NHS Dentistry Services

Baroness Gardner of Parkes Excerpts

Thursday 11th July 2019 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what assessment they have made of the availability of National Health Service dentistry services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, nationally, access to NHS dentistry remains high, with 22 million adults and 7 million children seen by a dentist in the 24 and 12-month periods ending 31 December 2018 respectively. However, we know that there are areas of difficulty and more work remains to be done. NHS England, in its role as commissioner, is responsible for commissioning NHS dental services to meet local need and is actively looking into dental access issues.

[Baroness Gardner of Parkes (Con)]

That is rather a disappointing Answer, although it certainly ties in with my experience: it was declared in Manchester that no children could have operations done under general anaesthetic because all slots were taken for the clearance of baby teeth. When I saw that, I wrote to the Mayor of Manchester, who has great experience in the field of health from when he was in the House of Commons. I did not even get an acknowledgement, so after a time I wrote again, saying that perhaps my letter never reached him so I was resending it, but to this day I still have not had an acknowledgement. The press reports get worse and worse about the shortage of these possibilities.

[Baroness Blackwood of North Oxford]

I am very sorry to hear of my noble friend’s experience with the Mayor of Manchester. Children’s oral health is now better than it has ever been, with more than 75% of five year-olds in England being decay-free, which we welcome. However, the number of children requiring tooth extraction remains a concern. It fell slightly between 2016 and 2017-18, which we welcome; however, we recognise that there is much more to do. That is why the NHS outcomes framework is working to ensure that we perform better, with much work being done to target improved oral health of young people, with the Starting Well core framework and Starting Well pilots in the 13 areas of greatest deprivation.

Domestic Abuse: General Practitioner Charges

Baroness Gardner of Parkes Excerpts

Thursday 15th November 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness will appreciate that this is not a matter for the Department of Health and Social Care, but it is something that I will be happy to look into. What I do know is that the draft domestic abuse Bill is looking to establish a domestic abuse commissioner. It may be that it is through that route that support of that kind may be made available.

[Baroness Gardner of Parkes (Con)]

My Lords, do we have any special reception facilities for men or women who have been abused? When I served on the United Nations Commission on the Status of Women, we had an opportunity to consider the excellent procedures in place in Brazil, a country which has taken this matter very seriously indeed. Over the years, this issue has been raised quite often, but do the police here pay any special attention to it, and do they protect those men or women who say that they have been attacked?

[Lord O’Shaughnessy]

My noble friend is right to say that domestic abuse can affect anyone, although of course it happens predominantly to women. The police, local authorities and the third sector are there to provide support for both men and women when they are abused.

Health: Stroke

Baroness Gardner of Parkes Excerpts

Wednesday 14th November 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness is absolutely right. In 2017, NHS England announced a rollout of the mechanical thrombectomy procedure to 24 centres across England. It is expected that 10% of stroke patients will be eligible. It leads to big reductions in disability after stroke, is now approved by NICE, and will be a significant part of the long-term plan which we will publish by the end of the year.

[Baroness Gardner of Parkes (Con)]

My Lords, my husband had a stroke and it was not recognised. It was a clot. He got to the hospital rather late and his arm was definitely damaged for ever more. He died 10 years ago; the stroke did not affect his continuing to live. The hospital in Newcastle was so far ahead in clot-busting that it was three years ahead of London. I remind the House of how much effort Lady Rendell, who is no longer with us, put into Act FAST, a campaign to let people know pretty quickly what the symptoms are and not to delay so that they have more hope of being successfully treated. We have made great progress, but there is a clearly a lot more to make.

[Lord O’Shaughnessy]

I did not know that my noble friend’s husband had had a stroke; I am grateful to her for sharing that with the House. She is right that the examples of Newcastle and Northumbria have shown that hyperacute stroke units—the centralisation of services—save lives. Closing hospitals or changing services can be controversial, but in stroke we know that it makes a big difference. It is a focus of what we need to do, and we need to take courage on that. The Act FAST campaign, which my noble friend mentioned, has been incredibly successful in making sure that we get fast action when people have a stroke. More than 5,000 fewer people have been disabled by stroke since that campaign started.

The NHS

Baroness Gardner of Parkes Excerpts

Thursday 5th July 2018 Lords Chamber

[Baroness Gardner of Parkes (Con)]

My Lords, I emphasise that I have worked in the health service for well over 60 years, but there is still such a lot to learn about it. Something important to have come out of today’s debate is that we should look at a lot of things again.

