Health and Social Care

Lord Colwyn Excerpts

Thursday 24th November 2016 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I am sure noble Lords will be grateful to the noble Baroness, Lady Finlay, for giving the House another opportunity to examine the reaction to the result of the referendum on the UK’s membership of the EU, particularly with regard to the health and social care workforce. I am looking forward to hearing from noble Lords, some of whom contributed to the debate introduced by the noble Baroness, Lady Watkins, on 21 July. I am not used to speaking at such a high position on the list and the noble Baroness is probably not used to speaking near the end, but I am sure we are all grateful to the noble Baroness, Lady Finlay, for securing this debate.

I will refer to the situation in the workforce and the implications the result of the EU referendum might have for doctors, nurses and other health professionals, as well as social care workers. I take this opportunity to highlight the fact that Britain’s exit from the EU is likely also to have a major impact on Britain’s fourth-largest healthcare workforce group: the dental professionals. My noble friend the Minister will be pleased that, like the noble Baroness, Lady Finlay, I have managed to refer to my own profession. I declare my interest as a fully retired dental surgeon, a fellow of the British Dental Association and vice-president of the British Fluoridation Society.

Of the 40,000 dentists registered to practise in the UK, close to 7,000 qualified in one of the EU countries outside Britain. Many of them relocated here in the early noughties in response to the well-publicised shortage of NHS dentists at the time, and there is absolutely no doubt that they make a crucial contribution to dentistry in the UK, both in the NHS and in private practice. These dentists’ ability to work in our country is based on the European principle of free movement and the professional qualifications directive. It is of utmost importance that their rights to live, work and have their qualifications recognised here is retained post-Brexit. The failure to do so could lead to a significant workforce shortage in general dental practice and create severe problems with access to dental care for patients in many areas.

Issues with recruitment of dentists for high street practices are already surfacing again in quite a few areas, and I am very concerned that this trend might be aggravated by Britain’s anticipated exit from the EU. It is crucial that EU dental health professionals receive firm and unequivocal assurances that they will be able to continue to practise in the UK following Brexit. We cannot afford to keep them guessing. In fact, the British Dental Association has informed me that it has been receiving inquiries from members who are considering leaving the UK as a consequence of the uncertainty of their status in the wake of the referendum result.

It is all too easy to think that if there is a serious shortage of staff in dental practices as a result of Brexit, we could just plug the gap with dental professionals from outside the EEA, but that is not as simple as it might sound. Any dentist coming to the UK whose qualifications are not recognised under the European professional qualifications directive must sit the General Dental Council’s overseas registration examination. This examination, at over £3,000, is not only incredibly costly but it does not have a particularly high pass rate. Due to the high cost of its administration, it is not held very often, which means that it could take a dentist applying to sit the exam—assuming that they are successful the first time round—more than a year to pass it. Add to this the necessary visas and the lengthy process of equivalence dentists need to undergo in order to be allowed to work in the NHS and it becomes very clear that relying on dentists from outside the European Union to fill the gaps in our dental workforce would not be wise.

Finally, we should not forget that while dentists are first and foremost health professionals, most high street practices are effectively also small independent businesses. This makes many dentists business owners, who invest in and develop their practices through their income and borrowing. Their business running costs are affected by inflation and given that a large proportion of their equipment and materials is imported, they will also be hit by the falling value of the pound.

A possible wider economic downturn that we might experience following Brexit could lead to a further drop in dental practices’ income. This is because many patients view oral healthcare as a discretionary cost—increasingly so in the context of ever-rising dental patient charges. If they need to tighten their belts, many will opt out of visiting their dentist, even if this is detrimental to their oral health. Any such drop in practice income could mean practice owners having to let go of some of their staff or possibly even compromise the financial viability of the entire practice and lead to its closure, leading to potential problems with access for patients who need dental help.

I would be very grateful for the Minister’s assurances that all dentists qualified in one of the countries of the European Economic Area will continue to have their qualifications recognised in the UK post-Brexit, and will be able to continue working in our dental services and serving British patients.

