NHS Dentistry: Recovery and Reform

George Howarth Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

I give my very sincere thanks to my right hon. Friend. The House can imagine the advocacy I have received from both him and my right hon. Friend the Member for Gainsborough (Sir Edward Leigh). On reaching rural and coastal areas, as a proud Lincolnshire MP myself I wanted to bring about a set of plans that will address those underserved areas. I am delighted that the plan meets with my right hon. Friend’s approval.

[Sir George Howarth (Knowsley) (Lab)]

The Secretary of State will be aware that the NHS dentistry crisis has been 14 years in the making. She will also be aware that it is impossible for anybody in Knowsley today to sign up with an NHS dentist. The measures the Secretary of State has described may, over time, help to meet the problem, but what advice would she give today to my constituents who cannot get an NHS dentist?

[Victoria Atkins]

The advice and guidance to dentists will be going out today, while the new patient premium that I have told the House about will come in from March—it is weeks away.

Pharmacy First

George Howarth Excerpts

Wednesday 31st January 2024 Commons Chamber

[Sir George Howarth (Knowsley) (Lab)]

As a long-standing supporter of the idea of Pharmacy First, I welcome the right hon. Lady’s statement and the specific reforms she has talked about introducing. She will be aware, however, that pharmacists in my constituency and further afield are very concerned that they are unable to do the job that they are already expected to because of lack of capacity and problems in accessing certain drugs that they need to prescribe. Can she indicate how the existing problems will be dealt with, so that they can do what is promised in Pharmacy First?

[Dame Andrea Leadsom]

I am grateful to the right hon. Gentleman for his support for the programme. There are around 14,000 licensed medicines, the vast majority of which are in good supply. The Department works very closely with the sector on finding alternatives and sourcing supplies of medicines, and most of the time we are able to meet the demand. Occasionally there are challenges, but that does not change in any way the ability of community pharmacists to be the expert medicine suppliers that they are, and to meet the need that members of the general public have for treatment and advice.

International Health Regulations 2005

George Howarth Excerpts

Monday 18th December 2023 Westminster Hall

[Mr Francois]

If what the hon. Lady says is true, why has Parliament just spent two weeks arguing about Rwanda? Can I ask her a direct question? She has heard many concerns expressed from the Conservative Benches about these proposed amendments. With the exception of the hon. Member for Lancaster and Fleetwood (Cat Smith), who introduced the debate, not a single Labour Back Bencher has even been present, let alone contributed. Here is the question: would a future Labour Government be minded to accept the spirit of those amendments to the WHO treaty or to oppose them? Our position is very clear. What is the hon. Lady’s?

[Sir George Howarth (in the Chair)]

Order. I understand that feelings are running high and people have areas that they want to explore, but I hope that any further interventions are brief.

[Preet Kaur Gill]

We all know that Rwanda is just a gimmick by this Government, and I think that I have already set out my position very clearly. I will continue to make my remarks so that the Government are absolutely clear as to where we stand on this issue.

I am pleased that the zero draft highlighted that states must retain sovereignty, and that the implementation of the regulations

“shall be with the full respect for the dignity, human rights and fundamental freedoms of persons”.

I ask the Minister to take this opportunity to update us on the progress being made in negotiations over the amendments and the draft text. Can he reassure our constituents that the Government would not sign up to anything that would compromise the UK’s ability to take domestic decisions on national public health measures?

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[Sir George Howarth (in the Chair)]

Order. I say to those in the Public Gallery that I know that there are strong feelings and that they have come here with a great deal of interest in the subject, but they need to be quiet. It is not an occasion for applause or shouting out. I would be grateful if people respected that. Thank you.

[Preet Kaur Gill]

I think that I have made my position really clear, hence my question to the Minister. Our constituents want reassurance that the Government would not sign up to anything that would compromise our ability to take domestic decisions on national public health measures. Nothing has been agreed. Today is an opportunity to hear from the Minister about how those negotiations are going forward and what amendments have been accepted. I also want to hear from the Minister.

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[Andrew Stephenson]

The negotiations are being led by civil servants across Whitehall. [Interruption.]

[Sir George Howarth (in the Chair)]

Order.

[Andrew Stephenson]

I do not believe it is right to name those civil servants. I am the overall lead on this in the Department of Health and Social Care. I am working closely and have already met with the Minister of State, Foreign, Commonwealth and Development Office, my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell). Many other Government Departments will also have a very clear interest in this, including the life sciences Minister, my hon. Friend the Member for Arundel and South Downs (Andrew Griffith). Any treaty agreed will of course be subject to cross-Government write-rounds in the usual fashion, to agree a UK-wide position. It is fair to say that there will not just be one pair of eyes from the ministerial ranks looking at this. There will be multiple pairs of eyes looking at this from across Government to ensure that when we get to a deal, it is a deal that can be agreed across Government and that we believe is in the UK national interest.

Community Pharmacies

George Howarth Excerpts

Thursday 14th September 2023 Westminster Hall

[Sir George Howarth (Knowsley) (Lab)]

It is always a pleasure to take part in a debate when you are in the Chair, Sir Mark. I congratulate the hon. Member for Waveney (Peter Aldous) on the timeliness of this debate and on the typically thoughtful way in which he presented his case. If I repeat some of his arguments, it is not that I am gratuitously copying what he said; the themes need to be emphasised, and I will try my best to do so.

At Prime Minister’s questions on 26 April, I raised the need for a new pharmacy-first approach as a means of providing additional capacity to deal with minor medical problems and consequently help to relieve the pressures on GP and hospital A&E services. I was encouraged by the Prime Minister’s positive response: he declared himself

“a wholehearted champion of and believer in the role that community pharmacies can play.”—[Official Report, 26 April 2023; Vol. 731, c. 732.]

Two weeks later, on 9 May, as the hon. Member for Waveney said, the Health Secretary made a statement to the House that set out the Government’s primary care recovery plan. In the second part of that statement, he announced the adoption of a pharmacy-first approach as part of a new NHS service. Again, it was a potentially positive step forward. He pointed out

“the incredible role that pharmacists played during the pandemic—their capacity to innovate and deliver for the communities that they served, freeing up GP appointments in doing so”.—[Official Report, 9 May 2023; Vol. 732, c. 219.]

As part of that approach, the Secretary of State committed to investing up to £650 million over the next two years, so that pharmacists can supply prescription-only medicine for common conditions such as ear pain, a urinary tract infection or a sore throat, without requiring a prescription from a GP. In the time available, I want to explore how that policy is developing and how the resources that the Government have earmarked meet the requirements for pharmacies to deliver such a service. I should add that the Secretary of State’s list could easily be added to, and I hope it will be.

I am grateful to the Company Chemists’ Association, Community Pharmacy England and Pharmacy2U for their comprehensive briefing for the debate, on which I will rely heavily. CPE points out:

“We are currently negotiating on how this funding commitment will be delivered to ensure that community pharmacies can meet patient needs and we welcome the confidence and additional investment in community pharmacy...Until those negotiations are complete, we do not know the extent to which this additional investment will help community pharmacies with these current pressures, but we do know that it will not address all of the pressures as outlined later in this briefing.”

Pharmacists refer to a funding black hole; I do not think the hon. Member for Waveney used that term, but he did use the figures involved. They point out that the recent announcement of funding is welcome but represents

“new money for new workers”.

They go on to say that there is currently an annual funding shortfall of at least £67,000 per pharmacy. Consequently, there is insufficient money in the system to deliver the services that they are already contracted for, let alone to take on new ones.

The CCA also draws attention to the trend between 2015 and 2022, which saw the permanent closure of 720 pharmacies. On a recent visit to Asda in Huyton in my constituency, I saw the consequences at first hand. The Asda pharmacy, which by the way is admirable, is having to fill the gap created by the loss of other smaller, independent local pharmacies, and the pressure on the dispensers while I was there was relentless. There was not a minute to pause for thought or have a conversation with people coming to pick up their prescriptions, because they were so busy.

Of the pharmacies that closed, 40% were in the 20% most deprived areas of England. That is worrying for me as the MP for Knowsley, which is one of the areas of greatest deprivation. One way in which high levels of deprivation are reflected is in the number of people in Knowsley living with long-term health conditions, which account for 70% of the total healthcare spend, 64% of hospital out-patient appointments and 50% of GP appointments. If community pharmacies could be deployed to deal with some of those cases where appropriate, that could help immensely in easing the burden on the NHS services that currently have to deal with them.

As the Minister will be aware, and as the hon. Member for Waveney referred to, there is a workforce crisis in community pharmacies in England. There is estimated to be a shortfall of 31,000 pharmacists. The Asda community pharmacy I visited had vacancies, one of which was for a pharmacist; I think they had been trying for a year, unsuccessfully, to fill the position.

