NHS Dentists: South-West England

Andrew Gwynne Excerpts

Wednesday 24th May 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Elliott. I thank the hon. Member for West Dorset (Chris Loder) for securing this really important debate and for the work that he does locally and here in Westminster to raise awareness of the issue. We have had a good, full debate. I thank my hon. Friends the Members for Bristol East (Kerry McCarthy) and for Plymouth, Sutton and Devonport (Luke Pollard) for their contributions, as well as the hon. Members for Torbay (Kevin Foster), for South Dorset (Richard Drax), for Newton Abbot (Anne Marie Morris), for Poole (Sir Robert Syms), for St Ives (Derek Thomas), for Bath (Wera Hobhouse), for Tiverton and Honiton (Richard Foord), and for Westmorland and Lonsdale (Tim Farron). That stretches the geography to the limits, but the hon. Member for Westmorland and Lonsdale has raised some very important points on behalf of his constituents and rural communities across England, not just in Cumbria.

Last week I responded to a debate on behalf of the shadow Health and Social Care team on dental services, but it was about the east of England. A couple of weeks before that I responded to a Backbench Business debate on NHS dentistry in the main Chamber. I do not raise those debates today to fill you in on my diary commitments over the past few weeks, Ms Elliott, but to highlight the strength of feeling across the House about the crisis we are currently experiencing in dental care.

We are all hearing from constituents who cannot access care, about parents trying to get their children seen and, in the most extreme cases, as we have heard today, patients attempting to perform dental treatments on themselves or on loved ones. So-called dentistry deserts are not being eradicated. Instead, they are multiplying, not least of all in the south-west, as we have heard today.

Last summer it was reported that out of 465 dentists across the south-west, just seven were accepting new patients. Indeed, we have heard more up-to-date statistics from Members during this debate. The number of NHS dentists practising across the south-west has fallen by more than 200, and in areas such as Exeter the current wait to get an NHS dentist is now two years. Behind the statistics are human beings who just want to be seen and to be treated, and we owe it to them to act. So my points to the Minister today will be familiar to him, and I fear that I will keep having to make them time and again until we see the Government’s dental plan.

My first point relates to the dental contract. As I have said before, it was the Labour Government who introduced the dental contract, but by the 2010 general election they had recognised that the contract needed to be substantially reformed. That was in our manifesto. The then Conservative Opposition agreed and it was in their election manifesto, too. The Government have been in power now for 13 years and change has moved at a glacial pace. In his response to the debate last week, the Minister said that he was under

“no illusion that there are significant challenges to address”,—[Official Report, 16 May 2023; Vol. 732, c. 353WH.]

but that those would be tackled in a forthcoming dental plan. Given the urgency of the situation, can the Minister provide an update on the development of the plan and when we can expect publication?

The hon. Member for West Dorset highlighted issues with unit costs being disincentives, and that was followed by other Members during this debate. It is true that dental costs have to be looked at on a per-unit basis because there are perverse incentives, but it would also be wrong to pretend that before the dental contract was introduced, there was a golden age of NHS dentistry. As I said last week, there is a reason why I have a mouthful of fillings and my children do not. It is not because I ate more sweets and did not brush my teeth as well as my children, but because of the then even more perverse incentives for dentists to drill and fill. They were paid for every filling that they put in so that people ended up with a mouthful of fillings whether they were needed or not. We need to strike a balance so that we get the public health needs and patients’ needs as well as a financial package that works for dentists to make a living.

On a similar note, can the Minister update us on the workforce plan? We have heard about that from hon. Members across the House today. We know that it has been produced and that it is on the Secretary of State’s desk. It is particularly pertinent, given that it was revealed earlier this week that the number of active NHS dentists in England is now at its lowest level in a decade, in spite of rising demand and in direct contradiction to claims made by the Prime Minister in Parliament.

Given that net Government spend on general dental practices in England has been cut by more than a third in the past decade and the number of NHS dental practices in England has fallen by more than 1,200, it is of little comfort to patients waiting in abject pain and misery to hear the Government say that a plan is coming. We urgently need to see the workforce plan published and implemented and reforms put in place that work for both patients and staff.

Labour knows we need to change if we are to secure the future of NHS dentistry. We want the NHS to become as much of a neighbourhood health service as it is a national health service. To do that, we will encourage joined-up services in the community that include dentistry. We want to see health professionals such as dentists working with family doctors as part of a neighbourhood team. That will not only help people get access to more care on their doorstep but prevent oral health problems before they become acute. It will also dismantle the two-tier system that has been allowed to develop, where those who can afford to pay receive treatment and those who cannot are left languishing. That is being further compounded by the way the cost of living crisis means some families are unable to afford even basic hygiene products. We are witnessing health inequalities widen in real time as a result, and that must not be allowed to continue.

What does the Minister plan to do to tackle oral health disparities and prioritise prevention? Will that work be part of his dental plan? I am sure this will not be the last dental debate I take part in on behalf of the shadow Health and Social Care team, but I sincerely hope that the next time I am face to face with the Minister in Westminster Hall or the main Chamber, we will have seen some long overdue progress.

It has been demonstrated during today’s debate that this need not be a partisan issue. It is in all our constituents’ interests that the Government crack on now and get improvements to dental care. We all want better dental care for our constituents and, as I said in the last debate and probably the one before that, addressing this crisis cannot wait until we have had a general election. In that vein and in closing, I urge the Minister to recognise that fact and get on with the job.

Cost of Living: Healthy Start Scheme

Andrew Gwynne Excerpts

Tuesday 23rd May 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

As ever, it is a pleasure, Mr Twigg, to serve under your chairmanship.

I begin by thanking my hon. Friend the Member for Stretford and Urmston (Andrew Western) for securing this debate and for the fantastic work that he is doing in raising awareness of this issue.

It has been a small but perfectly formed debate, with the hon. Member for Strangford (Jim Shannon) contributing to it. He always comes to Westminster Hall full of knowledge and willing to share the Northern Ireland perspective. We are always grateful for that, because we can learn a lot from different parts of the United Kingdom and it is really important that voices from different parts of the United Kingdom are raised in these debates, even though primarily these debates, when they relate to health, relate to health issues in England only. Nevertheless, we are the United Kingdom Parliament and it is really important to know what is happening in other parts of the country where there are devolved Governments.

The hon. Member for Glasgow Central (Alison Thewliss) speaks so well on these issues. She obviously has her role as the chair of the all-party parliamentary group on infant feeding and inequalities, and with the work that she does with that APPG she has got really stuck into the matters that we are considering today in real depth and detail. But she also brings a fresh perspective to these debates, as does the hon. Member for Strangford. We learn more from her about what is happening within Scotland through the Scottish Government, and it is important that across the United Kingdom Parliament we hear such examples and that we learn from best practice in different parts of the United Kingdom, so as to make better policy here in Westminster.

My hon. Friend the Member for Stretford and Urmston was absolutely right to raise the issues that he did in this debate, because Healthy Start is an essential scheme that ensures that there is a nutritional safety net for pregnant women, parents and children under the age of four in low-income families. It allows parents—in theory —to buy healthy foods such as fruit and milk, as well as to access free vitamins. However, in the context of the cost of living crisis—so eloquently set out by my hon. Friend—families are undoubtedly finding it increasingly difficult to get what they need. Analysis from the British Pregnancy Advisory Service shows that, although the benefit itself has not changed since 2021, the price of infant formula—as we have heard from the hon. Member for Glasgow Central and from my hon. Friend the Member for Stretford and Urmston—has increased substantially since then. The cheapest brands have increased in price by a phenomenal 22%, which is just unfathomable, in that short space of time.

