Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders

Andrew Selous Excerpts

Wednesday 22nd May 2024 Westminster Hall

[Peter Dowd (in the Chair)]

Before I call Andrew Selous to move the motion, I will give a little clarity. As is the convention for a 30-minute debate, there will not be an opportunity for the Member in charge of the debate to wind up, but we have a spare 10 minutes and the previous debate finished a bit early, so there will be a little more flexibility—but do not abuse that. A couple of Members want to intervene or speak, so there is some flexibility, at the discretion of the Member in charge and the Minister, to bear that in mind.

[Andrew Selous (South West Bedfordshire) (Con)]

I beg to move,

That this House has considered the Major Conditions Strategy and people with Ehlers-Danlos syndrome and hypermobility spectrum disorders.

I am delighted to serve under your chairmanship, Mr Dowd. I am extremely grateful to colleagues across the House who have turned up to attend this important debate. We understand that anywhere between 135,000 and up to 300,000 people in the United Kingdom have Ehlers-Danlos syndrome. Those are only the diagnosed ones, and we think that that is the tip of the iceberg. If we take that higher number, in rough terms, that is about 460 per constituency for all of us—that is only those with a known diagnosis.

I am grateful to Dr Emma Reinhold, who is herself a GP no longer able to work because she has EDS. She sent me this quote by Professor Rodney Grahame, who is well respected in the field:

“No other condition in the history of modern medicine has been neglected in such a way as Ehlers-Danlos syndrome.”

Ehlers-Danlos syndrome is a group of 13 genetic disorders in which connective tissue is abnormal. That results in fragile and hyperextensible tissues throughout the body, which can lead to a range of very debilitating symptoms. The effect on the body is widespread and not limited to one body system, as connective tissue is everywhere in our bodies. It is a complicated condition and can come with many comorbidities, which can include pain, gut issues, nutrition, cardiovascular autonomic dysfunction, postural tachycardia syndrome, low blood pressure, mast cell issues, musculoskeletal issues, and head and neck issues. Special considerations for children and women’s health, and anaesthetic and surgical considerations are issues as well. EDS can lead to physical disability and reduced quality of life. Some rarer types can be life-limiting. Hypermobility spectrum disorders have similar symptoms to the most common type of EDS, and are treated in the same way.

I am very grateful to Ehlers-Danlos Support UK; I publicly acknowledge the support it has given me for this debate. It supports people across the United Kingdom who live with Ehlers-Danlos syndrome and hypermobility spectrum disorders. It is a wonderful charity and has been a big driver behind the debate. It wants us to come here and make a difference, and that is my plea to the Minister.

[Mrs Pauline Latham (Mid Derbyshire) (Con)]

This is an important debate and many people, as my hon. Friend has said, do not know about Ehlers-Danlos syndrome or its diagnosis. Another complication, which he did not mention, is aortic dissection. People with Ehlers-Danlos syndrome can suffer from that and it can be deadly. One of my constituents has Ehlers-Danlos syndrome, but it took 30 years to diagnose. At one point, she was under 11 different consultant teams. Both her sons have the same symptoms, yet they cannot access diagnosis or service. Over those 30 years, there has been no improvement in our care. I hope that when the Minister responds, he will be able to give some hope to the people who suffer from this syndrome.

[Andrew Selous]

I am grateful to my hon. Friend, because it is these individual stories that really make the case. My hon. Friend’s constituents had to wait 30 years: that is a very long time indeed.

[Sarah Dyke (Somerton and Frome) (LD)]

A constituent of mine suffers from EDS. They make frequent trips to hospital, but every time they go they see a different consultant, who quite often treats the immediate medical emergency rather than taking a holistic approach and view of their condition. Does the hon. Member agree that people with EDS should be given a single point of contact—somebody who can review their condition as a whole, rather than just treating the individual symptom when it occurs?

[Andrew Selous]

The hon. Lady makes a sensible point. The four requests that Ehlers-Danlos Support UK wants me to put to the Minister are as follows. The first is a pathway for NHS diagnosis and care for hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders in England. Secondly, it wants National Institute for Health and Care Excellence guidelines for Ehlers-Danlos syndrome and hypermobility spectrum disorders. Thirdly, it wants a properly co-ordinated, multidisciplinary approach to diagnosis and care for people with these conditions and their associated comorbidities. Fourthly, it wants support and training for healthcare professionals to deliver this. Those are all reasonable and sensible demands.

To give more background about the condition and the work being done to bring about change, I will say a bit more about the symptoms, as many people are not aware of EDS. Whatever knowledge people have, it is undeniable that there is a widespread lack of awareness, and that is part of the challenge that people living with EDS face in accessing care and in dealing with their condition. Twelve types of EDS are rare and can be genetically tested, but—this is a really important point—there is no test for the most common type of EDS. That has led to multiple reports of people being disbelieved by healthcare professionals and by assessors for personal independence payments. In fact, recent research suggests that those with the condition can wait for up to 20 years for a diagnosis. My hon. Friend the Member for Mid Derbyshire (Mrs Latham) has just told us of her constituent who waited 30 years.

I am grateful to Danielle Humphreys, who researches in this area. She told me that quite a common response from doctors can be “Let me just check Google about this, as I’m not aware of the illness you are talking to me about,” or “Can you spell that?” I have some sympathy for doctors. Two of my children are junior doctors. They have a lot to learn in five or six years in medical school. They cannot know everything, but this is just not good enough. For each of us, the condition affects 500 or more of our constituents, so things need to change. I am pleased to put that on the record.

[Liz Twist (Blaydon) (Lab)]

Constituents have been in touch with me about this. A member of my staff has been in touch with me as well. They tell me just how difficult life is with EDS. As one person put it,

“these are horrendous afflictions to live with, and some people can work and live with it, but some can’t. Any Personal Independence Payments that are received are spent on transport to and from appointments, medications and private treatments just to make life bearable.”

Does the hon. Gentleman agree that we must do everything we can not only to improve standards of healthcare, but to make sure that the welfare system can continue to support them?

[Andrew Selous]

I agree with the hon. Lady, and I have experience of assisting constituents through the PIP process, which is tortuous for those with EDS so I am very grateful to her for putting that important point on the record.

The 13th type of EDS is not rare and cannot be tested for, which is really significant. Recent studies have shown that the diagnosed prevalence of the most common type can be as high as one in 227 people, although most are not diagnosed. Those with the most common type are twice as likely to use hospital services, and there is evidence that the cost of secondary care for them is an additional 29%. This places a significant burden on the NHS, so if we understood and could diagnose it earlier, we could take some of the strain off hospitals. That is another important reason why we must make progress.

[Richard Fuller (North East Bedfordshire) (Con)]

I thank my hon. Friend for giving voice in Parliament to those suffering from this disease. We have heard from a number of fellow MPs about their constituents. A constituent has contacted me to say that she, her mother and her children all suffer from this condition. She is so grateful that Parliament is finally taking some notice of it, and a daughter of a very close friend of mine is also affected.

The fact that this condition is not diagnosed early leaves parents scared—petrified about what is happening to their loved one and not knowing what the answer is. Does my hon. Friend agree, and perhaps the Minister will also talk about this, that progress in analysing health service data about certain conditions—so-called big data and AI—could play a role in assisting doctors? As my hon. Friend has said, doctors cannot learn everything during their training, so maybe technology can provide them with some assistance.

[Andrew Selous]

I am not surprised that my hon. Friend and county neighbour makes such an astute point. He is absolutely right about the power of technology to help the NHS get this right, and I am grateful to him for putting that on the record.

Ehlers-Danlos Support UK, a wonderful charity that we are so lucky to have, called on the Government last year to provide urgently needed NHS services for those with the most common type of EDS and HSD. Its petition secured 28,700 signatures in England, although I have to say that it was disappointed by the response from the Government:

“There are no plans for a national service for diagnosis or treatment of hEDS and HSD. Our plans for musculoskeletal conditions will be outlined in the major conditions strategy.”

The draft strategy stated that people will be supported in primary care and that

“GPs and expert physiotherapists…are being empowered to identify and diagnose hEDS and HSD through the use of validated approved clinical guidelines and toolkits.”