Children: Oral Health

Lord Colwyn Excerpts

Monday 31st October 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the introduction of the sugar levy is evidence that the Government take this matter extremely seriously and believe that it cannot be left solely to industry to reduce sugar levels. The Treasury is due to report on the extent of the sugar levy on 6 December. As part of the obesity strategy, targets are being set for nine key categories of food eaten predominantly by children. The results of reduction over time will be made transparent and open. A combination of those measures should have an impact.

[Lord Colwyn (Con)]

My Lords, although dental decay can easily be prevented by reducing sugar consumption, regular brushing and adequate exposure to fluoride, it has been shown to be the number one reason why children aged five to nine are admitted to hospital. It is painful, can be dangerous and wastes millions of pounds of NHS resources. When will the Government reverse those statistics and facilitate the fluoridation of all public water supplies?

[Lord Prior of Brampton]

My Lords, I think that I have already answered my noble friend’s question on fluoridation. On his second point about regular tooth-brushing, Scotland has a scheme called Childsmile, where there is supervised tooth-brushing in primary schools and nurseries, as well as a fluoride varnish twice a year. We can learn something from Scotland in that regard. It is expensive, but Public Health England is nevertheless looking at it and we may adopt it in our country soon.

Drug-Resistant Infections

Lord Colwyn Excerpts

Thursday 15th September 2016 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I congratulate my noble friend Lord Lansley on securing this debate on what is one of the greatest health and economic challenges of our age. Antimicrobial resistance—AMR—which is causing the rise in drug-resistant infections, is killing around 700,000 people worldwide. In the UK alone, it is resulting in 3,000 deaths a year, with an estimated cost to the NHS in excess of £180 million per annum. Without global action, AMR will kill another 10 million people annually by 2050, according to recent models referenced by my noble friend Lord O’Neill in his recent report on this issue. According to my noble friend’s findings, the increase in death and illness is set to wipe approximately $8 trillion off the world’s annual output by 2050. Previous speakers have referred to Dame Sally Davies, who frightened me when she described the threat of antibiotic resistance as being as great as the threat of terrorism.

The problem has been well documented and assessed; we now need to move on from discussing the problem to supporting the development and rollout of solutions. Policy discussion must go beyond just antimicrobial stewardship and the restriction of the use of existing antibiotics.

I note that at the May 2016 G7 summit, the then Prime Minister stressed the scale of the global problem of AMR and committed the UK to supporting British pharmaceutical companies to be at the forefront of bringing new products to market. Indeed, the report of the noble Lord, Lord O’Neill, called on the Government to provide:

“Better incentives to promote investment for new drugs and improving existing ones”.

I hope that the Minister will be able to reiterate this commitment on behalf of the new Prime Minister. Supporting the development of new antibiotics must be a key policy pillar in the Government’s antimicrobial strategy both at home and abroad.

This afternoon I would like briefly to touch on an example of the types of solutions that exist beyond better antimicrobial stewardship, which is combating AMR at home and abroad. In my career as a dentist, I was aware of some of the important work being done using oxygen in oral health care. I am excited that oxygen is now at the forefront of work to address AMR with the development of reactive oxygen technology.

Reactive oxygen is a British-led innovation which represents a new generation in antibiotics. It works by generating highly reactive, free-radical oxygen species, mainly hydrogen peroxide—one of nature’s fundamental defences against infection. It has been advanced by a small UK company, Matoke Holdings. Its chief executive, Ian Staples, is working with eminent clinicians, researchers and academics across Manchester, Southampton and Birmingham universities, including Dr Matthew Dryden of the University of Southampton School of Medicine and Professor Jonathan Cooke of Manchester University Pharmacy School and Imperial College London. These British scientists have developed a unique technology to precisely control levels and the rate of release of reactive oxygen, harnessing its ability to fight infection. No Gram-negative, Gram-positive or multiresistant bacteria tested to date have survived contact with reactive oxygen in either laboratory or clinic, including MRSA and Pseudomonas aeruginosa.