As we have also heard, huge concerns have been raised about the uptake of the vouchers themselves, particularly following the switch from paper vouchers to a prepaid card system. Healthy Start scheme data for January 2023 shows that up to 37% of eligible families with young children are currently missing out on the scheme. That cannot be acceptable, either. A huge proportion of the people who desperately need that support—or they would not be eligible for it—are missing out.

In an answer on 13 February to a written question tabled by my hon. Friend the Member for Stretford and Urmston, the Minister responded:

“While there are no current plans to increase the value of Healthy Start, this is kept under continuous review.”

With that in mind, I would be grateful if the Minister could update us on whether there have been any recent discussions regarding the value of the scheme and whether it is still his Department’s position that no increase in value is forthcoming. If that is the case, can the Minister set out what assessment his Department has made of the impact of inflationary price rises on low-income households, and what reassurances he can provide to all Members here today that families are not being priced out of essential goods on this Government’s watch?

Similarly, I will press the Minister on the uptake of the scheme. The Government’s target for uptake is 75%, but as I mentioned earlier, we are currently sitting at about 63%. A quick trawl of written questions shows that the Minister has been responding to concerns raised by Members on this issue with a boilerplate response—namely, that the NHS Business Services Authority promotes the Healthy Start scheme through its digital channels and has created free tools to help stakeholders to promote the scheme locally. That answer suggests to me that the Government are not particularly concerned about missing their own target. That is not acceptable. I remind the Minister that there is very little point in setting a target if they are not going to do their utmost to meet it. We all know that the NHSBSA promotes this scheme, but something is clearly not working if uptake is as low as it is. What additional action is the Minister planning to take to increase uptake so that all families who are eligible are not just able to access the scheme but do access it?

It would be remiss of me if I did not raise the problem of child health inequalities, which are widening at an alarming rate. At our mission launch on Monday, Labour committed to a children’s health plan that would give every child a healthy start in life. That includes our pledge to establish fully-funded healthy breakfast clubs across England and restrict adverts for foods high in fat, sugar and salt. We would oversee the retrofitting of 19 million homes in England, to keep families warm. We would reform universal credit. And we would pass a clean air Act, to protect our children from the serious respiratory illnesses caused by pollution. It is an ambitious agenda that would proactively tackle child poverty and ensure families could afford to feed their children and keep them well. Over the last 13 years, the UK’s progress on infant and child mortality has stalled, and we now have much worse rates compared with other developed countries. We must see a concerted effort from the Minister to tackle that. More of the same will just not cut it. What exactly is the Government’s plan to meet the scale of the crisis in child poverty and ill health?

All children deserve to lead long, happy and healthy lives, irrespective of where they grow up and which part of the United Kingdom they live in. That means ensuring that in England the Healthy Start scheme works, and that we do everything we can to tackle child poverty across the country. I strongly urge the Minister to better engage with campaigners on the issue and work proactively with Members on all sides of the House to ensure that the Healthy Start scheme is fit for purpose.

--- Later in debate ---

[Neil O'Brien]

If I can just complete the thought, the total cost of living support that the Government have provided is worth more than £94 billion across 2022-23 and 2023-24. That is, on average, more than £3,300 per UK household. It is one of the most generous support packages for the cost of living anywhere in Europe.

I turn to the critical role that the Healthy Start scheme plays in supporting hundreds of thousands of lower-income families across the country. Eating a healthy, balanced diet, in line with “The Eatwell Guide”, can help to prevent diet-related disease. It ensures that we get the right energy and nutrients needed for good health and to maintain a healthy weight throughout life. The Healthy Start scheme is one way that the Government continue to target nutritional support at the families who need it most, which is increasingly important in view of the cost of living.

Healthy Start is a passported benefit, one of a range of additional sources of help and support that the Government provide to families on benefits and tax credits. It is a statutory scheme that helps to encourage a healthy diet for pregnant women, babies and young children under four from lower-income households. Women who are at least 10 weeks pregnant and families with a child under four years old are eligible for the scheme if they claim: income support; income-based jobseeker’s allowance; child tax credit, if they have an annual family income of £16,190 or less; universal credit, if they have a family take-home pay of £408 or less a month; or pension credit. Pregnant women on income-related employment and support allowance are also eligible for the scheme.

Anyone under 18 who is pregnant is eligible for Healthy Start, regardless of whether they receive benefits. Following the birth of their child, they must meet the benefit criteria to continue receiving Healthy Start. The scheme offers financial support towards buying fresh, frozen or tinned fruit and vegetables, fresh, dried and tinned pulses, plain cow’s milk and infant formula. Beneficiaries are also eligible for free Healthy Start vitamins.

In April 2021, as has been mentioned, we increased the value of Healthy Start by 37%, from £3.10 per week to £4.25 per week. Unlike the Scottish Government’s scheme, which is for the under-threes, Healthy Start is for the under-fours. Pregnant women and children aged over one and under four each receive £4.25 a week, and children aged under one each receive £8.50 a week—twice as much. For a family with a six-month-old and a three-year-old, that is £12.75 a week to help towards buying nutritious foods. That comes on top of the benefits and all the other measures, such as the increase in the national living wage, that I mentioned.

[Andrew Gwynne]

I am grateful to the Minister for rattling off the sums. To go back to the point that the hon. Member for Glasgow Central (Alison Thewliss) made about the Healthy Start grant and why the Government chose not to uprate it, will he share with the House what the cost to the Exchequer would have been to uprate it? That must have been part of their deliberations as to why not to do it. What is the cost?

[Neil O'Brien]

We have chosen to spend over £3,300 per UK household, on average, on the cost of living support. Putting that into the schemes that are available and targeted at people with low incomes, and indeed at the entire population, is the choice that we have made. To reiterate my earlier point, and since the hon. Member says that I am rattling off the figures, it is worth stressing that we have invested £3,300 per household—a colossal sum of money. That is unprecedented. There has never been a cost of living intervention anywhere of that magnitude, so that must be an important part of the discussion about Healthy Start.

Dental Services: East of England

Andrew Gwynne Excerpts

Tuesday 16th May 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

As ever, it is a pleasure to serve under your chairmanship, Sir Mark. I commend the hon. Member for South Norfolk (Mr Bacon) for securing this important debate and for setting out some really important points not just for the people of the east of the England—although it has been impressed on me in the course of the debate that there is a specific issue that is pertinent to that area—but for the whole of England, because dentistry is nowhere near where we would want it to be in any part of the country, notwithstanding the differences in regional funding and access that we have heard about.

We have had a really good, thorough debate, and there has been consensus across the Chamber on the state of NHS dentistry. I thank the hon. Members for South Norfolk, for South West Bedfordshire (Andrew Selous), for Broadland (Jerome Mayhew), for Waveney (Peter Aldous) and for Boston and Skegness (Matt Warman) for the veritable tour of the east of England and south Lincolnshire that I have been sent on. I am well aware that south Lincolnshire is not in the east of England, although it is close to it and uses lots of public services within it. That is not least because my wife is from Bourne, in Lincolnshire, so I know how the area connects into Cambridgeshire and beyond.

