Coronavirus

Andrew Selous Excerpts

Tuesday 15th September 2020 Commons Chamber

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

I am really keen that we proceed on the basis of reliable and agreed evidence, so what would the Secretary of State say to people who point to Sweden as an example of how we can control the virus and minimise the impact on the economy and our social lives?

[Matt Hancock]

I have looked very closely at the situation in Sweden, and the challenge is that Sweden brought in significant laws curtailing social activity and that the population in Sweden followed more closely more than in almost any other country in the world a lot of guidance that was not enforced by law. The case rate in Sweden was also higher than in other geographically comparable countries.

The conclusion I have come to is that the approach we are taking, where we look around the world, learn from similar countries and take action where necessary, is the best way to control the virus and protect the economy. The rule of six is designed to try to restrict the transmission where we see it happening most, which is in social circumstances, and to protect the economy as much as possible by keeping the economy open within those social constraints. We are constantly vigilant and we are looking around the world for other examples of where we might be able to make changes. As my hon. Friend knows, we have made changes to our approach as we have learned throughout this unprecedented pandemic.

Coronavirus Response

Andrew Selous Excerpts

Monday 20th July 2020 Commons Chamber

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

A young couple contacted me over the weekend to ask why it is that any number of people without restriction can spend the whole evening eating and drinking in a pub, yet as from 1 August only 30 can go to a wedding reception. Can the Secretary of State give people in their position any comfort?

[Matt Hancock]

The explanation is that in the pub they will have to be socially distanced at 2 metres, or 1 metre plus mitigation. Unfortunately, this virus is still at large, so having very large groups of people in a situation where it is absolutely normal to be in very close contact is a risk. These are all judgments and unfortunately that is one of the judgments that we have had to make.

The National Health Service

Andrew Selous Excerpts

Wednesday 23rd October 2019 Commons Chamber

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

Thank you very much indeed, Madam Deputy Speaker. Although I wish the House were completing the necessary Brexit legislation today, it is always a particular pleasure and, indeed, a responsibility to speak on the important subject of the NHS.

I, too, start by thanking every member of NHS staff —including two members of my own family—for what they do. The pressures on them are unrelenting, day in, day out, as all of us in this House must acknowledge. I, too, have a personal reason to be grateful to the NHS: when I was 24, I had a haemopneumothorax in the middle of the night, and the NHS saved my life with an emergency operation carried out in the hospital just over the river. Had it not been for the brilliant care I got some 30 years ago, I would not be here today making this speech.

When I met a number of presidents of royal colleges last month, they told me that they thought we needed to double the number of medical students in training. It is brilliant news that we recently increased their number by a quarter, but the ongoing NHS people review shows that demand is such that a doubling is needed. Another area we need to consider is highlighted by evidence that one to three hours a day of a doctor’s work could be done by non-clinical healthcare staff. Are we using our staff as effectively and appropriately as possible? I am worried by how many medical students we lose: having trained in this country at public expense, too many then go off to Australia, Dubai or elsewhere. Are there perverse incentives in the system? Where is the value for money for the taxpayer?

I hear from staff that sometimes they work with computers that take half an hour to warm up. Yes, we want to get rid of the fax machines and to use the latest technology, but computers that are just turned on and then work are vital for NHS staff under pressure. We need to put more nurses into care homes to curb inappropriate calls on accident and emergency services for residents. We need to make sure there are enough practice nurse courses in rural areas, where there are gaps that lead to poaching. Perhaps we could use the apprenticeship route.

I understand that 27% of medical school students who graduate go into general practice, yet the Royal College of General Practitioners says the percentage needs to be nearer 50% to meet the acute need for doctors in GP practices up and down the country. There is also great variation in the proportion of medical school students who go into general practice. We need to learn how to increase the proportion going into general practice, so acute is the need. I am also concerned that we do not have a proper career path for associate specialists, particularly in surgery, in our hospitals. They are valuable members of staff, but they can drift around the system a bit, and I understand that about 20% of them are leaving. We need to look after them better and plan for them more appropriately.

We need to link our health visitors more closely with the new primary care networks. Health visitors do invaluable work, but their national child measurement data is not transferred to GPs. That leads to problems and to childhood obesity not being tackled. As co-chair of the all-party group on obesity, it is great that we have chapter three of the childhood obesity plan, but I would just remind the Minister that the actions from chapter two, on watershed promotions and point of sale, have not yet been implemented. We need them to be implemented.

We also have a very bizarre issue in that the equality and outcomes framework does not cover children’s weight. In fact, it specifically excludes it—it covers only adults. Come on! We need to vary the contract to make sure it measures children’s weight.

We must do better on foetal alcohol syndrome disorder. It needs to be included in personal, social, health and economic education, and we need a massive public campaign. I am awaiting a letter back from the Secretary of State on that. It is a huge and growing issue that we do not talk about enough in this House.

We live in an obesogenic polluted environment, with unacceptably low levels of active travel. We need to design the healthy environments of the future if we are to relieve the NHS of the pressures that are otherwise going to overwhelm it.

We also need to be aware of the opportunities that NHS staff have to spot incidents of modern slavery. I would like to commend a very alert healthcare worker who last week, on the eve of Anti-Slavery Day, spotted the first victim of modern slavery in her hospital. She was alert to the symptoms and had done the training. NHS staff have a unique opportunity to bear down on modern slavery, and that is so important.

I was staggered to hear from the Scottish National party’s spokesman that the taxpayer is paying out £80 billion for £30 billion-worth of hospitals.

[Dr Whitford]

The figure is £13 billion.

[Andrew Selous]

It is even worse, then. Some trusts are paying up to 16% of their income on PFI payments. We really must learn from that and do much better.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Matt Hancock]

We have recently announced that the way in which we are going to proceed with regard to sexual health services is co-commissioning between local authorities and the local NHS. This is the best way to ensure that we get the services on the ground. I would just slightly caution the hon. Gentleman; although he mentioned that some sexually transmitted diseases have been on the rise, others have been falling quite sharply. We have to ensure that we get the details of what we try to implement right, but I support the direction of travel that he proposes.

