Oral Answers to Questions

Anthony Mangnall Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Andrew Stephenson]

The Prime Minister has been very clear that getting waiting lists down is one of his top priorities, but he has also been clear that performance has been disappointing. One reason is that 1.4 million procedures have had to be rescheduled because of industrial action. I would gently ask the shadow Secretary of State whether he condemns those strikes.

[Anthony Mangnall (Totnes) (Con)]

3. What assessment she has made of the adequacy of oversight mechanisms for the General Medical Council.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

The General Medical Council has been constituted by Parliament to ensure that decisions about individual doctors are independent of both the profession and the Government of the day. The Professional Standards Authority oversees the work of all United Kingdom professional regulators and reports to Parliament on their operational performance. Parliament continues to set and oversee the principles and scope of the regulators’ powers.

[Anthony Mangnall]

Good governance means ensuring transparency, and one concern of my constituents is whether GMC decisions can be appealed. Will the Minister reassure me that we can have better transparency in the GMC on the decisions that it makes?

[Andrew Stephenson]

The GMC and other professional regulators have a statutory duty to investigate any concerns about the fitness to practice of one of their registrants and to take appropriate action to protect the public when that is needed. The regulators are overseen by the Professional Standards Authority for Health and Social Care, which has the power to appeal cases where, in its view, a sanction imposed by a regulator is insufficient to protect the public.

Tobacco and Vapes Bill

Anthony Mangnall Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Victoria Atkins]

No, because, as I have said, the modelling suggests that among the younger generation smoking levels will be close to zero by 2040. As for the hon. Gentleman’s point about tax, I do not remember him voting against the Government’s furlough scheme and other support during covid; nor do I remember him complaining that we were trying to help people with the cost of living. We as Conservatives understand that this is sound money, rather than the magic money tree that will somehow fund Labour’s £28 billion black hole.

[Anthony Mangnall (Totnes) (Con)]

I am somewhat perplexed by this debate, and indeed by the Bill. I do not consider it to be enforceable, and I also think it fails to take into account the effective tax measures and health campaigns that have been run by successive Governments to reduce the number of smokers. Nor does it respond to the fact that, in the long run, bad and poor diets are likely to kill more people than smoking. According to a recent study conducted by the Institute for Health Metrics and Evaluation in Seattle, more people are dying from malnutrition than from smoking. There is a principle at stake here: should the Government step in and deal with people who are eating unhealthy food?

[Victoria Atkins]

I am, of course, responsible for healthcare in England, so I will not trespass on the health needs of people in—as I think my hon. Friend said—Montreal. As for the Bill, it is intended to help children and young people to end their addiction to nicotine, which we know is one of the most addictive substances. As I said earlier, we should not assume that decreases in smoking rates such as those we have seen are inevitable; indeed, I have cited countries in which we have seen an increase. We also know that tobacco is being consumed in ways that are different from the ways in which it was consumed, say, 20 years ago. My hon. Friend the Member for Cities of London and Westminster (Nickie Aiken), for instance, mentioned the rise of non-cigarette tobacco smoking. We are trying to address that, for the health of the individual as well as the wider health of society.

NHS Dentistry

Anthony Mangnall Excerpts

Tuesday 9th January 2024 Commons Chamber

[Anthony Mangnall (Totnes) (Con)]

Will the hon. Gentleman give way?

[Wes Streeting]

I will, so that the hon. Gentleman can explain why that is the case.

[Anthony Mangnall]

Is there any greater landmine of a Labour legacy than the 2006 contract that it designed, which is pulling us down? Labour Members need look no further than their own designs on the NHS. We are sorting out their mess.

[Wes Streeting]

The sound you can hear, Mr Speaker, is the scraping of the barrel. How has the hon. Gentleman got the brass neck to stand up, after 14 years of his party in government, and say that a contract agreed in 2006 is the problem? If only the Conservatives had been in government for 14 years to sort it out.

Here is the other rub: we do not pretend that everything was perfect under the last Labour Government. In fact, reform of the NHS dentistry contract was in Labour’s 2010 manifesto, because we recognised that it needed to change. Had we been elected in 2010, we would have delivered. It was also in the Conservatives’ 2010 manifesto and 2015 manifesto. It was probably in the 2017 and 2019 manifestos, too, and they have not delivered. We have 14 years of Conservative failure. How dare the hon. Gentleman have the brass neck to stand up and blame someone else.

--- Later in debate ---

[Victoria Atkins]

I am grateful to the hon. Gentleman for raising that point, because according to the latest statistics available to me, 18.1 million adults were seen by an NHS dentist in the 24 months up to 30 June 2023. That is an increase of 10%, and what does it mean in reality? It means that over 1.7 million more adults were seen than in the previous year. I know that we are all concerned about the health of children; some 6.4 million children were seen by an NHS dentist in the 12 months up to 30 June 2023, an increase of 14%, which means, in real terms, an increase of 800,000 on the previous year.

I accept, of course, that there is more to do, and we will be setting that out in our dental recovery plan shortly, but this is not just about big numbers. [Interruption.] The hon. Gentleman asks when “shortly” will be. As he knows full well, “shortly” is a little shorter than “in due course” and a little longer than “imminently”.

We have introduced several simple and effective measures to improve the nation’s dental health. The Health and Care Act 2022 made it simpler to expand water fluoridation schemes, because raising the fluoride level to 1 mg per litre is a straightforward way to prevent tooth decay. It has proved effective in parts of England as well as Canada, the United States, Ireland and Australia, and the chief medical officer has concluded that there is “strong scientific evidence” that water fluoridation can drive down the “prevalence of tooth decay”.