I also want to raise the issue of medical supply chains. The current level of allowable margin is £800 million; it was first agreed in 2014 and has not been reviewed since. That amounts to an annual reduction in the margin available. In practice, all pharmacies are faced with diminishing resources for the purchase of medical supplies. On 18 May, with my hon. Friend the Member for St Helens South and Whiston (Ms Rimmer), I held a roundtable event with local pharmacies. It was pointed out to us by independent pharmacies that they are unable to negotiate lower purchasing rates, as they cannot buy in bulk in the way that larger-scale national pharmacy companies can.

This problem will lead to more local pharmacy closures and reduced capacity to serve the new pharmacy-first policy. As CPE puts it, reforms are needed

“to the medicines market to avoid the situation we are now in, where pharmacies are dispensing some medicines at a loss and patients are facing delays for medicines.”

Pharmacy2U, which is a delivery service, has pointed out that stakeholders now have to deal with the issue. It notes the difficulty with the interoperability of IT systems and points out that

“there is significant variation in the systems used by GPs, and pharmacy services are often unable to easily access patient records, heavily restricting their ability to support patients with their medicines. Ensuring that pharmacists have swift access to this data is vital in empowering pharmacies to play a central role in a reformed and improved primary care system.”

It suggests that

“HSC and NHSE should consult with system-wide stakeholders to ensure all pharmacists are enabled to access and, where appropriate, update patient records in line with data privacy rights, ensuring that GPs and pharmacies have a complete picture of the patient they are caring for.”

I will make one final point before asking some questions. I wrote to the Secretary of State on 17 July, following some written questions that I had tabled concerning hub-and-spoke provisions and the use of third-party hub providers; the answers seemed to indicate a specific problem in Northern Ireland. I would be grateful if the Minister chased up my letter, which has had no response, and if he could give an indication in his speech as to how the issue can be resolved.

I will conclude with a few questions. First, how do the Government propose to address the funding black hole that I have referred to? Secondly, what is the Government’s strategy for halting the alarming number of pharmacy closures? Thirdly, how do the Government intend to address the workforce shortages? Fourthly, will the Minister agree to consult stakeholders on how to deal with the issue of interoperability of IT systems? Finally, how does the Minister propose to enable all pharmacies, including independent pharmacies, to fund the gap between the cost of acquiring medicines and the resources available?

Accountability in the NHS

George Howarth Excerpts

Wednesday 30th November 2022 Westminster Hall

[Sir George Howarth (in the Chair)]

I will call Sir Mike Penning to move the motion, and then will call the Minister to respond. There will be no opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Sir Mike Penning (Hemel Hempstead) (Con)]

I beg to move,

That this House has considered accountability in the NHS.

It is a pleasure to serve under your chairmanship, Sir George. I called this debate on accountability in the NHS. As a nation, we love our NHS which does a fantastic job for us, day in, day out. However, like any human being or organisation, sometimes it makes mistakes. When the NHS makes mistakes, the process of trying to get an apology or a mistake rectified is invariably a bureaucratic nightmare.

I have a couple of examples I would like to raise. I have permission from one to use their name, but I probably will not do so, because I will yet again pass correspondence to the Minister. I appreciate that the Minister here, my hon. Friend the Member for Colchester (Will Quince), is not responsible in the Department for this subject. The relevant Minister, my hon. Friend the Member for Lewes (Maria Caulfield), is on the Floor of the House answering questions, and I thank this Minister for explaining why she is not here.

We in Parliament are here to speak up for those who sometimes cannot speak up for themselves. When something goes wrong, Sir George, you would think we could get answers for constituents and get matters rectified, but within the NHS there is a lack of ministerial accountability, which I will come to in a moment. The complaints procedure eventually ends up with the ombudsman, but it takes for ever. There is a feeling in my constituency that, when things go wrong, the longer the process can be delayed, the more people will just accept what has happened. In some cases, they will sadly not be around any more. For their families and loved ones, this short debate is very important.

Probably the most dramatic example for me, not of the physical effects of surgery but of the effect on someone’s life, concerns one of my constituents. The NHS decided in 1986 that he needed an operation on his nose, but the operation that took place was not the one that was supposed to. I will use the language: it was botched. It was probably not intentional; it was a mistake but, to this day, that has had detrimental effects on his quality of life.

My constituent tried to go through the process of getting it rectified. I have tried to find out what was going on. He has pushed from pillar to post by different trusts: University College London and West Hertfordshire. I have written to previous Ministers over the years, only to be told that Ministers do not interfere in individual cases. I accept that but, when we reach a situation where there is nowhere else to go, ministerial accountability is important.

NHS Dentistry

George Howarth Excerpts

Thursday 20th October 2022 Commons Chamber

[Sir George Howarth (Knowsley) (Lab)]

May I, too, express my gratitude to the Backbench Business Committee for the opportunity to debate this important matter today?

On 22 September, during a statement by the Health and Social Care Secretary, I raised these problems on behalf of the people of Knowsley and the Liverpool city region, and described the experiences they are having. I cited BBC research that showed that, to use the Secretary of State’s own term, Liverpool city region is a “dental desert”, with not one dental practice taking on NHS patients. In response, she said that she had

“set out in the plan today what we are seeking to do with dentists. First of all, it is the role of the local NHS—the ICB—to take responsibility for such provision, and I expect it to do so.”—[Official Report, 22 September 2022; Vol. 719, c. 839.]

Earlier this week, my office carried out a survey of dental practices in Knowsley to measure what, if any, progress had been made since that exchange. We found that, of the 13 dental practices in Knowsley, it is still the case that none—I repeat, none—is accepting new NHS adult patients, and only two are accepting children under the age of 18. I am therefore bound to conclude that no progress has been made in the ensuing weeks.

Also on 22 September, I urged the Secretary of State to take measures in the short, medium and long term to address this disgraceful situation. Since then, the British Dental Association has pointed out that

“the Government needs to show real ambition to bring NHS dentistry back from the brink.”

Although the new Administration—goodness knows there will be another new Administration shortly—has placed dentistry as a top ABCD—ambulances, backlogs, care, doctors and dentists—priority, no new proposals have been made

“to halt the exodus of dentists from the NHS”

to care for patients. Moreover, the British Dental Association points out that the key issues of contract referral, chronic underfunding and growing oral inequalities have yet to be addressed. This is not just a matter of cosmetic treatment, important though that may be in many cases. As the association pointed out, this is also about how to spot oral cancer earlier, which is one of the fastest rising types of cancer and claims more lives than car accidents. That is a particular concern for Knowsley. As the British Dental Association went on to say:

“People in the most deprived communities are significantly more likely to die from it than those in more affluent areas.”

Our dentists are in many cases the first medical professionals to detect cases. Access to NHS dental treatment can in such cases be the difference between life and death. Knowsley is one of the most deprived boroughs in the country and it is consequently in a very vulnerable position regarding the early detection of oral cancer.

The motion contains good points that I would happily endorse, but I am concerned that in terms of specific actions it calls for a progress report in three months’ time. My concern—I do not make this point to be at all mischievous—is that I do not know, and nobody in the House will be able to tell me, who is likely to be the next Secretary of State for Health and Social Care, and whether they will have a different strategy on NHS dental care. So we need something to be done more speedily. The Government have to take responsibility for the current turmoil, but the fact is that there is so much uncertainty and such issues are simply not being dealt with.

The motion does not address what the Government could be doing in the short term to alleviate the problems confronting people in Knowsley and elsewhere. I have two suggestions on short-term action that could and should be taken. First, I urge the Secretary of State to introduce a procedure to enable those in need of urgent NHS dental treatment to be referred to a suitable dental practice, preferably locally. My constituency office recently dealt with the case of an 18-year-old constituent who needed urgent root canal treatment on two front teeth, which she was unable to afford. The problem was exacerbating an existing mental health problem. Since she was in constant pain and probably barely able to eat and drink, I contacted NHS North West. I am grateful that it was able to make arrangements for her to receive the treatment she needed at a local dental practice. I suggest that that approach, which I just happened to stumble across, should be added as a matter of urgency for those in need of urgent dental treatment.

Secondly, I am aware that many NHS patients have been culled by dental practices, often on the basis that they were not making use of the service on a regular enough basis. I cannot give accurate figures for Knowsley, but I suspect that thousands of people are former NHS patients. However, no appeal process is available to such patients, who have just been struck off and there is nothing that they can do about it, other than pay to be treated privately. I am aware of one case involving a Knowsley resident who, as a result of extremely debilitating, extended cancer treatment, was unable to contemplate much-needed dental treatment. When he felt strong enough to do so, however, he tried to make an appointment as an NHS patient, only to discover that he had been struck off the list.

My second short-term suggestion is therefore to urge the Secretary of State to institute an appeal process whereby such patients could apply to NHS England in order for it to prevail on the medical practice concerned to reinstate NHS patients who had good reasons for not being able to visit the dentist during lockdown, or who could not do so for medical reasons, such as those I have referred to. On the medium term and longer term, and the national problems to which I referred, I simply urge Ministers to enter into meaningful discussions with the British Dental Association to help to resolve the issues that I are so bedevilling NHS dental services nationally.

