Dental Healthcare: East Anglia

Jerome Mayhew Excerpts

Wednesday 11th December 2024 Westminster Hall

[Peter Dowd (in the Chair)]

I will call Jerome Mayhew to move the motion and the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

I beg to move,

That this House has considered dental healthcare provision in East Anglia.

It is lovely to see you in the Chair, Mr Dowd. I am grateful to colleagues from East Anglia for supporting this debate and, I hope, making some interventions. I am also grateful to the Minister for Care for coming yet again to Westminster Hall, because this is not the first time that we have had a debate on dentistry in the east of England, and in East Anglia in particular. The reason for those numerous debates is the significant problem of access to NHS dentists in particular, but also to private dentists.

Peter Aldous, who I am sorry to say lost his seat at the recent election, was a doughty campaigner on the issue. I pay tribute to him for the numerous debates he brought forward. Most recently, in September, the hon. Member for Norwich South (Clive Lewis), who is not here today, held a debate on the topic. Time is short, so I will not focus on the need as much as I normally would, but the Minister has been here before and knows very well how significant the need is for increased access to NHS dentistry in East Anglia.

I will give highlights, however, because the Secretary of State for Health and Social Care has described Norfolk not only as a dental desert, but as the “Sahara of dental deserts”. The Minister—the noble Baroness, Lady Merron—confirmed in the other place on 25 November that the Norfolk and Waveney area has

“the worst ratio of NHS dentists to patients in England”.—[Official Report, House of Lords, 25 November 2024; Vol. 841, c. 479.]

In my last debate in this forum, I was shocked to report that in Norfolk and Waveney the ratio of dentists per 100,000 population was 39, when the national average was 52. Now I have to update those figures, because the Secretary of State has recently confirmed that the figure of 39 has dropped to 36 per 100,000 of population, while the national average has increased to 53. It is getting worse, not better.

The data from this month is even more concerning. The British Dental Association confirms that there are 3,194 NHS dentists in the east of England, which are the statistics we previously used. BDA’s further analysis last month reveals that that equates to just 1,096 full-time equivalent dentists in NHS roles. If those figures are run through the population, there are 17 full-time equivalent NHS dentists per 100,000 population in the east of England. Those are truly shocking figures.

The issue can be sliced and diced in another way. The amount of money that the Government spend on people’s mouths in the east of England makes for sobering reading. The national average is £66 per mouth spent on dental treatment by the NHS. In the east of England, that figure is just £39. What is it? Is it that our fillings and dental work are cheaper in the east of England, or are we doing less? It is not due to less demand; we have the greatest demand. We had more than 1,000 people presenting in the past year at NHS A&E with significant dental problems. I believe I am right in saying that dental concerns are the single biggest reason why primary school children present at hospitals.

[Jim Shannon (Strangford) (DUP)]

On that critical point, dental care must start in primary school. When I was at school—that was not yesterday, of course—they came in to check the children’s teeth. We had that the whole way through, but that process is missing today. Does the hon. Gentleman think that primary school should be the first stage of response?

[Jerome Mayhew]

This debate is about the east of England, not the east of Northern Ireland, but I will take the hon. Gentleman’s intervention anyway. He is right that we learn our oral hygiene habits as children. It is primarily the responsibility of parents to look after their children’s oral health, as well as their general health; that has always been the case, and that should always remain the case. However, we recognise, as did the last Administration, the increasing role of primary schools in reinforcing the role of parents.

[Jess Asato (Lowestoft) (Lab)]

Does the hon. Member agree that it is appalling that my constituents have had to resort to pulling out their own teeth because no NHS dentists in my constituency are accepting new patients, and that we need urgent action now?

[Jerome Mayhew]

I am shocked to hear that. An example of that in my constituency was reported to me, but that was in the height of the covid lockdowns; I have not heard an example since then. However, irrespective of the headline-grabbing anecdote, it is almost impossible for new applicants to register to an NHS dentist, and I have the figures to back that up. Office for National Statistics data for November indicates that 98.4% of those who were not registered to a dentist but who wanted to access NHS dental care in the east of England were unable to do so. That is the worst rate of all English regions, yet over that period there was a £58 million underspend in the east of England’s NHS dental budget. That is not because the Government do not want to spend the money, and it is not because the money is not available; it is simply because we do not have enough dentists to satisfy the huge need.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

Does the hon. Member agree that the absolute early priority must be to sort out emergency dentistry? Everybody must be able to contact an NHS emergency dentist for terrible toothache or dental emergencies, and that will prevent so many children from being admitted to hospital for their abscesses to be drained, which I have had to do as an ear, nose and throat surgeon.

[Jerome Mayhew]

My answer is yes and no. Over the past 18 months to two years in Norfolk and Waveney, a lot of money has been spent on increasing access to emergency dentistry. Although I welcomed that and it has helped to deal with some acute issues, there is a much more fundamental problem. We must fix the system rather than decide on the least worst form of emergency care once the problem has become acute.

The big question is why the east of England is in this position. The wrong analysis of how we got here will lead to our imposing the wrong solution. Some people say, “Well, it’s because Norfolk is a remote, rural area with lots of coastline, and that brings problems. If you’re a newly qualified dentist, it’s probably a rather unfashionable place to go to make your new career if you’re not from that neck of the woods. It has a more elderly demographic, which may put off young dentists. It’s not where they want to go to set up their new home.”

Yet compare Norfolk with similar counties, such as Devon. I often use Devon as an example because it shares many characteristics with Norfolk: a slightly older population, a large rural coastline and a pretty similar population size. Look at the number of dentists in Devon: they have 49.6 per 100,000 people, which is far more than we have in the east of England. What is the difference? The answer is obvious. Since 2005, Devon has had a dental training school at Plymouth, which was the last one to be set up. The east of England made a bid for that contract and lost out to the Peninsula bid, and we can see the consequences of that in the teeth of Norfolk residents.

If someone wants to train as a dentist in Norfolk, Suffolk or elsewhere in East Anglia, the nearest place they can go to train is either Birmingham or London. That means that our home-grown talent has to go off somewhere else, several hours away, to train and qualify. The usual things happen: they develop their professional relationships in that region; they meet someone, fall in love and settle down; they put down roots in the community and they stay there and do not come back. The exact opposite is the case for people not from our region who qualify elsewhere. What is the incentive for them to come and set up home in a part of the world that they do not know and that is perhaps not attractive to newly qualified people in their mid-20s?

We also know that about 40% of graduates tend to stay where they train. We have that data from the University of East Anglia and its medical school, because each year it surveys graduates to see where they get their first job and each year about 40% of them take a job locally. This is the really important question for the Minister: do he and his Department accept that analysis? If they do not accept it, what is his explanation for the dearth of NHS dentists and even private dentists in East Anglia?

