NHS Dentistry in England

Debate between Graham Stringer and Derek Thomas

Wednesday 22nd June 2022 Westminster Hall

[Derek Thomas]

I thank the hon. Gentleman for his intervention.

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

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

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

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

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

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

She said in February,

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

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

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

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

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

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

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

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

[Graham Stringer (in the Chair)]

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

Smart Metering: Electricity and Gas

Debate between Graham Stringer and Derek Thomas

Thursday 9th February 2017 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I am glad to have the opportunity to talk about smart meters. I remember when we did the inquiry; it was something that I thoroughly enjoyed and learned a great deal from. I thank my hon. Friend the Member for South Basildon and East Thurrock (Stephen Metcalfe), who is the Chair of the Science and Technology Committee, for introducing the debate today.

There is no doubt that we should welcome the roll-out of smart meters, and we do welcome it. There is a genuine opportunity to bring an end to physical meter reading. I live down a very long lane and twice a year some very delightful gentleman finds his way down to where I live, to read the meter. I will talk a little about how successful that has been later on.

I am not looking to put people out of jobs, but where technology helps us to get accurate information and manage our energy use, as well as to provide data that can help to manage the nation’s energy supply and planning, it needs to be welcomed, and I think the smart meter roll-out is welcome.

As we have heard, smart meters have clear benefits. Their introduction has the potential to help consumers to reduce their energy consumption, shift their energy demand away from peak periods, which the Chairman of our Committee referred to earlier, and improve customer choice. Choice is a particularly interesting angle; if smart meters allow people to switch suppliers quickly and to access better tariffs, they must be welcome.

All of these measures will help constituents in west Cornwall and on the Isles of Scilly. We already know that 80% of smart meter owners are taking steps to reduce their energy consumption. According to Smart Energy GB, individuals are turning off lights, switching off the heating at certain times and changing the way in which certain household appliances are used, all in a proactive effort to engage with their energy usage.

I was pleased to hear the hon. Member for North Ayrshire and Arran (Patricia Gibson) mention fuel poverty. My concern is that once people on limited budgets realise how much energy different appliances use, they will start to behave in a way that is harmful to them—particularly older people during winter months. So we need to be very careful about how we communicate with people and empower them to get the best out of their homes.

The smart meter roll-out on its own is not really good enough. I know that this is a slightly separate issue, but the Government must consider how we can improve the efficiency of people’s homes, particularly those of vulnerable people. Otherwise, the smart meter roll-out might actually be detrimental for those households.

Dr Sarah Darby of the Environmental Change Institute has said that smart meters are effective, smart systems that bring together every-day human intelligence and technical ingenuity. We are beginning to hear about some problems with the roll-out, and I am glad that we conducted the inquiry last year. We are well into the programme for 2020. As an elected representative in my first Parliament, I recognise that 2020 is coming around very quickly; it keeps me on my toes every weekend. Far more important, however, is the roll-out of the smart meter programme.

Technological advances should always benefit the consumer; it is really important that that is clear, otherwise we will never get proper engagement. However, the delay in the data communications company’s go-live date has put these benefits at risk. Originally, the company was meant to go live in autumn 2015; in reality, it was late in November 2016—more than a year later—and it was even later for the north of England.

That delayed start has meant that the 2020 deadline for the roll-out of smart meters across the country is rushing up on us. It has created an impractical timetable for suppliers. I am particularly concerned about the smaller energy suppliers. We are trying to encourage them into the market, yet we have created quite a challenge for them to supply their customers with smart meters. The delay to stage 1 of the roll-out has placed the availability of SMETS 1 meters under strain, as purchasing was done on the knowledge that their installation would have been completed a year earlier. I have been speaking to the smaller suppliers, and they are talking about the massive difficulty they have in sourcing the meters and the qualified competent engineers to fit them. There is now a need to extend the roll-out period for SMETS 1 meters to meet the delay in the go-live date and to address the functionality concerns about the SMETS 2 meters, which are being used for the mass roll-out of the scheme.

The lack of planning for the launch and the deadline for the roll-out of smart meters has increased costs and uncertainty for suppliers, who still have to meet the legally binding deadline of 2020. We know full well that if costs increase for suppliers, those costs will only ever go to the consumer. I am always referring to people struggling on limited budgets to meet their energy bills. The strict timetable has also meant that there is less time to test and learn the system, which could lead to greater problems down the line and has meant that many promised benefits for consumers cannot be delivered.

