In-patient Mental Health Services (Children and Adolescents)

Alison Seabeck Excerpts

Wednesday 23rd October 2013 Commons Chamber

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I am sure that my right hon. Friend has seen the note from the Royal College of Psychiatrists flagging up the point that because of the cuts to tier 3 there is increased pressure on and more likely to be admissions to tier 4, yet here we are discussing closures. That is a real problem.

[Alan Johnson]

My hon. Friend makes an important point. YoungMinds, the charity that deals specifically with child and adolescent mental health, makes exactly the same point. We need early intervention, and if we are cutting back on tier 3 there will be a bigger problem with tier 4. If the problems are not addressed anyway, we are stacking up a host of problems, and costs, never mind the tragedy to the individuals when they reach adulthood.

It is difficult to escape the conclusion that the changes have nothing to do with improving care, and everything to do with saving money. The closure of the West End unit has had a profound effect. I have a constituent who is a single mother, who works for the NHS as a staff nurse, whose 13-year-old daughter suffered a severe mental breakdown two years ago. Her daughter spent nine months at West End, which opened at weekends specifically to accommodate her needs. Her mother believes that the treatment given by the excellent staff at West End saved her little girl’s life.

When my constituent’s daughter needed further treatment this year, after West End had closed its in-patient facility, she was first of all sent to Leeds, 66 miles away, where the inability of her mother and five-year-old brother to spend as much time with her, led to a further deterioration in her health. She was then incarcerated with young offenders in Cheadle, 103 miles from her home. Her mother, coping with a five-year-old son and a job in the NHS, spent nine hours travelling to have just one hour with her daughter. For the rest of the time she was forced to listen to her deeply unhappy daughter sobbing at the other end of a phone. Is this what the NHS has come to? Is this the kind of treatment that any of us would accept for our children?

Health and Social Care

Alison Seabeck Excerpts

Monday 13th May 2013 Commons Chamber

[Alison Seabeck (Plymouth, Moor View) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Vale of Clwyd (Chris Ruane) and the hon. Member for Bosworth (David Tredinnick), who care passionately about health care in its widest and broadest sense.

This Gracious Speech is unprecedented. I cannot recall in all my years of working in this place, dating back to 1977, another instance of a Prime Minister saying it is okay for their party to vote against the Government’s programme. I cannot see the late Baroness Thatcher condoning such a move. This coalition Government are in meltdown, and the public must be wondering whether any of the proposals in the Queen’s Speech have the wholehearted support of their Members.

That said, there are measures in the health Bill that could and should be shaped and improved on a cross-party basis. It is therefore important that adequate time be allotted for the various debates and the Committee stage. The proposed programme is hardly onerous, so the guillotining of Bills should not be required—unless the Government decide that they dare not encourage full debate, and chicken out. We shall see.

Before moving on to the health-related elements of the Gracious Speech, I would like to mention the draft consumer rights Bill because it revisits the private Member’s Bill introduced by my father—Michael Ward, who was a Member of Parliament—which became the Unfair Contract Terms Act 1977. He was supported by the late David Tench in enacting what was groundbreaking consumer legislation. Lord Denning, the then Master of the Rolls, described it as

“the most important change in civil law”.

My father would, if he were alive, be very keen to ensure that the streamlining and simplification process in bringing together so much consumer legislation does not water down consumer rights.

There are a number of health-related proposals in the Queen’s Speech. In Plymouth—a mesothelioma hot spot because of the nature of its industrial base—people will welcome the further progress that has been made on speeding up the process through which insurance companies accept liability and pay compensation. However, for too many of my constituents progress has been tragically slow: they have not survived this awful disease long enough to benefit from the legislation. We have a moral duty to do everything we can to support the victims, and we need to ensure that the Bill, which has had a very slow gestation—it was discussed under the last Labour Government—does what it says on the tin and guarantees faster pay-outs. The failure to address other asbestos-related diseases is also giving rise to concern.

Those who are more fortunate are now, with support, living into grand old age, and we have to resolve the issue, which has dogged successive Governments, of providing care for our older citizens, as well as younger people with illness or disability. The care and support Bill should be welcomed as a step in the right direction, but I fear it will not be enough and, rather than having a full-blown national care service, we will end up with a piecemeal one. The level of the cap has been set too high—higher than Andrew Dilnot recommended—and without investment in local services the Bill will have serious consequences, as clearly set out in the opening speech by my right hon. Friend the Member for Leigh (Andy Burnham).

To deliver much of what will need to be delivered, local authorities will therefore be required to step up to the plate—the joined-up care that the Secretary of State talked about. Yet we know that many are having to dismantle the architecture upon which good care and support is offered—as we are seeing in Torbay, an exemplar—because of the deep cuts being made to their budgets. Can the Government please be clear about who will be running these care and support networks? If it is the private sector, how will they ensure that there is not a postcode lottery?

Oddly, earlier the Secretary of State was behaving like one of those nodding dogs we see in the backs of cars when it was pointed out that hospitals are under pressure and staffing levels are not all they should be. However, he has provided no real answers in this Queen’s Speech.

At long last, after almost four years, we have a Bill paving the way for a potentially dramatic change to the way defence procurement is carried out. There is consensus across the political divide that successive Administrations did not sufficiently reform defence procurement. Equipment programmes were overheated in respect of funding, and the Ministry of Defence was underpowered in the skills required to deliver increasingly complex programmes. There are too many questions that need to be asked for the time available, and today is not about defence, but we will need to come back to those questions. The themes, however, are the accountability of the proposed GoCo —Government-owned, contractor-operated organisation —and where the risk lies. For example, does it lie with the taxpayer or with the private company? Warning bells are already ringing around Westminster about the management of risk. We know from successive Public Accounts Committee and National Audit Office reports that the MOD struggles when it comes to assessing risk. We need to know whether the Ministry of Defence, like the Department of Health, is producing legislation that removes the Secretary of State’s power to intervene and take responsibility.

Finally, I come to the Bills that were not mentioned. My right hon. Friend the Leader of the Opposition emphasised the missing legislation in his response to the Loyal Address. The cold hand of the Prime Minister’s henchman, whose links to the tobacco industry as a lobbyist are well documented and who has accepted major donations to his campaign in Australia from British American Tobacco, is writ large on this Gracious Speech.

[Mr John Leech (Manchester, Withington) (LD)]

I agree that not having legislation to introduce standardised packaging for tobacco products is the wrong decision, but does the hon. Lady agree that it is appalling how the unions, too, have tried to stop this legislation?

[Alison Seabeck]

People work in those industries, and, understandably, the unions representing them have to consider the membership’s point of view. Among the unions as a whole, there is a broad range of views, very much reflecting those in this place today.

Returning to my point, perhaps that is why No. 10 has U-turned, from a position where it was wrong for children to be attracted to smoking by glitzy designs on packets and there were statements that children should be protected from the start, to the obverse position, where we are not being allowed to have legislation that would have a beneficial impact on the future health of our population and on the NHS budget. As my right hon. Friend the Member for Rother Valley (Mr Barron) said, we need to know who is pulling the strings in setting Government policy. The Government have bottled it; they are in thrall to their right wing. Young people in Plymouth, particular our Youth Parliament members and those in our youth cabinet, who wanted very much to see this change brought forward, will feel that they have been sold down the river. Many young people are asking what is in the Queen’s Speech for them; there is nothing to protect their future health and nothing to help them into work.

If the Government were serious about improving the health of the nation, we would have given these measures a fair wind. They would have had broad support from the Opposition, as would investment in other areas, such as housing that is affordable to rent, because good housing equates to good physical and mental health. Nothing has been said on those issues. The Queen’s Speech is a huge missed opportunity, and it is simply not good enough.

--- Later in debate ---

[Norman Lamb]

I disagree. We brought in Jennifer Dixon of the Nuffield Trust to advise on this matter. There will be ratings for specific services within hospitals to identify areas of great care, but the single rating will give the hospital the incentive to bring up to a proper standard those areas that are falling short, and that will be a good thing.

[Alison Seabeck]

Will the Minister give way?

[Norman Lamb]

I want to make some progress; I am conscious of the time.

The Bill will introduce a single failure regime, so that, for the first time, a trust can be put into administration because of quality failure as well as financial failure. Until now, it has been only the finances that can put a trust into administration. This Government recognise that quality failure is just as important, if not more so, and that such failure must carry consequences.

