Health Service Safety Investigations Bill [HL]

Lord Colwyn Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I declare my interest as a retired dental surgeon with more than 40 years’ experience of clinical dentistry. I am a fellow of the British Dental Association, and I served on the council of the Medical Protection Society and chaired its dental section, Dental Protection, from 1995 to 2001.

I am pleased to see the Bill return in the current parliamentary Session. It has already had a lengthy gestation period, dating back to a 2015 report from the Public Administration and Constitutional Affairs Committee of another place. I hope that the Bill survives the current political situation, perhaps as carryover legislation.

My remarks will focus on the relationship between the new provisions in the Bill and existing legislation. Many medical practitioners working in the NHS today do so under immense pressure, but it remains one of the safest healthcare systems in the world. Colleagues in the dental profession welcome scrutiny of their practice and are always keen to learn and improve. Yet it must be said that there remains some suspicion about how the regulator, the General Dental Council, operates and that, for a variety of reasons, newly qualified dentists are increasingly deterred from the prospect of a career offering NHS dentistry.

Whether it is the onerous and detested dental contract, which fails to incentivise the prevention of tooth decay, or the fact that government funding for NHS dentistry per capita in England has fallen by 29% in real terms since 2010, we face a genuine recruitment crisis for NHS dentists. Three-quarters of practice owners report struggling to fill vacancies—up from half just two years ago. Practices are closing in large numbers as they struggle to recruit and to make ends meet under the current dental contract. It is important to remember that high street dental practices are run like small businesses. Owners must invest their own funds to set up and operate the practice, all at considerable personal risk. Unless there is a change of direction, we will soon face an even greater exodus of dentists from the NHS. With these points in mind, we must not only ensure that the current NHS contract is replaced and proper investment secured but create an attractive working environment for NHS dentists, where they feel confident that they are valued and supported and they are not treated as scapegoats on the rare occasions when clinical errors occur.

It is sad to hear anecdotal evidence from the British Dental Association that younger dentists increasingly report being more risk averse in their practices by, for example, referring patients to hospital more frequently, thus putting further pressure on other parts of the NHS. Such is the culture of fear in which they now operate. It is crucially important that any learning from clinical incidents takes place without recourse to a blame game. I welcome the spirit of the Bill in this respect, while the references to “no blame” and “improvement of systems” in the text are welcome. Nevertheless, these phrases are thin on the ground, especially as the word “punished” is used in Clause 37. More information is needed on how it is proposed to avoid completely any focus on blame.

When placing dental treatment under investigation, we must act in a proportional manner, particularly in cases of so-called “never events”. For example, removing the wrong tooth is of course both unfortunate and alarming for a patient, but it is vastly different from removing the wrong kidney or limb. I therefore hope that any new investigatory framework for clinical incidents would be able to differentiate between the varying severities of incident both fairly and transparently. Additionally, I would welcome some clarification by the Minister on the following three points.

First, how will the proposed Health Services Safety Investigations Body interact with the existing patient safety functions of NHS Improvement, with its national reporting and learning system and the patient safety incident management system? Will it replace those functions or work alongside them? Secondly, how will we ensure that dentists and other NHS staff are not being investigated by different bodies at the same time? I am not sure that the current wording in the Bill is strong enough when it comes to the HSSIB working together with other bodies. We must be sure to avoid completely any risk of “multiple jeopardy” in this regard. Thirdly, how will the HSSIB work with others to ensure that issues are handled by the most appropriate organisation in the first instance? Furthermore, we must consider the threshold at which the HSSIB would investigate. When would an incident be considered serious enough to investigate, and what would be the trigger?

In the Queen’s Speech, reference was made to the body being “professionally led”. I cannot ascertain whether the clause on medical examiners is intended to address this. It is not clear and seems to be more about local NHS offices. Being “professionally led” would suggest that the chief investigation officer and part of his team are members of the health professions, but I cannot see that this is defined.

