NHS Dentistry

Derek Thomas Excerpts

Tuesday 9th January 2024 Commons Chamber

[Derek Thomas (St Ives) (Con)]

I listened carefully and with interest to what the shadow Secretary of State said in his opening remarks. I like the man, but he clearly sees this matter as a potential political football, which comes as no surprise to me. As for me, my interest is in the constituents I represent. They do not care so much about the bickering between us, but they do care about their oral health.

I am glad to have the opportunity to speak in this debate. As we have heard, every constituent will need access to dental activity during the course of their lives. I have taken a great interest in this matter and spoken about it to hundreds of constituents and several dentists. In fact, over the weekend I spoke to some dentists who do not support Labour’s plans and want to see the Government advance their reforms—I was glad to hear more about those reforms today. I have raised the matter of NHS dentistry several times in the House with two separate Prime Ministers, including in January 2022, June 2022, April 2023 and September 2023, and also with several Ministers, including the one on the Front Bench, and the Secretary of State.

The Secretary of State’s predecessor said it was a priority to increase the number of dentists in specific parts of the country, and mentioned the south-west in particular. We are seeing some early green shoots appear. None the less, people in the south-west and Cornwall are struggling to get access to a dentist. I still receive weekly emails from constituents who are not getting the treatment that they need, or who are spending their time and money travelling to NHS practices in Manchester or London, or even abroad, to pay for private care. I have witnessed dental practices giving up NHS contracts, or vastly reducing NHS treatment, forcing some people to fully fund their own care and others, who cannot afford that, to go without treatment. I have raised this issue with the Health Secretary in the Chamber quite recently.

When I spoke to people in dental practices, they said they were as frustrated as I am. They have a contract with the NHS to provide thousands of units of dental activity, but the funding allocation is clawed back by the NHS if they cannot deliver those units. They cannot deliver the units, as we have heard already, because the value is too low to attract the staff that they need. Last year, a practice that I was working with paid more than £132,000 in clawbacks to our integrated care board. That is enough funding to treat 1,600 patients.

Nationally, underspend in the NHS dental budget could reach £500 million. We know that the NHS dental contract needs reform: it does not work for dentists and it certainly does not work for our patients. None the less, I am pleased that integrated care boards are taking ownership of dentistry and driving the delivery of dental care in our regions. In Cornwall, the ICB has already gripped the issue, using what resources it has to increase capacity. I was disappointed by the shadow Secretary of State’s reference to the work going on in Cornwall. The ICB does not see the work that it is doing as restricting NHS dentistry just to children, the elderly and vulnerable people. That is absolutely not the case. What it is doing is looking at where the shortages are and seeking to address them with the resources it has. The truth is that one third of adults in Cornwall are still accessing NHS dentistry. We have seen new NHS dental provision in Helston and in St Ives—two of my major towns—and there is a real ambition among dentists to take on more once they are allowed to do so.

The workforce plan needs to set out not just the number of dentists, dental nurses and other dental professions, but where they are located. We have a brilliant dental suite in Truro, but graduates rarely stay in the south-west once they have been trained. We are seeing a slight improvement, with dental practices offering foundation placements for graduates in Cornwall, including in St Ives, where the potential is greater.

I recognise that the Minister is just as keen as I am to empower the entire dental team to work to their full potential for NHS patients, but there remain barriers to fully implementing direct access in NHS-funded dental care. As I understand it, medicines can be administered by dental care professionals when they provide care to patients who pay privately, but this does not apply to NHS dental patients. On a recent visit to a practice in St Ives, the owner explained to me the impact of this disparity.

We have therapists in most locations in the south-west ready to increase NHS access, especially for young children, as most of the work for that patient cohort is within their scope of practice. It is disappointing that we cannot use those therapists fully. Dentists are reluctant to sign off prescriptions because of time issues and because of not understanding the process. Our therapists are doing only hygiene work, and some of them are leaving because of the lack of work.

My understanding is that a statutory instrument is required, which is in the gift of the Minister. This simple piece of legislation would provide the opportunity for NHS dental practices to use the full skillset and competencies of their dental staff to increase the delivery of desperately needed dental care. Will the Minister indicate today whether she is able to bring such an SI to the House and unleash an army of dental professionals to do what they believe they are trained to do?

Finally, in 2021-22, £4.5 million of unmet dental care was returned from Cornwall to the NHS. It is now lost in the NHS system. Will the Minister assure me that never again will that kind of money be grabbed or stolen from Cornwall’s dental patients, returned to the NHS and not used to deliver the dental care that they need?

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 5th December 2023 Commons Chamber

[Derek Thomas (St Ives) (Con)]

I welcome the guidance that ICBs have received. Cornwall ICB has committed to ringfencing money for dentistry next year, but the truth is that, before it took on that commitment, £4.5 million for unmet units of dental activity was returned to NHS England. What can the Secretary of State do to ensure that Cornwall gets the money that was intended for Cornwall to deliver NHS dentistry?

[Victoria Atkins]

A theme is emerging of underspend in dental work, which is one of the things that the ministerial team and I are looking at. NHS England emphasised in its guidance to ICBs that the funding should be ringfenced. I very much understand the pressures that my hon. Friend and other south-west Members have been raising over many months on the care that their constituents are getting. To ease pressures in the south-west, NHS England has commissioned additional urgent dental care appointments that people can access through NHS 111.

NHS Dentists: South-West England

Derek Thomas Excerpts

Wednesday 24th May 2023 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I thank my hon. Friend the Member for West Dorset (Chris Loder) for introducing this debate. Nearly a year ago, I introduced a debate in this place on the same subject. The then Minister said it was a priority to increase the number of dentists in specific parts of the country, and she mentioned our loved area, the south-west. At the same time and soon after, contract changes were announced. I would not say that they were completely hopeless, as has just been suggested, but people in the south-west are still struggling to get a dentist, as we have heard. I still get emails from constituents who are not getting the treatment they need or spending their time and money travelling to London, Manchester or even abroad to access dentistry.

Since my debate, I have witnessed dental practices giving up NHS contracts or vastly reducing NHS treatment, forcing people to fund themselves fully, while others who cannot afford that go without treatment; I raised that issue with the Health Secretary in the main Chamber only recently. This week, a lady told me that she had filled her own tooth, using a kit she bought online and the torch on her mobile phone. She was frustrated, and so was the dental practice. It has a contract with the NHS to provide thousands of units of dental activity—UDAs—but that funding allocation is clawed back by the NHS if it cannot deliver those units. It cannot deliver those units because the value is too low to attract the staff it needs.