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

What can we do to make the workload terms and conditions more attractive for salaried GPs and GP partners compared with locums? GPs in my constituency tell me that a great number want to be locums, but that not so many want to be salaried or GP partners because of the workload. What can we do about that?

[Matt Hancock]

My hon. Friend is dead right. This is an important part of the work that Baroness Dido Harding is leading in the NHS people plan to ensure that we can make careers in the NHS—whether as doctors, other clinicians or more broadly—the most attractive that they possibly can be. This week we announced a pay rise for doctors and earlier this month we announced a long-term agreement with junior doctors, which I am delighted they accepted in a referendum with over 80% support. But there is more work to do.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 18th June 2019 Commons Chamber

[Seema Kennedy]

I have set out to the hon. Member for Sheffield Central (Paul Blomfield) the measures we have taken. Through the childhood obesity trailblazer programme, we are working with local authorities—I am hoping to visit one in Blackburn later this week—that want to see how they can use their powers to best effect, doing things such as limiting new fast-food outlets. We have spent billions of pounds over the past five years. The public health grant will be subject to the spending review.

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

Given that 46% of food and drink advertising is spent on unhealthy food—and unhealthy foods are three times cheaper than healthy food—will the Minister follow in the footsteps of her predecessor, and go to the Netherlands to look at the Marqt supermarket, which has 16 stores around Amsterdam and does not market any unhealthy food to children? It is a profitable business and a model for our supermarkets, so will she go and look at it?

[Seema Kennedy]

I thank my hon. Friend for his interest in this area. The Amsterdam model has been very successful, but it is not just about food—it is about place and culture. I would hope to be able to visit the model very shortly.

National Marriage and Mental Health Awareness Weeks

Andrew Selous Excerpts

Thursday 16th May 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir David. I congratulate my hon. Friends—they are my friends—the Members for Congleton (Fiona Bruce) and for Strangford (Jim Shannon) on two excellent speeches. It is very good to see the Minister, who I know takes this area seriously. She has responded to other debates of this nature in Westminster Hall, and is a deep and serious thinker on these issues. We are lucky to have her responding to today’s debate.

The debate quite properly has marriage in its title, because it is National Marriage Week, and mental health, but every single Member in the Chamber, myself included, is here for every type of family. We are here for every one of our constituents, whether they are married, single, cohabiting, widowed or divorced—whatever their state. It is important to put that on the record, because occasionally such debates, and this issue, can end up in an unnecessary culture war. That is not necessary. We have moved on. As MPs, we are for absolutely everyone. However, it is also right that at least once a year we come to the important issue of marriage.

On the cross-party consensus, I was really encouraged, as the vice-chair of the all-party parliamentary group for the prevention of adverse childhood experiences, that I, as a Conservative, could sit down recently with a Labour Front Bencher and a Liberal Democrat MP. The three of us, from different parties and traditions, were united in wanting to do more to promote couple stability, because we understand the links with inequality and poverty. I think all three of us would describe ourselves as true social justice warriors, as the hon. Member for Strangford mentioned. It is really important to put that on the record.

In 2016, 47% of all children in single-parent families were living in poverty. Frighteningly, the Resolution Foundation recently predicted that children in single-parent families will make up two thirds of all children living in poverty. Like every Member in the Chamber, I came into this House to eradicate poverty. That is the heart of what our politics are about. If children grow up in poverty, they do not have the life chances that we all want for them. They cannot make the most of their God-given gifts in terms of their education, career and contribution to their community.

I will focus on why this issue matters to Members in every party—the Scottish National party, the Democratic Unionist party, the Liberal Democrats, Labour and the Conservatives. I want us all to be united on this. We need to get behind the family/relationship aspect of poverty if we are serious about engaging with social justice issues and tackling poverty.

Given the fairly terrifying figures—currently, 47% of children in single-parent families are in poverty, which is predicted by the Resolution Foundation to rise to two thirds—we know that we want to try to keep mum and dad together in order to keep children out of poverty. Why, however, does marriage matter, and why have a debate on it? Is it not just another structure among many?

It matters for this reason: sadly, unmarried couples are six times more likely to break up before their child’s fifth birthday. If we are all on the same page in wanting to tackle poverty and reach a serious, evidence-based recognition of the fact that family breakdown, and the increasing numbers of children in single-parent families, is a major contributor to child poverty, we need to look at the type of relationships that will give our children the best chance of not growing up in poverty.

At this point, there is always a bit of challenge in the argument. “Okay, those are the facts,” people say, “but is that correlation or causation?” In other words, do a particular type of people decide to marry, which is why fewer of them are in poverty? I agree with my hon. Friend the Member for Congleton that we should dig into the data and compare like for like—people living in the same circumstances. I am absolutely assured by the researchers I have spoken to over the years that marriage still has a protective effect against child poverty in low-income communities, which many single-parent families live alongside.

That, in essence, is why marriage matters. If people accept my argument as I have laid it out so far, we need to be concerned about a number of facts. First, the marriage rate itself is in free fall; the figures show that it is really declining. As I said, I am genuinely delighted that today’s Minister will respond, because I know that she cares about this issue. I suspect that she was asked to reply to the debate because of the mental health part of the title. Had the debate been just on marriage, I wonder which Minister the Government would have put forward. I hope that it would have been her; perhaps it would have been someone else.

We might have had the new Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Colchester (Will Quince), as family policy is currently centred in that Department. However, if we are a Government and a Parliament that is four-square behind bearing down on child poverty, this issue needs to be at the heart of Government policy, not tucked away in one or two Departments. To my mind, it should be in the Cabinet Office, and there should be regular accountability through the Cabinet Office of all Government Departments on what they are doing in this area.

