Hospice Funding

Selaine Saxby Excerpts

Monday 22nd April 2024 Commons Chamber

[Selaine Saxby (North Devon) (Con)]

I want to take advantage of tonight’s debate to raise the specific issue of the North Devon hospice and its hospice to home service. When I last met its excellent chief executive, Stephen Roberts, last October, he flagged to me that the hospice was no longer in a position to continue its non-commissioned service after the end of this financial year. At the time, he wrote to the then Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), detailing those concerns. I instantly phoned my hospital trust, because North Devon is home to the smallest hospital on the UK mainland and it already suffers with discharge issues and an overstretched A&E service.

In February when I met Dr Sarah Wollaston, the chair of the Devon integrated care board, I asked about the service and was assured that it was all fine and the money was being found. When this debate was announced —many thanks to my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing it—I contacted Stephen Roberts at the end of the recess and said that I would like to check that this was all okay. He told me that my email was timely because everything was not okay, despite having had endless meetings with the integrated care board. He asked me to share with the House tonight some of the email that he sent back to the integrated care board following a phone call with its new chief executive, in which he said:

“Thank you for your time yesterday. I thought it would be prudent to summarise in an email where we have got to as there is nothing on paper or email that corresponds to the discussions we had around your offer of £95k. As a summary as to where we stand today: North Devon Hospice’s Hospice to Home Service is dedicated to support palliative patients who are at the ‘end of life’ stage through: increasing care at home, reducing unplanned/avoidable hospital admissions, and expediting hospital discharges.”

He goes on to detail the 15 staff who deliver that vital service, which costs just £495,000 and which the North Devon Hospice charitable funds have covered for the last decade. He said:

“North Devon Hospice asked for funding support of £157,540 which represents the same level of commissioning support as our bedded unit and community nursing team receive. Devon ICB have stated that they are willing to provide £95k as a one off”

before the next commissioning review period. But he said that the hospice had to state in return:

“due to our year on year million-pound deficit, having funded the service for 10 years and propped up the cost of this service through cost management elsewhere in the organisation we are no longer able to support the service which is at its minimum establishment to be able to operate.”

The hospice has been advising the ICB of this for three years.

[Peter Gibson]

My hon. Friend illustrates one of the biggest single challenges for hospice at home. Hospice at home relies on transport, which in an urban community can be delivered at a relatively small cost, but in a deeply rural constituency like hers, those costs need to be addressed and met in order to deliver that care. Does she agree that the funding models need to address the cost of transport and travel in rural constituencies delivering a hospice at home service?

[Selaine Saxby]

I could not agree with my hon. Friend more. There are many elements of healthcare, but the rurality of constituencies like mine is not fully reflected in the funding settlements.

My hospice requested that the ICB find the additional £65,000 to get it through to the end of the year. The chief executive took this back to the board to see whether we could get that seven months of cover through. However, it has now been through a full board meeting and consultation, and this is where my email came in. He finished his email to the ICB by saying:

“I sincerely hope that the good faith you have asked of us extends to Devon ICB’s good faith in finding the extra £65k.”

The email that he sent to me at the end of the recess says that he met the ICB chief executive,

“and he asked for 8 more weeks to see if he can do something, no promises made. My Board met last night where we agreed to wait for his response before making any decisions on the service. Therefore, any pressure you can apply would be greatly appreciated. The headline is: ‘Has it really come to the point where we have to beg for £62k to stop 32 people dying in an Emergency Room?’”

That was four weeks ago, and the hospice has still heard nothing. Our ICB is also in special measures. I beg the Minister to intervene and see if we can help our much-loved hospice, as well as tackle the ever-growing issues we have with our integrated care board back home in Devon. The hospice to home service is hugely valued by families and ensures that their loved ones can spend their final days at home, not in hospital. It also helps by taking the pressure off North Devon’s much loved, very small hospital. As it says across the shops back home in North Devon for our hospice, “Your life is a story, and the ending matters.” I very much hope that there is a way to secure the future of this hospice to home service to ensure that we have many other happy endings.

NHS Dentistry: Recovery and Reform

Selaine Saxby Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

I think it is very courageous of any Labour Member of Parliament to talk about education, because we know just how dire the education results are in Labour-run Wales. Yes, I have committed to reform of the dental contract, and we will deliver these services immediately because we want to deliver results for the hon. Gentleman’s constituents as well as ours.