[Steff Aquarone (North Norfolk) (LD)]

I congratulate the hon. Gentleman, my constituency neighbour, on securing this debate. I cannot speak for the Minister, although I certainly welcome the comments about the importance of a dental school. However, is the issue in East Anglia not a result of the region’s disproportionate failure under the previous Government’s dental recovery plan? It was said that East Anglia would miss its targets and that, even if it did hit them, it would still be 2.6 million dental appointments short of pre-pandemic levels. The hon. Gentleman was on the Government Benches in the last Parliament. Does he not understand why many people across East Anglia hold the Conservatives to account for the situation having become this bad?

[Jerome Mayhew]

I accept the hon. Gentleman’s argument, but I do not think that it is particularly helpful. We are trying to work out what the solution is now and going forward. A huge amount of money was spent by central Government on NHS dentistry. The problem we had, as we can demonstrate by the £58 million underspend of the budget that was available, is that there are physically not enough dentists now. That is not a short-term brickbat that can be chucked around for party political points in a Westminster Hall debate at 11.11 on a Wednesday morning. I submit that it is a rather more serious issue that deserves a slightly more serious approach.

[Several hon. Members rose—]

[Jerome Mayhew]

I will take an intervention from my other constituency neighbour, the hon. Member for Norwich North (Alice Macdonald).

[Alice Macdonald (Norwich North) (Lab/Co-op)]

Does the hon. Member recognise the support from all parties for a new dental school in Norwich? Does he welcome the £1.5 million that was announced last week by the Greater Norwich Growth Board in support of the bid for a new dental school?

[Jerome Mayhew]

That is the kind of intervention that I find constructive and helpful, and I am very grateful to the hon. Member for making it. She is, of course, quite right. We disagree on many things, as I do with the hon. Member for North Norfolk (Steff Aquarone), but there are some things that bring us together, and the need for a dental training school at the University of East Anglia is one of them.

[Pam Cox (Colchester) (Lab)]

Down the road from Norwich is the University of Essex, which is based in Colchester and already offers degrees in oral science. I think a collaboration between the two universities is really important, and I would be very happy to facilitate it. The University of Essex degree is not a dentistry degree, but an oral health degree. The university also has a community dentistry clinic that is already operating in Colchester, which could provide some very interesting examples of good practice. I invite the Minister and his team to come and visit both the university and the clinic.

[Jerome Mayhew]

The hon. Member is absolutely right. This is not about one organisation over another; there has to be a collaborative approach. We have plenty of dental need to go round, I am sorry to say, in Suffolk, Essex and Norfolk. The more we can collaborate and provide a synthesis of offers—some in dental health qualifications, some in straightforward dentistry and others in dental hygiene, another key part of this jigsaw that we have to put together—the better.

[Terry Jermy (South West Norfolk) (Lab)]

I am all for cross-party working, but I was struck by the hon. Member’s earlier comments about children. Does he accept that, because of the legacy of so many years of failure, any solutions will be much more difficult to find because we will have dental issues progressing as children grow older?

[Jerome Mayhew]

I thank the hon. Gentleman for his intervention. There is a difference between milk teeth and grown-up teeth, as I will call them, although I know that is not the technical term. I hope that that assessment is wrong, but undoubtedly there will be problems. If there is a long-term lack of access to dentistry, it builds up problems, whether in the teeth or in the gums, both for children and for adults.

We can all talk about how we got here, and I can defend lots of very good things that the previous Administration did, but did we get everything right? No, we did not. What I am more interested in is how we can encourage the Government and work with them across the parties to solve the problem in the very near future.

I hope we have got to a reasonable analysis of why we are in this position. If it is substantially because of a lack of dental training facilities in the east of England, an obvious solution, although not the sole solution, would be a school of oral health at the University of East Anglia. The Minister knows that the UEA is ready to go. He knows that there is a building under construction and that a large amount of funding has been applied for, some of which has been already agreed. He knows that the UEA is making an application for registration with the General Dental Council and that it will be completed within the next six weeks at the latest.

That brings us to the crucial next step, which is the Office for Students. I recognise that the Minister is important and impotent at the same time. He is important because as the dental Minister he sets direction and gives impetus to change, but I accept that in some sense he is impotent because the Office for Students is an arm’s-length independent body. I hope he will take these requests in the light of my acknowledgment of his constraints, but it would be helpful for the UEA and the residents of our area to have his confirmation on the following three points.

First, can the Minister confirm whether additional dental training places will be made available by the Office for Students in 2025? It is a political decision how much funding the Government are prepared to put into the overall number of dental training places in the country in 2025. What is the pot that the Office for Students has to work with? Can he confirm that the number will be increased to take account of increased need?

Secondly, if that is the case, will there be a regional allocation within that global figure specifically for the east of England, given that the need is not national? There are regional variations, and in the east of England it is worst of all. There is precedent for that approach: recently, medical training places had a regional allocation, although I accept that historically it has not happened with dental places. It is an important point and would be of huge encouragement to our residents.

Thirdly, can the Minister give some indication of the timetable on which he and the Office for Students will work to process the 2025 allocations?

[Adrian Ramsay (Waveney Valley) (Green)]

I welcome the hon. Member’s comments. Indeed, the funding for the dentistry school at the University of East Anglia is a welcome step in addressing our chronic shortage of dentists in the region, but we need to ensure that there are strong incentives for those dentists both to stay locally and to stay within the NHS, which means meaningful contract reform to make it economic for dentists to practise in the NHS in the long term. In addition to his points, does the hon. Member agree that we need the Minister to set out the timescales for the Government’s pledge to review the dental contract?

--- Later in debate ---

[Jerome Mayhew]

The hon. Member is absolutely right. The school is not the only answer, but it is part of the answer. Part of how it will encourage graduands and then graduates to be sticky—to stay locally—is through its training process. From year one, students will be placed in local dental practices, so they will be providing benefits to real people right at the start of their practice, but also developing professional relationships with those practices so that they can walk into good-quality, local jobs. That should help with the stickiness, but the hon. Member is right that it is not the full solution. We need reform of the 2006 NHS dental contract, but that is not specific to East Anglia and it does not explain why we are in a particular pickle in the east of England. That subject would happily take up another debate, so although I recognise its importance, I will not get too distracted.

The other problem, which is slightly more recent in origin, is the imposition of national insurance contributions on dental practice. The British Dental Association has outlined that the recent Budget could have a devastating impact on struggling NHS practices. A local practice in Norfolk says that

“the recent changes to employers’ NI and raising of the living wage will lead to bankruptcy and breakdowns. We have been trying to keep our 100% NHS dental practice open under very difficult circumstances, being unable to fill our vacancy for a full-time dentist. This post has been empty since April 2023 and we can no longer go on with only one dentist and pay the bills.”

I recognise that it is above the Minister’s pay grade, but I do hope that in his advocacy to His Majesty’s Treasury he will ensure that it is fully aware of the negative impact of the NI increases on dentistry, as well as on GP practices, and that that will be taken into account in future decisions.

