Community Pharmacies: Devon and the South-west

Sarah Dyke Excerpts

Tuesday 17th December 2024 Westminster Hall

[Rachel Gilmour (Tiverton and Minehead) (LD)]

I beg to move,

That this House has considered Government support for community pharmacies in Devon and the South West.

I am delighted to have secured my first Westminster Hall debate. It is an honour to speak under your chairmanship, Mr Betts. At a time such as this, when we repeatedly hear from the Government and our communities that the national health service is under strain, is heading into yet another winter crisis and is struggling with capacity, community pharmacies need the greatest consideration for further Government support. I will start by focusing on the role of pharmacies in our society, and then I will outline the challenges and end on what we might be able to do with the right support and engagement.

I wish to thank all pharmacists and their staff in Tiverton and Minehead for the invaluable work they do day in, day out. In particular, I commend Neil and Anna, who have run Bampton pharmacy in my home village for decades, and have, along with the owners of Wiveliscombe pharmacy and Alcombe pharmacy, provided me with first-hand, real-life insights into the challenges they face.

The 15 pharmacies in my constituency of Tiverton and Minehead provide a vital service to their communities —something they share with every pharmacy across Devon, Somerset, the south-west and, indeed, the whole of the United Kingdom. As I am sure we will hear from other hon. Members, pharmacies are under threat from the economic environment in which they now operate. Core pharmacy funding has decreased in real terms by more than 30% since 2016, and costs have gone in exactly the opposite direction. The number of pharmacies open in England is lower than it has been in any year since 2008-09, even though their workload is 40% higher, in terms of annual prescriptions.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

I thank my hon. Friend for securing this really important debate. As she was laying out, community pharmacies face large funding gaps, but the rate of pharmacy closure is Glastonbury and Somerton is nearly double the national average. Does she agree that the Government should commit to publishing the independent economic analysis commissioned by NHS England in early 2025, when the work is concluded? Does she also agree that we must reform community pharmacy funding and put in place a sustainable, long-term funding model?

[Rachel Gilmour]

I agree with both courses of action, and I thank my hon. Friend very much for that important and interesting contribution.

The increase in workload is not sustainable, but that workload is too important not to receive proper backing from central Government as they make headway on their ambition to create what they have referred to, on occasion, as a neighbourhood health service.

Being a Devonian, I would like to go through things logically. First, I will talk about prescriptions. In Tiverton and Minehead, each pharmacy dispenses an average of 7,540 prescriptions every month. Across all 15 pharmacies, that is an average of 113,175 prescriptions each month across the constituency. That is 20,000 more prescriptions each month than the House of Commons Library says there are people in the entire constituency. Prescriptions that provide life-altering medications for constituents are the front door to the work of pharmacies. They are what most people think pharmacies do most often, but our pharmacies do a lot more work in our villages, towns and cities.

--- Later in debate ---

[Sarah Dyke]

I thank my hon. Friend for giving way. As he is rightly pointing out, the employer national insurance contributions, alongside the national living wage, are increasing the pressure on our important community pharmacies. Does he agree that the Government must urgently exempt pharmacies, GPs and dentists from the tax hikes to avoid considerable damage to the sector?

[Edward Morello]

I thank my hon. Friend for the intervention. She will be pleased to know that there is, in fact, a Liberal Democrat amendment right now to do exactly that, which I am sure we will all be voting for, and which we would ask the Government to take the opportunity to support. Community pharmacies already face slim margins under the current community pharmacy contractual framework funding model, and while initiatives such as Pharmacy First have brought new funding streams into the sector, they are not sufficient to offset the rising costs of operation, including wages, rents and utility bills.

Community pharmacies are lifelines for rural constituents like those in West Dorset. They provide crucial access to healthcare services, especially for those who struggle to reach GPs or hospitals. They are also uniquely vulnerable due to small patient bases and higher operational costs, and the Government should recognise those disparities. That means revisiting the funding framework, addressing workforce shortages and offering targeted financial relief to offset rising costs, including the impact of national insurance contributions.

Community pharmacies are not just businesses; they help to support our strained healthcare systems and are a part of our communities. For the people of West Dorset, and for millions across the country, we cannot afford to let them falter. I urge the Government to prioritise this issue, undertake a comprehensive review of the funding model, work closely with Community Pharmacy England and provide the support necessary to secure the future of our pharmacies and the vital service that they deliver in rural communities.