The stories recounted by the right hon. Member for Cynon Valley (Ann Clwyd) and the hon. Member for Bridgend (Mrs Moon) reinforce our determination to make improvements and to ensure that people get the best possible care. I again pay tribute to the impressive work carried out by the right hon. Lady, and I thank her for her work on complaints procedures. The hon. Member for Mid Bedfordshire (Nadine Dorries) also talked about the importance of compassion in good nursing care.

The Bill will make it a criminal offence for providers to provide false and misleading information. My hon. Friend the Member for Stafford (Jeremy Lefroy), who has done great work representing his constituents in the most honourable and responsible way, drew our attention to the importance of mortality statistics being accurate so that we can rely on them. Alongside this Bill, we will introduce the statutory duty of candour—something of which I am personally proud. It does not require primary legislation, but the Government will introduce it.

The funding of care is to be reformed so that there will be a cap on the care costs that people will pay in their lifetime. This is long overdue. Reform has been in the long grass for too long. Several hon. Members, including the hon. Members for Worcester (Mr Walker), for City of Chester (Stephen Mosley) and for Lancaster and Fleetwood (Eric Ollerenshaw), made the point that people will no longer have to sell their homes during their lifetime to pay for care. So often people have had to sell their homes in distress at the moment they go into a care home. When they cannot organise their affairs properly, they have to sell up to pay for care. No longer will that be the case. They can delay all those issues because of the right to deferred payments.

It is this coalition Government who have bitten the bullet on a very important reform. I am very proud of the fact that we are doing this, introducing a long overdue reform. Andrew Dilnot himself has strongly supported the Government’s action. That is happening together with a very significant extension of support—I take on board what the hon. Member for Leicester West said—to help people of modest means with their care costs. Each one of those measures would be significant by themselves. Together, they provide real optimism that we can shake off the shackles of the past and look towards the future, not with fear, but with optimism. The Opposition are wrong to dismiss the importance of this Bill. They should recognise just how much it could improve the lives of some of the most vulnerable people in society.

Oral Answers to Questions

Alison Seabeck Excerpts

Tuesday 26th February 2013 Commons Chamber

[Norman Lamb]

I applaud my hon. Friend for repeatedly raising her constituents’ concerns about this subject. We have made it absolutely clear that primary care trusts must work closely with clinical commissioning groups to ensure that they meet the challenges of the current financial year. As for the future, the joint strategic needs assessment and the health and wellbeing boards will provide real accountability locally, and I think that my hon. Friend will be able to feed into that to ensure that her constituents are given the health services that they need.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

The Limbless Association wrote to Members of Parliament this month expressing concerns about proposals for the commissioning of extremely specialist prosthetic services, which would reduce patient choice and oblige the patient to follow the money rather than vice versa, and would damage some highly skilled professionals in the field. When did the Minister last meet representatives of the Limbless Association, and will he agree to meet them with me?

[Norman Lamb]

I should be happy to meet the hon. Lady and members of the association to discuss those concerns further.

Dementia

Alison Seabeck Excerpts

Thursday 10th January 2013 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

I am sure everyone who listened to the right hon. Member for Cynon Valley (Ann Clwyd) describing on the radio the terrible passing of her husband will have been moved, and all the accounts she has given this afternoon are certainly appalling and unacceptable.

I want to be concise, so I shall touch on only a few key points. My first point is on training for care assistants, a topic the right hon. Lady talked about. After I was first elected to this House some 30 years ago, several years passed before I first heard the word “Alzheimer’s”. At Christmas I would visit nursing homes in my constituency, and they were mostly full of spry widows in their 70s, but it is now impossible to get into a nursing home or residential care home in my constituency unless one is suffering from severe Alzheimer’s or dementia. As a consequence, many more people with mild dementia are now living at home in the community, being looked after by carers.

We must greatly expand the number of care assistants in three environments: first, in hospitals. If we are to have a graduate nursing profession, we also need to ensure that caring assistants see that they have a vocation— that they are part of a profession and they have a set of skills. We also need to ensure that there are sufficient well-trained and motivated care assistants in nursing homes and residential care homes. For a long time nursing homes would recruit staff from overseas, very often from India, the Philippines or eastern Europe. They would train them, and then in due course those people would go and work for the national health service. Because of various changes to migration policy, however, that is no longer possible. Thirdly, we have more people with dementia and mild dementia living at home, and they also need proper care and support from care workers.

I raised this issue with Ministers earlier in the year, and my hon. Friend the Member for North Norfolk (Norman Lamb) kindly gave me a comprehensive response:

“We are doing lots of work with the sector to grow the workforce. We are, for example, aiming to double the number of social care apprentices to 100,000 by 2017 and expanding the current care ambassador scheme to promote a positive image of the sector.”

I have to say that I do not get the feeling that there are currently 50,000 apprentices in the social care or care worker sector, and I do not get a sense of there being many social care apprentices in my patch. That may be because they are not promoted as such, and how does one recognise a social care apprentice or a qualified social care worker in a residential care home or hospital?

The Minister rightly says that the Government acknowledge the importance of training and qualifications in supporting workers in their roles and in improving the quality of care services, and the Government are spending £285 million each year on training and developing the care worker work force. This may just be my view, but, again, I do not get a sense of how that is being demonstrated in outputs. I say to the Minister that we need a clearer focus on the training and development of that work force. We have made nursing a graduate profession but we must also ensure that those who are not graduate nurses—care workers in our hospitals, in our nursing homes and in the community—have a similar sense of vocation and similar training and apprenticeships. They need to be recognised as qualified care workers, and we must continue to invest in that work force.

As the right hon. Member for Cynon Valley said, compassion is key to all of that. When my mother and her generation trained as nurses, they saw compassion as an essential part of their vocation; that was inherent in being a nurse.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I wish to give a further anecdote. My mother trained as a nurse and she said to me that on the first day in her job she was taken by the matron to the bed and told, “This is your world. The patient, and nothing else, is what you are there to look after. I want to know exactly what is happening with each and every patient in your care.”

[Sir Tony Baldry]

That was absolutely the case. There are occasions when one is just going to be out of touch on this, but hospitals are changing. When I was young, my father was a consultant and he had three wards. He was responsible for them and each had a sister, who was identifiable and accountable, as were the staff nurses. Everyone was accountable and everyone knew what was happening. Hospitals are changing, and in some ways medical technology means that things move a lot faster: for example, hysterectomies can now be day cases. However, people are staying longer in other parts of hospitals. As my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) said, a large number of people in hospital are also suffering from dementia, and hospitals, as well as treating the acute problems of such people, need to respond to that. They need to work out where those people go once they leave the hospital. Very often someone’s dementia is not spotted until they are in hospital.

--- Later in debate ---

[Alison Seabeck (Plymouth, Moor View) (Lab)]

Most Members in the Chamber will have received e-mails and letters and read in the media that MPs and people at Westminster have no idea what is going on in the real world. I hope people have been listening to and watching this debate and have heard the highly emotional, very personal, incredibly thoughtful speeches that we have had in the debate today, which give the lie to those cynical comments from those outside this place. I thank the Backbench Business Committee for allowing time for the debate and the right hon. Member for Sutton and Cheam (Paul Burstow) for opening it. His expertise and interest in care in relation to dementia are well known and noted, and I thank him for taking the opportunity, along with many others, to highlight one of the more important health issues facing the country.

Unlike almost every other Member who has contributed to the debate, I have not had anyone in my close family suffer from dementia—I know people who have, but they were not immediate family members—so my speech might sound a little more clinical than others we have heard. We probably all know someone who has been touched by dementia. As we live longer, virtually every family will be affected and, as with cancer, we will have to learn to cope with an illness that a century ago people would not have lived long enough to experience. Indeed, only 30 or 40 years ago—20 years into my life—we would not have experienced family members having that awful degenerative disease.

[Mrs Moon]

Does my hon. Friend agree that we must be careful not to make it sound as if dementia happens only to the elderly? Vascular dementia and prefrontal dementia affect young people. Certainly, prefrontal dementias tend to onset when people are in their 40s and 50s. We must not let the population of this country run away with the idea that dementia happens only to old people and that it is a consequence of old age, because that is not necessarily so.