This year, that practice alone will pay back £132,000 in clawback—enough funding to treat roughly 1,600 patients in west Cornwall. I have asked NHS regional commissioners where those funds go and whether they can be made available for additional dentists; I have not received a reply. In fact, although I previously appreciated a very healthy and helpful dialogue with NHS England commissioners, their engagement and response rate with me and my office this year has been woeful.

Nationally, the underspend in the NHS dental budget could reach half a billion pounds. If I could get just one commitment from the Minister today, it would be to ensure that that money is spent on the dental care we need. For example, it could be used to raise the UDA value to £30. That would be a small step, within existing budgets, that could help dental practices in my constituency afford to treat more patients.

In the longer term, we know that the NHS dental contract needs reform. It does not work for dentists, and it certainly does not work for our constituents—the patients. We look forward to integrated care boards, but we also look forward to their taking ownership of dentistry and driving the delivery of dental care for their regions. In Cornwall, we have an integrated care board just for Cornwall and the Isles of Scilly. It is really helpful now to know exactly where to go to talk about dentistry. As we heard earlier from my hon. Friend the Member for West Dorset, we must work together to really have local accountability and delivery solutions to address people’s oral health.

We need better workforce data on dentistry as part of the forthcoming NHS workforce plan. We heard yesterday that the British Dental Association reported that the numbers of NHS dentists had fallen. The Minister’s Department says that not all NHS dentists have submitted their data for the year. Whatever the truth is, that shows that we do not have credible data; without data, we do not have a plan. The workforce plan needs to ensure not just the number of dentists, dental nurses and other dental professionals, but where they are located. We have a brilliant dental suite in Truro, but graduates rarely stay in Cornwall once they have been trained. We are seeing a slight improvement, with dental practices offering foundation placements for those graduates in Cornwall—something that traditionally we have not done—including in St Ives, but the potential is far greater.

Finally, I recognise that the Minister is as keen as I am to empower the entire dental team to work to their full potential for NHS patients. However, some barriers remain to fully implementing direct access in NHS-funded dental care. In dental care, a system exists that enables the administration of medicines by dental care professionals when they provide care to patients paying privately. That does not apply for NHS dental patients.

On Friday, I visited a new dental practice. Did you hear that—a new dental practice? It is not all dreadful and miserable. The owner is providing five new treatment rooms. He has two dentists and a hygienist, and he will take on more UDAs and dentists—he will have the dentists if he has the UDAs—but he explained the impact of the disparity that I just raised:

“We have therapists in most locations in the Southwest ready to increase NHS access, especially for young children as most of the work for this cohort of patients is within their scope of practice, and it is disappointing we cannot use them fully. Dentists are very reluctant to sign off prescriptions because of time issues and not understanding the process. Our therapists are only doing Hygiene, and some of them are leaving because of the lack of work.”

My understanding is that a statutory instrument in this place is required. That simple piece of legislation would provide the opportunity for NHS dental practices to use the full skillset and competencies of their dental staff to increase the delivery of desperately needed dental care. I know that the Minister is aware of that and keen to drive that forwards. Will he indicate whether that SI will be forthcoming in the near future?

Oral Answers

Derek Thomas Excerpts

Tuesday 25th April 2023 Commons Chamber

[Steve Barclay]

The hon. Gentleman raises a very important point. He can see the success of the representations I made to Cabinet colleagues from the Chancellor’s Budget statement, when he announced additional funding to tackle, in particular, health impediments to access to the labour market. He will also have seen the recent announcement of targeted action on, for example, smoking cessation, which is a particular driver of health inequalities. That includes our financial incentive scheme to pregnant mums, which obviously has a big impact on both their health and the health of their baby.

[Derek Thomas (St Ives) (Con)]

It is becoming clear that in Cornwall the only way to get dental care is to go to a private dentist. In a deprived area, of which there are many across Cornwall, that is just not an option for people on low incomes. What can the Secretary of State do to increase the accessibility of NHS dentistry?

[Steve Barclay]

This issue concerns Members across the House. We have already started to reform the dental contract. We have introduced the £23 minimum value for units of dental activity and created more UDA bands, reflecting the fair cost. We are seeing more patients nationally—to March, up nearly a fifth on the year. But I recognise that there is more to do, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is undertaking that work as we speak.

Brain Tumour Research Funding

Derek Thomas Excerpts

Thursday 9th March 2023 Commons Chamber

[Derek Thomas (St Ives) (Con)]

I beg to move,

That this House has considered brain tumour research funding.

I am hopeful that we will have nodding heads on both sides of the House for this debate this afternoon. I thank you for the opportunity to speak, Mr Deputy Speaker, and thank the Backbench Business Committee for making time for this debate.

I pay particular tribute to those families around the UK who are living with a brain tumour diagnosis. When I meet some of these families, I see an enduring hope, when so often their outlook seems hopeless. It is for that reason that the purpose of this debate is to demand a greater emphasis from Government and to accelerate the effort to find more effective methods to treat patients with brain tumours and ensure that they have the best care and rehabilitation possible.

Many hon. Members will remember that back in 2015, the Realf family presented a petition with 120,129 signatories calling for an increase in national funding for the research into brain tumours. The Petitions Committee picked it up and the following Westminster Hall debate led to the Government Minister at the time establishing a task and finish group to look at the issue. That group published its report in 2018 and the Government subsequently announced a £20 million fund for research into brain tumours, boosted by a pledge of a further £25 million by Cancer Research UK.

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

As the hon. Gentleman knows, I have been on this journey with him since that quite remarkable Westminster Hall debate in 2016. We said then that we needed the money; we got the money, but now we find that there are structural problems still standing in the way of the progress we need. To me, that says that there is probably nobody in charge of the strategy within the Department. Does the hon. Gentleman agree that if we can achieve anything in this debate, it will be to hear a commitment from the Treasury Bench that somebody will take charge of this strategy and make it happen?

[Derek Thomas]

Of course, I agree with the right hon. Gentleman. Actually, I want the Government to go further and make brain tumour research the priority of all cancer research, because we have not seen the progress that we should have in that time.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

A constituent got in touch with me yesterday to tell the devastating story of her young niece, who struggled to obtain a diagnosis despite several GP trips and horrendous symptoms that left her unable to eat properly or attend school. Does the hon. Member agree that ringfenced funding, specifically for research into childhood brain tumours, must be agreed urgently?

[Derek Thomas]

I will come on to that point later. I am grateful for the contributions that we have already heard.