I hope that Ministers will accept that I have tried in my approach to deal with this important matter as constructively as I can. I sincerely hope that they will respond in a similar way and try to help to resolve the short-term problems that my constituents are experiencing in ways that can be easily implemented.

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[Andrew Gwynne (Denton and Reddish) (Lab)]

I thank the Backbench Business Committee for granting this important debate, and congratulate the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) on having secured it. We support the motion in the form in which it has been moved; there is nothing in it that we disagree with. If some of the political arguments are removed from the debate, I think there is consensus across the House as to what the problems are and what needs to be done.

[Sir George Howarth]

I am sorry to interrupt my hon. Friend so soon. I agree with him about the motion, but I did make the point that there were some short-term measures that could, and should, be taken within the three-month period that the motion envisages before the Government report back on progress.

[Andrew Gwynne]

My right hon. Friend is absolutely right. There is no reason why the Government cannot expedite action on the issues he mentioned in his contribution and get those improvements in place.

I pay tribute to my right hon. Friend and to my hon. Friends the Members for Blackburn (Kate Hollern) and for Bootle (Peter Dowd), as well as the hon. Members for Bath (Wera Hobhouse), for Mole Valley (Sir Paul Beresford), for Berwickshire, Roxburgh and Selkirk (John Lamont), for Gloucester (Richard Graham), for Salisbury (John Glen), for North Devon (Selaine Saxby) and for Loughborough (Jane Hunt), for their contributions.

I welcome the Minister to his place. I am not sure how long he is likely to be at the Department of Health and Social Care, but I hope he is there long enough to implement some of the changes. I am all for a bit of stability in the Department. He is a good person and a good friend, and I wish him well. However, when he comes to the Dispatch Box, he will no doubt seek to deflect from the situation that has been described my Members across the Chamber by saying that we are here today because of the pandemic.

The backlog has not helped—we all acknowledge that; it goes without saying—but the Government’s spend on general dental practices in England has been cut by more than a third over the past decade, with the number of NHS dental practices in England falling by more than 1,200 in the five years prior to the pandemic. My hon. Friend the Member for Bradford South (Judith Cummins) raised that, and it cannot be ignored. It creates the regional imbalances and dental deserts we have heard about. This is not a rural-urban thing; it is a rural and urban thing, sadly. My right hon. Friend the Member for Knowsley (Sir George Howarth), the hon. Member for North Devon (Selaine Saxby) and the right hon. Member for South Holland and The Deepings (Sir John Hayes) spoke about those dental deserts, which are very real.

The Minister’s next line of defence, if I were to guess what the officials have put in his red folder, will be, “It’s all because of the dental contract.” There is some truth in that. It is 16 years since that dental contract was introduced, and it was introduced for a perfectly good reason. There was no golden age of NHS dentistry before it. There is a reason why people of my age have a mouth full of fillings and my children do not. It is not because I did not brush my teeth as much as my children do, and it is not because I ate more sweets than my children do. It is because the emphasis for paying dentists prior to the introduction of the changes was on early treatment that was perhaps not necessary—“drill and fill” is what they called it. We recognised in 2010 that the contract had not worked in the way we hoped it would, and we proposed changes. Of course, we lost that election, but after 12 years of this Government, I am afraid the line will not wash that it is solely the contract, because they have had plenty of time to make changes to that contract and have not.

We hear about the ABCD plan, and I certainly welcome the “D” in it; at least there is a recognition of dentistry. However, like my right hon. Friend the Member for Knowsley, I worry that this kind of “Sesame Street” strategy does not come close to tackling the scale of the emergency that is gripping dental care. All we have heard from the Secretary of State is sticking-plaster solutions that tiptoe around the edges while failing to address the root cause. That is apparent in the Government’s “hit and hope” approach to dentistry. The £50 million of emergency funding announced earlier this year is a prime example. As my hon. Friend the Member for Bootle said, it is a time-limited, inaccessible pot of money that has done precious little to improve access. In fact, figures obtained by the British Dental Association showed that just 17.9% of that funding was drawn down. This is indicative of a sector that has completely lost faith in the Government’s ability to act, and to be frank, I do not blame them, because when we do see action, it does not meet the scale of the crisis, and in some cases it makes things worse.

As we have heard, the geographic, ethnic and socioeconomic disparities affecting access to NHS dentistry are becoming starker by the day. What does the new Health and Social Care Secretary do in response to that problem? She scraps the health disparities White Paper. It is beyond bizarre that in the face of such overwhelming evidence, the Government will not even consider possible solutions—let alone implement them.

I fully support what the hon. Member for Waveney and other hon. Members on both sides of the House have said about education. Dentistry in schools, a prevention strategy and an emphasis on good oral health is absolutely crucial. We would support the Government in implementing that—hopefully sooner rather than later. The consensus and mood is there to get that done, so I hope the Minister will take that up and get going on that opportunity.

As for many issues facing our NHS, much of the problem with NHS dentistry can be traced back to one thing: workforce. Several hon. Members raised that point. Any hope of an NHS recovery must be underpinned by a comprehensive workforce strategy. Where is that strategy? Was it accidentally shredded with the mini-Budget? I am sure the Minister will hail the fact that NHS stats show an increase of 539 dentists practising in 2021-22, compared with the year before. When we drill down beneath the surface, however, there is not much to be positive about.

Those stats are rendered worthless by the fact that a dentist performing a single check-up on the NHS in a 12-month period is weighted the same as one with a full cohort of NHS patients. BDA survey data shows that for every dentist leaving the NHS altogether, a further 10 are significantly reducing their NHS commitment. No matter how much Ministers might try to fudge the numbers, they simply do not add up. We cannot afford more bluff and bluster. We need action, which the Opposition will support.

The outgoing Prime Minister said that dentistry was in her top three priorities for her first 90 days. That now seems rather optimistic given that she is Liz of 44 days, but we really want the Government to act on that commitment. Can we have an update on how things are going?

The Labour party will fund one of the biggest NHS workforce extensions in NHS history. We will double the number of district nurses qualifying every year, train more than 5,000 new health visitors and create an additional 10,000 nursing placements every year. We will fund this transformative expansion by abolishing non-dom tax status. We will give dentistry the staff, equipment and modern technology it needs to get patients seen on time. Labour has a plan. Where on earth is the Government’s?

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[Will Quince]

Of course I take that point—it is a fair one—and when those who seek NHS treatment have an ongoing relationship with a dentist, they are more likely to get seen. When considering reforms to the system we will certainly take that point on board.

[Sir George Howarth]

The description that the Minister gave of the existence, or otherwise, of lists is accurate, but when anyone seeking to get NHS treatment in a dental practice rings up, they are most likely to be told by the receptionist that the practice is not taking NHS patients. The difference between the two situations, while technically correct, is not there in practice. Before he concludes his remarks, will he address the issue I raised about the short-term measures that can be, and I believe should be, taken to improve the situation?

[Will Quince]

I am conscious of your advice, Madam Deputy Speaker, but I am certainly willing to meet the right hon. Gentleman to consider what short-term measures we can take.

There is so much I want to say about the contract and my ambitions for the future, but politics is the art of the possible and deliverable, and I will be honest and frank with the House, and with stakeholders across the sector, about what we can deliver. We will then work towards what is within the art of the possible. International dentists are a vital part of the UK’s dentistry workforce, and I am happy to meet hon. Members to set out exactly what we are doing. I hope to bring forward legislative changes later this year. On dental training, I would love to talk more about the Advancing Dental Care review and the centre for dental development, but that may have to wait for another day—you have advised me about the time, Madam Deputy Speaker.

Prevention and oral health has been raised by many Members and is an important part of our strategy. I am looking closely at what more we can do with other Departments, especially around supervised toothbrushing, but also fluoridation, which was raised by numerous Members. Access to urgent care is important, and if people struggle to get an appointment they should call 111. This is the beginning of our work to improve NHS dentistry, not the limit of my ambition. This is just the start, and we are committed to long-term improvements, including changes to improve access to urgent care, and further work on workforce and payment reform. In the meantime there is lots we can do to improve access to urgent care, provide better access for new patients, and make important changes to workforce and payment reform. With that short response I hope I have assured hon. Friends and Members that action is being taken now to address the challenges of access to dental care, especially around recruitment and retention. I also want to reassure Members of my personal ambition and passion for bringing about the medium to long-term positive change that we want for NHS dentistry.

Dialysis Care Outcomes

George Howarth Excerpts

Thursday 19th May 2022 Westminster Hall

[Jim Shannon]

I thank all hon. Members who have spoken, and I thank the kidney charities that the Minister and everybody else referred to very much for what they have done.

The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) made some very pertinent points about depression, mental health and the psychological impact that dialysis treatment has on people. The Minister very kindly referred to that in her response, and she outlined the case.