I want to mention the hon. Member for North Norfolk (Duncan Baker), because he will have constituency issues that he would have dearly loved to raise in the debate. Having been a parliamentary private secretary myself, I know that they must be seen and not heard—it is one of the curses of the job. The great part of the job is getting to work with wonderful Ministers and being able to lobby them behind the scenes on all these issues. The downside is that constituents do not see the benefit of their MP most of the time. In addition, I thought the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) made some really important interventions.

It has been said already that we have been here before. I recently participated on behalf of the shadow health and social care team in a Backbench Business debate, which the hon. Member for South Norfolk co-sponsored. I spoke about people having to remove their own teeth, patients waiting over three years to access dental care, and individuals becoming addicted to painkillers because they cannot get treatment. I could go on and on with examples, but they all point to a simple fact: NHS dentistry is in crisis and is not working for the people who need to access treatment now. We have all heard from constituents at a loss about what to do, who are waiting day in, day out in utter agony and crying out for action on NHS dentistry.

As the hon. Member for South Norfolk made clear, the problem is particularly acute in the east of England. In 2022 no dentists were registering new patients in the whole of Suffolk, Norfolk or Cambridgeshire. In Norfolk, and indeed Waveney, there are only 38 NHS dentists per 100,000 people. It is little wonder that we hear stories of DIY tooth extraction, of Norwich hospital treating more people than ever before for opiate addiction and, in some parts of Norfolk, of 40% of under-fives suffering from dental decay.

We cannot go on like this—nationally, across England or in the east of England. Over the last decade, net spend on dental practices in England has been cut by over a third, with 2,000 NHS dentists quitting in 2021 alone. It is not just about this Government; there have been issues for a long period of time, and those have been compounded over a long period of time.

The hon. Member for South Norfolk and others mentioned the 2006 dental contract. As I pointed out in the Chamber in the Backbench Business debate, there was consensus on the effects of the 2006 contract by the 2010 general election.

The last Labour Government recognised that the dental contract needed reforming and pledged to do so in their election manifesto of 2010. So too did the Conservative party in its election manifesto in 2010. It would be remiss of me not to make this point, as the hon. Gentleman indicated I would: you guys have had 13 years to fix that dental contract. It is of deep frustration that in a decade and three years, that has not happened.

I have said this before: there was not a golden era of NHS dentistry before the 2006 contract. The hon. Member for South Norfolk mentioned that before 2006, dentists were paid for each treatment. That worked in the interests of dentists, but not always in the interests of patients. I have also said this before: there is a reason why my mouth is full of metal—crowns and fillings—and it is not because I ate more sweets than my children did or because I brushed my teeth less well. It is because dentists were incentivised to maximise the amount of work they did because that is how they got paid—drill and fill—and that was not always in the interests of public health or the patient.

It was not a bad thing that the Labour Government sought to make changes to bring NHS dentistry more in line with private dentistry, where the emphasis was on prevention rather than on drilling and filling, but it did not work—I make no bones about it. That contract needed to be reformed.

In a similar vein, there is still no sight of the NHS workforce plan—I say that at every opportunity when I face this Minister or others in his Department. We know it currently resides on the Secretary of State’s desk, despite the fact that 90% of dental practices with a high NHS commitment still find it difficult to recruit a dentist, so the key question to the Minister is: what does he plan to do to address the crisis in dental care across England? How do the Government plan to tackle the dental deserts that are causing misery to millions of people, particularly in the east of England? I would also appreciate an update on why the Government are yet to publish the workforce plan in full and when we can expect its release.

It is also important that the Minister recognises the extreme health inequalities that are widening to record levels. Children living in the poorest parts of England are around three and a half times more likely to have rotten teeth removed than those in more affluent areas. That problem is set to get much worse, with families unable to access basic oral hygiene products because of the cost of living crisis. I was very interested to hear of the project in the constituency of the hon. Member for Waveney. Such projects can make a big difference for a small amount of cash at a very local level.

What steps is the Minister planning to take to address the growing inequalities, and what assessment has he made of the continued impact of the cost of living crisis on families who are unable to access oral hygiene products? Labour Members have been clear since 2010 that tackling the crisis in dentistry has to be an absolute priority for any incoming Government, and I include the possibility of an incoming Labour Government. We have a big job of work to do across the whole NHS.

I understand the predicament that the current Government are in, but the previous Labour Government brought waiting lists down across the NHS from 18 months to 18 weeks, and we will do the same again. We want to secure the future of NHS dentistry, and we would provide the staff, equipment and modern technology needed to ensure patients get the care they deserve.

The hon. Member for South Norfolk was absolutely right: if the Government do not move on this territory, the Labour party is there. We have set out how we will pay for the next generation of doctors, nurses, healthcare workers and dentists, with our workforce investment paid for by abolishing the non-dom tax status. We can begin to chip away at the dreadful oral health inequalities that we see across England. We will train 5,000 new health visitors who work closely with families to promote and prevent ill health. We already know that health visitors have the potential to improve dental attendance and oral health in the families who are least likely to engage with dental services—a role that cannot be overlooked.

People in the east of England and across the nation deserve much better NHS dental services than they are getting. Slowly but surely, we are seeing the creation of the two-tier system that the hon. Member for South Norfolk set out in his opening remarks, where those who are able to pay are receiving essential care, and those who are not are languishing in utter agony, unable to find an NHS dentist. The next Labour Government stand ready and waiting to act to rebuild NHS dentistry. Until then, I urge this Government to get to work. Too many people are suffering, and the current state of crisis must not be allowed to become the new normal.

Food Labelling and Allergies

Andrew Gwynne Excerpts

Monday 15th May 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Graham. I am grateful to be responding to the debate on behalf of the shadow Health and Social Care team this afternoon.

I thank the hon. Member for Don Valley (Nick Fletcher) for his opening contribution and the compelling way in which he put the case to the House. I thank my hon. Friends the Members for Dagenham and Rainham (Jon Cruddas), for Hammersmith (Andy Slaughter) and for Sheffield, Brightside and Hillsborough (Gill Furniss) for their contributions, as well as the hon. Members for Winchester (Steve Brine), for South East Cornwall (Mrs Murray) and for Chesham and Amersham (Sarah Green), and the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who spoke for the SNP.

I begin by recognising the courage of Tanya and Emma, who are observing us from the Gallery. I know the etiquette is not to refer to the Gallery, but as we have heard, Tanya’s 15-year-old daughter Natasha died of anaphylaxis after unknowingly consuming sesame in 2016, and Emma’s daughter Shante died after a severe allergic reaction to hazelnut in September 2018. To both of you, I say: I cannot even begin to comprehend the loss that you have both suffered. We are incredibly grateful to be joined by you today, and I pay tribute to the exceptional work that you are doing via the Natasha Allergy Research Foundation. Thanks to the efforts of yourselves and others, full ingredient and allergen labelling on pre-packaged food for sale was introduced in October 2021—something that Members on all sides of the House agree is a vital step in the right direction.

But as has been rightly pointed out, there is still a very long way to go. The UK is now in the top three in the world for the highest incidence of allergies, with hospital admissions for food-induced anaphylaxis tripling over the last 20 years. The largest increase has been seen in children under 15, among whom there has been, on average, a 6.9% annual increase in admissions with a serious allergic reaction. Across all allergy sufferers, 20% live with a severe, debilitating form of their condition. The case for action could not be clearer.