I pay tribute to the late Dame Tessa Jowell, who sadly received her own diagnosis of a brain tumour soon after that debate, when Government funding was being announced. At that time, about five years ago, she said in the other place:

“For what would every cancer patient want? First, to know that the best, the latest science was being used…wherever in the world it was developed, whoever began it.”—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]

Sadly, she passed away in May 2018.

Soon after, an additional £20 million of Government money was made available and the Tessa Jowell Brain Cancer Mission was established. I pay tribute to Dame Tessa Jowell’s daughter and the mission for the way that they have transformed the pathway and the care that brain tumour patients get, and for the work that they continue to do. I appreciate the way that they have engaged with me and others on the all-party parliamentary group on brain tumours in their work.

The provision of £65 million heralded a significant shift in focus towards brain tumours. Given the high-profile commitment to brain cancer research, we should not be here calling for a commitment and a focus on brain tumour research five years later. Sadly, however, despite the £40 million of Government funds that were committed to research, there has been a lack of grant deployment to researchers.

It is important to note that Cancer Research UK, since announcing its commitment to spend £25 million on strategic initiatives in brain tumour research in 2018, has committed almost £28 million to that cause. That is not the case for Government funding. To date, the figures of the National Institute for Health and Care Research—the body responsible for distributing that research funding—state that of the £40 million, between £10 million and £15 million has been deployed, and that depends on how we interpret brain tumour research.

The all-party parliamentary group on brain tumours, which I am privileged to chair—perhaps I should have declared my interest at the start—decided to conduct the “Pathway to a Cure—breaking down the barriers” inquiry, which aimed to identify barriers preventing that important funding flowing to its intended recipients. We felt the need to launch that inquiry only because a series of meetings, including with the National Institute for Health and Care Research, the Medical Research Council, the Department of Health and Social Care and a Government Minister, failed to reassure us that dedicated research funding would or could be used to ramp up the research needed if we want to discover the breakthrough that every brain tumour sufferer and their family longs for.

Those of us who serve on the all-party group were able to understand the severity of the issue and the lived experience for patients, families, clinicians and researchers only because of the sterling work of the charity Brain Tumour Research. It provides the secretariat for the all-party group and brings together thousands of people across the UK to share their experience, knowledge and understanding, and to make up what I affectionately know as the brain tumour family.

In February last year, we launched our inquiry and took evidence from clinicians, researchers and patients. We released our report last Tuesday. Today, part of the way into Brain Tumour Awareness Month, we will set out what we have unearthed during the inquiry and press the Government to review and reform their method of deploying research funds to those who can make best use of them.

From our work, we know that researchers find it challenging to access Government funding, because the system is built in silos. We know that cell line isolation and biobanking are happening, but at only a minority of sites across the research community; that the pool of talented researchers is finite; and that NIHR processes act as a disincentive to researchers who can apply their expertise and intellect more easily elsewhere in the medical research field.

We also found that there are a limited number of clinical trials available for brain tumour patients, and that the national trials database is not reliable. We found that pharmaceutical companies are choosing not to pursue the development of brain cancer drugs in the UK, and that funding is not ringfenced—specifically for research into childhood brain tumours, as has been mentioned, where survival rates for the most aggressive tumours have remained unchanged for decades.

[Kirsten Oswald (East Renfrewshire) (SNP)]

The hon. Member is touching on a point that I am sure will have been heard by every MP in this place. Constituents who, sadly, have children who have been or are affected by brain tumours know only too well that things have not changed for decades. That is why what he has come here today to talk about is so important. We need to shift the dial. It is not good enough, it is terribly unfair and the consequences of us not shifting it are obviously profound.

[Derek Thomas]

Sadly, I have met far too many parents who have lost loved ones. It is heartbreaking to speak to them, and to see how a juggernaut has charged through and destroyed much of their lives. They give me so much hope that we can do this work because of the commitment they have to this subject.

Before I address the specific recommendations of the report, may I thank colleagues—many of them are here today—who have given up the last year to interrogate witnesses and to take evidence? I want particularly to mention my hon. Friend the Member for Scunthorpe (Holly Mumby-Croft), the right hon. Member for Leeds Central (Hilary Benn), my hon. Friend the Member for Buckingham (Greg Smith), the hon. Member for Ceredigion (Ben Lake) and Lord Polak CBE from the other place, but also Sue Farrington Smith MBE of Brain Tumour Research, Dr David Jenkinson of the Brain Tumour Charity, Professor Garth Cruickshank, Dr Antony Michalski and Professor Tony Marson, who took part in the inquiry, and most importantly, Peter Realf, whose son was lost and who triggered the petition back in 2015.

To turn to the findings, the Government must recognise brain tumour research as a critical priority. Five years ago, a remarkable effort was made by Government to respond to the shocking statistics that surround brain tumours. Brain cancer remains the biggest cancer killer of children and adults under 40. In order for survival rates to increase, the Government must go further and treat brain tumours as a key priority. This has been achieved in other countries through legislation, and I urge the Minister to see what can be achieved here. A brain tumour champion, which has already been hinted at, is needed to co-ordinate the funding and implementation of a strategy between the Department of Health and Social Care and the Department for Science, Innovation and Technology.

In order for brain tumour research to lead to tangible changes in survival rates for patients, it needs to receive funds across the research pathway, including discovery, translation and clinical research. I recognise the recent advances and improvements in molecular testing and prognostic information, but there is a requirement for further discovery research. That will improve the understanding of disease biology, and how best to frame and support pre-clinical trial research. For instance, a particular issue for tackling brain tumours is the complexity of drug absorption through the blood-brain barrier.

It is crucial that the Government enable the building of critical mass in these elements of the research pipeline. With no ringfenced funding to support poorly funded disease areas such as brain tumours, investment in the disease is not always prioritised. Focused calls for multidisciplinary research into brain tumours through organisations such as the MRC would support this. Additionally, making the blood-brain barrier a strategic priority and encouraging investment in cutting-edge research could yield game-changing results in the treatment of brain tumours and other neurological diseases.

On translational research, on average, it takes 15 years for an idea to move from the pre-clinical stage to helping a patient. Patients have not got that long to wait. Researchers have said they found it challenging to access Government funding for translational research, relying on charities to fund risky elements of the pipeline. More must be done to support this valley of death element of the research pipeline. That seeks to move basic science discoveries more quickly and efficiently into practice, and that shift would increase interest among the research community, ensuring a greater concentration of research expertise in this area.

The inquiry also found that there is a perception that review panels have a lack of understanding about the unique nature of brain tumour research, due to a deficit of specialists on panels. That was reported to account to some degree for low application success rates. During oral evidence sessions, it was also highlighted that a lack of feedback disincentivised unsuccessful applicants from reapplying, bearing in mind that they would potentially have spent a year on such work before their original application was ready for submission.