[Alison Seabeck]

My hon. Friend speaks with enormous knowledge and is absolutely right. My godmother died at the age of 56 from Alzheimer’s, as it was described then, although I suspect that it was something much more complex.

Our ageing population poses challenges, including how we discuss in a much more open and constructive way what has, in effect, been a no-go area. Cancer is a case in point. It is mentioned in hushed tones, in corners of rooms. The hon. Member for Truro and Falmouth (Sarah Newton) touched on that in her speech. Victims were often not told they had the disease. Dementia and Alzheimer’s have been treated in much the same way. As with cancer, I think that we are all learning not to be afraid of speaking about the disease. By doing so, we can better support those affected, their families and carers.

We know that the number of sufferers is going to rise. The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile)—we duplicated on this a bit—pointed out that the number is rising significantly across the UK. Indeed, it will probably rise to 1.7 million people by 2050. In Plymouth, probably around 3,000 people have dementia—I say probably because many people with dementia will not have gone to their GP and their families might not be aware of their condition. That brings us back to a point made by my hon. Friend the Member for Bridgend (Mrs Moon), because there are potentially so many people out there who are yet to be diagnosed. That is why such debates are so important in raising awareness. We cannot simply carry on sweeping the issue under the carpet. It is a little like hiding bills behind a clock on the mantelpiece: they do not actually go away; they just mount up. The same applies to dementia; caring issues mount up, and costs certainly will.

Dementia will cost the UK about £23 billion in 2013, yet dementia research is desperately underfunded, as we have heard. The Government invest about eight times less in dementia research than they do in cancer research. These are financially difficult times, but we need to ask whether we have that balance right. I welcome moves from the top of the Government to look at the priority dementia receives.

Dementia is a particular concern in the south-west. Figures show that 40,000 people across the region have been diagnosed, and Devon has one of the highest levels in the country, in part because of our demography—people want to retire there, so there is a significant number of older people. However, as my hon. Friend the Member for Bridgend has put me right, it is not just an older person’s disease.

I know from my constituency surgeries, as I am sure that others do, just how scary a diagnosis can be for patients and their families. We need to handle the diagnosis point with enormous sensitivity. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) made that point extremely powerfully and clearly. Every family copes in different ways, but they all ultimately need support. Some may pretend that they do not—that they can get on, manage and cope—but that is not the case.

Carers tell me that they get stressed and worried when they are out with their loved ones. They are acutely aware that others do not understand the behaviour of the person they are with who is suffering from dementia. Shopping can be a simply dreadful experience. One carer said to me, “It would be so good to be able to go out shopping and not worry.” The hon. Member for Chatham and Aylesford (Tracey Crouch) made a good point about that. I am delighted to hear that companies such as Asda are training their staff better to recognise and support customers who are having difficulties. I hope that other companies out there have heard that and will look at the excellent work that those companies appear to be doing.

Nor can we underestimate the pressure on carers’ mental health. They often struggle on in silence. We all know the type of person: they appear on the outside to be incredibly resilient, but in fact they are not. They need their needs to be fully understood, not only by the health service but by the people around them—those who work with them and live with them.

In Plymouth we are working towards becoming not only a dementia-friendly community but a dementia-friendly city. We have some superb people leading the campaign and taking the steps to move it forward, including Ian Sherriff and Dr Helen McFarlane from Plymouth university. We have councillors and officers on Plymouth city council, as well as a welter of voluntary organisations. We also have an accredited memory service. The diagnostic rate for the identification of dementia has seen a significant improvement following the work by Dr Cartmell to map a dementia pathway, which has provided GPs with a useful educational tool to support referral, diagnosis and treatment.

As we have heard from virtually every speaker, the early diagnosis of dementia is very important, as is the way in which society reacts to and supports those with the disease. People are helped to be empowered at a much earlier stage when they are better able to take important decisions about their care pathways. They are also enabled to share those decisions with the people closest to them, who may well be caring for them. Those affected should be able to take their own decisions for as long as that is feasible and possible. It is hugely important that they are able to take an informed view about their future life and lifestyle while living with dementia, guiding clinicians in the pattern of care wanted. Early diagnosis takes a certain tension out of the system, and we cannot overstate how important that is.

As I mentioned, in Plymouth we have lots of organisations working towards our becoming a dementia-friendly city. The hon. Member for Plymouth, Sutton and Devonport talked about the naval base, HMS Drake, where people have signed up to play their part in the Plymouth Dementia Action Alliance. Human resources policies have been amended to support service families, who may also be caring for somebody with dementia. Someone on the front line on a tour of duty in Afghanistan already has an awful lot to worry about apart from worrying about a relative, or somebody they are very close to, who has dementia. It is enormously important for them to be confident that that person is in good and caring hands while they are a long way away and out of contact.

The Dartmoor rescue team has also lent its skills. One might ask why, but I am afraid we have all heard these stories and all know people who have said, “A member of my family has left home and wandered off.” We have a young councillor on Plymouth city council whose grandfather has a habit of doing that and she often tweets asking whether anybody has seen him. The Dartmoor rescue team is bringing its expertise to bear not only by helping to track and find people, but by taking people for walks in areas they may be familiar with on Dartmoor and elsewhere.

As we have heard, the private sector is also buying in and schools such as Stoke Damerel have taken an interest, because children have grandparents who may be suffering. Helping them understand what is happening to their gran or grandpa offers reassurance.

I want to see the work that is being done in Plymouth to prepare us to be a dementia-friendly city come to fruition. I put on record my thanks to all those involved in the alliance who are pressing forward with that work. Importantly, I want every city in the UK to follow the lead of, and move in the same direction as, some of the country’s early pioneers.

I recently attended the opening of Waylands in Ernesettle in my constituency. It is a residential centre for people with varying stages of dementia. It is a well-thought-through development and I would hope to see more such developments being built to such a high standard. Everything has been thought through, including memory boxes and the colour of the walls. It is a superb facility. However, there is an issue—this has been touched on by other Members—namely the recruitment of staff with the right qualifications and attitude towards nursing and supporting patients with dementia. The centre tells me that it has been quite easy to recruit care assistants with good qualifications and the right attitude, but much more difficult to get properly trained dementia nurses. What is the Minister’s Department doing, alongside the Departments for Education and for Business, Innovation and Skills, to ensure that we have enough people with the right skills to meet that undoubted need? We also need reassurance that those people are properly trained. We do not want a recurrence of what happened in Stafford.

Patients with dementia cannot whistleblow, which is a real issue. If someone does not have a family around them to identify the problems they face, how will their voice be heard? As my right hon. Friend the Member for Cynon Valley (Ann Clwyd) has said, too many people are alone in hospital who do not have people to take action to feed them. I cannot say how strongly I feel about the importance of good, compassionate nursing care to look after people with every need—and I mean every need—and ensure that they eat and live as long a life as possible, given their conditions.

We also need to take into account the fact that dementia sufferers have a range of other physical ailments. We need to learn and do better on the ways in which they are nursed and how clinical teams handle them. These people are very afraid, in strange circumstances, often alone and faced with strange equipment and various other things. I genuinely think that an awful lot more could be done to make their progress through the health-care system altogether more sensitive to their individual needs.

I look forward to hearing the responses of both Front-Bench representatives to this debate. I want a firm commitment to a long-term dementia strategy but, more importantly, we have to have a national solution for care and it has to be affordable. As other Members have said, the figures in the press this week seem to be excessively high, but I will wait to hear what the Minister has to say about that.

NHS Commissioning Board (Mandate)

Alison Seabeck Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

The waiting time targets are among the board’s responsibilities under the mandate. Having care close to home is a key priority for many patients, often because they think that the quality of care will be better, if it is at a local hospital or—even better—in their own home. One major change resulting from the increased role for GPs under the mandate will be much better support for domiciliary care, which will enable people to live at home for longer.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

The tension between the postcode lottery and local commissioning has been discussed, but of paramount importance is how the budgets filter down to the various groups. The Secretary of State just said that funding to the cancer, stroke and heart networks will increase, yet a paper from the NHS Commissioning Board talks about funding cuts from £18 million to £10 million. I am afraid that the veracity of his figures is often challenged. Would he like to put the record straight on the figures?

[Mr Hunt]

I will happily look into the matter the hon. Lady raises, but my information is clear that the budget through which the clinical networks are funded is increasing.