When the Minister responds, perhaps he will tell us a bit more about what “empowered” means in this context. The only toolkit for diagnosing and managing hypermobile EDS is the one created by Ehlers-Danlos Support UK. There are no validated and approved clinical guidelines or genetic tests to use to diagnose, and in the past EDS UK has always been told that physiotherapists cannot diagnose EDS or HSD.

We need to do better. We need a proper multidisciplinary approach to diagnosing and managing hEDS and HSD, for two reasons. First, hEDS is a common type of EDS —it is the most prevalent—and is therefore not covered by the rare diseases action plan. Secondly, it does not fit solely into the category of musculoskeletal conditions and accordingly will not be covered by the major conditions strategy.

Like virtually all hon. Members in the Chamber, I am grateful to my constituents, one of whom, Alex Akitici, is here with us this afternoon. She has been to see me a number of times, and when she came to my constituency advice surgery in January, I could tell that something was not right. The colour of her face was giving me cause for concern, and when she got up at the end of the meeting, she collapsed flat on the floor and fainted in front of me. That was just a small example of what this group of people, whom we are all here this afternoon trying to help, have to deal with.

This is not just a musculoskeletal condition, because musculoskeletal conditions do not necessarily cause people to faint, but that is what happened to my constituent Alex. She has had to pay privately for a diagnosis—not everyone can afford to do that—and for her treatment and care. She and her husband have had to spend money adapting their home to make it safe as her collapses are frequent and unanticipated, as I witnessed. She lives in constant pain and has had an issue with personal independence payments, which were raised by the hon. Member for Blaydon (Liz Twist).

My constituent’s experience is common. Many people with EDS are also fighting to stay in work, but due to delays in diagnosis and a lack of appropriate care, they end up in a position where they can no longer stay in work.

I want to mention some people with EDS who are constituents of MPs who cannot be here today. As Under-Secretary of State for Culture, Media and Sport, my right hon. Friend the Member for Pudsey (Stuart Andrew) is not allowed to speak in this debate, but he contacted me ahead of it to tell me about his constituent Fran Heley, who has a connective tissue disorder. She has had to spend thousands of pounds on private healthcare, and she walked from Leeds to Parliament to draw attention to the condition. She has also undertaken a coast-to-coast walk across the north to raise awareness of the condition. What a brave campaigning lady! I thank her.

My right hon. Friend the Member for Calder Valley (Craig Whittaker) asked me to give a shout-out to his constituent Karen Huntley from Healthwatch Calderdale and Huddersfield, who works tirelessly to highlight the need for a Government strategy. I thank Karen Huntley for what she does.

The hon. Member for North Shropshire (Helen Morgan) contacted me before the debate with details of her constituent who has just had a battle royal to deal with her condition and get appropriate care and recognition for it. And one of my constituents contacted me earlier this week and said:

“Both my daughters and grandson have the condition”,

but they did not realise until the older daughter was “quite old”. Other hon. Members have made exactly that point. So we can see that the condition is widespread across the UK and that the same issues come up time and again.

I want to draw the Minister’s attention to what is happening across the United Kingdom. In Wales, Members of the Senedd have resolved as follows:

“The National Clinical Lead for Musculoskeletal Conditions is working with EDS UK and Community Health Pathways to develop a nationally agreed pathway for hypermobility in children and adults. This will support healthcare professionals to have informed conversations with patients and to provide access to the right specialist teams.”

That is a major step forward. If it is good enough for the Welsh, it is good enough for the English.

I am told that in the Scottish Parliament there will be a roundtable debate at the end of this month, which, by the way, is Ehlers-Danlos Syndromes Awareness Month. In Scotland, they want to try to understand how they can improve diagnosis and care there. A recent study launched in Holyrood included a recommendation to develop a pathway and NICE guidelines—a request I made to the Minister earlier—with lived experience as evidence of the need.

I hope that the Minister will reassure us that he and his officials are looking around the world at best practice, the best research and the best care. I stumbled across the Ehlers-Danlos Society of the United States of America today. Lots of clinicians involved in that do a lot on research. I hope that we are up on what is happening globally, so that we do not miss out here. Departments needs to look internationally to get best practice in the United Kingdom.

On Ehlers-Danlos support, I mentioned the four points: the pathway for diagnosis; NICE guidelines; a co-ordinated multidisciplinary approach; and support and training for healthcare professionals. I ask the Minister to really push for that in the Department. I know that he is a good man and that he has to get that through NHS England, but, frankly, the time really has come to make progress. I would like a meeting, if possible, with him and Ehlers-Danlos Support UK, which does so much in this space, so that we can take the matter forward.

I am grateful to colleagues who have attended the debate. With your permission, Mr Dowd, I am happy for my hon. Friend the Member for Watford (Dean Russell) to speak briefly.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 5th March 2024 Commons Chamber

[Helen Whately]

I am grateful to international care workers who have come to the UK to look after loved ones. Their work has contributed to reducing vacancies and increasing the supply of social care, but we need to get the balance right between international recruitment and our homegrown workforce. We are carrying out ambitious reforms of our adult social care workforce, and therefore it is right, alongside that, to ensure that we have the right numbers of people coming here from overseas for social care. That is why we have worked with the Home Office on changes to visas.

[Andrew Selous (South West Bedfordshire) (Con)]

The managers of the wonderful care home I visited in Dunstable on Friday were annoyed by the number of job applicants for care places who were making the interview stage and then not arriving on the day. Can the Minister have a word with ministerial colleagues at the Department for Work and Pensions to ensure that job coaches are certain that jobseekers are not wasting the time of care homes? It is not fair, and those who work in care homes are busy people with a lot to do.

[Helen Whately]

I work closely with colleagues in the Department for Work and Pensions on the recruitment of people looking for jobs in social care, and I will raise that point with my colleague in the Department.

--- Later in debate ---

[Victoria Atkins]

Again, I thank the hon. Lady for sharing her experience, and of course we are doing all we can. I know that the SNP Scottish Government share our determination to ensure that cancer treatment continues to improve. England is diagnosing earlier and treating more. We have seen cancer survival rates improve by almost 10 percentage points since 2005, but we also know that four in 10 cancers could be prevented, which is exactly why we are bringing forward the smoke-free generation work. Of course, if the Scottish Government would like us to help with some of their waiting lists, we genuinely stand ready to do so.

[Andrew Selous (South West Bedfordshire) (Con)]

T3. The general practice estates and technology transformation fund supported projects in my constituency and was appreciated by my local integrated care board. What evaluation has been made of it, and will it be continued?

[Dame Andrea Leadsom]

I have had a number of meetings with my hon. Friend and know that he is determined to resolve some of these long-standing issues in his constituency. I have assured him that ICBs have the freedom to increase capital for primary care in their region, so long as their plans remain within their overall capital allocation. I will certainly be happy to meet him again to talk about what more measures we can take to support his constituents.

Tackling Obesity

Andrew Selous Excerpts

Tuesday 27th February 2024 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

I congratulate my right hon. Friend the Member for Bexleyheath and Crayford (Sir David Evennett), and I agree with pretty much everything that the hon. Member for Somerton and Frome (Sarah Dyke) has just said as well. In July 2020, the House of Lords produced an excellent Select Committee report, “Hungry for change: fixing the failures in food”, which is pretty shocking. We are one of the most overweight nations in Europe, and that is not an accident, because our diet is pretty appalling. Page 19 of that report says:

“In the UK, more than half (50.7%) of all total dietary energy from purchases came from highly processed foods, compared to only 10.2% in Portugal and 13.4% in Italy.”

Our diets are so much worse than those of our fellow European nations. We are bombarded with advertising for unhealthy food. In 2017, £300 million was spent on the advertising of less healthy foods, compared with only £16 million a day on fruit and vegetables. We are doing really badly at even getting our five portions of fruit and vegetables a day. Only 31% of adults, and only 8% of teenagers, are achieving that; parents in the room will recognise that challenge.