Positive and proactive engagement with the research community should be nurtured through a continued programme of workshops and funding toolkits for researchers, supporting navigation of the funding system and increasing success rates. Currently, due to many of those issues, and a lack of funding and support, early stage researchers, especially post-doctoral researchers, are moving away from the field of brain tumour research. They are attracted by more readily available and secure funding in other disease areas. A solution for that would be the MRC and the NIHR ringfencing opportunities, such as specific brain tumour awards, across the research pipeline.

Funding could also be prioritised for a fellowship programme, supporting early stage researchers to develop their skills in the field. There is an example within the Cancer Mission, where two teaching fellowships, match-funded by the NIHR, are taking place. That number needs to increase. Learning about brain tumours early in careers results in researchers going on to choose the discipline.

Currently, only 5% of brain tumour patients are entering the limited number of trials available. Clinicians stated that many trials that patients with brain tumours are eligible to enter are not accessible to patients, who often have physical disabilities, as participants are expected to travel long distances across the UK. Poor health and the cost implications were key barriers to patients entering studies that were available to them.

A survey carried out by Brain Tumour Research highlighted that 72% of patients who responded would consider participating in research or a clinical trial if offered the opportunity. Only 21% believed that healthcare professionals gave sufficient information about opportunities to participate in clinical research, including trials.

That approach does not take account of the benefits that new and repurposed therapeutics could provide for brain tumour patients. If brain tumour patients are excluded at an early stage, possible benefits for such patients are not identified and carried forward in later trials. Access to trials should be assessed not by the location of the tumour, but by other individual criteria such as genomic profile and medical history.

It was also demonstrated that clinicians are risk-averse to children accessing early phase trials, despite parents’ wishes. As a result of those limitations, patients are encouraged to travel overseas in pursuit of treatment not available in the UK. Some small improvements to both systems would allow many more clinicians to successfully support patients to access trials across the country.

We have touched on this briefly, but paediatric brain cancer is viewed by researchers as different from adult brain tumours because brain tumours in children are linked to physical development, rather than ageing. Current treatments for children have significant long-term side effects and much more research is needed into kinder treatments and novel drug delivery for children. Additionally, more must be done to tackle brain injury issues and the consequences of brain tumour treatments.

In this place, we often talk about the need to support people to meet their potential and to live life to the full to address issues that curtail life chances. That is no less important for children and young people who have experienced a brain tumour or brain cancer. Using the method adopted by the NHS to measure survival rates, children’s survival following a tumour is positive. However, they are often left with a brain acquired injury caused by the surgery and treatment of the brain tumour itself.

Once the child is discharged from the hospital, there is no guaranteed pathway of rehabilitation or access to suitable education, therapies, services or physio. That causes tremendous additional strain on the family as they seek to access and fight for the appropriate step-down care. In many cases, the lack of those therapies means that the recovery and life chances of the child or young person are nowhere near as good as they could or should be.

In this place, we want life to be a success. I pay particular tribute to Success Charity and Dr Helen Spoudeas, who has worked tirelessly to ensure that these brain acquired injuries are taken more seriously and that a concerted effort is made to ensure the best possible recovery. Success Charity exists to advocate for survivors and provide them with the care and support that they need and deserve. It has its annual conference at the Royal College of Physicians this Saturday, which will give families an opportunity to share experiences and make friends with other survivors, siblings and parents, and to listen to inspirational speakers.

Having given some thought to this issue, and having discussed it with others, I think that an appropriate approach would be to introduce a commitment that every child and their family would be entitled to a carefully crafted package that ensures that all the needs of a growing and developing child are met, including access to education services, and that the best person to ensure the implementation of this package would be an occupational therapist.

This Government want the UK to be considered a science and technology superpower. The UK must start setting the pace for recovery rather than fall further behind. Business as usual threatens the UK’s ability to lead clinical trials for brain tumours. Brain tumour research must be seen as a critical priority, with Government developing a strategic plan for adequately resourcing and funding discovery and translational and clinical research. Robust tissue collection and storage facilities must be put in place across the country. As a Government Minister said in this place only last week, every willing patient must automatically be part of a clinical trial, and that includes collecting and storing tissue for research. There must be equity of access to clinical trials and a robust and up-to-date clinical trial database. The regulatory process must be simplified, with the introduction of tax relief and incentives for investors to encourage investment for the longer-term periods necessary to develop and deliver new brain tumour drugs.

There is so much more that could be said, and I am sure that much more will be covered this afternoon. I hope that the Minister will take the report and our recommendations seriously, and that he will have an opportunity to come back to us at a later date—when he may have more time than that afforded to him at the close of this debate—to set out how the Government intend to respond to our recommendations. Will he also agree to meet me and members of the all-party group to discuss the recommendations of our Brain Tumour Research report? Thank you, Mr Deputy Speaker.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

On a point of order, Mr Deputy Speaker. I apologise to my hon. Friend the Member for St Ives (Derek Thomas) and to the House for intervening on this very important debate—like others, I am fascinated by what is being said—but may I ask whether the Government have notified the Speaker’s Office that they intend to make a statement about the semi-briefings being made to the media that they have decided to pause or stop whole elements of HS2? Surely that would be best done through a statement to the House, rather than through elements of the media. I would be grateful for your guidance as to whether a statement should be made, and whether the Speaker’s Office has received any notification that the Government are inclined to do so.

--- Later in debate ---

[Derek Thomas]

I have noticed that Peter and his daughter Maria, who introduced that first petition all those years ago in 2015, are here. I am sure that if they were to do it again, they would get a lot more than 120,000 people signing the next petition.

The nature of debate in this place can be very toxic, but not today. I thank the right hon. Members for Leeds Central (Hilary Benn) and for Hayes and Harlington (John McDonnell), my hon. Friends the Members for Scunthorpe (Holly Mumby-Croft), for Buckingham (Greg Smith), for Meon Valley (Mrs Drummond) and for Great Grimsby (Lia Nici), and the hon. Member for Luton North (Sarah Owen). I also thank the hon. Member for Mitcham and Morden (Siobhain McDonagh). We cannot go away from this place and ignore the lived experience of her sister, Margaret, and her family.

The Minister has heard those contributions, and he has the report and each of the recommendations. I am encouraged that the discussion does not end here and that the work will continue. It must, because far too many lives depend on it. I appreciate the time that you have given us this afternoon, Mr Deputy Speaker.