We are here today to respond to two petitions. The first relates to Owen’s law, named after Owen Carey, and I pay tribute to Tanya and Emma. I also pay tribute to Paul, Emma and Owen’s family, who are in the Public Gallery. As we have heard, Owen was an 18-year-old who tragically died after eating a chicken burger marinated in buttermilk, to which he was allergic. Despite checking the menu and making his allergies clear to the server, Owen collapsed 45 minutes after his meal and could not be resuscitated. I know that the Food Standards Agency is considering what steps to take to increase the accuracy of allergen information on non-pre-packed food, but I would be grateful if the Minister provided an update on the development of Owen’s law and on what recent discussions he has had with the FSA on this vital issue.

The second petition calls for a specific allergy tsar, for which Members of different parties, but particularly my hon. Friend the Member for Hammersmith, have put the case so diligently. As the coroner highlighted following Shante’s death in 2018,

“there is no person with named accountability for allergy services and allergy provision at NHS England or the Department of Health as a whole.”

That is unfathomable, and this runs the

“risk that future deaths will occur unless action is taken.”

That warning was repeated recently by the coroner Heidi Connor following the death of Alexandra Briess in 2021. We have now had two senior coroners making a similar recommendation to the Government that someone —whether we want to call them a tsar, a lead or just someone with named accountability—should be appointed to take responsibility for allergy services in England. I would therefore appreciate it if the Minister outlined what assessment his Department has made or is making about introducing an allergy lead within NHS England or the Department of Health and Social Care, particularly in the light of the powerful interventions that we have heard from patients, bereaved families and coroners and in all the contributions to today’s debate.

The other point on which I would like to press the Minister is NHS service provision. Failings in care for allergic disease have been allowed to fester for far too long. My fear is that with the NHS under increasing stress in terms of waiting times, waiting lists and staff vacancies, the problem may well get worse, not better. What steps is the Minister taking to address the acute problems for allergy sufferers? The Natasha Allergy Research Foundation says that with many GPs not receiving training in allergies, with primary and secondary care services being disjointed and with a shortage of allergy specialists across the UK, there is a postcode lottery of care that is costing lives. That is being compounded by a lack of information, with more than half of integrated care boards not currently holding data relating to allergy disease and treatment. That is not acceptable. I hope the Minister agrees that we need rapid progress in the delivery of allergy care and the monitoring of prevalence and treatment. 

Finally, on research, what steps are the Government taking to support potentially game-changing treatments for many allergy sufferers? I am sure that the Minister will agree that we want to see a world in which allergy diseases are eradicated. Members across the Chamber would greatly appreciate any update on research in the field. We all want improvements in allergy care and support for those living with allergic diseases. We owe it to Tanya, Emma, Natasha, Shante, Owen, Alexandra and all the families who have lost loved ones because of avoidable and treatable allergic reactions. I sincerely hope that today’s debate will instigate a step change and that together we can work towards a future in which allergies are cured and those living with allergic disease are properly supported.

Reforms to NHS Dentistry

Andrew Gwynne Excerpts

Thursday 27th April 2023 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a full and thorough debate this afternoon on NHS dentistry—something that really matters not just to us as Members of Parliament, irrespective of the party we represent, but more importantly to our constituents. I, too, commend my hon. Friend the Member for Bradford South (Judith Cummins) for securing this debate along with the hon. Member for Waveney (Peter Aldous). The way that they both put the case before the House has been compelling. It is incumbent on us all to try to find a way through the morass that is NHS dentistry. I also pay tribute to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), my right hon. Friend the Member for Kingston upon Hull North (Dame Diana Johnson) and my hon. Friends the Members for City of Durham (Mary Kelly Foy), for Bootle (Peter Dowd) and for York Central (Rachael Maskell) for their contributions.

I also thank the hon. Members for Winchester (Steve Brine), for Hartlepool (Jill Mortimer), for Broxtowe (Darren Henry), for Milton Keynes North (Ben Everitt) and for Barrow and Furness (Simon Fell), the right hon. Member for Tatton (Esther McVey) and the hon. Members for Bolsover (Mark Fletcher), for Don Valley (Nick Fletcher), for North Devon (Selaine Saxby), for Broadland (Jerome Mayhew) and for Keighley (Robbie Moore) for setting out their own perspectives and the issues that their constituents have raised about NHS dentistry, which are not that dissimilar from the issues that my constituents raise.

It is not a party political point to say that NHS dentistry has been in crisis for a very long time. As we have heard today, patients are being failed on an unprecedented scale. Many are having to suffer through unending pain and misery because they cannot access the care that they so desperately need.

In preparation for this debate, I spoke with people right across the country, and I will share some of the cases that highlight the sheer scale of the crisis. In Darlington, local people have been told that it will take two years for the current backlog in dental care to be cleared, and some are being forced to wait over three years to access treatments. Some residents are being forced into removing their own teeth, in what has been dubbed “DIY” tooth extraction. I shudder to think what state someone’s dentistry services are in when they have to extract their own teeth. Reports have exposed gums becoming infected and individuals becoming addicted to opiates, and unintentionally overdosing on pain relief.

We heard from the hon. Member for Bolsover, but somebody I spoke to raised the fact that local Bupa practices in Bolsover are closing due to a lack of NHS dentists, and patients are being told to glue crowns back on themselves with denture paste because there is no other way of accessing care. The same is true in Corby, where patients are being left stranded after the closure of the Oakley Vale Bupa dental care centre. I could go on. In Loughborough, one resident said that they have been unable to register with an NHS dentist since moving to that part of the country in 2019, and nationally tooth extraction is now the biggest single reason for hospital admissions of under-10s, with 73 children a day having to receive emergency care to remove rotting teeth. When parents try to get appointments for their children, they are turned away.

In Bassetlaw, one resident told local councillors that when she tried to sign her son up to a local NHS dentist she was informed that there was a waiting list of 2,000 people, and that they would have to go private—something that she cannot afford. Local people in Ilkeston have been told to sign up to dentists in Derby because no local surgeries are taking on new patients. The same is true in Darwen, where people are being told that the nearest dentist they can see is in Salford. In Swindon, one parent looking for a dentist for her two-year-old was directed to the only practice that she could find that was taking patients. The problem was that it was 90 miles away in Birmingham. Such stories are commonplace. We have heard them in contributions from Members on both sides of the House.

It would be wrong to pretend that there was a golden age of NHS dentistry in recent years. There was no utopia. There is a reason my teeth, and I hazard a guess those of many Members in the Chamber, are full of fillings. It is not because we failed to brush our teeth as well as our children brush theirs, or because we ate more sweets than our children; it is because the financial incentive in the past was to drill and fill, whether someone required that filling or not. The contract, which is a big part of the problem today, was brought in with the right intention: to move NHS dentistry more towards prevention. However, it did not work. As the right hon. Member for Tatton set out, the issue of funding through units meant that many dentists were just not incentivised to take on NHS care. Tinkering will not work either. It is incumbent on us all to work out a system that will both work and put the capacity back into NHS dentistry, so that patients get the care that they need and deserve, and dentists get the appropriate financial recompense.

