Dental Healthcare: East Anglia

Adrian Ramsay Excerpts

Wednesday 11th December 2024 Westminster Hall

[Jerome Mayhew]

I thank the hon. Gentleman for his intervention. There is a difference between milk teeth and grown-up teeth, as I will call them, although I know that is not the technical term. I hope that that assessment is wrong, but undoubtedly there will be problems. If there is a long-term lack of access to dentistry, it builds up problems, whether in the teeth or in the gums, both for children and for adults.

We can all talk about how we got here, and I can defend lots of very good things that the previous Administration did, but did we get everything right? No, we did not. What I am more interested in is how we can encourage the Government and work with them across the parties to solve the problem in the very near future.

I hope we have got to a reasonable analysis of why we are in this position. If it is substantially because of a lack of dental training facilities in the east of England, an obvious solution, although not the sole solution, would be a school of oral health at the University of East Anglia. The Minister knows that the UEA is ready to go. He knows that there is a building under construction and that a large amount of funding has been applied for, some of which has been already agreed. He knows that the UEA is making an application for registration with the General Dental Council and that it will be completed within the next six weeks at the latest.

That brings us to the crucial next step, which is the Office for Students. I recognise that the Minister is important and impotent at the same time. He is important because as the dental Minister he sets direction and gives impetus to change, but I accept that in some sense he is impotent because the Office for Students is an arm’s-length independent body. I hope he will take these requests in the light of my acknowledgment of his constraints, but it would be helpful for the UEA and the residents of our area to have his confirmation on the following three points.

First, can the Minister confirm whether additional dental training places will be made available by the Office for Students in 2025? It is a political decision how much funding the Government are prepared to put into the overall number of dental training places in the country in 2025. What is the pot that the Office for Students has to work with? Can he confirm that the number will be increased to take account of increased need?

Secondly, if that is the case, will there be a regional allocation within that global figure specifically for the east of England, given that the need is not national? There are regional variations, and in the east of England it is worst of all. There is precedent for that approach: recently, medical training places had a regional allocation, although I accept that historically it has not happened with dental places. It is an important point and would be of huge encouragement to our residents.

Thirdly, can the Minister give some indication of the timetable on which he and the Office for Students will work to process the 2025 allocations?

[Adrian Ramsay (Waveney Valley) (Green)]

I welcome the hon. Member’s comments. Indeed, the funding for the dentistry school at the University of East Anglia is a welcome step in addressing our chronic shortage of dentists in the region, but we need to ensure that there are strong incentives for those dentists both to stay locally and to stay within the NHS, which means meaningful contract reform to make it economic for dentists to practise in the NHS in the long term. In addition to his points, does the hon. Member agree that we need the Minister to set out the timescales for the Government’s pledge to review the dental contract?

--- Later in debate ---

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Dowd. I thank the hon. Member for Broadland and Fakenham (Jerome Mayhew) for securing this vital debate on dental healthcare provision in East Anglia, and I thank hon. Members on both sides of the House for their important interventions.

The debate follows hot on the heels of a debate on 3 September that my hon. Friend the Member for Norwich South (Clive Lewis) led on healthcare provision in the east of England. We know that huge swathes of the region are dental deserts. These areas are facing great pressures from challenges in the recruitment and retention of dentists, leaving patients struggling to access the NHS dental treatments that they need. As has been pointed out, it is a scandal—frankly, it is Dickensian—that the No. 1 reason for children aged five to nine to be admitted to hospital in our country in 2024 is to have rotten teeth removed.

Norfolk and Waveney integrated care board had 31.5 dentists per 100,000 of the population in 2023-24, which is the lowest number in England. That is why I have met with colleagues from the east of England, including the hon. Member for Broadland and Fakenham, to discuss the specific challenges in the region and to discuss the University of East Anglia’s plans to open a dental school. The UEA’s proposal to begin training dental students is very welcome news. As I said to all the colleagues I met recently, and to the hon. Gentleman at oral questions last month, the Government strongly encourage the UEA to continue its progress towards establishing a dental school by submitting its bid to the General Dental Council as rapidly as possible.