Statistics from the Office for National Statistics show that the marriage rate is in free fall. However, it is even worse than that because, as my hon. Friend the Member for Congleton said, marriage rates among the better-off are holding up quite well. A company director or university lecturer is 48% more likely to be married than a building worker or office cleaner, and that gap is growing. In 2000, the gap was only 22%. Basically, marriage is almost completely disappearing from low-income communities. We have to call a spade a spade and recognise that fact.

I am really pleased that there are Labour Front Benchers who understand that fact and are concerned about it, because if we are to bear down on child poverty, we have to use every tool in the kitbag. Certainly, the Government, the welfare system, schools, youth clubs, community groups, the voluntary sector, the health service and all manner of different central Government and local government institutions have a role. However, we cannot ignore what is happening in our families up and down the country if we are really serious about this issue. The Marriage Foundation tells us, in a similar statistic put another way, that 87% of mothers from high-income groups get married, as opposed to only 24% from the lowest-income groups. We have to do something about that.

I am grateful to Tavistock Relationships for the briefing that it gave me for the debate. Its representatives sent me some research from Paul Amato, who they say is generally recognised as one of

“the world’s leading researcher on marital quality, divorce, and other family related issues”.

His research has shown that common mental health problems are much

“more prevalent in people who are experiencing relationship distress than those who are happier in their relationships”.

He warned against viewing marriage and cohabitation as interchangeable, stating that

“we should consider the fact that cohabitations are less stable than marriages”,

as I pointed out a moment ago.

Tavistock Relationships has a particular ask of the Department of Health and Social Care, because it believes that the huge overlap between relationship distress and depression is being largely ignored by the NHS. It points out that within the excellent IAPT— improving access to psychological therapies—programme, only 49% of the relevant NHS services provide couples therapy for depression. It is calling for that figure to be increased to at least 90%, although it would be best if couples therapy were universally available. I ask the Minister to take that point back to her Department.

Like my hon. Friend the Member for Congleton and the hon. Member for Strangford, I pay tribute to the many organisations up and down the country that are working hard to strengthen relationship quality and provide relationship support and education. They should be much more prominent in our national life and much better known in Whitehall and Westminster.

In no particular order, let me mention the four organisations that make up the Relationships Alliance: Relate, which is perhaps the best known and the largest, Tavistock Relationships, which I have already mentioned, Marriage Care and OnePlusOne. They are fantastic organisations and are at the front and centre of dealing with these issues and providing support day in, day out. In my view, they need to play a more prominent role in our national life in the fight against child poverty, because they are absolutely part of the solution.

I would like to mention the work of Nicky and Sila Lee, who run the marriage preparation course and the marriage course. I will also namecheck Jonathan and Andrea Taylor-Cummings of Soulmates Academy, which my hon. Friend the Member for Congleton mentioned. I commend them for their recent TED talk on this important subject and for their excellent work, particularly with employers. Many employers are beginning to realise that there is not a watertight seal between what happens at home and at work. Relationship distress and emotional distress at home have an unquestionable impact on performance and productivity at work.

We need the private sector to get a bit more engaged in the issue, because it is not just about the Government. Everyone always asks the Government to do everything, and while the Government have a role, employers and those in the private sector need to get with the programme and realise that they have a role to play too, alongside the community and the voluntary sector.

I will make a silly analogy that some colleagues will have heard before. I would guess that most of us in this Chamber own a car. It is the law that every year we have to give that car an MOT. We spend time and money taking it to the garage and having someone check under the bonnet so that the car is serviceable to go back on the road for another safe year’s motoring, which is the object of the exercise—and quite right, too. Should not our relationships and marriages have the same treatment? Are they not just as important?

I use the phrase “marriage MOT” or “relationship MOT”. Some people may have done a little preparation before getting married, but will that last a lifetime? In my own marriage, I have got into bad habits and have had to be corrected by my wife or by good friends. I have gone on marriage MOTs from time to time with my wife and with other couples, and have found them helpful. We should try to make that more normal and mainstream. It is not just about therapy, but about something that all of us need: a little advice and assistance to get out of bad habits and maintain good ones. I am grateful to my hon. Friend the Member for Congleton for mentioning some of the practical things that are involved.

Research shows that the No. 1 reason why children present at child and adolescent mental health services is family relationship issues at home. The hon. Member for Strangford spoke about the huge growth—the epidemic—in children’s mental health issues, which can extend until they are university students. Recent studies have shown that a quarter of all young women at university and in their early 20s experience some form of mental health issue. Very often, family relationships are at the core of those issues.

I will conclude with a quotation from an excellent article by Ed West that appeared in The Spectator in December 2017. The Spectator is not a magazine that I read very regularly, but I commend the article to anyone who is interested. I will read out his final paragraph, because I found it so striking. On the subject of marriage, he writes:

“How much does the government care? The answer is not very much. About a decade ago, David Cameron said he’d be the most pro-marriage leader the Tories have had in his lifetime, but his enthusiasm cooled quickly.”

Actually, I think that the last Prime Minister did some good things in the area. I would have liked him to do more, but I think that that criticism is a little harsh. The article continues:

“Jeremy Corbyn is unlikely to be talking about family values, which is a shame because a true social justice warrior would be obsessed with this issue. Marriage is becoming a luxury item, a trend that is likely to cause ever-increasing inequality down the generations. Any government that is genuinely concerned about helping those at the bottom should think about what it could do to make marriage for the many, not the few”—

a phrase that perhaps the Labour party could think about. I think that those are powerful words on which to conclude my speech.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 26th March 2019 Commons Chamber

[Stephen Hammond]

My right hon. Friend the Secretary of State and I have both had conversations with the Treasury and the Chancellor, and there are ongoing discussions.