I know that the noble Lord, Lord Mawson, spoke about doing away with health centres. I do not agree at all with that. As a dentist, I found that health centres were a very effective way of giving treatment to children. Parents, especially now that you have to pay for dental examinations, no longer take their children to their own dentist twice a year, which is what used to be the practice. Now, children are lucky if they are seen before they are in pain, which is a most awful reason for anyone to go for treatment: you are automatically very worried and unhappy from the start.

I congratulate the noble Lord, Lord Darzi, on securing this debate. It is very far-reaching and should be considered in detail. Certainly we should use more of those health centres, as we did in the past, and more respite care, or cottage hospital-type recovery after hospital. We are using a very expensive facility to keep people in hospital during their recovery when they would probably much rather be in slightly more homely surroundings. Of course, they would have to be adequate for the treatment that they were recovering from, but all these things are possible if enough thought is applied to them: that is what I believe should happen.

In these couple of minutes which is all we have, I pay tribute to the very many dentists and doctors—huge numbers of them—who came from the Commonwealth in the early days of the National Health Service. In Australia, where I graduated, anyone who had been in the forces was allowed to go to university if they had enough qualifications. As a result, 150 dentists a year qualified in Sydney and there was no work for them; they were just out digging the roads or working on the Snowy River scheme; anything to be earning a crust. Then someone discovered that, yes, there were jobs over here. The first ones came and they passed the word on to all the others. In the early years, in this country, the big thing was that people looked to full clearance of teeth at the age of 21 as the desirable situation in dentistry, which was unbelievable. When we arrived, children’s teeth were in a terrible condition.

Commonwealth dentists, in particular from Australia, New Zealand and South Africa, all of whom had a higher degree, which was acceptable here, did a huge amount. We almost got the situation completely under control, but now it is as bad as it ever was. In Manchester, we find that children cannot have ordinary operations under general anaesthetic because every slot is taken with clearance of baby teeth: that is just hard to believe. I have almost run out of time so I will not go on further, but I think we have a lot to think about and a lot to aim at. I want to pay tribute also to Lord Pitt, David Pitt, who did a marvellous amount here, coming from quite a different part of the Commonwealth. He was a hospital patient in the hospital I was chairman of and was so undemanding it was just hard to believe. There is still a great deal for us to do.

Domiciliary Home Care Support

Baroness Gardner of Parkes Excerpts

Wednesday 25th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I have huge respect for the noble Lord and his expertise in this area. I take this issue very seriously, which is why I used the opportunity in answering the noble Baroness to provide the reassurance that is in law. Local authorities need to step in to provide continuity of care with notice from the CQC, which now has a new responsibility to monitor the financial sustainability of providers and to make sure that that care is provided, whether it is delivered in-house or through contracts with other providers. That reassurance did not exist before it was introduced in the 2014 Act. It ought to provide a degree of reassurance among vulnerable people, who I accept will be anxious. That responsibility is in law.

[Baroness Gardner of Parkes (Con)]

The Minister has said that this is a matter of law. There has been a court judgment that fees should be paid to carers for time spent going between clients, which can be nearly half of their day. They may have one hour to spend with many clients. Is he aware that providers of domiciliary care—run as agencies and used by most local authorities —are not honouring that legal decision that this should be paid as part of their employment?

[Lord O'Shaughnessy]

My noble friend is right to bring up that issue. They should of course be paid. If she has any specific examples to share with me, I shall be glad to investigate.

NHS: Winter 2017-18

Baroness Gardner of Parkes Excerpts

Wednesday 18th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I am not sure how much pressure I can bring on the Chief Whip for anything, but I look forward to debating the review in whatever form we can when it comes out.

[Baroness Gardner of Parkes (Con)]

My Lords, in view of the discussions about whether people from overseas should be able to use the health service, can the Minister tell us whether any statistics are kept on any impact they would have had during this crisis, or how much of our budget would have been spent on them?

[Lord O'Shaughnessy]

I do not believe that we have specific statistics on the demand from overseas visitors during winter. I say to my noble friend that overseas visitors are most welcome to use the NHS but it is important that they pay. We are reclaiming more money than ever from overseas visitors to go into funding the NHS.

HPV Vaccinations

Baroness Gardner of Parkes Excerpts

Monday 26th March 2018 Lords Chamber

[Lord O'Shaughnessy]

The committee has to take a number of considerations into account—the public health benefits, short-term and long-term, and cost effectiveness—just as NICE does when approving medicines. It has to make a judgment about whether the incremental pound spent could be better spent across the entire health system, where, of course, there are many competing demands. But it is up to it to make that decision, and that will inform its final advice.

