Queen’s Speech

Lord Colwyn Excerpts

Thursday 19th May 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 am sure that noble Lords will not be surprised to hear that in my remarks I am keen to turn the attention of the House towards the important but too often overlooked field of dentistry and oral health. As noble Lords will probably realise, the noble Baroness, Lady Benjamin, virtually made my speech word for word, but that is the problem with getting briefs from the same source.

Yesterday, I was disappointed to discover that the Government have yet again continued to kick the badly- needed reform of health regulation into the long grass. In the wake of the Francis inquiry back in 2013, the Prime Minster pledged to sweep away the outdated and inflexible legislation governing health regulators. Yet, despite repeated commitments to reform of the regulation of health professionals, three Queen’s Speeches later parliamentary time has still not been found to introduce a Bill which would simplify and modernise the regulatory framework for dentists and more than a million of their fellow healthcare workers in Britain. The complex, burdensome and frankly antiquated laws we currently have in place hurt patients and practitioners and cost time and money. Will the Minister set out a clear timetable for action in this area?

While there was no mention of improving health outcomes in the gracious Speech, statistics clearly show why oral health deserves much more attention this Parliament. One in four five year-olds in England has tooth decay, and the number of children facing hospital admission for tooth extractions under general anaesthesia went up by a quarter between 2010-11 and 2014-15. While data published last week by Public Health England show modest improvements in the oral health of English children, the pace of progress is significantly slower than in Scotland and Wales, where devolved Governments have introduced innovative preventive dental health programmes. Data also show that despite the small overall improvement, regional and social inequalities in oral health continue to persist. I welcome the proposed measures to establish a soft drinks industry levy to help tackle childhood obesity, and I support the noble Baroness, Lady Walmsley, in the use of fluoridation, which should be much more widespread than it is at the moment. I urge the Minister to show the same ambition and appetite for innovation as her colleagues in Holyrood and in the Senedd. The Childsmile and Designed to Smile schemes have cut NHS treatment bills and shown that dental disease and deprivation do not have to go hand in hand. Will the Minister consider learning from their success and investing in a similar national oral health programme to drive improvements in children’s oral health in England?

I am pleased to see that access to NHS dentistry continues to increase, with the latest data showing that more than 30 million patients were seen by a dentist in the 24 months. However, there are still many areas where access to a dentist remains a significant challenge and there is anecdotal evidence of constituencies where not a single practice accepts new NHS patients. I am sure the Minister will agree that this is largely due to the way NHS dentistry is currently commissioned, with the current dental contract putting a cap on how many patients each dentist can see in a year. This April marked the 10th anniversary of the introduction of the current contract, and to mark the occasion the British Dental Association conducted a survey of more than 1,200 dentists. Seven out of 10 said that the current contract prevented them being able to take on more national health patients.

Noble Lords will agree with me that a shift in focus from treatment to prevention is crucial if we are to ensure the long-term sustainability of the NHS, and this is as true in the area of dentistry as it is elsewhere in our health system. It is crucial that the new contract for NHS dentistry improves access and rewards dentists for keeping their patients healthy rather than for carrying out interventions, as is currently the case. Dentists and patients were promised a new contract back in 2010, but the Government are dragging their feet and the new arrangements are not expected to be rolled out earlier than 2018-19.

With a second round of pilots going live this spring, this time labelled “prototypes”, it seems increasingly likely that we might end up with little more than a watered-down version of the current system. The prototypes contain the tarnished structure of payment per unit of dental activity alongside payments for capitation and quality. That is a step back from the previously tested pilots, which moved away completely from rewards for activity. The BDA feels strongly that the options currently on offer are decidedly unambitious and thinks that all reward should be based on keeping local communities healthy, not on the number of procedures performed. How can a system improve oral health, deliver prevention and provide continuing quality care when the proposed contract continues to offer perverse incentives to treat instead of rewarding dentists for improvement in oral health? Both dentists and their patients deserve a contract with a square focus on prevention, and neither of the options being tested goes far enough in meeting that objective.

Lastly, I want to reflect on the recent hike in charges for NHS dental services. As many noble Lords will have heard, fees for treatment are going up above inflation, by 5% this year and a further 5% next year. I fear that this unprecedented increase will discourage patients who most need to see the dentist from going to see one, and will undermine the relationship between patients and practitioners. One in five patients already says that they had delayed dental treatment because of its cost, and this will only go up as the cost of NHS dental treatment continues to rise much faster than people’s earnings.

