision, to attract more dentists to under-served areas?

At the heart of the issue of NHS dentists moving into the private sector is the current target-based dental contract that was introduced by the Labour Government in 2006. It was widely considered unfit for purpose even before the pandemic, which has only served to highlight its flaws, and I am aware that the Government are rightly looking to replace it. The present system effectively sets quotas on the number of patients whom a dentist can see. NHS dentists are commissioned to deliver a set number of units of dental activity—UDAs—which caps the number of dental procedures that they can perform in a given year. If they deliver over 4% more than they have been commissioned to deliver, they are not paid for the extra work; moreover, they have to bear the cost themselves of any materials used, any laboratory work, and all other overheads. That penalises dentists who treat patients in the greatest need.

The contract also penalises dentists who under-deliver on the activity that they were commissioned to deliver, perhaps owing to difficulties in filling a practice vacancy. In addition, it pays a set amount for particular types of treatment, regardless of the number of teeth that need to be treated. For example, a dentist would be paid three units of dental activity—worth an average of £75 —for one simple extraction, but would also be paid £75 for an entire course of treatment including six fillings, three extractions and a root canal treatment, which would not be enough to cover their overheads. That means that the system effectively punishes dentists for taking on new patients with high levels of dental need.

There is also—believe it or not—a huge variation in the value of UDAs. I said that the average was £75, but in fact, across England, dental practices are paid anything between £15 and £45 per unit of dental activity delivered, with an average value of £27.50. In Lincolnshire and Leicestershire, the value is between £18 and £38, with an average value of £25. For example, in Spalding, Lincolnshire—in the constituency of my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes)—two NHS practices just over a mile apart are being paid £23 and £28 per UDA respectively, a difference of more than 20% for the same work in the same town. That illustrates how dysfunctional Labour’s dental contract has become, making it more difficult for practices with lower UDA rates to recruit because they cannot pay the dentists whom they hire as much for the same work. When we compare this with private practice, where remuneration is based on actual work done, it is clear why this flawed contract has had a devastating impact on recruitment and retention among NHS dentists.

Research by the British Dental Association shows that nearly half all dentists plan to stop providing NHS services or to reduce their NHS commitment, and more than a quarter plan to move to fully private provision in the next 12 months. That has been seen in Lincolnshire, where there has been a net drop of 30 dentists providing NHS services in the year to the end of April 2021.

I am pleased that the Government have recognised the problems that this contract is creating, and are piloting alternatives. It is crucial that they deliver on their commitment to roll out new contractual arrangements by April 2022. Within the new contract, remuneration needs not only to reflect the number of dentists working in high-need areas, but to address the problems of attracting dentists to work in rural areas.

Dentists trained overseas can play an important role in filling vacancies in under-served areas. They already contribute to our NHS, and many more wish to come here, but despite the lack of NHS provision, dentists are not currently on the shortage occupation list. Moreover, it is possible for dentists from countries such as those in the EU where we recognise the equivalence of university dental qualifications to come and work here in the private sector immediately, but additional paperwork and training, with additional costs, are required for them to work in the national health service. That is a clear disincentive to working in our health service, and I would like the Minister to elaborate on what she is doing to remove bureaucratic burdens such as those that limit NHS capacity.

The covid pandemic has further exacerbated problems with access to NHS dentistry. In the spring of 2020, all routine dental care in England was necessarily paused for two months. With social distancing, gaps between treatments and decontamination between patients having been essential since then, dentists have been able to see only a fraction of their usual patient numbers. In North Kesteven alone, 22,733 NHS dental appointments were lost between April 2020 and March 2021, further adding to the unprecedented backlog.

In the short term, to address the impact of covid-19 infection prevention and control protocols limiting the number of patients who can be seen, funding for ventilation equipment could drastically reduce the time lost between seeing patients by reducing the number of times the air is changed over an hour. Currently, after each aerosol-generating procedure—which includes most courses of dental treatment including drilling—dentists are required to leave the treatment room empty for up to an hour, which dramatically lowers the number of patients they are able to treat. The experience of my constituent Emma highlights this. Her seven-year-old daughter is still waiting for a routine check-up from November 2019, and Emma is being told that the surgery is running at 50% capacity due to coronavirus prevention controls.

This fallow time can be reduced, and patient throughput increased, by installing high-capacity ventilation. However, this can cost a practice up to £10,000. England does not currently invest in ventilation for dental practices, although the devolved nations of Wales, Scotland and Northern Ireland do. Capital funding for ventilation equipment would have a transformative effect on the throughput of patients, and would in effect pay for itself through increased patient charge revenues from paying NHS patients. Could the Minister please outline what review mechanisms are in place to reduce dentists’ covid measures—particularly now that the fantastic vaccine programme this Government have put in place means that more than 90% of people have antibodies—so that dentists can increase capacity from 65% to 100%?