All these figures are worst for the poorest members of our society. I commend The Times on its excellent health commission report and on some of its recommendations. It thinks it is outrageous that some of these highly processed foods can have “natural” and “organic” on the front of the packaging. That is deceptive and misleading, and many of the big food producers have a lot to answer for. The Times says that all children should learn to cook properly and that those lessons should be inspected by Ofsted with as much rigour as maths and English. This matters. If people turn up to university able only to open a packet and put it in the microwave, they are probably not set for the most healthy life and it will probably cost them more as well.

Children are bombarded with these images. Bite Back, with which I have worked very closely, wants to get rid of the use of cartoon characters and other tactics that appeal to children, which hook our young people into unhealthy food. The Times also says that we should not have just environmental, social and governance for our businesses; it should be environmental, social, governance and health because employers can do their bit as well.

How do we know how many calories we are eating each day? I, as a man, am supposed to eat no more than 2,500 calories a day. For women, it is 2,000. How do we know? The signs in some of the restaurants are tiny. Let us make it easy for people to do the right thing. That is a generally quite a good strapline: make the right thing the easy and affordable thing to do. I salute my local markets in Leighton Buzzard, Dunstable and Houghton Regis, which provide fresh fruit and veg and often at very good prices; I have to say that my supermarkets do so as well. We all know that exercise is important, but I have a little caveat on that: you cannot outrun a bad diet, but exercise is always brilliant for all of us and we should all do more of it.

It was great to hear the speech from the Liberal Democrats because this is not a nanny state, entirely private matter. This is why: children don’t get to choose what they eat. They get fed what their parents give them; what we feed our children really matters. We have to be honest; there is limited supply in the NHS for all of us, so if other people eat really bad food, that means that NHS capacity is being taken up with dealing with type 2 diabetes, cancer, heart problems and other issues. We all have a stake in us all eating well, and I hope we can combine on that issue.

Countess of Chester Hospital Inquiry

Andrew Selous Excerpts

Monday 4th September 2023 Commons Chamber

[Steve Barclay]

The hon. Lady raises extremely important issues and I am happy to give her the assurance that these issues will be explored. NHS England is looking at that. On the concerns expressed around the regulation of managers, the chief exec of NHS England hosted a meeting last week with key stakeholders to discuss these very issues and I will of course relay to the chief exec the points she has raised.

[Andrew Selous (South West Bedfordshire) (Con)]

A few years ago, I was a whistleblower myself against an orthopaedic surgeon in my local hospital who was putting the same metal implant into patients’ backs whether they needed it or not. No other hospital was doing it; the specialist hospital only ever took it out. From that work, I was a parliamentary advocate with my constituent Tim Briggs for Getting It Right First Time. We pushed that for eight years before the NHS took it up, so I am pleased to hear the Secretary of State talking about it. What I discovered then was that the desire of trust management to cover things up to protect the reputation of their institution seemed to trump doing the right thing and throwing the spotlight of transparency on what was happening. What are the key reforms the Secretary of State spoke about today that will mean that will not happen in future and those brave clinicians who spoke up will be listened to in future cases like this?

[Steve Barclay]

The key reforms include Getting It Right First Time, the work of Professor Tim Briggs—I raised with him the issue around Chester and the fact that his team have been reviewing that data—the strengthening of the freedom to speak up guardians, the appointment of a new patient safety commissioner, the strengthening of the Public Interest Disclosure Act, the role of child death overview panels and the scrutiny they provide, and the expanded role of medical examiners, which were not in place. So significant actions have been taken, but it is right that through the inquiry we look at the specific issues raised at Chester and any further steps that are appropriate.

NHS Long-term Workforce Plan

Andrew Selous Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

Barnett consequentials will apply to the £2.4 billion funding over the five years. In respect of new roles, regulatory changes apply on a UK-wide basis. The plan itself is for the NHS in England, but we stand ready to work with partners across the United Kingdom where there is shared learning on which we can work together.

[Andrew Selous (South West Bedfordshire) (Con)]

I am really pleased to see the 50% increase in the number of annual training places for GPs—it is music to my ears—but they will need somewhere to work. The £20 billion for the hospital programme is great, but when I look at section 106 applications for my constituency, I still see health getting a tiny proportion compared with education and the environment. May I have an assurance from the Secretary of State that as we increase the number of GPs in the primary care team, they will not have to scrabble around trying to get little bits of money for planning applications here and there, but that there will be a guaranteed capital budget for new doctors, in the way that we are sorting that out for hospitals?

[Steve Barclay]

My hon. Friend raises a perfectly valid point. As we expand the primary care workforce, there is a capital consequence. The 50% expansion he talks about builds on the expansion from 2,100 in training in 2014 to 4,000 now, so there has already been an expansion, but we are taking that further by 50%—and on the higher figure. His point about section 106 applications is absolutely valid, and that is part of the primary care recovery plan. I understand that he is discussing the importance of getting that funding in place with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough.

Bladder and Bowel Continence Care

Andrew Selous Excerpts

Thursday 29th June 2023 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

I beg to move,

That this House has considered bladder and bowel continence care.

It is a pleasure to serve under your chairmanship, Sir Graham. This week is World Continence Week, so I am grateful to the Backbench Business Committee for allocating this debate on what is often a taboo subject, and therefore something of a neglected area of healthcare. Continence issues affect millions of people in England and across our whole country.

In 2018, the NHS England “Excellence in Continence Care” guidance was published. It estimated that there are 14 million people of all ages in England with bladder problems, and a further 6.5 million—again, of all ages—with bowel problems. Those are huge numbers, which is why this debate matters. Continence problems can take away people’s freedom and mobility, in some cases leading to people becoming housebound. Those problems can also lead to depression and wellbeing issues.

The Paediatric Continence Forum has informed me that continence difficulties, including bedwetting, daytime wetting, constipation, soiling and difficulties with toilet training are predicted to affect approximately one in 10 children. Unless treated, those problems can perpetuate into adolescence and adulthood. They have significant cost implications for the NHS in unplanned admissions, A&E attendance, costly consultant appointments and so on. Children need a community-based and nurse-led service.

I was honoured to take over as the chair of the all-party parliamentary group for bladder and bowel continence care, following the excellent work of my predecessors, the late Baroness Greengross and Rosie Cooper. It was the APPG that lobbied NHS England to produce the guidance that I have spoken about. I am also grateful for the many clinicians, royal colleges, charities, patient advocates and patients themselves who have given freely of their time and expertise to assist the APPG in bringing forward the debate today.

I am concerned that there has been little monitoring or review of the implementation of the “Excellence in Continence Care” guidance produced by NHS England. I hope the Minister will tell us what he is doing to address that. The last full published audit of continence care was carried out by the Royal College of Physicians in 2010. Dr Adrian Wagg, then the clinical director of the national audit of continence care, painted a stark picture when he said:

“Bladder and bowel incontinence affects 1 in 5 people causing ill health, depression, social isolation, and costing the NHS millions of pounds. Although these are treatable conditions, people of all ages, and vulnerable groups in particular (frail older people and younger people with learning disability) continue to suffer unnecessarily and often in silence, with a ‘life sentence’ of bladder and/or bowel incontinence”.

An up-to-date audit would provide a complete list of services and show regional gaps in provision. It could benchmark improvements. We could look at the number of services and specialists, identify areas for training programmes, recruitment and commissioning, as well as identifying the causes of incontinence and looking at the impact on the quality of life and comorbidities. Such an audit would also need to look at the costs involved and where savings might be made. I hope the Minister will commit to an updated audit.

Many people are too embarrassed even to talk to their GP about these issues. People suffer in silence and can become depressed and isolated, before eventually seeking help. That can affect employment, education and socialising. There is some evidence that half of people with those conditions will wait five years or more before seeking medical advice. The lack of awareness and promotion of pelvic floor health leads to acceptance of bladder weakness, particularly as part of ageing or as a result of childbirth; by the way, pelvic health is every bit as important for men as for women.

I note that NHS England’s maternity and women’s health team has an excellent initiative on perinatal pelvic health, which is very encouraging to see. I also commend NHS England for launching a programme in 2021 for pregnant women and new mothers to prevent and treat incontinence and other pelvic floor issues. It has 14 pilot sites around the country, and I would like to know what learning has come from these and what the next steps for the NHS are.