Regional Pay (NHS)

Alison Seabeck Excerpts

Wednesday 7th November 2012 Commons Chamber

[Kerry McCarthy (Bristol East) (Lab)]

I, too, was in the Westminster Hall debate this morning and I congratulate my right hon. Friend the Member for Exeter (Mr Bradshaw) on securing it.

As we have heard, regional pay would damage our economy and the NHS. As the shadow Secretary of State said, 60 senior academics have written to The Times to warn the Chancellor that there is “no convincing evidence” to support his claims on the benefits of regional pay and that

“On the contrary, such a policy could reduce spending power, undermine many small and medium-sized businesses in areas of low pay, and aggravate geographical economic and social inequalities.”

According to research by the New Economics Foundation, the Government’s evidence of an alleged public sector pay premium

“suffers from a number of serious shortcomings”

and their statements are

“at best misconceived, at worst mischievous and ideologically driven.”

It concludes that regional pay would cost our economy £2.7 billion at best—if the private sector expanded where the public sector contracted—but that the cost could be up to £9.7 billion each year, with the loss of 110,000 jobs. Regional pay would reduce spending power in the south-west by £1.2 billion.

When we consider regional pay from the perspective of the NHS, we cannot, or at least should not, talk about private sector jobs replacing public sector jobs. The public’s response to the Government’s disastrous reorganisation of our NHS proved that patients do not want to be treated by Virgin Care or Serco, but Ministers still seem determined to remove the N from NHS.

For my constituents, today’s debate is even more important because, as we have heard, trusts in our region have been developing the NHS south-west pay, terms and conditions consortium. This morning, I asked the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry)whether the Government knew about the consortium before it was established and whether they encouraged the trusts to set it up, and it was interesting that she said, “My understanding is we were involved”—[Interruption.]

[Alison Seabeck (Plymouth, Moor View) (Lab)]

That is a fascinating answer because it is at odds with the one I received from the Secretary of State during Health questions.

[Kerry McCarthy]

I very much hope that when the Government—[Interruption.]

--- Later in debate ---

[Alison Seabeck (Plymouth, Moor View) (Lab)]

It is a pleasure to follow the hon. Member for Aberconwy (Guto Bebb), who very openly mulled over some of the problems posed by regional pay.

The unfairness, irrationality and economic illiteracy of the proposal made by the south-west cartel, as highlighted by the hon. Member for Southport (John Pugh), who is no longer in his place, are stunning. The upshot of the documents that have been leaked to the public has been an outcry in my region. I, too, have received hundreds of e-mails and letters from local people who are concerned about what they see as an unfounded and unfair attack on hard-working Plymouth families.

The south-west proposals are tacitly supported by the Government. When questioned in the House, they washed their hands of any responsibility for the action being taken by the 20 trusts in my region. Why is that? Is there something about the south-west? Did the Government believe that the south-west would be supine because there are lots of Government MPs in the region? Did they think they would try regional pay in the south-west and put their toe in the water and perhaps that nobody would notice—after all, it is a long way from London? Did they think, “We now have regional pay in the south-west. It’s a good idea, so we’ll roll it out in the rest of the country”? The response from people across the party divide in the south-west, including those working in the NHS, has put the proposal firmly in its place. We will not accept it or take it lying down.

[Dr Wollaston]

Does the hon. Lady agree that there are concerns in the south-west that regional pay will impact on the ability to recruit in certain key specialties?

[Alison Seabeck]

The hon. Lady speaks from a wealth of experience of working in the NHS. She is absolutely right on that point, which I will make more of later in my speech.

The public have a right to know what the Government’s position is, but as with so much else, confusion reigns. The Deputy Prime Minister has said at times that he is not in favour of regional pay, but it will be interesting to see how he votes today. The Chancellor of the Exchequer is clearly in favour, but the Prime Minister says nothing. The Secretary of State for Health has not helped to clarify matters today. The amendment, which is in the name of the Chief Secretary to the Treasury, is interesting. It states that the Government will not go down the route of regional pay

“unless there is strong evidence and a rational case for proceeding”.

How will the Government consult and gather the evidence to decide whether there is a rational case for regional pay? When will the Minister make the evidence available to Members of the House?

The Government must understand that the proposal is causing huge concern. The debate is not just about public sector pay restraint. Labour Members have accepted that there needs to be restraint in the public sector. We are not saying that that should not happen in times of austerity, but there is a need for equal pay for equal work. It is wrong if a nurse in Plymouth, working the same hours, doing the same job and providing the same high-quality care, is paid less than her counterpart in a hospital in Peterborough or Preston.

[Chris Skidmore]

Does the hon. Lady therefore disagree with the concept of London weighting, which has been around since the 1920s? There are 44 London MPs in the London area, so I would be interested in her views on London weighting.

--- Later in debate ---

[Alison Seabeck]

The hon. Gentleman dug an enormous hole for himself earlier, and I think I will leave him in it. As hon. Members know, London weighting has been around for quite a long time.

Even NHS employers in the south-west have admitted, in their submission to the consultation that the Government are allegedly carrying out, that the breaking up of national pay systems could jeopardise the progress made in delivering equal pay for women, a hard-fought right being all too easily diminished. “Agenda for Change” was a challenge for the NHS when it was introduced, but it has been a driver for change and fairer pay.

Although the Government are unlikely to listen to questions of principle, it is normally incumbent on Governments to look at evidence to understand the history of a policy that they are considering introducing or broadening. NHS regional pay was tried over a period of about a year in the 1990s. When the evidence was looked at, the differentials across the region were so small that it was put to one side. Regionalised pay is not an idea whose time has come; it is an idea whose time has long since passed. It should be left to lie in peace.

However, as the Government have chosen to resurrect regional pay, perhaps it is worth questioning why they think it is a good idea. The Chancellor claims it is good for the economy, but all the evidence speaks to the contrary. It would be nice if we had a Government who were willing to accept the facts. Instead, their plan is to introduce pay cuts for nurses while introducing tax cuts for millionaires. They are looking to make savings by hitting people throughout the health sector. Regional pay is not just about nurses—the paperwork from the consortium is clear about the impact on doctors and consultants as well as people on lower pay grades.

The Government are ignoring the impact that regional pay would have on living standards and the private sector. It risks a brain drain from the regions. I had an e-mail from a man, now in his 70s, who told me that he had voted Conservative all his life, and that he had even campaigned and canvassed in south Wales for the Conservative party, which takes some courage. The issue that moved him was regional pay. I went to have a chat with him, and while I was there, his daughter—a nurse—came in. I asked her about her experience and how morale was, and she said, “I’m already looking for jobs outside the region. I went to a jobs fair in London, where I spoke to the people from Devon NHS. They did not tell me about regional pay and were not up front about the fact that it’s being discussed.” She found that absolutely shocking. She has considerable experience, but she is looking to move out of our region.

Can the Government look hard-working families in the south-west in the face and tell them that their food bills are lower than anywhere else? Can they claim that south-west gas and electricity bills are not going up in the same way as those in the rest of the country? No. Would they dare say that water bills in the south-west are the same as for everybody else in the country? No. They certainly cannot say that housing is cheaper. The mortgage to income ratio in the south-west is exceeded only by that of London and the south-east. If rising living costs are having the same pernicious effects in the south-west as elsewhere, why should the south-west be singled out for the policy of regionalised pay cuts? Once again, the case simply fails to hold together. By not opposing this policy, the Government are, by stealth, supporting it.

The Government also claim that they need to address the differences in pay in the private and public sectors. Higher pay in the public sector is supposed to be skimming off the best talent and holding the private economy back. They work hard to pit worker against worker, but the evidence shows that 55.8% of public sector workers have a degree, diploma or equivalent, compared with only 28.5% in the private sector. That is comparing apples and pears. People in the public sector are better qualified and can quite reasonably expect to be better paid. Many hon. Members have experience of the law, and barristers and others would certainly expect to be paid better because they have their qualifications.

We also see a skewing with unskilled workers. In the private sector, we often see corners being cut—unfortunately —and very low levels of pay, whereas in the public sector, we expect unskilled workers to be paid a decent wage. It is not yet always a living wage, but that is a separate debate—and one that we certainly need to have.

Is it fair that a nursing graduate in Plymouth, with a degree and £30,000 of debt, should, if she wants to stay in the area and work for the NHS—a job for which she has been training for many years—have to take a pay cut? That does not work for me.