Additionally, part of the changes to the DCC functionality has removed the ability of consumers to switch between credit and prepay modes. In the inquiry, I remember talking about those with prepay meters and the kind of revolution that smart meters would bring for them. Prepay customers pay more for their energy, and they pay up front. Some of the people I meet have no choice; they are in properties that belong to other people. When I talk to social landlords, they see the roll-out of smart meters as an opportunity to help their tenants to reduce their bills and manage their finances more easily. What we are finding is that they are not able to switch between credit and prepay modes. The meters cannot deliver in the way we expected. That is a disadvantage for millions of prepay meter customers across the country as they cannot gain access to the market.

Dr Sarah Darby’s definition of smart meters also pointed to the importance of shaping human behaviours. We have already heard about that today. Improving energy use practices and consumer’s energy know-how are essential to ensuring that the full benefits of smart meters are realised. Data from the “Smart energy outlook” show that awareness of smart metering and its benefits rose by only 7% in the past year. That needs to be improved, and that is despite Gaz and Leccy. Gaz and Leccy are enormous role models for my children. We watch their adverts regularly. If you do not know Gaz and Leccy, Mr Turner, you must go home and do the research. It will add value to your life. I share an office with three other MPs, and they have spent considerable time in research, watching Gaz and Leccy. They are fantastic adverts. They are absolutely worth watching, and they help to get across the point that we are not in control of the energy we use. However, if we are seeing only a 7% increase in awareness, despite that brilliant media campaign, we are not getting the information out in the way we should. Unless consumers understand the benefit of smart metering, we are not going to win the battle.

I was a builder before I came here. I used to do barn conversions. For many years, in every barn conversion I completed, a smart meter was installed, but often concerns about how the data would be used meant that it was never used. Instead, it was just left on the side. Because it was not integral to the structure of the building, it would just be unplugged. Customers would tell me, “I don’t want my energy supplier knowing when I am making a cup of tea or when I’m getting out of bed or when I’m doing this or something else.” There is a real need to make customers aware of what data are collected, why they are collected, for whose benefit and how they are used. That is a battle we have not yet fully dealt with or addressed.

Smart metering will improve the temporal resolution of energy data, but it will still not differentiate between heating and other energy demand, nor will it show where in the building energy is used so the need to address energy efficiency in the home remains.

There are some connectivity issues with smart meters, and I want to talk about my experience. We did the inquiry last year. I explained that the gentleman walks or drives down my lane a couple of times a year. On an unusual occasion I met him, and he said, “Do you know, your meter is still showing ‘blank’”—I had an old-fashioned meter—“so I have not been able to take a reading for four years?” I said, “Okay. What can I do about it?” He said, “I don’t want to tell you this, because it will put me out of a job, but you ought to put a smart meter in.” I applied for a smart meter and had one fitted. The energy company had estimated how much energy I had used in the past four years. I disputed it and, with the help of my children, managed to reduce the estimate. The energy company gave me a new bill that was considerably less, although that is a matter for another debate altogether.

The smart meter was fitted. Once a month, I have to go outside and take a photo of my smart meter and send that photo over broadband to the supplier, because I do not have connectivity. My smart meter is not connected to anything, because I do not have mobile phone signal. That will be a challenge if we are going to provide 20 million smart meters—or however many we are supplying; it is quite a lot—by 2020.

I am the local MP and, interestingly, the local BBC presenter recently emailed me to say that he had a smart meter fitted, and he has to do exactly the same thing. It is a bit worrying if we are to win public support for smart meters if the local MP and the local BBC presenter have meters that do not work. Clearly, this is a private meeting, so I am not telling the world that my smart meter does not work, but I do enjoy telling the story.

[Graham Stringer (Blackley and Broughton) (Lab)]

I have no idea where the hon. Gentleman lives in Cornwall—he is clearly not getting a signal—but it is a much more general problem. At the present time, the smart meters are not functional in tall buildings. Does he consider that to be as big a problem as the one facing those living in the remoter parts of Cornwall?

[Derek Thomas]

The hon. Gentleman is absolutely right, and I thank him for that intervention. I raised the issue because I am wedded to the idea of getting smart meters. If we get them right, they are a fantastic thing, and we should be ambitious, but the roll-out will be flawed and difficult to recover if we cannot deal with the connectivity issues. The issue is not just for the Minister; it is for the whole of Government to recognise the challenge of giving each of us the best available modern-day technology. I will move on, because I am probably taking too long.

The roll-out of smart meters will undoubtedly help my constituents in west Cornwall and the Isles of Scilly, but there is work to do to convince them of the benefits and how smart meters can help them manage their energy better and in a different way, so that we do not place such a demand on, dare I say it, fossil and nuclear power. In Cornwall, we generate more energy than we use, such that wind turbines are turned off. If we get it right, and we learn to store energy, we will get people moving to electricity and away from oil for heating. We will be able to be much smarter about the generation and use of energy.