Lincolnshire is proud to be the home of the Royal Air Force, including RAF Cranwell, RAF Digby and RAF Barkston Heath, which are in my constituency of Sleaford and North Hykeham. Repeatedly moving location can pose particular difficulties for service families as they find themselves on lengthy dentists’ waiting lists. My constituent Karen waited five years for her and her three children to access an NHS dentist after her husband was posted to my constituency, and she is still having difficulties in securing adjustments for her disabled son. Our veterans, cared for by the Ministry of Defence during their service, often find it difficult to get an NHS dentist at the point of retirement. The Armed Forces Bill will enshrine in law the military covenant, our commitment to our brave service personnel and their families. Will the Minister outline what work she is doing to ensure that military families and veterans can access high quality NHS dental care wherever they move to, in order to meet their particular challenges of moving around frequently?

Without significant changes soon, the problems facing NHS dentistry in access and in the recruitment and retention of dentists will continue to grow. My constituents in Lincolnshire deserve to be able to see an NHS dentist, and dentists working in Lincolnshire deserve a contract that correctly rewards them for the work they do and addresses the perverse incentives that currently exist. After a decade of work on the new system, there can be no more delays. I hope the Minister can give me assurances that the Government will stick to their commitment to roll out new contractual arrangements by April 2022, so that my constituents can smile once more.

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

I congratulate my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) on securing this important debate. I am really pleased to hear dentistry getting some more parliamentary time and being put on the radar, because it is such an important issue. I am aware that there are long-standing concerns around dental access in parts of the east midlands. In my response I will consider the impact of covid on access to dentistry. We are aware of this, and I will focus on it initially. However, we have to acknowledge that there were problems in accessing NHS provision before covid. Even once we are through the recovery from the pandemic, we will need to address those issues once again. They will not disappear once the pandemic has passed.

As my hon. Friend highlighted, dentistry posed a significant risk during the pandemic because of the aerosol-generating procedures. I thank all the dental teams across the country who showed such resilience and dedication during this period, because they kept going and provided urgent care while facing considerable risk and anxiety. The steps we took during the pandemic ensured the safety of both dental patients and staff, but they have led to a reduction in the number of patients who can be seen.

We have worked closely with NHS England to consider the level of NHS dentistry that can be safely delivered in the environment of a pandemic. The thresholds that have been set for dental practices since the start of the year are based on what is achievable while maintaining infection control measures.

My hon. Friend will be pleased to know the UK Health Security Agency published new guidelines on 27 September that include three pragmatic changes to infection prevention and control measures, with a focus on elective care that allows providers to start making further safe changes to open up their services. I take her point, and I will consider what more support can be given for ventilation to help dentistry premises open up further still.

In the light of the reduction in activity, dental practices have now been asked to deliver as much care as possible, prioritising urgent care, care for vulnerable groups and children, and delayed planned care. Practices are now being asked to deliver 65% of their units of dental activity and 85% of contracted units of orthodontic activity from 1 October. Our figures suggest that we are starting to see a natural return to pre-covid levels of activity in dentistry, and I am pleased to see that in England urgent care has been back to pre-pandemic levels since December. We have made real progress there.

[Sir John Hayes]

It is widely acknowledged that the Minister brings both understanding and diligence to her role. Does she recognise that there are particular problems in rural areas such as Lincolnshire? We hear a lot in the place about urban deprivation and metropolitan needs, but we hear rather less about rural deprivation. In healthcare, public services and dentistry in particular, our county is peculiarly deprived. Will she take particular measures to help rural places such as Lincolnshire?

[Maria Caulfield]

My right hon. Friend makes an excellent point, which I was going to address. Officials tell me that the areas where we are seeing significant gaps are referred to as “sheep” and “seagulls,” with the sheep being rural areas and the seagulls being coastal stretches. They are the two areas of the country with a significant shortfall in NHS dentistry provision, and they are the two areas on which we will particularly focus.

National Security and Investment Bill

John Hayes Excerpts

Report stage & 3rd reading & 3rd reading: House of Commons & Report stage: House of Commons
Wednesday 20th January 2021 Commons Chamber

It is quite clear that national security is not just in our defence interests; national security is the defence of our prosperity, and indeed our way of life. With this Bill, we are at last considering our commercial interests, including the interests of our research institutions, and the areas where the two meet. National security is a primary responsibility of Government, and hopefully the Bill will see the Government start to think about our economic strategy and resilience, but they must also think about our social resilience, as so many have said. That has to be a good thing.