I will pose a few questions to the Minister, because we know that a plan is coming. Will he set out, first and foremost, what steps the Government will take in that plan to immediately improve access to dental treatment in the so-called dental deserts? Additionally, given that a recent BDA member survey showed that more than nine in 10 owners of dental practices with a high NHS commitment found it difficult to recruit a dentist, what is he doing to fill the widespread vacancies across the sector? I assume this information exists in the NHS workforce plan, which is still sitting on the Secretary of State’s desk. Will the Minister update the House on why the plan is yet to be published and when we can expect the Government to release it?

We know that NHS dentistry has not worked for a very long time. Governments of all colours are responsible for where NHS dentistry is today. I am not bothered about the past. People with toothache or oral health issues want help today, so it is incumbent on all Members to make sure NHS dentistry is fit for the future, because the stories and statistics that Members on both sides of the House and I have communicated in this debate are simply not acceptable. The Opposition stand ready and willing to help the Government to build the NHS dental services this country needs and, when the time comes under the next Labour Government, to make those NHS dental services the best they can be.

Oral Answers

Andrew Gwynne Excerpts

Tuesday 25th April 2023 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Secretary of State is absolutely right: we should be narrowing the health inequalities in this country. It is just a shame that, on his watch, we are not. A baby born in Blackpool today will live eight years less than a baby born in Kensington. Under this Tory Government, health inequalities have widened in many parts of the country. They have scrapped their health disparities strategy and cut the number of health visitors by a third, and ordinary families are paying the price. Why does the Secretary of State not get a grip, adopt Labour’s plan to scrap the non-dom tax status and train 5,000 new health visitors, so that every child has a healthy start to life?

Medical Technology Regulations and the NHS

Andrew Gwynne Excerpts

Tuesday 28th March 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure, as always, to serve under your chairmanship, Sir Gary, especially now that this radiator down at my ankles is working. It is also a pleasure to contribute on behalf of the Labour Front Bench in this important debate.

I commend the way in which the hon. Member for Gosport (Dame Caroline Dinenage) presented the case for medical technology. She is absolutely right, because whether it is diagnostic or surgical devices or the digital tools that assist us in making healthcare more accessible, medical technology underpins much of the work that the NHS does. It is also, as has been highlighted in this debate, a key contributor to the UK economy. Medtech generates an annual turnover of over £27 billion and provides around 138,000 jobs. The importance of supporting and, indeed, turbocharging this sector cannot be overstated.

Labour has been clear that it wants to see Britain leading medical science and technology on the world stage. That ambition will be at the heart of our 10-year plan for change and modernisation, which will revolutionise care in this country, transforming our healthcare system from one that just treats the symptoms of illness to one that addresses the root cause of ill health. Imagine a country where we could get out into communities and harness new technology to spot cancer cases early or support individuals at potential risk of developing rare diseases—a country where, using genomics, we do not just treat illnesses such as cancer, diabetes and heart disease, but predict and prevent those conditions.

All that might sound a little far-fetched or sci-fi, but the technology to do it exists in British laboratories and research centres today, and it is ready and waiting to be realised fully. It is therefore extremely welcome that the Government have finally published their medical technology strategy. That is an important step in better utilising this sector, but it must be followed up by concrete action. Crucially, it must come alongside targeted work to reduce waiting times and the elective care backlog. I note that the strategy states that medtech will help the NHS to use

“fewer resources…through informing effective healthcare purchasing, championing sustainability, embracing innovative technology and improving health data”.

I do not disagree. We must maximise the use of medtech across the NHS. It is not a party political point; it is a common sense one for the future.

For medtech to realise its full potential, we need staff—an area on which the Government have had little to say. I am hoping that something will come in the weeks ahead. In fact, the Government have the opportunity to nick Labour’s workforce strategy; they did not do it in the spring Budget, but I am sure the Minister is on the case.

Put simply, there is no one silver bullet to solve the crisis in our NHS—we need a whole-system approach—but medtech has a massive role to play in the future. What does a whole-system approach mean? It means giving the NHS the tools, staff and reform it needs to survive. Without all three, we will not be able to rebuild our health system, which is sadly under enormous pressure right now.

With regard to the strategy, I would appreciate some clarity on a few points from the Minister in his response. The first relates to the adoption routes for new technologies. The Health Tech Alliance estimates that it takes approximately 17 years for a device to be adopted into the NHS. The Government strategy mentions adoption rates, but it is relatively light on detail. If new technology is safe and effective, we should be doing everything we can to get it into the hands of NHS clinicians. What further work is he planning to undertake in that respect, and will he provide more detail on how he plans to improve technology adoption rates?

I will touch on regulatory requirements, which the hon. Member for Gosport mentioned, and the speed with which we get new treatments to patients. Last year, we had an agonising to and fro over the pre-exposure prophylaxis Evusheld. The drug was designed to protect those who are acutely vulnerable to covid-19 and still shielding, but the process for approving it for use in the NHS took far too long. By the time the drug had been fully reviewed, it no longer responded as effectively to covid variants, and it was therefore not recommended for use.

NICE recognised that fact in recently published guidance, and it has committed to developing a new review process to streamline approval for covid-19 treatments. Has the Minister had any discussions with NICE on the timeline of that process, and what action is he taking to ensure that future safe and effective treatments and technologies do not face similar regulatory delays? Similarly, with unwelcome reports that the antivirals taskforce is being wound up at the end of this week, what steps is he taking to ensure that suitable provision of those essential treatments continues?

Finally, I will press the Minister on small and medium-sized enterprises. A recent study found that up to 24% of UK-based health tech SMEs are now looking to launch their innovations outside the United Kingdom. That would be a travesty, and I am sure it concerns him as much as it concerns me, the hon. Member for Gosport and the SNP spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day). The UK should be empowering home-grown tech, not missing out on it because of neglect and miscommunication. Despite the problem, the medical technology strategy made little reference to SMEs, aside from saying that the Government would support improved management of SMEs and upskilling of workers. That is just not good enough for companies that make up 85% of the medtech sector.

What more is the Minister doing to ensure that SMEs are sufficiently supported to launch their innovative new products here in the United Kingdom? I appreciate that he will be required to work across Departments to ensure that this growing sector, which has so much potential to grow further, is as supported as we would expect. What more can be done to streamline the regulatory processes that many SMEs are grappling with?

To close, we need to ensure that Governments of whatever political colours are not too slow to harness the medical technology sector. If we are, ultimately it is patients—the people we are sent here to represent as Members of Parliament—who pay the price. We need to build an NHS that is fit for the future, where patients are seen on time and technology is employed to tackle ill health and inequalities. That is something that I and the Labour party support, and I suspect the Government will say they support it too. Let us just get on with it.

Draft Health Education England (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Andrew Gwynne Excerpts

Monday 20th March 2023 General Committees

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward, and to represent the shadow Health and Social Care team. As has already been noted, the draft statutory instrument facilitates the merger of the body responsible for the education and training of the health workforce —Health Education England—with NHS England. We agree that it is a sensible move. With a wry smile, I conclude that it is yet another of the bureaucratic reforms introduced by Lord Lansley that are now being unpicked by this Government, although it is a sensible choice.