[Selaine Saxby (North Devon) (Con)]

I thank my right hon. Friend for securing this vital plan, and I also thank her team for their ongoing engagement in what has been a difficult issue in my constituency since long before the pandemic. I cannot wait to see a dental van in South Molton and Ilfracombe, and to welcome new dentists to Barnstaple, Braunton and beyond. However, I recognise that this will take time. We have recruitment challenges despite our staggeringly beautiful surf beaches, which extend far beyond my right hon. Friend’s Department. Given her success in securing today’s announcement, might she be able to help me to promote these new dentistry opportunities to attract those who may not have previously considered spectacular, if remote, North Devon to be their future?

[Victoria Atkins]

My hon. Friend is exactly right. She is a wonderful constituency Member who speaks up for her constituents, and I can assure them that she has been talking to me since the moment I was appointed. As for advertising the new services, this is an opportunity for Members across the House—and I do hope that Opposition Members will be gracious—to ensure that their constituents are aware of them. We all want the best for our constituents, and the more we encourage local dentists to take up the new patient premiums and units of dental activity as well as the golden hellos, the sooner we will all see benefits in our constituencies.

NHS Dentistry

Selaine Saxby Excerpts

Tuesday 9th January 2024 Commons Chamber

[Selaine Saxby (North Devon) (Con)]

I rise for the 15th time during my time in this place to raise my concerns about the state of dentistry in my constituency. On being elected, the first letter I wrote was about dentistry, and although I fully accept the Government’s position that things have got worse following the pandemic, they were pretty bad in North Devon before. When I moved to Devon six and a half years ago, it took me two years to find an NHS dentist, and then I had to travel 45 minutes to get there.

One of my concerns about the statistics used is that they compare dentists per 100,000 of population. As a very sparsely populated rural location, we might not look like as much of a dental desert as some other places, but at present the nearest dentist taking NHS patients is over 100 miles away. A constituent contacted me before Christmas to say

“with regards to the extremely limited dental care in North Devon. My partner, who suffers from mental health issues which limits him from performing daily tasks and travelling, was in need of dental treatment this weekend. However, after being on hold for almost an hour I was told that there were no appointments in the whole of North Devon and the nearest appointment was in Exeter. Travelling that distance is just not possible for someone who has mental health issues, and due to the nature of his illnesses, he cannot drive and I don’t either at present.”

Exeter, which is the nearest city to my constituency, is over 50 miles away for most North Devon residents. Even private practices in North Devon are unable to take on the volume of patients in some parts of my constituency. I have parents writing weekly to ask what to do when their appointments are cancelled because dentists are handing back their NHS contracts. And because residents in North Devon are unable to get check-ups, by the time they are seen they have extensive dental needs costing hundreds, if not thousands, of pounds. Calling us a dental desert is no help at all. Given the structure of dentistry, dentists are not going to want to deal with the oral backlog each unseen mouth potentially holds.

I welcome the new dentistry Minister to her role, and thank her for her immediate engagement on this issue. I very much hope that her experience will ensure that the Government’s plan to further recover and reform NHS dentistry is expedited because, frankly, the good people of North Devon have waited long enough to see a dentist.

[Richard Foord]

I am grateful to the hon. Member for giving way, and I recognise what she is describing in North Devon. A 75-year-old and his wife who live in Tiverton told me that they were contacted by their dentist, who said that they were not seeing NHS patients any more. They called a further 20 dental practices and were told by several receptionists that no NHS appointments were available in Devon at all. Does she recognise the experience of my constituents?

[Selaine Saxby]

I thank the hon. Gentleman for his intervention. While I recognise some of those concerns, I will come on to the response that the Minister has given to my petition in this place.

The waiting list for dentistry is reportedly over 100,000 in Devon, and there are reports of children having all their teeth extracted. While that is horrific, we need to encourage children and adults alike to practise good dental hygiene, as schools and nurseries have more than enough to do to educate their children without also brushing their pupils’ teeth every day. When I visit schools in my constituency, they raise concerns about why dental hygienists with plaque-disclosing tablets no longer visit schools at least to highlight where poor brushing at home might be an issue. When I visited the Marines based in my constituency, they raised the issue of dentistry. On every social media post I put out, whatever topic it is on, someone raises dentists. Can the Minister please confirm when we will see a catch-up plan, since the last one apparently got stuck at the Treasury? As I have said before, I understand that money does not grow on trees, but neither do teeth.

I have presented a petition in this place about dentistry in North Devon, and I thank the Minister for her response, which details some improvements such as the Access Dental helpline in Devon. However, we know that even the post-covid schemes to help dentistry catch up did not reach places that needed it most, with the majority of the funds not actually being spent on dentistry. I have listened to my ICB’s plans for catching up, but I am not sure that anything I have heard fully reflects the issues around rurality and dentistry. Delivering most healthcare solutions in a rural environment is different from delivering them in an urban one: in rural constituencies, the closure of one dentist can leave patients travelling an additional 50 miles. As I have explained, popping to Exeter for treatment is not an option for many, and far too many of our health treatments involve that 120-mile round trip. We need the dentists to come to us, not us to the dentists, please.