Smart meters have an important part to play, but the Government need to look at the challenge of delivering the programme by 2020. There is a real need for an independent review of the safety, cost and deliverability of the roll-out of smart meters. We must consider the pressure that suppliers are under to find and retain qualified engineers, to source the meters that will do the job and to ensure that they are fitted in a way that helps rather than hinders the consumer. The 2020 deadline is too ambitious. The cost and expertise required for installing smart meters has been underestimated, and if we stick to the current deadline, the impact on consumer experience will undoubtedly be negative. That is a shame, because this is a once-in-a-lifetime opportunity to get it right.

To conclude, it is clear that the intentions behind the roll-out of smart meters are good. I am absolutely a fan of the ambition, but we have to accept that the timetable is over-ambitious and potentially harmful to consumers. We therefore must use caution, re-evaluate the timetable and draw on the words of Benjamin Franklin—we must prepare properly, or prepare for smart meters to fail. I did not write that last bit, and I am not sure that it is the best bit of my speech. Thank you very much, Mr Turner.

Employment for People with Disabilities

Debate between Graham Stringer and Derek Thomas

Tuesday 5th July 2016 Westminster Hall

[Graham Stringer (in the Chair)]

I remind hon. Members that “you” refers to me and that they should use normal parliamentary protocols.

[Derek Thomas]

Thank you Mr Stringer. I also made that mistake.

I work with FE colleges in Cornwall and other groups such as Mencap, Leonard Cheshire Disability and others. I am talking to all of them and have been since being elected to Parliament to see how we can bridge some of the gaps. I share the concern about academies. League tables, albeit not necessarily the intentions behind them and incentives they put in place, present a problem to schools across the board in terms of how they maintain a high position in league tables and continue to attract children. We must look at the incentives that may marginalise and exclude people. I accept that is important.

It is obvious that different people have different hopes and aspirations. That is equally true of people with learning disabilities and, or autism. Community-based organisations can help to develop a creative and flexible approach to employment and occupation to achieve optimum positive outcomes. That is particularly true of how we work with employers to find opportunities to provide spaces and places for people.

--- Later in debate ---

[Derek Thomas]

I do agree. We need to understand that every penny we spend effectively and successfully now is a penny saved that can be used to support the next individual. My hon. Friend is absolutely right. How do we prioritise? Who should we work with most? Do we just go for quick wins or do we go for the greatest challenge? We must recognise the contribution that people will make to the economy and society if we get this right, as well as the savings to the state. At the moment, so much of what we are spending, almost to maintain the status quo, is not money well spent.

I found that, although willing, employers would be nervous about whether a candidate had the skills and support network needed to work in often busy workplaces. Community-based organisations can build trust with business owners and have the connections to help to equip prospective employees with the skills and confidence they need.

I want to mention a couple of things that need to be taken seriously as we look at the Green Paper. We hear often in the Chamber now about constituents who have written to us to raise a particular issue. The chairman of Cornwall People First, who has a learning disability, asked me to raise the following issue in this debate. At the moment, he has a free bus pass for use after 9.30 am. If he wants to get employment or to access training, that bus pass needs to serve him at a time when people are actually going to work. It would be brilliant if we could talk to local authorities and change that, so that bus passes are free to use when they are actually useful to the people who need them and have a right to them.

Also, we talk a lot about the role of jobcentres, but one of the jobcentres in my constituency, in Penzance, is in a huge granite building that is completely uninviting, and often when I walk past there is a security guard standing at the door. In Helston, there is a large, glass-plated shopfront, and again, by the door stands a security guard. For someone who is vulnerable and feels they are being pressured to take part in a system, that is a barrier in itself. We need to look at how we can improve that.

In recent decades, people with disabilities have made huge progress in the workplace and more are now in work than ever before. However, despite wanting to work and often having the right skills and experience, many people still face significant barriers to accessing employment. I have focused on people with learning disabilities, but that is true for all people who have a disability. As the Green Paper on disability employment is progressed, I would ask that significant consideration and support be given to these small but effective community organisations. They are ready and primed to address the barriers to employment that exist for people with disabilities.

I am a huge fan of Cheshire homes and have enjoyed my visits to the home in Marazion in my constituency. I want to conclude by reading Leonard Cheshire Disability’s statement of belief, which serves as a reminder of why we are taking part in this debate today:

“We believe that disabled people should have the freedom to live their lives the way they choose—with the opportunity and support to live independently, to contribute economically and to participate fully in society.”

[Graham Stringer (in the Chair)]

I intend to call the Scottish National party spokesperson at 10.30 am and obviously the debate finishes at 11, so there is approximately 35 minutes left and there are five Back-Bench speakers. The arithmetic is straightforward.