Oral Answers to Questions

Jerome Mayhew Excerpts

Tuesday 19th November 2024 Commons Chamber

[Andrew Gwynne]

I am grateful to the hon. Member for his question. We are a mission-led Government and, of course, tackling health inequalities is a job not just for the Department of Health and Social Care, but for all Government Departments. I will be very happy to raise the role that Ministers can play in improving mental health and wellbeing in my bilaterals with the Ministry of Housing, Communities and Local Government.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

4. What estimate he has made of the number of new dental training places needed in the east of England.

[The Minister for Care (Stephen Kinnock)]

Fourteen years of Conservative neglect and incompetence have left huge swathes of the east of England as dental deserts. As part of our 10-year plan, we will be working with NHS England to assess the need for more dental trainees in areas such as the east of England where we know that many people are struggling to find an NHS dentist. I am aware of the University of East Anglia’s plans to open a dental school and I recently met MPs from the east of England, including the hon. Gentleman, to discuss that process. I encourage the UEA to continue with its bid for a new dental school.

[Jerome Mayhew]

The Minister well knows that there is a lack of dentists in the east of England, because there is no undergraduate training facility. The nearest place is either Birmingham or London. He has kindly mentioned the University of East Anglia, which is ready to go with a new building under construction. It has wide cross-party support, as he also knows from the meeting that he held recently, so when will he make the announcement?

[Stephen Kinnock]

I thank the hon. Gentleman for that follow-up question, but he will recall that, when we met, I and my officials made it clear to him that the UEA has not yet submitted its bid for a dental school. In that meeting, we said: “Please go back to the UEA and encourage them to submit that bid. When they do, we will look at it very carefully.”

National Insurance Contributions: Healthcare

Jerome Mayhew Excerpts

Thursday 14th November 2024 Commons Chamber

[Karin Smyth]

My hon. Friend makes an excellent point. As I said in my response to the hon. Member for Hinckley and Bosworth (Dr Evans), we faced a situation where we were told that we would have to reduce appointments by 20,000 a week. We have taken serious steps, and my right hon. Friend the Secretary of State fought hard for our Budget allocation so that we can have 40,000 extra appointments as promised in our manifesto, which was overwhelmingly endorsed by the British public. We are determined that we will bring change to the system and tackle the waiting lists.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

Increased taxes for hospices, care homes, GPs and pharmacies. Is that a deliberate decision by the Labour Government or just a cock-up?

[Karin Smyth]

We understand the precarious situation that hospices are in—the precarious situation that they found themselves in before we came to power— and we are committed to talking to them and other affected providers. We will be going through the normal process of allocations in the next few months.

Oral Answers to Questions

Jerome Mayhew Excerpts

Tuesday 15th October 2024 Commons Chamber

[Andrew Gwynne]

I agree with my hon. Friend, which is why we have set a goal for fewer lives being lost to cardiovascular disease. We will make it easier for people to have checks in the comfort of their own homes through, for example, the digital NHS health check and the new workplace trials.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

Labour’s cut to the winter fuel payment will cause 262,000 cold pensioners to seek NHS treatment, according to the End Fuel Poverty Coalition. Do the Government agree with those figures, and if not, what are their own estimates?

[Wes Streeting]

The decision on the winter fuel allowance is not one that the Government took lightly, but we inherited a £22 billion hole in the nation’s finances. We continue to stand behind vulnerable households by increasing the state pension with the triple lock, delivering the warm home discount and extending the household support fund to support the most vulnerable pensioners.

Healthcare Provision: East of England

Jerome Mayhew Excerpts

Tuesday 3rd September 2024 Westminster Hall

[Clive Lewis]

I thank the hon. Gentleman for his intervention but will leave the response to the Minister, because it is a question that she would be better able to answer. Frankly, given that the last Government had 14 years to sort out that mess and have handed it over, pretty much complete, to the new Labour Administration, I will not be singing their praises when it comes to dentistry. That will not be going on the record.

I will conclude by looking at the social and economic roots of the healthcare crisis, which are the elephant in the room. As I have outlined, many of the causes of ill health are socially determined. Waiting lists, ill health and mental health issues are signs that our healthcare system is breaking down, but also that we have an economy with a degrading social fabric—one need only look at the race riots this summer to understand that. But do not take my word for it; listen to civil society organisations in my constituency that are at the coalface of this crisis. The Norfolk Care Association says:

“Around 10% of health outcomes result directly from healthcare delivery, with a more significant proportion derived from the physical, social, and economic factors that people experience day to day. The government must do more to tackle poverty, ensure quality housing, and create safe communities, as these are fundamental to improving health outcomes.”

Age UK Norwich says that the key healthcare issue older people face is

“chronic health conditions and limited spend/focus on prevention: around 55% of Norfolk’s older population have one or more long-term health conditions; however, most are treated independently”.

That organisation points to the need for

“Rebalancing healthcare focus and investment to underlying causal factors”—

the “wider determinants” that make up 80% of a person’s overall health status.

Let us have a quick look at some more drivers of ill health. Take, for example, fuel poverty: 10% of people in the east of England live in fuel poverty, and it is almost 12% in Norwich South. Fuel costs in the UK are on average 30% higher than the EU average.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

The hon. Member makes an important point about fuel poverty and its direct link with illness, so will he support his Government’s removal of the winter fuel allowance?

[Clive Lewis]

I thank the hon. Gentleman for his interesting question. I am not happy with the removal of the winter fuel payment—of course I am not—and I do not think anyone on this side of the House will be happy with it, but I also understand that there are two points in the year when you support your Government: the King’s Speech and the Budget. I am not looking to break that, but like many of my colleagues I have severe concerns about the impact this proposal will have on people’s health and wellbeing and on their pockets. I have every confidence that my Government will put in place the best possible response to the £22-billion hole left by Conservative Members. I just do not think that the removal of the winter fuel allowance is necessarily the right way forward, but we shall see what happens in the days and weeks ahead. My question to the Minister is this: does she believe—this almost pre-empts the question asked by the hon. Member for Broadland and Fakenham (Jerome Mayhew)—that the cut to winter fuel payments will improve the situation in terms of fuel poverty and its impact on health?

Another example is financial insecurity. Age UK Norwich told us that 35% of Norwich wards fall within the top 10% of the most deprived areas in England. There has been a 35% rise in food bank use in the city, fuel poverty is at nearly 16%, and 68% of Age UK Norwich inquiries are about money, debt or bills.

Another example is poor housing and malnutrition. We have quite extreme malnutrition in Norwich. Norfolk has the highest malnutrition rate in England; malnutrition affects one in five people in Norfolk and Waveney. Jade Hunter, the headteacher of West Earlham infant and nursery school, told The Guardian:

“We do get a lot of bad chests because they’re in damp homes that are maybe mouldy, and we get a lot of sickness and diarrhoea because the quality of the food they’re eating isn’t great”.