[Sir John Hayes (South Holland and The Deepings) (Con) [V]]

This Bill is apposite. It is an appropriate response to an ever-pressing but rapidly changing problem: our national wellbeing. I want to speak briefly about its scope, its dynamism, and the oversight that is necessary to make it as effective as it can be.

That national security is inextricably linked to our national interest is axiomatic. It is obvious that our trade and investment also serve our interest. The potentially paradoxical objects of economic interest and keeping our nation safe are brought into sharp focus by the Bill, which I welcome, and I congratulate the Government and the Minister on bringing it forward. The Government response to the changing circumstances that we face could not be more significant. Malevolent forces of ill intent—both hostile state actors and non-state organisations, including global commercial interests—must be countered, curtailed and, where necessary, controlled. As the hon. Member for Aberavon (Stephen Kinnock) said, greater assiduity in this respect is to be commended. No longer can we be naive about the ethics of the free market or free trade; nor should we appease foreign powers that, frankly, embody tyrannical tendencies, in a chilling echo of the worst of the 20th century.

As the scope of the Bill’s provision must be used appropriately, so it should also be used as necessary, and as circumstances dictate. I am afraid it is not enough to count risk and resilience in the way we have, historically; we need to measure risk and prepare the necessary resilience in a new way. So I am sympathetic to new clauses 4 and 5, which look to establish factors to which the Secretary of State must have regard when assessing risk, but I hear what my hon. Friend the Member for Beckenham (Bob Stewart) said: given that that risk is as I have described it—dynamic—it is important that there should be a framework, rather than specifying precisely what the risks are or may be. It does seem to me, however, that the Government can do more work, as the Bill continues its passage through both Houses, to be clearer about the circumstances in which the Government might assess risk and define its character and the response to it.

That BEIS is to take the lead in this policy area is new, and it empowers Ministers in a very particular way, but in my estimation, security is likely to be the business of all aspects of Government. As has been said by previous speakers, in respect of health, is it really in the national interest for vital health supplies to be dependent on provision from unstable and unhelpful places? Should the supply of technology, which is so critical to so much of what we do in business, in the public sector and as individuals, be in the hands of those who are either capriciously cavalier or maliciously malign? Should our universities become so dependent on funds from overseas that they are obliged to transfer knowledge to individuals or states that may use it against us?

From now on, the whole of Government have to be associated with the effort to measure risk, develop resilience and understand the threats to our security. In those terms, the Bill must allow sufficient responsiveness to metamorphosising threats, to allow us to alter our response to counter those threats. That implies acting quickly and Ministers using their executive power without the scope, space or time always to seek parliamentary approval. If they did seek such approval, they would be doing so almost every week, certainly every month, and possibly by the day or hour. That is why oversight matters so much, yet the Bill is not yet quite right in that respect, as several contributors to the debate have said.

The existing accountability to Select Committees is valuable, but not enough. As the Chairman of the ISC, my right hon. Friend the Member for New Forest East (Dr Lewis), explained, that Committee is designated. Indeed, it was set up for precisely this purpose, dealing with highly sensitive information, including secret documents that would normally not pass through the House as a whole because of the public implications of that. Adequate oversight is therefore essential.

Public Health

John Hayes Excerpts

Wednesday 6th January 2021 Commons Chamber

[Sir John Hayes (South Holland and The Deepings) (Con) [V]]

Supporting businesses as they endeavour to cope with covid and its multiple challenges has rightly been among the Government’s primary priorities. A comprehensive package of support, including the job retention scheme, loans, rate holidays, cash grants and a temporary cut in VAT for the hospitality and tourism sectors, has provided a means of survival, but no more than that. This lifeline for livelihoods must not be cut now. Firms that depend on advertising revenue are particularly vulnerable.

Some 99% of firms in our nation are SMEs. They have a central role, whether it is pubs, family-run hotels, cafés or restaurants, manufacturers or independent local shops. They are at the heart of our economy, and they provide the lifeblood that flows through our communities. We must ensure that covid does not further widen existing disparities, advantaging the big at the expense of the small, advancing the national at the expense of the local and the urban to the detriment of the rural. In that respect, I repeat what I said earlier to the Prime Minister. We need the vaccine in rural communities. It needs to be delivered locally and accessibly for those who live a long way from large towns and cities.