Lastly, the Bill relates to the NHS, but issues also arise in the private sector. Given the current discussions and concern about botched cosmetic procedures, is this not a problem that also needs to be addressed? I reiterate that the focus of the Bill really does need to be on learning and improving systems, not on blaming individuals. With that in mind, I welcome the spirit of the Bill and look forward to more detailed scrutiny at Committee stage.

Children: Oral Health

Lord Colwyn Excerpts

Tuesday 12th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness makes a very important point about ensuring that dental care is available and accessible to all. Dental commissioning responsibilities are for NHS England, which is responsible for ensuring that dental services meet local needs and helping individuals who are unable to access a dentist. She has raised a very important point about access for those with learning disabilities and I shall ensure that this is raised within the department.

[Lord Colwyn (Con)]

My Lords, we will not reduce oral health inequalities if we do not ensure that every child is able to get their free NHS dental check-up. Dentists’ morale is so low that every week NHS dental practices are closing, leaving some patients facing a 90-mile round trip to find a dentist. A recent survey showed that three in five of all NHS dentists are planning to scale down or leave the NHS in the next five years. Government funding has fallen in real terms and we are waiting for the rollout of the new dental contract, work on which started eight years ago. Will my noble friend comment on these important changes? Programmes such as Starting Well Core will not able to help any children if there are no NHS dentists left to deliver them. I declare my usual interests, which include vice-presidency of the British Fluoridation Society.

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question; he is of course very expert in this area. We want NHS dental services to be attractive for the profession and we remain committed to reforming the dental contract, which should help, but we recognise that there are a range of reasons for contracts being handed back, whether it is retirement, a decision to concentrate on private work or, in some cases, reorganisation of the companies providing the service. It is important that NHS England works with other local dentists to ensure that patients can continue to access dental care. There is a level of concern about recruitment and retention of dentists, and those difficulties need to be addressed by NHS England in its role as the commissioner. It is continuing to ensure that it works collaboratively with the profession and the department is keeping a close eye on this.

The NHS

Lord Colwyn Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I welcome the debate of the noble Lord, Lord Darzi. I must also declare my 40 years in the NHS and that I am a fellow of the British Dental Association.

In 1948, the nation’s dental health was in a worse state than that of defeated and occupied Germany; decay and gum disease were rife and more than three-quarters of the adult population had complete dentures. The creation of the NHS meant that, for the very first time, dental care was free at the point of use and the demand was overwhelming. By late 1948, more than 80% of practising dentists had signed up to work in the NHS and, in the first nine months of its existence, NHS dentists provided over 33 million artificial teeth, performed 4.5 million extractions and put in 4.2 million fillings. By 1951, the NHS started running out of money and so charges for dentures were introduced—the first charges of any kind for NHS treatment. This controversial move caused much debate and led to the resignation of Aneurin Bevan. Charges for other types of dental treatment soon followed and, to this day, dentistry remains the only part of the NHS that is not free at the point of use.

NHS dentistry today looks very different from the way it did 70 years ago. Modern technology means that dentistry today is relatively pain free compared with the dentistry of the past. Our nation’s oral health continues to improve and most of us keep at least some of our own teeth past the age of 85. Satisfaction with NHS dentistry is at a record high. Despite an estimated 10 million adults in the UK reporting dental anxiety and 6 million experiencing dental phobia, 85% of patients rate their NHS dental experience as positive.

We cannot, however, afford to be complacent. Although oral health on average is steadily improving for the general population, there are still unacceptable variations in outcomes, depending on where you live. Almost half of five-year-old children living in places such as Pendle, Rochdale or Burnley have tooth decay, but a mere 5% are affected in Waverley or Guildford. Tooth decay remains the leading reason for hospital admissions among young children, despite being almost entirely preventable—a scandal in 21st-century Britain. Increasingly, there are also problems with access to NHS dentistry in many areas. A recent BBC investigation revealed that only 52% of dental practices were able to accept new NHS patients. Almost half of all adults in England—a total of 21 million people—have not seen an NHS dentist for over two years.