[Anthony Mangnall]

I congratulate the Secretary of State on the progress that has been made, while, obviously, recognising that there is more to be done. I wonder if she will help me to ask the shadow Minister to correct the record. He said that in 2010 and 2015 Labour had a plan for dental practice, but there is no mention of that in the Labour manifestos. I will come back and correct that if necessary, but the hon. Gentleman is out there stating that Labour has had a plan for dental recovery since 2010, and that is not in those manifestos.

[Victoria Atkins]

My goodness me! My hon. Friend has identified a “cavity” in the shadow Minister’s so-called plans.

--- Later in debate ---

[Anthony Mangnall (Totnes) (Con)]

It is a pleasure to speak in the debate and to raise the issues that so many people face across the south-west and south Devon, many of whom are in immense pain. I will start by responding to some of the remarks made earlier in the debate. It is acceptable to make the point that the NHS contract from 2006 does not work and has not worked. It is acceptable to say that we tried to make it work, and we hit an enormous roadblock in the form of the pandemic, which has shown the system to be wanting. None of those are controversial statements to make.

Labour should not be outraged when we ask for their plans. Time and again, Labour Members go in front of the cameras and say they have a plan for this and that and everything we might possibly imagine, so we therefore should be able to ask them, given that this is their debate. They can laugh, as they are doing now, or smile about this, but it is a serious and legitimate question. If they are a Government in waiting, they should come up with proposals for a short-term solution to this issue.

The shadow Health Secretary, the hon. Member for Ilford North (Wes Streeting), decided to tell me that he and the Labour party have been talking about this issue since 2010. Indeed, he said it was in their manifestos in 2010 and 2015. I cannot find any record of it being in their manifestos. In fact, it is hard to actually see when the shadow Health Secretary even cared about this issue before his appointment, but I will leave that to others to make clear in the course of the debate.

My right hon. Friend the Secretary of State made perfectly clear the challenges we face. She made the point clearly that there have been some improvements, but no Conservative Member is complacent. We are all aware of this, because we speak to our constituents and look at our email inboxes. We are aware of the size of the trouble and problems being faced. It should be welcome that we are now pushing taxpayer-funded dentists who have been in training to work within the NHS at the end of their training. It should be welcome that there are 40% more dental training places and that we are looking at ways in which we can bring dentists from abroad, as well as creating training places right across the country. I welcome the report and comments by the Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester (Steve Brine).

All of that boils down to what we think the priorities of NHS dentistry should be. Simply put, having spoken to many dentists in my constituency, the priorities boil down to three areas: prevention, education and pain relief. [Interruption.] I do not think many people are looking to disagree on that point, but if the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) wants to disagree with me, she can. The point is that the pandemic has blown two of those priorities off course. The focus for the short term must be how we address pain relief. That is the issue we face today, and children and those of an older age are suffering from it across the country.

What are the short-term actions that we can take today? They have been mentioned by many Conservative Members. We can look at dental access centres and mobile units that can move across the country. We might think those are fantasy, but they are already in practice in some places in the country. Indeed, they have been raised by a number of dentists in my area of south Devon, who suggest that they are not just feasible but incredibly possible with the underspend that has not been utilised. We must unlock the money that has not been spent through NHS contracts. I am sure my hon. Friend the Member for North Devon (Selaine Saxby) will correct me if I am wrong, but I understand that some £50 million of underspend on NHS dentist contracts could be made available to help those on waiting lists.

As a number of Labour Members have said, we must allow dental therapists to play a larger role in helping treat people within the process and address their needs. As I have said, we must focus on pain relief as the priority. Reform of UDAs has to happen as quickly as possible. The time and geographical disparity means the system has been found wanting, and it is clear right across the country—whether in urban, rural or coastal community settings—that there are huge disparities in remuneration for a UDA. Rather than standing here and speaking about parliamentary candidates, it is probably more appropriate to think about the solutions that we can find to help those who are suffering so much.

I will give examples of what is going on in Devon. We have 17,000 more UDAs, which is welcome. We have a dental care stabilisation system. We have 406 extra appointments per week, which can be found through contacting 111. We have one of the finest dental training schools in the form of the Peninsula Dental School, located just outside Plymouth. It is working to help address the need and to support the Government in helping areas across the country. It is looking to help ensure that its trainees remain within the area after their training, to make the NHS as flexible as possible to the needs of those who need to use it.

We must have reform. Many of us on the Conservative Back Benches agree that we must have the reforms that have been promised before, because they are the hook that we can hang our hat on, and they will be the solution. If the Minister could look at the short-term solutions I have proposed and give a response, that would be welcome not just in my part of the country, but all across the country.

Hospice Services: South Devon

Anthony Mangnall Excerpts

Wednesday 29th November 2023 Westminster Hall

[Kevin Foster (Torbay) (Con)]

I beg to move,

That this House has considered support for hospice services in south Devon.

It is a genuine pleasure to serve under your chairmanship, Mr Sharma. It is probably worth saying in my introduction why I brought forward this debate. At its root is a subject we often do not want to talk about: the end of life, and death. It can be uncomfortable; there may be people listening to this debate who are facing a difficult illness, whose prognosis is uncertain, or for whom discussion of hospice services brings up memories of the loss of a loved one. This is never a subject we can discuss without doing this, and this effect includes me.