SMEs, particularly those in remote areas, face a daily struggle and need continuing support. Contrast for a moment independent, family-run shops, passed down through generations and struggling to cope, with a Tesco executive rejoicing as profits continue to soar. Contrast an Amazon director celebrating a 37% increase in their earnings with the owner of a much loved bookshop dutifully distilling and distributing the wisdom of ages and struggling with the strain of debt.

Schumacher argued that small is beautiful, and small is indeed beautiful, because people are the things that matter most. The Government must try out a new orientation, in which the needs of small, independent family businesses come above the interests of faceless corporations. A new challenge brings new chances for cathartic change. At present, the Government are preoccupied with responding to covid and are defined by that to some degree, but we can chart a new normal that is fairer, freer and fraternal—a different kind of social order where social capital matters as much as economic prosperity and where the wellbeing of communities is at the heart of all that Government do. As our Prime Minister rightly reiterated, only through determination, perseverance and togetherness will the clouds of this storm clear. We must build a new nation—one nation—based on fraternity at Westminster.

Historical Stillbirth Burials and Cremations

John Hayes Excerpts

Thursday 6th February 2020 Commons Chamber

[Sir John Hayes (South Holland and The Deepings) (Con)]

Proust said:

“The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.”

My eyes were opened to the subject by the hon. Member for Swansea East (Carolyn Harris), since when we have worked together to bring about the children’s funeral fund—under her leadership, by the way; I was merely her acolyte. In doing that work, I became interested not just in that subject but in the whole matter of how people are dealt with when they die and how their loved ones are treated. There is much to be said on that, but time does not permit us to say it all today, for this particular debate is of course about stillbirth and lost children.

The Minister rightly said that things have improved. Some of this issue relates to the past—what happened to those who were loved and lost in years gone by—but I implore the Minister to reflect on whether it is possible for us to do more with local authorities, which are responsible for these matters, because, as she said, cemeteries maintain records, and cemeteries lie within the purview of local government. Perhaps further work can be done to impress on local authorities the need to make information available. Furthermore, in respect of people who are stillborn now, perhaps we could be certain that all health authorities are doing their best. I agree that things have improved, but we need to make sure that that improvement is consistent throughout the country.

In respect of the support given to those who have lost, as a number of Members have said, we need to ensure that the counselling, which makes so much difference, is readily available, quickly, and to whole families. Much is made of maternal love, and rightly so, but too little is made of paternal love. It is sometimes underestimated and often under-celebrated. The love of fathers and grandparents needs to be taken into account, too. Support for whole families when these events occur is critical.

[Tim Loughton]

My right hon. Friend makes a good point about fathers. We talk a lot about the perinatal mental illness suffered by at least one in six women—and much more is being done about that—but it is less known that many fathers, particularly new fathers, suffer from perinatal mental illness as well. The impact of losing a newborn is of importance not just for the mother but equally for the father. We forget that at our peril.

[Sir John Hayes]

My hon. Friend, who served with me in the Department for Education, where he was responsible for matters concerning children, has a long track record of defending the interests of families and fathers. I pay tribute to that and entirely endorse what he has just said. Grandparents also feel these things very deeply. My children are only 19 and 15, so I am not enjoying grandparenthood yet, but those Members who are will know quite how profound their involvement is and their distress at loss can be. I entirely agree with what has been said about counselling, support and mental health.

I hope you will forgive me, Madam Deputy Speaker, for saying a word about public health funerals, a parallel but closely related matter on which the hon. Member for Swansea East and I have also co-operated. Councils in the UK spend about £4 million a year on nearly 15,000 burials or cremations for those with no next of kin or whose families are unable or unwilling to pay. They are known as public health funerals, although rather chillingly they are sometimes described as paupers’ funerals, which sounds so Dickensian, does it not? None the less, public health funerals are held for about 3% of all deaths, and there are real concerns about poor practice. The number of public health funerals has increased dramatically since 1997.

Tragically—in some cases councils are providing the bare minimum provision. Some of these funerals are held behind closed doors and families are prohibited from attending. There are instances of councils refusing to return ashes to families, even when requested. Sometimes, loved ones are not told when the funeral is going to take place, so they do not even know whether their loved one has been buried or, in most cases, cremated. I take this opportunity, with your permission, Madam Deputy Speaker, to call again on the Government to communicate with local authorities about the strict need to ensure that these funerals are dealt with in a decent, civilised and humane way. I am not confident that that is happening across the whole country, and it needs to do so without further delay.

I know that other Members want to contribute, so I shall draw my remarks to a conclusion simply by saying this. I spoke earlier of the Dickensian character of paupers’ funerals. Dickens said:

“A loving heart is the truest wisdom.”