The independent Office for Students is another key player. It has statutory responsibility for allocating funded training places to dental schools. As the hon. Gentleman has pointed out, the OfS is independent from the Government. I cannot make specific commitments about allocating additional training places for future years, because to do so would be to cut across the independence of the OfS. The OfS makes decisions based on its own assessments, following guidance issued by Government. What I can say to the hon. Gentleman is that our guidance is influential, but I cannot guarantee its outcome.

The guidance for the 2026 academic year will be published in due course. Provided that the UEA meets those requirements, it would absolutely be considered for Government-funded dental training places. That would certainly help to retain local dentists in East Anglia. As a Member for a rural constituency, I absolutely understand how important that is to the hon. Gentleman and to the many other hon. Members present who represent his part of the country.

We also need a clear-headed diagnosis of where we are. It is beyond doubt that NHS dentistry was left in an appalling state of disrepair by the previous Government. As the Prime Minister said last week, the precious contract between the state and the British people has been broken. He rightly said that our public services are

“in crisis, unable to perform their basic functions”

and that they are

“unable to provide the timely care and dignity that Britain relies on”.

Almost five years on from the beginning of the pandemic, NHS dentistry has still not recovered to pre-pandemic levels. Only 40% of adults were seen by an NHS dentist in the 24 months to June this year, down from almost 50% before the pandemic. Although 34 million courses of dental treatment were delivered in England in 2023-24, that is down from almost 40 million courses five years ago. As I say, it is disgraceful that having rotten teeth removed is the single most common cause of hospital admissions for children aged five to nine, causing them untold pain and suffering and affecting their ability to sleep, speak and socialise.

On the subject of the general state of dentistry, I thank the National Audit Office for its recent investigation of the previous Government’s dental recovery plan. Its report lays out in black and white something that was already apparent to millions of people across the length and breadth of our country: the dental recovery plan that we inherited did not go far enough. We are reflecting on every line of the NAO report as part of our efforts to rebuild dentistry, get it back on its feet and make it fit to serve people of all ages. We have launched the largest ever national conversation to inform our 10-year plan to reform the NHS, and our workforce will play a central role, because they are key to unlocking improvements across our communities.

The golden hello scheme offers dentists £20,000 to work in underserved areas of the country for three years. The recruitment process is well under way, with posts being filled by dentists in those areas as we speak. As of 7 November, 64 posts had been advertised. Our manifesto pledged 700,000 more urgent dental appointments, and we are working to ensure that patients can start to access them as soon as possible. They will be targeted at the areas that need them most.

Strengthening the workforce is key to our ambitions, but for years dentistry has faced chronic workforce shortages. We have to be honest that bringing in the staff we need will take time. To rebuild dentistry in the long term and increase access to NHS dental care, we will reform the dental contract with a shift to focusing on prevention and the retention of NHS dentists. There are no perfect payment systems, and careful consideration needs to be given to any potential changes to the complex dental system, so that we deliver a system that is better for patients and the profession.

[Adrian Ramsay]

I thank the Minister for reiterating the Government’s commitment to reforming the dental contract. Please will he set out a timescale for that work commencing?

[Stephen Kinnock]

I was just going to say that we are continuing to meet the British Dental Association and other representatives of the dental sector to discuss how we can best deliver our shared ambition to improve access for NHS dental patients. We are working on this as a matter of urgency. I cannot give a specific timeframe, but it is a top priority for the Department.

NHS Dentistry: Rural Areas

Adrian Ramsay Excerpts

Tuesday 5th November 2024 Commons Chamber

[Sarah Gibson]

My hon. Friend makes an interesting point that I was not aware of. From discussing this matter with dentists, it was my understanding that these days, nobody is actually registered with a dentist; they are merely allowed to come regularly, and if they do not, they are taken off that dentist’s lists. My understanding was that it is quite difficult to register, so that is an interesting point that I hope the Minister will note.

A particular concern to dental practices, and a point that Denplan made very clear to me, is that once a dental practitioner has handed in their NHS provider number, even if the dental contract is improved, they are unlikely to come back to the NHS because of the complications involved in getting that provider number reinstated. That is why we need the Government to act now, before more dentists leave the NHS. Another issue for dental practices is that when qualified dentists come over from the EU, their qualifications are valid, but they have to spend an extra year training before they are allowed to register as NHS practitioners. That is slowing down any chance of increasing our intake from our European partners.