However, direct use of the gas is prohibited because ozone should not be inhaled. Professor Eddie Lynch, a colleague of mine, has shown that primary root carious lesions can successfully be treated with a novel ozone delivery system able to avoid any toxic risk. The system includes a source of ozone and a dental hand-piece with a removable silicon cup for exposing the tooth’s lesion to the gas. Although it is many years since I observed this treatment, it was very effective, with no side-effects. It could be considered a valid alternative to conventional drilling and filling for the management of primary root carious lesions.

I was delighted to hear from Matoke Holdings earlier this year. Reactive oxygen is one alternative that can play a vital role in tackling drug-resistant infection. The first product from this innovation, Surgihoney RO, is already approved by the EU regulatory body as a topical antimicrobial gel with antibiofilm action for wounds, burns and ulcers, including diabetic, and it has already been prescribed through the NHS. It has also been used by volunteers in Uganda and Ethiopia to prevent and treat infections, taking this British innovation to parts of the world where it is desperately needed. This is made possible given it is a low-cost, effective antimicrobial that is easy to use and does not require refrigeration. But, such innovative products need to be made available more widely to support some of the most vulnerable international communities.

The technology is now rapidly being developed to tackle other complex clinical infections for which conventional antibiotics are failing, including cystic fibrosis, chronic rhinosinusitis and recurrent urinary tract infections. Such technology has huge potential to deliver significant savings to the NHS and international health economies by providing a new effective treatment for chronic wounds, reducing amputations and days spent in hospital and nursing care. Such British innovative technology, which represents a new generation in antibiotics, needs to be brought to the forefront of the policy discussion about how we tackle AMR, both within the UK and globally.

While reactive oxygen technology is being pioneered by one British SME, this needs to be supplemented by strong government support for innovation to address this global challenge at scale and at pace. Investing in British research and development and supporting British enterprise will support our economy and allow us to export solutions to the threat of AMR across the globe. British innovation can still be a leader in the post-Brexit world. I ask the Government to do all they can to put British enterprise and R&D at the forefront of their strategy to combat AMR and to ensure that they look at the innovative new solutions that are already out there.

NHS: Health and Social Care Act 2012

Lord Colwyn Excerpts

Thursday 8th September 2016 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I declare my interest as a retired dental surgeon and a fellow of the British Dental Association. I thank the noble Viscount, Lord Hanworth, for securing this debate. Although I shall need to read his speech in Hansard to make full sense of it, he gives me time to make a brief intervention to remind noble Lords of the importance to the long-term sustainability of the NHS of improving the nation’s oral health and ensuring good dental care.

We were reminded of this very starkly earlier this week when the front page of the Times and other newspapers reported the results of the research carried out by the British Dental Association, showing that 600,000 people a year seek help with toothache from their doctors—their general medical practitioners—who are neither qualified nor set up to deal with dental issues. This puts unnecessary pressure on the system, costing the NHS at least £26 million a year and wasting GPs’ time, resulting in longer waits for people whom they can really help.

People are seeking a free GP appointment instead of going to see a dentist because of the chronic underfunding of NHS dentistry and constantly increasing dental patient charges. The fees for NHS dental treatment continue to rise much faster than inflation and people’s earnings, having gone up by 5% this year and increasing by a further 5% next year. I have been arguing that this unprecedented increase will discourage patients who most need to see the dentist from going to see one, but this latest research clearly shows that it also puts an avoidable burden on the rest of the already-strained NHS.

While NHS care is supposed to be free at the point of use, this latest increase means patients now cover 26% of their NHS dentistry costs—up by more than a third compared with a decade ago. If this trend continues it will take just 15 years before patients pay for most of their treatment. This is set against the backdrop of £170 million of NHS dentistry funding having been cut by the Government since 2010, with patient charges increasingly used to make up the shortfall.