Love is greater than life because love lasts longer and, because it does it should be at the heart of policy makers’ considerations when they deal with the highly important, very sensitive and profound issues that we debate today.

--- Later in debate ---

[Tim Loughton (East Worthing and Shoreham) (Con)]

I had not intended to speak in this debate, but, as is usual with subjects brought here by the hon. Member for Swansea East (Carolyn Harris), it is difficult to resist; they are always such important and emotive issues, and the contributions we have heard have only heightened that fact. I also pay tribute to the sensitivity and real-world personal knowledge that the Minister has brought to this debate, and indeed to everything to do with children and babies generally. It greatly heightens the worth of what we do here.

Stillbirth, a hugely underappreciated subject, has been disproportionately debated in the Chamber in recent years, thanks to the brave personal testimonies of many right hon. and hon. Members whose families have been affected by baby loss in such tragic ways. Their contributions have been hugely valuable and moving, but, more importantly, have led to changes in legislation and greatly raised the profile of this important issue. It is an example of some of the great but underappreciated things we do in the House, and this is another great opportunity for us to do good on a really important issue.

My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) was right to mention the connection with mental illness, particularly around extended family members. Too often we look at mothers in isolation, with all the problems of pregnancy and childbirth, whether it is a healthy child or a stillborn child. We need to do more, as a society and as a Government, to think of the family in the round and the implications and impact that the tragedy of stillbirth can have on others, besides the mother.

We have made great progress in legislation in recent years, but, more importantly, we have made much progress in the sensitivity with which hospitals treat bereaved parents. We have legislated for bereavement leave, for example, but we should now consider extending that to this area as well. We have maternity and paternity leave, but losing a baby is hugely traumatic and impacts on the ability of parents to work normally afterwards.

I recently visited again the new bereavement suite in Worthing Hospital, which is officially the best hospital in the country with what is officially the best maternity department in the country. The bereavement suite is a fantastic facility. It is hard to imagine that until a few years ago mothers who had sadly just given birth to a stillborn child, or a child who died soon after, would be left within hearing range of children who had fortunately been born healthy to a mother in the same ward. Greater sensitivity is now shown throughout the whole NHS. It was great to visit that example of how well we now look after parents who tragically cannot take their child home with them.

It was through Worthing Hospital’s maternity department and the experience of my constituent Hayley from Worthing that I became much more familiar with the issue of stillbirth. She came to me to say that she had given birth to a stillborn child at about 19 and a half weeks at Worthing Hospital. She had been there in labour throughout the weekend and had gone through all the pains and anguish of giving birth to a stillborn child. That led to my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019 and a debate about the whole issue of how we look at and recognise the existence of children stillborn before the 24-week threshold.

Hayley’s experience goes back to the extraordinary revelations we have heard already about how we used to deal with stillborn babies and how the parents had no involvement. Once a woman was delivered of a stillborn baby, any authority or interest the parents had in that child apparently came to an end. It was an extraordinarily brutal and inhumane approach. In the case of Hayley, she and her partner held the child, named the child, had a formal funeral for the child and now know where the child is buried and can mourn. That has been part of the grieving process for them. It is right that the parents be able to do that, if it is their wish; they got the footprint and the photographs, and that was right for them.

The tragedy still is, however, that that child never existed in the eyes of the state, because he happened to have been born before the 24-week threshold, and that is what the 2019 Act aims to address. I wish to make a plea to the Minister. Section 3 obliges the Department of Health and Social Care to conduct a review into how we can do something about pre-24-week stillbirths—they are not technically called “stillbirths”. To give him his due, the former Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), set up the review before the Act became law—I sat on and contributed to it, along with the hon. Member for Washington and Sunderland West (Mrs Hodgson)—but it has not met since 2018 and no subsequent review has been forthcoming. We still need to sort this out, because too many babies are being born just before 24 weeks. In previous debates, I have given examples of children born at 23 weeks, six days and a few hours. In one case, twins were born either side of the 24-week threshold. One was recognised and registered and one was not. This is an anomaly and an inhumanity and it is so important that we deal with it. I urge the Minister to inquire into where we are with the review.

We talk a lot in the House about historical injustices—this debate is technically about historical injustices, although we have spoken more about the present. I think of the historical child sex abuse scandal, the inquiry into which will go on for many years, but there are also parallels with the forced adoptions that occurred many years ago, when women, in an era of different morals, were forced to give up babies born out of wedlock. Many of those children ended up in Australia. There have been many reviews into how that was allowed to happen and into helping those children to re-establish connection with their birth parents.

