NHS Dentistry

Andrew Murrison Excerpts

Thursday 20th October 2022 Commons Chamber

[Peter Aldous (Waveney) (Con)]

I beg to move,

That this House is concerned by the growing crisis in NHS dentistry; notes that nine out of ten dental practices in England do not accept new NHS patients; regrets the number of dentists moving away from NHS practice; welcomes the Government’s commitment to levelling up health outcomes and dental health across the country; calls on the Government to take urgent steps to improve retention of NHS dentists and dental accessibility for patients; and further calls on the Government to report to the House on its progress on the steps it has taken to address the NHS dentistry crisis in three months’ time.

I thank the Backbench Business Committee for granting this debate, and the hon. Member for Bradford South (Judith Cummins) for her work in helping to secure it. I also highlight e-petition 564154, signed by 11,067 people, calling for an independent review of the NHS dental contract.

Colleagues have been securing debates on the state of NHS dentistry for the past two years. This crisis has been brewing for a long time, and the situation can be likened to that of a house built on shallow and poor foundations that has come crashing down with the earthquake of covid. The King’s Fund describes NHS dentistry as being on “life support”, while the British Dental Association describes it as undergoing a “slow death”. In its monthly report for October, Healthwatch repeats that NHS dental care continues to be one of the main issues it hears about from the public, who across the country are clamouring for NHS dentistry that is both affordable and accessible.

In Suffolk, there are 70 dental practices with NHS contracts, but not one is taking on new patients. Locally, there has been some welcome support in that, in Lowestoft, a local practice was granted additional units of dental activity that allowed it to see emergency patients until the end of September, and in July the Dental Design Studio was awarded a contract to deliver NHS dentistry for up to eight years. However, very quickly both practices were fully booked up and have had to turn away patients. There is a need for root and branch reform, and I shall briefly set out the issues that need to be included in a blueprint plan for NHS dentistry.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my hon. Friend on securing this debate. Would he agree with me that the fundamental problem with NHS dentistry at the moment is the 2006 contract and the units of dental activity? Does he share my disappointment at the statement made in the summer about how to resolve the situation based on the consultation launched last year, and furthermore, does he hope that UDAs will be expunged from all of this so that dentists can be properly rewarded for the job they do and thus return to the NHS?

[Peter Aldous]

I thank my right hon. Friend for that intervention, and I agree wholeheartedly with him on that point. I will come on to it as I set out what I believe needs to be done to improve the situation, but I think he and I are very much on the same page on that issue.

First, I will address the issue of funding. There is a need to secure a long-term funding stream. In recent years, the NHS dental budget has not kept up with inflation and population growth. Since 2008, NHS dentistry has faced cuts with no parallel elsewhere in the NHS, and the British Dental Association states that it will take £880 million per annum to restore the service to 2010 levels. I acknowledge the budgetary challenges that the Chancellor faces, but the reform process is doomed from the start without an appropriate level of investment. There is a need for a protected budget, and any funding that is clawed back must be kept in dentistry.

Secondly, a strategic approach should be adopted towards recruitment and retention, with a detailed workforce plan being put in place.

Access to GP Services and NHS Dentistry

Andrew Murrison Excerpts

Tuesday 21st June 2022 Commons Chamber

[Sajid Javid]

My hon. Friend is campaigning passionately for primary care services in his constituency, and he points to some fantastic practices. I congratulate all the people involved in delivering that and support him in his work with his local commissioners to make sure that they are getting even better local primary care.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Does my right hon. Friend recognise that the crisis in NHS dentistry, which affects my constituency as it does his, well predates the pandemic, and indeed goes back to at least 2006 when the then Labour Government changed the way in which dentists are paid? Will he undertake to look at the units of dental activity system, which disincentivises dentists from providing dental work particularly in the most disadvantaged communities?

[Sajid Javid]

My right hon. Friend is absolutely right in his analysis, and I can give that undertaking. I will say a bit more about that in a moment.

If the hon. Member for Ilford North wants to talk about funding for the NHS, I am happy to oblige. Under the last NHS long-term plan, before the pandemic, we made a historic commitment of an extra £34 billion a year. Because of the pandemic, we then necessarily put in £92 billion of extra funding. At the last spending review, we increased funding still further so that the NHS budget will reach £162.6 billion by 2024-25, supported in part by the new health and social care levy.