The Government have rightly stated that the purpose of the integration is to improve long-term workforce planning and strategy for healthcare staff recruitment within the NHS. Labour is committed to long-term workforce planning for the NHS and for social care, which would necessitate independent workforce projections. The fact that the NHS has not had a workforce plan since 2003 is staggering. We want the Government to get on and deliver a plan. Our plan or their plan—a plan—would be great. For that reason, we will not oppose these measures.

I wish, however, to raise a couple of points on which I would appreciate some clarity from the Minister. When we debated the merger of NHS Digital and NHS England in January, I made the point to the Minister that we must ensure that talent and expertise are retained. I do so again today. Given that we are looking at an estimated 40% cut in workforce numbers, we need to ensure that NHS England still has the staffing resources it needs to function adequately in this sphere. Will the Minister provide an update on how that work is progressing? What assurances can he give to Members that staff are being treated fairly throughout the process? Can he also set out what specific service improvements he anticipates as a consequence of the merger, and what metrics will his Department use to judge NHS England’s performance within its new remit?

It was recently reported that a £100 million redundancy budget has been set for the mergers, alongside a £13 million contract to PA Consulting to oversee the merger. I do not quote those sums to put the Minister on the spot, but instead to reinforce that public money is being spent, so we need to ensure that we see positive results at the end of the process. That is something we want to see, which is why I ask about it in the spirit of co-operation.

Finally, given that the merger will, according to the Government, put healthcare staff recruitment and retention at the forefront of the national NHS agenda, can the Minister outline when the NHS workforce plan will be published? He gave an indication to his right hon. Friend the Member for Chipping Barnet that it would be soon. I am a little more impatient than that, given that we have not had one since 2003. Also, what will NHS England’s role be within that workforce plan when we get it?

The Opposition will not oppose these very sensible regulations.

Car Parking: Care Workers

Andrew Gwynne Excerpts

Thursday 16th March 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure as always to serve under your chairmanship, Sir Robert, and to speak on behalf of the shadow Health and Social Care team. I thank the hon. Member for Southport (Damien Moore) for securing this important debate and for all the work he has done to raise awareness and champion the cause, which I do not think anybody can have any issue with. I very much support it—let us get it over the line.

We have had a small but perfectly formed debate today. As well as thanking the hon. Member for Southport for securing the debate from the Backbench Business Committee, I also thank the hon. Member for Strangford (Jim Shannon) for always giving the Northern Ireland perspective in these debates. It is really important that we learn from different parts of the United Kingdom, because no one home nation has the right answer to all these things. It is good to learn from one another and have the perspective from other parts of the United Kingdom as we deliberate on what we should be doing here in England to support our care workers.

I thank my hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) for her contribution. She is absolutely right about how we need to come together across party lines and support care workers. Parking is a big issue and a pressure on those who work in our health and care system. I also place on the record my thanks to care workers, because they do an extraordinary job, as has been highlighted throughout the debate. We should never take their efforts for granted, because they are the linchpin in ensuring that the most vulnerable people in society are cared for and looked after in their time of need.

I am not making a party political point, but we know that the care sector is in crisis. It is under enormous stress and strain; the demand far outstrips the ability for us to meet many expectations. Primarily, a recruitment and retention issue in the workforce is at the heart of that. As a consequence of those pressures, many staff feel undervalued, overworked and underpaid, and it is our duty as parliamentarians to try to resolve those issues. We will support the Government on the measures they introduce; we have our own ideas as well, which the next Labour Government can hopefully introduce, but while the current Government are in office we will work with them to try to resolve these issues.

Problems such as parking charges put additional financial pressure on carers already going above and beyond and compound the stress that many of those people are under. That is demonstrated by the difficulty in retaining domiciliary care staff. As Nuffield Health points out, more than one in three domiciliary care workers left their roles last year, and many opted to work in sectors that offer better working conditions and pay.

Two issues are at play here. There is, of course, the specific issue of car parking changes, but that speaks to the question of how we treat our social care staff in general. Some good points have been made, mainly by the hon. Member for Southport in opening the debate, about free parking for domiciliary care workers—what the charity Engage Britain refers to as a green badge scheme for care workers. As the charity points out, several local authorities already operate a similar scheme, but a bit of a postcode lottery in provision seems to be developing. At the heart of the issue are care workers who are just trying to do their job.

I want some clarity from the Minister on a few questions. First, have the Government considered the green badge proposal? There is a huge problem here. It cannot be right that care workers are effectively being priced out of doing an essential job. They are desperately trying to care for vulnerable individuals, rushing between houses and having to worry about whether they will be able to afford the parking. I am not comfortable with that being a calculation that care workers have to make in 21st century Britain, and I sincerely hope and expect that the Minister feels the same. Will the Minister set out whether the Government are in conversation with care leaders and staff on what support can be offered?

Secondly, in the absence of a national free parking scheme, what steps is the Minister taking to engage with care agencies to incentivise companies to pay their staff back for the money that they have to spend on parking? It is not right that staff can accrue personal costs in the day-to-day administration of their employment and not be fairly recompensed by their employer. There needs to be a clear message from the Government that that is not an acceptable business practice.

Engage Britain provided my office with a good quote from a care support worker on a zero-hour contract, who said that with free parking,

“social care workers will be able to make appointments on time, with less stress, less rushing around”

and would be able to

“provide more attention and better support to the vulnerable people we are visiting”.

That quote raises an important point. Has there been any assessment of the impact that parking charges are having on quality of care? If care workers are scrambling around trying to find a parking place, there is a risk that they are unable to do their work to the standard that they want. Indeed, it has been brought up in the debate that, in an emergency in which a care worker has to stay with a very ill person until a blue-light response can arrive, the worker may incur not just additional parking costs but, potentially, fixed penalty notices and fines. That is totally unsustainable. It is little wonder that the care sector is asking for the Government sincerely to look again at this measure and provide more support.

That all speaks to a point that I made at the beginning of my contribution: social care staff feel that they have been neglected for many years and that they have been a bit of a Cinderella in the health and care system. We desperately need staff to feel more love from Government and to be better paid and supported in their careers. Vacancy rates are at a record level—up by 50% in the last year alone—and we now have a record 165,000 vacancies in the sector. That is totally unsustainable and we cannot just sit on our hands and wait for the system to collapse.

Labour has committed to a new deal for care workers, which would focus on recruiting and retaining the staff we need by ensuring fair pay and terms and conditions, and by improving training and career progression. We would change the remit of the Low Pay Commission, so that, alongside median wages and economic conditions, the minimum wage would reflect the cost of living. That would have a transformative effect across all sectors, but particularly on social care, where problems are especially acute. We would also ensure that new contracts for care are given to ethical providers—to providers who will provide fair pay, fair conditions and training for staff. Parking may well be part of that equation, in the terms and conditions, or through the reimbursement of costs incurred by agency staff.

The Chancellor could have used his Budget yesterday to announce a long-term workforce plan for the NHS and to reform pay for social care. He did not, even though we offered him Labour’s plan—we would have been very happy for him to pinch it. Instead, he handed a tax cut to the very wealthiest. That says all we need to know about the priorities of this Government. The next Labour Government will improve and invest in social care. At the very heart of that ambition will be ensuring that our incredible social care staff receive the pay and terms and conditions that they so deserve.

On the issue before us today, I implore the Minister to do the right thing. As the hon. Member for Southport so eloquently set out in his opening speech, this would be a small improvement, but a game changer for so many hard-pressed, social care staff. I urge the Minister to do the right thing.