My mother, Linda, passed away in St Luke’s Hospice in Plymouth back in January 2014. This week would have seen my parents mark their golden wedding anniversary. My step-daughter, Anne, was also supported by both a hospice and NHS palliative care services prior to her death. These experiences are why I want to be sure hospice services will be there when they are needed, at what will be the most difficult time in anyone’s life, ensuring that not only the patient is supported, but their whole family is, too.

Debate on hospice services in south Devon must start with mention of the services provided by Rowcroft Hospice in Torquay. Established on 4 May 1982 and located in 23 acres of beautiful gardens, it delivers specialist palliative care, free of charge, to more than 2,500 adult patients each year, across 300 square miles of Torbay and south Devon. It does this 24/7, 365 days a year, with a clinical and professional staff supported by a small army of volunteers who give their time simply with the aim of helping others in need. The hospice is also innovative in its approach to supporting our whole community, having recently launched a new project to support homeless communities across south Devon. Funded by the Masonic Charitable Foundation, the project is a collaborative initiative working in partnership with other charities and organisations that support homeless people in the region, with the goal of improving access to end of life care and palliative care for them.

A debate on hospice services in south Devon should also include a mention of the vital support provided by Children’s Hospice South West, one of the largest children’s hospice organisations in the UK, which provides vital support to children with life-limiting diseases across the whole of the south-west peninsula. The charity, which Eddie Farwell and his late wife founded in 1991, offers care and support to around 600 children from their three hospices located in north Devon, north Somerset and Cornwall. They are currently supporting 29 children from Torquay postcodes, and a further 63 from the EX and PL postcodes, which cover south Devon.

[Anthony Mangnall (Totnes) (Con)]

I thank my hon. Friend not only for calling this debate but for his wise speech on an important subject that is often not talked about out in the public. I commend him for his reference to Rowcroft Hospice and the services that are provided across the south-west. He may intend to do so, but I encourage him to ensure that a collaborative approach is also supported by Government funding, and that we can bring Ministers down to see what is going on in the south-west and how our services are actually leading the charge in the UK in terms of high-quality hospice care and supporting those most in need.

[Kevin Foster]

I always welcome an intervention from my hon. Friend, who is absolutely right that we are seeing leading work. He will be unsurprised to hear that later in my speech I will refer to some of that and invite the Minister to see for herself what is being done.

Hospice services provide vital support to those with life-limiting conditions, but they do face challenges themselves. In terms of their income, a Hospice UK survey in March 2023 revealed that 96% of hospices were budgeting for a deficit. While some of this confirms planning based on the likelihood of receiving bequests from wills, which for obvious reasons cannot be specifically predicted, it reflects the way hospices must continually look for support to maintain their services. There is also strong regional variation in the percentage of statutory funding; to be clear, this is a balance between NHS funding, contract funding and the fundraising income they receive. The variation in the percentage of support provided through statutory funding is significant: for example, in London this accounts for an average of 43% of funding, whereas in the south-west it accounts for just 24%—the lowest overall percentage rate, which it shares with south central and Wales.

The range of statutory funding percentages for individual hospices is worth noting, with 23 getting over 50%, while 85 get less than 32% of their funds from statutory sources. I accept that fundraising abilities vary depending on the community and the type of services, as well as the type of services being contracted, but these figures are very stark in their difference.

Oral Answers to Questions

Anthony Mangnall Excerpts

Tuesday 6th June 2023 Commons Chamber

[Steve Barclay]

Chorley is extremely important, Mr Speaker—I am very sighted on that.

Our commitment is that that is part of the new hospital building programme. We said that it is part of the rolling programme, so it will not be completed by 2030 but we are keen to get work started on it, and that is exactly what we will be discussing with Members of Parliament in the weeks ahead.

[Anthony Mangnall (Totnes) (Con)]

12. When he plans to publish a dental recovery plan.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

Our dental plan will be out shortly. We are already taking steps to reform the contract. We have created more bands for units of dental activity, to better reflect the fair cost of work and to incentivise NHS work. We have introduced a minimum UDA value to sustain practice where it is low, allowing dentists to deliver 110% of their UDAs. As a result, the amount of dental activity being delivered is up by about a fifth on a year ago, but we know that we must go further.

[Anthony Mangnall]

I welcome the Minister’s response and his comments in a recent Westminster Hall debate. It is clear that there is still a problem, and many of us are still asking for the recovery plan to come forward. I am afraid that “soon” is not good enough. Nearly every single one of the NHS dentists in my constituency is either not taking on new patients or leaving the area. “Soon” needs a date. Can we have this plan either immediately or sooner?

NHS Dentists: South-West England

Anthony Mangnall Excerpts

Wednesday 24th May 2023 Westminster Hall

[Chris Loder]

I thank my hon. Friend for her kind intervention, and I wholly agree. Her constituency of North Devon is not dissimilar to mine; we share many challenges and many wonderful things. I am sure the Minister has heard what she has to say, and I look forward to his contribution.

Without a dental school in Dorset, recruitment continues to be a real problem, as staff often leave the county, and indeed the region, after receiving their training. That leaves Dorset residents short-changed, especially given that our council tax is among the highest in the country.

The third impacting factor is the backlog following the covid-19 pandemic. We are all well versed in that, but I wonder whether we fully appreciate the pressure on dental services since then. It is estimated that as many as 40 million NHS dental appointments have been lost since the start of the pandemic, and that is exacerbated by the fact that 45% of dentists in England have reduced their NHS commitments since the start of the pandemic, which puts more pressure on an already strained system. A reported 75% of dentists say that they are thinking of reducing their NHS commitment this year, so it is important to look at what needs to be done to help the dentists still committed to NHS work and the people up and down the country—particularly in the south-west—who rely on those services. To my mind, there are two primary actions: contract reform and quick investment.

