Hospice Funding

Barry Gardiner Excerpts

Monday 22nd April 2024 Commons Chamber

[Sally-Ann Hart (Hastings and Rye) (Con)]

I beg to move,

That this House has considered the postcode lottery of funding for hospices; and calls on integrated care boards to urgently address the funding for hospice-provided palliative care in their areas.

As a member of all-party parliamentary group for hospice and end of life care, I am very happy to be co-leading this debate with my lovely friend, the hon. Member for Darlington (Peter Gibson), who applied for this debate today.

I have so much admiration for hospice and palliative care providers, and empathy for those experiencing dying, death and bereavement. Both my parents died of cancer, and I will always be grateful for the amazing care that they received. Hospice care is important to so many people and we are very lucky to have St Michael’s Hospice in beautiful Hastings and Rye, and Demelza House, which offers palliative care for children—largely through outreach work.

When my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) was Health and Social Care Secretary, he announced the legal right to palliative care for all ages. This was in an amendment to the Health and Care Act 2022, which declared, for the first time, a duty for integrated care boards in England to commission palliative and end of life care that meets the needs and demographic of the population it serves.

I could not believe that end of life care was not already a legal right. We should all want to see the best support available for those people who are nearing the end of their lives as well as their families, and excellent palliative care—support for people physically, mentally and spiritually—is vital.

[Barry Gardiner (Brent North) (Lab)]

I agree with everything that the hon. Member has just said. I wish to highlight the importance of palliative care for children and the amazing support that some children’s hospices are able to provide not just for the child, but for the entire family. It really is wraparound care, and so important for those parents going through that bereavement process.

[Sally-Ann Hart]

I thank the hon. Member for his intervention, and I could not agree more; he is absolutely right.

Edenfield Centre: Treatment of Patients

Barry Gardiner Excerpts

Thursday 13th October 2022 Commons Chamber

[Will Quince]

I thank the hon. Gentleman for his question. As a former Children’s Minister who every week read the serious incident notification report, I am a little bit disappointed in it for one reason. I mentioned some of the steps that the Government are taking, and yes, we always need to do more, but no Government can ever legislate for or produce procedure or guidance that will stop anyone who is not acting with empathy and kindness. In this case, we have seen some of the most horrific abuse. No Government can legislate to stop that, but we must do all in our power to identify it and prevent it. The CQC has an important role in that. My understanding is that, as soon as a whistleblower brought the matter to its attention, it investigated. We then understand that there was the BBC investigation. Of course, we will look at how the CQC responded and hold it to account.

[Barry Gardiner (Brent North) (Lab)]

What was the earliest date on which a whistleblower or member of a family contacted either the Department or the CQC? With respect to what the Minister said about the CQC, given that we have repeatedly seen such degrading behaviour at Winterbourne View and other places, what confidence does he have that it can assure the public that care is being given at the quality that is required?

[Will Quince]

On the hon. Member’s first question, I am a little cautious only because I am not the responsible Minister, but my understanding—I have not heard this at first hand—is that the first whistleblower complaint was made around Easter. I know that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Sleaford and North Hykeham, will write to him on the specifics about the point at which the CQC was first notified.

Is this in any way acceptable? The answer is no. Do we therefore need to look at processes and how the CQC investigated, how it acts and its ability to identify? Yes, of course we do. But, in the same way, going back to my time as Children and Families Minister, I know that when people act in a way in which they know they should not, they deliberately hide that from the authorities and investigative bodies. So we do need to cut the CQC a little bit of slack, because this is often not in plain sight. Where it is, it is easier to identify. However, the hon. Member is right that where there is a whistleblower complaint, we must act, and we must act swiftly.

Ambulance Services and National Heatwave Emergency

Barry Gardiner Excerpts

Wednesday 13th July 2022 Commons Chamber

[Maria Caulfield]

I am sorry to hear about the sad death of the hon. Member’s constituent. Her region is one of the six areas that have the worst handover times and at which we are targeting support. I would be happy to meet her and update her on the specific support that we are offering her region.

[Barry Gardiner (Brent North) (Lab)]

When discussing ambulance response and waiting times, the Minister kept using the phrase “month-on-month” improvements. Can she specify which months? She will know that it depends on which month you choose as your baseline—if it was the worst month in recorded history, it is not difficult to show month-on-month improvements.