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Sir Robert. I congratulate my hon. Friend the Member for Southport (Damien Moore) on securing this debate on free parking passes for care workers. I know it is an issue close to his heart and I commend him on his speech.

Improving adult social care and supporting care workers is one of my highest priorities, and I am delighted that my hon. Friend shares my enthusiasm, particularly for supporting domiciliary care workers. In his compelling speech, he spoke about the difficult job they do and the skills necessary for their work, as well as some of the practicalities of the job, such as the many short journeys that some care workers will be making and the challenges that result, including parking. He also spoke about the vacancy rate in social care, particularly in domiciliary care.

Recruiting and retaining staff is a particular challenge for many care providers, especially following the reopening of the economy after the pandemic. Many people had come from the hospitality or travel sectors to work in social care during the pandemic, which was hugely helpful in those difficult times, but many then often returned to those sectors. Not all did; some had found their vocation in social care, and that has been wonderful, but others, understandably, returned to their previous sector, making it harder for the social care sector to retain and recruit staff as the economy opened up. I am hearing some positive news about recruitment at the moment, but that does not mean that it is easy. It remains a real challenge, particularly with domiciliary care and in rural areas.

As my hon. Friend also said, we are seeing a growing demand for social care, as people live longer—that is a positive for us all to remember, but it does mean more people living with health conditions, and more frail and elderly people, who need people to come in and care for them. The hon. Member for Strangford (Jim Shannon) talked about the importance of living independently. We want people to be able to live longer in their own homes. There is a time when it is better for people to live in residential care—that can be the right thing for some people—but most of us want to stay living in our own home behind our own front door for as long as possible. Domiciliary care workers, who go to someone’s home, are absolutely crucial.

My hon. Friend for Southport referred to our 10-year vision for social care, which I am truly passionate about. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), talked about the challenges that social care faces. Those challenges have been around for many decades, so we are not going to fix this overnight. I share the impatience of my hon. Friend the Member for Southport. That is one reason why I try to do things in the here and now. However, I am also realistic, and some social care reforms that we want to do will take time, hence that long-term vision.

My hon. Friend spoke very specifically about the cost of parking and rightly about the stress of looking for a parking space when the clock is ticking. He also spoke about unexpected situations, such as when care workers need to stay longer and call an ambulance. The hon. Member for Erith and Thamesmead (Abena Oppong-Asare) also spoke about that in her intervention.

I heard that my hon. Friend the Member for Southport called on his local council to fix that in his area during the pandemic. He welcomed our free parking scheme during the pandemic, so I am glad that he saw it taking good effect. That was one of many things that we tried to do to help key workers through that difficult time. That ended, and I absolutely hear his argument for a new national scheme, particularly to help care workers with parking while they are on duty.

I thank the hon. Member for Strangford. It is a pleasure to be in Westminster Hall with him at any time in the week, but particularly on a Thursday; we do this not infrequently. He spoke powerfully, if I understood him correctly; sometimes I do not pick up every word he says. He spoke about his brother, Keith. He said that, following a brain injury, Keith might well have lived in a care home, but has in fact been able to live independently with the support of family, including his mother and the hon. Member, but of course with care workers visiting. He brings a very personal perspective on the important role of care workers in our communities.

The hon. Gentleman also spoke about us working across the parts of the United Kingdom. I am always happy to talk to colleagues in other parts of the Union, because I think we can all learn from each other to try to get the best for our constituents.

Taking a step back, I want to say that I am incredibly grateful to all health and care staff. I recognise the extraordinary commitment and hard work, particularly of our care workers and domiciliary care workers, who are less frequently spoken about in Parliament. I want to ensure that care workers gain the recognition they deserve from society. I truly thank them for all the vital work they do every single day, whether in care homes, people’s homes or beyond.

Many people want to work in care because they want to make a difference to the lives of others. In my conversations with care workers, many have told me that they find their work truly rewarding. Just a few weeks ago, I had a wonderful conversation with a home care worker, who told me that she loves her job. That is great to hear, but there is no denying that it can be a very demanding job, both physically and emotionally. Domiciliary care workers play a crucial role in providing care and support to people who need it within their own home, enabling them to continue living independently even when they have substantial care needs. From going on the rounds with care workers and speaking to them, I know how committed and passionate they are about what they do.

Turning specifically to parking, I heard the points made by my hon. Friend the Member for Southport on free parking for care workers, and I am sympathetic to them. I have had many conversations with those who provide care in people’s homes about some of the challenges they face, including travel and parking costs. For instance, I share the concerns about underpayment for travel times, which is a live issue within the sector.

All social care workers are entitled to be paid at least the minimum wage—I should say, the national living wage—for the work they do. The Government are clear that time spent caring for clients, travelling between appointments and waiting to start the appointment must be included in pay calculations. I labour that point because I hear accounts, usually anecdotal, of whether travel and waiting time is being paid for. It may not be within the care worker’s control if they turn up for an appointment when, for instance, another health worker is visiting somebody and they have to wait. If they are having to wait as part of their job, of course they should be paid for that working time.

Responsibility for setting the terms and conditions for parking permit schemes and delivering social care is devolved to local authorities. Some local authorities, such as Cornwall and Devon, already run health and care parking permit schemes. I am glad to be talking about this important issue today and it is right that, at the very least, the national Government support the sector by raising awareness of and driving forward innovation and best practice. I therefore encourage local authorities who are not already undertaking similar projects to look and learn from those areas that have implemented their own parking schemes, especially as we know about the recruitment and retention challenges in adult social care. I also commit to working with my colleagues across Government, in particular in the Department for Transport and the Department for Levelling Up, Housing and Communities, to consider what more can be done to help care workers with the cost of parking.

More broadly on the adult social care workforce, the Government recognise the current workforce challenges in social care.

[Andrew Gwynne]

I want to take the Minister back to where she rightly said that terms and conditions are matter between the employer and the employee. She was, rightly, very robust on the expectations of the national living wage being paid for waiting to do work. Does she also take a strong view that employers should reimburse their staff for any incurred parking costs?

[Helen Whately]

The hon. Gentleman will allow me to pause, because I do not want to find that I have unintentionally misled anybody. I am very happy to write to him on that specific question. What I am completely happy to do here and now is reiterate the importance of social care workers being appropriately paid for the work they do. At the very least they should be paid at the legal level to which they are entitled and reimbursed for the expenses of the job they do. I hope the hon. Gentleman is happy with that response.

As I said, we recognise the recruitment and retention challenges in the social care workforce. The Government are supporting local authorities and providers with the recruitment, from both home and abroad, and retention of workers. For instance, we have been running a national recruitment campaign with continuous activity across job boards, video on demand, digital audio, radio and social media to encourage people to come and work in social care. That campaign will run until the end of this month.

In addition, in February last year we made care workers eligible for the health and care visa, and added them to shortage occupation list. The latest data published by the Home Office shows that a total of 56,900 visas were granted for care workers and senior care workers in 2022. I do not suggest for a moment that international recruitment is the whole answer to our recruitment challenges in social care, but given that we have such a substantial need for care workers, it is really important to help boost our care workforce. I have heard from many care providers who really welcome it, as it helps them to recruit and fill vacancies, and bring valuable staff into our workforce.