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

The Government have done well to get more medical students into general practice, but we are not doing quite so well at retaining GPs later on. What more can we do to make sure that GPs stay in general practice, so that more of our constituents can go and see a doctor more easily?

[Stephen Hammond]

NHS Improvement has a number of retention schemes in place, for GPs and for nurses, to look at why some people are leaving. The interim plan being developed by Baroness Harding has an employer of excellence work stream, which will report on a number of potential issues.

Services for People with Autism

Andrew Selous Excerpts

Thursday 21st March 2019 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

I beg to move,

That this House has considered services for people with autism.

Every year, my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan), in her role as chair of the all-party parliamentary group on autism, moves a motion along the lines:

“That this House notes that World Autism Awareness Week runs from 1 April to 7 April; observes that autistic people continue to face a number of barriers to full participation in society; notes that it is 10 years since the Autism Act became law; and calls on the Government to improve support for children and adults on the autism spectrum, and ensure that the Autism Act is fully implemented across the country.”

My right hon. Friend cannot be with us today. She has asked me to explain that a close family member is critically ill and that she cannot leave their side. Though you, Mr Deputy Speaker, I send the love of this House to our right hon. Friend. She is a formidable champion of this cause, and someone to whom many of us have turned in our own hour of need. The best tribute that I can pay to her is to deliver the speech that she prepared and would have made today. These are her words:

“I welcome the Minister to the Front Bench and look forward to hearing what she has to say. My thanks to the Backbench Business Committee for granting this debate as we look forward to World Autism Awareness Week, a full seven days when people across the UK take part in activities to raise awareness of autism. I also thank the National Autistic Society for its ongoing support for the all-party parliamentary group on autism.

Hon. Members will be aware of my long-standing commitment to improving the lives of people on the autism spectrum, most notably through my role in spearheading the introduction of the Autism Act 2009—which has now been on the statute book for 10 years.

I was proud to introduce that Bill that became the only Act—which is the only Act dedicated to improving support and services for one disability. It was a landmark in the battle to improve the lives of autistic adults and their families. As a result of the Act, there has been a fundamental shift in how policy is developed and delivered for adults on the autism spectrum. For the first time, legal duties were placed on councils and the NHS to provide support to autistic adults in their local areas. In addition, the Act placed a responsibility on the Government to produce the national autism strategy, to set out its vision—and, importantly, to keep that strategy under review.”

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

Like my hon. Friend I pay huge tribute to our right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) and all that she has done on the issue for so long. I am listening carefully to my hon. Friend’s excellent speech, and I wonder what he would say to a constituent who wrote to me about her son. She writes:

“My son is 21 years old and since leaving education has had nothing to do. He is not disabled enough to qualify for benefits but he is not able to compete for a job. He is caught in the middle.”

What more does my hon. Friend think we can do to help people like that young man with their future?

[Huw Merriman]

I thank my hon. Friend for his words and for championing his constituents. As he rightly says, some autistic people tend to fall through the gaps. Of course, all local authorities have a responsibility to take note when it comes to autism. We see individuals who are on the autism spectrum but are not receiving help because they might be outside a defined period. The extension of plans up to the age of 25 will go some way towards addressing that, but we still see people falling through the gaps. I will touch on some of the other areas that might address his concerns, or I will at least make calls to those on the Front Bench.

My right hon. Friend the Member for Chesham and Amersham continues:

“This year, it falls on the Government once again to review its strategy and identify what more needs to be done.

Each of us has about 1,000 people on the autism spectrum in our constituencies and it affects one in 100 people. We each will have many autistic people and their family members contacting us to ask for our help on areas from education to adult support, diagnosis to employment...”

Dental Health: Older People

Andrew Selous Excerpts

Wednesday 27th February 2019 Commons Chamber

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

This Adjournment debate provides an opportunity to discuss a very important but often overlooked issue, which can have a major impact on the wellbeing of older people: their oral health. Many of us will have older relatives who have reached the stage where they need some extra support. It might be that they live in a residential care home, have a carer who visits them in their home a couple of times a week, or just require a bit of extra help from us personally to stay independent.

However, one issue that often slips under the radar when we think about an older relative’s needs is their oral health; it can often seem like a small issue, but in fact poor oral health can have much wider implications. Having a painful oral health problem can impact on someone’s ability to eat comfortably, to speak and to socialise with confidence, and on the ease with which they can take medication, something which may be a particular issue if an older person is living with other long-term health conditions. Maintaining good oral health can also become much more challenging for older people with reduced dexterity, who may for example have more difficulty with brushing their teeth. Furthermore, for the most vulnerable older people, such as those with dementia, who may have difficulty communicating where they are experiencing pain, an oral health problem can be especially distressing.

Ensuring that older people are supported to maintain good oral health, and have access to dental services when they need them, is therefore very important. However, while data on this issue is limited, the information that we do have suggests that these are areas in which we often fall short.

The Faculty of Dental Surgery of the Royal College of Surgeons published a report on “Improving older people’s oral health” in 2017, which estimated that 1.8 million people aged 65 and over in England, Wales and Northern Ireland could have an urgent dental condition such as dental pain, oral sepsis or extensive untreated decay. Moreover, the Faculty of Dental Surgery also highlighted that this number could increase to 2.7 million by 2040 as a result of several demographic factors, thereby increasing pressure on dental services in the future. As well as the ageing nature of Britain’s population, increasing numbers of people are also retaining their natural teeth into old age; while this is good news, it also means that dental professionals are facing new challenges as they have to provide increasingly complex treatment to teeth that may already have been heavily restored.

