Eating Disorders Awareness Week

Wera Hobhouse Excerpts

Thursday 29th February 2024 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered Eating Disorders Awareness Week 2024.

It is a pleasure to serve with you in the Chair, Mr Hollobone. Across the UK, 1.25 million people have eating disorders, which include binge eating disorder, bulimia, anorexia, other specified feeding or eating disorders, and avoidant/restrictive food intake disorder.

Left undiagnosed and untreated, eating disorders can be silent killers. Anorexia has the highest mortality rate of any mental illness, and results from one study have shown that a third of people with binge eating disorder are at risk of suicide. For too long, sufferers have been left feeling trapped and alone. Urgent action is needed to tackle this rising epidemic.

The theme for Eating Disorders Awareness Week 2024 is avoidant/restrictive food intake disorder, or ARFID. The condition is characterised by a limited range of food intake. Sufferers may eat only “safe” foods, and can avoid entire food types. That means that they have difficulty meeting their nutritional and energy needs, and can experience weight loss and health problems.

ARFID can come from sensory sensitivity and fear of negative consequences from eating. Beliefs about weight and shape do not necessarily contribute. Be Body Positive, an NHS-backed psychoeducation website, has shared a story of what life can be like with this condition. Tahlia was diagnosed with ARFID when she was 20. She was initially misdiagnosed as a fussy eater before eventually being misdiagnosed with anorexia as a teenager as a result of her significant weight loss. Because she was misdiagnosed, she missed out on early vital treatment. In her own words:

“Growing up, I felt misunderstood and isolated because of my eating habits…Knowing that ARFID exists has been a validating experience, connecting me with a community of people who share similar challenges.”

The helpline run by Beat received more than 2,000 phone calls from people looking for support for ARFID last year—2,000 only last year! However, awareness of ARFID is still very limited. Misperceptions that it is just fussy eating leave sufferers like Tahlia feeling alone. There is no solid data on how many people in the UK have ARFID; it could be anywhere from less than 1% of the child and adolescent population to over 15%.

Because of those perceptions, accessing specialist treatment can be a lottery. There is a lack of standardised treatment pathways for ARFID, and it is hard to find out what support is available. A recent survey of NHS websites found that only six of the 55 NHS providers of eating-disorder services for children and young people explicitly stated that they provided treatment for ARFID, and only one of the 49 NHS providers of adult eating-disorder services said the same—one out of 49!

Rigid stereotypes of eating disorders persist in other areas. Despite their high prevalence, eating disorders are frequently misunderstood and viewed as a lifestyle choice. Contrary to popular belief, eating disorders are most common among people with severe obesity. I have been appalled by stories of people being turned away from treatment because their body mass index was too high, and have long supported Hope Virgo’s “Dump the Scales” campaign to change that.

National Institute for Health and Care Excellence guidelines state that single measures such as BMI should not be used to determine whether someone receives treatment. However, those guidelines are not being uniformly implemented. Some services are still using those barriers due to severe mismatch between demand and capacity in chronically underfunded services.

It is not uncommon for patients to get to a worryingly low BMI before they are considered appropriate for an in-patient bed. That requires investment, but eating disorder treatment is cost-effective at any stage. We know that early diagnosis is critical: the earlier someone receives intervention for their eating disorder, the more likely they are to make a full recovery. The longer symptoms are left untreated, the more difficult it is for someone to recover. Healthcare should focus on prevention before cure. Access to the right treatment and early support is life changing. If we want to save money, prevent hospital admissions, save lives and improve outcomes for all sufferers, we need to ensure full implementation of clinical guidance around diagnosis.

There are many wonderful organisations working up and down the country to get people the help they need. I pay tribute to SWEDA, previously known as the Somerset and Wessex Eating Disorders Association, which provides invaluable support to so many families across my local area and is expanding its operations this year. Last year, SWEDA told me that it saw a 150% increase in people attending support and guidance appointments for eating disorders compared with pre-pandemic figures. Its children’s service was overwhelmed with young people and their parents desperately seeking help.

Eating disorders wipe out adolescence. Young people suffering from eating disorders miss out on so many educational and social opportunities. Those years are stolen from them—not to mention the potentially irreversible effect on their physical health. I welcome the access and waiting time standards already set for children and young people’s services. However, those targets have still not been met; 6,000 children and young people are stuck on the NHS waiting list for treatment. In two thirds of those cases, patients have been waiting for over three months, despite the standard stating that for routine cases, treatment should start within a month. Between 2022 and 2023, fewer than three quarters of children’s urgent cases started treatment within one week—well below the 95% standard. If we have standards, the Government must provide the resources to meet them.

For adults, there are not even targets in place. Adult eating disorder services in England are severely under-resourced, especially now that demand has risen to even higher levels as a result of the pandemic. Those services typically have either long waiting lists or strict referral criteria. That means that many adults are unable to access the treatment they need until they have become very ill. On average, people wait almost three and a half years to get treatment for their eating disorder, and adults wait twice as long. Shockingly, sufferers are reaching the point of emergency hospitalisation before they can access care.

Delays have deadly consequences. In 2017, the parliamentary health and service ombudsman published a damning report into the failings that led to the death of 19-year-old Averil Hart from anorexia and that of two other adults with an eating disorder. Last February, the Health Service Journal identified at least 19 adults with eating disorders whose death sparked concerns from coroners about their care. At least 15 of those were deemed avoidable and resulted in formal warnings being issued to mental health chiefs. We can never allow that to happen again. We must remember that eating disorders are treatable.

Targets are crucial if we are to tackle this epidemic. An access and waiting time standard for adults would provoke significant extra funding and focus. If we want to encourage people to seek help, we need to give them a guarantee that they will be seen. Having clear standards can facilitate service improvement. They enhance the experience for patients and drive up health outcomes. Although there is still a way to go, the standards introduced for waiting times for children and young people’s eating disorder services have driven some crucial service improvements. We need to see the same for adults.

Our health service is simply neither equipped nor empowered to deal with eating disorders. I was disappointed that the Government decided against publishing a 10-year cross-Government mental health and wellbeing plan for England; instead, they developed and published a major conditions strategy, which included mental health alongside cancer, cardiovascular disease and dementia. We need targeted and varied strategies for targeted and varied issues.

I again point the Government towards Hope Virgo’s eating disorders manifesto. It calls for the Government to implement an evidence-based national eating disorders strategy, with a plan outlining how they will tackle the huge rise in the number of people affected by eating disorders. I would also like to see the appointment of an eating disorders prevention champion to co-ordinate the Government response.

The strategy should integrate obesity and eating disorder prevention plans, because there are so many overlapping factors between the two. The Government should also consider reforming treatment approaches. For example, an Oxford University study found that using the integrated CBT-E or enhanced cognitive behaviour therapy approach rather than the current in-patient approach reduced readmission rates for people with anorexia by 70% over the course of a year.

We should also consider the other available options. The all-party parliamentary group on eating disorders, which I chair, is currently conducting an inquiry into intensive out-patient treatment. Such programmes are designed to support people with severe eating disorders for whom traditional out-patient treatment is not working. Patients go home in the evening and at the weekends, and have access to increased meal support and therapy. They can be treated in a familiar community-based setting. Such programmes are recognised as an effective and less expensive alternative to in-patient care. Importantly, both patients and their loved ones often find this form of treatment far preferable to other forms of treatment.