NHS Dentistry: South-west

Sarah Dyke Excerpts

Tuesday 12th November 2024 Westminster Hall

[Richard Foord (Honiton and Sidmouth) (LD)]

I beg to move,

That this House has considered NHS dentistry in the South West.

It is a pleasure to serve under your chairship, Mr Vickers. I am grateful to the Chairman of Ways and Means to have been granted a debate on NHS dentistry in the south-west of England, which has particular problems.

I know that the new Minister will have encountered enough problems with NHS dentistry as it is, but the south-west is a special case. To illustrate: if we were to go back to 2015, 51% of adults in the south-west could see a dentist. That was also the case across England at the time, with 51% of patients who wished to see an NHS dentist having access to one. By 2024, however, that figure has declined sharply. Now, the current average across England is 40%, and in the south-west it is just 34%.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

I thank my hon. Friend for securing this important debate. In Somerset, the percentage of adults who have seen a dentist has dropped by 20% over the past decade. Does my hon. Friend agree with me that we should guarantee access to an NHS dentist for everyone needing urgent and emergency care?

[Richard Foord]

That is exactly what is needed for urgent and emergency care. My hon. Friend draws attention to Somerset; the situation is bleak in Devon too. In Devon in 2015, 55% of adults were able to see a dentist, but that has since dropped to just 37% today.

I have had so much correspondence from my constituents on this subject, and the decline, as I see it, is a direct result of 14 years of Conservative neglect of our health services and of NHS dentistry in particular. I find it really troubling that the situation is affecting people in some of the most vulnerable categories, such as older people and children,

Children in Devon are missing out on crucial dental check-ups. Once upon a time, they used to have check-ups twice a year; now, it is not possible for children to be registered for NHS dentistry in many dental practices. It is therefore no surprise that tooth decay is now the leading cause of hospital admissions for five to nine-year-olds in the country. I talked to one primary school and was told that pupils are going to hospital in Bristol to have their teeth removed—often between four and 10 teeth at a time. The number of NHS dentists in Devon has dropped from 549 to 497, so the reality is that NHS dentistry is simply no longer available for all.

NHS Dentistry: Rural Areas

Sarah Dyke Excerpts

Tuesday 5th November 2024 Commons Chamber

[Sarah Gibson]

I agree that dentistry has been failed over the past 14 years.

According to the House of Commons Library, 51,000 children have not seen a dentist in Wiltshire in the past year.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

My constituent in Ilton is now in debt because they had to take their son, who is eligible for free NHS dentistry, to a private dentist, as they could not find an NHS dentist in the whole of Somerset. Sadly, that comes as no surprise, given that four in 10 children in Somerset have not been able to see a dentist this past year. Does my hon. Friend agree that dentists need to be encouraged back into the NHS by reforming the broken NHS dental contract?

[Sarah Gibson]

I do agree with my hon. Friend, and I will mention that point later in my speech. It is no surprise to me that children in her constituency are having similar problems to children in my constituency.

According to NHS England, only 33% of adults under the NHS Bath and North East Somerset, Swindon and Wiltshire integrated care board have seen a dentist in the past two years. According to a freedom of information request by the British Dental Association, my local ICB’s projected dentistry underspend equates to £4.6 million.

When Hathaway closed its door to NHS patients last Friday, this was a major blow to my constituents.

World Stroke Day

Sarah Dyke Excerpts

Tuesday 29th October 2024 Commons Chamber

[Sarah Dyke (Glastonbury and Somerton) (LD)]

I am grateful to have this opportunity to address the House on World Stroke Day. Stroke is the UK’s fourth biggest killer and the single largest cause of complex disability in the UK. On our current trajectory, the number of stroke survivors will increase by 60% over the next decade, which will swallow up nearly half the current NHS budget. By that time, one in three people in Glastonbury and Somerton will be 65 or older, so we will disproportionately feel the impact of the increase in strokes over the next decade.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate. She mentioned the age of 65, which is really important; in Northern Ireland, there are some 2,800 new strokes every year. While the majority of strokes affect people who are over the age of 65, they can strike at any age. Some 25% of people who have strokes are under the age of 65, so does the hon. Lady agree that we must get away from the notion that stroke awareness is only for older people, and that we must be very aware of the FAST signs—face, arms, speech and time—that can make the difference between death and recovery? It can happen to young people as well.