There are clearly a number of issues with the NHS dental contract, as we have said. I recently wrote to all 17 dental practices in my constituency, and I am in regular dialogue with the local integrated care board, and they all tell me that the dental contract needs urgent reform. It seems that the current terms of the contract make it incredibly difficult for local boards to recruit new dentists to meet local demand. I worry that the situation for our integrated care boards is not sustainable and could become worse.

The contract also seems to include irregular and sometimes near-nonsensical patterns of remuneration, which are undoubtedly playing on the minds of dentists considering their commitment to NHS work. For instance, dental practices are often remunerated for one filling only, regardless of the number of fillings needed for a given patient, which reduces the incentives for dentists to stay working with the NHS. That cannot be right.

Behind-the-scenes work is often missed when the work that a practice has carried out is calculated. For example, if a patient were to require one X-ray examination, two fillings, one extraction and two appointments for root treatment, that would total more than four hours of clinical time and would be counted as five units of dental activity or UDAs, which is the way that the NHS measures practice activity. Not included are the cost of materials, the nurses’ time setting up the procedures or the receptionists’ time booking the appointments and chasing patients should they not attend, all of which are hidden from the current contract. Transparency is key. As part of a wider reform of the NHS dental contract, West Dorset constituents who have got in touch with me would appreciate greater transparency in the requirements for such treatment.

One of my constituents recently had an abscess in their jaw. Like many in that situation, they called the nearest dental practice. As I said earlier, there was a 22% chance that they would be told that the practice had gone private, a 42% chance that they would be told that it was closed to new patients, and a 50% chance that they would be added to a 12-month waiting list, leaving them with an abscess until this time next year. Fortunately, those things did not happen. My constituent got through and made an appointment, although the dentist informed them that they did not regard the situation as an emergency, so my constituent was forced to go elsewhere, which reset the clock on their waiting list.

The dental practices that have contacted me have also shared stories of the abuse that their staff receive on a daily basis due to the lack of capacity, of how 111 continues to tell people to call their dental practices despite them not holding emergency contracts with the NHS, and of how the unfair UDA system acts as a direct negative contributing factor to the current situation faced by NHS dentistry.

Reformation of the service is clearly vital. When we previously debated the Health and Care Act 2022, I said that simply throwing money at the problem will not make it go away. Yet funding is, of course, the other vital area of improvement in this equation. Between 2010-11 and 2021-22, total funding for dental services in England fell by 8% in real terms, from £3.36 billion to £3.1 billion. Further, where practices have underperformed in the past, NHS England have not released the funding, resulting in an underspend of the national dental budget. I therefore urge the Minister to maintain his commitment to reforming the unpopular 2006 dental contract, to make vital and necessary changes to unfair remuneration, and to act before the situation gets any worse and more dentists are lost. That is very important.

[Anthony Mangnall (Totnes) (Con)]

I apologise for interrupting my hon. Friend’s concluding remarks. Does he agree that it is also worth considering whether we can improve the role of dental therapists so they can take on some of the roles, whether the £50 million underspend in the south-west should be delegated across the whole area to deal with that issue, and whether those graduating from the Peninsula Dental School—something we are proud to have in the south-west—should be encouraged to stay in the area, given that the demand there is greatest? Above all, given my hon. Friend’s excellent speech and the points he has made, does he agree that the dental recovery plan, which we have been promised and for which we have been waiting for too long, must be brought forward immediately?

[Chris Loder]

My hon. Friend gives me no chance to do anything other than agree. He is right. I hope the Minister is hearing loud and clear from the south-west that we cannot go on with this situation. There is no need, especially when we have dental underspends, for us not to take advantage of those opportunities as they arise. I also agree with him that we need to find more new and innovative ways of solving the issue and help a broadly willing dental team across the south-west.

To conclude, I urge the Minister to take note of all that I have said and what all my hon. Friends and hon. Members will have to say. I will also leave the Minister with a clear idea of what we need in West Dorset. First, I understand that there are plans for a substantial dental school in Dorset. I am pleased to hear that and am eager to lend my support. Can the Minister share more details? Secondly, NHS 111 needs to understand the situation of our dental practices and stop directing frustrated patients to those practices’ already swamped telephone systems, causing busy staff to receive unnecessary abuse for problems that are not necessarily within their power to fix. Finally, the contract and the amount of compliance within it, as my hon. Friend the Member for Totnes (Anthony Mangnall) pointed out a moment ago, needs an immediate review and immediate reform. Otherwise, we will continue to lose NHS dentists and the situation will worsen dramatically. I look forward to hearing from my hon. Friends and hon. Members in this debate and, indeed, the Minister at the end.

NHS Workforce

Anthony Mangnall Excerpts

Tuesday 6th December 2022 Commons Chamber

[Sam Tarry]

I cannot speak for the Welsh Government, but if we look at their record—the times that they have been returned to office with a stonking majority, and the fact that there are no strikes on their railways, which they had the guts to take into public ownership; they called it what it was—I would much rather be living under them than the appalling Government we have.

The impact of those shortages on existing staff is enormous. Reports by Unison have repeatedly highlighted the acute strain that understaffing has put on the workforce, with stress and burnout rife among NHS staff. That predates covid, which demonstrates the immense damage done by a decade or more of Conservative Governments and the failure of successive Governments and Prime Ministers to invest in the workforce or take workforce planning seriously. As the RCN has said, the dispute is about not just pay, but patient safety, which is key for all of us. Staffing levels are so low that patient care is being compromised; only paying nursing staff fairly will bring the NHS to a point where it can recruit and retain people to address those issues.