However, intensive out-patient treatment is not widely available across the country and there is no up-to-date information about exactly how many services are providing it. Again, we return to the importance of appropriate early intervention. Universal access to intensive out-patient services could minimise the need for disruptive in-patient stays. I hope to hear comments from the Minister about investment in such treatments.

Much of what I am talking about comes back to resources. The Government funding needs to reach frontline services, but the APPG on eating disorders found that 90% of the additional NHS funding given to clinical commissioning groups for children’s services did not reach the frontline. The Government must ensure that their funding pledges are not empty words and that money gets to where it is needed. A one-off boost is not enough. Soaring demand for underfunded services will leave people missing out on care when they need it most.

To tackle eating disorders, we also need to understand them fully. From 2015 to 2019, eating disorders accounted for just 1% of the UK’s already severely limited mental health research funding. The APPG on eating disorders previously conducted an inquiry into eating disorder research funding, which found that a historic lack of investment has led to a vicious cycle of underfunding. The APPG also emphasised that we need to diversify the research agenda.

Certain eating disorders and patient groups have not been served by current research. That is a real barrier when it comes to efforts to improve care. We cannot identify the obstacles that exist without having more information. Some progress is being made. It has been encouraging to see some increased investment into eating disorder research and a commitment to actively involve people with lived experience in emerging research collaborations. We now need to see targeted investment and ringfenced funding.

Eating disorder sufferers are being abandoned. We are well aware that the NHS is in crisis. However, although we have heard harrowing stories about delays in ambulance services and accident and emergency departments, the impact on mental health services has received little attention. Eating disorders are an epidemic and the sooner we realise that, the sooner we can treat them with the attention they deserve. No one should be condemned to a life of illness and nor should anyone die of an eating disorder in 2024.

[Mr Philip Hollobone (in the Chair)]

This debate can last until 4.30 pm. I am obliged to call the Front Benchers no later than 3.57 pm and the guideline limits are 10 minutes for the SNP, 10 minutes for His Majesty’s Opposition and 10 minutes for the Minister. Then the mover of the motion will have two or three minutes at the end to sum up the debate. In the meantime, it is Back-Bench time. I call Olivia Blake to speak.

[Olivia Blake (Sheffield, Hallam) (Lab)]

I thank hon. Members across the House for their support in this debate, and I thank the hon. Member for Bath (Wera Hobhouse) for securing it. All the work that the APPG on eating disorders does is very much appreciated, and it rightly puts this issue back in front of us to discuss during each and every Eating Disorders Awareness Week. I also thank the Backbench Business Committee for granting us time to debate this issue.

Like many serious mental illnesses, eating disorders are often endured in silence. That means symptoms can go unnoticed, resulting in devastating consequences. Without diagnosis and treatment, eating disorders can be deadly. They have the biggest mortality rate of any mental health condition.

Around 1.25 million people in the UK live with disordered eating—a number that has inevitably been made worse by the pandemic. Although younger women are especially at risk of suffering from eating disorders, it is vital to remember that eating disorders can and do affect all people regardless of age, gender, ethnicity or background. So the general topic of today’s debate—Eating Disorders Awareness Week—is an important one, and it is especially important to one of my constituents.

I want to talk about someone I have been supporting for the past two years, who has shared her deeply distressing experience as an in-patient on a mental health ward. She spoke about the way in which she was

“reduced to numbers before receiving help.”

Despite not being able to eat, drink or take medication for five full days on the ward, and after asking for medical help, she was told she would only be referred once she had reached a specific blood pressure and blood sugar reading.

During my constituent’s ordeal, she was not provided with any support at mealtimes and, eventually, staff stopped asking if she wanted any food or drink. That resulted in her being transferred to another hospital in a critical condition and requiring emergency medical treatment in the ambulance on the way. As my constituent rightly told me,

“no one should ever be left to the point of medical emergency before needing help.”

It is right that we acknowledge the hard work of eating disorder specialist NHS workers and campaigners in my constituency and across the country, such as Hope Virgo, whom we have heard about, and many others. Specialist frontline workers continue to provide vital life-saving care in increasingly difficult circumstances and with increasingly scarce resources. We also need much more training in eating disorders for all frontline staff so that they understand how to treat patients in their care.

We know that eating disorder services are at breaking point. Demand is going up, cases are becoming more critical, training and resources are scarce, and the availability of support is a postcode lottery. This means that unacceptable cases such as this are inevitably becoming more and more common. The current system is failing. As I said last year, we face a crisis with terrible human consequences.

The specific theme of this year’s Eating Disorders Awareness Week is avoidant/restrictive food intake disorder. Anyone can have ARFID; it can affect children, teenagers and adults. Although it is a little known and often misunderstood condition, it can have serious consequences for health if left untreated. Too often, misconceptions about picky or fussy eating trivialise this serious condition. The stigma and fear of judgment means that those with ARFID and their carers often suffer in silence. The charity, Beat, has reported an increase in calls to its helpline from people affected by ARFID. In 2018, it received 295 inquiries about the disorder. By 2023, that had ballooned to 2,054 calls.

[Wera Hobhouse]

Does the hon. Member agree that this is also about the carers, care givers and the parents who need to know about the condition? They are often worried to death when they see a child or a young adolescent in such a condition and they do not know what to do.

[Olivia Blake]

I absolutely agree. I have had carers contacting me to ask where they can find guidance because of the limits locally, which I will go on to in a bit. That is probably why we have seen the increase in calls for support for carers.

Carers are hearing time and again that people are struggling to get the help that they desperately need. That is partly due to limited awareness, limited research on the condition and a lack of standardised treatment pathways. Today’s debate plays an important role in tackling the misconceptions in the system and raises awareness of a serious condition that can have fatal consequences if left untreated, due to malnutrition and other issues.

Another part of the problem is under-resourcing in the system. Since 2011, hospital admissions for eating disorders have nearly doubled in England, going from 2,287 to 4,462 last year, after peaking at 5,559 cases in the year 2021-22. Currently, 12.5% of 17 to 19-year-olds are estimated to suffer from disordered eating. Shockingly, an NHS England survey found that 59.4% of 17 to 19-year-olds exhibited behaviours that suggested it was possible that they had an eating disorder. Among girls, the figure rises to just over three quarters, at 77%.

While Ministers promised more funding, the scale of response simply is not matching the alarming level of demand. The waiting time targets for specialist eating disorder services for children and young people are consistently not met, even though they have only recently been put in place, while the lists have simply been growing longer and longer. As a bare minimum, there should be an action plan to address the backlog, and a similar target must be put in place for adults seeking help. That was part of a previous plan, but it has clearly been dropped in the major conditions strategy, which the hon. Member for Bath mentioned. Without a clear plan in place to meet those targets, it is really important that we make sure that care is available to people. All children and adults with an eating disorder should be able to get access to the care that they need.

It is not good enough to address the in-patient figures alone. We know that early intervention is the right treatment. The devastating consequences of eating disorders can be prevented, yet the Government have done very little to move us in the right direction towards preventive care.