One of the most important things I can do in this debate is to promote the bladder and bowel CONfidence app, which is packed with helpful pelvic floor health advice. It was commissioned by the Florence Nightingale Foundation to celebrate the year of the nurse and midwife in 2020. The project was led by Dr Nikki Cotterill, professor in continence care at the University of the West of England. The app aims to provide quality-assured health and wellbeing information, promote safe self-care and aims to reduce avoidable demand on services. It signposts services and other sources of support and makes it easier for people to get help. I would like to know from the Minister what the NHS can do to promote the app and ensure that the information on it is widely known.

I understand that the NHS workforce plan is imminent. I very much hope that there is a plan to increase the number of specialist continence nurses, as many of them are retiring. I ask the Minister if NHS England is working with the General Medical Council to mandate that the medical, nursing and physiotherapy curriculums include bladder and bowel continence training more extensively in their syllabuses in all these areas. I would also like to know if Health Education England will be providing more specialist education courses for both stoma and urology continence nurses to enter the profession.

The APPG has worked with the Nursing and Midwifery Council to get basic training for bladder and bowel continence in their standards for nurses and midwives. We would like to see this mandated in their curriculum and be applied to general practitioner education standards as well. I would also like to know if the Minister has had any conversations with the Royal College of General Practitioners and the Royal College of Nursing about continuing professional development, including one-day training courses on continence care. This has huge potential to upskill the existing workforce to deal with this problem.

For many people, incontinence should not be accepted as a normal part of life. A high proportion of cases are curable, particularly bladder weakness. Consulting a medical professional may flag indications of underlying causes such as bladder, bowel or prostate cancer, which is why the five-year waits for a first consultation are so concerning. There is variability of access to specialist support across the country.

One of the clinicians who advises the APPG, Professor Charles Knowles, wrote the excellent report on pelvic floor services in 2021. I hope the Government took careful note of it, because it was a combination of work by 30 experts and made recommendations in six areas: awareness and education, technology-enabled care, integration of expertise, surgery procedures and premises, utilising human resources and novel approaches to freeing up resources.

As parliamentary co-conspirator with my friend and constituent Tim Briggs CBE, the originator of the Getting It Right First Time programme, I would like to know whether there is a GIRFT programme for continence care. If there is not, there certainly should be, because it has had amazing results in all the other specialisms. Are the royal colleges and the Department of Health and Social Care able to give greater direction on the need for so-called benign surgery for bladder and bowel conditions, which people are currently waiting longer for and can badly affect quality of life and wellbeing? I understand that clinicians who work with the APPG have highlighted that they believe there is racial inequality in the provision of continence care. Can we start investigating this by publishing ethnicity data on NHS treatment rates in continence care?

The APPG has led the Boys Need Bins campaign, given that men’s toilets very rarely have sanitary disposal provision. Around 11% of men in the 60-to-64 age group have urinary incontinence—that would include quite a few Members of the House—and the percentage rises with age. That figure does not include other continence issues, such as the need to use stoma bags. Men who need to use pads, catheters, stoma bags and other related items need to be able to dispose of their used products hygienically, discreetly and correctly.

One in eight men diagnosed with prostate cancer is likely to experience some degree of incontinence as a side effect, and men often say that this poses a greater problem to them than the cancer diagnosis itself. Prostate Cancer UK alerted me to the following comment in its survey regarding men having to use disabled toilets:

“Consequently, men are often forced to use disabled toilets in order to dispose of their pad or associated stoma bag products in the provided sanitary bin. It is important to note that nearly 1 in 4 men stated that they are not disabled so find it ‘embarrassing’ to use this toilet to access a sanitary bin whilst 42% stated feeling embarrassed, stressed, and anxious about using a disabled toilet, as they had experienced or felt that people will judge them. Indeed, one man told us that: ‘Whilst at a football ground, I had to ask a (male) steward if I could have access to an accessible toilet…(and) he commented, “You don’t look very disabled”’. This experience…felt inappropriate, degrading, humiliating and embarrassing.”

What do the Government expect these men to do when there is no disposal provision where they work or are being educated?

In June 2022, the BBC Radio 4 “PM” programme had a discussion about this issue that led Prostate Cancer UK and a number of other organisations to support the Boys Need Bins campaign. The campaign targets employers, hospitality venues, sports venues, retail outlets and local authorities—Winchester Council, for example, has successfully implemented such as scheme.

We have had reports of a postcode lottery in the supply of products needed. Getting the right products could lead to a reduction in urinary tract infection and skin problems such as dermatitis and pressure ulcers, and reduce costly hospital admissions. I would like reassurance that the NHS will look at the total costs in the patient pathway and not just at the unit cost per product, which could be a false economy, leading to higher costs for the taxpayer and less good outcomes for patients.

One of the most upsetting facts I discovered while preparing for the debate is that of hospital-acquired incontinence. A National Institute for Health and Care Research-funded study was published in June 2022 by the Geller Institute of Ageing and Memory, which is based at the University of West London. The research revealed that among patients with dementia admitted to hospital, over a third developed hospital-acquired incontinence, having previously been continent. There were some very upsetting accounts of patients who were not allowed to leave their bedside to reach the toilet, and even patients who were able to get to the toilet unaided were required to ask permission. Should there not be a right to self-toilet if someone can get to the loo on their own? The Spinal Injuries Association has contacted me to say that some of its members’ carers were not allowed to accompany them to hospital, leading to deep distress when people were not able to get to a toilet.

This is a very sensitive and delicate issue that does not get enough attention, and let me say straight away that I have all the sympathy in the world for nurses and healthcare assistants, who are rushed off their feet. We will not find the right way forward in this debate, but I implore the Minister to take this issue back to the Department so that we can preserve the continence, and therefore the dignity, of as many hospital patients as possible. If we get these issues right, we can save the NHS money that is currently spent on pads and appliances, reduce comorbidities and hospital admissions, and improve the lives and wellbeing of so many people.

A large number of people are admitted to hospital with urinary tract infections caused by catheter-associated urinary tract infection, and that greatly increases A&E attendance and unplanned admissions. Clinicians who advise the all-party group say that improving catheter care in the community would significantly reduce A&E attendance and hospital admissions.

I draw Members’ attention to a new service in Cornwall that has been piloting a continence car service run by NHS Cornwall 111. The cars are staffed by specialist paramedics who have additional skills, including catheter/continence management. The service reports that this has meant fewer patients being transferred to hospital and has taken the pressure off the local ambulance service. That seems to be yet another shining example of best practice in the NHS, so my question to the Minister is: what is NHS England doing to urgently evaluate it? If it is as good as it appears to be, we should mainstream it across all integrated care boards.

I want to give the last word to a young person in their 20s who has lived with chronic issues of bowel and bladder continence all through their life. This person wrote to me this week after seeing the debate advertised to say that they had never been referred to a specialist unit outside of paediatrics. It was only through a friend that they found out about the world-leading continence facilities at Northwick Park Hospital.

The pads that this person used suddenly stopped at one point because they had not been graduated from the paediatric to the adult system. They were discharged from the paediatric system and were no longer on anyone else’s system even though they have a lifelong condition. Despite the issues, this young adult works in an office and shares a flat with friends, ostensibly having a normal life even though since infancy they have needed to change pads three times a day to maintain cleanliness.

This person has three requests: first, they want the whole issue to be destigmatised in the public’s mind. Secondly, they want schools, colleges and universities and employers to care for students and workers experiencing these conditions sensitively and in an informed way. Lastly, they want proactive support for people living with bladder and bowel incontinence to explain the range of possible treatments available and the offer of mental health support for patients living with these conditions.

I salute the courage of this outstanding young adult for not being defeated by these issues and for working and leading a normal life. I want the Minister to take their comments to heart and back to the Department for action.

--- Later in debate ---

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Sir Graham. It is unusual to have almost an hour to respond to a Westminster Hall debate. I assure you that I do not intend to use all that time, but I will endeavour to answer as many questions as possible.