The issue of foundation trusts has been raised on many occasions. Foundation trusts have members, and they all encourage people to join and become members. Plymouth Hospitals NHS Trust is no exception. I suggest that people who have very strong views on regional pay might want to consider becoming a member of a trust, because that will give them a direct line to the chief executive and chairman of the trust, and the board, and they can make their views very firmly felt.

We should support the motion tonight. I hope that Members from across the region who have publicly opposed the measure will join us, and we can put an end to the nonsense of regional pay once and for all.

--- Later in debate ---

[Dan Rogerson]

I agree with the hon. Lady up to a point, in that there has been a narrowing in the “distance from target” figure. Of course, it is much easier to get closer to target when there is more cash around and more money is being put into the NHS—in the good times. That is when the distance from target should have been tackled. We are obviously very much not in the good times in terms of the economic circumstances, for reasons that all parties would agree with.

If the trusts continue down this path, and create efficiencies by doing so—as well as making life much more difficult for their valued employees—we run the risk of what I call the boa constrictor approach. Snakes that kill by constriction wait until their victim breathes out and then tighten up, so they cannot breathe in again. My worry is that if trusts in Cornwall make these changes first, before other areas, they will make it easier for the distance from target funding to continue. The view will be, “Well, they don’t need the cash now, because they’ve dealt with the problem.” But the burden will have been borne by NHS employees, and that cannot be right.

I think this process is wrong because, as hon. Members on both sides have pointed out, there is an existing process for NHS employers and employee representatives to engage in to examine terms and conditions and pay levels, and see where savings can be made.

[Alison Seabeck]

Does the hon. Gentleman agree that the document that became public contains clear reference to the fact that the consortium had already been working with those staff-side organisations effectively to find some changes? We need to build on that rather than pursue this policy.

[Dan Rogerson]

That is exactly the point that I was going to make. Given the history of the two sides of the House, it is interesting to note that the motion tabled by the Opposition does not refer to the role of the trade unions in these negotiations. However, the amendment calls on the Government

“to continue to support employers and trade unions to work together for the benefit of patients and staff.”

I very much agree with that. I do not think that the approach set out by this consortium—or cartel, as others have called it—goes along with that, and that is why the amendment would send a powerful signal to those employers to get back round the table with the representative organisations, the trade unions. I do not join in the trade union bashing—talking about Labour’s paymasters and so on. Having met trade union representatives here, as the hon. Member for Plymouth, Moor View and others have, I know that some give a certain amount of cash to the Labour party and that others do not. That does not matter. They are local representatives representing their staff and doing the job that they are there to do. I have always supported, and continue to support, officials having time to do that job, as it actually saves the public sector a great deal of money. There will be accord from some parts of the House on that issue, too.

This is about market-facing pay versus a top-down, imposed regional pay structure. The Deputy Prime Minister has said that we will not have that. I am delighted that he said that, and I support him. I think that all hon. Members on these Benches—including many of our coalition partners—would say that that is not the way to go. We are not going to have a regional structure that mandates a different level of pay in different parts of the country. However, there is a risk with the market-facing approach, of which the hon. Member for Kingswood (Chris Skidmore) seems unfortunately to be a fan, that that could happen via another route.

The argument has been made repeatedly that public sector pay somehow holds back private sector employment. That is absolute nonsense. The idea that the widget factory next door to the hospital is struggling to employ people, and that if we pay nurses less they might suddenly all decide to go and work in the widget factory, is absolute rubbish and I hope we can knock it on the head right here and now. However, if there are challenges facing the NHS, as there are in other public services, as a good employer it should get around the table and look at ways it can defend jobs and make sensible changes that have the support of the work force. Local government has done that in a lot of places. The challenges facing local government have been great, but in a number of areas that process has protected jobs, so it is possible. There is a national process under way to deal with that, as other hon. Members have said.

I am opposed to the process that is going on independently of national pay bargaining. The motion effectively states that the current system is encouraging that process and that the Secretary of State needs to step in and stop it. I would like a stronger message from the Secretary of State—do not get me wrong about this—and I hope that the Minister will listen to remarks from all parts of the House about the message that we would like the Department to be sending to the trusts. However, if I look at the motion and the amendment, it is the amendment that mentions the continued role of staff, employers and trade unions working together, and that is what I will be supporting tonight.

Oral Health Services

Alison Seabeck Excerpts

Wednesday 17th October 2012 Commons Chamber

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I am pleased to have this opportunity to raise the question of oral health in the UK. Oral health is given far too little attention, in terms of what practitioners can bring to improving a population’s general health, as well as how it can be used to prevent the development of disease. Rather like opticians, our dentists are undervalued, in terms of what they can bring to the table to help to improve our nation’s health. Perhaps it is because dentists are not the most popular group in society—although I suspect that they are outdone by politicians. Why is going to the dentist not seen as a pleasurable experience? I will leave that to others to judge, but although going to the dentist may not be pleasurable, it is absolutely essential, and good practice starts right at the beginning, with the emergence of milk teeth.

Here in the UK we can be proud of many of our successes in achieving a good quality of oral health. The UK is one of the top-performing countries for oral health in Europe, but there is still much we can do. In fact, a recent joint report by Wrigley and GlaxoSmithKline suggests that Britons love their teeth and take very good care of them compared with our European neighbours. More Britons have more of their natural teeth than people in any other European country, and since the 1980s Britain has cut its decayed, missing and filled teeth score by two thirds. That is an impressive step, but there is certainly still room for improvement—I should explain, Mr Speaker, that Wrigley is based in my constituency.

I recently attended the launch of the report and listened with great interest to Professor Ken Eaton talking in detail about the work that has been going on across Europe looking at patterns of dental health. Other speakers included Dr Nigel Carter from the British Dental Health Foundation and Juliette Reeves, a dental hygienist and nutritionist with over 30 years’ experience. All the speakers set out clearly the importance of dental checks in the early identification of a number of diseases, particularly cancers, which we know are growing in prevalence, mouth cancers in particular. There has been a 48% increase in mouth cancers in the last 12 years. Early identification can make all the difference, in terms of the treatment required and the survivability of the patient. Dental health problems can also be indicative of other diseases, such as diabetes. All those issues are easily picked up during a dental health check. One of the good things in the new contract for NHS dentistry is that it recognises the importance of prevention. This will be challenging for some in the profession to implement, as they will have to change the way in which they work, but most dentists will learn to accept that prevention should be a priority.

The report’s evidence showed that although a majority of us in the UK keep to the suggested practice of brushing twice a day, only half of us brush for two minutes or longer—the rest of us just whizz around and hope that is sufficient—and that almost two thirds of us eat or drink between brushing and going to bed at night. There is clearly space to improve our personal oral hygiene practices, and there is scope for policy and campaigns to achieve that.

Personal oral hygiene is essential. Dental disease is completely preventable, and so, therefore, are those occasionally uncomfortable visits to the dentist when invasive treatment is necessary. These diseases constitute a significant public health problem across the UK and Europe. I cannot stress strongly enough that prevention is the key, and it needs to be encouraged. Many will say that the treatment is expensive. Yes, it can be, but when set against the money saved by regular dental checks reducing the likelihood of more complex treatment, the expense looks like good value for families. The prevention of debilitating diseases will certainly reduce the social and economic costs for the country and the individual.

Curative dental care is a significant economic burden across Europe, with spending close to €9 billion. In the UK, the cost is substantial. An estimated 0.5% of gross domestic product was spent on oral health care services in 2010, and that figure is rising. Expenditure on treatment for oral diseases often exceeds that for other diseases, including cancer, heart disease, stroke and dementia, yet the simple fact is that the causes of most oral diseases in the UK are preventable through cost-effective measures that would ultimately save the taxpayer money. Brushing, flossing, using mouthwash and chewing sugar-free gum—a much-maligned practice that is actually quite effective—could all be more effectively promoted to help to keep dental costs down in Britain, and the sharing of good practice should be encouraged.

Policy needs to be designed and implemented to improve research into oral health promtion. There is currently a lack of comparable data across Europe, although the report goes some considerable way towards addressing that problem. To tackle the burden of oral disease we also need to consider taking action in various ways, some of which have been suggested in the report on the state of oral health in Europe, which I hope the Minister has had an opportunity to read. The report suggests the need to address increasing oral health inequalities, improve the data and knowledge base and support the development of the dental work force.