She told me that one way teachers know children are hungry is that they chew their pens and chew sand. That shows that they are not being given what they need to thrive at school.

Before I conclude to allow others to contribute, I would like to ask the Minister some more questions. We know there will be a Government review of NHS England structures. There is an incomprehensible patchwork of bodies covering different geographical areas, including the Norfolk and Suffolk NHS foundation trust, the East of England ambulance service, the NHS Norfolk and Waveney integrated care board—the list goes on. Are there plans to simplify those structures and make those bodies more accountable? I understand that NHS reorganisations and reforms are not always popular, particularly with staff, but I wanted to ask that question.

Secondly, before the general election, all Norfolk MPs called for an undergraduate dental school to be established at the University of East Anglia. With my hon. Friend the Member for Norwich North (Alice Macdonald) and many others across the region, I have been working on that proposal, so will the Minister tell us whether there has been any news or developments? Such a school will be critical to beginning to end the dental desert in Norfolk and Waveney—dentist provision in Suffolk is in almost as bad a state.

Finally, I campaigned for mental health before I was an MP, I and continue to do so to this day, despite the difficulties. Despite the past 15 years of so-called change and reform in our local mental health service, it is still arguably the worst in the country. Will there be a statutory public inquiry into the systemic failure of mental health services in Norfolk and Suffolk? This scandal—this slow-motion disaster—has gone on too long, disrupted and ruined too many lives, led to people dying unnecessarily, and caused much grief. People need answers, and if we are to learn lessons from what has happened in the past 15 years, we need an independent public inquiry to get to the bottom of these issues.

--- Later in debate ---

[Jerome Mayhew (Broadland and Fakenham) (Con)]

I congratulate my constituency neighbour, the hon. Member for Norwich South (Clive Lewis), on securing this important debate about the health service in the east of England.

We have just recovered from a general election, and I hope we have all had time off—a bit of a break—to recharge our batteries so that we can start thinking about how we should lead this country in the years and months ahead. Health and the health service was a key election issue on the doorsteps of Broadland and Fakenham. As the Conservative candidate, I was armed with a whole series of data about how we had 20,000 more doctors and had, I think, recruited 50,000 more nurses. We had paid for and secured 50 million more GP appointments each year—an increase to 350 million per year. We had provided a lot more funding for the NHS, increasing it by £28 billion, or 17%, since 2019. I would have the conversation on the doorstep and read off all these facts about how we had funded the health service, but that was not how things felt to our constituents, and that was a key negative impact for Conservative candidates such as myself. As a Government, we felt we had done what we could—we had increased the funding—but the outcomes our constituents experienced did not tally with that.

I have come up with a number of factors to explain that. One was the covid backlog for elective surgery. Back in early 2020, covid was thrown at the Government, who were caught unaware, and it created a huge backlog. Steps were taken to address it in Norfolk. We had two new operating theatres for elective surgery at the Norfolk and Norwich university hospital, and we got the diagnostic centres at the James Paget university hospital and the Queen Elizabeth hospital, as well as a new one at Cromer. However, these things take time to work through, and the election came before our constituents felt the benefits of that enormous local investment.

However, there was a bigger problem, which the Conservative Government failed to address. A key, proper criticism of our Government is that productivity in the health service went down between 2019 and 2024 by about 5.8%. We were putting much more money in and we had more staff, but what they achieved decreased. If there is one thing the Minister should address—I would be grateful if she could do so in her summing-up—it is what plans the Government have to improve productivity, rather than just funding and staffing, in the NHS, because that is the absolute key. My starter for 10 is that productivity will not improve if we have pay deals like that awarded to ASLEF, where money was provided and productivity improvements were removed from the deal.

[George Freeman]

My hon. Friend makes a really important point about productivity in the health system. I have been a Health Minister and I have observed that—not because of ministerial diktat, but just because of the way the health system works—if you deliver more for less, the Treasury and the Department of Health give you less, but if you struggle to deliver more for less, we give you more. If we ran a business like that, we would go bust. Does my hon. Friend agree that, ultimately, the east needs a much more decentralised, empowered system? In Norfolk, we have an ambulance trust, a mental health trust, three hospital trusts and five clinical commissioning groups. That is bonkers. We need one Norfolk healthcare system that provides what patients need: an integrated patient pathway.

[Jerome Mayhew]

We have made progress in that direction with the integrated care board, which is a very good step in the right direction because it allows the whole care system in Norfolk to come under one remit. We were beginning to see some of the benefits of that with the mental health trust. Although it has a long and pretty disgraceful history of underperformance, there have been tentative signs of improvement since the ICB came in.

The next issue, particularly in Norfolk, is the physical state of our hospitals. We have the Queen Elizabeth hospital at King’s Lynn, which is a RAAC—reinforced autoclaved aerated concrete—hospital, the James Paget in Yarmouth, and the pretty modern Norfolk and Norwich in Norwich. The last Government fully funded and agreed full rebuilds of the QEH and the James Paget, which are long overdue. Those hospitals should be rebuilt by 2030, and I am very concerned to hear that that funding commitment is now under review. The Minister might be constrained in what she can say at the Dispatch Box, but whatever reassurance she can give the residents of Norfolk about the Government’s intention to continue those rebuilds would be much appreciated, because they are enormously important to my constituents.

Then there is dentistry. The hon. Member for Norwich South talked about our dental desert in Norfolk. We have 39 dentists per 100,000 of population, compared with a national average of 52. If someone who grows up in Norfolk wants to be a dentist, the nearest place they can train is Birmingham or London, so it is no surprise that we do not have domestic, home-grown talent becoming dentists in Norfolk. What incentive is there for a just-qualified 26 or 27-year-old who is not from the eastern region to move to a largely rural area? For those reasons, we desperately need an undergraduate dental training school at the UEA in Norwich, perhaps in partnership with other academic establishments in the east of England. I am not squeamish about what it might look like, but we need to have undergraduates being trained in the east of England and in Norwich, because 40% of UEA medical school graduates become “sticky”—they stay in the area because they fall in love, get married and develop commercial relationships with GP surgeries and the like.

The dental Minister in the last Government came to the UEA in about May for a lecture and a series of meetings. The impression given was that we were on the cusp of an announcement of a dental training school but that the election got in the way. All eastern region Members of Parliament, irrespective of their political colour, are wholly in support of that, and we would be very grateful, as the hon. Member for Norwich South said, if we could have some indication that it is still on track.

There is a huge amount to be done in the east of England and in Norwich in particular. We have great staff and good structures, but we need to get the productivity working and the expectation of early GP appointments back on schedule. One recurrent complaint I get from constituents is about how difficult it is to see a GP. I note that 43% of all GP appointments are now same-day appointments, and that record needs to be built on. I have listed a number of areas on which I would be grateful if the Minister could give an indication of the Government’s thinking, and I look forward to hearing her response.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I will try not to be too evasive, and to be pleasant.