The reasons for that can be traced back to two main problems: the lack of funding and a failed dental contract. NHS dentistry has been chronically underfunded in recent years. Nominal spending on dental services per capita fell from £41 in 2013 to £36 in 2017. This drop is even greater if we take into consideration inflation and the rising cost of dental materials. At the same time, patient charges in England have increased at an unprecedented pace—a 5% rise each year for the past three years. Data shows clearly that this fee makes many people delay going to the dentist until the problem has escalated, ultimately requiring more expensive treatment.

The second reason for problems with dental access and rising inequalities in England is the way that dentistry is commissioned. The failed NHS dental contract effectively sets quotas on the number of patients a dentist is able to see on the NHS.

[Baroness Manzoor]

I am so sorry. We are running late and have to go to the next speaker.

[Lord Colwyn]

I have only one more sentence. It has led to such low morale in the workforce that 58% of dentists are looking to leave the NHS in the next five years.

The Long-term Sustainability of the NHS and Adult Social Care

Lord Colwyn Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I declare an interest as a retired dental surgeon and a fellow of the British Dental Association. I am sorry I was not on this committee. It was well organised and the noble Lord, Lord Patel, deserves our congratulations. He assured me that it was his hope that the debate would provide an opportunity for Members to speak about the broader issues facing the health and social care systems in our country today. With this in mind, my noble colleagues will not be surprised to hear that I am keen to turn the attention of the House towards the question of where oral health and dentistry sit in the wider context of the NHS being able to meet its future demands.

More and more studies now confirm what dentists have always suspected—that a healthy mouth is a gateway to a healthy body, and that neglecting oral health can sabotage our long-term overall health. Tooth decay and gum disease are increasingly linked to heightened risk of serious health problems such as stroke, heart disease and diabetes, yet funding for NHS dentistry has fallen by 15% in real terms since 2010, while patient charges have gone up by an inflation-busting 5% in each of the past three years.

Underfunding NHS dentistry might seem tempting in a time of austerity, but such thinking is short-termist and wholly counterproductive. Patients who cannot find an NHS dentist or delay treatment due to its cost end up piling huge pressures on other parts of the NHS. Every year, hundreds of thousands of patients seek free help for dental pain from their GPs or at their local A&E, which is not equipped to cope with and help them. Add to that the cost to the economy of sleepless nights and lost working days caused by tooth pain, and it becomes even clearer that cutting dental services is not only bad for the patients but a false economy.

The number of children going to hospitals to have decayed teeth extracted under general anaesthetic is rising fast, with the latest figures released earlier this month showing that a child in England is admitted to hospital every 10 minutes for this almost entirely preventable condition. Public Health England estimates that around 60,000 school days a year are missed as a result, not to mention the wasted £36 million that these preventable procedures cost. All things considered, it is appalling that more than four in 10 children in England have not seen a dentist for over a year, even though they should ideally have a check-up every six months. We must make sure that we improve access to NHS dental services so that both children and adults can attend regular check-ups, get a timely diagnosis and get appropriate treatment for any problems early on.

The past few months have seen one local newspaper after another announce acute shortages of NHS dentists in their area, as practices struggling to make ends meet under the current dental contract have been quitting the NHS in large numbers. This brings into sharp focus the urgent need to deliver a reform of the dental contract. It is crucial that we introduce a new, more preventive contractual basis for NHS dentistry. This April sees the 12th anniversary of the introduction of the current dental contract, which is not only widely detested by dentists and discredited by health policy experts but, more importantly, is bad for patients because it rewards dentists for carrying out interventions rather than for keeping their patients healthy to avoid them. Shifting the focus to preventive treatment would not only yield long-term savings but improve the quality of life across the country. Dentists were promised a new, improved contract back in 2010 but, with Ministers recently announcing that pilots of the new arrangements will run for at least another two years, it looks like this badly needed reform is being kicked into the long grass.