We should be proud that Britain is a high achiever when it comes to oral health in Europe, but there is certainly room for improvement. Despite our successes, oral diseases remain a burden for much of the population, and the economic impacts are significant. There needs to be a greater focus on prevention rather than treatment, and improvements in education and awareness are also needed.

I am proud that we have the Peninsula dental school in Plymouth. I was asked by my local media why I had chosen oral health as the subject for this debate when so many other issues could have been raised. That was a good question. Having the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), here to respond is of course a good reason. There is also the small question of the ballot for Adjournment debates. MPs often put in for a number of debates over the Session, and we cannot tell which one will be lucky enough to come out of the ballot. I was lucky on this occasion.

Also, one of the first major campaigns that I was involved with when I was first elected to Parliament was to get a dental school sited in Plymouth. I remember fighting tooth and nail—the pun is intended—for that, alongside my former colleague, Linda Gilroy, and experts such as Sir John Tooke. It was during that campaign that I began to understand just how important good dental health is, and how essential it is that we train our dentists and technicians to the highest standards. My subsequent involvement in the all-party parliamentary group on dentistry, which is chaired so well by the hon. Member for Mole Valley (Sir Paul Beresford), has maintained my interest in the subject.

The groundbreaking training offered by Peninsula in Plymouth closely links the trainee dentists and technicians to local communities that have historically had very low levels of contact with dentists, and it is making a difference. This was one of the strong points of the case we made for a dental school in Plymouth.

We have an excellent community development team at the dental school who ensure that the training includes opportunities to go out into these communities, taking dentistry to “places it has never gone before”. Some of the projects included highlighting the impact of high-sugar drinks for professional rugby players at Plymouth Albion; making mouth guards for them; offering oral health advice to local schools; and letting children enjoy and play in a clinical environment to make it less scary. The dental school also works alongside experts to support people with drug and alcohol abuse issues, and is certainly doing some excellent work around oral cancer and smoking cessation with young adults and teenagers.

There continues to be concern about access to dentists in some parts of the country. In Plymouth, we have good months and bad months. Since the start of 2012, however, improvements have been made, with an additional 6,500 NHS places coming on stream in our city. This is possible in part because the graduate dentists from the dental school are staying in the area—yet another reason why we so wanted a dental school in Plymouth. I was pleased that the then Labour Government recognised the importance of dental training—unlike the last Tory Government, who closed dental schools.

There continues to be an issue about the cost of dental care and treatment for many families, particularly in the recession. That cost is still not easily met by some families.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way and for bringing this matter to the House for discussion. Oral health is a big issue right across the whole of the United Kingdom. In Northern Ireland, some plans have been mooted to introduce fluoridation in the water. That has been resisted by the Northern Ireland Assembly and resisted by the population of Northern Ireland. A new consultation process has started, but it will again be resisted. Does the hon. Lady feel that the best way of addressing tooth decay is, as she has already indicated, by regular brushing and diet, and not by fluoridation of the water?

[Alison Seabeck]

I know that the hon. Gentleman feels strongly about this issue. I feel equally strongly about it, but I disagree wholeheartedly with him, not least because a lot of toothpaste has fluoride in it in any case. Neither of my daughters, now 30 and 26—they will probably kill me for revealing their ages—has any fillings, and they have lived in an area with full fluoridation. They have had no side-effects at all either.

[Jim Shannon]

The hon. Lady is generous in allowing me to intervene again. There are statistics and information showing that fluoridation of water leads to osteoporosis and other diseases. Is it not important to be careful before pursuing a policy that could affect people’s health negatively rather than help them?

[Alison Seabeck]

I understand the hon. Gentleman’s concerns, and I am sure the population in his area will continue to have that debate, but I am convinced by the data and information that I have seen that, on balance, fluoridation of the water is a good thing. I was intending to touch on it later, but I shall now skip around it.

I will come back to the issue of families and the cost of dental care. Brushing teeth from an early age is certainly something we should all be doing; it has no significant cost and has positive outcomes. Dental treatment can be expensive, so a dental contract that focuses on prevention, works with people identified as having a higher risk of dental decay and takes a more risk-based approach—patient by patient—could lead to some families spending less on their visits to the dentist each year. That would obviously be a good thing for those families. Those people who have no visible issues of tooth decay—an increasing number in the UK, thanks in part to fluoridation—do not need a service focused on drill and fill. They need a system that rewards dentists for the preventive work they do, which should lead overall to less expensive treatments.

The wider use of expert dental hygienists to monitor and advise patients as well as to carry out treatments could have a significant benefit, although there will be some dental practices—these issues have been raised—that are not currently suitable and do not have enough space to accommodate the additional clinics. Some of the proposed changes could be problematic for them. I would welcome an update from the Minister about whether he is picking up concerns from some of the pilots as to whether or not this is an issue. The result of the contract pilots will be crucial when it comes to deciding whether the patient, as well as the dentist, benefits from the change in emphasis. The wider health benefits of preventive work will also save the NHS money, if other health problems are caught early. Preventive work can save lives, which is obviously hugely important.

I urge the Minister to consider whether, as well as the pilot schemes, further public information campaigns are needed to make the general public aware of the growing number of oral cancers that are linked to smoking and alcohol consumption—particularly among young women—and the importance of brushing babies’ first teeth. It should be emphasised that dental care can be preventive, rather than something that we all have to suffer when we have toothache.

I know that companies such as Wrigley run their own campaigns linked to their products and support wider campaigns such as Keeping Britain Smiling, but, given the massive cost to the NHS of poor dental health and linked ill health, the Government also have a role to play. I hope that the Minister will not only take on board the concerns raised by me and by others, but will tell me about the steps that are currently being taken, and about those that may be planned. I invite him to come down to Plymouth, visit the dental school and look at some of the outreach work that it is doing in deprived communities, because I think that there are some very good lessons to be learnt.

We should all speak to and lobby our health commissioners to ensure that those who are involved in the new health commissioning system understand what dentists can contribute to an overall reduction in poor health and the early identification of health problems. I hope that the Minister will note that plea.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate the hon. Member for Plymouth, Moor View (Alison Seabeck) on securing the debate. I do not think that she needs to justify her pursuit of this issue to her local press, because it is an important issue, and we should all pay tribute to her long campaign. The need to improve dental health is often underestimated, and it is not discussed enough in the context of the health service. I am sure that the hon. Lady will continue to campaign strongly, as a member of the all-party group, in the Chamber and in her constituency, where she supports the medical and dental schools. I should be delighted to take her up on her invitation: I intend to go to Plymouth in the near future, and I hope to be able to visit the dental school then.

The hon. Lady rightly observed that, in health care generally, we do not talk enough about the fact that prevention is much better than cure. In many parts of the health service, payment systems have not properly rewarded staff in line with the recognition that good health care is about preventing people from becoming unwell in the first place, rather than picking up the pieces when they have developed cancer or other problems. The new dental contract makes it easier to identify key prevention issues. It focuses on the desirability of spotting early symptoms of ill health—in this instance, oral ill health—rather than spotting them much too late, when a patient’s cancer is already well advanced.

The hon. Lady also referred to important public health concerns about smoking and alcohol consumption. She was right to draw attention to the problem of binge drinking, not just among young men but nowadays increasingly among young women, and to the effects of excessive smoking and drinking on oral health. The links between high alcohol consumption and smoking and a number of cancers—particularly throat cancer and other cancers in the mouth—are well established. I am optimistic about the possibility that the new dental contract and the important focus on preventive care will enable us to identify cancers, and those who are at risk of developing them, much earlier, rather than waiting to treat people later when they are very unwell. The health service in general needs to be geared up in order to do that better, particularly in the context of oral health.

The hon. Lady also raised the issue of the European platform on oral health. I believe that the all-party group hosted a reception on that recently, praising its work. All the work we have been doing in this country has been rightly highlighted in that report, and I shall discuss that a little later. It is worth dwelling on how over the past 20 or 30 years, under consecutive Governments, we have had a record of improving oral health and improving access to dentistry, particularly in the past few years. If we are taking oral health seriously, it is important that we improve access, and we are beginning to do that well.