Neglecting oral health puts pressure on not only our general practitioners but our hospitals. The number of people going to A&E with emergency dental problems has been rising sharply and tens of thousands of people continue to be admitted for scheduled tooth extractions. It is frankly a scandal that tooth extractions under general anaesthesia remain the number one reason for hospital admissions in young children, with 160 youngsters and their parents going through this painful and stressful procedure, which is not without its risks, every day. The cost of these completely preventable treatments has gone up by more than 60% in the past four years and now stands at £35 million a year. Again, it is the kind of avoidable pressure our struggling hospitals could really do without. We simply cannot continue to treat oral health as separate and inferior to other areas of health, neglecting prevention and reducing NHS dentistry funding while topping it up with inflated patient charges. It is not only bad for people’s dental and general health; it is also a false economy that puts unnecessary strain on our GPs and hospitals. It is an important part of our health service which we must not overlook when discussing the long-term sustainability of the NHS.

Dental Health: Children

Lord Colwyn Excerpts

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think that the obesity strategy, which will be announced later in the summer, will answer part of the noble Baroness’s question. The new contract for dentists, which will have prevention at its core, is being piloted and will be introduced in 2018. This is a very high government priority.

[Lord Colwyn (Con)]

My Lords, my noble friend talks about the dental contract. Will he tell us when the Government will complete the long-standing delay on dental contract reform? Will they ensure the new contact works for both dentists and patients?

[Lord Prior of Brampton]

My Lords, the new dental contract is under discussion as we speak. Prototypes will be tried in a number of areas over the next two years, I believe. It will be heavily weighted towards prevention, with a high degree of capitation in the contract. It will be very much outcomes-based. I believe that we expect the new contract to be introduced fully in 2018.

Health: Cancer

Lord Colwyn Excerpts

Wednesday 20th January 2016 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I congratulate the noble Baroness, Lady Walmsley, on securing time for this debate. Her excellent speech enables me to bring the dental profession to your Lordships’ attention—again. A speaking slot of four minutes is always very restrictive but I am pleased to be able to make reference to dental professionals, most of whom play an important role in the detection, diagnosis and treatment of many forms of oral cancer.

As we all know well, cancer remains one of the biggest killers and burdens on our health service. In turn, tobacco is by far the biggest preventable cause of cancer, with more than one-quarter of all cancer deaths in the UK being linked to it. Cancers of the head and neck are among the ones most directly linked to smoking, second only to lung cancer. Two-thirds of all cases are as a direct result of tobacco use and as many as nine in 10 cases could be prevented. Oral cancer is also one of the fastest-increasing types of cancer, with cases up by almost 40% in the last decade alone. With almost 7,000 patients diagnosed every year, it now kills more people in the UK than cervical and testicular cancers combined.

With tobacco cessation and early diagnosis being the keys to reducing the incidence and improving the survival rates of this particular kind of cancer, we cannot overlook the important contribution dentists can make in the fight against this terrible disease. Dental professionals are on the front line in the fight against mouth cancer. Dentists are uniquely placed to diagnose oral cancers very early, 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 their diagnosis is delayed. The British Dental Association and Cancer Research UK have recently jointly launched a very useful new scheme called the Oral Cancer Toolkit, which improves dentists’ knowledge of how to prevent and detect oral cancer. This is something that could and should be built on.

Being the only health professionals who regularly see healthy patients, members of the dental team are also in an ideal position to help prevent future cases of oral and other cancers by becoming involved in tobacco cessation. They update the patient’s medical history form, which includes questions on tobacco, during every visit and can often see visual evidence of smoking or chewing tobacco during a check-up or treatment. Trials have revealed that dentists with the right support and access to information on tobacco counselling can contribute significantly to tobacco control measures in the community. It is important that the dental profession is involved in the development and delivery of the new tobacco control strategy, as it is a potential resource we truly cannot afford not to harness in the fight against cancer.

General Dental Council (Fitness to Practise etc.) Order 2015

Lord Colwyn Excerpts

Monday 18th January 2016 Grand Committee

[Lord Colwyn (Con)]

My Lords, I thank my noble friend for his explanation of the order, and I look forward to reading in Hansard what exactly it is. It is complicated. I declare my interest as listed on the register.