What downside can there be to giving every assistance, difficult though it may be, to parents who, after having a stillborn child, were given no role in what happened to the body and have no knowledge of where the child’s remains are? I acknowledge that, as the Minister said, it would be difficult, particularly going back several decades, but we must make sure that hospitals, crematoriums and other public agencies do everything they can to respond sympathetically and extensively to queries from those people, just as we have done with child sex abuse and historical forced adoption.

The point I raised with the Minister might meet with some reluctance in some hospitals where practices were not of a quality we might have expected. Another section in my Act empowers coroners for the first time to investigate stillbirths. At the moment, they cannot do that, because a child who is stillborn is deemed never to have lived, and coroners can only investigate the deaths of humans who have lived. In a minority of cases—this practice was not extensive—children born alive have been designated as stillborn to avoid investigation through the coronial system. There is no reason why, once the further regulations are passed—I hope they will be soon; the Minister is right that the consultation ended last June—that we should not get on with giving coroners the power to investigate where they have reason to suspect that a stillbirth is not as simple or straightforward as it appears and that there might have been some medical negligence, oversight or whatever. If there were clusters of unexplained stillbirths, people might be reluctant to be co-operative in tracking down the details of what happened to that child and afterwards. I would hope, in the interests of providing parents who have already suffered a loss with some degree of closure, at least on what happened to the body of that child, that everyone involved in the national health service and other public agencies would want to be as co-operative as possible.

[Sir John Hayes]

I asked the Minister to consider new guidance for local authorities about both past and present practice, and perhaps my hon. Friend might echo that call by suggesting that the Government should make direct and urgent contact with health authorities, for exactly the reasons he has described, with the same kind of vehemence.

[Tim Loughton]

That is really the point that I was looking to make, but my right hon. Friend has done it much more clearly.

If it had not been her intention already, perhaps a takeaway from this debate for the Minister might be to send a communication around maternity departments, and indeed local authorities responsible for crematoriums and others, to express the hope that they would co-operate and to set out the exact extent of the potential issue that we are dealing with.

Acquired Brain Injury

John Hayes Excerpts

Thursday 6th February 2020 Westminster Hall

[Sir John Hayes (South Holland and The Deepings) (Con)]

Today, like every other day, some 954 people will be admitted to hospital with an acquired brain injury. That is one person every 90 seconds. As the hon. Member for Rhondda (Chris Bryant), who has done such great work to highlight the issue, has already said, all kinds of events can be involved. It could be a brain tumour; I am president of the Lincolnshire brain tumour support group. Alternatively, it could be a traumatic event, such as a car accident or a blow to the head, or something else, such as a stroke. The effects are so varied that they are hard initially to diagnose, and then hard to rehabilitate—but that does not mean that we should not do so.

The initial NHS response to strokes, tumours and dramatic, traumatic events is invariably good, but the multitude and diversity of the effects of these events, as well as the difficulties faced by those with acquired brain injury, will often not be obvious until long after the patient has left hospital. Indeed, the unpredictability of the consequences, as described in the previous speech, is immensely distressing for both the person concerned and those around them. There can be inappropriate behaviour and changes of personality, as well as the obvious matter of decreased capacity.

Proust said:

“Happiness is beneficial for the body, but it is grief that develops the powers of the mind.”

Grief is, of course, for the departed, but it is also for any kind of loss. People grieve the loss of capability and capacity—the inability to do the things they once did or the lost chance to do the things they had hoped to.

I had a serious head injury in my youth, but I was able to do all that I had hoped to. As I have said before, I wanted to be a Conservative MP from the age of seven; when I say that, the hon. Member for Rhondda usually raises his eyebrows in disbelief—right on cue, Mr Robinson, he is doing it again. My head injury did not stop me from achieving that ambition, but it might have done if I had had other ambitions, if the treatment and care I received had been different, or if, to be frank, I had not enjoyed the same good luck.

We cannot be clear either about the pace of recovery, which is also immensely variable—not only is the severity of the effect unpredictable, but so is the speed at which people’s lives can change. Although there can sometimes be a deterioration, more often there is a gradual—sometimes very gradual—improvement. That means that although the adjustment they will have to make, at work and home, to go about their normal affairs will sometimes initially be very great, gradually they will be able to do more and more.

As an all-party group we produced an extremely good report, which was, though I say it myself, very well received. It was the result of a great deal of work, done not just by us—in fact, done rather less by us than by the many people to whom the hon. Gentleman has already paid tribute. The Government gave it a good hearing and we have had a good response from Ministers, but as has already been said repeatedly, the issue requires a cross-departmental approach; I have a long speech here that I am not going to make, but I will highlight some points before allowing others to contribute.