With tooth and gum disease linked to many other costly health conditions, such as diabetes and heart disease, our health system cannot afford to wait much longer for NHS dentistry to be commissioned in a way that makes a decisive break from activity targets and puts prevention squarely in the centre. The British Dental Association tells me that dentists want to be paid for keeping their communities healthy, not for the number of treatments performed. That is what makes most sense for the long-term sustainability of our NHS too. We cannot achieve improvements in oral health with a system that continues to offer perverse incentives to treat instead of rewarding dentists for preventing disease.

Finally, much progress has been made in the field of oral health and dentistry over the past few decades, and that momentum cannot be allowed to falter. A new, improved contract, a focus on prevention rather than cure and making sure that dental services are properly integrated with the rest of the NHS are essential components not only in delivering cost-effective dentistry but in improving general health outcomes for the British people.

Antimicrobial Resistance

Lord Colwyn Excerpts

Thursday 8th March 2018 Grand Committee

[Lord Colwyn (Con)]

My Lords, I congratulate the noble Baroness on securing this debate on the risks of antimicrobial resistance, or AMR. Although it is last on the list of the short debates this afternoon, this debate follows quite nicely on from the debate we had on 22 November last year when we discussed the same sort of problems. The standard of wound care was the main subject then.

The global threat of AMR, in both human and economic cost, has been well documented. I will not repeat the statistics of the grave consequences that are predicted if we do not act. I shall have to read what the noble Baroness said. It sounded terribly complex, but I will catch up with it tomorrow.

As noble Lords will know from past debates, I have been a champion of research and development to create new treatments so that we can get ahead of the superbugs. I have been greatly impressed by the work of Matoke Holdings. This small British biotech firm has pioneered reactive oxygen technology, a novel antimicrobial, initially as a treatment for serious infected wounds. This could be ground-breaking in tackling antimicrobial resistance. I do not have any financial interest to declare, but I have an interest in that my younger brother recently lost a leg from MRSA and the remaining leg was successfully treated with reactive oxygen technology. Professor Davies has warned in the past of apocalyptic consequences if antibiotics stop working. Overuse of antibiotics is speeding up the rate at which bacteria evolve, making common infections much more difficult to treat. With a lack of significant investment in antimicrobial R&D from big pharma companies, it falls to small and medium-sized enterprises, such as Matoke, to put in the leg work to develop new products to meet the global AMR challenge. However, for SMEs in particular, the cost and timescale of the R&D process is a significant challenge.

I was pleased to see in the Government’s response to the Accelerated Access Review at the end of last year the announcement of a new accelerated access pathway to support R&D for the most innovative products. The pathway will designate around five breakthrough products a year, which will receive bespoke support from government to take new innovations from lab bench to bedside. Given that there have been no new antibiotics in the past 30 years, the pathway is an excellent opportunity to speed up the development of new antimicrobials and to get ahead of the AMR threat. Will the Minister confirm whether the pathway will prioritise novel antimicrobials when allocating breakthrough product status? Will the Minister join me in meeting Matoke to get a first-hand account of the challenges faced by SMEs on the front line of the struggle against AMR?

Dental Care

Lord Colwyn Excerpts

Thursday 1st February 2018 Lords Chamber

[Lord O'Shaughnessy]

I am afraid I do not recognise the picture that the noble Baroness paints. She is quite right that 25% of five year-olds are not decay-free; obviously, that is not good enough, but that figure has been increasing over the past 10 years. I should also point out that there are more dentists practising in NHS dentistry than ever.

The noble Baroness is quite right that a pilot has been going on in 75 dentists’ surgeries. An evaluation report will be produced by the deputy Chief Dental Officer in the next few months. That will set out the path toward the full reform of the dental contract.

[Lord Colwyn (Con)]

My Lords, dental care would be improved by the addition of fluoride to the water supply. This has been agreed by my noble friend and his department, but not all water authorities are prepared to take this step. In the last decade, dentists’ average earnings have gone down by a third in real terms. This is of great concern to dentists, who do not receive any government funding and have to cover all costs—equipment, staffing and training—unlike medical general practitioners. I declare an interest as vice-president of the British Fluoridation Society. According to a recent BDA survey, more than half of all dentists intend to leave NHS dentistry in the next five years. Perhaps my noble friend could start by looking at the current salary structures and contractual arrangements.