Unavoidably Small Hospitals

Derek Thomas Excerpts

Tuesday 6th September 2022 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I thank my hon. Friend the Member for Isle of Wight (Bob Seely) for securing this important and timely debate. As I represent a set of small islands myself, it is good to have him banging the drum with me on so many shared issues.

We understand the urgency of the subject. We have pretty much all just come back from beautiful parts of the United Kingdom—fantastic parts of the world—but they have particular challenges and sometimes there are not enough people to justify the Government’s funding formulas. We understand the pressures on urgent care, such as the ambulance delays that none of us are hidden from. My urgent care hospital has around 160 people there who have no medical need whatsoever. There is a backlog because of covid and also housing, which was mentioned in the previous speech.

The massive pressures on our bigger hospitals in the urgent care system—in my case, that hospital is in Truro—are eased by the existence and support of smaller hospitals. The debate is not only about small hospitals, but about how critical they are in helping the whole of the NHS and social care system to provide for communities, so that when we say healthcare in the right place and at the right time, we actually mean it.

Along with the others who have already thanked their nursing staff, I want to thank the NHS staff in my three small hospitals: St Mary’s on the Isles of Scilly; Helston Community Hospital—when I was a child it was Helston Cottage Hospital—which is a brilliant outfit that we spend far too little time talking about; and West Cornwall Hospital, which is an urgent care setting in Penzance that provides an important set of services to avoid people going to the centre of Cornwall. The pressing issue right now for these small hospitals is access to the NHS care workforce. The problem we have with small hospitals is that for them to fully function we need a wide range of disciplines and, as we heard earlier, that is difficult to find when the bigger hospitals try to put all their services in one central place. I understand and agree with everything that has been said so far. However, I particularly want to raise the issue of capital funding because for all the pressures and concerns about urgent care hospitals we have heard from constituents over the recess, some could have been eased if the capital programme had moved just a bit quicker.

We heard that one of the 40 hospitals is in the constituency of my neighbour my hon. Friend the Member for North Devon (Selaine Saxby). A £9.1 million fund was promised in 2019—two Prime Ministers ago now. The building work is ready to go. It should have been opened by next year, but it was paused by the Treasury. The work has all been done locally, the plans are agreed and the hospital wants to get on and build it. It will deliver a new outpatient centre, which will take patients away from the more pressured urgent centre in Truro, and refurbish the urgent treatment centre in Penzance. That work could have been under way but it is not because it was paused by the Treasury. The money—£9.1 million—was promised by Government for West Cornwall Hospital in Penzance. In west Cornwall we are all waiting for the Treasury to agree that fund, which was committed. The work has been done and huge amounts of money have been spent to get the hospital to where it is now, and we want to get it built, so will the Minister feed that back? It is not even one of the 40 hospitals; it predates that.

St Mary’s Hospital on the Isles of Scilly has enormous challenges, and anyone who has been involved in Government for a while will know the challenges we on the Isles of Scilly have had with keeping health and social care alive. The council on the Isles of Scilly runs the nursing home. For a long time, it desire has been to integrate the home with St Mary’s Hospital and collocate them on one site. In fact, also in 2019, the Government agreed to progress plans to create one single campus, put care and health services in a single building and collate primary care, community health, urgent care, mental health and adult social care all in one place. It made complete sense.

We had a Chancellor who gave us the green light—the one previous to the former Chancellor, my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak), who is in the room now—and we had a Health Secretary come over and see in detail what was being proposed. There are two reasons why the plan is such a good thing for the Government to support. One is that it integrates health and care on the Isles of Scilly, which stops people having to move or be flown out of the Isles of Scilly for no real reason to get healthcare on the mainland. While I am on that subject, a couple of comments were made about how funding is allocated for moving people from the Isles of Scilly to Penzance. If the situation on the Isle of Wight is reviewed, it would be far better to replicate what we do than to take away the great service that we have, so I ask the Minister to please go the right way when making that decision and ensure equality for the Isle of Wight.

We have a brilliant plan to do far more on the Isles of Scilly, again using the skills we have, which would enable those skills to be used more effectively and fully both in health and social care. Not only would it deliver for the Isles of Scilly, but it would provide a good blueprint for how health and social care could be delivered on the mainland, particularly across Cornwall. Again, the plan has sat with the Department of Health and Social Care for a very long time. I am told that a decision will be made before Christmas, and I urge the Minister to feed back again about St Mary’s Hospital and the integrated health hub. We urgently need a decision. Again, we were under the impression that it could have been built this year—2022. A lot of the delays that are putting pressure on the system across Cornwall and the Isles of Scilly unfortunately sit with the Department of Health.

My hon. Friend the Member for Isle of Wight made an important point about who controls funding. Unavoidably, small hospitals fall foul of pretty much every funding formula—for good reason, as public funding must deliver value for money. However, if that is interpreted as “bums on seats”, or in the case of hospitals “bums on beds”, smaller communities such as Scilly, rural Cornwall and the Isle of Wight will always be discriminated against, because they will never fully be able to compare or compete with places such as London or other vast urban masses where a hospital can deliver so many more outcomes for the local population.

On Scilly and in west Cornwall, it will always cost much more to deliver health and social care, so decisions about such areas must be taken separately to other NHS funding decisions, because care is not delivered for the same numbers of people. However, there is no reason why people living in rural and isolated areas should receive any less care. We should look very carefully at how the funding formulas are worked out. It will always be the case that an NHS funding body will prioritise the areas where we can deliver more health.

NHS Dentistry in England

Derek Thomas Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I beg to move,

That this House has considered NHS dentistry in England.

It is a privilege to serve under your chairmanship, Mr Stringer. I am delighted to bring this debate to Parliament and to combine it with a petition that has been signed by more than 10,000 members of the public. The petition calls for

“an independent review of the existing”

NHS dental

“contract and a radical rethink of the way in which dental services are delivered.”

We may not need an independent review to tell us that NHS dental services need a radical rethink; we all know that they do.

NHS dentistry is a huge concern for all Members here today, and the number of us present reflects what a huge concern it is for our constituents. I already had a good indication of how significant the lack of dentistry was across my constituency, but to grasp the detail and the scale of it, I posted a survey at the beginning of the year asking constituents about the problems they had faced in accessing NHS dentistry. Within a day, it had received more responses than any other survey I had run—more than surveys on bus services, post office closures, noise pollution, or whether the Cornish flag should appear on a Cornish numberplate.

The picture that came out of my survey was shocking. Nearly half of respondents had been waiting more than three years for an appointment. Tim has had temporary crowns awaiting replacement for eight years; the teeth underneath have rotted away. Robert’s solution was to wait until a tooth was

“beyond repair and intolerably painful before getting an appointment with the emergency dentist to have it extracted. Last time they removed three in one go.”

