NHS Dentists: Cumbria

Debate between Lord Walney and Seema Kennedy

Wednesday 3rd July 2019 Westminster Hall

[Seema Kennedy]

The hon. Gentleman anticipates my speech: I will talk about contract reform later. He knows much better than me that the problem with the previous contract was that it was introduced with perhaps a bit too much haste, and we are now living with the consequences. We are mindful that we need a contract that works well and is sustainable for the future.

Nationally, we are introducing so-called flexible commissioning, which allows local NHS commissioners to commission a wider range of services from dental practices. That is expected to make NHS dentistry more attractive to new performers. Another key recruitment and retention challenge—of course, this is not confined to dentists; it applies to a whole range of healthcare and other professionals—is the growing demand among younger dentists for more varied portfolio careers. NHSE is working closely with Health Education England and a wide range of stakeholders to make portfolio careers a reality for dental professionals, allowing dentists to move between specialities such as prevention, restorative work, oral health and special care dentistry.

We want UK-trained dentists in the NHS, and we want them to stay in those careers, but dentists from overseas also play an important part in delivering NHS care. I am pleased that the NHS and the Government have taken steps through the launch of the EU settlement scheme to maintain that essential supply of dedicated and skilled workers, including European economic area-trained dentists, when we leave the EU. Last summer, doctors and nurses were removed from the tier 2 cap, leaving more places for other highly skilled professionals, including dentists.

The interim NHS people plan, which was published early last month, commits to creating a capable and motivated multidisciplinary dental workforce of a sufficient size to meet population health needs. The full people plan will be published later this year.

We are working closely with NHSE to reform the current dental contract. Feedback from dentists who are testing the prototype contract suggests it is a more satisfying way of delivering care. It supports a better skills mix, allowing dental care to be supported by a wider range of staff, such as therapists and hygienists. At a meeting a couple of weeks ago with a wide range of dental stakeholders, I announced that a further 28 dental practices had joined the programme, bringing to 102 the number of practices that are testing the new prevention-focused way of delivering care. NHSE is considering carefully when that approach can be rolled out more widely across the NHS. It is important that we get the new contract right, but I am hopeful that the roll-out will happen as soon as possible.

I want to touch briefly on three questions hon. Members asked. The first and most important was about children’s oral health. I heartily agree with the hon. Member for Westmorland and Lonsdale about the importance of children’s oral health and all the preventive measures the Department can take to protect children’s teeth. He rightly pointed out something that not all hon. Members are aware of: the biggest cause of emergency admission for children is poor oral health. Of course, that is entirely preventable. The Government are committed to that, particularly among deprived children. We have made the Starting Well approach available to other NHS England commissioners, and that is promoting increased access and early preventive care for very young children.

[John Woodcock]

That more than a third of children under five in Barrow have tooth decay is truly appalling. The Government need to make faster progress. I assume the Minister would vigorously oppose any attempt to weaken the sugar tax, which is designed to move people away from that harmful substance towards a healthier lifestyle.

[Seema Kennedy]

The hon. Gentleman makes a very timely intervention. We can see how successful the soft drinks industry levy has been in how it has helped to reformulate sugary drinks, the amount of money it has raised that has been recycled into school sports, and the fact that it is changing people’s tastes and behaviour. The prevention Green Paper is in train; let us hope that he is pleased with what is announced in it.

The hon. Member for Westmorland and Lonsdale mentioned emergency dentistry and I will have to write to him with specifics about the commissioning of services.

On the public health budget, I know from conversations with Members across the House that there are pressures on local government budgets. The ring-fenced public health budget will be a matter for the forthcoming spending review, when it will be assessed using all available evidence. The hon. Gentleman can be assured that I will take away all the evidence I gather from meetings with Members across the House and in my ministerial position to feed into the spending review process.

Acquired Brain Injury

Debate between Lord Walney and Seema Kennedy

Tuesday 2nd July 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Rosindell. I thank the hon. Member for Rhondda (Chris Bryant) for introducing the debate, and for challenging the Government on this important issue. He is an indefatigable champion for those living with acquired brain injury, about which he has taught me a lot in the few months for which I have been in my position.

I also thank all right hon. and hon. Members who have spoken, and those who have been present but have not spoken. People have shared personal experiences—things that are painful to them, and that they have lived with for a long time. I particularly welcome the hon. Member for Newport West (Ruth Jones) to her place. I think that this is the first time that I have responded to a debate in which she has spoken.