Due to the delays in identification, referral and waiting times, those able to access treatment are waiting on average three and a half years between onset and start of treatment. That is far too long, when we know that the earlier we get to people, the better their chances. The delay is potentially fatal to many, with recovery being far more likely for patients who receive medical intervention early, when behaviour can be adapted before it becomes too ingrained. For ARFID, we need an NHS-commissioned treatment pathway and trained NHS staff so that people do not go undiagnosed or untreated, or sit in treatment pathways that are not suitable for their needs.

It is seven years since the Parliamentary and Health Service Ombudsman report, which has been mentioned. That report was damning. It concluded that patients had been failed by NHS eating disorder services. It is shameful that we cannot point to more progress in this area and that, since then, the ombudsman has felt the need to reiterate the findings of that report to try to get more action.

This crisis should be an opportunity to rethink our approach to how we support and treat people in the UK who suffer from an eating disorder. I urge the Minister to look at the transformative work that groups such as South Yorkshire Eating Disorder Association are doing to help build an alternative framework for care nationally. It is time that we acknowledged the crisis and committed the training and resources necessary to fix it.

[John McDonnell (Hayes and Harlington) (Lab)]

I congratulate the hon. Member for Bath (Wera Hobhouse) not just on securing this debate, but on her dogged pursuit of this issue over the years. The Minister should be aware that the all-party parliamentary group on eating disorders is one of the most active and effective in Parliament, as a result of her work. She has collected around her hon. Members, such as my hon. Friend the Member for Sheffield, Hallam (Olivia Blake), who are extremely committed in representing their constituents.

We all come to this issue as a result of dealing with our constituents and the hardships that they have faced. I thank Hope Virgo for her work, her campaign and the book she has written. If it was not for her, I do not think we would have been on this agenda as effectively as we have been in recent years.

I thank the Government as well because, early on, they recognised that there was an issue and brought forward some resources. I am grateful for that, but this is one of those issues where things are moving so rapidly in terms of the scale of the problem. We will have to come back to the Government regularly to look at how we top up those resources.

Much has been said about the statistics. I heard the figure of 1.25 million people mentioned and others have said 1.6 million, but it seems like a bottomless pit. The health survey was really interesting. If I remember rightly, it looked at those who had the potential for an eating disorder, so it was trying to get ahead of the numbers, and it said that 16% of the population—19% of women and 13% of men—could be at risk. One of the issues that the APPG has been really good at breaking through on is that this is not just about women; a large number of men are also affected by this problem, and that needs to be addressed.

In all these debates, we try to get across the impact and, to a certain extent, highlight to our constituents that we understand how their lives are affected. Of course, the mental health issues are fundamental. There have been suicides and deaths, but there has also been an outbreak of self-harm among people suffering from this condition. People have reported that there has been an impact on their ability to work, meet socially and engage in a full life. What has worried me most is the huge increase in the numbers being admitted to hospital—I think there has been a fourfold increase in recent years.

As has been said, this is the mental health condition with the highest mortality rate. Part of that is because there is a mismatch between the scale of the problem and the resources available, and that includes the number of hospital beds. I understand that there are only 450 specialist beds, but the admission rate is about 20,000, so there is a startling difference between what is needed and what has been provided.

[Wera Hobhouse]

Does the right hon. Gentleman agree that the biggest problem is that for too long, this condition has been seen as a lifestyle choice rather than an illness? We still need to make a breakthrough on that.

[John McDonnell]

Thanks to the work that the hon. Lady, the campaigners and others have done, the media reporting of this issue has, to a certain extent, changed dramatically, but that has taken years to achieve. I agree that this is still seen as a lifestyle choice. It is not seen as serious; people do not relate deaths to this condition, but we all know from dealing with our constituents that that is what happens.

The other issue about the access to hospitals and clinics is that we have all had to map out, across the country, where constituents can go. Often, what happens is that they are discharged from one unit and it is then almost impossible to get them into another, particularly if there are specialist concerns.

The issues that we are reiterating today include the fact that the funding needs reviewing again, because the situation has moved on since we last discussed funding with the Government. There is also a lack of clarity, so we need a concrete action plan for the coming period. One of the issues is how we bring people together. There is a real concern about the lack of monitoring. One of the proposals, which I think Hope Virgo first raised, is to have a discussion about how we are monitoring this situation, both in terms of incidents and the effectiveness of different treatments. A proposal from one of the discussions we had is that it is time to bring together again those with experience of the condition and the key clinicians in the field, so that we can stand back and objectively look at where we are at. When we have dealt with homicides and suicides in other fields, we have set up independent inquiries because of the seriousness of the matter. In some instances, I feel that we need some form of inquiry to see where we are at and what is needed in the future.

The hon. Member for Bath and my hon. Friend the Member for Sheffield, Hallam mentioned the staff. The impression I get from the discussions I have is that, because of the increasing demand, staff are experiencing a level of exhaustion and a morale issue about simply being able to cope with the numbers and severity of the conditions they are dealing with. One thing we can do today, as others have, is to acknowledge the commitment and dedication of those staff, while recognising that they need greater support, in terms of both numbers and pay, to demonstrate just how valued they are.

The issue around the NICE guidelines has already been raised, and my experience is the same as others’, really. It is hit or miss; there is a postcode lottery in the provision of treatment under the guidelines. The Dump the Scales campaign by Hope Virgo and others has been effective at moving the debate on from just talking about BMI, so that a wider range of discussions are now taking place, which I really welcome. However, there is still no recognition across services that eating disorders are a mental health issue, and that therefore mental health practices that have been effective elsewhere need to be applied here. I argue very strongly for the need to fund cognitive behavioural therapy, which has a success rate of 70%, I think. It has also reduced readmission rates down to about 15%, so it is a huge money saver for the NHS. Again, we need to look at the levels of investment, both in training staff for that and in ensuring access.

I want to mention another issue that has been raised before. We have found too many examples of the provision of palliative care to eating disorder sufferers, which we are hoping will end. Palliative care should be offered only if there is another life-threatening condition; it should not be offered just because of this condition. We hope that that has now been ended, but it needs monitoring again to ensure that the message is out there. Our overall view is that, with the right support and early enough intervention, people’s lives can be saved, and that their lives can be transformed as a result, but it does need adequate funding.

The hon. Member for Bath mentioned the ringfenced fund that is needed for research. At this stage, it is time to stand back, bring together sufferers and clinicians, and look at what the strategy should be. We need an adequately funded, concrete strategy that we can all sign up to. This is a cross-party issue; it is not party political. As I say, I welcome what the Government have done so far. We are now at the stage where we know so much more about the escalation of the problem and the need for therapeutic interventions, and about what works and what does not.

My final point is to pay tribute, as others have done, to all the campaigners who have put this issue on the agenda and provided support throughout. I pay tribute to all the clinicians, of course, and to one group in particular, which is the school nurses—Members may recall that we held a session with them. They brought forward their programme for how they would provide advice and assistance to pupils, which proved to be incredibly effective. Of course, I also pay tribute to all those who have supported the all-party parliamentary group of the hon. Member for Bath with such expert advice, as well as consistent nagging.