I have visited my local hospital, King George Hospital, on many occasions and I have heard about the impact of staff shortages and pay cuts on staff and patients alike. Recently, for once, I went to open some new services in paediatric emergency and radiology—something positive after 20 years of campaigning for our local NHS in Ilford—yet the staff were still overstretched, run ragged and demoralised. They just want the support that they need to care for their patients, which means pay recognition and ensuring fair practices at work without undermining their working conditions.

I spoke to staff who, during the worst of the pandemic, received food donations from the local community just to get by. That should never, ever be allowed to happen and makes it even more sickening to hear about the outright corruption on the other side of this House and the despicable corrupt PPE deals with people like Baroness Mone. People in Ilford are sick and tired of that because of the attacks on our local services. We even had to stand up and campaign for our local ambulance station not to be shut down under the Government’s measures.

Conservative Members seek to present nurses’ demands as unreasonable and undeliverable, and have asked nurses to tighten their belts even further, while they have allowed the pay of the wealthy to explode. This year, FTSE 100 CEOs collected an average of 109 times the pay of ordinary workers—that is part of the answer to where we get the money to pay the people who actually keep our country off its knees. Where is the Government’s commitment to pay restraint when it comes to high pay and those sorts of people? How many Conservative Members have fat cat salaries and executive directorships, and coin it in left, right and centre?

[Anthony Mangnall (Totnes) (Con)]

You all have second jobs!

[Sam Tarry]

I do not think a single person sitting on the Opposition Benches has a second job.

The truth is that NHS staff pay demands are reasonable and fair. Nurses’ pay is down by £4,300 and paramedics’ pay is down by £5,600. One in three nurses cannot afford to heat their homes or feed their families. NHS staff are at breaking point. When I met NHS Unite members from Guy’s and St Thomas’s Hospitals—I welcome any hon. Member to come with me and speak to them, because they are just across the river from this House—they were justifiably furious about the way that for too long, they and their colleagues have been exploited and abused by the Government, as they see it.

Staff are the backbone of the NHS, and if they break, so does the NHS. As the RCN general secretary said:

“Nursing staff have had enough of being taken for granted, enough of low pay and unsafe staffing levels, enough of not being able to give our patients the care they deserve.”

Allowing the NHS to collapse will cost the country considerably more, financially and in national wellbeing—as we are already seeing on the Government’s watch—than the rightful pay demands of NHS staff. If our NHS is not providing the care that we need, the costs are far greater, as is economically demonstrable.

Many hon. Members on both sides of the House believe that the NHS is our greatest institution. We cannot take it for granted and it is well worth fighting for. Conservative Members have the power to stop this dispute; to sit down with the trade unions; to face the nurses and NHS staff; and to negotiate a fair deal to prevent misery, ensure patient safety and save the NHS. If the Government will not do it, they should resign now, because a Labour Government will save the NHS and support NHS staff.

World AIDS Day

Anthony Mangnall Excerpts

Thursday 1st December 2022 Commons Chamber

[Lloyd Russell-Moyle]

I totally agree. As dark forces around the world try, I am afraid, to withdraw money from programmes that talk in a rational and evidence-based way about sex and reproductive rights, we have a greater responsibility. We must step up, because if we do not, others will not. As the right hon. Lady points out, there are two sides to the coin: providing better sexual health education means that girls stay in school, and staying in school allows them to get better education about their health. Those are both positive things. Both issues need to be tackled together.

Another inequality standing in the way of ending AIDS is the inequality in the realisation of human rights. Some 68 countries still criminalise gay men. As well as contravening the human rights of LGBT+ people, laws that punish same-sex relations help to sustain stigma and discrimination. Such laws are barriers preventing people from seeking and receiving healthcare for fear of being punished or detained. Repealing them worldwide is vital to the task of working against AIDS.

Of the 68 countries that outlaw homosexuality, 36 are Commonwealth countries. The majority of Commonwealth countries are still upholding laws that we imposed and that never originated in the countries themselves. In fact, before British colonialism—British imperialism, I should say—many of those countries had better customs and practices around homosexuality than they do now. These customs and practices are not native to people’s home countries; they were imposed. They should be discarded with the shackles of imperialism, which we all now recognise was wrong. One in four men in Caribbean countries where homosexuality is criminalised have HIV. Globally, 60% of people with HIV live in Commonwealth countries. Collectively, we have a responsibility to tackle that in the Commonwealth. Barriers undermine the right to health: a right that all people should enjoy.

Beyond the human rights implications, the laws criminalising homosexuality also have an impact on public health. LGBT+ people end up not seeking health services for fear of being prosecuted. Those who do seek health services often have to lie about how they were infected. Astronomically high numbers of people with HIV in Russia say that they were infected because they were drug-injecting users; that is widely believed to be partly because of the attitude in Russia that it is better to be a drug-injecting user than an LGBTQ person. Without accurately knowing the source of infections, we cannot accurately run public health programmes to save people. Putting people undercover in the dark, hidden in corners, means that the virus lives on. That is a danger for us all.