As the hon. Lady knows, in 1973 the average 12-year-old in England and Wales had five decayed, missing or filled teeth, but by 2003 the UK average was 0.7 fillings. So we have made great strides in the past 30 or 40 years. That improvement was partially due to the introduction of fluoride toothpaste in the 1970s—that brings me to the issues raised by the hon. Member for Strangford (Jim Shannon) in his interventions—and to the hard work of dentists up and down the country. They, along with dental hygienists, highlighted the importance of good tooth care and preventive measures through effective tooth brushing using toothpaste.

Adult oral health has improved in a similarly impressive manner. In 1968, the first adult dental health survey found that 37% of the adult population of England and Wales had no remaining natural teeth, but the 2009 survey found that the proportion had dropped to 6%. Again, that is a mark of how this country is taking this issue seriously, and we must continue to do so. Access to NHS dentistry has grown steadily, with more than 1 million more patients having been seen by NHS dentists since May 2010.

The hon. Lady rightly highlighted the European platform on oral health report and outlined some of its recommendations. I have read the report and it rightly identifies the promotion of good oral health as one of the most significant health care challenges facing EU countries. However, as she said, England’s oral health compares well with all the countries surveyed in the report, and we are especially pleased that it highlighted the “Delivering Better Oral Health” toolkit, which was a guide to prevention in practice published jointly by the Department of Health and the British Association for the Study of Community Dentistry as an example of good practice. Notwithstanding the fact that we have made good progress historically and that the European platform on oral health report highlighted the good things we do in this country, we must never be complacent. We must continue to ensure that we drive further improvements and reduce the inequalities in access and in oral health that still exist and are very real in some parts of the country.

The hon. Lady raised the issue of the new dental contract. The reforms of the contract focus on a number of things, including improving access to care. There is an important focus on preventive dentistry—preventing bad things from happening to people and on picking up things early. As she is aware, the new contract that we are introducing will be based on registration, capitation and quality, rather than a more payment-by-results system. Such an approach will allow more focus to be put on those preventive measures, rather than on the more reactive measures that a payment-by-results system tends to deliver. The new contract will replace the existing model that rewards units of dental activity rather than taking a more holistic view of what is good for the patient. We can learn from this approach as a good model of health care as we develop tariffs throughout the health care system. Such a model is already being used well in some parts of the country—in stroke care and other areas of preventive care, for example, where a more holistic, joined-up approach to what happens before hospital admission and afterwards in rehabilitation is as important as immediate treatment in a hospital setting.

Elements of that contract are being tested in 70 practices at the moment, and we are rolling them out to an additional 20 to 25 practices as part of the pilot to make sure that that contract is fit for purpose. When the further results from those are available, I will be happy to share them with the hon. Lady, so that we can ensure that we design the best contract.

[Alison Seabeck]

Perhaps it might be appropriate to share some of that information with the all-party group, rather than one to one.

[Dr Poulter]

Absolutely, and I would be very happy to do so. The hon. Lady’s commendable focus on this area of health care would, of course, lead me to wish to share that information with her, but of course I would be delighted to share it with the all-party group, too. The work done by a number of all-party groups, including hers, helps to ensure that many of these important issues are never forgotten and that they are kept at the forefront of the minds of our fellow parliamentarians.

Of course, as the hon. Lady rightly highlighted, there are some inequalities across the country and, as we know, among different socio-economic groups. Improving access to care will play an important part in addressing those health care inequalities. I draw the attention of the House to our progress in preventive care, in addition to the new contract. The number of adults being treated with fluoride varnish, which is one of the most effective preventive treatments available, rose by 43% last year. Among children the figure was 64%. By investing in preventive treatment, we are ensuring that future generations will enjoy good oral health throughout their lives. In addition to promoting the application of fluoride varnishes, we will seek to promote the learning of lessons from the best performing areas of the NHS and to work with the devolved Administrations and local and regional government to iron out inequalities across different geographical areas. It is important that in all areas of health care, including dentistry and oral health care, we learn from things that have gone well so that we can roll out that good practice elsewhere and ensure that it is learned from. We should also be open and honest when things have not gone so well, so that we can learn lessons and improve services for the benefit of patients.

The hon. Lady mentioned the Peninsula dental school and rightly stated that it was opened in 2007, under the previous Government, as a joint venture between Plymouth and Exeter universities. The school has been a great success. I know that she has been a great advocate for it and is rightly very proud of what it has achieved and of what it is doing in Plymouth. Earlier this year, the two universities announced changes in how the school is run. Exeter will now operate a medical school of its own while the teaching of both medical and dental studies will continue in Plymouth. I know that it is important that her constituents are reassured about that and that as we have a successful dental school we should recognise that and support its continuing function. Many of the changes were purely administrative, rather than to front-line services.

I acknowledge the concerns expressed by the hon. Lady tonight and elsewhere, but both universities have stated that the split will improve the administration of medical education in the south-west and we expect the changes to have no negative impact on the dental school. I know that she will ensure that the voices of the dental school and her constituents are heard loudly both locally and in Parliament, and I am happy to support her in that.

Let me finally make a few points about dentistry in the south-west of England. The hon. Lady talked about NHS dentistry in her constituency, including the case of an individual constituent who had problems accessing it. We know that we have further to go in improving access, but the Government have made good strides in that direction, as did the previous Government. We have made significant progress and the latest NHS figures show that since March 2010 the number of people who accessed an NHS dentist in the south-west over the previous 24 months has increased by almost 150,000. That is a strong step in the right direction.

In Devon, £500,000 was invested in four practices in March to provide a further 6,500 dental places, which will become available over the next 12 months. I understand that at the same time a further two practices have increased their capacity and will provide an additional 3,000 places over the next 18 months. We are continuing to ensure that we widen access to dental services in the south-west.

In the south-west, as in the rest of England, we are making vital improvements to access to NHS dentistry and putting in place the measures needed to continue the improvements in this country’s oral health. Access is rising, rates of decay have fallen and continue to fall, and we are piloting a new contract designed further to increase access and improve oral health, focusing on prevention as a key part of our efforts to improve people’s oral health and general health, and to keep them well. We are committed to ensuring that NHS dentistry is available to those who want it, and improving oral health is at the heart of what dentistry does.

Of course challenges remain. We must make sure that pilot studies are effective and that we listen to any concerns that emerge from them, so that we can improve the new contract accordingly. The fundamental focus is on moving away from a reactive service to a preventive care service. That will both improve oral health by reducing the incidence of cancer, and give children the best start in life by engendering good dental health habits through the involvement of hygienists and other practitioners. Our aim is to move dental care on to a more stable footing. This Government are committed to continuing the progress that consecutive Governments have made in widening patients’ access to dental services, particularly those patients who have had difficulty accessing such services in the past.

Question put and agreed to.

Business of the House

Alison Seabeck Excerpts

Thursday 6th September 2012 Commons Chamber

[Mr Lansley]

A consultation is taking place on the mandate of the NHS Commissioning Board. It will deal with, among other topics, the board’s responsibility to allocate NHS resources on the basis of equal access for equal need. If my hon. Friend wishes to make his points again, the board will be able to take them into account when it receives recommendations from the Advisory Committee on Resource Allocation.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I welcome the members of the new team. They will be as surprised as I was to hear what happened to a constituent of mine, a victim of domestic violence. Her screams and the breaking of a window from the inside attracted the attention of the police, but it is she who is now subject to antisocial behaviour powers. Will the Leader of the House please ask the new Home Office team to come to the House and engage in a debate about the way in which domestic violence victims are supported—or not—by police forces around the country?

[Mr Lansley]

I am surprised, and like the hon. Lady, I am obviously disappointed. I will of course ask whether my colleagues in the Home Office can respond to her on the issue.

National Health Service

Alison Seabeck Excerpts

Monday 16th July 2012 Commons Chamber

[Andrew George (St Ives) (LD)]

It is a pleasure to follow the hon. Member for Ealing, Southall (Mr Sharma), a fellow member of the Health Committee. He makes a strong case on behalf of his constituents, and one hopes that any reconfiguration will be evidence-based and, above all, based on clinical governance and clinical safety.

This is an important debate—indeed, we cannot debate the future of the NHS enough, because it concerns many Members and their constituents. It draws passion and a great deal of interest, because it affects everyone’s lives. I therefore congratulate the Opposition on giving us the opportunity to debate it this evening.