[Adrian Ramsay (Waveney Valley) (Green)]

I am very grateful to the hon. Lady for securing this debate, and particularly for highlighting the added impact that the loss of dentists has in rural areas, where, if people lose their dentist, there is often no other dentist nearby. In my constituency, people frequently say that they struggle to find any dentist taking new NHS patients. She is right to highlight that the dental contract is the root cause of the issue, and to press for a clear timescale. Does she agree that by the end of this calendar year, the Government should have set out a timescale for starting crucial negotiations on the contract?

[Sarah Gibson]

I agree that a timeline for reforming the dental contract is vital; that is what I am asking for. If we lose this opportunity and our NHS dentists leave the system, we will be in an increasingly difficult place. Across Wiltshire, for those not already registered with an NHS dentist, it is absolutely impossible to get one. There is not a single practice taking on NHS patients right across the unitary authority of Wiltshire, despite its size.

Access to Primary Healthcare

Adrian Ramsay Excerpts

Wednesday 16th October 2024 Commons Chamber

[Adrian Ramsay (Waveney Valley) (Green)]

On pharmacies, a new report from Healthwatch England reveals a worrying picture of pharmacy closures and reduced hours hitting older people and rural communities the hardest. NHS Norfolk and Waveney integrated care board, which covers much of my constituency, has reported the highest number of hours lost per pharmacy. Does the hon. Lady agree that we urgently need a national evaluation of pharmacy funding, including the size, role mix and distribution of the pharmacy workforce?

[Helen Morgan]

That is an important point. In my constituency, carers who go to pick up prescription medicines are finding that the pharmacists are not there because they are relying on locums. The pharmacy funding problem needs to be addressed as a matter of urgency, and I will say more about that later.

Growing the economy is so important that we need to get people off the waiting and referral lists and back into work. Liberal Democrats believe that people should be in control of their own lives, not “chained up” at home, unable to get out of bed, because they have no access to healthcare. They should be able to get the help that they need, when they need it, in their own homes and communities.

Let us start with GPs. The Liberal Democrat manifesto—it was well received, which is why there are so many Members sitting behind me on these Benches—called for the right to see a GP within seven days or 24 hours if the situation is urgent, and for those aged over 70 or with a chronic health condition to have access to a named GP. Those rights are extremely important. People who go to the same GP for more than 15 years have a 25% lower chance of dying than those who have seen a new GP in the last year. Primary care networks tell me that their inability to deliver continuity of care because of the shortage of GPs is one of the problems that worry them most.

NHS Performance: Darzi Investigation

Adrian Ramsay Excerpts

Monday 7th October 2024 Commons Chamber

[Adrian Ramsay (Waveney Valley) (Green)]

Thank you, Madam Deputy Speaker. It is a pleasure to follow the new hon. Member for Basingstoke (Luke Murphy) and hear about his pride in his constituency.

Our NHS provides amazing life-saving, dedicated care every day, but we also know that people are too often let down. Too many patients languish, often in pain, on long waiting lists. In rural constituencies such as mine, people often have to travel lengthy distances to access treatment. Lord Darzi points to systemic and chronic under-investment caused by austerity in funding and capital starvation. Resilience was stripped from the NHS before covid, and we owe it to those whose lives were lost or changed forever by the pandemic never to repeat these same mistakes and to do things differently. However, the Chancellor’s arguments about tough decisions and a black hole of £22 billion are alarmingly similar to those made by the previous Government. It is good to see the Chancellor signalling some movement on fiscal rules, and I hope this logic will apply to supporting our public services, which are a crucial investment in our future.

Putting wellbeing at the heart of what we do should help us navigate how we support the NHS. Bad planning, poor housing, weak transport and divisive social policies have a huge impact on health outcomes, for example. So I welcome the Secretary of State’s comments and he has been bullish about reform, but he has not been specific about exactly what he means by private sector involvement in the delivery of NHS services. There are real reasons to keep delivery of the NHS public, and not to outsource it to private providers. The Secretary of State has made statements about using the private sector to reduce waiting lists, but he has not explained whether he considers this to be a short-term plan while the NHS is being rebuilt, or a permanent policy. Lord Darzi’s diagnosis was helpful and the emphasis on prevention is hugely welcome, but to deliver it we require bold action and investment.

[Madam Deputy Speaker]

Order. Thank you so much, but please be seated.