The impact on individuals, in respect of benefits, the education system and possible changes in personality and capability, may mean that they engage in activities, including malevolent activities, in which they would not otherwise have engaged. The criminal justice system has a part to play, as does, accordingly, the Ministry of Justice. There are other things too, beyond health: almost every Government Department has a part in addressing the issue of acquired brain injury.

However, Governments are extraordinarily bad at cross-departmental co-operation and collaboration, as I know having been a Minister in many Departments myself. Unless there is a real determination on the part of Ministers, and probably the Cabinet Office, to pull together the activities of Government Departments—for the most part, by the way, officials resist that; they do not like that kind of thing—things will not improve in the consistent way we want. Some Departments have already done good work, while others have been rather slower to respond to the recommendations in the report—it is available to colleagues and others, so I will not go through those recommendations in detail.

I want to amplify the call made by the hon. Member for Rhondda for a new emphasis on collaboration and for a mechanism to bring that about—probably through a Cabinet Office working party pulling together Ministers from different Government Departments. That can work, as I know from my own time in Government. I implore the Minister to set about the business of putting that in place, following this debate.

I have two other things to say, Mr Robertson. The hon. Gentleman drew attention to neurorehabilitation. A rehabilitation prescription should be made available to all individuals with acquired brain injury on discharge from acute care. It should be held by the individual, with copies made available to the general practitioner. A national review of neurorehabilitation is required to ensure that service provision is adequate. The Government should collate reliable statistics for the number of individuals presenting at A&E with acquired brain injury, and record the numbers that require and receive neuro-rehabilitation. There should be a significant increase in the number of beds, too. I am sure the Minister will want to comment on the whole subject of rehabilitation when she winds up the debate. Those are just a few of the things that we have argued for and to which I wanted to draw the House’s attention, on the back of the remarks made by the hon. Member for Rhondda.

I said I had two further points, and that will not have been lost on you, Mr Robertson. So, finally, I draw attention to the important work that has been done at universities. My own university, Nottingham, is doing important work on both the primary science of the subject and the psychological effects of injury. I hope that the all-party group will go to Nottingham to take a closer look—indeed, we were discussing that yesterday. When the Government work with the higher education sector, they can drive forward public policy changes resulting from important work on assessing the effectiveness of different approaches by public sector, private sector and charitable organisations, such as Headway, of which I am a patron.

Proust also said:

“A change in the weather is sufficient to recreate the world and ourselves.”

When the storm of head injury happens, the skies darken for individuals. Our job as parliamentarians is to bring change to those individuals, through brightening their prospects in all that we do.

--- Later in debate ---

[Caroline Dinenage]

The hon. Gentleman is absolutely right to raise that issue. NHS England has a veterans trauma network, which delivers comprehensive medical care to veterans, including those suffering from brain trauma. It does excellent work, but there are also many individual charities up and down the country that work to support veterans who may not have been diagnosed; they may have been diagnosed with post-traumatic stress disorder or something else, but never actually had the original head injury diagnosed.

Almost as if to highlight the fact that this is a hugely cross-Government issue and the inadequacy of Ministers working in their individual silos, I will today be able to focus massively only on the issues relevant to our health service, but I will try to come on to a lot of the questions that right hon. and hon. Members asked.

[Sir John Hayes]

I am extremely grateful to the Minister for giving way. We had meetings as an all-party group with the former Chancellor of the Duchy of Lancaster, the former right hon. Member for Aylesbury. I believe that at that point there were suggestions, at least, that a Cabinet Office piece of work would be initiated. Can we take it from the Minister’s assurances that she will write to the Cabinet Office colleagues who are now responsible for these matters and copy that letter to participants in this debate?

[Caroline Dinenage]

Yes, I am very happy to commit to doing that.

Before I go on to talk about the health implications of ABI, I want to deal with a couple of other things. They are not within my realm of expertise, but I want to touch on them.

The hon. Member for Mitcham and Morden spoke about the Headway brain injury identity cards—how important they are and how important it is that they are recognised across the criminal justice system. I wanted to mention how Headway has been integral in partnering NHS England’s health and justice liaison and diversion services programme team, to provide workshops in London and Leeds to raise the awareness of the prevalence of ABI within criminal justice populations. The objectives were designed in a “train the trainer” format, so that the attendees could return to their services and cascade the learning on how to identify people with brain injury, how to identify the brain injury cards that Headway has brought forward and how to understand the implications. I thought that was quite positive.

My right hon. Friend the Member for Hemel Hempstead was right to mention the positive progress that has been made in some sports. The Rugby Football Union’s Headcase campaign and the British Horseracing Authority have also made great strides in this area. However, he was also right to say that other sports have a long way to go.