--- Later in debate ---

[Andrew Stephenson]

I completely recognise the shadow Minister’s challenge on that point and the concern that she has—I will set out what we are doing to address it. She also mentioned the Royal College of Psychiatrists, which published a report on this today. It is worth putting on record that we very much welcome that and that we look forward to working with it and other stakeholders. Waits are not as short as we would like, and the Government are determined to meet our waiting-time standards for children and young people with eating disorders. Extra investment is going into the services to meet increased demands and reduce waits, so hopefully we will start to see progress made towards meeting those targets. However, we acknowledge that, while there has been record investment and progress in improving access to eating disorder services and improving quality, there has also been a significant increase in demand for those services over the past few years. That was especially true during the pandemic, with increased demand outstripping the planned growth in capacity.

Children and young people’s eating disorder services are treating 47% more children and young people than before the pandemic, with almost 12,000 children and young people starting routine or urgent treatment in 2022-23, compared with just over 8,000 in 2019-20. That surge in demand has made meeting our waiting-time targets more challenging, and waits are not as short as we would like them to be. However, I am proud that our services and clinicians, backed by new funding, are supporting more children and young people than ever before. Those services are changing and saving lives.

We also know that even earlier intervention is critical to prevent eating disorders from developing. Community-based early mental health and wellbeing support hubs for children and young people aged 11 to 25 can play a key role in providing that support. In October 2023, we announced that £4.92 million from the Treasury’s shared outcomes fund would be available to support hubs, and an evaluation to build the evidence base underpinning those services.

[Wera Hobhouse]

Can the Minister perhaps comment on what I said about intensive out-patient units, in that we really do not have any information on how widely spread they are and where they are being provided? They are a very good alternative way of treatment, and we really need more information about where they are available.

[Andrew Stephenson]

We do need more information on that, and I will come to that point. The next point that I wanted to make was on an announcement that I know the hon. Lady will already be aware of, but other hon. Members may not be. Following the evaluation of some excellent commercial tenders from hubs across the country, the Government announced just this week that we are now providing an additional £3 million, which means that total of 24 hubs will receive a share of almost £8 million in 2024-25. That is more than double our original target of funding 10 hubs, and organisations across England—from Gateshead to Truro—will now benefit.

I appreciate that there is still a bit of a postcode lottery around the country, but we are looking to strengthen services, working with different partners across England, to ensure that we are improving services—enhancing existing services—or developing new services where they have not been provided in the past.

--- Later in debate ---

[Wera Hobhouse]

I want to thank everybody who took part in today’s debate on Eating Disorders Awareness Week. It was an opportunity for all of us to learn more about ARFID, or avoidant/restrictive food intake disorder —it has a long and difficult name, but it is a very severe condition and it is important we understand more about it, as it now affects many young people and their families. I am therefore glad that Beat chose that particular theme for this year’s Eating Disorders Awareness Week.

We have heard about the many different forms that eating disorders take. Many aspects of those different forms are still not entirely known, and that includes ARFID. We need a lot more research into the condition. Most of all, we must increase awareness of support for sufferers and caregivers, urgently increase access to services and especially provide access in a timely manner. We have heard several times that we have targets for children and young people, but they are not being met, and we certainly need targets for adult services. While we have made progress, there is still much more to do.

I want to thank Beat, the many other eating disorder charities and those working in eating disorders services for their sterling work. They are all doing amazing work. Last but not least, I want to pay tribute to the indefatigable Hope Virgo. Without her tireless campaigning, we would not be here today. However, there is still a lot to do. I know the Government are listening and I hope for and look forward to further co-operation.

Question put and agreed to.

Resolved,

That this House has considered Eating Disorders Awareness Week 2024.

NHS Dentistry

Wera Hobhouse Excerpts

Tuesday 9th January 2024 Commons Chamber

[Wes Streeting]

I agree. I am afraid that when it comes to serving personnel and veterans, there is a gulf between what the Government say and promise and what they do; that is not the only example.

One thing not in the Government’s amendment to Labour’s motion is a pledge to protect the NHS dentistry budget. That is odd, because the Prime Minister promised to do exactly that 18 months ago. The truth is that the Prime Minister broke that pledge in November when he gave the go-ahead for dentistry underspends to be raided, effectively waving the white flag on the future of the service. Can you believe it? Despite everything we have heard, there are dentistry underspends, and the Prime Minister thinks that other things are greater priorities than this crisis. The consequences of that decision are now being felt. The budget in some areas of the country is running out and dentists are having to stop NHS work for the remainder of the year. It is so deeply frustrating.

NHS dentists want to do more NHS work; it is the Government who are standing in their way. The Nuffield Trust’s stark report into the crisis suggested that NHS dentistry may have to be scaled back and made available only to the least well-off. Such an approach would be the end of NHS dentistry as a universal public service, yet that is exactly the approach that the Government are piloting in Cornwall. Children, the over-80s and those with specific health needs are given treatment; everyone else has to go private or go without. They will not admit it, but this is the future under the Tories: further neglect, decline and patients made to go without.

Worse still, NHS dentistry is the ghost of Christmas yet to come under the Tories. That is not partisan overreaction on our part; that is according to the lead author of the Nuffield Trust’s report. He wrote:

“For the wider health system, the lessons are troubling: without political honesty and a clear strategy, the same long-term slide from aspiration to reality could happen in other areas of primary care too.”

What has happened to NHS dentistry under the Tories is coming to the rest of the NHS if they are given another five years. That is not the continuity that the country is looking for—it is looking for change with Labour.

[Wera Hobhouse (Bath) (LD)]

My Bath constituency is also described as an NHS dental desert. The only option for people is to go private. The hon. Member has already said that it is Dickensian. Does he agree that it is not just a health problem but an equalities issue that the Government fail to recognise?

[Wes Streeting]

I totally agree. In fact, Claire Hazelgrove, Labour’s candidate in Filton and Bradley Stoke—next-door to the forthcoming by-election—was telling me about problems in her constituency and that exact challenge of people being left without or having to go private. One patient told her that her dental practice was now only seeing private patients. That same patient cares for her 84-year-old dad with dementia, who needed a tooth removal to allow him to eat. His appointment was also cancelled. That is what is happening before our eyes.

What of those who cannot afford it? Anna Dixon, Labour’s candidate in Shipley, told me of a woman in her town who had been turned away as an NHS patient and could not afford to go private. She was struggling with pain, it was affecting her eating, and she was at her wits’ end. With the Tories, if you have not got the money, you have not got the care.

--- Later in debate ---

[Victoria Atkins]

I am extremely grateful to my hon. Friend. His intervention shows the level of detail that colleagues on the Conservative Benches have gone into in trying to address the understandable concerns that local NHS providers are voicing. I will look into that. I am very keen on my three words: faster, simpler, fairer. I want to make it as simple as possible for dentists to rejoin and join the NHS. I will say more on that later.

The choice of whether patients are offered NHS exams and treatment lies with the dentists, who are independent contractors to the NHS. As well as making simple, common-sense changes, in July 2022 we announced a package of far-reaching reforms to make NHS work more attractive to dentists. We have created more bands for units of dental activity, so that dentists are properly rewarded for taking on more complex care, and the best-performing practices can see more NHS patients.