As with many long-term conditions, ABI affects not only a person’s health but aspects of their family life, work and relationships. I responded to the debate on 9 May. I am still chasing ministerial colleagues in other Departments for their comments, but because time is quite short I will focus today on the many points that have been raised about the health aspects. However, I will go back to ministerial colleagues, chase them and impress on them that this important issue affects many Government Departments.

I met representatives of Headway after the debate on 9 May, and I thank those who work with Headway and organisations such as the UK Brain Injury Forum. Such organisations are really valuable to people living with ABI. They raise awareness and provide help to support those with the condition, as well as families and carers. The hon. Member for Darlington (Jenny Chapman) mentioned how important that is. I take on board the report of the all-party group, to which the Government responded, and I pay tribute to the hon. Member for Rhondda and my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes).

In 2014, two years after the introduction of major trauma centres, there was an independent audit of the regional trauma networks, commissioned by NHS England. That audit showed that patients had a 30% improved chance of surviving severe injuries, and that the networks had saved 600 lives. That does not mean that they are perfect, but some progress has been made since their inception. Although the majority of rehabilitation care is locally provided, NHS England commissions specialised services for those patients with the most complex levels of need. For people who have ABI, timely and appropriate neuro-rehabilitation is an important part of their care.

I thank the APPG for all the work it has done on rehabilitation prescriptions, which reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient, and are an important element of rehab care. Of course, the APPG report stated that all patients with ABI should benefit from an RP.

I will touch on lots of the points that Members have mentioned. In particular, I thank the hon. Member for Rhondda for drawing the House’s attention to the third and final report of the audit, which was published in April 2019, only a few days before we last discussed this matter. It is encouraging that 94% of patients accessing specialist rehab have evidence of functional improvement, but the report suggests that there is more work to be done to ensure that all patients who could benefit from specialist rehabilitation can access it.

[John Woodcock (Barrow and Furness) (Ind)]

Does the Minister share my concern that there is no universal information for when people present at A&E or the doctor’s with a head injury? After I fell off a ladder in 2012, I was surprised that I was not given so much as a leaflet to say that there might be long-lasting effects. Some people are clearly good at picking it up, but it should be absolutely obvious that everyone who strikes their head should be given extra attention by the NHS in case they develop symptoms.

[Seema Kennedy]

I thank the hon. Gentleman for raising that point. I was talking to another colleague who had a brain injury just last year, and she said exactly the same thing. That was not in A&E; it was at a GP practice. There are of course training modules for GPs to access, but debates such as this one and my conversations with NHS England can only help in raising awareness. I thank the hon. Gentleman for bringing that point to my attention.

To return to the audit, its authors estimate that current provision caters for 40% of those who need the services, so there is a lot more to do. On capacity, the audit made some recommendations, including that trauma centres should review their processes and ensure that standards for rehabilitation provision and availability are met, and that commissioners should consider opportunities for development of specialist rehab capacity, both for in-patient and community-based services—a point that hon. Members have raised. These are important points. Although we only had this debate two months ago, I am glad that the hon. Member for Rhondda has raised the subject again. I will discuss with NHS England what it is thinking, what it is doing on the audit and what the next steps are. We need to impress on it the importance of bed provision.

The majority of rehab care is commissioned and managed locally and there are guidelines produced by NHS England, such as the principles and expectations for good adult rehabilitation, which describe what good rehabilitation care looks like. There is additional guidance that covers both adults and children.

Many hon. Members mentioned neuro-rehabilitation for children, and I know that NHS England is aware that there is variability in the provision for children. Best practice guidance was published in 2016, but there is always more to be done. I will take the points away and speak to NHS England. We are looking at how we can educate people on foetal alcohol syndrome, and I am happy to report back to the House on that.

The hon. Member for Newport West raised a specific issue about speech and language therapists and physiotherapists. I very much agree that we need a joined-up approach to care and I am concerned to hear that there is a gap. Members can make representations to NHS England on that. I know the situation is different in Wales, but I would be very happy if the hon. Lady would keep me informed.

The hon. Member for Rhondda raised the injury cost recovery scheme. Again, that is a matter for the DWP and I will be pressing ministerial colleagues to respond on that point. That scheme allows for the recovery of costs for providing treatment to an injured person where that person has made a successful personal injury claim against a third party. It recovers funds from insurance companies and pays into the NHS or hospital ambulance services. The current cap is around £53,000, renewed annually in line with inflation. I will follow up with more detail—the hon. Gentleman looks slightly sceptical.