I am also concerned that the money raised this way is not ring-fenced to be spent on improving dental care or access to dental services. Dentists are being asked in practice to play the role of tax collector while their patients are singled out to subsidise the wider health service. Expenditure on primary-care NHS dentistry as a proportion of the total NHS England budget has gone down by 13% in cash terms over the past four years, while proceeds from dental charges were going up even before this latest surge in prices. Treating dental patients as a source of easy money is not fair and, as the increasing sums spent on hospital extractions show, it is also a false economy.

Much progress has been made in the field of oral health over the past few decades and that momentum cannot be allowed to falter. Adequate funding for NHS dentistry, investment in reducing oral health inequalities, a new regulatory framework and an improved, truly preventive contract are all essential components of not only delivering quality cost-effective dentistry but improving health outcomes for the British people.

Queen’s Speech

Lord Colwyn Excerpts

Wednesday 3rd June 2015 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I must declare my interest as a now fully retired dental surgeon. Single-minded as my focus on dentistry has been, and may be, it is no mere quirk or niche focus, but rather a genuine concern for an area of health that deserves much more attention over the course of this Parliament.

The election campaign demonstrated the importance of all health issues. The parties tried to outbid each other on spending, but where does dentistry sit in that health debate? When it comes to issues the public care about, oral health is conspicuously absent. I was flattered to be included in meetings with my noble friend Lord Howe and with the Secretary of State to consider likely health issues for the manifesto, but it was telling that, of all the major parties, only the Greens and Plaid Cymru mentioned dentistry in their manifestos. It was conspicuously absent from the manifestos of my party and that of the Opposition Labour Party’s policy platform.

This is in spite of some worrying figures. In the 2013 Children’s Dental Health Survey, nearly a third of five year-olds and nearly half of eight year-olds had obvious decay experience in their primary teeth. Under a Government led by a one-nation vision, we must feel deep concern about oral health inequality that sees a fifth of five year-olds eligible for school meals with severe or extensive tooth decay, compared with 11% of those from more privileged backgrounds.

Dentistry is too readily seen in aesthetic terms and so perhaps more easily dismissed, but at its core is a commitment to good health that has holistic benefits for individuals’ overall health, including mental health. More than a third of 12 year-olds and more than a quarter of 15 year-olds reported being embarrassed to smile or laugh due to the condition of their teeth.

The 2010 Conservative manifesto promised to,

“introduce a new dentistry contract that will focus on achieving good dental health, not simply the number of treatments achieved”.

Beyond a few pilot schemes, the dental profession is still waiting for any conclusions. A contract that ends perverse incentives to undergo more costly interventions and instead rewards improving oral health can only be to the benefit of patients and dentists. I sincerely hope that we can finally implement the promise from 2010.

Worldwide scientific evidence, including three systematic reviews of studies comparing children from fluoridated and non-fluoridated communities, indicates that water fluoridation reduces the amount of tooth decay experienced by children and increases the proportion of children who do not experience tooth decay at all. A fourth systematic review found that adults who have lived mainly in fluoridated areas have lower tooth decay rates than those who have lived mainly in non-fluoridated ones. Water fluoridation has made a significant contribution to oral health improvements in communities where it has been introduced. Fluoride has the greatest efficacy in preventing caries, so it was with disappointment that I noted Southampton’s recent rejection of water fluoridation. Hull is currently undergoing a consultation to fluoridate its water supply to deal with an epidemic of poor oral health. More than 43% of children aged five in Hull have fillings and tooth decay; fluoride would play a vital role in combating that. Last year, Birmingham celebrated 50 years of water fluoridation—a great success that saw the number of children with tooth decay halve in six years. Other cities could learn from that example.

Many dentists will also hope that this Parliament will have a rethink as to how the profession is regulated. The dental profession has expressed grave concerns with its regulator, but also a willingness to move to a better model for all. It is therefore disappointing that the gracious Speech made no reference to the Law Commission’s recommendations for health regulation—something health regulators and unions are all keen to scrutinise with a move to implementation.

The gracious Speech called for integration of health services, as well as devolution across the UK and within England. It is essential that dentistry is factored into integrated healthcare and “devo-Manc” style devolution of health budgets and priorities. More than 25,000 children were admitted to hospital in 2013-14 because of tooth decay—the single largest reason for admission across all the National Health Service, and up from 22,500 three years previously. This cost about £30 million. It is clear that dentistry cannot be considered in isolation: the interplay between oral health and general health, dentistry budgets and other NHS budgets, must feature in any discussion on healthcare provision over the next five years.