I am sure all noble Lords will agree with me that the measures included in the order are a welcome and very long overdue step in the right direction toward speeding up the overall process of complaints handled by the GDC. The current legal framework hinders improvements to the effectiveness and efficiency of this process—improvements which, with a major case backlog and cases costing an average of £78,000 to process, the GDC badly needs. However, I will make some brief comments about some conditions that must be met for the implementation of these changes to make a meaningful difference.

First, the case examiners this order introduces must be properly independent from the GDC, as well as appropriately trained and supported in carrying out their new duties. The success of the new system will lie with the calibre and qualifications of the individuals carrying it out. Case examiners might be exposed to significant internal and external pressure when carrying out their functions, and their credibility will ultimately rest on their independence from the GDC. It is also crucial that the clinical case examiner should always be a professional from the same profession as the individual whose case is being examined. That is very important.

However, it is equally important that, for the new system to bring the expected time and cost savings, we need to see a proper culture change in the regulator’s management of fitness-to-practise cases. The BDA has raised with me the hard-line approach of the GDC in its fitness-to-practise investigations. Dentists say that the GDC tends to treat even the most vexatious or minor complaints as potential cases, which leads to heightened and often undeserved stress for the dentists concerned. I share their fear that if this culture prevails, the new case examiners might simply become an additional layer in the fitness-to-practise process, without any meaningful reduction of case loads and costs.

I hope that the GDC will take these points into consideration when implementing the order, so that these changes achieve a decrease in the cost and increase in the speed of decision-making in fitness-to-practise cases—which we all want to see.

National Health Service

Lord Colwyn Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I declare my interest as a now fully retired dental surgeon with over 40 years’ experience and a fellow of the British Dental Association.

All too often when we speak about our health system, oral health is conspicuously absent from the debate, and this morning is no exception so far. Both the Government and Opposition seem united in seeing a more integrated approach to delivering health and social care services as the key to ensuring the future sustainability of the NHS. It is essential that dentistry is factored in and included in any wider health strategies, and that the interplay between oral health and general health, and dentistry budgets and other NHS budgets, features in any discussions on healthcare provision.

An excellent report published by the Faculty of Dental Surgery reveals how much further we need to go in our fight against tooth decay. A third of five year-olds in England are still suffering from caries, and within that group the average child has at least three teeth affected. It is simply shocking that in this day and age tooth decay—an entirely preventable condition—continues to be the most common cause of hospital admissions among five to nine year-olds, with 500 primary school-age children requiring hospital treatment every week. This not only causes the children and their parents unnecessary stress and pain but is also a complete waste of NHS resources, costing the taxpayer over £30 million a year.

A fifth of five year-olds eligible for school meals have severe or extensive tooth decay, compared with just one in 10 among those from more privileged backgrounds. The situation is particularly alarming considering that approximately 90% of dental problems are preventable and the damage they cause is cumulative and costly. We must also raise awareness of the risks of tooth decay, especially of the impact of sugar consumption on children’s teeth. I fully agree with the BDA that no option should be left off the table in the efforts to end Britain’s addiction to sugar. Possible measures range from lowering the recommended daily allowance, through action on marketing and labelling, to possible sales taxes.

I also urge the Minister to consider investing in a national oral health programme to drive improvements in children’s oral health in England, following and learning from the success of such programmes in Scotland and Wales. I once again urge the Government to consider the overwhelming worldwide scientific evidence which clearly points to fluoridation being a safe and effective way to fight caries and narrow the significant inequalities in children’s oral health across the country, and to encourage local authorities that do not yet use this resource to introduce water fluoridation schemes.Noble Lords will all agree with me that a shift in focus from treatment to prevention is crucial if we are to ensure the NHS will be able to face the challenges of the future. This statement is as true in the area of dentistry as it is elsewhere in our health system.

My time is up. I was going to say a few things about oral cancer and the importance of the dental team in the new tobacco control strategy, and was going to bring your Lordships good news of a dental treatment that does not involve drilling.