In some countries, people living with HIV are at risk of being criminalised even when they take precautions with their sexual partners. That opens them up to blackmail and fraudulent claims from former partners. People with HIV in the UK are not immune to that either, as we have seen in some high-profile cases. We have known for at least 20 years that antiretroviral therapy reduces HIV transmission, and for the past few years we have known that it stops it completely, so there should be no doubt that a person with sustained undetectable levels of HIV in their blood cannot transmit HIV to their sexual partner, and laws should not punish them. However, under Canadian criminal law, for example, people living with HIV can be charged and prosecuted if they do not inform their partner about their HIV-positive status before having sex. The law does not follow the science, and it puts people at risk.

Laws requiring disclosure perpetuate the stigma against HIV-positive people. With the advent of PrEP and with “Undetectable = untransmittable”, the law should now reflect the fact that everyone has a role in protecting themselves against HIV and everyone must step up. The criminalisation of drug-injecting users and sex workers has an equally negative effect on HIV prevention and treatment, as I have outlined, in LGBT communities. In all these areas, a health and human rights-based approach must be taken if we truly want to see the end of HIV.

Beating pandemics is a political challenge. We can end HIV and AIDS by 2030 in this country, but only if we are bold in our actions and our investments. We need courageous leadership. We need people worldwide to insist that their leaders be courageous. That is why last month it was so disappointing not to see courageous leadership from this Government. The UK Government were the only donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria to cut their financial settlement—by £400 million. The fund asked donors to raise their pledges by 30% this year, and almost all the G7 nations—which are suffering economic problems that are, in many respects, similar to ours; as the Government often remind us, this is a global crisis, not a crisis of their own making, although in our view it is a bit of both—increased their amounts. For decades the UK was the leader in the global response to these infections and diseases, but that is no longer the case. When our allies met the fund’s request for a 30% increase, the UK went for a 30% cut from their 2019 pledge.

[Anthony Mangnall (Totnes) (Con)]

I thank the hon. Gentleman—my friend—for making this speech; he is an extraordinary advocate in this area. However, I want to put on record the fact that the UK is the third biggest funder of the Global Fund. We have, to date, contributed just under £4.5 billion.

The hon. Gentleman has said that we are leading the way in respect of our health and our treatment, and that other countries are following. This, too, is a commodity that can be traded and given to other countries. It is not always a question of the value of the money that we give, because we can trade skills, research and development as well. The hon. Gentleman knows where I stand on the development issue, but I think it is worth making that point.

[Lloyd Russell-Moyle]

The hon. Gentleman has been very good on development issues in the past, and I think he is right. He has also touched on the discussion about patents and patent waivers. There is a live discussion about how we can ensure that the poorest countries in the world can gain access to some of the frontline drugs. Long-lasting drugs are one of the latest innovations, with the possibility of either an injection or a set of, effectively, implants—I cannot think of the exact term off the top of my head—which would last for up to a month and a half. That is revolutionary, especially for those who have irregular access to health systems. The problem is that these are the most expensive drugs because of the way our patent system works; but they are also the most useful in the parts of the world that are hardest to reach. In the UK, most people have regular access to medical settings and can receive daily pill medication. The UK has not always been the very best when it comes to seeking patent waivers. We have done it in the case of many HIV drugs, but we should consider doing it more widely. That might be a good compromise, but we will then need to step it up.

The UK’s decision on the 30% cut is, in my view, a disastrous decision, which stems from the Conservatives’ 0.5% cap on international development. Rather than considering that amount to be a floor and saying that it is the bottom of our ambition, the Government have said that it is the top of our ambition. Moreover, as a result of their insistence on including the Homes for Ukraine scheme, whereby we are housing Ukrainian people here in the UK, in that 0.5% cap, money is flowing out of the international development Department. International development—internationally spent money—should be 0.5%; that would enable us to fulfil many of our commitments quite easily. The additional aid and charity that we provide should be celebrated, but it should not be detrimental to others. This cut will result in the preventable deaths of up to 1.5 million people, and risk over 34.5 million new transmissions of HIV, TB and malaria. It will no doubt harm our credibility, and I hope we will reverse it as soon as we can.

We in the APPG have the political will to meet the targets set by UNAIDS and the action plans for Wales, Scotland, England and, I was pleased to hear, Northern Ireland. We will continue to work with and challenge the Government in ensuring that they do the same, because it is time we stepped up and pushed for that final mile. When you are at the end of the race, you do not slow down; you speed up. This is a prize that we can win, so let us not allow it to slip through our hands. In the words of the former Prime Minister Boris Johnson, let us end the “dither and delay”. Let us end HIV/AIDS today.

Liver Disease and Liver Cancer: Diagnosis

Anthony Mangnall Excerpts

Tuesday 11th October 2022 Westminster Hall

[Anthony Mangnall (Totnes) (Con)]

It is a pleasure to serve under your chairmanship, Mr Betts. I begin by congratulating the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this debate on an important issue. It is striking how similar the points she made about her constituency are to the issues affecting many constituencies across the country, especially down in the south-west. It is a pleasure to follow my hon. Friend the Member for Darlington (Peter Gibson), who added such a personal point to his speech, as well as the hon. Member for Caerphilly (Wayne David) and his extremely good work on the APPG.

I can be very brief, because I want to make just a few points. I come to the debate having not known a great deal about the issue before I was elected. Like so many people, I was lobbied and introduced to the subject by constituents, specifically the Meredith family, who are very involved in liver diagnosis and transplant services and the need to improve them in the south-west. Over the last three years, I have met them regularly to discuss the issue, to see how the UK can improve its services across the whole of the country and to look at some of the positives and negatives. Of course, I am participating in the debate to point out some of the negatives, but it has been a fascinating journey. I met Professor Cramp of University Hospitals Plymouth NHS Trust to discuss the matter, to see where we might be able to improve it and to lobby my colleagues in the south-west about beginning a campaign to improve south-west transplant and diagnosis services. There is a real need to do so, and the statistics speak for themselves.