[Maria Caulfield]

When we look at our figures, of course we look month on month, but we also compare them with previous years. As I said in my opening remarks, we are seeing an increase in calls—over 100,000 more compared with May 2019. The hon. Member shakes his head, but those are the facts. We are comparing month on month, and comparing with previous years. We are seeing an improvement in response times and in the amount of ambulance hours lost to ambulances queuing at A and E.

Health and Care Bill

Barry Gardiner Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

The Opposition congratulate the Lords on their hard work on the Bill, which is much improved from when it left the Commons. We support the Lords amendments, which are sensible and proportionate and will go some way to tackling health inequalities that are still sadly far too prevalent.

Over the past two years, we have seen the very best of our NHS. Publicly owned and free at the point of use, it is the best of us and has protected our families for generations; I hope it will continue to do so for many years to come. Unfortunately, the Government are set on a power grab, and refuse to act to tackle workforce shortages and ever-growing waiting lists. Waiting times for cancer care are now the longest on record, patients with serious mental illnesses are being sent hundreds of miles away for treatment, and one in four mental health beds have been cut since 2010. We deserve better. Our NHS deserves better.

We can all agree that the amendments in this group are wide-ranging, so I will be covering a range of subjects. A number of amendments in the group speak to women’s health. We have seen time and again that the Government are dismissive of women’s health and have ignored the needs of half the population. In its original form, the Bill was far too scant on tackling health inequalities; it is only because of colleagues in the other place and Labour votes that we are making ground on tackling them at all.

Along with the rest of our health team, I am proud to support the continued provision of telemedical abortion services in England. Maintaining the existing provision of at-home early medical abortion following a telephone or video consultation with a clinician is crucial for women’s healthcare. Not only did that preserve access to a vital service during the pandemic; it enabled thousands of women to gain access to urgently needed care more quickly, more safely and more effectively. Women’s healthcare must reflect the needs of those whom it serves. Scrapping telemedical abortion services would drastically reduce access to that vital service, and would simply serve to increase the number of later-term abortions. Everyone should have access to safe and timely healthcare. I say to Ministers: please do not ignore clinical best practice and the expert opinions of organisations and royal colleges.

We welcome provisions to ban hymenoplasty, and the power to create a licensing regime for non-surgical cosmetic procedures. Those too were a result of Labour votes, because the original Bill did not even mention them. Ministers must stop treating women as an afterthought in healthcare provision. However, we are glad to see that the Government have accepted the Lords amendment to remove coroners’ access to material held by the Health Service Safety Investigations Body.

On the NHS frontlines, I see at first hand the pressure placed on staff. Staff must feel protected, and must be encouraged to come forward. It is crucial for the Bill to promote a learning culture, so that any investigation can establish what training and procedures need to change in order to prevent any future mistakes. Only by enshrining that culture can we ensure that staff will feel comfortable about coming forward.

We welcome Baroness Hollins’s amendment to introduce mandatory training on learning disabilities and autism for all regulated health and care staff, and we are pleased to see that the Government support it. Everyone deserves access to safe, informed, individual care, and hopefully the amendment will go some way towards reducing health inequalities that are faced all too regularly by people with learning disabilities and autism.

[Barry Gardiner (Brent North) (Lab)]

I agree with much of what my hon. Friend is saying. For instance, I too believe that it is a woman’s right to choose. One of the features of a physical consultation was that it gave the woman an opportunity to do so in a free environment. Does my hon. Friend share the concern that I know exists among many of our constituents that if the consultation is done by telephone, it is possible that a woman who is being coerced will not be understood to be being coerced by the consultant who is dealing with her? It is important that, in preserving the right to choose for the woman, we do not allow a situation in which that woman could be coerced, by a coercive partner, into making a choice that is not her own.

[Dr Allin-Khan]

I thank my hon. Friend for his intervention. There are widely held variations in views across the House, but I stand by the principle that everyone should have access to safe and timely healthcare, and that scrapping telemedical abortion services would drastically reduce access to a service that is incredibly important for women, and, as I have said, would simply increase the number of later-term abortions, which can have physical and mental impacts on the mother herself.

As for Lords amendments 85 to 88, it is disappointing to see the Government going against their own ambitions and targets. The consultation referred to in Lords amendment 83 would be on a statutory “polluter pays” scheme to make tobacco manufacturers fund measures to reduce smoking prevalence and improve public health. Smoking is responsible for half the difference in life expectancy between the richest and the poorest in society. Will the Minister please explain why we are still waiting to see the Government’s tobacco control plan, which we were promised by the end of 2021? The Government need to stop kicking public health matters into the long grass. They say that they recognise the stark health inequalities associated with tobacco use, but delays will do nothing to level the playing field and eradicate health disparities.