On his latter point, the hon. Member for Runnymede and Weybridge (Dr Spencer) might want to look at some of the speeches I made during the passage of the Health and Care Act 2022; accountability is writ large through them, although we may disagree about the form it takes. The previous Government had an opportunity to resolve some of these issues, and they did not take it. They destroyed accountability and, indeed, the foundations of the health service with the disastrous Lansley Act—the Health and Social Care Act 2012—which propelled me into coming to this place.

It is a pleasure to be here for the first Westminster Hall debate, and I thank my hon. Friend the Member for Norwich South (Clive Lewis) for securing it. I told my officials that it would be busy. Some of the people in this Chamber and some of those who have left are already my most frequent correspondents because of the state of the NHS in the east of England and more broadly. Getting the NHS back on its feet will be an enormous challenge, but we have the skill, motivation and commitment of our NHS staff. This Government will be unwavering in our support for them, and we will do what is needed to get the NHS back on its feet. We have committed to a 10-year plan because that is what it will take. We will deliver an NHS fit for the future. That is what we promised the British people at the election; that is what we were elected to do.

[Jerome Mayhew]

The Minister says she will deliver an NHS plan for the next 10 years. Does that include a full rebuild of the Queen Elizabeth hospital and the James Paget?

[Karin Smyth]

I will come on to those hospitals. As hon. Members will appreciate, we are in the early days of this, so “We will come back to people” may do a bit of lifting—I apologise for that.

We want to be clear and honest with Members of Parliament and the British people. We want to move the health service from treatment to prevention, which hon. Members have raised; from hospital to home, which is very important in the east of England, which has rural issues; and from analogue to digital. As a first step, my right hon. Friend the Secretary of State asked Lord Darzi to give us a raw and frank assessment of the state of the NHS, and these debates and the work that hon. Members are doing will inform that. This autumn, we will also launch an extensive engagement exercise with the public, staff and stakeholders to inform the plan.

I have at least eight questions from my hon. Friend the Member for Norwich South and a number of others. I will do my best to get through them in the next eight minutes, but I will of course respond to people if they want to come back to me on anything I do not pick up.

My hon. Friend talked particularly about prevention, and touched on climate change, dentistry and mental health, which are clearly important to many people. Prevention is a key part of the Government’s health mission and our mission across all Departments. We want to support people to stay healthier for longer. My hon. Friend said that we want the security of good health; the NHS was set up to provide that so that people can lead fulfilling lives. That promotes greater independence and shortens the time people spend in ill health. We have not touched on that much, but that is a critical target for this Government.

The NHS health check aims to prevent heart disease, stroke, diabetes, kidney disease and some cases of dementia among adults between 40 and 74 years of age. Thanks to the hard work of NHS staff, the programme engages more than 1 million people and prevents about 400 heart attacks or strokes, but take-up of the health check is low—hon. Members could perhaps encourage their constituents to take part. We want to improve access to the service and develop a new digital health check that people can use at home. We have now launched the next phase to develop the service, and I am pleased that Norfolk county council has been selected as one of the three pilot sites that are due to start in 2025.

Hon. Members are right that access to dentists is a pressing issue facing patients. We all knew that before the election campaign, and that is why that is a core part of our commitment to the British public. Only 40% of adults have seen an NHS dentist in the past two years. My hon. Friends the Members for Luton North (Sarah Owen) and for Lowestoft (Jess Asato), in particular, highlighted what we all see when we visit primary schools to look at young people’s oral health. Hon. Members have read our manifesto and know what our plans are. To be clear, the Secretary of State and the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), met the British Dental Association immediately on taking office and are meeting it regularly to resolve the issues with the contract. We will provide 700,000 more urgent dental appointments and recruit new dentists to areas that need them most. We will rebuild dentistry for the longer term by reforming the contract.

I cannot go into too much detail on the proposal from the UEA. It is a place close to my heart, as it is where I went, almost exactly 40 years ago, to university. It is where I fell in love and got married, but sadly I had to leave the east of England. That is a fantastic hospital. I know it is supported by the local ICB, and I understand that individual Members are seeking to meet with the Minister for Care. I hope we will be able to update Members on that shortly.

My hon. Friend the Member for Norwich South talked about the dire state of the mental health service and the Norfolk and Suffolk NHS foundation trust. To update Members—although most will know—the trust has been in the recovery support programme since July 2021, after the CQC’s inspection report of “requires improvement”. To address quality and safety, the trust has implemented and completed a range of actions from that inspection report. In July it published the “Learning from Deaths” report, which was commissioned by the chief executive to review every death that occurred from April 2019 to October 2023. To improve the culture, the trust has launched Listening into Action, a trust-wide programme to improve how staff work together and listen to each other. In April, NHS England formally agreed a revised timeline for the trust to exit the recovery support programme at the end of 2024, and transition planning for post-exit has commenced. Obviously, we will be paying attention to that very closely, and I know hon. Members will also do so.

In response to the concerns about hospital buildings, we are all in no doubt about the inheritance that we have received from the last Government, particularly on capital, and about the state of our hospital estate. Each trust with a hospital with RAAC issues has invested significant levels of NHS capital to mitigate any safety risk. The safety of our patients must always come first. It is clear that the last Government’s promise to deliver 40 new hospitals by 2030 was not achievable, and it did not have the funding required to deliver it. That is why we are reviewing the programme to put it on a sustainable footing, which means a realistic timetable for delivery and clarity of funding. We will be honest with the British people and transparent about what we can deliver, and we will update the House and hon. Members on the programme’s next steps as soon as we can.

My hon. Friend the Member for Norwich South touched on climate change. This is a really big issue for the east of England. I will not have time to go into some of the issues but personally, and, as far as this Government are concerned, the impact of climate change on health and the provision of the health service is a serious issue, with surges in demand for services during periods of extreme weather and heat-related disruption to utilities, such as power outages. We are cognisant of those, and I do think it is an important issue for the health service. The NHS is doing well to become on target to reach net zero by 2040, and all trusts have targets. That is something we will watch closely.

I will give some rapid fire responses. We are not going to look at changing structures. We want to work with the system that we have inherited. It has to work, it has to bring people together, and it has to bring services into neighbourhoods. We have talked about the contract as well. We are keen to work together with local services in the ICB structure. We all know in our own areas that geographies are never quite perfect, but we do not want another reorganisation. We think that detracts from what we need to get on with.

The matter of productivity raised by the hon. Member for Broadland and Fakenham (Jerome Mayhew) is an issue—the concern about what we measure and how we measure it, and making sure that every taxpayer’s pound is used well within the NHS. Part of the issue is the breaking of the foundations of the system. Locally, that has meant it is very difficult for the service to deliver. That is why we are looking at this on a 10-year basis. The foundations need fixing.