Previously, regardless of the amount of time the dentist took on each patient, they received the same payment for every individual treatment package in band 2, which covers fillings and tooth extraction. Perversely, that meant they received the same payment for doing one filling as for three. That left many dentists unable to afford to take on patients who had not seen a dentist for some time and therefore needed extensive treatment. That needed to be put right for the sake of both patients and dentists. Thanks to our reforms, dentists now receive five units of dental activity when they treat three or more teeth, which is a significant increase from the old maximum of three. Root canal treatment on molar teeth is now rewarded with seven units of dental activity, as opposed to three, meeting one of the British Dental Association’s key demands.

We also recognise the barriers that too many communities have faced when accessing NHS dentistry, with people left phoning around practices to see who was taking on NHS patients. That is why we have made it a contractual requirement for dentists to update the NHS website regularly, making it clear whether their practices are taking on new patients, as well as explaining the services that they offer, thus making it easier for patients to find a dentist that can deliver the care they need. These reforms have improved access to dentistry and ensured that the system better supports dentists and their teams, so they were well received by dentists, their representatives and patient groups across England, with Healthwatch’s national director recognising that these reforms show that the Government are listening to patients and taking action, and these reforms can help ensure that dental care is accessible and affordable to everyone who needs it.

[Wera Hobhouse]

I am pleased to hear about some of the reforms that we have raised in this Chamber many times, particularly on changing the dental contracts and units of dental activity, but may I raise another point? In official workplace data, dentists who do just one NHS check-up a year are counted the same as an NHS full-timer. Does the Secretary of State recognise that that is a problem, because that workplace data hides the scale of the problem?

[Victoria Atkins]

I am extremely grateful to the hon. Lady, who makes a fair point about measuring within the system how much work NHS dentists are doing. As I say, we are looking at all of this in the work that we are doing on the dentistry recovery plan. I repeat that I want to make it as simple as possible for dentists to register with the NHS, to continue offering the care that we all want them to, so I am grateful to the hon. Lady for her intervention.

Osteoporosis

Wera Hobhouse Excerpts

Thursday 26th October 2023 Commons Chamber

[Judith Cummins]

My hon. Friend makes a valuable intervention. He has been a staunch advocate for those suffering from osteoporosis and has backed the Better Bones campaign, for which I am very grateful. I agree that this issue is all about ensuring equity in access to NHS services, including FLS.

[Wera Hobhouse (Bath) (LD)]

I am lucky enough to represent a constituency with a fracture liaison service, which can identify 91% of fragility fractures, but other constituencies are not so lucky. Does the hon. Lady agree that a modest transformation fund would make such a big difference?

[Judith Cummins]

I welcome that intervention and I absolutely agree. The whole tone of the campaign and my speech will address those very issues, because it is so important that we recognise that prevention is key to tackling osteoporosis. We cannot prevent the condition unless we ensure first that people are diagnosed. Osteoporosis receives too little attention, given the scale of numbers affected by the condition: half of all women and one in five men over 50.

Mental Health Treatment and Support

Wera Hobhouse Excerpts

Wednesday 7th June 2023 Commons Chamber

[Neil O’Brien]

It is just not true there was an increase in suicides because of the lockdowns. There have been a whole series of careful studies of this and that is just not the case. I am afraid that my hon. Friend is not correct about this.

[Wera Hobhouse (Bath) (LD)]

Eating disorders are a national scandal and have reached epidemic proportions. Anorexia nervosa has the highest mortality rate of any mental health disorder and a third of people with binge eating disorders are at suicide risk. With at least 125 million people suffering from eating disorders and with soaring waiting lists, is it not time that the Government appointed something like an eating disorder prevention champion to tackle this incredibly difficult but rising crisis?

[Neil O’Brien]

I completely agree about its tremendous importance, and I take this opportunity to mention the incredible work on this hugely important issue by brilliant charities such as Beat. I will outline some of the general things we are doing to increase capacity further.

NHS Dentists: South-West England

Wera Hobhouse Excerpts

Wednesday 24th May 2023 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

It is a pleasure to serve with you in the Chair, Ms Elliott.

In Bath and North East Somerset, more than 105,000 adults have not been seen by a dentist for two years. That is 44% higher than the number in 2018. Children are not faring any better: nearly 15,000 were not seen by an NHS dentist last year, which is an increase of 90% since 2018. Routine dental check-ups are a vital first line of defence against more serious problems such as oral cancer, which is one of the fastest rising types of cancer and claims more lives than car accidents in the UK. Meanwhile, tooth decay is now the most common reason for hospital admissions for young children.

The British Dental Association has said that NHS dentistry is facing an existential threat that long predates the pandemic. The shortage of NHS dentists means that it is now nearly impossible to get a dentist appointment in Bath. Last year’s NHS statistics for England show that my Bath constituency is one of the worst places for NHS dentistry in the country. There were just 44 NHS dentists per 100,000 people living in the area. The Association of Dental Groups described my constituency as a “dental desert”. It stated that this already dire situation will worsen unless the Government take urgent action.

Staff are leaving NHS dentistry at an alarming rate. One in eight are approaching retirement and 14% are close to leaving the profession. Nearly 15% of dentists have been lost from Bath’s clinical commissioning group since 2016. Committed dentists are being forced out of the NHS. The Prime Minister boasted that 500 new dentists are practising in the NHS because of a Government reform; in reality, more than 500 dentists do just one NHS check-up a year.

The British Dental Association described official data on NHS dentistry as a work of pure fiction. Recent polls indicate that more than half of dentists in England have reduced their NHS commitments since the start of the pandemic. That is not tracked in official workplace data: dentists doing one NHS check-up a year are weighted the same as an NHS full-timer. The British Dental Association says the Government have never attempted to collect data on the workload of NHS dentists, or on how much time they spend seeing private or NHS patients. I would like a commitment from the Minister that such data will be collected. We need it urgently to understand the extent of the crisis.

However, we need more than just data: we need urgent reform. We Liberal Democrats are calling for an NHS dental healthcare plan to ensure that everyone can access affordable dental care when they need to. To start, we must immediately invest the money set aside for NHS dentistry and focus it on boosting the numbers of NHS appointments. The Health Service Journal reported that the national dentistry budget is set to be underspent by a record £400 million this year. How can that be when we are facing such a crisis?

The current NHS dentistry contract does not encourage dentists to take on NHS patients. Many dentists simply earn more in the private sector, but frankly many dentists tell me that they can afford to stay open and take on NHS patients only because they are cross-financing NHS and private patients. How can that be? We Liberal Democrats would carry out wholesale reform of the dental contract so that dentists are incentivised to work as NHS dentists without the fear of having to close their doors.

The Government must also encourage those who are ready and able to be dentists to enter the profession. The cap on the number of dental school places available in the UK has remained static since 2013, despite increased demand for dentists. We cannot let this crisis escalate any further. We Liberal Democrats would put into law a proper workforce plan, which would include protections for dentists and dental staff. Dental care is a right that everyone in Bath and beyond should be entitled to. It is time the Government’s response matched the scale of the crisis.

Epidermolysis Bullosa: Drug Repurposing Trials

Wera Hobhouse Excerpts

Tuesday 9th May 2023 Commons Chamber

[Gareth Bacon]

I thank the hon. Gentleman for his kind words and the way he expressed them, and I agree entirely with those sentiments. Without giving out too many spoilers at this stage, there will be a request for a small amount of funding towards the end of my speech.