Ministers need to make sure they listen to the Lords, whose amendments go a long way towards eradicating the vast health inequalities that exist across society today. Rather than wasting time trying to overturn the changes, Ministers should now focus relentlessly on bringing waiting times down.

Future of the NHS

Barry Gardiner Excerpts

Monday 31st January 2022 Westminster Hall

[Barry Gardiner (Brent North) (Lab)]

I begin by praising all the staff in the NHS, who, often at enormous personal risk, have provided dedicated care to so many of us over the past two years. The Minister must know—and the Government should acknowledge—that they are exhausted. As a country, we must show that we care for all of them as they address the backlog of over 5 million people waiting for treatment.

That care must be more than warm words and clapping. It must be tangible and financial, and it must be realistic. That means expanding workforce capacity, both as regards beds and staffing, in order to reduce the pressures our NHS heroes are facing. It means meeting the capital maintenance backlog of more than £9 billion. It was dereliction by the Chancellor to entirely omit any funding for infrastructure and building repairs when announcing the NHS settlement. There are two futures for the NHS: the disastrous one contained in the Health and Care Bill, or one that integrates health and social care in an efficient, comprehensive service that is free to everyone, from cradle to grave, whatever their medical need. It would be delivered entirely by, and be accountable to, our public sector—staff who are fairly treated and properly rewarded. I want to pay tribute to all the unions, particularly my own, Unite the union, for the work they have done to ensure that that is the case for staff.

By “comprehensive”, I mean that the service should include mental health and public health. If the pandemic has taught us anything, it should be the importance of public health, yet the integrated care boards have no delegated places for directors of public health, mental health or adult social services. There is not even a place for the voice of the patient, around whom everything should be centred.

By “efficient”, I mean that the service must deal with the backlog of 5.3 million patients waiting for treatment. By “whatever their medical need”, I mean that it should definitely include dentistry, as we have heard from my hon. Friends. By “accountable public service”, I mean that there should be no conflict of interest that allows a private company to sit on the ICB and commission contracts from which it will then be able to benefit. In 2012, I railed against the imposition of section 75 because it put competition, rather than co-operation, at the heart of our health system. I thought—correctly, as it turned out—that this would give rise to increasing privatisation, the rationing of care and the lessening of patients’ access to the care they need. Putting competitive tendering at the heart of the service destroyed trust and introduced a profit motive, rather than allowing a focus on successful medical care outputs.

It may be wondered why the reversing of the Health and Social Care Act 2012, introduced by Andrew Lansley, would be of concern to me. In 2012, none of us could have conceived of the fact that doing away with competitive tendering might mean not less, but more privatisation, unregulated by the tendering process. In 2012, we would not have believed that we would see VIP commissioning routes, through which contracts for medical equipment worth billions—not millions—of pounds would be given out to friends of Ministers, but that is what we face in the Bill. It puts that ability into legislation, which is why the Bill should be stopped.

Health and Care Bill

Barry Gardiner Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Greg Smith (Buckingham) (Con)]

I rise to speak in this debate to outline the case behind amendments 106 to 109 in my name, and to speak in favour of those in the names of my hon. Friends the Members for Carlisle (John Stevenson) and for North East Bedfordshire (Richard Fuller). I am also grateful from the outset for the time that my right hon. Friends the Secretaries of State for Health and Social Care and for Digital, Culture, Media and Sport have afforded me in recent weeks to discuss these matters.

First and foremost, I want to set out that in principle I am opposed to the expansion of the nanny state. I did not get into politics to tell people what they should or should not eat, or businesses how they should go about advertising their products and wares. However, I equally do not doubt for one moment that obesity is a serious health concern for this country. It is a question of the detail and the manner in which we go about tackling it as a country—principally, that we go about it through education and ensuring people are able to make choices for themselves, rather than using blunt tools that I fear will not work. As I highlighted in a Backbench Business debate on the obesity strategy some months ago, the Government’s own research shows that the measures in the Bill will reduce calorie intake among children by only 1.74 calories a day. If that is the outcome, we must seriously question the measures before us.