Separately, in 2014 Public Health England published the findings of research looking at oral health services for dependent older people in north-west England, which found that access to domiciliary and emergency dental care can often be very challenging for those living in residential care homes or receiving “care in your home” support services. More recently, Public Health England last year published the results of a national oral health survey of dependent older people living in supported housing. This revealed that nearly 70% of respondents had visible plaque and 61% had visible tartar, indicators of poor oral hygiene, and that in some parts of the country, such as County Durham and Ealing, over a quarter of dependent older people would be unable to visit a dentist and so required domiciliary care in their home.

It is difficult to get a complete up-to-date picture of the oral health needs of older people across the country, partly because there has not been an adult dental health survey for 10 years, an issue I will return to later. However, these figures, as well as anecdotal reports from dental professionals working on the frontline, suggest there is a real issue here which potentially impacts on large numbers of often vulnerable older people.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this important issue to the House. As he said, 1.8 million elderly people across the United Kingdom of Great Britain and Northern Ireland have problems, which is shocking. The hon. Gentleman outlined some of the solutions such as extra attention on domiciliary care and in residential homes, and for those at home and dependent on carers. Does he agree that older people’s confidence can also be diminished by not having their teeth correctly done? My mother went this week to have her teeth done; she is 87 years of age and she depends very much on her dentist. She has attended over the years, but many have not, and we need to have that care at all those different levels.

[Andrew Selous]

I am grateful to the hon. Gentleman for giving us his personal family experience of this issue.

There have been some welcome developments over the last few months, including the recently published NHS long-term plan highlighting oral health as one of the priorities for NHS England as it rolls out a new “Enhanced health in care homes” programme across the country. However, I would like to draw the Minister’s attention to five particular areas in which more could usefully be done: training for health and social care professionals; access to dental services; data; regulation; and the social care Green Paper.

First, on training, health and social care professionals regularly do a brilliant job of caring for older people, but as I have mentioned, oral health is one issue that can easily fall between the cracks, particularly if someone is living with a range of other health conditions that also require care and attention. One example of this is oral care plans. Ideally, whenever someone is admitted as a resident to a care home, their oral health needs should be considered as part of their initial health assessment. Those needs should then be reflected in an oral care plan that all their carers are aware of and that will, for example, set out whether the resident needs extra help brushing their teeth.

There is some good guidance from the National Institute for Health and Clinical Excellence, but this can often be overlooked. In Public Health England’s research in north-west England, 57% of residential care home managers said that they did not have an oral care policy, and one in 10 said that an oral health assessment was not undertaken at the start of care provision. Knowing how to provide good oral care is especially important when it comes to supporting those with more complex needs. For example, for those with dementia, electric toothbrushes can sometimes be quite intimidating, and it makes a big difference if a carer knows that they should use a manual toothbrush when helping with tooth brushing. More broadly, if someone who is living with dementia refuses oral care, this can become an obstacle to maintaining good oral health, so it is important that carers understand how to manage these situations, ideally with input from a dental care professional.

Equally, for those with dentures, it is important that training and procedures are in place to minimise the risk of a denture getting lost, even if this is a simple thing such as ensuring that they are kept in a jar by the bedside when not in use. A lost denture takes weeks to replace, and this can be a devastating experience for an older person who relies on them to eat and speak. This is particularly sensitive if someone is coming to the end of their life, when it may not be possible to manufacture a replacement in time as they spend their remaining days with loved ones. An understanding of good denture care is particularly important in these situations.

Improving awareness of oral health among health and care professionals should therefore be a priority, and was a key recommendation in the Faculty of Dental Surgery’s 2017 report. This highlighted schemes such as the Mouth Care Matters programme, in which mouth care leads are recruited to provide oral care training to staff in hospitals and care homes, and I would be interested to know from the Minister whether there were any plans to replicate such initiatives nationwide.

Secondly, ensuring that older people can access dental services when they need them is essential. It is not uncommon for people to think that if someone has no teeth, they cannot be experiencing pain or other oral problems. Sadly, this is not the case and they should still have an oral check-up once a year, not least because the majority of cases of oral cancer occur in people over 50. There are all too many tragic instances of an older person being diagnosed with oral cancer too late—the saddest two words in the English language—simply because they had not seen a dentist in a number of years. Attending a dental appointment can be a particular challenge for those with reduced mobility—for example, if they are unable to climb stairs to reach a dental practice on the first floor—in which case, domiciliary visits are vital. However, evidence suggests that access to domiciliary dental care can be challenging, particularly for those living in care homes or supported housing, and I would appreciate the Minister’s thoughts on how we can address this.

In 2015, Healthwatch Bolton reported that it was easier for a local care home resident to get access to a hairdresser than to a dentist. In 2016, Healthwatch Kent reported that care homes had told it about accessibility problems for wheelchair users within dental practices. In 2016, Healthwatch Lancashire reported that care home staff said:

“The residents don’t get regular checks; they are only seen when there is a problem.”

Healthwatch Derby was concerned about the lack of information for social care providers about how to access dental services for their residents. While the commitment in the NHS long-term plan to

“ensure that individuals are supported to have good oral health”

in care homes under the “Enhanced health in care homes” section is welcome, there is no mention of a similar commitment for older people who use domiciliary care agencies. Those people should not be forgotten, so what do the Government intend to do about that for domiciliary care agency users under the NHS long-term plan?

Thirdly, the intelligence around older people’s oral health is quite limited, making it difficult to build a full picture of the level of need or assess the barriers that older people face in accessing dental care. The most immediate action that could be taken to address that would be for the Government to commission a new adult dental health survey. It is one of the few resources to provide detailed, national-level data on standards of oral health among older people, and it is a key reference for many commissioners, policy makers and dental professionals. The survey has been conducted every 10 years since 1968, but the last edition was published in 2009, so a new one is due. However, the Government have yet to give any indication of when or if a new survey will be taking place, which is causing increasing concern within the dental profession, so an update on that would be most welcome.