What I learned during the visit I referred to was truly moving, and I am particularly grateful to have met Wendy. I also thank DEBRA’s director of research, Dr Sagair Hussain, and the excellent staff at the charity shop in my constituency, for inviting me to visit them and learn more about how they help individuals who live with this painful condition. In the spirit of thanking people, I also thank the Minister for his interest in this subject and for being here this evening to respond to the debate, and the Minister for Social Care for recently answering a written parliamentary question that I tabled about EB.

I stress that we cannot merely wait for a cure for this condition. We need to make a difference for patients who are suffering today and those who will be living with the condition for the foreseeable future. All EB patients are crying out for better therapeutic treatments, which have the potential vastly to improve their lives. DEBRA has set an objective of securing two to three treatments from drugs that are already licensed for other conditions, to radically improve the quality of life experienced by people with EB. In reply to my recent written question, the Minister for Social Care said that medicines that are potential candidates for repurposing in this way should be put forward for consideration for support from the Medicines Repurposing Programme. I am grateful for her guidance, and officials from the MRP have been in touch with DEBRA since to talk about the programme’s work. That is excellent news.

In addition, I was delighted to hear that some innovative treatments for EB are either in trials or are being considered by the National Institute for Health and Care Excellence. Specifically, NHS England is working with NICE on the evaluation of two products for EB: birch bark extract for skin wounds, and a gene therapy with a name that I find particularly difficult to pronounce, although I will give it a shot—beremagene geperpavec. I have almost certainly mispronounced that, but it is still encouraging news. However, my understanding is that those two treatments will be available only to a fraction of the total number of people suffering from EB. That is why the repurposing process for more mainstream therapeutics is so important.

DEBRA has identified six anti-inflammatory drugs that could help with EB. Several of those are already available for people with more common skin conditions such as eczema and psoriasis, but for people with EB they could be nothing short of life-changing. They have the potential to transform thousands of lives by improving wound healing, reducing pain, and lowering the burden on the family members and carers of those with EB.

[Wera Hobhouse (Bath) (LD)]

Does the hon. Gentleman agree that the problem with skin conditions, particularly rare conditions, is that people are also embarrassed and want to hide them, which adds insult to injury?

[Gareth Bacon]

I agree with the hon. Lady. That was very much the story for Wendy, the lady I met in the shop, and she was not alone in that. It is particularly true when people are young and have EB but doctors are unable to diagnose it at that stage. They do not know why they have open and weeping sores. These things sometimes attract a smell as well, and as a result people are ashamed of their condition. It has a bad social stigma and is bad for their sense of morale.

The drugs would also have a significant economic benefit. For example, research by an expert dermatology professor at King’s College London found that, when used for EB, one of the drugs has been reported to reduce daily bandaging time from three hours to one by reducing the severity of the wounds, and to reduce skin itch by 60%. That in turn would save time and money for the NHS, and reduce stress on the family unit supporting the patient. Studies by the London School of Economics in 2016 and 2022 reported that EB has a wider economic impact, as parents and family members are currently obliged to reduce labour market participation due to the informal care of their loved one. The same study also revealed a higher prevalence of psychological and psychiatric symptoms among those with EB—that refers back to the point made by the hon. Member for Bath (Wera Hobhouse)—indicating a further tranche of support costs that could be reduced if treatments were improved. The most recent LSE study, published in September 2022, said that the annual cost per patient with dystrophic EB—the most severe form of the condition—is about £45,800, depending on the level of disability. That takes into account direct and indirect costs for patients and care givers. So the benefits are hugely significant, but, to enter the MRP process, the treatments in question will need to go through research trials to prove their efficacy in treating EB. To pay for that, DEBRA is seeking just £10 million from the Department of Health and Social Care, the NHS and the devolved Administrations to go with a further £5 million from its own fundraising campaign. That relatively small amount of money would do so much to address the misery caused by this awful condition.

Reforms to NHS Dentistry

Wera Hobhouse Excerpts

Thursday 27th April 2023 Commons Chamber

[Judith Cummins]

My hon. Friend makes an important point. I will specifically cover access to NHS dentistry for children later in my remarks.

On the Government’s plan for a plan, experience suggests that positive change for my constituents may well be wishful thinking. My constituents are suffering and take no solace whatever from the Government’s commitment to plan for a plan for reform. The contract has been in place since 2006, and the Government have been undertaking a review of the process since 2011. After 12 years, it is still a work in progress.

[Wera Hobhouse (Bath) (LD)]

The British Dental Association has shown that over half of dentists have reduced their NHS work since the start of the pandemic. Official workforce data counts people, not how much NHS work they do compared with private work. Does she agree that it is important that the Government collect that data?

[Judith Cummins]

I absolutely agree with the hon. Member’s important remarks. Collection of data is paramount for solving the issue.

The dodging of responsibility for more than 12 years is nothing short of a disgrace. Now, we all bear witness to the human consequences of this crisis. The victims of Government negligence are—as they almost always have been—the most vulnerable people in our society. In Bradford, 98% of dentists are now closed to NHS patients. As I informed the Prime Minister just last month, 80% of practices are now refusing to accept children as new NHS patients.

The lack of access is having crushing consequences. In the financial year of 2021-22, 42,000 NHS hospital tooth extractions were carried out for 0 to 19-year-olds—an 83% rise on the previous financial year. A dental nurse has recently spoken of routinely extracting up to 10 teeth from a single child, so children are routinely losing half their teeth. This dental crisis is now ultimately a crisis of inequality. The rate of tooth extraction is more than three times higher in Yorkshire and the Humber than in the south-east of England. Children living in our country’s most deprived communities face an extraction rate three and a half times greater than those living in the most affluent areas.

In care homes for the elderly, the access crisis has been just as devastating. In 2019, 6% of care homes reported that they were unable to access NHS dental care services, but by 2022, that figure had risen more than four times to 25%—a quarter of all care homes.

As this Conservative Government continue to mull over minor reforms, they fail entire generations of people, who deserve a reasonable standard of care. No more are the cradle-to-grave principles of the NHS.

A 21st-century Britain requires a 21st-century approach. We need more than mere revision of the contract. My right hon. and learned Friend the Leader of the Opposition has spoken of the need for a new healthcare system that is just as much about prevention as about cure. It is a concrete fact that no dental treatment is stronger than protecting a healthy and original tooth, but in 2021-22 tooth decay was again the most common reason for hospital admission of children between six and 10 years old. For zero to 19-year-olds, hospital tooth extractions cost our NHS a shocking £81 million a year. In 2022, instead of children visiting the dentist on a regular basis, it cost our NHS an average of more than £700 for a single minor extraction of a child’s tooth in hospital.

We are paying for the cost of catch-up with our failure to prevent tooth decay, so prevention should be at the heart of our Government’s agenda for dental reform. We owe that to the generations of people currently being let down by the system. This country once had a strong school dental service. With the current shocking rates of tooth decay among children, now is the time to resurrect that policy as an interim prevention measure. It is not only the right thing to do but a sensible option for the country’s finances. Care homes would benefit from a dental contract that commissions stronger community dental services, as used to happen.