I warmly welcome the steps that this Government are taking to train more dentists, but as even the Prime Minister conceded when he spoke to local press on his recent trip to the North Devon District Hospital, those steps will not help in the short term. The Opposition clearly have no plan in this area, and they have very little grasp of what rural life is like, given that most Opposition Members represent urban seats. I was delighted to hear the Secretary of State commit to fairness in rural and coastal areas, but I ask the Minister to see whether it is possible to get some dentists on to buses and into rural areas, and especially into our schools. Over 50% of children in North Devon have never seen a dentist. Dentists come to see our fishermen; why can we not similarly arrange for them to see our servicemen’s families, our schoolchildren, and those who simply cannot travel to an NHS dentist or afford to see one locally?

I do fear that the magnitude of the issue is not well understood by those living in London. People who call an NHS dentist in London will likely be seen almost immediately, and probably quicker than someone back home would have their phone call answered. Ideally, we would have regular dentist check-ups prior to getting toothache, but as even the bard said,

“there was never yet philosopher that could endure the toothache patiently”.

My patience and that of my constituents is running thin with the ongoing delay in hearing that the dentist will “see you now”.

Oral Answers to Questions

Selaine Saxby Excerpts

Tuesday 5th December 2023 Commons Chamber

[Victoria Atkins]

I assume from the hon. Gentleman’s question that he fully supports our efforts to get consultants back into hospitals as well as junior doctors and doctors in training. It is all very well to sit there commenting, but we on the Government side of the House are working with doctors to try to help them look after the NHS for us all.

[Selaine Saxby (North Devon) (Con)]

While I recognise that money does not grow on trees, neither do teeth. Can my right hon. Friend advise me of how quickly my North Devon constituents will be able to see the NHS dentists they so desperately need?

[Dame Andrea Leadsom]

My hon. Friend is absolutely right: there is a lot more that we can do. We are working at pace to see what announcements we can make on the dental recovery plan as soon as possible. In the meantime, she will be aware that, in the south-west, NHS England has commissioned additional urgent dental care appointments that people can access via NHS 111.

Radiotherapy: Accessibility

Selaine Saxby Excerpts

Tuesday 18th July 2023 Westminster Hall

[Dame Maria Miller (in the Chair)]

Before we start, may I point out that there will be some videoing by the education department? Please do not be distracted. The Doorkeepers are aware and the video will simply be used to illustrate how a Westminster Hall sitting works, so just ignore it.

[Selaine Saxby (North Devon) (Con)]

I beg to move,

That this House has considered the accessibility of radiotherapy.

It is a privilege to serve under your chairmanship, Dame Maria. I thank the Backbench Business Committee for granting this important debate, all colleagues who supported the application, and Professor Pat Price for her tireless work in supporting the all-party parliamentary group for radiotherapy and championing this vital treatment.

We all know that the cancer backlog was affected by the pressures of covid-19, but in May this year there were 7.47 million people waiting for cancer treatments and 3 million of those have been waiting for over 18 weeks. Only 61.7% of patients receive their first treatment within two months, far below the operational standard of 85%. Radiotherapy is a key part of cancer care. It is the second most effective treatment for cancer and is needed in four out of every 10 cancer cures.

Radiotherapy targets the cancer with radiation. The cancerous cells are more affected than the healthy cells, which are better at repairing themselves. Modern radiotherapy has come on leaps and bounds, and within the last 10 years breakthroughs have increased the accuracy and focus of the treatment to within millimetres, significantly reducing collateral damage to healthy cells.

Surgical treatments require intensive care, with all of the hospital resources and emotional trauma that that entails, and chemotherapy has a significant impact on the immune system. In contrast, radiotherapy is an out-patient treatment that requires fewer patient visits to care centres. It only costs between £3,000 and £7,000 per patient, despite being incredibly high tech.

The international recommendation is that 53% to 60% of cancer patients receive radiotherapy treatments. However, in the UK only 27% of cancer patients received radiotherapy treatment in 2019. In my North Devon constituency, only 4.7% of my constituents live within the recommended 45-minute travel time for radiotherapy treatment. The other 95.3% are among the 3.4 million people in England for whom distance from a radiotherapy service effectively limits the availability of treatment.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

As the hon. Member said, radiotherapy is the second most effective cancer treatment and is required by half of all cancer patients. However, the ability to access treatment has been described as a postcode lottery, with 3.4 million people unable to access radiotherapy without travelling more than 45 minutes. Does the hon. Member agree that it is unacceptable that there should be such significant disparities in access to radiotherapy?