There are other steps that would help to improve our understanding of such issues. For example, NHS Digital publishes a regular set of NHS dental statistics for England, which reports on the proportion of children aged zero to 17 who attended an NHS dentist in the preceding 12 months, as well as the proportion of adults aged 18 and over who attended an NHS dentist in the past two years. That data provides a useful measure of access, and expanding the figures to include attendance rates for older people would help us to develop a clearer picture of whether there are particular groups or areas where access to an NHS dentist is a problem.

[Jim Shannon]

Many elderly people are independent and proud, and one of the things that puts them off attending the dentist—I see this in my constituency—is that they think they have to pay for the treatment, but they do not. Perhaps we need to put out a reminder about that.

[Andrew Selous]

I am grateful to the hon. Gentleman for putting that on the record.

Fourthly, in addition to health services, care home providers and dental professionals, regulators can play an essential role by monitoring standards of oral care and driving improvements. The Care Quality Commission in England does not explicitly look at oral health during its inspections of hospitals and care homes, although I understand that it is doing a lot of work behind the scenes to try and push that on to the agenda for care providers, which is obviously welcome. Health and care regulators in other parts of the UK can also make a valuable contribution to ensuring that the importance of oral health is recognised by those that they inspect.

Lastly, I continue to look forward to the publication of the Government’s long-awaited social care Green Paper. Given the importance of oral health to our wider health and wellbeing, an all-encompassing model of care for older people must include dental services, so it will be important that the Green Paper clearly sets out how social care and dental services can work together in the future and what more can be done to ensure that older people have access to dental services when they need them. As I have mentioned, one of the most valuable things we can do to improve older people’s oral health is to ensure that it is not overlooked amid the many other issues that we are dealing with, and I hope that the Government will show leadership on that in the Green Paper.

Oral health can sometimes seem like a small issue, but it has a significant impact on quality of life. The Minister will be aware that we have spoken a lot in recent years about the need to improve children’s oral health, and quite rightly so, but it is also essential that we do not take our eye off the other groups who need support. For an older person who is in pain because of an oral health problem, finding it difficult to eat or speak, or who may be distressed at the loss of a denture that will take weeks to replace, such issues are very real. We can all contribute to addressing them, including Members who care for older relatives in our everyday lives. Indeed, the Faculty of Dental Surgery published some useful advice over Christmas about using visits to older relatives as an opportunity to check their oral health and for how to spot the signs that they might have an oral health problem. That is something that Members could do over Easter when visiting elderly relatives, and we could encourage our constituents to do the same. However, I hope that the Minister will recognise that Government also have an important role to play and will look carefully at what can be done to help improve oral care for our older people.

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

I realise that a debate on older people’s dental health is merely of passing interest to you, Mr Deputy Speaker, as you are many years from it being of direct interest, but I hope you enjoy my response.

I congratulate my good friend, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), on securing time for this debate and on setting out his case so clearly. I will do my best to answer his points in the time available. As he knows, I will write to him on anything I do not answer.

Oral health has improved significantly over the 40 years that I have been alive. At the start of the NHS—it is worth noting this incredible statistic—40% of the population had no natural teeth. The figure is now—answers on a postcard—6%. These massive improvements are to be celebrated but, of course, with improvements come new challenges.

As we are all aware, older people—we categorise those aged over 65 as older people for the purpose of this conversation—make up an increasingly large proportion of the population. By 2032, we project there will be 13.5 million people aged 65 and over in our country. Older people are retaining far more teeth, often heavily filled, than previous generations. As people age, so do their fillings and all the other bits of their bodies, and ongoing restorative work is needed.

Many older people live independently and are in full charge of their oral health, as are working-age adults, but we recognise that frail older people—those with additional needs, often living in care homes or supported to remain at home, as my hon. Friend set out—can face real barriers to accessing the appropriate care and support they need to maintain good oral and dental health.

My hon. Friend set out some of the reasons why good oral health is an essential part of active ageing. We know that poor oral health can affect an individual’s ability to eat, which can lead to an acute episode and an encounter with the tertiary sector, or even to speak and socialise. Obviously, poor oral health hits their confidence and then it spirals. For older adults who are frail, good oral health is particularly important to maintaining hydration and the ability to eat comfortably and easily, which helps them to stay healthy and independent for as long as possible, and even to stay well in a care home setting.

As we set out in our 2017 manifesto, we are committed to improving the nation’s oral health, from children right the way through to older people. The NHS long-term plan, published last month, set out our plans specifically to ensure that individuals in care homes are supported to have good oral health. My hon. Friend raised that point.

The long-term plan national implementation framework, due to be published later this spring, and the national implementation plan, due to be published this autumn, will provide further information on how the LTP will be implemented, but I will now turn to the five specific issues raised by my hon. Friend.

[Andrew Selous]

The Royal College of Surgeons obviously raised concerns about people who use domiciliary care agencies. While there is still time, will it be possible for the NHS long-term plan to address that issue, too, so that we look after all older people whatever type of care they receive, not just those in care homes?

[Steve Brine]

I will touch on that, but I take my hon. Friend’s point. I will make sure it is flagged up in writing as a note from me, the Minister, to the relevant officials as a response to this debate.

In 2016, the National Institute for Health and Care Excellence published its “Oral health in care homes” report, which was an important piece of work. As we know, it set out a number of recommendations for care homes to help maintain and improve oral health and ensure timely access to dental treatment for their residents. In dental health, as in every other part of health, prevention is better than cure.

I completely agree that we expect care homes to follow NICE guidance and NICE recommendations in this area, as in every other. Alongside the importance of appropriately trained staff, my hon. Friend makes an important point about the role regulators can play in this area.

The Care Quality Commission is responsible for this area, as it is for many other areas of policy, and it is currently looking in depth at oral health for older people in residential care settings, and much needed that is, too. So last autumn, the CQC’s dental inspection teams joined adult social care inspectors on visits to about 100 care homes to gain a better understanding of the oral health care support for residents. I know that the CQC intends to publish the findings later this year. I have asked to be kept updated on the progress of this work and to have early sight of its findings. I will update the House and my hon. Friend in particular on this, given his interest and the fact he is a member of the Health and Social Care Committee. I will make sure the rest of the Committee are aware of this as well.