[Sarah Dyke]

The hon. Member makes a really important point. Although we often assume that it is older people who suffer with strokes, so many young people suffer in the same way.

Unless there are major improvements, Somerset’s poor ambulance response times and poor life-after-stroke care will mean that a disproportionate number of the 42,000 people who will die from stroke in 2035 will be from my constituency.

[Christine Jardine (Edinburgh West) (LD)]

Further to the point that the hon. Member for Strangford (Jim Shannon) made, although I fully accept that we have to do more in terms of stroke care, does my hon. Friend agree that the population of this country is generally unaware of the early warning signs of stroke to look for? When it actually happens, we recognise the symptoms, but we have no awareness of the long-term warning signs. We need to invest in teaching people what to look for and how to care for themselves to avoid a stroke.

[Sarah Dyke]

I thank my hon. Friend for making such an important point. I think we have progressed in our understanding of stroke awareness, but there is so much more yet to do.

Neither strokes nor the grim predictions I have made are inevitable. Stroke is preventable, it is treatable, and it is recoverable.

[Alan Gemmell (Central Ayrshire) (Lab)]

Will the hon. Lady allow me to place on record my thanks to the innovative team at the stroke unit in Crosshouse hospital, whose new treatment, thrombolysis, means that—as the hon. Lady said—there is a way for many people to recover following strokes? I would like to thank charge nurse Elizabeth, consultants Martin and Sundeep, and Julie and Debbie in the hospital management team for saving my former teacher, Christine Stewart, when she self-diagnosed with FAST.

[Sarah Dyke]

The hon. Member makes a very good point, and I also celebrate those people, who do such hard work within their communities.

The UK knows how to deliver world-class stroke care, and some parts of England are doing that as I speak. Stroke is one of the few conditions that takes patients through the entirety of the health and social care system, from emergency services and acute care to social care, specialist rehabilitation support and end-of-life care.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am really grateful to the hon. Member for securing this debate. Time is everything with regards to a stroke, particularly around diagnosis, but also if treatment such as thrombectomy is needed. Does she agree that we should be looking at ambulance response times in particular, and perhaps at recategorising stroke as a category 1 call-out?

[Sarah Dyke]

I thank the hon. Member for her intervention and for all the work she has done in this area. I will come to the issue of ambulance response times a little later in my speech.

Delays in urgent care are currently leading to high mortality rates, and post-stroke services that provide crucial emotional, practical and social support are often treated as optional, rather than essential.

[Andrew Cooper (Mid Cheshire) (Lab)]

I thank the hon. Lady for securing this important debate. She rightly talks about the need for stroke patients to receive urgent medical treatment. Last month, I attended a thrombectomy awareness event at which my constituent, Mark Paterson, was speaking as a stroke survivor. Mark’s remarkable recovery was thanks to the emergency thrombectomy procedure he received. Sadly, many others are not so lucky, with too many people dying or suffering disability due to the previous Government’s postcode lottery in care. About this time last year, the Stroke Association said that about 9.8% of patients receive that treatment in London, compared with 0.4% in the east of England. Does the hon. Lady agree that we need to see an increase in the proportion of patients receiving thrombectomies across the country?

[Sarah Dyke]

I thank the hon. Member for the intervention. He makes a strong point.

Our health and social care services are likely failing the 14,159 registered stroke survivors in Somerset at some stage in the system, but there is reason to be optimistic. If the Government put stroke at the heart of our health and social care system, each and every part of the system will be stronger and deliver better outcomes for everyone—not just stroke survivors.

Leaving aside the human cost, there is also an economic cost, as strokes lead to an avoidable £1.6 billion annual loss of productivity. I recently spoke to Garry, who works in Somerset and had a stroke in his 30s. He told me that he could have been back to work after nine months if he had had access to life-after-stroke care. Instead, he spent five years recovering, during which time he had to rely on the benefits system. At the start of the debate, I said that stroke is preventable, treatable and recoverable. If that is true—I know that it is—why are people like Garry forced to waste years in the prime of their life learning how to recover from strokes themselves?