The hon. Member for East Lothian (Kenny MacAskill) referred to the travel costs of taking children to the few centres, and he talked about the impact that has on families. He said that dialysis patients have higher levels of treatment. He also referred to prepayment meters, which can prevent people from accessing home dialysis treatment to start with. I know that is not the Minister’s responsibility, but the hon. Gentleman highlights an issue. We all know the Minister is very thorough, and that she will pass on the issues that have been brought up but are not her responsibility to the relevant Departments.

The shadow Minister referred to the two kidney patients she met yesterday. She also thanked the charities and referred to the 3.1 million people living with kidney disease in the United Kingdom. As we all did, she underlined the need for equal treatment, access and cost reimbursement across the whole of the United Kingdom.

I thank the Minister very much for her comprehensive, detailed response to the issues. She referred to the 11 renal networks and the regional care systems that feed into the transformation programme recommendations.

All hon. Members referred to rising costs. Energy tariffs are not the Minister’s responsivity, but perhaps she will be able to refer that to the right person, whoever it may be. Hon. Members also referred to proactivity and the need to reimburse people. As we were sitting here, Fiona Loud, who is in the Public Gallery, sent me a wee note that said that at least some of the people are getting their money. Perhaps people are taking note of the fact that this Westminster Hall debate is happening, because people are getting their money out—there is a commitment.

All NHS trusts must act and respond better. We need to address the reimbursement of moneys as soon as possible. The shadow Minister referred to that. It is great that the Minister and the Government are setting a target of 20% for home dialysis. We want to see that target achieved.

I welcome the chance to communicate with the Minister outside with the kidney charities, to understand better what the real problems are. We have to thank the charities for their campaigns. The reason I have knowledge is half the time because of them. Without them, none of us would be able to deliver the details, as the hon. Member for Rutherglen and Hamilton West has done.

I always look forward to the future. We bring forward issues to the Minister, and then we look forward to the response. The response we have listened to today sets out a programme of events, strategies and visions for the future. We want to see things improve. We will probably regularly come back to the Minister—I hope we do not have to, but we may have to. If we do, we will do that collectively in a positive fashion. In my life, I always try to do things positively. We bring things to the Minister and say, “Here’s where the shortfalls are. Here’s where we can do better.” What we heard today from the Minister has given us some heart, hope and confidence for the future. On behalf of all kidney charities, on behalf of the patients out there and on behalf of us all, we thank the Minister. I thank you, Sir George, as always, for the excellent way you chair these debates. I appreciate it very much.

[Sir George Howarth (in the Chair)]

I thank the Front Benchers and the Back Benchers for the constructive and consensual way in which this debate has been conducted. It is a model of how we should conduct all our debates.

Question put and agreed to.

Resolved,

That this House has considered dialysis care outcomes.

National Strategy for Self-Care

George Howarth Excerpts

Tuesday 26th April 2022 Westminster Hall

[Sir George Howarth (Knowsley) (Lab)]

I beg to move,

That this House has considered the potential merits of a national strategy for self-care.

As ever, Sir Charles, I am pleased to have this debate with you in the Chair. In October 2019, I chaired a roundtable event on self-care, which involved healthcare professionals, pharmacists and other experts. It was organized by the consumer healthcare association the Proprietary Association of Great Britain, and following the event we produced a report that the Minister, or at least the Minister who was supposed to be here—the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield)—is aware of. I am indebted to PAGB, the Juvenile Diabetes Research Foundation and Diabetes UK for the briefing they have provided for this debate.

It might be helpful if I define what I mean by self-care. Essentially, it is about the actions individuals take for themselves, on behalf of others or with others to develop, protect or maintain their health. It can be summarised as a spectrum that includes the promotion of everyday wellbeing, taking care of self-treatable conditions, and the management of long-term conditions. It is important, however, to point out that self-care is not no care. Those who need medical support on a more traditional basis should be entitled to that type of care.

The covid-19 pandemic has revealed the important role that self-care can play in reducing the burden on GPs and hospital A&E departments, so that those with the most serious ailments can be treated with greater urgency. Prior to the pandemic, it is estimated that 18 million GP appointments and 3.7 million A&E visits were for minor ailments, including a blocked nose, dandruff and travel sickness, at an estimated cost of £1.5 billion annually. A survey of frontline healthcare professionals carried out by the self-care academic research unit at Imperial College in 2021 indicated that 95% of those who responded felt that self-care was important during the pandemic, compared with 55% pre-pandemic. However, a further survey carried out by PAGB later in 2021 found that the percentage of members of the public saying that they were more likely to self-care had fallen from 69% in 2020 to 55%, which illustrates that the trend in that direction has reversed.

My key point in this debate is to highlight the necessity for a new national strategy for self-care. The previous such strategy, “Self-care—A Real Choice”, was published in 2005. Since then there have been many new developments and the case for a new strategy has been more clearly recognised.

Before I move on to describe what the elements of a new strategy might be, I will use the example of those with diabetes to illustrate how self-care can work well. Other conditions could also serve to make that point, but, to avoid taking up too much time, I will use this single example. JDRF has pointed out that 79% of the management of type 1 diabetes is carried out by the individual with the condition, often with the help and support of their families and carers. That makes type 1 diabetes a case study in how to successfully promote self-management. JDRF also draws attention to the need to invest in technology as a crucial benefit to the long-term sustainability of the NHS post-covid.

JDRF’s 2021 report, “Covid and Beyond”, concluded that people with type 1 diabetes who had access to relevant technologies felt more confident in managing their diabetes in the absence of routine NHS care and support. The charity Diabetes UK points out that diabetes is

“the fastest growing health crisis of our time”,

with the equivalent of one in 14 people—that is 4.9 million in total—living with the condition, and that it accounts for 10% of the NHS budget—that is a staggering figure—80% of which is spent on treating largely preventable conditions.

Diabetes UK draws attention to the fact that, to live well with diabetes, avoid complications and successfully self-manage diabetes, those living with the condition require five things: first, access to education about diabetes and how to manage it; secondly, emotional and psychological support, which is increasingly important; thirdly, access to technology to support self-management; fourthly, access to weight-management support when needed, and I will say more about that in a moment; and finally, facilitated peer support.

Typically, those with diabetes spend about three hours a year with their doctor, nurse or consultant, and a staggering 8,757 hours managing the condition themselves. As Diabetes UK points out:

“Managing diabetes day-to-day can be difficult. This is why it’s important people have the knowledge and skills to manage their diabetes so they can live well and avoid complications.”

[Alison Thewliss (Glasgow Central) (SNP)]

I appreciate what the right hon. Gentleman is saying and I understand that he has spoken to my constituent Scott Craig. Does he agree that there needs to be awareness of the risks, and training for people who are self-managing and for their families? I understand that my constituent’s husband’s device failed, leading to his untimely death. Does the right hon. Gentleman agree that there needs to be greater awareness of how these devices work and what people need to do should things go wrong?

[Sir George Howarth]

As the hon. Lady is aware, I spoke to her constituent about that point earlier today. She makes a good point and I agree with her, and I would add that it is important that those who use technology are properly trained in how to use it best. The devices need to be reliable, so that technology can provide effective help with these conditions.

Those with type 1 diabetes who also struggle with eating disorders experience problems if they omit to take their insulin in order to lose weight. I know that you are familiar with this issue, Sir Charles. The right hon. Member for Maidenhead (Mrs May) and I will shortly carry out an inquiry into this growing problem, with the support of JDRF. We hope to point to how self-care can play an important role in dealing with this worrying trend. Hon. Members may be aware that there is a storyline in the soap opera “Coronation Street” that covers this subject. It has not yet concluded, but it offers a helpful perspective of how the problem has arisen, what it is and what the dreadful consequences can be.

I will refer to the recommendations from the report following the roundtable I chaired in October 2019. First, the Department of Health and Social Care should develop a national self-care strategy. Secondly, NHS England and Improvement should explore the implementation of self-care recommendation prescriptions, to support clinicians to discuss self-care with patients and refer them towards it. Thirdly, primary care networks should consider ways to improve self-care in local populations as part of the development of the network across the local health system. Fourthly, NHS England and Improvement should enable community pharmacists to refer people directly to other healthcare professionals. That has become even more apparent during the covid-19 pandemic.

The fifth recommendation is that NHS England and Improvement should support moves towards community pharmacists being granted read and write access, to give them full integration and interoperability of IT systems as part of local health and care records partnerships, and promote national support for such data-sharing agreements. That would unlock the door to a hugely increased, positive role for community pharmacies. Sixthly, the Government and royal colleges should include in the healthcare professional curriculum and the national curriculum self-care modules that can be delivered sustainably by schools. Finally, NHSX should explore technologies that could be used to promote self-care and manage demand on the NHS.