I continue to learn about this issue. In fact, I was completely unaware of the link between smoking and liver disease; given the fact that I am trying to quit smoking, that has only redoubled my efforts. It is important, because we talk in this debate about where we can tackle things at source: people who have alcohol addiction, smoking addiction or issues around obesity. We must address those at-source points.

However, I will focus very briefly on geographical disadvantages. The hon. Member for Rutherglen and Hamilton West described what she sees in her own constituency, but it is absolutely the same in mine. People who are in need of liver transplants have to travel across the country for a potential transplant, and they are then rejected when they arrive at the hospital. They then travel back to the south-west, which on a good day can be a four, five or six-hour round trip—far more if they are travelling by car. That is incredibly debilitating for them. It is incredibly destructive, and it hurts their health. We need to look at where we can improve that geographical disadvantage, and the south-west is more than a good case in point.

As I understand it, there is due to be a review of adult liver disease services this year. I understand that it was meant to be 2022-23. Would the Minister update the House—I apologise for not being here for her concluding remarks, but I will look at Hansard tomorrow—on whether that will be undertaken this year, and when it is likely to report? It is hugely important. A great many of us are banking on that report to identify some of the pitfalls across the country. May I also invite the Minister to meet the Meredith family and Professor Cramp to discuss the issue, get a better sense of where we are in the south-west and get a sense of where there are disadvantages for those who are suffering?

We have a real opportunity. I do not think there is any politics in the issue. We all recognise the pitfalls across the country—where the problem is increasing, and why it is increasing—and we have the opportunity to address it. I look forward to seeing the Minister’s response, and I again congratulate the hon. Member for Rutherglen and Hamilton West on securing the debate.

NHS Dentistry in England

Anthony Mangnall Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Anthony Mangnall (Totnes) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I will be very brief because many points have already been made, but I want to try and give a further south-west example of the problems that we face, particularly in rural and coastal communities. The problem is sizeable and the requirement to respond to it is urgent. As has been said by so many colleagues from across the House, we must grip the issue now. If we let it slide, it will get worse and worse, and the backlog will get bigger and bigger.

The hon. Member for Sheffield Central (Paul Blomfield) was right to say that, like buses, it is good to have two debates on this. I was sorry not to be able to make my comments known yesterday. I was particularly struck by some of the positive developments that have come out of the Department, most notably that urgent care is back to pre-pandemic levels. There are also 700 centres for urgent care, £50 million has been made available to encourage 350,000 extra appointments, and there is an urge and a push to upskill dental nurses, assistants and technicians. Those are all very welcome steps.

I do not mean to be critical of the Government, because the Minister, who has responded to my letters, has spoken to me at length on the issues that we face in south Devon. There are a few outstanding issues that I hope she might be able to take on board. I hope she might also be willing to listen to some of the suggestions that colleagues and I are making.

One the five areas where I see a significant problem, which has already been raised, is children not getting access to dentists. On pensioners, countless constituents have contacted me who cannot get access to the very necessary dentistry services that they require. We must find a way to address that, for children and pensioners alike. We can find a way through this. The problem in my patch is that dentists are not taking on new patients. In fact, to give a concentrated example, there is one practice within 15 miles of Totnes that is accepting patients, and in that instance it is only children. I understand that the practice is already oversubscribed and therefore unable to see people in a reasonable timeframe. This is a real problem that, as others have said, is becoming exacerbated as time goes by.

My next point is about urgent dental care centres. I have heard about 700 of them being set up across the country, but I am not aware of one that is dealing with my constituents. In fact, when people use the hotline to even contact the NHS to discuss it, they cannot get through. I have constituents in considerable pain contacting the helpline and not being able to even get through to convey their point. That needs to be addressed. It is bad enough not being able to see a dentist; it is perhaps even worse not being able to talk to someone about the help one needs. It is also reflected in why we see so many people ending up in A&E with problems with their teeth. Addressing this issue would help the A&E numbers.

The Minister, as ever, is assiduous in responding to our correspondence. I hope she will not take this the wrong way, but she responded to one of my letters that it may be helpful to know that patients are registered with a dental practice only for the course of their treatment, meaning there are no geographical restrictions on which practice a patient may attend. She has been to south Devon, I am sure. If she has not, she is very welcome—it could not be a better time to visit over the summer. Our geography is very difficult at the best of times. We do not have rail lines—they were all ripped up in the 1950s. Our bus services have been cut back. There are no major routes even between the major towns in my constituency and the hospitals—I think of Dartmouth and Kingsbridge.

If we do not have the transport system to help people to get to those practices, the geography matters a great deal. We need to focus on a response for the rural and coastal communities, because they are at a significant disadvantage, as my right hon. Friends the Members for Ashford (Damian Green) and for South Holland and The Deepings (Sir John Hayes) said.

The £50 million made available is welcome, but the percentage awarded to the south-west is 9%, which, if my maths is good enough—probably not as good as my hon. Friend the Member for St Ives (Derek Thomas)—is £4,762,000. That will not be enough to deal with the sizeable issues in what is classed as the south-west, which is Somerset, Dorset, Devon and Cornwall.

I said I would not speak for long, but I have a few points that I hope the Minister will take on board. I hope we can find a solution on the basis of cross-party consensus and co-operation and of the urgent need to address this issue. Evidently, we need more dentists. There is no doubt about that. Training takes time. It is great that we are looking at how to retrain people, but what steps are we taking to encourage the creation and set-up of dentist schools across the country?