[Selaine Saxby]

I do indeed agree with the hon. Member. In my case, North Devon is the fourth worst constituency in the country for access to radiotherapy services. North Devon is home to the smallest and most remote hospital on the UK mainland—and possibly the most loved. An exceptional team works tirelessly to deliver the best care, despite the challenges of rurality and the availability of staff, mostly linked to the availability of affordable housing, which is currently at its most extreme.

Radiotherapy is usually a series of daily treatments over a number of weeks. Far too many of my constituents choose not to have radiotherapy because the 120-mile round trip each day is too much to consider on top of the understandable pressures that patients with a cancer diagnosis already experience.

Radiotherapy is a far less invasive treatment than many others. With such an elderly population in North Devon it is often the best treatment for patients. A further complication that has been brought to my attention by the wonderful volunteer drivers we have in North Devon who help patients to their appointments across the expansive county, often to Exeter—a 120-mile round trip—for many different treatments, including radiotherapy. I do not want to discourage anyone from reaching out for those services, it will be clear to everyone that a daily radiotherapy session involving a journey of that length is a significant undertaking for patients and volunteer drivers alike. We have a declining number of volunteer drivers, which restricts driver availability for other patients.

It is hard to explain to those who have not visited North Devon the remoteness and the distances involved in undertaking all sorts of treatments. We benefit hugely from the merger of our hospital trust with Exeter’s, but that does not bring Exeter any closer. While it is positive that the backlog of patients waiting longer than 62 days for a GP referral is improving, the 62-day wait to start treatment is not. We know that every four weeks of delay in starting cancer treatment can increase the risk of death by 10%. To ensure everyone receives timely cancer care, radiotherapy needs to be an accessible treatment for every patient.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward a matter that is so important, which I think all of us here recognise. She has set the scene very well.

Another issue, which the hon. Lady is perhaps coming to shortly, is the shortage of radiotherapists across the United Kingdom. I understand that England is some 1,500 shy, and we have vacancies in Northern Ireland as well. The training takes five years, which means that it will be five years before the workforce, who are under pressure now, make gains, and that is if all the vacancies are filled. Furthermore, the age of current radiotherapists is an issue. Does the hon. Lady think that the Government need to take the initiative and put in place a visionary recruitment plan for the five-year period?

[Selaine Saxby]

I thank the hon. Gentleman for his intervention. We do not talk enough about the lack of specialist staff in this area, and I am indeed going to talk about the need for a proper plan for radiotherapy. Obviously, that involves resources of all types moving forward.

I think we all ask why a treatment as effective as radiotherapy is not used more often. Funding for radiotherapy falls between the cracks, and radiotherapy receives only 5% of the cancer budget. While there has been specific investment in radiotherapy, such as the £162 million in 2016 to replace 64 out-of-date machines, and the additional £32 million in 2019, there will be approximately 74 machines in need of replacement by the end of 2024.

We all know the NHS budget is under strain, but radiotherapy is the closest thing we have to a silver bullet for improving cancer care. An investment of £200 million would update all the machines due to be out of date by the end of next year, benefiting an estimated 50,000 people a year. An investment of £45 million in an innovative British technology—surface guided radiotherapy—could reduce waiting times by 1.8 weeks nationwide, and the use of artificial intelligence tools in radiotherapy could save clinicians two hours per patient.

If radiotherapy received between 10% and 12% of the cancer budget, instead of 5%, we could invest in more machines to bring ourselves up to international standards. In England, we have 4.8 treatment machines per 1 million people, while France has 8.5. and Italy 6.9. New machines and techniques would treat patients more quickly and help to clear the backlog. We need to reap the benefits of successful investment in early diagnosis and increased screening programmes so that early diagnosis leads to timely treatment and improved patients outcomes, rather than long and stressful waits for treatment.

We also need to focus investment in the right areas. Treatments such as proton therapy do not help patients outside Manchester and London. Proton therapy assists only 1% of patients, and my constituents in North Devon do not benefit from more investment in urban centres.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

Does my hon. Friend agree that satellite radiotherapy centres have an important role to play? People from my area have to travel down to Hillingdon from north Hertfordshire. The journey is supposed to take 40 minutes, but it is actually an hour and a half each way. If we had a satellite radiotherapy centre in north Hertfordshire it would make all the difference.

[Selaine Saxby]

I thank my right hon. and learned Friend for his intervention, and I agree entirely. Indeed, I believe the Government should look at bringing radiotherapy treatments closer to patients such as those in my constituency of North Devon. I ask the Minister to consider bringing radiotherapy to satellite centres or community cancer treatment centres to complement diagnostic tools such as radiology in community diagnostic hubs.