Let me finish by once again thanking colleagues for bringing their own insights into heath and care in the east of England. Many new Members have come here from all parties. These are important debates, and it is important for Ministers such as myself to hear directly from Members’ constituents. Many of the issues are symptomatic of an NHS that is broken. That is why we are ending the sticking plaster politics. As the Prime Minister said a week ago, that is worth doing. It will be harder, and it takes more time. We are not going to give deadlines that we cannot meet. I hope that after just about two months in this role, I given answers today that show that we understand the scale of the issues that we face, and that this Government are committed to tackling them. If I have missed anything in particular, I will of course, correspond with hon. Members.

Under-age Vaping

Jerome Mayhew Excerpts

Wednesday 12th July 2023 Commons Chamber

[Jerome Mayhew (Broadland) (Con)]

One of the great pleasures of being tail-end Charlie in these debates is that one has the opportunity to sit through and listen to every contribution. The disadvantage is getting nudged to hurry up by those on the Front Bench. So, I have torn up my original speech, Madam Deputy Speaker, and will focus instead on the bits from the contributions of others that you did not have the opportunity to hear yourself.

There have been lots of interesting suggestions on how we can solve this problem, which we all agree needs to be addressed. I am a father of teenage children as well, and I share the concerns of my hon. Friend the Member for Winchester (Steve Brine). I have experience of my own children’s friends using vapes—their friends, I hasten to add.

[Kirsten Oswald]

That’s what they all say!

[Jerome Mayhew]

As the hon. Lady says, that is what they all say. Obviously that is wholly inappropriate, but part of the problem in reaching the correct solution to this shared concern has been demonstrated by the richness of the debate we have had today.

All sorts of suggestions have been made. My non-exhaustive list indicates that some hon. Members said that we should ban flavours. Some of them said that we should ban all flavours; others said that we should ban only flavours that are targeted directly at young palates. There have been suggestions that we should ban disposable vapes, or that we should require bland packaging for vapes, although others suggested that the issue is not so much the packaging as the fact that they should be hidden behind closed doors. There has been a suggestion that we should increase the cost of vapes, but that was controversial—the hon. Member for North Tyneside (Mary Glindon) rightly pointed out that for adults seeking to give up smoking who are on very limited means, the cost of vapes is a very relevant consideration.

[Dr Caroline Johnson]

The cost is indeed important, both in pricing children out of the pocket money market and in ensuring that smokers who are seeking to quit can do so. However, to a smoker who can afford a packet of cigarettes, even if £5 is put on the cost of a disposable vape, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) described, the vape is still cheaper.

[Jerome Mayhew]

I am grateful for that intervention. I do not have skin in the game about whether it is better to have a higher cost or a lower cost, but my hon. Friend’s intervention has highlighted my fundamental point, which is that this is a complex area where we need evidence to base our policy on.

It has been suggested that we should crack down on marketing. Others have suggested that we should increase education in schools, and there is a wider debate about schools policy and the use of loos in schools. There are other concerns, overriding all of these, about what impact our actions in relation to vapes—including single-use vapes—could have on the ability of adults to give up smoking, in order to continue the downward trend of smoking addiction in this country. These are serious and interrelated issues. If this debate were to result in a Division, there is no way that I could support the Labour motion, which focuses solely on banning branding and advertising for the young, because it may not go far enough. It may just focus on one little area, when the richness of the debate on both sides has highlighted how much wider and more complex the issue is.

As such, what we are really talking about is not so much our concerns about vaping, including by children: the main issue is, “How should we make our law?” It is a given on both sides of the Chamber that action should be taken, and the first speech on behalf of the Government, made by the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien) made it clear that the Government have already acted and are intending to go further. In fact, the Secretary of State said at Health questions yesterday that the Government were looking to go further, particularly on single-use disposables. It is not a question of whether we are going to act: the question is, on what basis do we act? For my money, we should act on the evidence and not solely on anecdote, important though that is.

[Kirsten Oswald]

Will the hon. Gentleman give way?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I would gently say that the hon. Lady has made a long contribution, and I do have two other speakers to get in. That is the only problem.

[Jerome Mayhew]

Thank you for that indication, Madam Deputy Speaker.

To wrap up my submissions, I will say that the Government are absolutely right to have put out a call for evidence. That evidence has now been obtained, last month, and the Government should take every second that is needed to assess it and come up with draft proposals, but not a second longer, because this is a very important issue. As a parent, I share the concerns that have been expressed across the House. We need to address this issue—we cannot waste time—but we should do so based on the evidence.

New Hospitals

Jerome Mayhew Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

My hon. Friend is right on both counts—first, that the Royal Berkshire is part of the rolling new hospital programme, and secondly, that there are complexities with that site. As she knows, part of the site is grade I listed, and there have been some specific issues with the existing site on which survey work has been undertaken. That is having an impact on the target date for work. We are funding a mental health crisis facility this year, along with the survey work, and I look forward to having further discussions with her as that progresses.

[Jerome Mayhew (Broadland) (Con)]

This announcement could not be better news for the people of Broadland. In the west of my constituency, they are going to be served by a brand new build at the Queen Elizabeth Hospital in King’s Lynn, and a brand new hospital at the James Paget will be serving constituents at the other end of my constituency, joining the work of the Norfolk and Norwich University Hospital in the centre. Can my right hon. Friend just confirm that the modular nature of the design will still provide the absolutely first-class facilities that the people of Norfolk deserve?

[Steve Barclay]

Today’s announcement is transformative for healthcare in Norfolk, for the reasons my hon. Friend has set out: a new hospital at the James Paget and a new hospital in King’s Lynn. Of course, there will be further work from Government on the diagnostic centres and surgical hubs, about which there will be further discussion. In terms of the quality of the modular design, we are bringing the country’s leading experts together, as well as engaging with the market to finalise those designs so that we can have the best inputs as we standardise the design, and then roll that out as the template for schemes at King’s Lynn and James Paget. The quality of the scheme should be of a very high order.

Dental Services: East of England

Jerome Mayhew Excerpts

Tuesday 16th May 2023 Westminster Hall

[Jerome Mayhew (Broadland) (Con)]

One of the unifying features of the speeches today is that we have heard them all before. Not only have we all heard it before, but we have all said it before, so I will try—I may fail—not to do that. However, I do have to highlight some elements of the problem, which has been ably covered by my hon. Friend the Member for Waveney (Peter Aldous).

Access to NHS dentistry in Norfolk, which is the worst in the east of England, was surveyed in 2020 to 2021, and of the 150 sub-regions of the country, Norfolk came 147th. As I said to the Minister in a previous speech, we have to follow the money. As my hon. Friend the Member for Waveney pointed out, the best areas spend nearly £80 per mouth per year on dentistry; in the east of England, the figure is £39—a full 50% less. Does the Minister have an explanation for that? I genuinely struggle to understand how spending on NHS dentistry in the east of England is so far below that in the rest of the country. It seems to be without explanation.