We should also recognise and highlight the ongoing work of NHS England and Public Health England, which I sponsor within my portfolio, to improve the oral health of vulnerable older people. As is referred to in the long-term plan, NHS England considers oral health for older people, particularly those in care homes who may be vulnerable, an important issue. I have asked also to be kept updated on progress as NHS England takes forward action on this and other areas highlighted in the plan.

Public Health England has published “Commissioning better oral health for vulnerable older people”—a snappy title—which is designed to support commissioners of services to improve the oral health of vulnerable older adults so that they can lead a healthy, long and meaningful life outside the acute sector. My hon. Friend highlighted the Mouth Care Matters programme, which, as he says, is a local training initiative from Health Education England offering support and training in oral healthcare for the elderly and for hospital staff looking after patients who may need help with mouth care. I know the programme has been very successful locally in Kent, Surrey and Sussex. Decisions on whether to extend the training more widely are for HEE, but I would hope the success of the programme to date means that HEE is able to take it forward to new areas in the longer term, including to his county. I cannot give the nationwide answer that he asked for in his speech, but I suggest that the early signs are positive.

On access to dental services currently, NHS England is legally responsible for commissioning services to meet local identified need, and that includes the commissioning of domiciliary care services, where appropriate. However, it is important to say that where residents can, the care home and the local NHS work together, often very successfully, to ensure that dental services are provided in the most appropriate setting for those residents, whether that is within the care home itself or in a dental practice, or provided by the community dental service. Often people in care home settings will enjoy the trip out to the dentist; it is part of their socialisation and their routine, and we should not overlook that.

I note my hon. Friend’s concerns about the availability of oral health data, particularly for the older age groups. I agree that the adult dental health survey is an important tool for understanding oral health changes over time. I can reassure him that although there is not yet a date set for the next survey, no decision has been taken to discontinue this important source of information. I take this debate as a bit of a nudge to ask more questions about this. If my hon. Friend looks at my track record, for example, on the cancer patient experience survey, which I was clear was an important tool to give me information about cancer patients’ experience, he will see that I place value on such patient health surveys. In the shorter term, I agree that the regularly published NHS dental statistics on numbers of people seeing an NHS dentist could provide more helpful information by analysing the data by age. I am going to ask my officials to work with NHS England and NHS Digital to pursue this further, and I will ensure that my hon. Friend is kept informed on that point.

My hon. Friend made a point about the social care Green Paper, which remains very much a priority but is not yet in reach. The Green Paper will cover a range of issues that are common to all adults with care and support needs, and will bring forward proposals to ensure that we have a social care system in which people know that the care they receive will help them to maintain their independence and wellbeing, and that we have a social care system that we can be proud of. We will publish the document shortly, and it will set out proposals to reform the adult care system. I take the points made by my hon. Friend about the importance of including dental and oral health in the Green Paper. I will make sure that a copy of this remarks is sent to the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage).

In the remaining few minutes, I wish to touch on the prevention Green Paper. We set out our prevention strategy last year, and it is one of the Secretary of State’s three priorities. We are now in the process of developing the prevention Green Paper, which is an exciting piece of work with which to be involved. It will be called “Prevention is better than cure” and will do exactly what it says on the tin. I will engage with key dental stakeholders—including the British Dental Association, Mr Deputy Speaker, so there is no need to tweet me—in the coming weeks. I look forward to those engagements.

In conclusion, although I am disappointed not to have heard from the hon. Member for Strangford (Jim Shannon) during my speech, I know he has already intervened, and I am pleased that we have had the opportunity to discuss these issues. I think this is the first time I have responded to an Adjournment debate on this subject, and I have responded to quite a few. I hope I have been able to demonstrate the Government’s commitment to improving oral health. Of course there is more to do, and that commitment absolutely includes work on the oral health of older people in care homes, as set out in the long-term plan, and in domiciliary care settings. Our plans to engage in the coming weeks with key dental stakeholders on the development of the prevention Green Paper are honest and sincerely meant. I will continue to watch the work of the CQC and the outputs of its report with interest, and I will follow up on the dental survey so that we have the key data we need to improve services for the people we are here for—our constituents.

Question put and agreed to.

Early Parenthood: Supporting Fathers

Andrew Selous Excerpts

Wednesday 30th January 2019 Westminster Hall

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

It is a pleasure to speak in this debate. I begin in the same way as my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) did, by saying that we are all here for mums as well, including single mums. In fact, the last debate of this nature that I shared with the Minister was on maternal perinatal mental health. A number of men led that debate, so it goes without saying that we are all 100% behind mums and single mums, just as we are behind dads.

Mums need support, so an important issue is involving fathers and helping them to play their role in equal parenting, which is a really important phrase—I am glad it has been introduced several times in this debate. We know from the research that we are not getting this right at the moment, because 69% of fathers feel like a spare part. If fathers are supported and helped to be involved, as the vast majority of them want to be, they have the ability to offer round-the-clock support to new mums.

There are some worrying figures on what is going on at the moment. Looking at income groups, less than 31% of people earning under £20,000 turn up to antenatal classes; among those earning more than £70,000, more than 71% turn up. We are not managing to reach really important groups of fathers who need that support. The inspection framework does not look hard enough at what areas are doing to help fathers—indeed, fathers are absent from a lot of the inspection frameworks.

From Government research in 2012, we know that if fathers are involved in the care of a young child, parents are a third less likely to split up. When the Minister was recently before the Select Committee on Health and Social Care to discuss suicide prevention, she said that debt and relationship breakdown are the two major causes of suicide. That is a really powerful reason, with a number of important outcomes, as to why we should help fathers to be involved in the care of their new-born children.