Healthcare Provision: East of England

Adrian Ramsay Excerpts

Tuesday 3rd September 2024 Westminster Hall

[Adrian Ramsay (Waveney Valley) (Green)]

I thank the hon. Member for Norwich South (Clive Lewis) for securing this crucial debate. Our region is rural and many Members have talked about the decline in health services in rural areas. I want to talk about some issues that particularly affect my constituents in Waveney Valley, which straddles the Norfolk-Suffolk border.

Whether it is the long waiting lists for surgery, long delays in getting assessments for mental health or the difficulty in accessing a GP or a dentist, we have seen a decline in our health services and it is becoming harder and harder for people in our villages and market towns to access them. At the Budget in a few weeks’ time, I very much hope the Government will look at all options for increasing funding to the NHS, including being willing to ask the very richest in society to pay a little more in tax—modestly more—in a way that could enable us to get the funding needed to keep pace with demand.

I want to raise three specific issues on the decline of rural health services that particularly affect my constituency. I would appreciate it if the Minister addressed them in summing up the debate. The first is the lack of hospital services in rural constituencies, which others have already referred to. For example, Hartismere hospital in Eye is a wonderful building that has had a lot of investment, but lacks the services that the local population, particularly older people and people without a car, would really like to be able to make more use of.

The League of Friends at the hospital showed me round the excellent facilities a couple of weeks ago. The hospital runs a range of clinics that people really value. However, both the league and local doctors would like to see facilities such as an X-ray scanning unit, the return of a community consultant, particularly in services for older people, and a GP walk-in surgery. Will the Minister consider how hospitals in rural areas, such as Hartismere hospital in Eye, can be given the resources and support to provide a greater range of services?

[Victoria Collins (Harpenden and Berkhamsted) (LD)]

The hon. Member talks about hospital services, especially for the more elderly in society. Will he join me in calling for more cross-party talks on social care, which is often the back door to the support that a lot of people who go into hospital need?

[Adrian Ramsay]

I totally agree with the hon. Member’s point. I have had family experiences in recent months that have shown me, starkly and at first hand, just how much we need to address the crisis in social care and the lack of integration with the health service.

I want to highlight that on the Norfolk-Suffolk border, in towns such as Eye and Diss, people are 20 miles from the nearest big hospital in Norwich, Bury St Edmunds or Ipswich—and in towns such as Halesworth, which does not have a local community hospital at all, people are even further away. I ask the Minister to consider what support can be given to rural hospitals to provide more services, and particularly to encourage cross-county border working in the health services that will enable us to look at how services can be provided in a way that benefits communities straddling the county border, as they do around Diss and Eye in my constituency.

Secondly, is no surprise that we have heard about dentistry from nearly every hon. Member who has spoken in this debate. We have the Sahara of dental deserts in the east. In the winter, I conducted a survey of residents in Waveney Valley to which more than 800 people responded. A quarter had given up on dentistry treatment altogether because of lack of NHS provision, others were driving long distances to access a dentist and some had even pulled out their own teeth. That is just not tolerable in the 21st century.

I welcome the Government’s commitment to reforming the dental contract. From my discussions with dentists and dental organisations such as the British Dental Association, it is clear that reform of the dental contracts is the root cause of the big exodus of dentists from the NHS. Dentists are not being paid appropriately for the work they do. Can the Minister set out the timescale for reviewing that contract? Health organisations have told me that for every effort they put in to getting new dentists into the NHS, dentists are leaving at a greater rate. We must address the root cause of the problem.

Thirdly, I want to highlight optometry. I received correspondence from an optometrist in Norfolk concerned about the lack of post-operative aftercare, particularly for operations such as cataract surgeries. They highlight that private companies are operating services of that kind and then discharging members to the community without aftercare, which is having a knock-on effect on A&E. Can the Minister ensure that, where private companies provide such services, the proper aftercare is also provided? Will she commit to looking at whether that highlights the problem of relying on private companies, which might seek to cut corners in the name of profit, to provide services?

To conclude, our rural services, particularly in market towns and villages, are severely affected by the decline in health services. Whether it is dentistry or a lack of local hospital services, we need urgent action and I would welcome the Minister’s addressing my specific points.

[Sir Christopher Chope (in the Chair)]

Mohammad Yasin, you have one minute.