More locally still, in Broadland the lack of dentists of any description is profound. I was lucky enough to persuade the Department to advertise a new contract for NHS dentistry in Fakenham last year. The money was available and the contract was advertised; not a single organisation applied for the contract, and it is still vacant. In Sheringham, in the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker), who is unable to speak in this debate, there is a dental practice that is owned by an organisation that has an equivalent practice in London. The organisation has been advertising consistently for a new private dentist in Sheringham for 10 years, and it has yet to fill the role, whereas during the same time multiple positions in its London practice have been advertised and filled. It is therefore not just a regional issue; geography really matters.

I am sorry to say that just last week the latest in long and ignoble line of announcements came when Brundall Dental Practice, which is an NHS practice, contacted patients to say that it would no longer be accepting adult NHS patients from 1 September this year. People are being asked to move on to monthly subscriptions for dental care, which are between £150 and £400 a year. I struggle to know what to say to the many constituents who have contacted me, because not a single NHS practice in the county of Norfolk is currently accepting new patients under an NHS contract. The £11 a month is only for check-ups and hygienists; it is not for dental care, which is an extra charge.

People might say that many can afford to pay for dentistry if they have to, but we have to also consider those who are excluded from paying dental charges because of their financial circumstances. What are we asking of those constituents? Where are they to turn not a single provider in the county of Norfolk is accepting NHS dentistry? The answer, of course, is that they will go to the Norfolk and Norwich University Hospital when their dental problems become acute, and we merely transfer the problem from the dentistry budget to the NHS and acute budget. The problem will be so much worse, and so much harder and more expensive to treat, because we are not nipping things in the bud but dealing with acute emergencies. That cannot be the right answer.

The reason I do not want to prolong the agony of discussing the problem is that I know that the Minister gets it. If he was not educated before, he has certainly been educated on numerous occasions, either here or in the main Chamber, by many of the Members present—the problem has already been fed back. Government Members have great confidence in the Minister and in his grip, grasp and focus on the issue. We know that a dentistry plan is imminent—the sooner that it is published, the better, and more power to the Minister’s elbow—but there are a number of suggestions I hope will find their way into the plan.

In the short term, we need additional improvements to the current dentistry contract—other Members have spoken eloquently about that, and I would highlight it as being very important. As regards the medium term, we have had reference to centres for dental development. The University of Suffolk has progressed far in its application, and there is a necessity for a similar venture at the University of East Anglia, or at least similar work in Norwich. However, in the long term, we simply have to train more dentists. We have to open the market to allow people to access a lucrative and fulfilling career that is currently not being explored in the east of Anglia and in Norfolk, in particular.

We need to train people in the east of England. The University of East Anglia has put forward proposals for a dental school. The medical school it founded in Norwich about 10 years ago knows definitively, from surveying all its graduates each year, that about 40% go on to take their first job locally. The single act of setting up a dental school in Norwich, linked to the Quadram Institute and the research work at the Norwich Research Park on the human microbiome, is the long-term solution.

I hope the medical plan will look beyond the national numbers. I was told by the NHS that roughly the right number of dentists are being trained each year, but I dispute that. It has been seven years since it surveyed what those dentists are up to. It has no idea whether the dentists notionally on its books have retired, gone abroad, are working in the NHS, are working part-time in the NHS, are working privately, or none of the above.

[Andrew Selous]

My hon. Friend is making a powerful point about the link between where people train and where they work. I would gently make the point to the Minister that the east of England is quite a large area. Norfolk and Suffolk are deeply wonderful places, with which I have a great affiliation, but they are quite a long way from Bedfordshire, which is also in the east of England. If we were to think that it was job done because we had trained dentists in Norwich or wherever, I would want to know what that meant for the good people of Leighton Buzzard, Dunstable, Houghton Regis and the surrounding villages. I put that marker in the Minister’s mind.

--- Later in debate ---

[Jerome Mayhew]

That is fair enough. However, if someone grows up in the east of England, whether in Norfolk, Suffolk or even Bedfordshire, there are only two places where they can train: Birmingham and London. There is no other place in the entire east of England where they can train, so is it surprising that we have a dearth of dentists? Is it surprising, particularly in rural areas, that we do not attract dentists who are newly qualified and therefore likely to be in their early to mid-20s? Do they wish to relocate in large numbers at that stage to a rural location? Many do not, so we need to bring the beauties of East Anglia, including Bedfordshire, to trainees so that we can benefit from the stickiness of tertiary education and location.

Finally, my hon. Friend the Member for Waveney raised the issue of fluoridation, which I wish to develop. There is no fluoridation in Norfolk at the moment, and perhaps it shows. The data suggests that the level of decay across the teeth of Norfolk is not universal but is substantially located towards west Norfolk and King’s Lynn. All sorts of factors may account for that, but areas of higher dental decay correlate with those that have reduced natural levels of fluoridation in the water, with the lowest levels around King’s Lynn. I raise that as an issue that I hope the plan will address.

[Matt Warman (Boston and Skegness) (Con)]

I congratulate my hon. Friend the Member for South Norfolk (Mr Bacon) on securing the debate. Although my constituents use the facilities of the east of England, I welcome his hospitality in the debate as well. This is a shared issue, especially for many in the southern part of my constituency.

I wanted to speak today because, as we have heard from many other hon. Members, this is not just a top issue, but the top issue, in the postbag and particularly on social media. We all feel the immense frustration of our constituents on this important issue. In Lincolnshire, nearly a quarter of five-year-olds are suspected to have tooth decay. Last year, a dozen Boston children had teeth removed. The problems we have heard about in the east of England are present in my part of the world too, and the burden of that partly falls on the services provided in the east of England, which is why it is relevant for me to speak today. These are real problems.

I asked my office to do what I called a secret shopping exercise because, like my hon. Friend the Member for South West Bedfordshire (Andrew Selous), I did not trust the data NHS England had provided. On that secret shopping exercise, we see that just a single NHS practice is offering access to new patients and, even then, only to children. There are huge problems with local provision. When I spoke to the ICB, which has recently taken on the responsibility, it said that there are particularly acute issues in coastal and rural areas and, as we have heard, that there are no silver bullets. However, it raised a few issues, which I will use to augment previous speakers’ excellent contributions.

First, there is the enormous backlog in the General Dental Council exams. I gather that 1,700 people are seeking to take the part 1 exam and that the GDC website does not even say when it plans to put another one on. When it does, it is likely to put just 150 people through it. I know that the GDC is an independent body, but will the Minister do all he can—I know he is already doing so—to encourage the GDC to pull its finger out?

Secondly, on the issue of having a dental school in the east of England, there is a medical school in Lincoln; if it were to train dentists, that would benefit the broader area. As we have heard, there is a clear need for many more dentists to be trained across the country, so perhaps we could do something for East Anglia and see benefits for the whole region from having Lincoln-trained dentists.