Before concluding, I would be grateful if the Minister, or his colleague, could consider some questions. It is not necessary for them to be answered today; theyj could respond by letter if that would be more effective. First, will the Minister undertake to look closely at the recommendations for a new self-care strategy? Secondly, will he give consideration to the report’s seven recommendations, which I referred to earlier? Thirdly, will he agree to meet a representative group of healthcare professionals, other interested parties and me to discuss potential ways forward? Finally, will he meet diabetes charities, the right hon. Member for Maidenhead and me to discuss the relevance of the two conditions—it is often overlooked that type 1 and type 2 diabetes are two distinct conditions—and to explore how the condition can serve as an example for self-care management? I look forward to the Minister’s response.

[Sir Charles Walker (in the Chair)]

I thank the right hon. Gentleman for his speech and for the support that he has given to two of my constituents—Neal and Lesley Davison. Perhaps I might tag along to one of those meetings with him.

--- Later in debate ---

[Karin Smyth]

I absolutely agree. The pandemic has been a terrible time for most of us, but it has provided the opportunity to look at, and to trial in real time, different ways of working with and helping people. A lot of third-sector organisations have been able to use technology, particularly in rural areas, so that people no longer have to travel to centres if they do not want to. Such organisations have been supporting people to use more online communication methods, and people have been coming together in more localised settings and been supported in a different way.

From my many years in the health service, I know that getting online appointments organised and, as the hon. Gentleman has heard me say before, managing things—for example, dermatology—using online services was a really hard task. We have now gone through that process and need to learn the lessons from the pandemic. It is a unique opportunity to promote self-care as an essential part of healthy living. We have heard from my right hon. Friend the Member for Knowsley about the numbers involved. People are keen to take this opportunity to promote self-care and improve our understanding of, and confidence in, our own health, so that people can access the right service at the right time, and we ensure that our highly professional health service and specialist services are well used.

I would like to mention local pharmacies in my constituency of Bristol South. Bedminster pharmacy has been commended several times—it has the most commended pharmacy team in the United Kingdom—by national awards. I echo the points that have been made about pharmacies, which are often overlooked by other professional organisations. Some primary care services in different parts of the country are better than others at working together across the piece. I certainly hope that is a feature of the new integrated care systems, which have a huge opportunity to support pharmacies properly so that they can do their day-to-day work.

[Sir George Howarth]

My hon. Friend makes a good point about community pharmacies and the potential they offer. Does she agree that in the past the potential of community pharmacies has been underused, just as the capacity of GP and A&E services has been overused? It is not just about sloughing off the responsibility to somebody else; it is a matter of using the expertise that already exists.

[Karin Smyth]

Absolutely. I refer back to one of my favourite pieces of legislation, the Health and Social Care Act 2012; one of the many terrible things that that Act did was to demote the role of pharmacists in local communities and affect the support they were given by primary care trusts. In my area, we had a huge team supporting pharmacies who were very much part of that local community offer. I hope that the integrated care systems recognise that that was a mistake. We have lost a decade and really should be working much more closely together. Pharmacies exist in most areas and are easy for local people to access. They can give people confidence to look after themselves and the literacy that I mentioned.

It is vital that people receive a consistent message about self-care when they look at NHS services online, call 111, or visit a GP or local pharmacist, and that requires local systems to work together. A national self-care strategy would help to embed consistency across the country. As has been mentioned, self-care is a continuum that covers adopting healthy lifestyle choices and managing long-term health conditions, be they mental or physical. We must ensure that health literacy and targeted actions to tackle health inequalities take account of the systemic barriers in place for many people who wish to live a healthier lifestyle, particularly given the rising cost of living. I look forward to hearing from the Minister about how the Government’s upcoming White Paper on health inequalities will consider the issue.

We need to remember that self-care is for everyone at all stages of life. Educating children through programmes in school is an important part of that. As I said earlier, the confidence to manage our own health with appropriate support is as important for someone in a care home as it is for a parent looking after a new baby or for children growing up, particularly those growing up with long-term conditions.

Empowering and enabling us all to take charge of our health, be that through using digital interventions, improving health literacy or providing greater support for self-care, is important not only for the long-term sustainability of the health and care service, but for patients. We must ensure that the system does not inadvertently disempower people or result in gaps in the care pathway. I very much look forward to hearing the Minister’s thoughts on this.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

It is always a pleasure to serve under your chairmanship, Sir Charles, and a particular pleasure to serve opposite the hon. Member for Bristol South (Karin Smyth), the shadow Minister. We spent many happy days in Committee on the Health and Care Bill, even if we were not in full agreement. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), within whose portfolio this would normally sit, has just been answering a debate in the Chamber, which is why I am responding to this debate.

I will endeavour to do justice to the very important points that the right hon. Member for Knowsley (Sir George Howarth) raised in his speech. I will do something, which, even within my own portfolio, would cause my officials to wince—and I suspect that the same may happen given that this falls within somebody else’s portfolio—which is that, notwithstanding the wonderfully well written notes that my officials have provided me with, I may well say what I think on this subject and respond to the specific points that have been raised in the course of this debate. This could be career limiting, but we will see.

The right hon. Member made a powerful speech. Essentially, the way in which he illustrated through the prism of a particular condition of diabetes a number of the points that could be applied more broadly across the spectrum of self-care was particularly helpful to hon. Members. Although we may not have a huge quantity of hon. Members in this Chamber today, what we do have is quality, judging by the contributions that we have heard.

The right hon. Member is absolutely right, as is the shadow Minister, that, in talking about self-care, we must be very clear that we do not see it as an alternative—an either/or—to medically qualified support or other forms of support. The two parts of the system should work hand in hand. Indeed, I see it as a continuum. I have seen the work done by PAGB, the Self-Care Forum and others on that self-care continuum. We start at one end with education, which I will turn to in a moment. The pure end of self-care is around diet, daily calorie intake, and the simple lifestyle changes that can make a big difference to our own health and the risk of our contracting illnesses or diseases. Those lifestyle and dietary factors may not be for everyone given the nature of particular conditions, but, by and large, are within the control of the vast majority of us.

At the other end of that continuum, we have things such as major trauma, or treatment for illnesses such as cancer or cardiac conditions where medical care, and often hospital-based care is essential. Then there is that space in the middle around self-treatable conditions. There are the minor ailments where people might be able to self-care, but where, as the hon. Member for Bristol South put it very well, some might need some confidence or advice to be able to do so.

There is also the management of acute conditions and long-term conditions, which, I suspect, will entail a degree of professionally qualified medical care, but, equally, a degree of self-care based on that advice as well. We have that spectrum—that continuum—and it is important that we view it in that way. The ability to turn to the right type of support at the right time is crucial to maximising the benefits and opportunities for individuals in self-care.

Through the pandemic, we have seen the opportunities to innovate. They were opportunities forced on us by the circumstances in a dreadful situation, but, none the less, there have been ideas and innovations that have come out of that pandemic. We have seen also the consequences of demand within our healthcare system, particularly at GP practices, at accident and emergency, and at urgent treatment centres. Notwithstanding the record investment by this Government in our NHS, and notwithstanding the record numbers of staff in the NHS, we do see pressures. An effective and proportionate self-care approach that people feel confident in can play a key part in helping to manage the pressures, where people go to the most appropriate point to be treated.

Empowerment is key—people understanding and being educated in their choices and the implications of their choices, through public health messaging. There is a telling statistic, although it may be a little out of date—I was discussing this with some officials earlier this week: 43% of the population do not feel fully confident in understanding health information conveyed in words. The figure leaps to 61% of people who do not feel fully confident in understanding information about their own health and their choices when the information contains words and numbers. That signifies that there is a lot more work for us to do.

[Sir George Howarth]

I am encouraged by the first part of the Minister’s speech that he gets this, as I was by the response of my hon. Friend the Member for Bristol South (Karin Smyth) on the Front Bench. The Minister is right that people who have long-term conditions—or, for that matter, the general population—need to understand better what they can do for themselves. It is not always obvious to people what they can do. It is also important—I referred to the recommendations—that medical practitioners understand these issues in their initial training and that they are kept up to date on the potential. Otherwise, people are operating in a fog, without understanding the potential. I am sure the Minister will agree that those things are important.

[Edward Argar]

I entirely agree that for health professionals, having up-to-date and refreshed knowledge is hugely important. In my current role and my previous role at the Ministry of Justice, I have looked at this point when considering domestic abuse and domestic violence. GP practice staff are often the first people to get an indication that something is wrong—not necessarily because a patient presents saying so, but because of the nature of their injuries or what they present with. Up-to-date knowledge across a range of areas is hugely important.

The hon. Member for Bristol South is right that education cannot start too early for forming good habits, and that, through school and beyond, it is important to educate people about the choices they make and the impact of those choices. That is not the so-called nanny state; it is about people being given the information to make an informed and educated choice for themselves and the benefit of their health. Another key element is confidence. People need information, but they also need to be confident to take a decision on that basis and to know where to go if they are not sure. I will turn to community pharmacies in a moment.