The amendments in my name, however, seek to rectify an unfairness that will exist if the Government push ahead with these advertising restrictions, which have businesses in my constituency very concerned. For example, farmers such as Morris of Hoggeston, who grow oats, are concerned that within the categories under the HFSS, or high in fat, sugar or salt, measures, products such as porridge and granola, which are hardly the choice of most children—certainly not my children—are in scope. We need to do something to sort that out. Great British broadcasters, both public service and fully commercial, also stand to lose some £200 million a year from the restrictions we have before us.

My amendments are about fundamental fairness, and seek to treat broadcasters the same way as online platforms. In the first place, research shows that children, who these measures are most prominently aimed at, do not watch broadcast television as much as they used to. They look more and more to YouTube, on-demand services and online; I can testify to that from my own home, where my five-year-old much prefers YouTube to watching CBeebies or other children’s television programmes, and I think that is the same for most children. [Interruption.] I am not sure what is causing amusement on the Opposition Benches.

In fact, 95% of viewing of broadcast television before the 9 pm watershed is by adults, not children, and there are already regulations in place during scheduled children’s programming. So I fear the measures in this Bill will not work, and the fundamental unfairness that I spoke of earlier is the manner in which broadcasters will be treated compared with the online platforms.

[Barry Gardiner (Brent North) (Lab)]

I have listened carefully to what the hon. Gentleman has said. Given that there is this disparity between the online advertiser and the broadcaster advertiser, and if we are seeking to restrict broadcasting advertisement to children so that they do not become unhealthy, would not the logic follow that we should equally restrict the online advertiser, rather than saying, “Let’s allow more of a free for all because this is more difficult to do for the online”?

[Greg Smith]

I am grateful to the hon. Gentleman for his intervention. If he will let me make a little more progress, I think he will find that my amendments seek to put a harsher perspective of this on the online platforms, rather than letting anyone off anything whatsoever. I repeat that my fundamental position is one of opposition to the nanny state and restrictions, but recognising that if the Government are going to push these restrictions forward, we have to have fairness and parity across broadcast and online sectors, otherwise there will be loopholes, things will fall through the cracks and the Government will not achieve their objectives.

--- Later in debate ---

[Alex Norris]

Yes. That was a strong theme in Committee that we on the Opposition Benches are very much against; it is likely to be a prominent theme during our discussion of upcoming amendments. Through what we are discussing now, we at least have the chance to put something in the Bill that might improve the public’s health.

[Barry Gardiner]

My hon. Friend talked about waiting lists. Would he confirm that at the moment approximately 5.6 million people are on the waiting list and that the Government’s own projections are that that figure could rise to 13 million? What in the Bill does my hon. Friend believe can address that extraordinary situation?

[Alex Norris]

My hon. Friend makes an important point. This Secretary of State must be the first in the history of the NHS who came into that important role saying that he was expecting waiting times to grow to the extent that they are. That is of course pandemic-related, but it also has a reality far beyond this extraordinary last 18 months. There are more than 125 clauses in the Bill and the Government have proposed more new clauses in Committee and on Report, but not one of them will have a meaningful impact on waiting times, so people should be really disquieted.

--- Later in debate ---

[Dr Whitford]

I thank the hon. Member for North East Bedfordshire (Richard Fuller) for clarifying that I had not voluntarily added my name to his amendment.

Whenever we talk about such subjects, we hear a lot about the nanny state. As a surgeon working in A&E in general surgery, however, the difference when seatbelts, airbags and speed limits came in was night and day in how much time I spent dealing with people in operating theatres who had been involved in car crashes. Sometimes the state has to take action to protect people’s health and wellbeing.

The Bill focuses largely on reversing some of the most egregious aspects of the Health and Social Care Act 2012, which I welcome, but these measures focus on improving public health. There is no question that obesity, type 2 diabetes and other diseases associated with obesity pose not just a real threat to individual health but a threat that will overwhelm national health services in future. When I looked at the original Bill, however, I was surprised that, apart from the measures around obesity, there was little in the way of public health policy to improve and promote health, and there is also little enough about care.

It is not the national health service that delivers health. I have often said that it would be more appropriate to call it the national illness service, but who would want to work somewhere called that? The NHS spends most of its time catching people when they fall. Health comes from a decent start in life, a warm dry home, enough to eat and a decent education. Those are the things that deliver health, but there is nothing like them in the Bill.