Furthermore, may I recommend a trial in North Devon? We have a proud history of raising funds locally for cancer care provision, and I would dearly love to work with the Minister to deliver a new radiotherapy machine—on a partnership basis, if necessary—to begin to tackle some of our challenges head on. Indeed, that sounds significantly more achievable than tackling some of the other health inequalities from which my constituents suffer. Not a single NHS dentist across Devon is taking patients, and the last orthodontist has just left Barnstaple. I recognise that dentists are hard to come by but, for anyone listening, the surf is fantastic and you will be the most welcome blow-in we have ever seen in Devon.

Sorting out radiotherapy could be easier with a community-driven fundraising scheme and some assistance from the Minister to facilitate such as trial. I have former community hospitals waiting, and space on the main hospital site that could accommodate the machine and bunker. As we look to 2040, when an estimated 500,000 people will be diagnosed with cancer each year, we need to invest in cost-effective and efficient treatment.

Half of us will get cancer in our lifetime, so one in four of us will require radiotherapy treatment. Access to such treatment should not be limited by someone’s postcode. I ask the Minister not just to look at modernising and supporting radiotherapy, but to ensure that planning for cancer care accounts for rurality and that everyone has access to all available treatments.

--- Later in debate ---

[Will Quince]

I will come on to the hon. Gentleman’s specific point, but he is absolutely right. On remaining in post and Government reshuffles, the Prime Minister giveth and the Prime Minister taketh away, but I thank the hon. Gentleman for his best wishes ahead of any future reshuffle. Having been in the Departments of Health and Social Care, for Education and for Work and Pensions, I know that any Minister understandably ends up taking a considerable interest in their work. I assure the hon. Gentleman that whether or not I maintain my position in the Government, I will maintain my interest in all the areas I have worked on as a Minister. I certainly commit to continuing that work from the Back Benches when one day the Prime Minister chooses to dispense with my services.

[Selaine Saxby]

I thank the Minister for all his time and commitment and for meeting me so regularly. When he takes things away and reflects on them, will he bear in mind that although community diagnostic hubs are fantastic, it is still a 120 mile round trip from my constituency to get to one, so there are issues in respect of rurality. In Ilfracombe in my constituency, the healthy life expectancy is 59. Remote coastal communities need to be able to access services, and we are underdiagnosing because it is so hard to access even a diagnosis, let alone the treatment.

[Will Quince]

I will come on to this point in greater depth, but many of the conversations that my hon. Friend and I have had on health issues, and previously on education issues as well, were about rurality and the challenges of rural and coastal communities. Her points are well made—I certainly understand them—and she makes a compelling case. I will address them in greater detail later in my speech.

Not only are we building the community diagnostic centres and surgical hubs—and notwithstanding my hon. Friend’s point about the distance that some have to travel to get to them—but we are creating them deliberately closer to communities; they are not just based in district and general hospitals. In each of the next two years they will be supported by an additional £3.3 billion of funding, which was announced in the autumn statement, and that will enable rapid action to improve emergency, elective and primary care performance towards the pre-pandemic levels.

On cancer specifically, NHS England recently set out the progress made on reducing the number of patients with urgent suspected cancer who wait for longer than 62 days, and announced that the faster diagnosis standard was met for the first time in February this year. It also confirmed the ongoing priorities to improve performance and long waits, prioritise diagnostic capacity for cancer and, of course, focus on the cancer pathway redesign.

The Government and NHS England have pushed to improve the early diagnosis of cancer, which is so important to give patients the best chance of receiving successful treatment and in turn see more people living longer following a cancer diagnosis. However, as my hon. Friend the Member for North Devon eloquently and articulately pointed out—the hon. Member for Easington also made this point—we know that early diagnosis needs to be backed up by high-quality treatment options such as radiotherapy, with its remarkable ability to shrink tumours, as has been set out, and often with minimal side effects.

The hon. Members for Easington and for Denton and Reddish referred to the 62-day cancer target and the changes required to improve cancer outcomes. I hear the strong and compelling arguments that have been made, and I am happy, as I set out at the beginning of my speech, to meet hon. Members to discuss the steps that we are already taking and the further steps that can be taken, alongside NHS England, to improve cancer outcomes.

The hon. Member for Denton and Reddish asked specifically about steps to meet the 62-day target. To target support towards the most challenged trusts in the country, NHS England has developed an intervention model that is designed both to maximise and expand capacity. Challenged trusts have been placed into tiers 1 and 2, and all tiered trusts have weekly or fortnightly oversight calls, and they also have visits with the regional and national teams from NHS England. They receive support on things like the development of a co-ordinated support plan, which is monitored by fortnightly progress meetings. The plans have focused on areas such as pathway improvements, workforce support and targeted capacity increases. That supports the trusts that do not have the resource or bandwidth internally to turn around services.

