NHS Dentistry: Recovery and Reform

Judith Cummins Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

I thank my hon. Friend and recognise the enormous expertise he brings to the Chamber on this matter. He knows—he has genuinely talked to me about this on many occasions—the important role that the General Dental Council plays to ensure that we get international dentists registered as quickly as possible. I very much look forward to discussing that with the GDC so that we can get more international dentists on to our register and working in our practices.

[Judith Cummins (Bradford South) (Lab)]

I welcome much in the plan, which mirrors many of my ideas over the years, and indeed much in Labour’s plan. However, on access, the Government claim that the recovery plan will deliver care for up to 2.5 million people, but Government data shows that 12 million people in England have unmet dentistry needs, which leaves about 9.5 million people without an NHS dentist. That includes my constituent Beverley Kitson, who has osteoporosis and takes alendronic acid as treatment. The drug has damaged her teeth, and she now requires a check-up every three months after four of her teeth have decayed to such an extent that they need to be extracted. Beverley has been with the same dental practice for 50 years, but she has just been told that it is going fully private, leaving her without an NHS dentist. Will the Secretary of State guarantee Beverley that she will be able to access an NHS dentist under these plans?

[Victoria Atkins]

We have very much tried to ensure that dentists who already hold NHS contracts will keep them and keep working them. That is why we have fallen upon the new patient premium to make it more in their financial interests to take on new patients. I appreciate the hon. Lady’s point about retention, which, again, we are looking to address through the increase in the UDA. But we all acknowledge that dentists are independent contractors, so we must ask them—and particularly those who are new dental graduates—to do their bit and help our NHS out.

NHS Dentistry

Judith Cummins Excerpts

Tuesday 9th January 2024 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

The Nuffield Trust recently announced that without radical action universal NHS dentistry was “gone for good”. Some 90% of practices across the UK no longer accept new NHS patients. For 14 years this Conservative Government have brought about the decay of our vital NHS dental healthcare services, so now is the time for a clear strategy, a recommitment to the future of a universal NHS dental service, and a Government who are determined to provide the care that people across this country, and their children, deserve.

The crisis of NHS dentistry has been entirely predictable. In fact, I have been at the forefront of these predictions over many years. Just last year, in a debate that I led in this place, I described the path of NHS dentistry as a “slow-motion car crash”. In 2016, I warned of a mounting crisis and drew the Government’s attention to a report warning that half of dentists were thinking of leaving the NHS. In the following years, I again warned that the number of dentists intending to leave the NHS was rising even further and, in 2020, after years of repeated warnings, I once again informed the Government that of those remaining, some 58% of the UK’s dentists were planning to move away from NHS dentistry within five years.

Last year, the then Minister assured the House that he was planning to publish a plan to reform dentistry, but the limited reforms proposed in July did little but paper over the growing cracks. More than 1,000 dentists have left the NHS since the pandemic, and the number of treatments completed each year is now 6 million lower than it was before the pandemic. Even before the pandemic, access was poor, with only enough dentistry commissioned for around half the population in England. As it stands, the future is bleak. A BDA survey shows that 75% of dentists are thinking of reducing their NHS commitments this year.

In Bradford, a shocking 445 people had to be treated in hospital for dental-related issues between 2022 and 2023. This cannot be the future of NHS dentistry: extractions and emergency care, but only for those who cannot afford private dental care. One dentist in my constituency said:

“I've been saying it for years: the NHS dental contract needs fundamental reform. Without immediate action, there will be no Universal NHS Dentistry.”

But NHS dentistry is not yet “gone for good”. That claim would leave swathes of people in this country destined for a future of rotting teeth and poor dental health. We cannot stand by and let the principle of NHS dentistry in this country be eroded. The decline is not irreversible or inevitable—it is a political choice.

I know that targeted investment is possible. In 2017, I worked on a project in Bradford with the then Health Minister, the hon. Member for Winchester (Steve Brine), who is now Chair of the Health and Social Care Committee. The project invested £250,000 of unused contract clawback in my Bradford South constituency, and ensured that patients were able to access roughly 3,000 new NHS dental appointments in an area of proven high dental deprivation. Although that provided a short-term solution, it did not address the wider long-term issue of access to NHS dental care. We can still save NHS dentistry, but we need a Government who are committed to reform and to the NHS.

It right that the Labour party puts NHS dentistry front and centre alongside plans to build an NHS fit for the future. Labour has committed to provide an extra 700,000 urgent dental appointments and to real reform of the NHS dental contract. As the Leader of the Opposition, my right hon. and learned Friend the Member for Holborn and St Pancras (Keir Starmer), has made clear on many occasions, healthcare must be as much about prevention as it is about cure.