Dentists are not by nature the most militant of professionals, but there are worries among many that the trade union reforms set out in the gracious Speech will impact on them. Many have called for the introduction of electronic balloting, so that should unlikely industrial action ever take place it could be done with a legitimate turnout, meeting the threshold being suggested by the Government and proving that these reforms are about legitimacy, not diminishing the right to withdraw labour.

In conclusion, I thank my noble friend Lord Howe and his team for their long and important contribution to dental politics, and more recently my honourable friend Dr Daniel Poulter for his time at the Department of Health. I also welcome my right honourable friend Alistair Burt as the new Minister of State for Care and Support, with responsibility for dentistry. There are many challenges ahead and real opportunities for dentistry in the UK. With a Conservative majority Government, we should show what we can do to end inequalities and improve oral health for all.

Schools: Emergency Life Support Skills

Lord Colwyn Excerpts

Monday 3rd February 2014 Lords Chamber

[Lord Nash]

My Lords, I know that the Department of Health is developing a better vision for school nurses. There are 1,300 school nurses but all schools have access to a much wider range of health professionals who may be appropriate depending on the particular conditions. It may be the school nurse’s job to be the bridge between that wider range. We are conscious that, with the new medical condition provision that we put in the Children and Families Bill, we will need to watch carefully to ensure that there is capacity in place to deliver it.

[Lord Colwyn (Con)]

My Lords, as we have heard, the British Heart Foundation found significant support for teaching emergency life support skills in schools. Is the Minister aware that, in your Lordships’ House, Mr Phipps and his team have signed up to a London ambulance accreditation scheme which includes the use of defibrillators? The scheme could easily be used in schools nationally, 78% of children having stated that they wanted to undertake this training.

[Lord Nash]

I have already said that this is something that we are looking at.

Children and Families Bill

Lord Colwyn Excerpts

Wednesday 6th November 2013 Grand Committee

Relevant document: 7th, 9th and 11th Reports from the Delegated Powers Committee and 3rd Report from the Joint Committee on Human Rights.

[The Deputy Chairman of Committees (Lord Colwyn) (Con)]

My Lords, if there is a Division in the Chamber while we are sitting, the Committee will adjourn for 10 minutes.

Clause 51: Appeals

Amendment 181

Moved by

Education Bill

Lord Colwyn Excerpts

Monday 11th July 2011 Grand Committee

[Lord Willis of Knaresborough]

I meant the other bishop—the secular bishop.

Electricity is considered a very important part of delivering the curriculum. I have tried to get your Lordships’ support for both amendments. The idea is that to deliver a 21st century curriculum we have to have 21st century methodology and 21st century equipment. To deliver the curriculums to all children, they have to have access to the technologies and be able to take advantage of them. There was a time when technology, particularly information and communications technology, was regarded as an additional extra. If you had the resources you put it into schools. It was certainly a resource that the wealthiest families in this country provided early on, and which most families now provide. In reality, it has now become not simply an additional extra but the lifeblood of schools.

I was in a primary school on Friday last week watching a young teacher teaching the solar system to a group of primary children. She had blacked out the whole room and had her white board and overhead projector and was using the BBC programme on the solar system by Brian Cox. It was very dark and by the time one of the episodes of that wonderful programme had come on, the children’s faces looking at the solar system as they had never seen it before, were remarkable. That is the use of technology today. In every area of the curriculum we can bring countries from the other side of the world into the classroom. Skype can be used to communicate directly with children in other parts of the world. I remember when I began teaching geography back in 1963 that it took three months to get a letter from a school in Sierra Leone. Now children can talk daily. Technology is no longer simply an added extra; it is very important indeed.

It has worried me, and I have said to the Minister that we seem to have messages from the Government, particularly from the Schools Minister, that if you have technologies you are putting books out of reach of children and that somehow it is either/or. You either have books or technology. It is not like that at all. You have to have both. The reality is that most children today, often from the age of three, use Google as a normal part of their activities. As they get older they cannot use internet search engines unless they have a good command of English. They have to be able to read effectively, disseminate and arrange information. This is not an added extra. It is fundamental. It is not an either/or; it is part and parcel of the same activity.

I have another worry. I say to the Minister that this is an impression rather than a reality. We now have a Division, which is a reality.

[The Deputy Chairman of Committees (Lord Colwyn)]

If the noble Lord is not about to wind up, I think that we probably do not have time to get through this so we will have to come back after the Division. There is a Division in the House. We will adjourn until 7.40 pm.