Other people tried DIY solutions. Looking up how to make temporary fillings on YouTube was commonplace. Mark pulled out his wisdom tooth himself.

Other constituents have given up completely. They do not show up on the waiting lists because they have given up on waiting. Lauren told me:

“I don’t use the right side of my mouth to chew as it’s sensitive and causes me pain but it is too difficult to get an appointment so I am having to live with it”.

Anna racked up three times her usual phone bill trying to get through to the appointments line before she gave up. One constituent comes from a family of seven, of whom only the youngest has ever seen a dentist, and only then because he went to hospital for urgent surgery; the oldest is 20. Patients who can afford to go private do so, but so do patients who cannot afford it. The fees for Anthony’s private dental care represent a tenth of his pension; that is not affordable. The fees that Megan paid to remedy just one of her abscesses equated to a month’s rent. She has just had a baby, and cannot afford to pay another two months’ rent for the other two abscesses.

The situation is particularly grave in Cornwall. Last week, NHS England and NHS Improvement presented a report to Cornwall Council showing that in 2020-21 only 24% of the dental activity commissioned in Cornwall was delivered. In 2021-22, it has increased, but only to 59%. By the end of this month, we should be returning to 100% of normal activity, but that is simply not happening in Cornwall. The total number of adults with access to an NHS dentist dropped from 188,000 in June of last year to 155,000 in December.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I congratulate my hon. Friend on securing the debate. Things are clearly not as they should be in Cornwall, but in Lincolnshire they are even worse. Greater Lincolnshire has three of the four worst dental deserts in the United Kingdom, according to the Association of Dental Groups, with just 38 dentists per 100,000 people. Finding a dentist in Lincolnshire is like finding the holy grail. It is vital that we have more dentists, for the reasons my hon. Friend set out. People deserve better.

[Derek Thomas]

I completely agree. My right hon. Friend will know that in Cornwall we are very competitive; we always want to win, but I do not want to win this competition. This tragedy for both Cornish residents and his constituents highlights the fact that something needs to be done urgently. I thank him for his intervention.

[Damian Green (Ashford) (Con)]

I am very grateful to my hon. Friend for giving way again and allowing me to continue this tour of woe around the country. I can tell him that the situation is equally bad in Kent; it is almost impossible in Ashford to find an NHS dentist. My frustration and that of my constituents about this is compounded by the lack of response of the health service generally. The clinical commissioning group refers me to NHS England, and NHS England—the Minister may take note—just does not reply. I have before me an email I sent seven weeks ago regarding someone who could not find a dentist, but there has not even been a reply from NHS England. From top to bottom, this system needs complete reform.

[Derek Thomas]

I appreciate that intervention. In my case, NHS England, and commissioners for the south-west have been fairly good and engaged with the challenge. However, it is a tale of woe, as my right hon. Friend says. Perhaps we can all commit to coming back to this place in a year or two to commend the Minister and celebrate the fact we have a new contract that addresses exactly the challenges that we are all quite rightly highlighting today.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing this debate. He is right to highlight this national challenge. We have substantial challenges with access to NHS dentistry in Suffolk. Part of that, as our right hon. Friend the Member for Epsom and Ewell (Chris Grayling) said, relates to the quality of the commissioning and monitoring of contracts by the local commissioner. Will my hon. Friend join me in urging the Minister to put pressure on local commissioners to take this issue seriously? Also, does he agree that we need to ensure that dentists who are commissioned to perform NHS services do actually provide the services that they are commissioned to provide? Some of them are not doing so at the moment.

[Derek Thomas]

I thank my hon. Friend for that intervention. He is right to say that there are commissioned units of dental activity that are not being delivered. There are all sorts of reasons for that, which I hope to cover in my speech. Ultimately, however, we need to look at the contract itself and consider whether it actually works for patients. The contract was introduced by the Labour party in 2006. We know that it does not work today and is in urgent need of reform, which I will come on to in my remarks.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman give way?

[Derek Thomas]

I will make a little progress first and then I will give way to the hon. Gentleman.

We have heard about other examples and concerns elsewhere, but in Cornwall we do not have the capacity to assess the patients in the backlog, let alone to treat them. This is not just about dental health. Dental examinations pick up the early warning signs of mouth cancer, or poor periodontal health associated with diabetes, for example. I should declare an interest, Mr Stringer, as the chair of the all-party parliamentary group on diabetes. It is estimated that 60,000 people with type 2 diabetes had their diagnosis missed or delayed because of the cancellation of dental examinations.

I will now give way to the hon. Member for Strangford (Jim Shannon).

[Jim Shannon]

I know that this debate is about NHS dentistry in England, but may I say—regionally—that the problems are just as real in Northern Ireland as they are anywhere else? My concern is that there is no access to NHS dentistry any more in Northern Ireland; either people pay for dentistry, for example through a subscription, or they do not get it.

Does the hon. Member agree that dental care should not be restricted to those who have the money to pay? The impact of this situation will clearly fall on those who see dentistry as being the bottom of the list when it comes to paying? People in the poverty trap who feel the pressures of rising prices will be even more detrimentally affected than ever. Does he feel that now is the time for Government all across the United Kingdom of Great Britain and Northern Ireland—although I appreciate that the Minister who is here today does not have responsibility for Northern Ireland—to do something specifically for people on the breadline?

[Derek Thomas]

I thank the hon. Gentleman for his intervention.

It is probably fair to say that although the responsibility lies with the Minister here today, it is not her responsibility, or even in her power, to ensure that every member of the British public can access NHS dentistry, simply because NHS England, or indeed any part of the NHS, does not commission enough dentistry to cover the whole population. Perhaps the Minister will clarify today the Government’s expectation regarding access to NHS dental care, and say whether there is a right for everybody, whoever they might be, to access that care. However, it is a very important point that has been raised. It surprises people that we do not commission enough dentistry to meet the needs of every one of our constituents.

It is not enough to blame the pandemic, although it has certainly not helped. I was raising the state of NHS dentistry in Cornwall before we had a single case of covid in this country. Over two years ago, I spoke about the difficulty of recruiting and retaining dental staff. At Prime Minister’s questions two years ago, I raised the shocking results of the lack of access to NHS dentistry for children in Cornwall. I also told hon. Members that these inequalities needed to be addressed quickly and creatively.