The hon. Member for Rhondda spoke about trauma centres. As he knows, in 2012 22 regional trauma networks were developed across England to ensure that those with the most serious brain injuries received the best care. Two years after their introduction, an independent audit showed that patients had a 30% improved chance of surviving severe injuries. Since then, as he says, the network has saved literally hundreds of lives.

For people who have ABI, neurorehabilitation that is timely and appropriate to their circumstances is a massively important part of their care. Access to high-quality rehabilitation saves money and, more importantly, significantly improves outcomes for patients. NHS England commissions specialised rehabilitation services nationally for those patients with the most complex level of need. As we have already heard, trauma unit teams work to assess and develop a rehabilitation prescription for brain-injured patients. At the unit, patients can access care from specialists in rehabilitation medicine, whose expert assessment helps to inform the prescription.

These rehabilitation prescriptions are an important component of rehabilitation care, because they reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient. The APPG argued that all patients should benefit from an RP; as I understand it, at discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialist or local rehabilitation, supported by the RP. However, I take on board what the hon. Gentleman says about ensuring that the letter and the prescription itself are written in language that people can understand, are easily accessible and are available to them and their family members.

The “National Clinical Audit of Specialist Rehabilitation for Patients with Complex Needs Following Major Injury”, published in 2016, found that, on average, 81% of patients had a record of a rehabilitation prescription. That audit appears to have had a significant impact, because the latest data shows a rise to an average 95% completion rate. In April 2019, the third and final report of the Audit Commission to NHS England’s audit programme was published, and it is encouraging to see that 94% of patients accessing specialist rehabilitation have evidence of functional improvement.

However, the audit report also suggests that much more work needs to be done to ensure that all patients who could benefit from specialist rehabilitation can access it. Using data provided from participating centres, the audit’s authors estimate that the current provision caters for about 40% of those who need the services. To address the capacity issues highlighted, the audit makes a range of recommendations.

It is important to recognise that these audits play a massively valuable role in helping services to improve. They shine a light on variation and help to support services to best meet the needs of patients. However, there will always be different models of improving access to specialist rehabilitation, depending on the set-up of the services around the country. Therefore, local service providers and commissioners should review capacity in the pathways for specialist rehabilitation in the light of this audit, taking action where they can.

The majority of rehabilitation care is commissioned and managed locally, and NHS England has produced some documentation and services plans to help with that. “The Principles and Expectations for Good Adult Rehabilitation” describes what good rehabilitation care looks like and offers a national consensus on the services that people should expect. The NHS long-term plan has also set out some key actions on this, designed to improve care, treatment and support for people with long-term conditions such as ABI.

Community services, which play a crucial role in helping people remain as independent and well supported as possible, are going to receive significant investment, with £4.5 billion of new investment in primary and community care. Furthermore, NHS England has set out plans to roll out the NHS comprehensive model of personalised care, which includes self-care care planning, personal health budgets and social prescribing. It will reach 2.5 million people by 2023-24 and is particularly relevant to people with acquired brain injury. The model is currently implemented across one third of England, but by September 2018, more than 200,000 people had already joined the personalised care programme.

The hon. Member for Mitcham and Morden asked about free car parking. From April, all hospital trusts will be expected to provide parking to groups who may be frequent visitors. I interpret that to mean families visiting people who are in hospital for a long period of time, which I think is what she was asking me.

Health and Social Care

John Hayes Excerpts

Thursday 16th January 2020 Commons Chamber

[Matt Hancock]

Yes, we are doing that work to make sure that, as we pump hundreds of millions of pounds into Hertfordshire to improve its healthcare, we get the exact locations right. I look forward to working with my right hon. Friend on that.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I am extremely grateful to the Secretary of State for giving way, and I know he will move seamlessly from new hospitals to new treatments. I have rushed here from a reception being held today in the House on the subject of tinnitus. Tinnitus affects numerous constituents of his and mine and people across this country, and it is urgent that we do more research and put more funding into the subject.

Will the Secretary of State give me news that I can rush back to the reception with—I am hosting it, while simultaneously being here—thereby giving good news to hundreds of thousands of our constituents?

[Matt Hancock]

I think that is an early warning that my right hon. Friend is going to leave immediately after his intervention. He is quite right to raise the subject. We are increasing the research budget, and I very much look forward to working with him on making sure that that research goes where it is needed. I am very happy to look specifically at the case for increased research funding for tinnitus and to work with him on it. If he were to meet the Lords Minister, who is responsible for the research budget, that would be the most productive way to take this forward.