I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this important debate, and on his appointment as chair of the all-party parliamentary group for bladder and bowl continence care. I join him in paying tribute to campaigners such as the Urology Foundation for their incredible work during Continence Week and throughout the year.

I thank my hon. Friend for sharing the experience of the young adult who contacted him. That is what this debate, and this place, is all about. It is about destigmatising the issue, which was the No. 1 ask of that young adult. It is also about trying to bring about positive change not just for him but for patients up and down the country, especially given how many people we know are affected by continence issues.

We know—my hon. Friend set this out very articulately and eloquently—that incontinence is an issue with which too many suffer in silence. We must all learn to speak more openly about it. As the hon. Member for Bristol South (Karin Smyth) rightly set out, it is estimated that around 14 million men, women, young people and children, of all ages, are living with bladder problems. As has also been pointed out, all continence problems can be debilitating and life-changing. As we have heard, they can affect a wide range of care groups and can be of particular concern to the ageing population.

As my hon. Friend the Member for South West Bedfordshire rightly set out, this also creates pressures for our healthcare system. Complications and treatments for continence problems—for example, pressure ulcers, urinary tract infections, catheterisation, which my he pointed to, or faecal impaction—can all lead to admission and extended stays in hospital, which we should try to avoid wherever possible. The need to do what is right for patients and healthcare professionals alike means that care pathways should be commissioned to ensure the early assessment and effective management of incontinence.

To improve continence care across the whole public health and care system, NHS England has established the national bladder and bowel health project to improve continence care. As my hon. Friend rightly pointed out, it has also published “Excellence in Continence Care”, which is a practical guide for leaders and commissioners. That includes guidance for commissioners—so ICBs—and leaders in healthcare systems to ensure that people who are diagnosed with UTIs receive high-quality treatment.

I have heard my hon. Friend’s concerns about the implementation of the continence care guidelines. I will, as he asked, take this back to the Department and raise it with the Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), to discuss what more we can do alongside NHS England.

On 9 May, NHS England published its delivery plan for recovering access to primary care. It is an ambitious plan that includes proposals to improve options for community-based services to treat urinary tract infections. As part of that, appropriately trained community pharmacists will be commissioned to provide a clinical service to care for patients with urinary symptoms, providing timely access to assessment, information and advice.

In addition—this does fall within my direct remit in the Department—the National Institute for Health and Care Excellence has produced guidance on the management of faecal incontinence in adults, which healthcare professionals and commissioners are expected to take fully into account as part of the delivery of services. That guidance outlines that management strategies should consider diet, bowel habit, toilet access, medication and, importantly, coping strategies. Those management strategies will be required to account for the sensitive and socially stigmatising nature of incontinence, as my hon. Friend the Member for South West Bedfordshire set out. We know how important that is to patients, their families and—as the hon. Member for Strangford (Jim Shannon) pointed out—their carers.

I want to touch on another area, which my hon. Friend the Member for South West Bedfordshire touched on also, which is antimicrobial resistance, because we have updated the 2019 to 2024 national action plan on tackling antimicrobial resistance. The plan is core to this debate because it outlines that the UK will enhance the prevention of UTIs by providing early, accurate diagnosis and treatment of suspected and confirmed UTIs. That includes the prescription and use of antibiotics and therapeutics for older people, both in their own homes, which is critical, and in care homes, so that patients get the care they need, when and where they need it, and are less likely to suffer from the discomfort of urinary tract infections, or indeed secondary infections, which we know can follow.

To improve bowel care for people with spinal cord injury, NHS England has also published a service specification, with specialist multidisciplinary teams that provide advice and care in bowel management, including promoting and managing continence. My hon. Friend also referred to medtech, and I am really passionate—

[Andrew Selous]

The Minister might not be able to respond to this now, but before he moves on to the tech, the Spinal Injuries Association made the very good point that a lot of people with spinal injuries have carers—trained people—who are willing to come in and assist the very hard-pressed hospital staff, but are unable to. Can that be looked at? I get the complications, and I am not asking the Minister for an answer now, but one of my children spent some time in healthcare in hospitals in Africa, and in many parts of the world, if a patient’s family and friends do not go into the hospital, they will not survive. If we completely keep carers out and bar the door, have we not gone a little too far? There have to be standards, of course—it would have to be done in agreement with the staff and there would have to a be risk assessment. I absolutely get all that, but the current position seems bizarre, when there are hard-pressed staff and carers who are willing to come into hospital with their patients, so I wonder whether that could be looked at.

[Will Quince]

My hon. Friend makes a very good point. Instinctively, I totally agree with him, and I would be very happy to meet him to discuss, alongside NHS England, what more we would need to do to enable that to happen. I suspect that, in this kind of area, an individual with incontinence would often much rather have a family member, a carer or another trusted loved one support them through that process, alongside trained medical professions than anything else. So it is a good point, a fair challenge and one I will take away and consider in more detail.

Let me turn to medtech, which is a real passion of mine. We want to make sure that patients in our NHS get access to the most cutting-edge technological advances. We talk a lot about pharmaceuticals, but medtech is something that we should take very seriously, too. Earlier this year, we published our first ever medtech strategy, which says that the lowest price does not always translate to the best value. That is an important point, because the Government believe that the value of a product should be considered across the whole patient pathway, not in terms of the individual cost.

The application and adoption of value-based procurement in the NHS is a key priority in the medtech strategy, in order to realise, as I have set out, the potential of that technology to improve patient outcomes and, importantly and alongside that, to support the NHS workforce. Without getting too technical, the strategy includes a commitment to modernise part IX of the drug tariff, which lists devices that can be prescribed in the NHS.

The reason I am labouring this point is that the Government and I recognise how important patient choice is, and that a range of continence products is really important to living well with this condition. That is why there is a focus on making changes to part IX. By re-categorising part IX into groups of clinically comparable products that are interchangeable by their nature, cost-effectiveness can be compared fairly, and ICBs and clinicians will be more informed and more likely to use part IX. Doing so will also enable companies that are making innovative products to enter the market and encourage further innovation in this space, which will ultimately only benefit patients. We will continue to support the provision of a range of continence products in part IX of the drug tariff, to ensure equitable access for all patients.

The reason I labour the point about patient choice is that we must ensure that patients have a voice in the product range available in the drug tariff, so that patients’ interests are at the heart of how the tariff operates. We are currently engaging with patient groups, which is really important, and a targeted consultation will be launched later this summer to ensure that the tariff continues to be able to provide effective products to patients.

My hon. Friend and others also referred to the long-term workforce plan and the need for specialist continence nurses. I have spent the last few months saying that the plan will be published “soon”, then “very soon” and now “imminently”. I do not know if I can say “very imminently” —I am not sure there is such a thing—although I have spent most of today talking about the NHS long-term workforce plan. I anticipate spending most of tomorrow, and indeed Monday, talking about the NHS long-term plan. My hon. Friend and others will not have to wait very long before they will be able to read the plan in full. I am sure that he and others will understand why it would not be right for me to share details of it ahead of publication, but I mean it when I say that he will not have to wait very long at all.

On the points about public toilets and accessible toilets, I am conscious that I am straying into the territory of the Department for Levelling Up, Housing and Communities, which has responsibility for building regulations. It approves documents for the provision of toilets in publicly accessible buildings, which falls under the Building Act 1984 and the Building Regulations 2010. That legislation does not currently require sanitary bins in men’s toilets, but I understand the points made by my hon. Friends the Members for South West Bedfordshire and for Don Valley (Nick Fletcher), as well as the hon. Member for Strangford, about the anxiety that men feel. They make a compelling argument, and I would encourage them to raise it with the relevant Minister at DLUHC—I will do that too.

I understand that Colostomy UK has a stoma-friendly toilet campaign that is aimed at organisations, businesses and individuals. The campaign focuses specifically on accessible toilet facilities and the needs of people living with a stoma. The hon. Member for Strangford makes a fair challenge to the civil service and Government Departments to lead by example on that point. I will raise the issue with the Cabinet Office to see whether it is something we should explore further.