[Lord O'Shaughnessy]

We have talked about fluoridation a lot in this House recently. My noble friend knows the position: it is up for local areas to come forward with proposals. On his particular issue about dentists, they are doing a fantastic job in the NHS. We have more of them than ever. I want to point out that the 1% cap that was applied—we know that was because of the fiscal retrenchment that has had to take place in this country—no longer applies; indeed, we are waiting for dental review bodies to report on it so that we can arrange future payments for dentists.

Health: Atrial Fibrillation and Stroke

Lord Colwyn Excerpts

Tuesday 12th December 2017 Lords Chamber

[Lord O'Shaughnessy]

Yes, I shall certainly write to NHS England to find that out, and I will write to the noble Baroness with that information.

[Lord Colwyn (Con)]

My Lords, it is quite clear that many people do not receive the anti-coagulants that they need, and my noble friend has reminded us of the figures relating to those suffering from this problem. Since 2012, four novel oral anti-coagulants—NOACs—have been recommended by NICE as both clinically and cost effective for the prevention of stroke in patients with AF. Their use is increasing but is lower than expected. Can my noble friend explain why access to the full range of anti-coagulation therapies is not acceptable to many GPs, who appear to lack confidence in their use of NOACs, and why some patients are still being given aspirin to prevent AF-related stroke? I should declare my interest as an officer of both the Arrhythmia Alliance and the Atrial Fibrillation Association.

[Lord O'Shaughnessy]

My noble friend is quite right to highlight the benefits that come from new treatments. We clearly have a long way to go, as half the people presenting with strokes have not had those anti-coagulants, but there has been an increase in the number of pre-stroke patients receiving anti-coagulants, up from 38% to 53%, so it is an improving picture. The NICE guideline recommends the use of anti-coagulants and, critically, encourages patient choice for the new breed of NOACs and DOACs. There is very clear guidance within the system. It is getting better, but there is some way to go.

Children: Oral Health

Lord Colwyn Excerpts

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is quite right that fluoridation is effective. The 2012 Act allows local areas to choose to introduce it—with local legitimacy, which is important because this issue still stirs passions. We encourage any local area considering this—I believe that Greater Manchester is one—to look at the study my noble friend mentioned in order to see its effectiveness.

[Lord Colwyn (Con)]

My Lords, I am delighted that my noble friend mentioned the dental contract because the current target-driven contract was introduced in 2006. The Government committed to reforming it in their 2010 manifesto, but progress has been very slow. The latest reports speak of a national rollout no earlier than 2021. We urgently need a new contract that rewards prevention. Does my noble friend not agree that patients and dentists should not have to wait so long?

[Lord O'Shaughnessy]

Yes, I agree with my noble friend. Preventive care is important. Pilot schemes have been going on in 75 practices to look at incentivising preventive care and population care. I understand that an evaluation report of that first full year of prototyping is due to be published in the new year.

--- Later in debate ---

[Lord O'Shaughnessy]

I am certainly happy to look again at that issue because we know the benefits of fluoridation. That is one reason why more children are having fluoride varnishes, for example.

[Lord Colwyn]

My Lords, I forgot to declare my interest, so I apologise.

NHS: Wound Care

Lord Colwyn Excerpts

Wednesday 22nd November 2017 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I congratulate the noble Baroness, Lady Wheeler, on her explanation of the follow-up questions asked by the noble Lord, Lord Hunt, on the development of a strategy for standards of wound care in the NHS. If noble Lords will permit, I shall establish the context in which wound care sits within the pressures faced by health services. I do not have any financial interests to declare.