People want to train and work in this country. The NHS is a draw to medical students around the world. We should be able to train them here and encourage them to work in our system, at least for a certain amount of time. What steps are being taken to recognise the equivalent level of qualification that might be found in other countries to encourage them to come to this country?

I have mentioned it three times, but for added effect I will make the point again: we need a robust response for rural and coastal areas. Is the Minister willing to meet all coastal and rural MPs, on a cross-party basis, who have an issue with dentistry to discuss this issue? It is significant that, from Cornwall to elsewhere in the country, we all make similar points about how we are disadvantaged. That is no disrespect to the hon. Members for York Central (Rachael Maskell) and for Sheffield Central, but I hope the Minister will take that on board, because it is becoming more urgent.

Contract renegotiation has already been mentioned. We need more details on that, and it has to be sped up. Nobody wants us to sit here pointing the finger—I accept that Labour brought in this terrible decision in 2006; there we are, I have pointed it—but what we want is a solution. We can find a solution. If yesterday’s debate and this debate are anything to go by, there are sensible options being put forward. The time to act is now. Too many people have been in significant pain for too long.

--- Later in debate ---

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for St Ives (Derek Thomas) for securing this important debate and praise hon. Members for their powerful contributions, which contained a lot of personal experiences setting out just how dire the situation is across the country.

Here we are again. The problem with NHS dentistry has come up time and again over recent months. No matter how much the Minister wants to bury her head in the sand, issues with access to NHS dentistry are just not going away. The situation is a national scandal, as recognised by Members from across the House, by the sector and by our constituents, whose heartbreaking cases continue to fill our postbags. One cannot help but feel emotional at the immense pain people are having to live with.

Shamefully, we know that children are particularly badly affected. Half of all children in England have no access to an NHS dentist, with 78 children under 11 going to A&E every single day for a tooth extraction. The hon. Member for St Ives described a family with three children, none of whom had ever seen a dentist, with one child only seen because they had to go to A&E. In Wakefield, a fifth of children suffer from tooth decay before the age of three. This is not just unacceptable; it is a downright disgrace.

In yesterday’s debate, the Minister held her hands up and recognised the problem in primary care. Frankly, I was delighted to finally hear something akin to humility from the Minister on access to NHS dentistry. However, just as it seemed we would make some meaningful progress, the same old script was rolled out and the blame was laid at the door of the Labour party. I put it to the Minister yesterday, and do so again today, that her party has been in government for 12 years. When Labour was in government and saw that the contract was not working, we committed to reforming it, as set out by my hon. Friend the Member for Sheffield Central (Paul Blomfield), and put that in our 2010 manifesto, just as this Government did in theirs.

[Anthony Mangnall]

How does the hon. Lady explain the Labour performance in Wales, where dental practices are going down and the system is not being addressed? It is clear that the Labour party has no suggestions.

[Feryal Clark]

I thank the hon. Gentleman for his intervention. If he wants to know about Labour’s performance on the NHS, he should look at the performance of the Labour Government between 1997 and 2010. Waiting times went from 18 months to 18 weeks.

--- Later in debate ---

[Maria Caulfield]

The negotiations started back in March and there have been a number of meetings with the BDA. The BDA has been sent final recommendations, but we have not yet heard back, so I encourage the BDA to respond.

I will touch on a number of other issues that have been raised, the first of which is overseas dentists. For obvious reasons, no overseas registration examinations took place during the pandemic, creating a backlog of over 800 overseas dentists waiting to take their exams. Exams restarted earlier this year, and extra sessions are being held to get through that backlog of dentists so that we can get them into the system and working as dentists as quickly as possible.

We have also been working with the General Dental Council, which is the regulator, on recognition of overseas qualifications. The GDC did a consultation on regulation and recognition of overseas dentists, which I think closed on 5 or 6 May. We are waiting to hear the feedback from that consultation, but we are happy to lay regulations in this place—if necessary, we can do so by the end of the year—to give the GDC the power to mutually recognise overseas dentists according to its judgment. It is not for the Government to mutually recognise qualifications; it is for the regulator. However, we are happy to give the GDC the power to do so, and we look forward to its feedback on the consultation it undertook, because our overseas dentists are a rich source of the talent and skill that we need.

When it comes to getting more dentists into certain parts of the country—obviously, one of those areas is the south-west, whether that is Cornwall, Devon or Plymouth —significant work is going on. I met with Health Education England this morning to look at how we can set up centres for dental development. Those centres are different from dental schools, which are often very expensive and take a long time to set up, and, as was said during the debate, there are not always dentists available locally to supervise the training. Centres for dental development can be much more flexible and meet existing local needs while also looking at what needs could develop.

As such, we will be working up a programme, looking at what we can do in those specific parts of the country with the greatest need. In Norfolk, I recently met a group of local MPs and representatives from the local university and the local enterprise partnerships, all of whom are willing to work together to make that happen. I am going to Portsmouth on Monday, to Gosport, to see exactly the same thing—dentists coming together to come up with local solutions that will make a difference.

[Anthony Mangnall]

I am grateful to the Minister for giving way, and I thank her for those words. Far from burying her head in the sand, she is putting her head above the parapet. That is most welcome. As mentioned by my right hon. Friends the Members for Ashford (Damian Green) and for South Holland and The Deepings (Sir John Hayes), there is clearly significant data that highlights the worst affected areas. Given that the data is there, could we expedite that roundtable meeting as quickly as possible?