More broadly, the Government are making available up to £7.5 billion over the next two years to support adult social care and discharge, with up to £2.8 billion available this coming financial year and £4.7 billion the following year. That is an historic funding boost to put the adult social care system on a stronger financial footing and help local authorities to address waiting lists, low fee rates and workforce pressures in the sector.

Another way councils are able to support their adult social care workforce is through the market sustainability and improvement fund. At the autumn statement, the Chancellor announced that £400 million of new ringfenced funding would be made available for adult social care in the next financial year. We have combined that with £162 million of fair cost of care funding to create the fund. We are allowing councils to use the new funding flexibly on three target areas: support for the workforce measures; increasing fee rates paid to providers; and improving social care waiting times, which will improve adult social care market capacity and sustainability. My hon. Friend the Member for Southport might be pleased to know that Sefton Council will receive £3.6 million through that fund. Many local areas have chosen to use a significant proportion of the adult social care discharge fund on measures that support the adult social care workforce, including those who work in home care.

The hon. Member for Denton and Reddish talked about the importance of commissioning—I think he referred to ethical commissioning. I assure him that I think how local authorities commission care is really important, because it influences the terms and conditions on which care providers employ their workforce. That is one reason why, in April—just a couple of weeks away—we are starting the Care Quality Commission assurance of local authority social care provision. That will increase oversight of how local authorities are implementing the Care Act 2014, and part of that is very much about how they commission care. It will enable us to identify local authorities that are doing a really good job and will give us more information about those whose commissioning does not support their market or leads to some of the practices that we have been talking about.

As I said at the beginning, we want quick answers. My hon. Friend the Member for Southport wants change here and now, and so do I, but we also have to look to the longer term for our social care reforms. People at the heart of care must set out a longer-term vision for social care. I will shortly be publishing a plan setting out our next steps for the reforms. It will include substantial reforms to the adult social care workforce to strengthen careers and opportunities, and make adult social care a better sector to work in. That will help attract more people to work in social care and retain those valuable staff members.

I thank my hon. Friend for making the case and other Members for showing support for domiciliary care workers. I share my hon. Friend’s aspiration to support his care workers. In fact, I believe I have shown that in practice—for instance, through the support I put in place during the pandemic for the social care workforce; things I am doing right now with the funds such as the market sustainability and fair cost of care fund; and things that I will do in the future, including with our adult social care reform. I am happy to consider his proposals further as part of the work I am doing to boost our support for the care workers our constituents depend on.

National No Smoking Day

Andrew Gwynne Excerpts

Thursday 9th March 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Efford, and to speak on behalf of the shadow Health and Social Care team. I congratulate the hon. Member for Harrow East (Bob Blackman), not just on securing the debate and on his opening speech, but for all the work that he has done over a long period of time on the issue. We know from his contribution today what drove him to champion the cause of smoke-free England 2030, and we thank him for the work that he has done. This is not a party political issue; it is something on which we all want action.

We also had good contributions from my hon. Friends the Members for North Tyneside (Mary Glindon), for York Central (Rachael Maskell), for Blaydon (Liz Twist) and for City of Durham (Mary Kelly Foy), and from the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), who leads on the issue for the SNP, and helpful interventions from my hon. Friend the Member for Ealing, Southall (Mr Sharma).

The first No Smoking Day took place in 1984. Back then, 35% of people smoked. In the almost 40 years since then, we have made great strides in tackling smoking prevalence. We now have a smoking rate of around 13%. We have seen a clampdown on tobacco advertisements, an increase in public awareness of the dangers of cigarettes, and, most notably, Labour’s ban on indoor smoking, which led to a truly transformative impact on public health.

Do not get me wrong—smoking prevalence is still too high, and incredibly so in some of the poorest communities in England—but it is undeniably heartening to see the progress that has been made in the last four decades. The progress is primarily thanks to the tireless work of public health researchers and campaigners, who sounded the alarm about the dangers of smoking, and who continue to put much-needed pressure on policy makers for further action.

I do not say that to give us all a pat on the back, but to highlight how political will can make a real difference. We need that political will now more than ever. This Government have committed to a smoke-free England by 2030—an ambition that is supported across the House. However, we are on track to miss the target by around nine years, which is frankly unacceptable. The Government should not commit to a target because it is politically expedient, but then never deliver it. We need to see smoke-free 2030. Why? Because every year, the evidence of the damage of smoking continues to pile up. Smoking causes around 75,000 deaths every year in the UK alone. It harms pretty much every organ in the body. As the research to mark this year’s debate demonstrates, it is strongly linked to dementia, too. In addition to the tragic human cost, smoking also costs the economy around £20 billion in lost productivity, ill health and NHS resources. The facts are overwhelming, and we must act.

I am sure the Minister will agree on all those points, and I would like to raise a few matters on which I hope we can get some clarity. The first has already been mentioned to my hon. Friends—the tobacco control plan, which seems to have disappeared into the ether. Can the Minister confirm that he still intends to publish the tobacco control plan, and when it will be released? The hon. Member for Harrow East was very forceful on this point. If, as I fear, it is being held back because the Prime Minister is scared of upsetting some on his Back Benches, the Minister should front up and admit it.

The last tobacco control plan was published almost six years ago, and it has now expired. We are left in the bizarre situation where the Government continue to insist they are committed to smoke-free 2030, but they have no plan for how they intend to get there. The Minister is driving us to a destination, but he forgot to bring the map.

In addition to providing a date for the next tobacco control plan, will the Minister provide a date for when he expects to respond in full to Javed Khan’s smoke-free review, which his Department commissioned and seems to have forgotten? Secondly, given the extremely concerning figures from ASH that show just 18% of smokers know that smoking can cause dementia, will the Minister advise Members on what action the Government will take to increase awareness of that risk? Concerns have rightly been raised by public health charities about the fact that media spending on stop smoking campaigns has declined by 95% since 2008-09. Will the Minister confirm how much his Department has earmarked for spending on TV ads for Stoptober this coming October, and if he has assessed how current media campaigns are performing in raising public awareness?

Finally, it would be remiss of me not to mention the public health grant, which has still not been released to local authorities in England. I asked the Minister about this at Health questions on Tuesday and was told the grant was coming in days, not weeks. I am not sure what that means, because we are two days on and there is still no sign of it. Any additional information the Minister can give would be greatly appreciated, not least because this grant is essential to smoking cessation services in communities across the country, including communities I represent in Greater Manchester.

It is time to get serious about tackling smoking prevalence. The last Labour Government took decisive steps to improve public health, and we would do so again. That is why the next Labour Government will consult on all Javed Khan’s smoke-free 2030 recommendations and put prevention at the heart of everything they do. Our NHS is at breaking point. Seven million people are on waiting lists. Solving that challenge obviously requires an expansion of the NHS workforce, which Labour is proud to have committed to, but unless we simultaneously tackle the root causes of why people get ill, we do not stand a chance of rebuilding our NHS and making it fit for the future.

Labour stands ready and waiting to build a healthier, happier and more prosperous England. Until then, the Minister has my assurances that whatever support the Government need to get back on track for their smoke-free 2030 target in England, Labour will provide. He need not rely on the votes of those in his party who do not necessarily understand the importance of public health. Tackling smoking is not partisan. It is in all of our interests to work towards a smoke-free 2030, so my message to the Minister is clear: we will support him, and let’s get on with it.