[Chris Bloore (Redditch) (Lab)]

The hon. Lady is making an important point. Our clinical profession does an incredible job of saving many people who suffer from a stroke, but the rehabilitation work that follows surviving a stroke—the ability to get back into work, build emotional confidence and rebuild relationships—is so important. As she was detailing, too many people who survive strokes have to wait for years to get on with their lives, including their work, friendships and relationships.

[Sarah Dyke]

I wholeheartedly agree, and that is exactly the point that I was making.

Research from the Stroke Association shows that the NHS faces £1,300 of additional pressure for each person like Garry who does not receive life-after-stroke care, due to avoidable secondary strokes and other health complications. It is an injustice for stroke survivors who are suffering longer than they need to, for the taxpayer who could be paying less, and for the friends and families who often have no choice but to become unpaid carers to support stroke survivors, as my mum did for my dad after he suffered a stroke.

Unpaid carers currently bear 62% of the cost of prevalent strokes, with the NHS and social care bearing only a distant 9% and 22% respectively. Unpaid carers do a remarkable, important and often invisible job, and the Government must ensure they have access to the support that they need, including paid carer’s leave and a statutory guarantee of regular respite breaks.

There are not many easy answers when it comes to stroke. Constituents across Glastonbury and Somerton have written to me almost every month since my re-election because they are concerned about the closure of Yeovil district hospital hyper-acute services. It is right that steps are being taken to address the fact that 60% of people who arrive at hospitals do not get into a stroke unit quickly enough, so services are being reconfigured to provide patients with cutting-edge care in Dorchester or Taunton.

By concentrating hyper-acute services, wards can process patients more quickly, which is so important when caring for patients suffering from a stroke. After critical care has been provided, patients will be moved back to services closer to their home, such as Yeovil, so that family and friends will be able to visit their loved ones there rather than in critical care further away. I can understand why people are scared of potentially having to travel further in an emergency when response times are so poor. In fact, with an average response time of 42 minutes and 50 seconds, people in Somerset wait longer for an ambulance than anywhere else in England. For every minute a stroke is left untreated, nearly 2 million brain cells die, so fast ambulance response times are necessary for getting stroke patients lifesaving, disability-reducing treatments in time.

This is especially important for those living in rural locations, such as Glastonbury and Somerton, who may need to travel further for treatment. Liberal Democrat analysis has revealed that waits for life-threatening calls are 45% longer in rural areas than in urban ones. The average handover time for a category 2 ambulance call in Somerset has risen to over an hour, despite the ongoing 18-minute target, which results in ambulance crew being able to see only two or three patients per shift. The Government could lower these ambulance response times by increasing the number of staffed hospital beds, and ensuring our social care system is resourced well enough to allow people to recover outside hospital. We know that a matter of minutes can make all the difference in emergencies, so it is heartbreaking that ambulance delays are worsening and stroke victims are being left for hours for help to arrive.

I am inspired by the stroke quality improvement for rehabilitation project, which has helped over half the stroke survivors who were previously being failed by services in Somerset. The pilot has ensured that survivors have access to personalised and face-to-face support to help them with behavioural changes and re-entering work. Despite its success in preventing secondary strokes, and thus saving the health and social care system a great deal of money, the pilot is unlikely to receive funding from April next year, and 250 patients in Somerset face the prospect of losing access to good-quality life-after-stroke support.

I am particularly worried about stroke survivors in Glastonbury and Somerton, and elsewhere in Somerset, who will instead have to rely on Yeovil district hospital if this happens, as Yeovil district hospital provides only the minimum level of occupational therapy, physiotherapy, and speech and language therapy a week to less than half as many patients as the national average. There is a future where we no longer need to have a World Stroke Day, and that is what I am looking for—a future without a World Stroke Day.

Innovations such as the use of artificial intelligence in diagnosis could revolutionise recovery prospects for stroke patients, and preventive programmes could limit the impact stroke has on working-age people. We saw stroke mortality halved in just 10 years when stroke was prioritised in 2000, so progress can be made. If we are to reach that future, though, we must start by ringfencing budgets to enable the NHS to adopt innovative digital tools, invest in new technologies and develop a digital strategy.

This Government have already begun to make some progress with the Darzi report, which showed that the NHS is on its knees after years of mismanagement by the Conservatives, but we must ensure that stroke remains a top priority in their health mission.