Atrial Fibrillation

Lord Colwyn Excerpts

Wednesday 4th November 2015 Lords Chamber

[Lord Colwyn (Con)]

My Lords, everything that could be said probably has been. I declare an interest as a member of both the AF APPG and the stroke APPG. We have meetings tomorrow, as we have heard. I also have personal experience of living with AF for many years.

Atrial fibrillation is the most common sustained cardiac arrhythmia and estimates suggest that its prevalence is increasing. If left untreated, atrial fibrillation is a significant risk factor for stroke and other morbidities. Men are more commonly affected than women and prevalence increases with age.

It has been suggested that AF can be detected by a simple pulse check. I have found that a pulse check should be verified with an oximeter. It is difficult to self-diagnose irregular cardiac rhythms that are often in excess of 150 beats per minute without the use of an oximeter. Perhaps that is what the GRASP machine is; I had not heard of it before. AF affects around 1 million people in the UK. Sometimes the condition does not cause any symptoms and a person with it may not be aware that their heart rate is irregular. It is important that AF is diagnosed so that medical practitioners can decide when active treatment is needed.

The aim of treatment is to prevent complications, particularly stroke, and to alleviate symptoms. Drug treatments include anticoagulants, to reduce the risk of stroke, and antiarrhythmics, to restore or maintain the normal heart rhythm or to slow the heart rate in people who remain in atrial fibrillation. Non-pharmacological management includes electrical cardioversion, which may be used to shock the heart back to its normal rhythm, and catheter or surgical ablation to create lesions to stop the normal electrical impulses that cause atrial fibrillation. I have had both of these techniques.

There are also new updated guidelines that address several clinical areas in which new evidence has become available, including stroke and bleeding risk stratification, the role of new antithrombotic agents, and ablation strategies. The recommendations apply to adults—those aged 18 years or older—with atrial fibrillation, including paroxysmal, persistent and permanent atrial fibrillation, and atrial flutter. They do not apply to people with congenital heart disease precipitating atrial fibrillation.

Sadly, many people with AF are not diagnosed and many who have been diagnosed do not receive the anticoagulation treatment that they need. Between April 2014 and March 2015 only 38% of patients with diagnosed AF who were admitted to hospital with a stroke were being treated with anticoagulants. It has been estimated that as many as 700,000 people in the UK may have undiagnosed AF.

In recent years several anticoagulants, known collectively as non-vitamin K antagonists, have been recommended by NICE. Under the NHS constitution, patients should have access to the full range of treatment options recommended by NICE. However, data from NHS England reveal that only 11% of patients being prescribed anticoagulation are receiving these treatments. Improving access to the full range of anticoagulation therapies would bring benefits to patients and the NHS. The Government have estimated that up to 7,100 AF-related strokes could be prevented annually if everyone with AF were appropriately managed.

Since 2012 four novel oral anticoagulants have been recommended by NICE as both clinically effective and cost-effective for the prevention of strokes in patients with AF. These treatments should now be available to all patients whose doctors wish to prescribe them. Their use is increasing, but it is lower than expected. All healthcare professionals caring for people on anticoagulation therapy should be familiar with the full range of treatment options. Despite having a NICE recommendation as being clinically effective and cost-effective, many GPs appear to lack confidence in the use of NOACs to prevent AF-related strokes.

Primary Care: Targets

Lord Colwyn Excerpts

Tuesday 13th October 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord makes a very perceptive point. Demography is driving healthcare. The whole thrust of government policy is to treat as many people as possible outside acute hospital settings. Over the next five, 10, 20 years, I expect to see a far greater share of the health budget going to primary and community care, and a lower percentage to acute care.

[Lord Colwyn (Con)]

My Lords, in view of the massive costs of agency staff working in the NHS, could not the Government consider setting up their own agency?

[Lord Prior of Brampton]

My Lords, it is our intention —for all kinds of reasons; cost, safety and quality of care—to reduce our dependence upon staffing provided by agencies. We would much rather see staff employed on a permanent basis or through hospital banks.