When my hon. Friend the Member for North Devon made the case for a satellite centre in her constituency, she raised specific challenges in relation to North Devon that are translatable to other parts of the country that have rural and coastal characteristics. I will outline the basis on which provision is reviewed, but before I do let me acknowledge the local efforts that she mentioned. She is rightly proud of her constituents’ initiative in terms of support with travel and other things.

The network oversight group, in conjunction with the relevant specialised commissioning team and cancer alliances, is required to review service provision on a regular basis to ensure that optimal access arrangements are in place. That applies to proposals that relate to the expansion or re-provision of existing services, or to the development of any satellite facilities. The development of any new service location requires the development of a business case, as my hon. Friend pointed out, and business cases must demonstrate, among other criteria, the consideration of the effect on the provision of existing cancer pathways, both within and outside the network geography.

As I have mentioned, that responsibility sits not with the Government but with the integrated care boards, cancer alliances and local specialised commissioning teams. I am happy to meet my hon. Friend, alongside the ICB, to understand the challenges and what can be done in this space. I understand from NHS England that around 450 patients a year travel from my hon. Friend’s constituency to Exeter for treatment, but I am cognisant of the point made by the hon. Member for Westmorland and Lonsdale that many more patients might want to access those services but do not because of the travelling and distances involved. That is why a meeting between me, my hon. Friend and the ICB might be a good starting point.

--- Later in debate ---

[Selaine Saxby]

It has been a pleasure to participate in a debate with you in the Chair, Dame Maria. I thank the Minister for such a comprehensive response, and I thank all right hon. and hon. Members for participating in the debate. I very much hope that the next time we come together we will be celebrating some successes and improved access for our rural constituents to radiotherapy and other cancer treatments. I thank the Minister once again for his time.

Question put and agreed to.

Resolved,

That this House has considered the accessibility of radiotherapy.

Oral Answers to Questions

Selaine Saxby Excerpts

Tuesday 6th June 2023 Commons Chamber

[Steve Barclay]

The Minister of State has met with campaigners, and I know he stands ready to have further such meetings. As we touched on earlier, the £40 million is available; obviously, that needs to be allocated to research bids of the necessary quality, and the remaining money is open to researchers to bid for. I hope they will do so.

[Selaine Saxby (North Devon) (Con)]

T3. I thank my right hon. Friend for reconfirming the investment into North Devon District Hospital. Will he meet with me, the hospital trust and my local housing association to ensure that the housing committed to on the Barnstaple site can rapidly commence?

[Steve Barclay]

I am very keen to meet with my hon. Friend. I know this is an extremely important scheme for her constituency, particularly the key worker accommodation, and I look forward to having that discussion with her and the leadership of her trust.

NHS Dentists: South-West England

Selaine Saxby Excerpts

Wednesday 24th May 2023 Westminster Hall

[Chris Loder]

I thank my hon. Friend for his intervention. I wholly agree with him that reforms are needed urgently, which is the main point I will be sharing with the Minister towards the end of my contribution. It is clear that some of the measures from the 2006 Act do not go far enough. In many cases, they actually deter NHS dentistry provision.

Many of these issues are evident up and down the country today. Discussions with my own integrated care board in West Dorset—which, as of 1 April this year, has taken delegated responsibility for commissioning dental services from NHS England—have confirmed to me that the dental contract signed in 2006 is simply not fit for purpose. It actually restricts the ability of the board to respond to the current situation. That is because the terms and structure of the contract make it incredibly difficult for the integrated care board to attract new dentists to work in Dorset. I am sure that other integrated care boards across the south-west share that problem. The ability to attract new dental talent, especially those who are working on NHS contracts, is further hindered by our specific circumstances in Dorset. We do not have adequate training infrastructure.

[Selaine Saxby (North Devon) (Con)]

Does my hon. Friend agree that this problem is particularly exacerbated for those of us in very rural parts of the south-west? Would the Minister consider putting dentists on a bus and bringing the dental service to us, so that our young people can see a dentist? Realistically, we will not be able to attract the new dentists we need in some of the remote locations that we love to live in.

[Chris Loder]

I thank my hon. Friend for her kind intervention, and I wholly agree. Her constituency of North Devon is not dissimilar to mine; we share many challenges and many wonderful things. I am sure the Minister has heard what she has to say, and I look forward to his contribution.

Without a dental school in Dorset, recruitment continues to be a real problem, as staff often leave the county, and indeed the region, after receiving their training. That leaves Dorset residents short-changed, especially given that our council tax is among the highest in the country.