[Uma Kumaran (Stratford and Bow) (Lab)]

I would just like to share my experience. On my first day here in the Commons, my husband suffered a stroke. This is a timely debate, so I thank the hon. Member for securing it. I am pleased to say that my husband is doing much better now, and he is here in the Gallery of the Chamber, as are those from the Stroke Association, who have been absolutely invaluable to our family and many stroke survivors across the country.

I would like to pick up a point that the hon. Member made about stroke. One in four strokes happens to people of working age, and one in three in this group will have to give up their jobs. It is very clear that, although the NHS has given excellent care to my husband and to families such as mine, there is much more to be done. The Darzi report revealed the scale of the challenges that our health service faces, especially with stroke services, and the severe impact of the underfunding of the last Conservative Government.

[Sarah Dyke]

I thank the hon. Lady, and it is so good to hear that her husband is making such a full and quick recovery.

World Stroke Day is a pertinent reminder that stroke must be well represented in the new 10-year health plan and that the Government must engage with patients, carers, and health and social care professionals, so that their lived experiences can help inform policy decisions.

Access to Primary Healthcare

Sarah Dyke Excerpts

Wednesday 16th October 2024 Commons Chamber

[Sarah Dyke (Glastonbury and Somerton) (LD)]

We know that primary care has been struggling—struggling to meet targets, keep up with demand and help the population remain healthy. Those difficulties are particularly acute in rural areas such as Glastonbury and Somerton, where primary care faces specific issues such as recruitment, retention, and access to services. GPs serve a crucial and multifaceted role in healthcare, but they are all too often inaccessible in rural areas. Last year in Somerset, 21% of GP appointments took more than two weeks from booking to appointment—higher than the average wait in England —and 7% of appointments took well over a month.

GPs play a crucial role in serving people’s mental health, as well as their physical health. The Environment, Food and Rural Affairs Select Committee’s report on rural mental health concluded that NHS mental health services are not fairly accessible for rural communities. A one-size-fits-all approach does not fit everyone; appropriate services should be developed to serve rural communities. To help mend the mess left by the Conservatives, the Lib Dems want to give everyone the right to see a GP within seven days, or within 24 hours if urgent, with 8,000 more GPs to deliver on that commitment. Rural communities also suffer from poor access to public transport, which makes it more difficult to access services, and poor rural broadband, which makes it hard to access online services. It is clear that cross-departmental work is needed to address the challenges rural people face in accessing mental health support. Those hurdles must be factored into the national strategies that are focused on addressing mental health.

We must look at how pharmacists can ease the pressure on GP services, but they too need urgent support. Between April 2015 and June 2024, there was a net loss of 1,200 community pharmacies—1,402 closures and only 179 openings. The rate of pharmacy closures in Glastonbury and Somerton is, shockingly, near double the national average. Community pharmacies provide an essential high-street service in rural market towns, but many have now simply gone.

The Liberal Democrats believe that we need a clearer, more sustainable long-term funding model for pharmacies, and we must build on the Pharmacy First approach to give patients more accessible routine services and ease the pressure on our GPs.

The new Government have spoken out about our crumbling public services, but now is the time to act. My constituents cannot wait.

Oral Answers to Questions

Sarah Dyke Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Stephen Kinnock]

I thank the right hon. Gentleman for his question, but he appears to be living in a parallel universe. We are in the midst of a mental health crisis as a result of 14 years of Tory chaos, neglect and failure. We have a plan, with 8,500 more mental health workers, young futures walk-in hubs, specialist mental health support for young people and mental health specialists dealing with talking therapies. Of course, we will also introduce legislation following the Gracious Speech to deal with helping people who have more severe conditions. That is a plan of action with which I hope we can once again make our country proud of how we deal with this extremely serious issue.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

Mental health pressures in the farming community are rising, with the Farm Safety Foundation survey finding that 95% of farmers under 40 agree that poor mental health is the biggest hidden problem facing the industry. Will the Minister work with colleagues in the Department for Environment, Food and Rural Affairs to improve access to NHS mental health services in rural areas and support the continued roll-out of rural health hubs?

[Stephen Kinnock]

I thank the hon. Lady for raising that extremely important question. We are indeed looking at that issue through our 10-year plan for the future vision of our health service. Issues around isolation and the huge pressure on what are often family businesses are creating tremendous strains for that community. We take that seriously and will of course work with our colleagues in DEFRA to address it.