I thank my hon. Friend the Member for South West Bedfordshire for alerting me to the bladder and bowel CONfidence app, which was something that I was not aware of before my research ahead of the debate. I now know that a number of NHS trusts and medical centres are aware of the app and promote its use. Following this debate, I will look into whether NHS England could reference the app on its health webpages, which would be really helpful. I will also look into what more we can do to promote the app, as it sounds like a great tool.

My hon. Friend the Member for Don Valley raised the possibility of a men’s health strategy, and specifically a Minister with responsibility for men’s health. I know it is an issue that he is hugely passionate about and has campaigned long and hard on. I can give him the assurance that the major conditions strategy will take into account the needs of both men and women. Of course, we recognise that different approaches need to be taken for men and women in the provision of treatment of major conditions, especially over the whole course of life.

The Secretary of State for Health and Social Care, in Men’s Health—which is not a magazine I have read, but I have seen the cover—explicitly invited men to respond to the call for evidence to help us to ensure that the strategy takes into account the needs of men. I know that my hon. Friend the Member for Don Valley wants the Government to go further on this issue. He has already raised the issue with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), and I would also be happy to meet with him to discuss it.

[Andrew Selous]

I ask the Minister to forgive me if he was coming to this, but before he concludes, will he say a little bit about the third of dementia patients who go into hospital continent and come out incontinent? Many of them are actually trying to get to the toilet but have had difficulty. I find that very upsetting. As I said, it is not an easy issue, and I 100% get the pressures on the staff, but I think the issue is something that has not been spoken about. It has just happened under the radar. I am not expecting an answer today, but I would like a recognition that the Minister has clocked it, is concerned about it, and will take it back to the Department, because I was really upset when I learnt about that figure.

[Will Quince]

I entirely understand why my hon. Friend would be upset. In truth, I do not have an answer for him immediately. If he holds fire, however, I am going to make a broader offer to meet with him directly or alongside the APPG to discuss that and any other issues with NHS England and officials in the Department who are experts in the area. He raises a powerful point, and it is an issue that we need to explore further.

The hon. Member for Strangford raised prostate cancer statistics. I will write to him specifically, because I know he would like more detail on this issue. He is absolutely right that there has been a considerable increase in diagnoses of prostate cancer. I think the statistics are that in 2020 we diagnosed something in the region of 36,000 cases, whereas in 2000 it was 25,000, which is something like a 45% increase. Diagnosis is generally a good thing, especially early diagnosis, because it means that we are catching the disease early. However, I understand that about 51% of prostate cancers were diagnosed at an early stage in 2021, which demonstrates that we have a lot more to do in that space. I will write to the hon. Gentleman on that point, and will raise it with my hon. Friend the Member for Faversham and Mid Kent.

I have not answered all the questions that my hon. Friend the Member for South West Bedfordshire asked. As tempting as it is to take up the remaining 35 minutes of the debate, I will commit to meeting with him personally, or indeed with the all-party parliamentary group and campaigners, alongside NHS England and the Department, to talk about some of the other issues in detail. I think they certainly warrant that, so I would be delighted to do that.

In summary, NHS England has published its delivery plan, which sets out our proposals to improve options for community-based services to treat urinary tract infections. In addition, NICE has produced guidance on the management of faecal incontinence in adults. The annual spend on incontinence products from part IX items alone is approximately £255 million. As I said, we know how important patient choice is and understand that having a range of continence products is important to living well with this condition. That is why I can promise that there will be a focus on making changes to part IX of the drug tariff.

To conclude, I know that many people who experience bladder and/or bowel problems experience stigma, a point made eloquently by my hon. Friend the Member for South West Bedfordshire. They can be embarrassed to talk about the symptoms with friends, family and even, to some extent, healthcare professionals. That is why I am particularly pleased that my hon. Friend secured today’s debate, which has provided me the opportunity to play a small part in tackling the stigma that surrounds this issue. I think all hon. Members that have taken part in this debate have helped to defeat the stigma that surrounds the issue. I am not so naive as to think that there will be thousands watching this debate at home, but the debates are kept online and I hope people will watch. They will realise that it is vital to talk to medical professionals about their health issues and problems in this space and, wherever they feel it is necessary, to seek out professional care.

[Andrew Selous]

Thank you, Sir Graham, for looking after us this afternoon; I thank all my colleagues who came along. The hon. Member for Strangford (Jim Shannon), who is such a stalwart of these debates, was so right to say that this has traditionally been seen as a women’s issue. He pointed out that it is not and talked about the impact on intimate relationships, which is vital to highlight as well. He talked about the importance of the Dispose with Dignity campaign and the needs around it, which we have heard good commitments on from the Minister on today.

My hon. Friend the Member for Don Valley (Nick Fletcher) also supported the Boys Need Bins campaign and talked about the negative impact on men’s mental health. He called on us to listen and act, and asked how this issue could fit within the men’s health strategy. I am extremely grateful to him for coming along. I completely agree with the shadow Minister, the hon. Member for Bristol South (Karin Smyth), that this is an issue we need to prevent, cure and manage. She is 100% right about that. I am grateful for her support for the app, which comes from her part of the world.

I am hugely grateful to the Minister for his commitments. I will take him up on that meeting. I will also put him down as a Boys Need Bins champion in Government. I know it is not his departmental responsibility, but if he can be there with us to try to make progress, I will take that as a win this afternoon. I look forward to the meeting.

Question put and agreed to.

Resolved,

That this House has considered bladder and bowel continence care.

Dental Services: East of England

Andrew Selous Excerpts

Tuesday 16th May 2023 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

I congratulate my colleague and good friend, my hon. Friend the Member for South Norfolk (Mr Bacon), on an excellent and passionate speech. I agreed with every word that he said.

I, too, am a veteran of these debates. I dusted off the speech that I made on this subject—probably in this very chair—on 10 February 2022, and things are not better, so I am back, as we all are. It is the duty of Back-Bench Members of Parliament to speak out on behalf of constituents. In February 2022, I had been told a month or two before by NHS England that of the 47 dental practices in my constituency, six were taking NHS patients, but I do not think that was accurate because it was not the experience of my constituents. When NHS England told me that it had done a search on dentists available to take NHS patients in my constituency, I do not think that it had knocked on doors and gone in and asked them. I think it had sat and looked at what an out-of-date website said, and that is not good enough. For a public service that matters, it should not look at an out-of-date website and give Members of Parliament inaccurate information.

The situation is still not better. If we look at the figures from the House of Commons Library briefing on the percentage of children who have seen a dentist, just before the pandemic in September 2019, it was not high enough—it was 58.5%, so just under six out of 10 children saw a dentist every year. The pandemic has a lot to answer for in a lot of areas of our national life, and the latest figures that we have from the Library show that in June 2022, the figure for children seeing a dentist in the last year had declined from 58.5%, which was not high enough anyway, to 46.2%. Less than half of the children in England see a dentist every year, yet we know how important it is for them to do so. Children go to hospital to have teeth taken out, and so on, but regular trips to the dentist, proper prevention and proper brushing could prevent that.

The situation is no better for adults. We have similar figures for adults going to see a dentist in the last two years; I am not sure why it is two years for adults and one for children. In September 2019, just before the pandemic, 49.5% of adults had been to see a dentist in the past two years. That has crashed down and, as at June 2022, is now barely more than a third at 36.9%. Just over a third of adults in England go to see a dentist every two years.

Serious work clearly must be done, because oral health matters. It matters for young children, as I have said, far too many of whom turn up in hospital having to have teeth taken out. It is important that we teach children to brush their teeth well, and we all need to be reminded of that. A Radio 4 programme that I was listening to the other day reminded us that we should not rinse the toothpaste out of our mouth but should only spit it out. You might think that is rather piffling, Sir Mark, but if it helps the nation’s teeth to be a bit healthier by leaving the fluoride on our teeth, it is actually quite important information. There is a job to be done of educating the whole nation about how to look after our teeth properly.