The third impacting factor is the backlog following the covid-19 pandemic. We are all well versed in that, but I wonder whether we fully appreciate the pressure on dental services since then. It is estimated that as many as 40 million NHS dental appointments have been lost since the start of the pandemic, and that is exacerbated by the fact that 45% of dentists in England have reduced their NHS commitments since the start of the pandemic, which puts more pressure on an already strained system. A reported 75% of dentists say that they are thinking of reducing their NHS commitment this year, so it is important to look at what needs to be done to help the dentists still committed to NHS work and the people up and down the country—particularly in the south-west—who rely on those services. To my mind, there are two primary actions: contract reform and quick investment.

There are clearly a number of issues with the NHS dental contract, as we have said. I recently wrote to all 17 dental practices in my constituency, and I am in regular dialogue with the local integrated care board, and they all tell me that the dental contract needs urgent reform. It seems that the current terms of the contract make it incredibly difficult for local boards to recruit new dentists to meet local demand. I worry that the situation for our integrated care boards is not sustainable and could become worse.

The contract also seems to include irregular and sometimes near-nonsensical patterns of remuneration, which are undoubtedly playing on the minds of dentists considering their commitment to NHS work. For instance, dental practices are often remunerated for one filling only, regardless of the number of fillings needed for a given patient, which reduces the incentives for dentists to stay working with the NHS. That cannot be right.

Behind-the-scenes work is often missed when the work that a practice has carried out is calculated. For example, if a patient were to require one X-ray examination, two fillings, one extraction and two appointments for root treatment, that would total more than four hours of clinical time and would be counted as five units of dental activity or UDAs, which is the way that the NHS measures practice activity. Not included are the cost of materials, the nurses’ time setting up the procedures or the receptionists’ time booking the appointments and chasing patients should they not attend, all of which are hidden from the current contract. Transparency is key. As part of a wider reform of the NHS dental contract, West Dorset constituents who have got in touch with me would appreciate greater transparency in the requirements for such treatment.

One of my constituents recently had an abscess in their jaw. Like many in that situation, they called the nearest dental practice. As I said earlier, there was a 22% chance that they would be told that the practice had gone private, a 42% chance that they would be told that it was closed to new patients, and a 50% chance that they would be added to a 12-month waiting list, leaving them with an abscess until this time next year. Fortunately, those things did not happen. My constituent got through and made an appointment, although the dentist informed them that they did not regard the situation as an emergency, so my constituent was forced to go elsewhere, which reset the clock on their waiting list.

The dental practices that have contacted me have also shared stories of the abuse that their staff receive on a daily basis due to the lack of capacity, of how 111 continues to tell people to call their dental practices despite them not holding emergency contracts with the NHS, and of how the unfair UDA system acts as a direct negative contributing factor to the current situation faced by NHS dentistry.

Reformation of the service is clearly vital. When we previously debated the Health and Care Act 2022, I said that simply throwing money at the problem will not make it go away. Yet funding is, of course, the other vital area of improvement in this equation. Between 2010-11 and 2021-22, total funding for dental services in England fell by 8% in real terms, from £3.36 billion to £3.1 billion. Further, where practices have underperformed in the past, NHS England have not released the funding, resulting in an underspend of the national dental budget. I therefore urge the Minister to maintain his commitment to reforming the unpopular 2006 dental contract, to make vital and necessary changes to unfair remuneration, and to act before the situation gets any worse and more dentists are lost. That is very important.

Reforms to NHS Dentistry

Selaine Saxby Excerpts

Thursday 27th April 2023 Commons Chamber

[Selaine Saxby (North Devon) (Con)]

Access to dentists in North Devon is an issue that I was aware of before I became an MP. When I moved there, it took me over 18 months to find a local NHS dentist. Since I was elected, the issue has topped the casework league in my inbox most weeks. I have constituents in dire need. A recent case concerns a lady who is recovering from bowel cancer and a full hysterectomy. She had chemotherapy that made her teeth rot. She managed to see a dentist, but unfortunately is unable to afford what was supposed to be the “affordable” private treatment, because due to her other treatment, she is unable to work.

Another constituent, having phoned almost all the dentists in North Devon, has been told that there is a seven-year wait list to even see an NHS dentist. Many surgeries state in their recorded message that they cannot help anyone who is looking for NHS assistance. My constituent found a dentist, only to be told that the work needed was close to £2,000. They say:

“I am entitled to free NHS dental treatment which means absolutely nothing if it is not available. I cannot express how distressing and painful this is for me.”