Particularly, and surprisingly, there is nothing in the Bill on reducing harm from tobacco products and alcohol, which is why I rise to speak in support of new clauses 2 to 4, which seek to strengthen the health warnings on all tobacco products; new clauses 7 to 10, which seek to allow regulation of tobacco pricing; and particularly new clause 6, because the use of sweet flavourings to entice children and young people to take up smoking is indefensible.

[Barry Gardiner]

I heartily commend the hon. Lady for her comments. Does she experience in her constituency, as I do in mine, that smoking cessation services are diminishing and becoming less successful? As the tobacco industry concentrates on a core group of existing addicts, it is desperate to move down the age range and encourage new addicts. That is why that element of the new clause is important.

[Dr Whitford]

I agree that new clause 6 is the most important of the new clauses, because tobacco companies are driven to recruit new victims—as I would have to call them, as a doctor—and they are recruiting them from young people.

Public health is devolved, so we have not had the cuts in public health funding that we have unfortunately seen in England since 2016. Therefore, we have not had the cuts to smoking cessation and sexual health services that many local authorities experienced across England when public health moved into local government.

Smoking does not just cause respiratory problems such as chronic obstructive airway disease, but affects all the blood vessels causing peripheral vascular disease, vascular dementia, strokes, heart attacks and many forms of cancer, not just lung cancer. Stopping smoking is the best favour anyone can do themselves, but many people require the very smoking cessation services that the hon. Gentleman mentioned.

--- Later in debate ---

[Justin Madders]

I thank my hon. Friend and neighbour—I am getting all my neighbours in tonight. She makes a brilliant point: the proposal exacerbates regional inequalities through an unfair tax and is certainly not a plan to fix social care. Hon. Members should look at what my hon. Friend the Member for Leicester West has said about what needs to be done to tackle the social care crisis in this country; it is an awful lot more than putting in place a cap that benefits only some people in certain parts of the country.

Not only will the proposal not stop people having to sell their home to pay for their costs, but it will bake in unfairness for a generation. It does nothing for working adults with long-term care needs, who seem to have been completely missed out, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said. It is not what was promised, but hon. Members do not have to take my word for it. Let us listen to the experts. Age UK says:

“The change the Government has announced makes the overall scheme a lot less helpful to older people with modest assets than anyone had expected. It waters down Sir Andrew Dilnot’s original proposal to save the Government some money, but at the cost of protecting the finances of older home owners…This feels like completely the wrong policy choice and we are extremely disappointed that the Government has made it”.

The King’s Fund says of people with more modest assets that,

“the Prime Minister’s promise that no one need sell their house to pay for care…doesn’t seem to apply to them.”

Instead, it will only “benefit wealthier people”.

[Barry Gardiner]

My hon. Friend referenced the Prime Minister’s statement that nobody would have to sell their house to pay for social care. I know that my hon. Friend would never seek to call the Prime Minister a liar in this Chamber, but does he wonder, as many hon. Members do, why the Bill appears to be turning the Prime Minister’s words into a lie?

[Justin Madders]

I thank my hon. Friend for his intervention—I think. What I can say here and what I might say outside are not the same, and I do have to finish my speech, so I will leave it there. I am sure that the public will make up their own minds about the veracity or otherwise of comments made by the Prime Minister.

Sir Andrew Dilnot said that the proposals will create a north-south divide, that those with assets of £106,000 will be hardest hit and that anyone with assets under £186,000 will be worse off than under his proposals. According to the Health Foundation, assuming care costs of about £500 a week, those with assets of £150,000 will take a year and a half longer to reach the cap than they would have under the Dilnot proposals, those with assets of £125,000 will take four and a half years longer, and those with assets of under £106,000 will never reach the care cap. Contrary to what the Minister has said, people with assets of £106,000 or less will not benefit from the proposal at all.

NHS Update

Barry Gardiner Excerpts

Wednesday 21st July 2021 Commons Chamber

[Helen Whately]

We have indeed committed to build 40 new hospitals by 2030. Together with eight existing schemes, that will mean 48 new hospitals by the end of the decade—as my hon. Friend says, the biggest hospital building programme in a generation. The programme is absolutely on track, but I will have to take up the specific hospital in her constituency with the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), who is the hospitals Minister.

[Barry Gardiner (Brent North) (Lab) [V]]

In order to ensure that the Minister is damned if she says no and damned if she says yes, can she confirm whether she believes that pushing the Government response to the pay review into the long grass or sneaking it out during the recess, when Parliament is not sitting, is an adequate and fair reflection of the sacrifices that NHS staff have made to keep our country safe during the pandemic?