We have made sure the NHS has the right level of resourcing to face the future with confidence, but we must also be alive to the consequences. The British people expect every pound spent to be spent well, and they expect us to be honest with them that every extra pound the hon. Gentleman calls for will be a pound less spent on education, infrastructure, housing and perhaps defence. I believe in a fair deal for the British people, and especially for our young people. We will be making plenty of changes alongside this funding.

Health and Social Care Leadership Review

Andrew Murrison Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

The place-based working that the hon. Gentleman talks about is also at the heart of the integration White Paper that the Government presented recently.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I welcome Gordon Messenger’s review, but does the Secretary of State not agree that in the history of the national health service, reorganising senior management has often been a distraction? Will he prioritise the area that would make a real change to health and care—the interface between the two—and focus on career progression and development for care workers in particular, who hold the key to unblocking the awful problems that we have in both sectors?

[Sajid Javid]

I know my right hon. Friend speaks with experience, and I appreciate that he will not have had time to look at the report in detail yet, but I think when he does read it he will find that it is precisely what he has just asked for. This is not a reorganisation; it is all about strengthening management, and the report sets out in quite some detail how that can work.

Integration White Paper

Andrew Murrison Excerpts

Wednesday 9th February 2022 Commons Chamber

[Edward Argar]

The hon. Lady will have seen yesterday the announcement and publication of our plan to tackle waiting lists caused by the covid pandemic, the investment that underpins that, the approach to the workforce and how we will bring those waiting lists down. This White Paper builds on that; they are complementary and work together. This is about looking to the future to improve how our systems work together, but we set out a clear and comprehensive plan yesterday to do exactly what she speaks of.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I declare my interest as a doctor. I wonder what the practical consequences of this will be. Can I suggest to my hon. Friend, whom I admire greatly, that one of those practical consequences might be to end the awful business of people waiting for weeks and weeks in acute hospital beds for discharge to more appropriate settings in the community? It does them no good, it is massively expensive to the system, and it prevents them moving on to places that can better care for them and give them what they need while allowing the acute sector to do what it can do, which is to manage people who are acutely unwell. At the moment we have 10,000 people in the system waiting for discharge. That will not do, and I would be interested to know from my hon. Friend how these proposals will help.

[Edward Argar]

I am grateful to my right hon. Friend in this respect. Discharge of people from hospital safely, either into a care home setting or back to their own home with support, is vital not only for their own health outcomes but for the flow of patients through our acute hospitals to enable A&Es and other parts of the system to function effectively. Through the national discharge taskforce and through the work we have done throughout the pandemic, we are bringing together acute hospitals and local authorities, and we have made huge strides together within localities in improving this and learning lessons. This White Paper sets out a way in which they can be embedded to ensure that they continue to deliver long-lasting benefits.

Elective Treatment

Andrew Murrison Excerpts

Tuesday 8th February 2022 Commons Chamber

[Sajid Javid]

I agree with the hon. Gentleman about the importance of the workforce, especially in the context of specialisms, and pathology is a really good example. That is why we are putting record amounts of investment into the workforce and training. It is also one of the reasons why, to get a more joined-up plan in health, I have decided that Health Education England should be merged with the NHS. This will enable more joined-up thinking and much better planning for the future, especially in specialist areas.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I declare my interest as a doctor. Will the Secretary of State look again at how we structure doctors’ pay and remuneration? At the moment, we are training lots of doctors—more and more of them—which is a great thing, but typically they leave in their late 50s, so we are losing a whole decade of productive medical time. That cannot go on. Will he look again to see how we can disincentivise early retirement of medical professionals?

[Sajid Javid]

My hon. Friend speaks with great experience and raises a really important issue. The short answer is yes. We have fantastic doctors throughout the NHS and more in training in medical schools than ever before, but we should also focus on retaining talent throughout the NHS. I assure him that that work has already begun.