It is no exaggeration to say that improving wound care in the NHS is a crucial part of tackling one of the greatest health and economic challenges of our age: antimicrobial resistance. AMR is causing a rise in drug-resistant infections, killing some 700,000 people worldwide. In the UK alone, it results in 3,000 deaths a year, with an estimated cost to the NHS in excess of £180 million a year. Without global action, according to the 2016 report of my noble friend Lord O’Neill on this issue, AMR will kill another 10 million people annually by 2050. According to my noble friend’s findings, the increase in death and illnesses is set to wipe approximately $8 trillion off the world’s annual output by 2050. Discussing how we can improve wound care is vital to addressing the challenge of AMR.

Some of the most challenging wounds are skin and soft-tissue infections. These include infections of skin, tissue, fascia and muscle. SSTIs are the second most common infection in hospitals. They often involve the invasion of deeper tissues and typically require significant surgical intervention. Between 7% and 10% of hospitalised patients are affected by SSTIs and such infections are very common in the emergency care setting. For complicated SSTIs, the response to therapy is often complicated by underlying disease states, such as infected burn wounds and deep-space wound infections. These infections are often limb or life-threatening.

A significant body of research on SSTIs has been conducted by Dr Matthew Dryden, clinical director of infection at Hampshire Hospitals NHS Foundation Trust and at Public Health England. Dr Dryden has highlighted that SSTIs are some of the most common infections, suffered by everyone at some point in their lives and encountered by all doctors. However, it is clear that if we are to improve the way the NHS addresses wound infections and halt the rise of antimicrobial resistance, new treatments are needed. Thankfully, along with colleagues at the Universities of Manchester, Birmingham and Southampton, Dr Dryden has been working to develop an extremely promising new treatment based on reactive oxygen technology.

At this point I have a personal interest to declare, as my younger brother suffered wounds infected with MRSA, C. difficile and pseudomonas. Despite hospitalisation and intravenous antibiotic treatment over three years, the bacteria were antibiotic-resistant and, after he eventually developed sepsis, to save his life his leg was amputated. Following this, a further wound developed, showing pseudomonas. Having read about the success experienced with reactive oxygen and the work carried out by Claire Stephens and her charity Woundcare4Heroes, I was able to introduce them to my brother’s clinical team. His wound has since been successfully treated with reactive oxygen and I am pleased to say that the bacteria have cleared and the wound is now fully healed—although he is still minus one leg.

The research and development of reactive oxygen is being led by a British biotechnology SME, Matoke Holdings, which is committed to meeting the challenge of antimicrobial resistance. In my career as a dentist, I was aware of some of the important work being done using oxygen in oral healthcare, about which I have spoken in previous debates. I am excited that oxygen is now at the forefront of work to address wound care and AMR, with the development of reactive oxygen.

Reactive oxygen is a British-led innovation that represents a new generation in antimicrobials and offers a breakthrough in medical research. In both laboratory and clinical tests, reactive oxygen has been proven an effective treatment of Gram-positive, Gram-negative, multi-resistant and pan-resistant bacteria. Indeed, research has demonstrated that it can kill many of the priority superbugs highlighted by the World Health Organization.

The first product based on this technology, a medical device, is already approved by the EU regulatory body and being prescribed through the NHS. Such technology has huge potential to save lives and deliver significant savings to the NHS by providing an effective new treatment for chronic wounds. This can reduce the number of amputations and days spent in hospital with nursing care. Scientific research suggests that the technology has a far wider potential, including as a stimulant of tissue regeneration and in the treatment of urinary tract infections and respiratory infections.

I am aware that Matoke is going through the pharmaceutical regulatory approval process, involving clinical trials, to address infected human soft tissue. Such innovative British technology, which represents a new generation in antibiotics, needs to be brought to the forefront of the policy discussion about wound care, both within the UK and globally. However, the cost and timescales involved in research and development are a hindrance to bringing new treatments into the NHS. Given the scale of the AMR threat, public bodies need to do more to identify the most promising potential solutions and help push these forward.