Health Services: Rural Areas

Sarah Dyke Excerpts

Wednesday 17th July 2024 Commons Chamber

[Jamie Stone]

The hon. Member makes his point with his customary charm. It is no wonder that he is so well liked in this place, because he always speaks for his constituents.

I have talked about the delays in vaccinations, which also applies to the lifesaving vaccinations that babies must have. The Scottish Government take a one-size-fits-all approach that, frankly, does not work in remote rural areas such as mine. The retention and recruitment of GPs and other healthcare workers is crucial, but poor wages and terms and conditions, and a lack of proper travel reimbursement, all lead to a general impression that the game is simply not worth the candle. That is why we are missing key workers and doctors, and why we are paying through the nose for locum and temporary staff. Madam Deputy Speaker, can you believe that NHS Highland has spent £21 million on locum staffing in the past year? That is almost 3% of its entire budget—an eye-watering sum. Could that money not have been spent much better, for example on care homes, hospitals or pain clinics that have been forced to close?

[Sarah Dyke (Glastonbury and Somerton) (LD)]

I apologise for coming a bit late to this debate. Primary care is asked to do more in rural areas than in urban settings, piling pressure on GPs, pharmacists and dentists, yet they struggle to recruit staff, as my hon. Friend said. A dental practice in Street, in my constituency, has been without an NHS dentist on its books for 18 months, despite its best efforts. Does my hon. Friend agree that we must explore ways in which we can incentivise healthcare professionals to practise in rural areas?

[Jamie Stone]

I absolutely endorse that. I am glad that I said in my opening remarks that my experience in a very remote part of Scotland applies to other parts of the United Kingdom. What we have just heard proves that this is the case.

NHS Scotland has halted all new builds and repairs to health centres across the entire country, which is another problem for healthcare. I have said already how big my constituency is. Just by commuting or doing house visits, healthcare staff will rack up 3,500 miles easily, because the distances are so great. At that point, their reimbursement per mile is more than halved, which does not encourage people to get involved. It is, in fact, discrimination against healthcare professionals who live in rural communities. Training is overwhelmingly based in urban areas, and there is very little incentive to get people to come and work in rural areas. Other factors, such as a lack of housing and job opportunities, feed into this problem.

There is another issue I want to raise: the lack of women’s health provision, which is pretty severe. In my maiden speech in 2017 I spoke about the need to restore maternity services to Caithness. Seven years later, that is more important than ever. Caithness general hospital used to have a consultant-led maternity service, which meant that expectant mothers could have their babies locally in the far north of Scotland. It was downgraded when I was my constituency’s Member of the Scottish Parliament. At that time, I had more influence and I got it restored. Since then, however, the maternity services have been downgraded again, and there appears to be no movement from the Scottish Government to reverse that. I wish that some Members from the party of the Scottish Government were present today.

Let me give an example of what this situation means: pregnant mothers have to make a 200-mile round trip in the car to deliver their babies. Imagine a trip like that in the middle of winter, and on rickety-rackety roads in the highlands. In 2019, a pair of twins were born—one was born in Golspie, and the other was born 50 miles away, in Inverness. It is a miracle that those children survived, and that neither a mother nor a child has perished. I have been calling for a safety audit all along, but there has never been one. We know perfectly well what the result would be: the arrangements would be deemed unsafe, if not a breach of human rights.

It is not just about maternity services; women’s health has been removed from the far north. A routine trip to see a gynaecologist and get a diagnosis for a life-threatening ovarian cyst, or for endometriosis, means travelling the same huge distance—if a woman is lucky enough to get an appointment before her condition has progressed too far for her safety. I wonder what we can do to encourage healthcare professionals to relocate to remote areas, because the health and wellbeing of their wives and daughters must surely be a factor when they consider moving.

For children growing up in the far north, it is no better. The waiting list for child and adolescent mental health assessments is three years. For neurodevelopmental screenings—for the diagnosis of dyslexia, autism, attention deficit hyperactivity disorder and so on—it is four years. That is the majority of their time at school. One family I spoke to during the election had waited 13 years for a diagnosis. That is a disaster. Dentistry has already been mentioned, and we know that intervention is crucial for long-term dental health