Oral Answers to Questions

Andrew Murrison Excerpts

Tuesday 18th January 2022 Commons Chamber

[Edward Argar]

I think I heard the hon. Lady correctly and she asked when those discussions began. That was last year, prior to the peak of this wave. We believe that the use of the independent sector to assist our NHS and provide additional capacity is absolutely the right thing to do. Thus far, during the course of the pandemic, it has provided, I believe, over 5 million procedures to patients. Therefore, we think this is a valuable and important addition to our capacity, and it is right that we have this surge capacity insurance policy in place to help to meet further demand.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

10. What assessment he has made of the effectiveness of the covid-19 vaccination programme in reducing hospitalisations.

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

Vaccination continues to offer our best line of defence against hospitalisation due to covid-19. The latest data shows vaccine effectiveness against hospitalisation with the omicron variant was 58% after one dose and 64% up to 24 weeks after two doses. Vaccine effectiveness against hospitalisation was 92% in the first two to four weeks after a third dose or booster and 83% after 10 or more weeks. Those who are unvaccinated are eight times more likely to be hospitalised. That is why it is so important that everybody takes up the offer to get boosted.

[Dr Murrison]

I thank the Minister for that reply. The facts are that the vaccination programme has been massively successful in reducing hospitalisation, particularly admission to intensive therapy units. So will the Minister confirm that, on 26 January, particularly given what we now know about the nature of the covid variant that we are currently struggling with, those regulations will lapse? Will she further confirm that she will amend advice on working from home? Most importantly, will she ensure that we reverse the counterproductive compulsory vaccination of NHS staff that the Government’s own figures suggest—

[Mr Speaker]

Order. Come on, we cannot have questions that are so long.

Vaccination Strategy

Andrew Murrison Excerpts

Wednesday 12th January 2022 Commons Chamber

[Maggie Throup]

Misinformation costs lives. It is totally inappropriate, and there is no place for it in our society. As the hon. Lady rightly highlights, testing centres have also been attacked, which I am sure is under police investigation. I reassure her that we have a unit that considers such issues all the time, and numerous online presences are taken down on a regular basis. As she will imagine, various police investigations are under way.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

When the facts change, we are entitled to change our minds, and since we passed the regulated activity regulations in December we have had further evidence to suggest that the transmissibility of covid declines after 10 or 12 weeks, as has been mentioned. In light of that, has the Minister gone back to challenge the JCVI on its advice about whether we should compulsorily vaccinate health workers, particularly given that it now appears that the risk they pose to patients declines after a very short period, and especially given that we have the alternative of regular lateral flow testing, which will tell, more or less in real time, whether healthcare professionals pose a threat to their patients?

[Maggie Throup]

It is important to go back to some of the stats I set out earlier. Those who are unvaccinated are eight times more likely to be hospitalised, and more than 60% of people in intensive care units are unvaccinated. If we can stop people getting the virus in the first place, it will not be transmitted and people will not catch the disease and be hospitalised. It is important to note that it was the will of the House to introduce that policy in December. As I have said repeatedly, the JCVI keeps all the data under constant review, which obviously has an impact on Government policy.

Public Health

Andrew Murrison Excerpts

Tuesday 14th December 2021 Commons Chamber

[Sajid Javid]

I of course understand the importance of my right hon. Friend’s question; as he said, he asked it yesterday and, understandably, has asked it again today. I hope he will understand that I am not able to give that commitment alone; it would not be a decision for me and my Department alone, but I know the Government would consider it together seriously.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Might the Secretary of State consider going a little further? Since the data is changing all the time—almost by the minute—it is inconceivable that in a week’s time and a week after that we will be in the same place that we are in today. This House needs to consider the information available to it in near real time, so will he go away and consider whether it would be appropriate now to ensure that the House is able to consider these matters for sure next week and the week after that?

[Sajid Javid]

I will consider that. My right hon. Friend is right to point out that this is a fast-moving situation and it is right that the Government continue to monitor it and respond when necessary, but I hope my right hon. Friend will agree that right here and now the matter being debated and the regulation before the House is the best possible response that can be given by this Parliament today.

--- Later in debate ---

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I draw the House’s attention to my entry in the Register of Members’ Financial Interests: I am a doctor and vaccinator.

Statutory instruments Nos. 1400, 1415 and 1416 are without question relatively modest, certainly by comparison with the restrictions that currently apply in similar jurisdictions, and it is a very good thing that they will fall on 26 January. Nevertheless, I urge Ministers to think about the rapidity with which the evidence is changing. Currently, the evidence from South Africa is relatively positive: I am particularly impressed by the fact that mean hospitalisation in this particular wave is 2.8 days—it was previously eight days with the beta variant predominant in South Africa, whereas we have had delta, which is worse. From that, we can deduce, because it is the same population with the same demographic issues, that this variant is relatively mild. That has to be our working hypothesis, but we really do not know. We are struggling for evidence and the evidence appears to be evolving by the day. It seems to me unreasonable for the public to see their representatives leave this place for two weeks when they would expect us to be here to hold the Government to account on a real-time basis, which would require the House to sit next week and the following week, inconvenient though that may be for a lot of colleagues. I urge Ministers to give that some thought so that we could consider, for example, the advice on working from home that is currently having a significant impact on sectors of the economy.