I am passionate about dental care for older people as well. With busy adult social care staff, it can get forgotten, and in nursing homes and care homes it has not always been given the priority that it needs. I had a debate in the main Chamber a while ago on this subject and domiciliary care. The care needs to be there, because poor oral health can contribute to a whole host of other problems and can make them worse. For example, someone might have a low-level bacterial infection in their mouth because they do not have good dental hygiene. We need to get this right.

I was very taken with the suggestion from my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) about NHS dental students giving some time to the NHS. I think five years was suggested. I am conscious that, unlike when I went to university, there are grants and that students leave with quite a lot of student debt, but there is something we could and should do there. If someone is training to be a doctor or a dentist, they receive a large amount of taxpayers’ money, and taxpayers can reasonably ask what they are getting back in public service. Whether we could do something on the amount of debt they have, or vary or pause the interest rate, if they gave those five years to the NHS, that would be worth looking at, and having a greater supply of dentists would make a significant difference.

I come back again to say that the situation is not as I would want it to be. I want my constituents to be able to see a dentist easily. I spoke to the Minister before the debate, and I know the Government are earnestly working on the subject and will come up with a plan in the next few months. I have particular confidence in this Minister—sparing his blushes—because he has been incredibly helpful to me on general practice provision in my constituency. He is an outstanding Minister: highly intelligent, does the detail, delivers and asks the questions that need to be asked. I have hope and confidence in him, but I say to him today, as all hon. Friends do, that this is urgent and it matters. Please deliver—deliver properly and deliver quickly.

--- Later in debate ---

[Jerome Mayhew (Broadland) (Con)]

One of the unifying features of the speeches today is that we have heard them all before. Not only have we all heard it before, but we have all said it before, so I will try—I may fail—not to do that. However, I do have to highlight some elements of the problem, which has been ably covered by my hon. Friend the Member for Waveney (Peter Aldous).

Access to NHS dentistry in Norfolk, which is the worst in the east of England, was surveyed in 2020 to 2021, and of the 150 sub-regions of the country, Norfolk came 147th. As I said to the Minister in a previous speech, we have to follow the money. As my hon. Friend the Member for Waveney pointed out, the best areas spend nearly £80 per mouth per year on dentistry; in the east of England, the figure is £39—a full 50% less. Does the Minister have an explanation for that? I genuinely struggle to understand how spending on NHS dentistry in the east of England is so far below that in the rest of the country. It seems to be without explanation.

More locally still, in Broadland the lack of dentists of any description is profound. I was lucky enough to persuade the Department to advertise a new contract for NHS dentistry in Fakenham last year. The money was available and the contract was advertised; not a single organisation applied for the contract, and it is still vacant. In Sheringham, in the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker), who is unable to speak in this debate, there is a dental practice that is owned by an organisation that has an equivalent practice in London. The organisation has been advertising consistently for a new private dentist in Sheringham for 10 years, and it has yet to fill the role, whereas during the same time multiple positions in its London practice have been advertised and filled. It is therefore not just a regional issue; geography really matters.

I am sorry to say that just last week the latest in long and ignoble line of announcements came when Brundall Dental Practice, which is an NHS practice, contacted patients to say that it would no longer be accepting adult NHS patients from 1 September this year. People are being asked to move on to monthly subscriptions for dental care, which are between £150 and £400 a year. I struggle to know what to say to the many constituents who have contacted me, because not a single NHS practice in the county of Norfolk is currently accepting new patients under an NHS contract. The £11 a month is only for check-ups and hygienists; it is not for dental care, which is an extra charge.

People might say that many can afford to pay for dentistry if they have to, but we have to also consider those who are excluded from paying dental charges because of their financial circumstances. What are we asking of those constituents? Where are they to turn not a single provider in the county of Norfolk is accepting NHS dentistry? The answer, of course, is that they will go to the Norfolk and Norwich University Hospital when their dental problems become acute, and we merely transfer the problem from the dentistry budget to the NHS and acute budget. The problem will be so much worse, and so much harder and more expensive to treat, because we are not nipping things in the bud but dealing with acute emergencies. That cannot be the right answer.

The reason I do not want to prolong the agony of discussing the problem is that I know that the Minister gets it. If he was not educated before, he has certainly been educated on numerous occasions, either here or in the main Chamber, by many of the Members present—the problem has already been fed back. Government Members have great confidence in the Minister and in his grip, grasp and focus on the issue. We know that a dentistry plan is imminent—the sooner that it is published, the better, and more power to the Minister’s elbow—but there are a number of suggestions I hope will find their way into the plan.

In the short term, we need additional improvements to the current dentistry contract—other Members have spoken eloquently about that, and I would highlight it as being very important. As regards the medium term, we have had reference to centres for dental development. The University of Suffolk has progressed far in its application, and there is a necessity for a similar venture at the University of East Anglia, or at least similar work in Norwich. However, in the long term, we simply have to train more dentists. We have to open the market to allow people to access a lucrative and fulfilling career that is currently not being explored in the east of Anglia and in Norfolk, in particular.

We need to train people in the east of England. The University of East Anglia has put forward proposals for a dental school. The medical school it founded in Norwich about 10 years ago knows definitively, from surveying all its graduates each year, that about 40% go on to take their first job locally. The single act of setting up a dental school in Norwich, linked to the Quadram Institute and the research work at the Norwich Research Park on the human microbiome, is the long-term solution.

I hope the medical plan will look beyond the national numbers. I was told by the NHS that roughly the right number of dentists are being trained each year, but I dispute that. It has been seven years since it surveyed what those dentists are up to. It has no idea whether the dentists notionally on its books have retired, gone abroad, are working in the NHS, are working part-time in the NHS, are working privately, or none of the above.

[Andrew Selous]

My hon. Friend is making a powerful point about the link between where people train and where they work. I would gently make the point to the Minister that the east of England is quite a large area. Norfolk and Suffolk are deeply wonderful places, with which I have a great affiliation, but they are quite a long way from Bedfordshire, which is also in the east of England. If we were to think that it was job done because we had trained dentists in Norwich or wherever, I would want to know what that meant for the good people of Leighton Buzzard, Dunstable, Houghton Regis and the surrounding villages. I put that marker in the Minister’s mind.

--- Later in debate ---

[Mr Richard Bacon]

I enjoyed listening to the remarks of every contributor, including my parliamentary neighbour, my hon. Friend the Member for Waveney (Peter Aldous). I was going to say “the Member for Aldous”—going around my constituency, one finds quite a lot of Aldouses; I have not yet established whether they are all related, but if one scrapes under a stone in East Anglia one quickly comes across an Aldous. He gave us a tour d’horizon—a tremendous summary of the expertise that he has gathered over the last few years. Together with the hon. Member for Bradford South (Judith Cummins), he has led the way in drawing the issue to the attention of other hon. Members. I pay tribute to him for that, and I am deeply in his debt, because reading his speeches was a great way to read my way into the subject—one that I was drawn to not because of any expertise, but because of my constituency postbag. We have heard that the same is true for all hon. Members.

Opinion pollsters are sometimes behind the curve on what is a salient issue, but hon. Members on both sides of the House know that this is the top issue facing us. My plea to the Minister is not to go so fast that he gets it wrong, but to bide his time and ensure that he has taken everything into account. He should talk to his Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay)—an east of England MP who has the same problems in his constituency postbag—and come up with an answer that is attractive and provides lasting change. That is what we want to see.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), another of my parliamentary neighbours, raised the interesting point of how we encourage people who have had money spent on them by the NHS to stay in the NHS, even if they are paying fees themselves, as my hon. Friend the Member for South West Bedfordshire (Andrew Selous) said. I would be open to a wide variety of methods for doing that, including forgiveness of part of or perhaps all student loans. We need to make radical changes.

My hon. Friend the Member for Broadland (Jerome Mayhew) quoted a startling statistic: £80 per head is spent on dentistry in the areas that have the best dental care, and only £39 in parts of the east of England. What annoys me more than anything else is that, outside London and the south-east, the east of England is the fastest growing area of the country. It contributes the most gross value added to the economy outside London and the south-east. That is an argument that MPs in Norfolk and elsewhere in the east of England have been making for many years. We have been saying for years, “Give us the infrastructure, give us the broadband, give us the rail connectivity and give us the mobile telephony that actually works, without the need to go 100 yards down the road, stand on one leg and hope there is an “r” in the month to get a mobile telephone signal. Then we will provide the economic growth.”