By using integrated care systems, upskilling care workers, and further involving local authorities, access can be increased and the pressure on dental services reduced. Prevention really is better than cure. We have a duty to ensure that taxpayers’ money is spent effectively in areas right across the country. A decade of savage cuts by the Tory Government has left long-term damage. An estimated £880 million a year is now required just to restore to 2010 levels of resources. There will be no escaping the need for more investment, but it must be thoughtful investment. One answer could be the introduction of a prevention-focused capitation-type system, where lump sums are provided to NHS dental teams to treat sections of the population.

Successful targeted investment is possible, and in 2017 I developed a project in Bradford with the former Health Minister, the hon. Member for Winchester (Steve Brine). I thank the hon. Member, who is now the Chair of the Health and Social Care Committee and who is present in the Chamber. He worked with me on the pilot scheme, which invested over £250,000 of unused clawback over three years into my constituency of Bradford South. That went straight back into local services and ensured that patients were able to access roughly 3,000 new NHS dental appointments in an area with high dental deprivation—targeting extra resources straight into an area where they were needed.

Although that was never meant to be a long-term solution, it proved that targeted investment is possible. Where there is a will, there is a way. With a staggering 10% of this year’s £3 billion national budget for NHS dentistry set to be returned, the system is clearly broken. Taxpayers’ money is returned not because people are not desperate for NHS dentists, but because the Government continue to push an underfunded and unworkable system. They lack the will to act and to find a way forward to protect dental health in this country. Now is the time to put “national” back into NHS dentistry.

The Government may once again list the challenges that stand in the way of re-establishing a truly universal dental care system. We are in a time of extraordinary change, with unprecedented cost of living crises, war on the European continent, and a society impacted by a deadly virus. Our health system is undoubtedly challenged, but 80 years ago the Conservative-Labour coalition Government published a guiding principle of NHS dental reform, just as this country fought for its very freedom and independence. In Sir William Beveridge’s own words:

“A revolutionary moment in the world’s history is a time for revolutions, not for patching.”

It is time for real change, not empty promises. This is the time for a Government dedicated to acting in the public good, to revitalise and resurrect NHS dentistry once again, ending the shoddy record of this Government’s patching of our NHS dental services.

Oral Answers

Wera Hobhouse Excerpts

Tuesday 25th April 2023 Commons Chamber

[Neil O’Brien]

I recently had a very productive meeting with my Scottish Government counterpart. As I mentioned, we have already doubled the duty on cigarettes since 2010 and have brought in a minimum tax for the cheaper cigarettes. Of course, tax is a matter for the Treasury, but we will always be interested in things that can drive down smoking.

[Wera Hobhouse (Bath) (LD)]

6. What steps his Department is taking to improve access to maternity care in the south-west.

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

Accessibility and choice remain high in the south-west. All but one trust in the region have a minimum of three birth options.

[Wera Hobhouse]

In my local council area, birthing units were closed in 2020. My constituents were promised a new midwife-led unit at the Royal United Hospital in Bath, but three years on it is still not up and running. The Minister will say that it is a funding decision for the local area, but it is an NHS England funding decision and the Government are the paymaster, so when will Bath get its midwifery unit at the RUH?

[Maria Caulfield]

I am very happy to contact the hon. Lady’s local commissioners to find out the answer for her. However, I highlight the fact that the £7.6 million health and wellbeing fund is funding 19 projects across England to reduce health disparities in new mothers and babies. Two of those projects are in the south-west: the Trelya in Cornwall, a community-centred whole-family provision that takes a holistic approach to working with children and their families; and the Splitz Support Service in Wiltshire, which aims to improve community knowledge, access to and engagement with pre-conception and perinatal care. We are investing in the hon. Lady’s region, but if she has a local funding issue I am very happy to speak to her local commissioning group on her behalf.

NHS Winter Pressures

Wera Hobhouse Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

I could not agree more. There is a huge opportunity for pharmacists to do more, and I have asked the Department and NHS England to explore that at pace. I expect to say more on that when I announce our recovery plan at the end of the month.

I think we can go even further because, alongside pharmacists, there is much more scope to work with employers. Staff absences due to cardiovascular conditions are a significant cost to employers, so it is in their interest to work with us on prevention measures.

Much more can also be done through home testing. One of the lessons from covid is that the public will test at home. In looking at the challenge of excess deaths, there is a significant opportunity to do more home testing, employer testing and work in the community, particularly through pharmacists.

[Wera Hobhouse (Bath) (LD)]

When a constituent of mine fell seriously ill recently, his wife rang 999. It was a category 2 emergency that then escalated to category 1, but it still took the ambulance nearly two hours to arrive and, despite the paramedics’ heroic efforts, my constituent sadly died. There are now up to 500 avoidable deaths per week because of A&E delays, according to the Royal College of Emergency Medicine. Will the Government support the Ambulance Waiting Times (Local Reporting) Bill, introduced by my hon. Friend the Member for St Albans (Daisy Cooper), to identify hotspots with the largest waiting times and put support to where it is most needed?

[Steve Barclay]

I have seen a lot of speculation in the media about the excess mortality to which the hon. Lady refers. I have discussed the issue in detail with both the chief medical officer and the medical director for NHS England. The point to note is, first, that this is something that has happened internationally. It cannot be ascribed just to one issue, as is so often the case. Some of the excess mortality will be due directly to covid, albeit that that will be a diminishing proportion, and some of the non-covid excess mortality will also be driven by quite a wide combination of factors, so we have to be cautious when those sorts of numbers are bandied around.

NHS Workforce

Wera Hobhouse Excerpts

Tuesday 6th December 2022 Commons Chamber

[Wes Streeting]

My hon. Friend is absolutely right. One reason why this country has much poorer cancer outcomes than many comparable economies is precisely because of late diagnosis. I know from my own experience how vital early diagnosis can be for good cancer outcomes. I am terrified by the fact that, within those 7 million patients waiting in the elective backlog, there will undoubtedly be cases of undiagnosed cancer and other conditions. If the NHS had eyes on the patients, they would be detected faster, patients would receive treatment much more quickly and the outcomes would be better. One of the tragedies for the NHS is that, because we do late diagnosis, we get more expensive and less effective treatment. If we could diagnose faster, patients would get better outcomes and taxpayers better value for money. That is the kind of reform to the model of care that Labour would like to see.

[Wera Hobhouse (Bath) (LD)]

On diagnosis, access to GPs is also a vital part of the puzzle. Is it not terrible that the Government are not listening to GPs, who say they need a different visa system? They cannot recruit enough GPs into the system because the Government are so stuck with these immigration rules, and the Home Office does not want to change certain parts of the visa system?

[Wes Streeting]

I am grateful for that intervention. We are in the worst of all worlds on immigration and the NHS. The Government try to have it both ways. They talk tough on rhetoric, so we end up with a very bureaucratic, ineffective and costly system, but because they fail to invest in our own homegrown talent, they are over-reliant on immigration from other countries, including those who desperately need their own doctors and nurses. I do not think it is good enough, after 12 years of Conservative Government, that we are turning away bright potential doctors, nurses and allied health professionals because the Government cannot be bothered to pull their finger out and train our own homegrown talent. We need to see improvement, so we that can draw the best international talent and make the system smooth, efficient and effective, but it is also crucial that we train our own homegrown talent.