[Helen Whately]

As I have said, we are considering the recommendations of the NHS pay review body. This is an extremely important decision for the Government; it clearly has consequences for a very large number of NHS staff. We will be announcing our decision on pay as soon as we can.

Covid-19: Dental Services

Barry Gardiner Excerpts

Thursday 14th January 2021 Commons Chamber

[Barry Gardiner (Brent North) (Lab) [V]]

The Book of Proverbs says:

“Confidence in an unfaithful man in time of trouble is like a broken tooth.”

We are in a time of trouble and there are lots of broken teeth. While I make no aspersions about the fidelity of the Prime Minister, I can tell him that confidence in his Government, even before covid, was already at an all-time low with the dentists I speak to in Brent. There has been a total lack of investment in dental laboratories, a failure to recruit and train dental technicians, flawed dental contracts and chronic underfunding.

My hon. Friend the Member for Putney (Fleur Anderson) has lucidly set out the key demands of the British Dental Association: abandon the activity targets; support practices to increase the number of patients they can see safely; prioritise access to the vaccine; safeguard the supplies of PPE; and extend the business rates holidays to dentists. I will not rehearse and repeat her excellent arguments; I want to give voice to the frustration felt by the dentists who continue to serve my constituents in Brent so well.

The BDA has catalogued the failure to properly communicate with the public, but what I had not appreciated until I spoke with my local dental committee is just how poor the Government’s communication with dentists themselves had been. I quote from their letters. One said that

“dental services have often been treated as an afterthought with no understanding of the NHS contract imposed on the profession. Dental practitioners found out in May on the news, at the same time as patients that they were to reopen in June…The panic and frustration this caused is deplorable. Dental practices, despite being high risk because of the aerosol generating procedures, were not able to access PPE from the Government portal until September and the vital FFP3 masks were not added to that until November. It is clear that little thought, if any, had been given to dentists and their teams.”

One dentist wrote:

“When on the 8th June our high street practices in England were allowed to resume face-to-face care, the reality of what a new normal might look like hit…fallow time means the number of patients able to be seen is significantly reduced. It was anything but ‘business as usual’. I ask myself, at this time, what would be the worst thing to impose on dental practices? Very high up on my list would be precisely what the government has decided to impose—targets. The emphasis on targets from the NHS clearly prioritises a metric and finance over patient interest. To achieve targets, footfall would have to increase and non-urgent patients be prioritised.”

My local dental committee tells me:

“Many practices are already finding the conflicting strain too much, and this comes on top of the emotional and physical drain of wearing full PPE for hours every day…The imposition of a target at this time serves no purpose whatsoever other than to destabilise, perhaps terminally, NHS dental provision, and to demoralise an already exhausted profession further.”

Covid-19 has been felt most severely by those who were already more likely to have poor health outcomes—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sorry, Barry; we are going to have to leave it there because we have run out of time. I will call James Wild next, and then hopefully we will get Scott Mann back on the line.

Covid-19 Update

Barry Gardiner Excerpts

Thursday 17th December 2020 Commons Chamber

[Matt Hancock]

Yes, if my right hon. Friend has the test reference number I will get on to it right away. If NHS Test and Trace has not contacted the owner, that might imply that he does not have to self-isolate, but of course I will want to look into the details of the case before making such a recommendation. I will ensure that my right hon. Friend’s constituents get a full, clinically approved recommendation ASAP.

[Barry Gardiner (Brent North) (Lab)]

Mr James Canning became our first octogenarian in Brent to receive the vaccine earlier this week. While congratulating him and the Wembley Practice team who delivered it, does the Secretary of State share my concern that care homes in Brent have been advised that the 970 doses that are in the vaccine packs cannot be split because of the licensing conditions, meaning that those in our care homes who are over 80 may have to wait until February or for the Oxford vaccine before they get vaccinated? Is that the case? If so, why? That is hardly the “protective ring” around care homes that he promised.

[Matt Hancock]

I am glad to say that we are making significant progress on tackling this issue. When the hon. Gentleman says it is a licensing concern, that should not be read to imply that it is some bureaucratic rule; it is about ensuring that things are done safely. If the vaccine is not delivered safely to the site, it is not an effective vaccine. Therefore, we are taking it carefully to be able to vaccinate in care homes. There has been some vaccination in care homes across the UK, so it can be done, and I hope we can make good progress soon.