I apologise to the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), for not having heard his speech. I had to attend an urgent meeting with a Minister to discuss the closure of a Remploy factory in my constituency. My hon. Friend the Member for Southport (John Pugh) gave me a précis of the Minister’s wise remarks as best he could—without, of course, being able to convey fully his panache and oratorical dexterity. I understand that the Minister made a number of important remarks about one issue that I want to discuss, as a Member representing west Cornwall and the Isles of Scilly, which, apart from being the centre of the world, are in the far south-west. That issue is pay and conditions for staff. As I understand it, he emphasised the point that no such independent review of pay, conditions and the salaries of staff in such an area can proceed without the full involvement and support of the unions, and their engagement in the final decisions.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

It is absolutely right that the trade unions should be involved, because this is an enormous issue, particularly for staff morale in the south-west. Does the hon. Gentleman not share my concern that thus far the consortium has shown no great desire to undertake that consultation in the south-west? That really has to change.

[Andrew George]

The hon. Lady makes an important point. Lezli Boswell, the chief executive of the Royal Cornwall Hospitals Trust, wrote to me on behalf of the consortium about concerns that have been raised, including by the unions, saying that once the national pay review has concluded under “Agenda for Change” it would then be appropriate, if it is at all appropriate, for any further local discussions to proceed. Without union involvement in the work of the consortium, I agree with the hon. Lady that the proposal is irrelevant and potentially disruptive and dangerous, given its impact on staff morale throughout the NHS in the south-west. My hon. Friends will be listening closely to this debate, and to the concerns that have been raised by many Members and, indeed, by staff across the south-west about the consequences for staff morale and the impact on NHS services. I certainly hope that the Secretary of State will address those issues when he concludes the debate.

A key issue is one that dare not speak its name—it affected staff morale under the previous Government as well—but it is the increasing pressure on front-line NHS staff. The staffing levels at the coal face have never been sufficient to provide a safe staff to patient ratio. Many people have been critical of nursing and care standards in the NHS, but they often overlook staffing ratios.

I have also expressed concerns about the out-of-hours service in Cornwall—I know that we will not have time to discuss that—and the Care Quality Commission will produce a report as a result of those concerns, which were also voiced by the hon. Member for Truro and Falmouth (Sarah Newton).

On pay for staff in the south-west, the chief executive of the Royal Cornwall Hospitals Trust said to me in a letter:

“In recent years NHS organisations have largely exhausted other avenues of potential cost-saving (including reducing reliance on bank or agency staff and implementing service improvement initiatives). Monitor…has also estimated that NHS organisations with a turnover of around £200m will need to produce savings of around £9m a year for each year until 2016/17 to remain in financial health.”

She goes on to say that the consortium, which consists of 20 organisations in the south-west,

“is looking at how pay costs may be reduced, whilst maintaining a transparent and fair system that is better able to reward high performance, incentivise the workforce and support the continued delivery of high quality healthcare.”

Does the Secretary of State agree with that, and how does he intend that that should proceed? How will he protect staff and staff morale, because the consequences will, I fear, derail national negotiations on “Agenda for Change” and drive down pay and morale, particularly in an area of very low wages? I hope that he is listening.

Mental Health

Alison Seabeck Excerpts

Thursday 14th June 2012 Commons Chamber

[Alison Seabeck (Plymouth, Moor View) (Lab)]

It is a privilege to follow the hon. Member for Totnes (Dr Wollaston). She has great personal and professional experience in this field. I congratulate the hon. Member for Loughborough (Nicky Morgan) on securing the debate, and I apologise to her for missing her opening speech as I mistimed my arrival in the Chamber. I will read it in Hansard, however.

This is a very important debate. Mental health problems stigmatise. We have heard harrowing stories from colleagues on both sides of the House about how mental health issues affect our constituents—and also Members of Parliament. I pay tribute to my hon. Friend the Member for North Durham (Mr Jones) for his brave speech; he will now only have greater respect. It was interesting to hear how his experience made him stronger. The hon. Member for Totnes made that point, too, from her own experience. The hon. Member for Broxbourne (Mr Walker) made a speech that managed to be entertaining despite the seriousness of the subject under discussion, and all I have to say in response is “rock ’n’ roll.”

Mental health problems are met with intolerance and discrimination, and sometimes fear. When I was growing up, the terms used to describe people with mental illness included lunatic, nutter, headcase and maniac, all of which have associations of dangerous or unpredictable behaviour. No real effort was made to understand or support. The usual solution chosen was to lock people away, or to stay away from them.

Many people, especially men, are reluctant to admit they have problems or that they are feeling depressed or are hearing voices. Some people do not understand that their lives are being affected by the state of their mental health. We find in our surgeries that people sometimes start talking about one problem, but when we dig we find layers of issues, including mental health issues. About 60% of the people I see have an underlying mental health issue, ranging from severe stress to serious psychotic conditions, and I do not think my constituency is unusual in that regard. Teasing out what support they have, or have not, sought can require great sensitivity, and very few MPs are trained counsellors or therapists. At times, however, we find ourselves taking on that role and doing our best.

Plymouth has a number of organisations that work with people across the full range of conditions; the Samaritans and Plymouth Mind are excellent. Mind has been in touch with me to express serious concerns that, at a time when more people are struggling, money is a huge problem, relationships are failing, young men and women are returning from war and housing pressures are intolerable for some, the main provider of mental health services, Plymouth Community Healthcare, is no longer structuring mental health as a specifically defined directorate of health care and appears to be shifting resources from mental health to generic health services. My right hon. Friend the Member for Leigh (Andy Burnham), on the Front Bench, talked about bringing mental health closer to acute care, and that is obviously a better approach. Mind is concerned that in Plymouth the limited funds are being shifted away from mental health support. The charitable sector, too, is struggling as a result of a reduction in resources. There are some truly excellent support groups in Plymouth, and I pay huge tribute to the staff and volunteers at those, many of whom have come through mental health illness themselves. There are far too many of them to name, but I just wanted to put that on the record.

I have mentioned housing pressures. How many of us have constituents who are living in desperately overcrowded situations? We encounter pressure on parents because their children have turned up, perhaps with their grandchildren. A woman who came to my surgery is sleeping on the sofa in her front room while the rest of the house is taken up by her children. These people are clearly struggling. Many of them are on antidepressants or more powerful medication, and some are suicidal. Our caseworkers also deserve enormous credit for the way in which they sometimes have to support people in those circumstances.

Equally, housing officers often cannot manage the tide of human misery that they face. People with mental health issues are much more difficult to deal with. A housing officer can understand someone who has a physical disability, as it is often obvious—it is there in front of them and it is not invisible—and they can offer adaptations or a possible move. Things do not work in the same way for people with mental health issues, and it is much more difficult to deal with those.

As we have heard repeatedly, mental health cuts across every area of our society. We have heard a great deal about the need and support for our armed forces and the excellent work done by organisations such as Combat Stress. We have heard about the iniquitous treatment of people at the hands of Atos and about problems faced by those in the criminal justice system, but there are other areas to address. The hon. Member for Totnes touched on the issue of young women, who clearly often need support both before and after childbirth. Midwives are potentially very important in that scenario, and I would be interested to hear from the Minister on what guidance and training they specifically receive on supporting women in those circumstances.

Work is also being done to address the needs of children. The Minister mentioned the work of YoungMinds, but we are still failing very many young people. Recent media reports on suicides highlighted just how difficult it can be for young people who are being bullied or are struggling through other personal issues. Tragically, schools and other responsible adults have failed to recognise what was going on in their lives. I pay tribute to the incredibly well-informed speech by the hon. Member for Worthing West (Sir Peter Bottomley), which specifically dealt with those issues. YoungMinds, which was praised by the Minister, is concerned by the service cuts and reductions in provision for child and adolescent mental health. We also have to address an issue about the transition from support in that area into adulthood. That area needs a lot more attention, and I hope that the Minister will address some of these specific issues in his correspondence with us.

Finally, I wish to offer my support to the hon. Member for Croydon Central (Gavin Barwell) in his attempt to make significant changes on the whole issue of stigma. Intolerance or discrimination in employment, and preventing people from holding public office because they have been sectioned, is wholly unacceptable. He is right to say that this archaic piece of legislation needs to be binned, and I welcome the support that he has received from the two Front-Bench teams. I also welcome the fact that we will have a further opportunity to debate some of these crucial issues and just get it out there.

[Several hon. Members]

rose—