There are two other broad points to highlight—mental and emotional health—which the hon. Member for Bootle (Peter Dowd) quite rightly highlighted. I hope that all of us in this place agree, and that it is understood more broadly in society, that we cannot look at physical health in isolation. All elements interact with and impact on each other. We need to be fully cognisant of that and of the broader determinants of health and health inequalities, be they social, economic or health factors. There are a whole range of impacts on individuals and their overall health.

We need to ensure that people have access not only to information, but to the technology and kit to be able to manage their condition. During the pandemic, virtual wards have become more prevalent. For example, there are pieces of kit that monitor oxygen levels in blood and report back to the GP to give an early indication. That is just one example of how technology can assist, and it expanded rapidly of necessity.

I will turn to the recommendations in the report, speak a little about community pharmacies, which have quite rightly been highlighted, and then turn to the request of the right hon. Member for Knowsley for a meeting—always an easy point to respond to when one is not the Minister responsible. It is always nice to be able to commit other colleagues to meetings, but I will also address the issues in my own right.

I hear what the right hon. Member for Knowsley says about the need for a specific strategy, but I would sound a slight note of caution. It is often the case that the first call in a particular area of policy is, “We need a strategy around this”, and I am slightly cautious about having a multiplicity of strategies without bringing together a whole range of actions. That may be a point that the right hon. Gentleman wishes to raise with my hon. Friend the Member for Lewes, who I will commit to meeting him in a moment.

On that specific recommendation, self-care is an integral part of the NHS long-term plan, which we are looking at at the moment in the light of the experiences and impacts of covid, and the community pharmacy contractual framework—the five-year deal running to 2024. For that reason, I merely sound a note of caution about an additional national strategy, because over the past two and a half—almost three—years, what I have often seen in the Department of Health is a strategy for a particular issue or area of care that does not always interact with other elements of the system or take into account just how complex that landscape is. The right hon. Member for Knowsley is aware of that point from his many years in this House, but I merely sound a slight note of caution.

[Edward Argar]

The hon. Gentleman is seeking to find a way through some of these points in his typically dexterous way. Suggesting “a strategy, if that is what we want to call it”, leaves open the option for my hon. Friend the Member for Lewes to consider other ways in which the same thing might be achieved. I do not want to prejudge the conclusion that she will come to, but I will ensure that she receives a transcript of this debate.

[Sir George Howarth]

I hear what the Minister says. To be honest, I am not overly fussed about what we call it. My concern is that the Government—and, for that matter, the rest of us—are able to draw on the experience of patients, clinicians, and all those in the healthcare system to examine how we can do things better. If the Minister wants to call it something else, I am not here to have a row with him about that; I am here to try to make some progress.

[Edward Argar]

I am grateful to the right hon. Gentleman for that typically courteous intervention. A lot of what we are seeking to do in this area comes back to the refresh of the NHS long-term plan, which will have to happen in the context of what we have seen during the pandemic. The hon. Member for Bristol South highlighted the health inequalities White Paper, which will come forward in due course. There is a genuine opportunity to use that White Paper to draw a number of these elements together.

I am conscious that the right hon. Member for Knowsley had six other key recommendations, which I will address briefly. I will say a little bit about community pharmacy before I turn to meetings. He raised the issue of building on the successful community pharmacist consultation service, and exploring additional pathways to access that service through the implementation of self-care recommendation prescriptions to support GPs and other professionals to appropriately refer patients to self-care. Rather than taking the issue of community pharmacy separately, I will address it in response to this point, because that is probably the neatest way to do so.

I fully recognise the value of community pharmacy, and the hon. Member for Bristol South also rightly highlighted its importance. My first official engagement when I took on this job in 2019 was to attend, in lieu of the Pharmacy Minister at the time, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), the Pharmacy Business Awards ceremony, which recognised community pharmacies that had done amazing work in their communities, such as the one the hon. Member for Bristol South highlighted.

As constituency Members of Parliament, we all know the depth of expertise and local knowledge that our community pharmacies bring to the communities they serve, and we know just how well regarded they are by our constituents as friendly, accessible sources of advice. Constituents do not have to be there first thing in the morning, and they do not have to make an appointment. They can stroll in and talk to a pharmacist who can give them genuinely helpful advice, without having to wait. I put on record my gratitude, and I suspect that of all hon. Members, to community pharmacies.

We are increasing our potential to expand the Community Pharmacist Consultation Service to urgent treatment centres and A&E departments. It has already taken just shy of 184,000 referrals from GPs, which, as hon. Members have suggested, is of benefit to our general practitioners, who can better manage their workload, given that some people do not need to see a GP. We are promoting the uptake of that service and incentivising its use through the GP contractual arrangements. Negotiations with the PSNC on what community pharmacy will deliver in 2022-23 as part of the five-year deal are ongoing, and hon. Members would not expect me to prejudge those negotiations. As soon as they conclude, we will announce the arrangements so that Members can consider and scrutinise them as they see fit.

The right hon. Member for Knowsley talked about primary care networks. I know the value of primary care networks. My own GP in Leicestershire is actively involved in the PCN. We saw their potential to do amazing things during the pandemic when they supported our communities with the vaccination programme and in a whole range of ways. He is right to highlight their potential to consider ways to improve self-care in their local populations as part of their network development. I hope that the soon-to-be-statutorily-constituted ICSs and ICBs will also take that very seriously, obviously subject to the other place and their deliberations later this evening.

I know from my own GP, who I regularly speak to, that many local health systems are proactively exploring upstream prevention initiatives across the health and care system and looking for further partnership opportunities to support people to improve their overall health and care outcomes. Clinical commissioning groups—soon to be ICSs—and NHSEI regionally also have the option to commission a local minor ailments service in addition to CPCSs. I hope they will explore those options as they go forward—particularly ICSs.

The fourth recommendation was that NHSEI should enable community pharmacists to refer people directly to other healthcare professionals where self-care is not appropriate, enhancing the role of pharmacists as a first port of call for healthcare advice. I entirely agree with that. There is an educational point as well in making people aware that they can go to their pharmacists. Equally, all community pharmacists are required under the terms of service to signpost people to other health and social care providers and support organisations as appropriate. There is, I suspect, more we can do in that space, but I think we have an extraordinary resource there at our disposal. NHSEI is accelerating efforts to enable community pharmacists to populate medical records and give them full integration into operability of IT systems as part of LHCR partnerships and national support for data sharing.

Data and the sharing of data in this space is, as all hon. Members know, a vexed and complicated subject, but when got right, it holds incredible potential for improving health outcomes and care. NHSX is leading the Government’s plans that will see the development of interoperable NHS IT systems that integrate health and care records, while of course considering issues that the hon. Member for Bristol South brought up in Committee when we were discussing similar matters—issues such as patient consent and data security.

We are very clear in our view that community pharmacy must play an enhanced role in the healthcare of our country, and it is our responsibility and NHS England’s responsibility to help support that. The right hon. Member for Knowsley made two final recommendations about meetings. The Government should promote a system-wide approach to improving health literacy, including working with royal colleges to include self-care modules in healthcare professionals’ training curricula and continuous professional development. I touched on that point in my response to his intervention. I have had many helpful and positive meetings with the royal colleges. I seek to meet them regularly—perhaps not as regularly as I would like, given the pressure of business in this place at times—because they have a depth of knowledge that is incomparable and incredibly useful.

Public Health England, when it was around, undertook a programme of work to improve health literacy across the country, and the Office for Health Improvement and Disparities will continue to work on that issue. The pharmacy integration programme will deliver a further almost £16 million-worth of post-registration training. That investment will equip pharmacy teams across primary care so that they are better prepared to support wider integrated healthcare delivery and expand their role in providing clinical care to patients. A pharmacist independent prescriber can provide autonomously for any condition within their clinical competence, with the exception of certain controlled drugs, particularly for the treatment of addiction. To become an independent prescriber, pharmacists must complete additional qualifications, which last typically six months, before they can prescribe.

In 2021, the General Pharmaceutical Council introduced new professional standards for initial education and training to ensure that the next generation of pharmacists is equipped with essential clinical skills. A key theme running through all the contributions today is that, when a resource is used, there can still be an untapped element of it that can be better utilised to provide support, alongside education, self-care and all the things we can do as individuals, to provide confidence and professional expertise.

NHSX should evaluate the use of technologies that have been developed during the covid-19 pandemic, and develop them to cover a wider range of minor ailments to promote self-care and manage demand on the NHS. I alluded to one example that we are working on. The Department is working with NHS Digital and NHS England and Improvement to encourage innovation and enable new approaches and organisations to support services and collaborate effectively.

I hope that, as someone whose policy area this is not, I have addressed at least in outline some of the right hon. Gentleman’s key recommendations. He made specific requests about meetings. I am always wary about that, because I have discovered that when I have meetings with my right hon. Friend the Member for Maidenhead (Mrs May) and you, Sir Charles, I come out having agreed to something or changed the direction of a policy, after being persuaded by both of you. I know that the right hon. Member for Knowsley is equally persuasive. With that in mind, I am happy to ask the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, to arrange to meet the right hon. Gentleman, my right hon. Friend the Member for Maidenhead and you, Sir Charles, to discuss this issue more broadly.