Thirdly, the issue of fluoridation affects my constituents as well. I do not think anyone, except those on the outer edges of the internet, could possibly argue against fluoridation, and we should encourage it as quickly as possible. On the outer edges of the internet, I give way to my hon. Friend the Member for Broadland (Jerome Mayhew).

[Jerome Mayhew]

I try not to inhabit that area. Does my hon. Friend not think that it is surprising that only 10% of the country’s drinking water is fluoridated?

[Matt Warman]

It is a surprising number. As I am sure my hon. Friend knows, the water companies have raised issues that are legitimate to some extent, but the overall public good from increasing that number is obvious and would pay real dividends relatively quickly. It would be public money well spent.

Reforms to NHS Dentistry

Jerome Mayhew Excerpts

Thursday 27th April 2023 Commons Chamber

[Jerome Mayhew (Broadland) (Con)]

We have had a full debate today. This is the third Backbench Business debate on the subject, but not the third debate on dentistry; I have had an Adjournment debate on dentistry, for example. The subject is well rehearsed. The reason why so many people are keen to speak today is that the issue affects areas right across the country. We all know that there is a problem with NHS dentistry, that the Government are focusing on it, and that they are coming up with a dental plan. We anxiously look forward to its publication in the next two to three months. In the few minutes available to me, I will not focus on the national problem so much as recognise that within the national difficulties, there are regional crises. In rural areas such as North Devon, but also in the east of England and Norfolk in particular, we can see that what is already a challenging picture nationally is exacerbated. To identify the issue, we have only to follow the money. I will look at funding for the east of England, then I will talk about recruitment and retention.

I know that funding has been impacted by covid, and the ability to undertake units of dental activity was restricted because of the covid pandemic and the aerosol activity of much of dentistry. I also know that funding has subsequently been increased because of the catch-up bid, so the numbers for the year 2018-19 give a more accurate reflection of the level of investment by the Government in dentistry in the region. The national average gross spending per mouth in England was £66 in that period. The best performing region was the midlands, which received £78 of expenditure per mouth. The figure for the east of England was £39 per mouth. That is exactly half the amount of money spent on dentistry per head of the population in the midlands. Now, there are many unconfirmed rumours about the number of fingers and toes that we have in Norfolk, but we do not have half as many teeth as those in the midlands—not yet, anyway.

My request to the Minister is to follow the numbers, to look at where the expenditure has been taking place and, more importantly, to look at the places where the expenditure has not taken place, and then to ask the question of his officials, “Why is that?” Why is it that even though in many parts of the east of England we have the worst dental health, the expenditure by the Government is fully half what it is in the midlands, and £20 less than the national average per person?

Looking to recruitment and retention, a potential answer to my first question is that there are physically not enough dentists in the east of England to carry out the work. The national average number of dentists per 100,000 of the population is 43. In the east of England, we have just 39. That compares to Devon, where there is a dental training school, which has 49. Why is it that people do not want to be dentists in Norfolk? The answer is because it is rural, and for those who grow up there, the nearest place they can train is Birmingham.

People cannot train to be a dental technician or a dentist anywhere in the east of England. It is the only region of the country, other than the south-east, which is next door to London, that has no dental school at all. People can go either to London or Birmingham. Is it surprising, then, that we do not have an indigenous population of would-be dentists growing up, training to be dentists in Norfolk and then staying there for their working life? We are reliant entirely on people relocating to the east, and to Norfolk in particular, to supply our dental needs.

When people qualify as a dentist in their mid-20s, the overwhelming majority do not wish to move to a rural location. Even though it is without question the best place in the country in which to live, to grow up, to learn and to bring up a family, it is not immediately attractive. A policy that relies on importing foreign-qualified dentists does not satisfy the need in rural locations either, because overwhelmingly the data tells us that when we import, say, South African or Australian dentists, they relocate to the cities. They set up their new life where there are already expat communities. They do not move to Fakenham, and the problem is very real in Fakenham. I persuaded the NHS to write a wholly new NHS dental contract for Fakenham. That contract went out, and not a single organisation bid for it. The money is there, but there is physically no supply of NHS dentists.

The issue goes further than that, because the lack of dentistry spreads out into the private sector as well. There are many examples right across the county of where private dental practices, whether in my constituency or in those of my hon. Friends the Members for North Norfolk (Duncan Baker) and for North West Norfolk (James Wild), have been advertising for years—in one case I am familiar with, for a decade—and are yet to fill the place. While the short-term answer to the national issue may well be to improve access to international dentists, the medium and longer-term solution for the east of England, and Norfolk in particular, surely is to establish dental training in the county. There are two ways to do that.

There are two ways to do that. In the short term—the very short term, I hope—there is a bid by the University of East Anglia to create a centre for dental development: a postgraduate training establishment that would help to draw in newly qualified dentists from other parts of the country. The hope is that if they do their postgraduate training in the east, a percentage of them will remain. There is also what I hope is not a competing but a complementary application from the University of Suffolk in Ipswich. Those bids should not be in competition; they should be working together to improve access in both Suffolk and Norfolk.

However, the real solution in the medium term is to unite with the University of East Anglia and its existing medical school to create a dental school at UEA, which already has the Quadram Institute—the world’s leading centre for the study of the gut biome, which of course begins with the mouth. The Norfolk and Norwich University Hospital is right next door. We would then have the ability to bring people in and train them in the city of Norwich; as evidence from the medical school demonstrates, a percentage of them would remain thereafter to develop their careers.

The hybrid nature of the UEA bid would mean that even in the first year of the five-year training period, people would be spending at least a day a week working in practices, helping work through the dentistry backlog, and developing community relationships that will make them more sticky to the region once they qualify. All that will go towards the long-term solution to the dental desert in Norfolk.

I very much look forward to the publication of the dental plan in the next few months, but it would be the most monumental wasted opportunity if that plan did not include training for dentistry in Norfolk.

[Mr Deputy Speaker (Mr Nigel Evans)]

Last but not least from the Back Benches, I call Robbie Moore.

NHS Industrial Action: Government Preparations

Jerome Mayhew Excerpts

Monday 12th December 2022 Commons Chamber

[Will Quince]

The hon. Lady talks about NHS staffing levels; we have 1.2 million staff within our NHS, and compared with last year, we have 3,700 more doctors and 9,100 more nurses, and compared with 2019, we have 29,000 more nurses and 2,200 more GPs, but we do have high vacancies. That is why it will not have escaped her notice that we have commissioned NHS England to publish a long-term workforce plan, and that will be independently verified as set out by the Chancellor in the autumn statement.

[Jerome Mayhew (Broadland) (Con)]

Inflation is the real enemy here, because it makes us all poorer. We have a political and economic choice: we either tackle it, or we give in to an inflation pay spiral. The Minister was right to mention that the Royal College of Nursing pay demands are in excess of three times greater than the average private sector payment at the moment. Does my hon. Friend agree that public sector pay demands of almost 20% would embed inflation for years to come and make us all poorer?