Turning to more of the Conservatives’ excuses—we have heard the excuses of the pandemic—let us now look at the excuse they are planning to deploy this winter. There is no denying that this winter could be the most challenging the NHS has ever faced. The Royal College of Nursing, for the first time in its more than 100-year history, is planning to undertake strike action. Just this lunchtime we got strike dates from Unison, the GMB union and Unite the Union. That raises the question: why are the Government not even trying to stop the strikes in the NHS from going ahead? Surely, when the NHS already lacks the staff it needs to treat patients on time, the Government ought to be pulling out all the stops, getting around the table and negotiating to stop industrial action? So why aren’t they?

The Secretary of State said in Health questions earlier that his door is open—as if we can just sort of wander in off the street into the Department of Health and Social Care, where there will be a cup of tea and a biscuit waiting, and he will be just waiting for the negotiations. That is not how this works. Everyone knows that is not how it works. He had a nice little meeting with unions after the summer, after Labour complained that we had not seen a meeting between a Secretary of State and the unions since the right hon. Member for Bromsgrove (Sajid Javid). Goodness me, we have had three Secretaries of State since then—and two of them are the Secretary of State on the Front Bench today. Why on earth are they not sitting around the table and conducting serious negotiations? I will tell you why, Mr Deputy Speaker: they know that patients are going to suffer this winter and they do not have a plan to fix it, so instead of acting to improve care for patients and accept responsibility, they want to use nurses as a scapegoat in the hope that they avoid the blame. We can see it coming a mile off. It is a disgusting plan, it is dangerous and it will not work.

If I am wrong, perhaps Conservative Members could explain why the Government are not trying to prevent the strikes from going ahead. Perhaps they could explain why the Secretary of State ignored all requests from the health unions for meetings and conversations this summer while the ballot was under way. Perhaps they could explain what the Government’s plan for the NHS is this winter. Perhaps they could explain why a Government source told The Times newspaper that

“Ministers plan to wait for public sentiment to turn against striking nurses as the toll of disruption mounts”.

They said the quiet bit out loud and they gave the game away.

What else would explain the unedifying and embarrassing spectacle of the chair of the Conservative party going on national television to accuse nurses of doing the bidding of Vladimir Putin? I should not have to make this point, but nurses are not traitors to this country. They bust a gut day in, day out to look after all of us. We clapped them during the pandemic and now the nurses are clapped out. They are overworked, overstretched and undervalued by this Government. Let me say to the chairman of the Conservative party that he would speak with greater authority on what is in Britain’s national interests if he did his patriotic duty in his own tax affairs.

When it comes to sending a message to Vladimir Putin, why does the burden consistently fall on the working people in Britain? Why is it that NHS staff must make huge sacrifices because of the invasion of Ukraine, yet people who live in Britain but do not pay their fair share of taxes here do not have to lift a finger? When it comes to paying the bills, the first and last resort of this Conservative Government is always to pick the pockets of working people, yet the enormous wealth of tens of thousands of non-doms is left untouched. They may blame covid, they may blame health professionals, they may even blame the weather, but it is 12 years of Conservative mismanagement and under-investment that has left the NHS without the doctors, nurses and staff it needs, and patients are paying the price.

I am sure every Member of this House, indeed everyone in the country, knows someone who has been let down when they needed healthcare in recent months. They all say the same thing: the NHS staff were brilliant, but there simply are not enough of them. There is no NHS without the people to run it, yet today there are more vacancies in the NHS than ever before: 9,000 empty doctor posts, 47,000 empty nursing posts, and midwives leaving faster than they can be recruited. There are 4,600 fewer GPs than there were a decade ago, and the right hon. Member for Bromsgrove admitted last year that the Government are set to break their manifesto promise to recruit them back.

--- Later in debate ---

[Steve Barclay]

Let me make some progress.

There is a fair list of omissions in the motion. It did not talk about how the Government are on track to deliver their manifesto commitment of 50,000 nurses by 2024, with nursing numbers over 32,000 greater than they were in September 2019, and the fact that there are over 9,300 more nurses and almost 4,000 more doctors than there were a year ago. There has also been a 47% increase in the number of consultants since 2010.

[Wera Hobhouse (Bath) (LD)]

The biggest problem for my constituents is access to GPs because there are not enough GPs in the system, so rather than talking about statistics, how can the Secretary of State make sure that my constituents can see a GP in time and not walk away in desperation because they cannot get an appointment?

[Steve Barclay]

I agree that it is not simply about statistics, but I think it is remiss not to point to the increase in doctor numbers, with 2,300 more in primary care—

--- Later in debate ---

[Steve Barclay]

The hon. Lady has had a go, so I will make some progress.

The hon. Member for Ilford North says that Labour would free up £3.2 billion by making changes in respect of non-doms—that was raised both at Question Time and in this debate. It will not surprise the House that the Opposition have now spent that money several times on their various pledges. His proposal ignores the fact that we need a tax system that is internationally competitive. His Majesty’s Revenue and Customs figures show that non-dom UK residents are liable to pay more than £6 billion in UK income tax, capital gains tax and national insurance contributions, so the proposal would leave us as a less attractive destination to people who, by their nature, are mobile and can go elsewhere. If they did, we would lose the tax they currently pay into the UK Exchequer.

The hon. Gentleman criticises the Government’s track record on medical training places, but it is worth reminding the House that it was this Government who, in 2018, funded a record 25% increase in medical school places and, in doing so, opened five new medical colleges. Of course, it will take time for that to bear fruit, and the first of those students will shortly enter the foundation programme training. This is an important investment for the long term, and it is why we now have a record number of medical students in training.

The motion covers nursing and midwifery placements. Here, too, we have seen progress, with more than 30,000 students accepting places on courses in England in the last year, a 28% increase compared with 2019. All eligible nursing and midwifery students will receive a non-repayable grant of at least £5,000 per academic year. NHS England has invested £127 million in the NHS maternity workforce and in improving neonatal care, on top of last year’s £95 million investment to fund 1,200 midwife posts and 100 consultant obstetrician posts.

As well as developing talent at home, we must also look to attract talent from abroad. In a motion focused on workforce, it is interesting that there seems to be no mention of recruiting from overseas. People hired from overseas make a fantastic contribution to our NHS, as I hope the House would agree. Unlike the Labour party, the Conservative party recognises the talent that international doctors, nurses and care workers offer, which is why we have been doing more international recruitment. It is interesting that the motion does not seem to welcome that fact, and does not seem keen on more international recruitment.

[Wera Hobhouse]

Will the Secretary of State give way?

[Steve Barclay]

The hon. Lady had a go earlier, but I will let her have a final go.

[Wera Hobhouse]

Yesterday I had a meeting with the Royal College of General Practitioners, which raised the issue of overseas talent wanting to work here and stay here. The Government and the visa system are making that very difficult. The Secretary of State might want to talk to the Royal College of General Practitioners about that point.

[Steve Barclay]

As part of making things easier, I set up a taskforce in the Department over the summer to look at how we can increase the numbers. We have increased the number of nurses recruited internationally, and care workers are on the shortage occupations list. If there are particular issues that the hon. Lady wishes to highlight, I would be happy to look at them with her, but we are keen to attract talent.