The right hon. Member for Knowsley also asked for a meeting with Diabetes UK and the relevant Minister. I will certainly pass that on to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes. In the context of the elective recovery work and my work with the NHS more broadly, I have met a number of charities in the course of developing the elective recovery plan and since we published it. I am always happy to meet charities and other organisations that do so much not only to educate people and campaign on issues, but sometimes to press us in particular directions. They always do so with good intentions and to support people. In that context, I have also met trade unions and other bodies, because I believe that a collaborative approach in this space is useful. I will pass the request on to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, but if the right hon. Member for Knowsley feels that this could also fall within the ambit of elective recovery or of my role as Minister sponsoring the NHS long-term plan, I will of course, framed in that way, also be happy to meet Diabetes UK—I have met many charities in recent months.

If that does not provide the right hon. Gentleman with immediate agreement on what he called on the Government to do, I hope it provides him with some reassurance of just how seriously we take this issue and the recognition of just how important self-care is for each of us as individuals, for our constituents, for our healthcare system and indeed for this country. And I am very grateful to him for bringing the matter before the House today.

--- Later in debate ---

[Sir George Howarth]

Thank you, Sir Charles, for calling me to sum up.

First, I thank everybody who has taken part in this debate: my hon. Friend the Member for Bootle (Peter Dowd), the hon. Member for Glasgow Central (Alison Thewliss), my hon. Friend the Member for Bristol South (Karin Smyth), who is the shadow Minister, and the Minister himself. As I had hoped it would be, it has been a constructive debate. Although the Minister did not quite go as far as agreeing with me on every single point that I made, he showed a degree of understanding and presented what he had to say as constructively as everybody else’s contribution was. He was unfailingly polite, although I have learned through bitter experience that Ministers can be unfailingly polite and then go away and forget all about the matter that has just been discussed. However, I am sure that will not be the case now.

I am grateful and I see this debate not as the end of a process but as its beginning, and I am pleased that the Minister has nodded in agreement with that comment. And believe me, we will take up his offer of various meetings to progress these matters, including with your good self, Sir Charles.

[Sir Charles Walker (in the Chair)]

Well, that debate was a pleasure to chair; it really was.

Question put and agreed to.

Resolved,

That this House has considered the potential merits of a national strategy for self-care.

Covid-19 Update

George Howarth Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

I agree with my right hon. Friend on the importance of protecting our children. We in this House all know how children have suffered throughout the pandemic and the impact on their education, mental health and socialisation with other children. He is right to talk about that importance. One reason to take the measures that we have set out, especially around expanding the booster programme, is the ensure that we prioritise children. On the issue of vaccinations for younger children aged five to 11, the JCVI is considering that. When the Government hear back from the JCVI on that, we will bring it to the House.

[Sir George Howarth (Knowsley) (Lab)]

I welcome the Secretary of State’s statement. Having listened to it and having studied the matter in some detail over the weekend, I will be supporting the Government and the measures that they are introducing tomorrow night. What would he say to those in the community who are saying, “If the rule makers can’t be trusted to obey their own rules, why should we?”

[Sajid Javid]

I thank the right hon. Gentleman for his support. It is important to emphasise that the rules that we are discussing—all rules of any type, really, but he is talking about those around the pandemic—are there for all of us and apply equally to all of us.

Eating Disorders Awareness Week

George Howarth Excerpts

Thursday 5th March 2020 Westminster Hall

[Sir George Howarth (Knowsley) (Lab)]

I beg to move,

That this House has considered Eating Disorders Awareness Week 2020.

It is a pleasure to serve with you in the Chair, Mr Rosindell. May I say how glad I am to have secured this debate during Eating Disorders Awareness Week? I am glad that we have the opportunity to talk about how people acquire eating disorders and how they can, or should, be able to get the help they need.

Let me place on record my thanks to all the people and organisations who helped me to prepare for this debate. It is a long list, so I hope hon. Members will bear with me, because they deserve to be highlighted: Sandie Atkinson from Diabetics with Eating Disorders, Beat Eating Disorders, the Royal College of Psychiatrists, the British Psychoanalytic Council, the Musicians’ Union, Equity the acting union, the British Dietetic Association, Professor Khalida Ismail of King’s College, London, Hope Virgo of the Dump the Scales campaign, the Priory Group, the House of Commons Library, which has produced a really good briefing, as always, the Parliamentary and Health Service Ombudsman, which has also provided a briefing, and Julia Tyson.

Some 1.25 million people are living with an eating disorder, 10% of whom suffer with anorexia nervosa, and 40% with bulimia; the remainder suffer from other forms such as binge eating. Research shows that the earlier the treatment is accessed, the better the chance of recovery. The figures show that 50% recover and 30% experience some improvement. Worryingly, however, 20% remain in a chronic condition. The most common age of onset is 15 to 25, although there is growing evidence that older people are affected as well.

I want to touch on three areas: first, diabulimia, which is a form of eating disorder that many may be unaware of; secondly, the interplay between the entertainment industry and social media, and the impact they have on people’s sense of their own appearance; and thirdly, treatment.

Diabulimia is a form of eating disorder that affects thousands of people with type 1 diabetes. We cannot give an accurate figure, because of how incidents are recorded—it will show up as an eating disorder but not necessarily for somebody who has diabetes. Simply by withholding insulin, type 1 diabetics are able to attain rapid weight loss. There are, however, serious physical health consequences, and it can be fatal. I will not say too much on this topic, although I will return briefly to it later, other than that the right hon. Member for Maidenhead (Mrs May) has agreed to co-chair an inquiry into this matter with me, which we hope to commence later in the year. The right hon. Lady and I intend that the inquiry will raise awareness of diabulimia and look at evidence of what practical steps can be taken to improve the treatments available.

The relationship between the entertainment industry and eating disorders is complex but real. It has been described as a vicious circle, whereby some musicians and actors are put under pressure to look a certain way. In many well-documented cases they subject themselves to eating habits that, as they see it, enable them to achieve that appearance. However, that is not without consequence for their mental and physical wellbeing.

Let me explain what I mean. The actress and Equity activist Jean Rogers has drawn my attention to the work of Dr Sara Reimers of Royal Holloway, University of London, on aesthetic labour, which is defined as

“the employment of workers with desired corporeal dispositions”

whereby

“employers intentionally use the embodied attributes and capacities of employees as a source of competitive advantage.”

That work formed the basis of the “Making an Appearance” research she conducted with the Equity women’s committee.

Maureen Beattie, the president of Equity, has given an account of her own eating disorder as an actress, which she struggled with from the age of 14 to 30. She said:

“When I was at drama school I found the mixed messages I received very confusing—on the one hand I was told I was a big, fat lump of a girl and on the other hand was always cast in leading lady roles which required elegance and charm and attractiveness. There was a lot of pressure on me to lose weight, but the more the staff (and my parents who were both in the entertainment industry) lectured me about my weight the more I needed to eat. I ate so much I sometimes felt like I had been drugged. I realise now I was protecting myself”.

She says that the pressure of acting contributes to eating disorders:

“The feeling of being an object to be pushed and pulled and commented on and criticised and laughed at by the public is very real to many people.”

Recently, on “Desert Island Discs”, Melanie Chisholm, the former Spice Girl Mel C, said:

“I was described as the plain one at the back…I ended up making myself really ill. I was anorexic for a few years. I was exercising obsessively, and I ended up being incredibly depressed. I was in denial.”

After being diagnosed, she described going from anorexia

“to having a binge-eating disorder”.

Tellingly, she concluded that her

“appearance began to change, which was the biggest fear”.

In the documentary “Miss Americana”, the hugely successful international singer Taylor Swift talked about how, as an 18-year-old, she was portrayed on the cover of a magazine. She said:

“The headline was ‘Pregnant at 18?’ and it was because I had worn something that made my lower stomach look not flat. So, I just registered that as a punishment”.

Consequently, she said of her performances that she

“thought I was supposed to feel like I was going to pass out at the end of a show, or in the middle of it”.

It is not only young women who are affected by eating disorders—the singer Sam Smith has talked about starving for weeks to prepare for photoshoots.

A 2016 Credos survey of 1,000 boys aged between eight and 18—“Picture of Health?”—found that 55% would consider changing their diet to look better. Interestingly, the survey also found that respondents felt under pressure from other factors to look good, with 68% citing friends, 58% social media, 53% advertising, and 49% celebrities.