The changes to dentistry contracts to allow more flexibility in who performs certain procedures are important and welcome steps, but unfortunately, in North Devon, we just do not have enough dentists. I have spoken before about the need to facilitate more international dentists’ coming to the UK. Recent legislation allowing the General Dental Council to amend its registration processes for international dentists is a step in the right direction, but we need to look at why we have dental deserts—and at how the practice of naming them “dental deserts” exacerbates the problem; it is not worth dentists taking on work when it is clear that each patient is likely to have significant issues, as the remuneration structure then does not reflect the work involved.

One key reason why we struggle to recruit more dentists to North Devon is the lack of affordable housing; that affects recruitment across all our health services. As we work to bring more dentists to North Devon, I hope that the Department will look at more creative solutions, such as including accommodation in employment packages. Alternatively, the Department might consider expediting our hospital redevelopment—it is one of 40 hospital redevelopments—the next phase of which involves nurses’ housing. Given that dental issues are the No. 1 reason why under-18s in North Devon end up in our hospital, it must be possible to join some of the dots together.

I am most concerned about the availability of dental care for our children. Good dental habits can set them up for a lifetime of healthy teeth. In the year up to June 2022, only 44% of children in Devon had seen a dentist in the last year. While the Department works to improve access to dental care in the long term, will the Minister look in the short term at the possibility of bringing dental buses or temporary dentists into areas such as North Devon, so that people can have their problems dealt with sooner, and the next generation can get their teeth checked before any issues cause them long-term harm?

My first constituency surgery appointment after being elected to this place was on dentistry. I want to get things done for North Devon. I have raised this matter with every dentistry Minister, every Health Secretary, my integrated care board and my council, yet nothing seems to change. Even the suggestion that charitable dentists be used is given a “Computer says no” response. There is immeasurable frustration at the fact that, three and a half years later, the situation with dentistry in my constituency is worse, not better. Please can an urgent solution be found that gets the excess dentists in some parts of the world to North Devon, and can some compassion be shown to those who desperately need dental treatment now?

Junior Doctors’ Strikes

Selaine Saxby Excerpts

Thursday 30th March 2023 Commons Chamber

[Steve Barclay]

I think we can see what sort of impact it will have from the previous strike, which was over three days and impacted 181,049 appointments. We can see there will be a significant impact. On mitigations, as part of our electives recovery plan, we are doing a range of things, including expanding community diagnostic hubs and the fast-tracking of surgical hubs. The NHS is responding brilliantly with things such as super Saturdays, where teams process higher volumes of treatments, particularly in certain areas. We have the Getting It Right First Time programme, led by Sir Jim Mackey and Professor Tim Briggs, which is looking at how we embed best practice. Having hit the first interim milestone of our recovery plan in the summer, the two-year wait, we are now focused on the 78-week wait target and working our way through that.

[Selaine Saxby (North Devon) (Con)]

The British Medical Association’s pay demands are more than four times the size of the private sector average pay increase. Does my right hon. Friend agree that inflation is the enemy, making everyone poorer, and that public sector pay rises of over 25% will only drive inflation even higher?

[Steve Barclay]

I agree with my hon. Friend that we need to do both: we need to get inflation down, recognising that has an impact across the whole workforce, including for those working within the NHS itself, and we need to recognise the real pressure that junior doctors and others within the NHS have faced. That is why we stand ready to have meaningful and constructive talks with junior doctors, in exactly the same way as we have had with midwives, nurses and others within “Agenda for Change”. We must balance the wider issue of inflation and what is affordable to the economy against recognising the real pressures the NHS has faced and responding to that, including for junior doctors.

Urgent and Emergency Care Recovery Plan

Selaine Saxby Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

As a former Minister in the Department, my hon. Friend speaks with great experience on these matters. He is right that the crux of the plan is now in its delivery. As I alluded to in my statement, a key component of that is more transparency in the data so that he and colleagues throughout the House can hold to account not only the ICBs but the local authorities. We need to bring those two datasets more closely into alignment.

[Selaine Saxby (North Devon) (Con)]

I warmly welcome today’s announcement, but will my right hon. Friend explain how for remote rural hospitals, such as the fantastic North Devon District Hospital, the workforce challenges that were present pre-pandemic might be addressed post pandemic, when we are now also dealing with a housing crisis? Might there be an opportunity to expedite the next phase of the redevelopment programme, which includes key worker housing?

[Steve Barclay]

I am keen to explore with colleagues how we can put more key worker accommodation on to the NHS estate, particularly by making use of modern methods of construction to expedite that. On the workforce plan, Devon is an area that has seen particular growth, given its older population, and greater pressure as a consequence. Those pressures will be worked through in the workforce plan that we will bring forward shortly.