I welcome the announcement of the new accelerated access pathway, chaired by Sir Andrew Witty, which I hope will accelerate the development of reactive oxygen and bring transformative treatments to patients in the NHS as a priority. I hope that Sir Andrew will consider reactive oxygen as a candidate for the pathway. If the Government are to deliver on their bold commitment to meet the global AMR threat, they also need to include specific support for SMEs involved in the development of new antimicrobials in their response to Sir Hugh Taylor’s life sciences strategy.

Britain is a world leader in scientific research. Improving the standard of wound care in the NHS will require us to improve how we translate this research into new wound care treatments in the NHS. I believe that reactive oxygen offers one of the most exciting prospects for achieving this. I would be grateful if the Minister would meet Matoke Holdings so that he can hear first-hand the challenges faced by SMEs working on the front line to make new wound care treatments available to the NHS.

Alcohol Abuse

Lord Colwyn Excerpts

Thursday 30th March 2017 Grand Committee

[Lord Colwyn (Con)]

My Lords, I am pleased to be associated with the short debate this afternoon in the name of the noble Lord, Lord Brooke of Alverthorpe, as it enables me to make a few comments relating to my personal expertise and draw the attention of noble Lords to the effects that alcohol and excess alcohol have on the mouth, larynx, pharynx and oesophagus and the consequential costs to the NHS. I declare my interest as a retired dental surgeon and a member and fellow of the British Dental Association. I am a vice-president of the British Fluoridation Society and a life vice-president of the Society for the Advancement of Anaesthesia in Dentistry.

Alcohol and lifestyles closely associated with alcohol can have detrimental effects on dentition—dental erosion, dental caries and periodontal disease being the most common. The new dental contract reflects the aims of the UK Government to focus the attention of dental healthcare professionals on quality, treatment outcomes and how well their patients are looked after. There is now more emphasis on health promotion. Since alcohol misuse affects patients’ general health, tackling that abuse is therefore important for primary care dental professionals from a purely dental perspective. Addressing this in primary care settings also enables dental professionals to meet wider health promotion responsibilities.

As we have already heard, alcohol causes at least seven different types of cancer, and oral cancers are among those most closely linked to drinking. About 70% of people diagnosed with oral cancer are heavy drinkers. There are almost 7,000 diagnoses a year. This means that almost 5,000 heavy drinkers will be struck by mouth cancer every year. The risk is even greater for those who tend to drink and smoke at the same time. It is estimated that heavy drinkers and smokers have 38 times the risk of developing oral cancer than those who abstain from both products.

This particularly debilitating disease, which kills thousands and leaves many of the survivors with disfigured faces and difficulty in eating and speaking, is, worryingly, one of the fastest-increasing types of cancer, with cases up by almost 40% in the past decade. It now kills more people in the UK than cervical and testicular cancer combined. Yet awareness of it and of the role that drinking and smoking play in causing it remains stubbornly low.

Dental professionals are on the front line in the fight against cancer. Dentists are uniquely placed to diagnose oral cancer very early on before the patient notices any symptoms and seeks help. This is crucial, as mouth cancer patients have a 90% chance of survival if the condition is detected early, but this plummets to just 50% if the diagnosis is delayed. As dental teams are the only health professionals who see healthy patients on a regular basis, they are also in a unique position to provide brief advice and support to their patients who drink above the lower risk levels, warning them not just of the increased risk of oral cancer but also of the possible periodontal disease and tooth erosion that is associated with drinking some types of alcohol. Where appropriate, dental professionals can signpost higher-risk patients to their GP or local alcohol services, with such early intervention helping to save the NHS money further down the line.

Screening and primary dental care would involve similar strategies to those used by primary medical practitioners, using the same valid and reliable questionnaires and motivational interventions developed in psychology. These have been found to be effective and cost-beneficial in some dental settings. Although suitable screening tools and treatment interventions are available, it is unclear which of them are most effective and precisely how and when they should be deployed in primary dental care. It is clear, however, that the dental team can contribute and that this contribution fits well with its responsibilities and interests.