SI No. 1415 is permissive, for which I congratulate the Government. I welcome it, and it should avoid another pingdemic. The advice about taking a lateral flow test for seven days is sensible, but only if, of course, lateral flow tests are available. I have heard that they are not available today in my constituency and hope that Ministers will attend to the issue as best they can.

I cannot get too excited about statutory instrument No. 1400, on face coverings. The best evidence published last month in The BMJ’s meta-analysis suggested that the wearing of masks had some effect on transmission, so it is the least we can do to wear the wretched things. The measure extends the list of venues that require people to wear a mask, but as we have all seen—those of us who use public transport and shops—the prevalence of mask wearing has increased in any event, thanks to the good sense and good will of the British people. We should encourage that at all times.

Statutory instrument No. 1416, on access to venues, starts to get a bit more sticky. The Secretary of State’s workmanlike recasting of vaccine certificates as an alternative to a negative lateral flow test yesterday was very helpful, but it was not helped terribly much by the remarks attributed to the chief medical officer earlier today that seemed to suggest that protection against transmission for vaccinated people is rather less than many of us had previously hoped. That did nothing to advance the case that the Government are trying to make, but I am more relaxed about that particular SI now.

I am slightly concerned about the SI on regulated activities. If a recent negative lateral flow test is okay under SI No. 1416 and, to an extent, SI No. 1415, why is it not okay for healthcare workers? With respect to my colleagues, the difference between the BCG and hepatitis B vaccines for those in the national health service who perform exposure-prone procedures and the situation we are discussing here is that there is an alternative to demonstrate that a healthcare worker poses no threat to their patients: a lateral flow test conducted very recently. It seems to me that, given the Regulatory Policy Committee’s damning assessment of the measure and the likelihood that as a result we will lose quite a few people in a health and care system that can scarcely afford to lose people, we need to look at alternatives to keep people in, not least because even the vaccinated will feel the pressure of some of their unvaccinated colleagues leaving. This could be something of a perfect storm in the winter months, and I hope Ministers will look again at whether we can have lateral flow testing—on a daily basis if we like, as I have had when I have been jabbing—as an alternative to insisting on vaccination.

I ask Ministers please to examine the issue of quarantine hotels and the requirement to bang people up. That is completely untenable, given the change in advice. I am surprised that Treasury lawyers have not already been advising Ministers that it is not appropriate, and I suspect there will be a wall of cases if those people are kept locked up when they should be released, in accordance with Ministers’ very welcome announcement today on the red list.

Covid-19 Update

Andrew Murrison Excerpts

Monday 13th December 2021 Commons Chamber

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I declare my interest as a vaccinator. I support the level of ambition that the Secretary of State has articulated, but does he distinguish between being offered a jab and actually getting a jab? Someone can be offered a hip replacement, but it does not mean they will get it any time soon.

[Sajid Javid]

First, I thank my right hon. Friend for being a vaccinator and for all the work he has done personally to help this country get through the pandemic. Of course there is a distinction—he is absolutely right. The NHS can offer an individual a jab—they might receive an email or a text saying, “Please come forward. Either book or walk in. You are eligible.”—but the individual has to come forward and take up that offer. That is why a huge amount of effort—even more effort than before—will go into persuading people to come forward.

Covid-19 Update

Andrew Murrison Excerpts

Wednesday 8th December 2021 Commons Chamber

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Our NHS is not being overwhelmed by covid, nor is it likely to be, but if the Health and Social Care Secretary really believes that it will come under pressure, what is he doing to ensure that novel antivirals, such as sotrovimab and molnupiravir, are freely available now to treat people, as we know that they will reduce hospitalisation and death by up to 80%?

[Sajid Javid]

We have secured, I believe, some 180,000 doses of new antivirals. There are two main antivirals that are specifically designed to work against covid-19. As I mentioned earlier in my statement, we are starting a national study that will help us to roll these out and make them targeted and effective. For those who are immunosuppressed and have a positive PCR test, we will be able to use them very shortly.