Going back to the Prime Minister’s points, I seem to remember that one of them is about economic growth. Here we are contributing so much to the economy and yet not getting our fair share back, when the opportunity in the east of England is unrivalled in the UK. A golden triangle could exist between the economic heat, innovation and intellectual firepower of Cambridge; the Norwich Research Park in my constituency, where scientists look at world-leading advances in genomics and plant science; and technology in Ipswich at the BT labs at Martlesham. That golden triangle represents an extraordinary opportunity for the whole United Kingdom.

I was recently at the Cambridgeshire Development Forum, where I heard people talking about east-west rail and comparing themselves with Boston and Silicon Valley, but saying that they do not have enough room to grow. I say to my hon. Friend the Member for Boston and Skegness (Matt Warman) that that is, of course, Boston in America. The obvious answer is, “You have got loads of room to grow. You have got the whole of the east of England.” To an investor from Dubai or Shanghai, it all looks like Cambridge. We have a huge opportunity, but we need not only the infrastructure but the world’s best medical and dental services.

[Andrew Selous]

In an uncharacteristic slip and momentary lapse of memory, my hon. Friend forgot to mention the world-leading research in Cranfield, which I am sure he was going to add to his golden triangle of opportunities in the east of England. I am sure that that slipped his mind accidentally.

[Mr Richard Bacon]

It might make it more of a pentagram, but I did mean to mention Cranfield, of course. My hon. Friend knows that in South Norfolk we speak of little else. I do not want to take up too much time, although we are slightly ahead.

My hon. Friend the Member for Boston and Skegness said that he is not technically in the east of England. I had a mad great-great aunt who lived in Brigg in Lincolnshire, and Lincolnshire has always been in the east of England, as far as I am concerned. He is very welcome at this debate, and I had a great interest in what he said. However, if it is true that the wilder fringes of the internet have got worse in recent years, and if my hon. Friend was responsible for 5G, to whom should we attribute the extra growth in the wilder fringes of the internet, if not to him? I only pose the question.

The hon. Member for Denton and Reddish (Andrew Gwynne) surprised me. I remember when he was shadow Secretary of State for the Ministry of Housing, Communities and Local Government portfolio. He mostly appeared at the Dispatch Box like an angry avenging angel. The fact that he is capable of sounding rather rational and sensible was a surprise to me. I am afraid he also confirmed my worst fears—

Recovering Access to Primary Care

Andrew Selous Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

Far from ducking Whipps Cross, I have actually been and visited in person, so I am very familiar with the issue and I recognise the importance of the new hospital programme. I hope to make an announcement about that programme and about the workforce plan shortly, just as I am doing today about the primary care recovery plan.

In today’s plan, the hon. Gentleman may want see at the proposals to look at the contribution to pressures on primary care from new housing developments, and at what changes might be made to ensure that where such developments take place, funding from them goes not only to new schools, as it frequently does, but into primary care, and particularly GPs.

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly praise all those who work in primary care in my constituency, including Dr John Henderson and Dr Stephen Price, who are the leaders of my two primary care networks.

It is great to see another 25,000 staff in primary care. They now need somewhere to work, including somewhere in the middle of Leighton Buzzard before we get the extra health facilities next year. When we build tens of thousands of extra houses, my experience, over decades, is that no Government, comprised of any party, have made sure that extra primary care facilities come on stream with as much certainty as a new primary school. If we could crack that, we would do a huge service to the whole nation. Please could the Secretary of State make it his personal mission to do that?

[Steve Barclay]

We plan to change planning guidance this year to address that specific issue. I have visited my hon. Friend’s constituency, and we resolved one of the issues in relation to the estate, which was extremely constructive. I know he has been discussing a further issue with the Department, but I hope he can take some comfort that his representations have been heard. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is planning to make changes to the guidance to better ensure that, where there is new housing, a contribution is made to primary care.

Edenfield Centre: Treatment of Patients

Andrew Selous Excerpts

Thursday 13th October 2022 Commons Chamber

[Will Quince]

I thank my hon. Friend for his further question. I know that he has met the Under-Secretary, NHS England and the trust, and has had an opportunity to ask questions. On his points on training, I suggest he has a further meeting with my colleague at the Department, who has responsibility for mental health, so that she can set out those plans.

My hon. Friend asked whether I will apologise to the patients and their families. Of course, I will do so unequivocally. It should not have happened, and it is our role as Ministers—in fact, it is the role of all those who work in the NHS—to do all we possibly can to prevent it from happening again. He asked for an independent inquiry, and I believe it does the meet the threshold for that.

Finally, my hon. Friend mentioned NHS funding. The NHS long-term plan commits to investing at least an additional £2.3 billion a year, which takes the total to about £15 billion last year, and there is an additional £10 million for winter pressure this year.

[Andrew Selous (South West Bedfordshire) (Con)]

I have a terrible feeling of déjà vu because I remember standing on a previous statement on an issue such as this, and here we are again. We are talking about the most vulnerable people, who cannot tell their own story, so I want to ask the Minister, who I know cares deeply about these issues, what more we can do to provide the proactive, independent evidence by any means necessary so that we nip this sort of behaviour in the bud. We have to care for these people, and I think that the overwhelmingly decent workforce in this industry will be equally appalled about what has happened in the Edenfield Centre. Will the Minister think about independent, verifiable, proactive evidence to stop this from continuing to happen?

[Will Quince]

I thank my hon. Friend for his question, and he is absolutely right that patients and their families deserve and indeed expect the highest standards of care quality. Safe services are by no means—never, in fact— optional extras, and where there are failures to deliver to those standards, we must continue to be transparent so that we can learn and improve. Whether it is in the CQC or local trusts, I know that the Under-Secretary, my hon. Friend the Member for Sleaford and North Hykeham, will look at any and all options to improve transparency, and to make it far clearer where cases of this nature do take place. He is also absolutely right to point out that the vast, vast majority of those who work in our NHS provide the most incredible world-class care, and where they are let down by a tiny number of individuals, as they have been in this case, such people are letting down everyone who works in the NHS.

Procurement of Evusheld

Andrew Selous Excerpts

Wednesday 12th October 2022 Westminster Hall

[Daisy Cooper (St Albans) (LD)]

I beg to move,

That this House has considered the procurement of Evusheld.

It is a pleasure to serve under your chairship, Sir Gary. I am pleased to have secured this important debate on behalf of the forgotten half a million immunocompromised and immunosuppressed patients in England, and the 18,617 people who have signed the parliamentary e-petition calling on the Government to fund the preventive covid-19 drug Evusheld. I pay tribute to the extraordinary campaigning work of Evusheld for the UK, Blood Cancer UK, Kidney Care UK and many other charities that have given their members a voice. There is clearly significant interest from colleagues across the House, and I will endeavour to take as many short interventions as possible.

Let me be blunt: the Government have got this badly wrong. Some of our most vulnerable people are now in an impossible position, or, as some of them have said, they have been left to rot. People with blood cancer, vasculitis, kidney transplants, multiple sclerosis, long- term conditions and rare diseases and those on immunosuppressant drugs are crying out for the preventive drug Evusheld. Why? For them, the covid infection is just as deadly—in fact, more so—than when we first went into lockdown two and a half years ago. They do not mount a response to covid through the vaccines like the rest of us. Covid is not just a bad cold or an inconvenience, but a killer disease. In a society where people are allowed to walk around with that killer disease without being required to wear a mask, test or isolate, nowhere is safe for the immunocompromised—not inside or out.

[Andrew Selous (South West Bedfordshire) (Con)]

I share the passion with which the hon. Lady speaks. Does she agree that it is incredibly important that the clinicians and scientists take this decision through the usual rigorous methods, and not us as politicians?

[Daisy Cooper]

I welcome that intervention and I do agree. I will outline all the scientific evidence that backs the decision to procure Evusheld and roll it out right now, this side of Christmas.