Another disturbing aspect is how a performer’s body shape is changed digitally. Victoria Hesketh, who performs under the name Little Boots, has drawn attention to the use of photoshopping to alter the appearance of artists, citing the case of the singer Meghan Trainor, herself a campaigner on the misuse of body image, whose 2016 video “Me Too” had been digitally manipulated to reduce her waist size without her express consent. Ms Hesketh commented in an article in The Independent:

“This stuff is nothing new, but I’m not sure if people really realise the extent to which image manipulation really matters, especially in pop music videos and even more so with female artists.”

She continued:

“I remember a music video director once telling me”—

this is really shocking—

“‘You should have seen Beyoncé’s ass before we got in the edit’.”

Let us think about the implications of what the editor in those circumstance thought was his responsibility. It is quite frightening.

In 2011, as part of their “Pretty as a picture” project, Jo Rigby and the advertising think-tank Credos commissioned Panelbase to conduct an online survey of 1,000 girls and young women aged between 10 and 21. Since that time, the fashion industry has become significantly more sensitive about body shape for models, which is to be welcomed. The survey found that 53% of young women took

“inspiration from adverts for their appearance”,

and that 37% wanted to

“look like models they see in adverts”,

even though 85% of them

“recognise that...images in advertising have been altered using airbrushing.”

Worryingly, about half of the young women involved admitted:

“Seeing adverts using thin models makes me want to diet/lose weight/feel more conscious of the way I look.”

On the issue of social media, Girlguiding UK’s “Girls’ Attitudes Survey 2019” concluded:

“Girls and young women say they’re aware of the difference between real life and what they see represented online and in the media. Almost half of girls regularly remind themselves that social media is not a real reflection of others’ lives. One solution may be making sure airbrushed pictures are always labelled as such, with over half of girls agreeing to this. Nearly half of girls agreed there should be a more diverse range of people on screen too.”

My point in citing those examples is to make a connection between what we see and the reality of young people trying to emulate the stars that they see as role models, which I described earlier as being a vicious circle.

Another pressure turbocharges this phenomenon—namely, the way in which social media can serve as a means of shaming people about their appearance. I confess that I find that to be an ethical minefield. In an open society, we rightly defend the principle of freedom of speech, but when that freedom normalises abuse and shaming, the platforms and the individuals who use them surely have to take responsibility for what is said and the potential consequences. What might seem a bit of fun can very easily have devastating consequences when it targets people in such a way as to drive them towards eating disorders.

In last week’s New Statesman, Amelia Tait wrote about personal responsibility for those who engage with social media. She stated:

“It’s not up to algorithms to change our behaviour, it’s up to us. We have to stop celebrating cruelty with our clicks, and instead make a conscious effort to reward people who are kind to others or people who call out poor behaviour when they see it.”

Social media platforms need to recognise how they can profoundly affect people’s mental health and behaviour. Either they accept that responsibility or, sooner rather than later, they will have to be regulated to do so. We all have an important role to play through the language we use. When we say things such as, “You need to grow a thicker layer of skin”, or “Get a grip”, that is not helpful. The effort required to tackle an eating disorder of any description is profound and massive. Simply telling people to “get a grip” does no good at all.

I said earlier that I am indebted to the charity Beat, among others, for its help in preparing for this debate. Its key policy suggestions are based on the current treatment available for adults, treatment for young people, medical training and research funding. My constituent Emily helps raise funds for Beat and has organised sponsored walks with her family and friends, which I have been pleased to support and I am probably healthier for having taken part.

Beat has pointed out:

“Adults with eating disorders in England face a postcode lottery”

in trying to access treatment. Only 26% of adult patients commenced treatment at a specialist service within four weeks of being referred. The average wait is nine weeks. In some clinical commissioning groups, adults are first referred to a non-specialist health service or to a panel for approval before being referred to a specialist service. That inevitably creates delays, which in some cases can have tragic consequences.

Beat and the Royal College of Psychiatrists suggest that a funded access waiting time standard should be introduced for all adults with eating disorders in England. An access and waiting time standard has already been introduced for the treatment of young people with eating disorders. By 2020-21, it is hoped that 95% of children and young people will commence treatment approved by the National Institute for Health and Care Excellence within one week of referral for urgent cases and within four weeks for less urgent ones. The most up-to-date information across clinical commissioning groups, however, shows that the rate for meeting the urgent referral target varies between 22% at worst and 100% at best. Beat is calling for the access and waiting time standard for children and young people with an eating disorder to be met in every area across England.

A further concern raised by Beat is that eating disorders are not sufficiently covered during medical training. On average, medical schools spend less than two hours teaching about eating disorders. One in five provide no training at all, and many do not even include a question on eating disorders in their final exams. As one fourth-year medical student put it:

“We don’t get any clinical skills experience.”

For those reasons, Beat recommends:

“Eating disorders are appropriately taught and assessed at all medical schools”,

and that all junior doctors in the UK

“gain...clinical experience during their foundation training.”

The Royal College of Psychiatrists has called on the Government to double the number of medical school places in order to provide the specialists needed to help people with eating disorders. I echo that call.

Beat’s final point relates to research funding. Given that the broader category of mental health accounts for 23% of NHS activity in 2018-19, 10% of the Department of Health’s research funding goes to mental health research, with just 0.09% devoted to eating disorders. That amounts to 96p per sufferer, compared with £228 per person spent on vital cancer research that has led to survival rates for cancer doubling over the past 40 years. I mention that not to suggest that too much money is being spent on cancer research, but because it shows that if more money is put into research, results follow. Beat is calling for a “significant increase” in funding for research into eating disorders.

Hope Virgo of the Dump the Scales campaign last week launched the z-cards campaign, a guidance resource for those with eating disorders and those supporting them. It has the timely and important aim

“to raise awareness of eating disorders”

and provide

“an educational piece for all frontline staff.”

Dump the Scales is asking the Government to recommit to NICE guidance 1.2.8:

“Do not use single measures such as BMI or duration of illness to determine whether to offer treatment for an eating disorder.”

The Royal College of Psychiatrists makes the same point. Hope Virgo is also calling for support for the roll-out of the z-card, training for GPs on eating disorders, and the development of a meaningful way of measuring the implementation of the guidelines, together with an annual implementation review.

I want to deal with the question of the best form of treatment for eating disorders. I have spoken to many people who have experienced them, and some believe that long-term residential treatment, sometimes including cognitive behavioural therapy, has been beneficial. There is, however, no consensus about cognitive behavioural therapy. Some experienced psychiatric specialists argue that although it may be a short-term way of dealing with the immediate problem it is not necessarily a long-term solution, in that it does not address the underlying cause of the disorder. I do not intend to draw any conclusions on that difference of professional opinion because, frankly, I do not feel equipped to do so, but I will refer back to the matter shortly. Some treatments at private healthcare facilities have been cited as having a positive effect on people’s eating disorders. However, such treatment can be very expensive and is usually beyond the means of most sufferers and their families.

Sandie Atkinson of Diabetics with Eating Disorders has said that there is still a desperate need to make insulin omission for weight loss, also known as diabulimia, a diagnosable condition. DWED supports the use of “type 1 eating disordered”, or T1ED, as an umbrella term for all disordered eating occurring in type 1 diabetes. The diagnosis would include subcategories for anorexia, bulimia and diabulimia, as insulin omission can occur separately or alongside other eating disorder symptoms.

I have a number of questions I want to address to the Minister, although I do not necessarily expect answers to all of them today. First, will she give careful consideration to the suggestions that DWED, Beat, and Dump the Scales have made about eating disorders, and will she undertake to respond in some form of written statement when she has had the opportunity to look at them more carefully? Secondly, will she undertake a review of the long-term effectiveness of cognitive behavioural therapy to assess its efficacy for treating eating disorders? Thirdly, will she undertake to meet representative bodies of the entertainment industry, Equity and the Musicians’ Union, to discuss the relationship between the promotion of a certain type of body image and the way in which it can affect young people? Finally, will she hold a similar meeting with social media providers to discuss what more they should do to prevent their platforms from enabling abusive behaviour, which shames some young people into acquiring eating disorders?

I hope we can agree that the issue of eating disorders is in need of urgent attention, not least because of the serious implications it has for the health and wellbeing of so many people and their families.

--- Later in debate ---

[Sir George Howarth]

It is always a pleasure to talk to the Minister. I start by thanking everybody who took part in the debate. The hon. Member for Broxbourne (Sir Charles Walker) spoke movingly on behalf of his constituents. As he knows, I have met them. They are a formidable couple who are trying to turn their grief into something positive, and I applaud them for that.

The right hon. Member for Romsey and Southampton North (Caroline Nokes) has been, along with me, ploughing this somewhat lonely furrow over many years. It is always a pleasure to have her as a combatant in the battle that we have been conducting. As ever, we saw the compassion of the hon. Member for Strangford (Jim Shannon), which is legendary—in this Chamber and elsewhere and certainly in his own constituency. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who spoke for the SNP, made a very helpful contribution, as did my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who spoke from the Labour Front Bench. I will take the Minister up on her invitation. I am very grateful to everybody for contributing to the debate.