Outside this House, I have been working to improve access to dentistry in the constituency, most recently by getting the council to overturn a decision not to allow electrical works to proceed in St Ives that would have delayed the opening of a new dental surgery until the autumn. I have been meeting the regional health commissioners and Cornwall’s public health officers to discuss dentistry on a regular basis, and I cannot fault their speed and creativity. Their south-west dental reform programme has been working hard to improve access by helping to reopen a surgery in Hayle and in St Ives, piloting child-focused dental practices, and developing its own evidence-based workforce plan, but the Government must lead the way. Resolving these oral health inequalities is not just this Minister’s responsibility; it will require a cross-Government approach.

NHS England has launched a drive to recruit dental professionals to the south-west, but a key challenge in Cornwall, and maybe other parts of the country, is finding housing for those who want to take up a job in dentistry. I am working on that issue with the Department for Levelling Up, Housing and Communities. The national food strategy was a wasted opportunity. We could have extended the sugar tax, which has successfully incentivised the reformulation of sugary drinks. That would have helped oral health as much as health in general. I shall continue to argue for a national food strategy that is truly strategic, even if the Government have made a tactical withdrawal from tax rises to support public health.

The Minister has responsibility for the dental contract. In oral questions in January, she agreed that the contract was

“the nub of the problem”.—[Official Report, 18 January 2022; Vol. 707, c. 195.]

She said in February,

“there is no doubt that the UDA method of contract payments is a perverse disincentive for dentists. The more they do, the less they seem to be paid. I for one certainly do not underestimate the problems that that causes dentists, and I can see why many hand back their NHS contracts.”—[Official Report, 7 February 2022; Vol. 708, c. 780.]

I could not have put it better myself. I have asked dentists in my constituency if they would prefer to see increased budgets or reform of the UDA contract, and they asked for reform.

There are two main issues with the dental contract, both of which are not just obstacles to dental health but actively create problems for the future. First, the current system does not focus on prevention. When units of dental activity are the sole measure of contract performance, there is no incentive for preventative work; nor is there an incentive to make the best use of the whole dental team’s skills when the practice cannot make a claim for payment for a course of treatment purely because it was initiated by someone other than a dentist.

I made sure that the title of the debate referred to NHS dentistry not NHS dentists. We need to recognise the contribution of the whole team of dental professionals —dental nurses, hygienists, therapists and technicians—and use them. Again, this is about not just saving money, but using professionals in the best way we can. Yesterday I spoke to a dental nurse who works with people in care homes. If she wants a resident to switch to a high-fluoride toothpaste, she has to get a dentist to prescribe it. Our regional dental commissioning team has been running a pilot to take supervised toothbrushing conducted by dental nurses out to the community. Given that more five to nine-year-olds are admitted to hospital for tooth decay than for any other reason, this work should be at the heart of NHS dentistry, not something that is topped up by flexible commissioning.

Second, the UDA method does not properly reward dental practices for their work. A dental practice is faced, in effect, with a UDA cap for an entire course of treatment, which means when a patient has complex needs, the money involved does not even cover the overheads of the practice. The predictable result is that dental practices are moving away from NHS work. Around 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. Every time a dentist leaves the NHS and is not replaced, approximately 2,000 people lose access to dental care. If you cannot do the arithmetic in your head, Mr Stringer, 3,000 times by 2,000 is 6 million, so 6 million patients have lost access to a dentist just over the course of the pandemic. For every dentist leaving the NHS, another 10 are reducing their NHS commitment by a quarter on average; that is another 500 patients losing access to an NHS dentist. According to the British Dental Association, 75% of dentists plan to reduce the amount of NHS work they do next year.

The fewer dental practices there are doing NHS work, the more pressure the remaining practices are under. A recent BDA members survey found that nine in 10 owners of dental practices committed to NHS work found recruitment difficult, with 29% of vacancies going unfilled for more than a year. That is nationwide, but one provider in Cornwall told me that their surgeries were unused 52% of the time due to shortages of dentists and nurses. The vast majority said that it was the UDA contract that was the biggest factor in their recruitment difficulties. The Minister said last week that the Government are serious about reforming the dental contract, but I want to press that point. It is not enough to be seriously planning a reform; we must be planning serious reform. Tweaks to the existing system are not enough when the contract is fundamentally flawed.

I have focused on the contract because we need the Minister to focus on the contract. Other Members will no doubt raise the issue of recognising overseas qualifications, passing the section 60 order that would give the General Dental Council discretion over qualifications, maintaining the mutual recognition of professional qualifications with Europe and extending that to the Commonwealth, and expediating the process for experienced candidates to register with the NHS. Dental care professionals need to be allowed to initiate treatments. The issue of funding will come up—for a catch-up programme of overseas registration exams in the short term, and university places in the long term—but it is striking how many of those proposals are cost neutral. We could even save money by catching mouth cancer in the early stages when it is more easily treated.

To quote the Minister, the contract is the nub of the problem. I urge her to commit to a firm date when we will see the end of units of dental activity, and a better contract focused on prevention and increasing access.

[Graham Stringer (in the Chair)]

I have indications from six Members who wish to speak. I intend to call the Opposition spokesperson at 3.40 pm. You can do the arithmetic—it is fairly straightforward—I do not intend to impose a time limit unless Members indulge themselves.

--- Later in debate ---

[Derek Thomas]

First, I thank and commend the Minister for her response and for the way in which she has engaged with this subject since taking up her role. I have found her determination to get this matter right really refreshing, because this has been a long battle.

I thank all colleagues, from all parties, for their contributions and for going into things—not just the problem but the solution—in great detail. I will leave the shadow spokesperson, the hon. Member for Enfield North (Feryal Clark), out of that assessment, because I do not think that that came across from her at all.

I wish the Minister all success with trying to get a new NHS dental contract. We know that getting new contracts can be very tricky and fraught with problems, so I wish her the very best, on behalf of all of our constituents, who urgently need good dental care.

Question put and agreed to.

Resolved,

That this House has considered NHS dentistry in England.

Childhood Cancer Outcomes

Derek Thomas Excerpts

Tuesday 26th April 2022 Commons Chamber

[Derek Thomas (St Ives) (Con)]

I chair the all-party group on brain tumours, which has been referred to. We have heard today of many children who have lost their lives, and many families who have faced that—we hear of that all the time in our APPG—but I want to focus my comments on the children who survive, but who do so with a terrible acquired brain injury.

This is how an acquired brain injury occurs. When a child first has a tumour, their brain is already being injured by the tumour. They may then have surgery and, again, more injury will be done to the brain during the surgery. Radiotherapy will cause more injury to the brain, and drug treatment, and so on, after that will cause further injury to it. If the brain tumour is got rid of and the child is cured of brain cancer, they are left with a life-long brain injury that will curtail their life chances and life experience.