In 2016, we set up a £39 million fund at the Department for Work and Pensions to reduce parental conflict in workless families, which was an excellent initiative that I really support. We need a second fund to improve the quality of relationships between couples who are at risk of separation when they have new children. There is evidence to support that, and I think there is an overwhelming need. It would be really helpful for mothers. I ask the Minister to take it back to the Department and to the inter-ministerial working group on the first 1,000 days, with which she is fully engaged. That would be a really good development.

I want to give a plug for a little programme called “Let’s Stick Together”. I am not allowed visual aids, so I better not hold it up, but the course reading material could fit into a purse or wallet very easily. I have personally handed a copy to our last two Prime Ministers and encouraged them to take it up across Government. It contains some really simple tips to help the quality of a couple’s relationship when they have a new child. I commend the work of the charity Dads 2 Be, which is active in a number of hospitals in south London. It focuses on antenatal work for groups of dads and helps them with the changes to their life, and also focuses on improving relationship quality. My question to the Minister is very simple, and it is my overriding plea to her: given that we are doing this in some NHS hospitals, can we please do it everywhere, throughout these islands, across the whole of our United Kingdom? It is sensible and a no-brainer. Dads want it, and we know there would be better outcomes for mums and children.

I commend some quite simple changes. A health visiting team in Lincolnshire managed to increase the participation rate of fathers in the primary birth visit from 20% to 70% by addressing their letter, “Dear new mum and dad” rather than just, “Dear parent”. That is a really simple thing and did not cost any money. It said very clearly to fathers, “We want you. You’re important and welcome. We expect and want you to turn up, and we’re here to help.” We can do some simple things that do not cost a lot of money; they just cost some political will. They are really needed, and I ask the Minister to do them.

--- Later in debate ---

[Eddie Hughes (Walsall North) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies.

I thank my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) for securing this excellent debate. As I have tweeted, what a great group of Conservative dads are supporting the debate, although I feel slightly unhappy about speaking after three people who are young enough to be my children. That makes me feel a little bit old. I wanted to contribute because my early career highlights the difficulty that dads can have. I thank my first wife for being kind enough to have our children on a Saturday evening, which meant I was dismissed from the hospital, and about an hour after my children were born I was in the pub with about 30 friends and family celebrating the birth. It all turned out damned convenient for me, although having heard stories from others, I appreciate it can turn out differently.

I started life as a civil engineer, working on a building site in an obviously male dominated environment. I will not make excuses for that, but construction, particularly the very large-scale construction I was involved in, has a particular nature. The idea that I might have gone to work one day and suggested to my boss that flexible working would be a good idea, and asked whether I could come in a bit later, is incredibly difficult. By the time I was 25, I was running a building site with a gang of up to 50 blokes who would have thought I was crazy. We were on site at 7 o’clock in the morning in a process that meant that if someone did not turn up and do their job at a particular time, other people would not be able to do theirs.

Fortunately for me, I decided that working outside was too cold, and joined an American company called Cartus, where I was responsible for maintenance of the properties in its portfolio nationally. I found the world to be a completely different place. It was a much more welcoming environment with regard to flexibility in the workplace, but I may not have appreciated at the time the majority female workforce. I mention that because, in preparation for this debate, I read documents and papers from around the world, and I had not realised how difficult legislation is in America. I read a paper from the National Bureau of Economic Research, published in 2015, when a form of parental leave was just being introduced in California. The early research from that paper showed that if parental leave was introduced, fathers were more likely to be engaged in parental support, and that, interestingly, fathers are more likely to take up that parental leave for their first child or if the child is a boy.

Clearly, there is some work to be done to ensure that men do not lose interest after the first child and that they take equal interest in daughters and sons. I have one of each, and I appreciate the stress that goes with having a daughter. She seemed considerably more difficult for me to manage and look after than my son did. It is interesting that research suggests that there might be a difference in the way they are treated.

Government have a role to play, and that does not always have to cost money. We need to show intent; we need to show men that they have a role to play and that it is important in the 21st century that they play it to their fullest ability. For that not to be the case seems counterintuitive. I loved my role as a dad; in fact, I told colleagues earlier that I am ready to be a grandparent and I have made sure my children are aware of that. There is no rush, but I will be ready when they come. Indeed, the hon. Member for Hampstead and Kilburn (Tulip Siddiq), who recently gave birth, sent me a photo, which made me immediately feel paternal.

We have a role to play, but what will we do to play it? Documents have been mentioned, and “A Manifesto to Strengthen Families”, published more than a year ago, has some excellent ideas for Government to follow. As has been mentioned, we have a more significant male population in prison, so it is very important to ensure that men do not lose contact with their families. To reduce reoffending rates, we need to maintain that bond.

[Andrew Selous]

My hon. Friend may not be aware that the Ministry of Justice commissioned the Farmer review, which offered 21 recommendations to strengthen the family relationships of prisoners, because there is evidence that that leads to less reoffending and keeps us all safe. The Ministry of Justice has adopted those 21 recommendations, so there has been some progress made in that area.

[Eddie Hughes]

It is excellent and reassuring to hear of that progress. The point was also made about the amount of paternity pay—£145.18. When I started work on a building site, I earned £50 a day, so £250 a week. Even 30 years ago, it would have been very difficult for me, as a young man starting off with a young family, to cope on a reduced income of £145, for a couple of weeks. It is great that the opportunity is there for men to take two weeks of leave, but it is important to try to make sure that is not financially difficult.

This is a complicated area, so I conclude by referring my constituents in particular to the website of the Share the Joy campaign, where they can find more details of their rights with regard to maternity and paternity leave. They can get more details about sharing parental leave up to 50 weeks, so they can take leave together and share the parenting experience very early on in their children’s lives.