NHS Dentistry and Oral Health Inequalities

Barry Gardiner Excerpts

Wednesday 25th November 2020 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

I beg to move,

That this House has considered access to NHS dentistry and oral health inequalities.

It is a pleasure to serve under your chairmanship, Mr Gray. I am delighted to have secured this debate on access to dentistry and oral health inequalities. I have spoken about this issue many times in this place, and it is more urgent now than ever. I will shortly turn to the effects of the coronavirus pandemic on dentistry in this country and, in particular, on access and oral health inequalities, but first I would like to set the scene a little.

In 2017, I held an Adjournment debate entitled “Access to NHS Dentists”. In that debate, I said:

“Millions of people each and every year are being left without access to an NHS dentist.”—[Official Report, 12 September 2017; Vol. 628, c. 812.]

I urged the Government to get on with dental contract reform and bring forward a coherent strategy to tackle the inadequacies and inequalities in the dental health system. That was three years ago, and of course no one could have foreseen the events of this year, but I am making the point at the outset of this debate that NHS dentistry in this country was already in a sorry state before covid struck. It was therefore extremely vulnerable to what has happened since March, the effects of which have been disastrous. The crisis in access that people were experiencing prior to March has been turbocharged. Solving it now requires the Government to dramatically change their approach to oral health treatment and prevention. In discussing the impact of covid on dentistry, I will focus mainly on England.

[Barry Gardiner (Brent North) (Lab)]

My hon. Friend is a student of the Old Testament, and she will know Proverbs 25, verse 19:

“Confidence in an unfaithful man in time of trouble is like a broken tooth”.

We are certainly in a time of trouble. It is not for me to call the Prime Minister an unfaithful man—

[James Gray (in the Chair)]

Certainly not. You must be brief.

[Barry Gardiner]

But the lack of support for dentistry and dental technicians has certainly resulted in a few broken teeth. What does my hon. Friend believe is the single most important thing that the Government can do to support dentistry and the oral health of the nation?

[Judith Cummins]

The single most important thing that the Government can do is reform the dental health contract with a view to more prevention.

During the initial period of lockdown, between March and June, all routine dental care in England was paused and urgent dental care hubs were set up to provide emergency treatment to patients. That period of closure has clearly led to an enormous backlog of patients requiring treatment. The British Dental Association estimates that in April and May only about 2% of patients were able to access dental care, compared with last year, and that between March and October 19 million appointments were lost. One local Bradford dentist told me:

“Our phones are ringing hot with new patients who have no dentist access, which has certainly been made worse by this year’s lockdown. On top of this we are facing significant staffing pressures, due to increased triage requirements and the need to thoroughly clean the practice between patients.”

Just yesterday, I was contacted by one of my constituents who has been trying to get a dental appointment for five months and is living with gum disease and toothache. That is simply unacceptable.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Bradford South (Judith Cummins) on securing this important debate. I know her long-standing and grounded interest, shared by many across the House, in helping individuals access better health care broadly and in particular for their oral health. She has much support, as my hon. Friend the Member for North Cornwall (Scott Mann) showed.

This is a challenge which, as the hon. Lady neatly articulated, has become much worse under the pandemic. I hope to go into more detail about the fact that dentistry has faced specific challenges while delivering what care it has been able to. There are particular long-standing concerns about access to dental treatment in Yorkshire, including the hon. Lady’s area. She gave credit to my hon. Friend the Member for Winchester (Steve Brine) for the work that he did with her, because flexible commissioning has been operated in that area, and it is agreed that most dentists would prefer to move in that direction. As she said, there are challenges with units of dental activity, and arguably an evolution towards capitation, looking at dentistry in the round, and highlighting prevention would start to address those. The Department, NHS England and NHS Improvement are committed to the growth of access to dental services. There have been a number of actions, and seeing them come to fruition in Yorkshire is helpful in understanding how they might benefit a wider population.

As I said, the pandemic had a significant impact on dentistry. That reduced drastically, as the hon. Lady explained, the number of patients whom dentists can safely see each day. The dental risks were new. At the start of the pandemic we stopped dentistry because of the risk of transmission being much higher, owing to the aerosol-generating procedures used. That applies to extraction, but there is even such a risk in scaling and polishing.