At the moment, we in the UK do not do very well in supporting such children. Many, many children survive a brain tumour—brain cancer—but they live for years with terrible eyesight, poor access to education and all sorts of disabilities and challenges in their daily lives. Their family spend their lives trying to access all sorts of support and rehabilitation.

Quite rightly, the Government have announced that they will put together an acquired brain injury strategy. People now have the opportunity to take part in the call for evidence about what should be in the strategy. I make it very clear to the Minister that the strategy must include a chapter for children who face an acquired brain injury because of a childhood cancer or another illness or diagnosis. That would really focus us on the opportunity for immediate and intensive rehabilitation and therapy to allow those young ones to have the best possible chances, as they deserve. It would allow families to continue to support children, possibly for the rest of their life; some of them will live into old age.

We launched an inquiry into the cost of living with a brain tumour. We talked about life chances rather than money. We met ambassadors, who are children who have had brain tumours and brain surgery, and heard about all the challenges that they have faced—the amazing prejudice and barriers that they face every day of their life, particularly in the transition from childhood NHS treatment to adult treatment, as the Minister will fully understand. So much is dropped, but the opportunity is there to give those children and their families a really good lived experience and good life chances. That requires a proper understanding of what is needed to support children with an acquired brain injury as a result of childhood cancer.

Health and Care Bill

Derek Thomas Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

The Minister made a valiant effort to dissuade some of us from supporting Lords amendment 29—the workforce amendment—but I suspect he knows he is not kidding anybody.

We have learned today that public satisfaction with the NHS is at its lowest level since 1997. We should not underestimate the blow that that news will deliver to the health and care workers who turn up, do an amazing job, and go above and beyond every single day. To say that that news is dispiriting is an understatement. It is important that those workers know that the public, and every Member of this House, loves our NHS; it is just that we want it to work a bit better. It is hardly surprising that people’s biggest frustrations are waiting times, a lack of proper funding and staff shortages. Those things are the fault not of health and care workers but of this Tory Government, who are driving our health and care services into the ground.

Cancer Research UK says that without the workforce amendment the Bill will fail to address the biggest barrier to the achievement of world-class cancer outcomes in the UK: the staffing shortages and pressures. The King’s Fund has said that the health and care workforce crisis will be the key rate-limiting factor in the reduction of the NHS elective care backlog. The workforce amendment may not be a silver bullet, but it is the closest thing to one, which makes it all the more frustrating that the Government will not accept it. As I suspect the Minister knows, the Government’s objections just do not stand up to scrutiny.

As the right hon. Member for South West Surrey (Jeremy Hunt) said, framework 15 simply sets out the number of staff the Government think they can afford, rather than the number of staff we actually need. I urge the Minister to think about what message that sends to my constituent, who is a newly qualified midwife. She wrote to me just a couple of months ago and said:

“I am extremely concerned about the crisis in maternity care. This isn’t caused by Covid-19—the systemic failings have been crippling the service for a generation—but the pandemic has made a bad situation worse.”

She said:

“I am being harmed, my clients are being harmed. Staff are being harmed. For every 30 newly qualified midwives, 29 are leaving. Parents are reporting bullying and coercion. Threats are being used to ensure compliance. Unnecessary medical interventions are at epidemic levels. Trauma—amongst parents and midwives—is rife.”

She said that “concerns are being missed” and interventions “made too late”, and that the reason was “staffing problems.” If that is not a wake-up call, I do not know what is.

I wish briefly to express my concern about the powers the Bill will give the Secretary of State. At best, the change will create a bureaucratic nightmare; at worst, it will lead to meddling and the politicisation of the day-to-day running of the NHS. The Government have tried to argue that the pandemic showed the need for Ministers to have more powers, but we know that during the pandemic the Secretary of State had powers over PPE and test and trace, both of which issues were handled extremely badly. The NHS’s operational independence is critical, but it will be undone by the introduction of the Henry VIII powers in the Bill, so Liberal Democrats will oppose them.

Finally, I congratulate the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith) on his impassioned speech. I agree with him wholeheartedly that we have a duty as a nation and as a society to ensure that the goods used in our publicly owned NHS are not tainted by modern slavery or linked to the behaviours that may lead to genocide.

[Derek Thomas (St Ives) (Con)]

I rise to speak in support of Lords amendment 29, in the context of those who suffer brain tumours. I wish to take a moment to reflect on the fact that Tom Parker, a member of The Wanted who had done so much work to raise awareness of brain tumours and who worked with the all-party parliamentary group on brain tumours, which I chair, died today of his brain tumour. I wish to take a moment to remember him, his family and the two young ones he has left behind.

As I say, I chair the APPG on brain tumours, so I wish to discuss the need for Lords amendment 29 in that context. As we have heard, there is currently no data on how many healthcare staff the country needs, but we know that staff are overstretched. As we heard from my right hon. Friend the Member for South West Surrey (Jeremy Hunt), £6.2 billion was spent on locums in the financial year 2019-20 to plug the gaps. The NHS and social care will never be able to keep up with demand without regular assessment of the numbers needed. As we know, the Government have so far dismissed this workforce planning amendment on the basis that the Department of Health and Social Care has commissioned a long-term strategic framework. We have heard already this evening why that is not good enough, although I am extremely aware of how much the Minister is engaged in, and concerned about, this workforce subject, and he has been generous with his time in talking to colleagues about what the Government hope to do.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 18th January 2022 Commons Chamber

[Sajid Javid]

The hon. Gentleman will know that survival rates from cancer were increasing before the pandemic, but as I think the whole House understands, the pandemic has had an impact on all other types of healthcare, including cancer. This is a challenge throughout the United Kingdom. He talks about waits for breast cancer treatment; those are longer in Wales, so this is an issue throughout the UK. It is right that we continue to focus on the workforce. We have 44,000 more health workers than we did in October 2020, and we will continue to build on that.

[Derek Thomas (St Ives) (Con)]

T5. Vast numbers of children and adults right across Cornwall cannot get access to an NHS dentist. That is not about funding, covid or even a lack of dentists; it is just that the contract under which they work is no longer fit for purpose. Next year, the responsibility for dentistry comes to Cornwall. Could we perhaps have a statement from the Minister about how we can reform that contract, which no longer works and keeps dentistry away from people who need it?

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

My hon. Friend gets to the nub of the problem. The 2006 contract, which was introduced under the last Labour Government and is dependent on UDAs—units of dental activity—creates perverse disincentives for dentists to take on NHS work. We are already starting work on reforming that.