[Baroness Gardner of Parkes (Con)]

My Lords, is the Minister aware that oral cancer is very largely due to the papilloma virus? As a dentist, and on behalf of the dental profession, I strongly support immunisation, but there will always be people who do not attend to have it, even when it is introduced. So it is also important to be aware that dentists are usually the first people to detect oral cancer. For many years I have proposed that, when people go into accident and emergency for anything, someone should take one minute to see if there was any abnormality in the mouth which could be referred on at that stage. Could this even be included in a questionnaire when people go in for treatment? It would be a way of picking up oral cancer, which has increased by 23% in the last 10 years.

[Lord O'Shaughnessy]

My noble friend is quite right to highlight the link between HPV and oral cancer. The growing evidence base is one of the things which the JCVI is taking into consideration. There is absolutely no doubt that HPV causes around 99% of cervical cancers. The link to other cancers, such as the one my noble friend mentioned, is not quite the same and is still disputed, but it is one of the issues being considered.

Prescription Drugs: Dependence

Baroness Gardner of Parkes Excerpts

Monday 19th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I completely echo the noble Baroness’s praise for the charitable sector. We have some very high-quality treatment centres in this country, provided both by the state and by charities. They do a fantastic job. In the most recently published figures, local authorities’ actual spend on funding for adults for drug misuse was about £490 million a year, so a substantial amount of money is going in. Of course, we need to make sure that it is getting to the people who are addicted to prescription drugs as well as illegal drugs.

[Baroness Gardner of Parkes (Con)]

My Lords, can the Minister explain the difference between dependence and addiction, as anyone who is on life-saving drugs is dependent upon them? Where does the definition come between that and addiction?

[Lord O'Shaughnessy]

My noble friend has just given a much better and more incisive answer than I could have given. There is a distinction; the point here is that these are drugs that people have started to take because they have needed them. I should point out one area that is not included in the review; it is not looking at cancer and terminal pain, because we need to make sure that there is appropriate pain relief for people who are in the last stages of their life.

NHS: Charitable Donations

Baroness Gardner of Parkes Excerpts

Thursday 22nd February 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree with the noble Lord that it is a gift. I also absolutely understand the sentiment behind what he is saying, which is a desire for people to contribute back to the NHS not just through the tax system. It is important to point out that there are more than 250 NHS charities, with an annual income of £400 million. One of the other great gifts we have in this country is people’s willingness to donate time and money not just to the NHS but to a range of health causes. So we do provide an opportunity for that and those gifts are supported by gift aid. With regard to itemising the bill, we worry about deterrence. Many users of the most expensive health services are older people. Itemising a bill could put some of them off and that would be the wrong thing to do.

[Baroness Gardner of Parkes (Con)]

My Lords, I am pleased that the Minister has acknowledged the great contribution made by charities, but is he aware that councils are also providing a lot of care for people in need, both pre hospitalisation and post hospitalisation, but that they cannot use gift aid in any way? Will the Department of Health liaise with the Treasury to see whether there is some way that special council funds could be set up, where you could make a charitable donation? Gift aid is a great attraction. Yesterday I got a letter asking me whether I would like to give something to my council. I would not give anything unless it had gift aid—so it seems that we are missing an opportunity there.

[Lord O'Shaughnessy]

My noble friend makes an important point. Gift aid is a wonderful scheme that obviously has driven huge contributions. She is quite right that public sector bodies cannot provide the gift aid opportunity, which is why in the health sector those charities attached to hospitals exist. She makes an excellent suggestion for what councils should do and I shall take it up with my colleagues in that department.

Agency Nurses

Baroness Gardner of Parkes Excerpts

Wednesday 10th January 2018 Lords Chamber

[Lord O'Shaughnessy]

I will certainly write to the noble Earl specifically on psychiatric nurses. He will, I hope, be aware of the plan to recruit many more mental health staff as we seek to radically improve outcomes and delivery in that area.

[Baroness Gardner of Parkes (Con)]

My Lords, as a former hospital chairman, I am aware that agency staff are called in only when they absolutely have to be, when there is no other alternative. I wonder whether the National Health Service has looked at offering existing nurses in hospitals the opportunity of doing some more work out of hours, as some of them would find that convenient. There is a tendency for doctors as well as nurses to look for locum and agency jobs because they are better paid.

[Lord O'Shaughnessy]

It is that last issue that we are trying to address. One factor is that there is now an hourly rate price cap on agency spend, precisely to drill down into that issue. The reason that the number of agency staff went up was in response to the Francis review and what it said about safe staffing levels in the service. The immediate response was to deal with that through agency staff. That was expensive, of course, which is why we have had to push down those costs. Nurses have to come from somewhere, and my noble friend is quite right that using existing nurses and support from nursing banks is one way of meeting demand with better value for money.