During spring, urgent dental care centres were quite rapidly set up. Up to 635 centres were set up across the country and the remainder of high-street practices were asked to deal with the three As—telephone advice, antibiotics and analgesics. I understand that that was a challenge for patients, but I am sure that the hon. Lady will agree that it was vital to ensure the safety of dentists, dental technicians, nurses and entire teams at the beginning of the pandemic.

[Barry Gardiner]

It is really good to hear the Minister giving a straight response to the questions raised by my hon. Friend the Member for Bradford South (Judith Cummins). She mentioned dental technicians. Is she as concerned as many of us are that because of the lack of work for them now, people are leaving that employment, and the skills base is being lost in such a way that it will be difficult to cope with the expansion of demand once we move from present circumstances beyond the epidemic?

[Jo Churchill]

I believe that the workforce, more broadly, is something we must look at properly in the round.

Aerosol-generating procedures present a high risk, as I said, and under initial guidance issued by Public Health England, infection control required that rooms should be rested for up to an hour, as the hon. Member for Bradford South said, to allow the airborne spray to settle. NHS dental practices were allowed to start offering services from 8 June providing that they had appropriate PPE and infection prevention and control measures in place.

In response to the hon. Member for York Central (Rachael Maskell) I would say that all NHS dentists can access the portal. Registration is voluntary, and 5,500—equating to about 81% of all NHS dentists—have signed up, and 50 million items of personal protective equipment have been dispensed. Making sure that our frontline services have what they require is vital, but the e-portal is being used, and I urge the remaining dentists to sign up.

There are more than 6,000 NHS practices in England that should now be offering face-to-face care, in other than exceptional circumstances. Guidance to practices has made it clear that during the difficult period they should prioritise care for vulnerable groups and then address the delayed routine check-ups; but that remains a challenge.

I recognise the comments that the hon. Member for Bradford South made about expectant mothers; I have asked my officials to look at that at speed, and I will come back to her on that. I am determined that we mitigate widening oral health inequalities as much as we can during this difficult period because, as we have alluded to, we know we had a problem beforehand.

NHSEI is keeping more than 600 urgent dental centres stood up to provide additional capacity in the system. My hon. Friend the Member for North Cornwall said he has problems too—and we have them across the country—so making sure that we have that universal coverage with UDCs is important. I must put on record my gratitude to dentists, dental nurses, technicians and all the team, because this has been a really difficult period. Dentists and their staff have kept vital care going through the initial peak, both remotely and in frontline urgent dental centres; many also volunteered to be deployed if needed on the frontline of covid services, and their contribution was very much appreciated.

It is important to ensure that NHS dentists are financially supported as businesses. NHSEI has continued to pay dental contracts in full, minus the running costs for downtime in the initial lockdown, whatever the volume of service to be delivered, and NHS dentists holding NHS contracts have welcomed that support. However, I am mindful that that support was for NHS dentists, and there are challenges in the private sector—and many practices are a mixture of both.

The focus now is on increasing dental provision as fast and as safely as possible. Key work has been done to establish ways to reduce room resting times, and that advice has been made available to the profession. I regularly meet with the chief dental officer, the BDA and other stakeholders, because it is vital that we keep looking at how we can get volumes up. That also means updating the existing dental infection prevention and control guidance, but it does not solve the challenge of delivering dental care at volume through the pandemic. It is an important step forward, but part of the problem is the variability in the estate, as the hon. Member for Bradford South alluded to—the different sizes of practices, where they are located, and so on. NHSEI is in discussion with the profession and is taking clinical advice on the expectations for delivery of services to the end of March.

I met the BDA and other dental stakeholders last week to progress conversations further, and I heard those messages. The challenge is to make sure that we can get the optimal amount of care for our constituents and patients while safely ensuring that dental teams can be protected, but we do need to see increased provision. I am keen to understand what further work can be done to solve the challenges in dentistry and how it faces the pandemic, and I have asked officials and NHSEI to look at potential solutions, including testing, increased use of ventilation and the financing thereof.

I understand the constraints under which the profession is operating and how vital services are. We know without doubt that oral health inequalities are likely to have increased over the period of the pandemic and NHSEI is working hard to ensure that caring for vulnerable communities is prioritised. Poor oral health can have a devastating impact on somebody’s quality of life, particularly a child’s, and dental disease is entirely preventable. In the Green Paper published in 2019 we committed to looking at those barriers, to fluoridation and to consulting on rolling out supervised tooth-brushing schemes in more preschool and primary settings. We are working as hard as we can to make sure we hit the consultation dates, but there are challenges.