In 2021-2022, tooth decay was, shamefully, the most common reason for hospital admission for children between six and 10 years old. This country once had a strong school dental service, and with such shocking rates of child tooth decay, it is time to look again at that policy, and at the role of dental therapists in the NHS. It is the right thing to do to catch up on a generation of lost dental health. NHS dentistry is not “gone for good”, but it stands on the edge of a new era. There is one clear solution: the Government must recommit to a universal NHS dental service that will care for every person, from the cradle to the grave.

Osteoporosis

Judith Cummins Excerpts

Thursday 26th October 2023 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

I am grateful for the opportunity to raise once again the importance of osteoporosis provisions and support. As many hon. Members know, I have campaigned on this issue for many years. Today’s debate is an important opportunity to highlight the deficiencies in support for a health condition that affects so many women and a large number of men in this country.

Historically, osteoporosis has been a condition shrouded in mystery. I have chaired the all-party parliamentary group on osteoporosis and bone health for some time now, along with Lord Black of Brentwood. Today’s debate coincides with our very first national media campaign on osteoporosis, co-ordinated by the APPG and the Royal Osteoporosis Society—the Better Bones campaign. I encourage all hon. Members to give their support to this important campaign.

Support for the Better Bones campaign has been staggering. It shows the public, professional and political demand for change, because nearly 250 parliamentarians, 44 charities, seven royal medical colleges, business leaders and trade unions are collectively calling on the Government to end the postcode lottery on access to crucial osteoporosis services in this country.

[Anna Firth (Southend West) (Con)]

The hon. Lady is making a critical speech on osteoporosis treatment and support, and on absolutely the right day as well, when her campaign goes national. Is she aware that one in three people over the age of 50 who break a hip die of that injury or related complications within a year? That is a terrifying statistic. A large proportion of those fractures are osteoporotic, so does she agree that prevention and screening are key? There is groundbreaking work going on in Southend. The fracture clinic at Southend Hospital, which I had the pleasure of visiting a couple of weeks ago, is to launch a new fracture liaison service next spring, with the support of Mid and South Essex Integrated Care Board. It will be the first FLS screening service in the UK to offer consistent screening support across a whole region.

[Mr Deputy Speaker (Sir Roger Gale)]

Order. If the hon. Lady wishes to make a speech, I think there may be time, but she is making an intervention.

[Judith Cummins]

The hon. Lady raises some important points. I agree that screening and prevention are key to tackling osteoporosis, and I congratulate her and Southend on getting their FLS up and running. It will make a real difference to the lives of people in Southend.

[Peter Dowd (Bootle) (Lab)]

My hon. Friend is doing a fantastic job in this policy area. Given only half of NHS trusts have a fracture liaison service, does she agree that it is vital that that 50% figure grows week in, week out, to ensure that everyone gets get that service?

[Judith Cummins]

My hon. Friend makes a valuable intervention. He has been a staunch advocate for those suffering from osteoporosis and has backed the Better Bones campaign, for which I am very grateful. I agree that this issue is all about ensuring equity in access to NHS services, including FLS.

[Wera Hobhouse (Bath) (LD)]

I am lucky enough to represent a constituency with a fracture liaison service, which can identify 91% of fragility fractures, but other constituencies are not so lucky. Does the hon. Lady agree that a modest transformation fund would make such a big difference?

[Judith Cummins]

I welcome that intervention and I absolutely agree. The whole tone of the campaign and my speech will address those very issues, because it is so important that we recognise that prevention is key to tackling osteoporosis. We cannot prevent the condition unless we ensure first that people are diagnosed. Osteoporosis receives too little attention, given the scale of numbers affected by the condition: half of all women and one in five men over 50.

[Eddie Hughes (Walsall North) (Con)]

The hon. Lady makes a point about statistics and the distribution of those who are affected. Just last weekend, I was grateful to attend a training workshop at Sacred Heart church provided by a guy called Sherwin Criseno, who explained to men and women over 50 the impact of this dreadful condition. Does she think it is really important that men are better informed about the impact of the condition, so they prepare accordingly and perhaps change their lifestyle?

[Judith Cummins]

I thank the hon. Gentleman for that important intervention. The condition predominantly affects women, but it does affect men as well. Small changes to lifestyle, as well as detection and prevention, are very, very important.

Osteoporosis often develops during menopause, when a decrease in oestrogen can lead to a 20% reduction in bone density. A loss of bone density affects people of all sexes as they age, but women lose more bone density more rapidly than men.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for securing the debate. I referred to this point earlier in the debate on menopause, but my staff and I deal every day of the week with benefit issues relating to osteoporosis. It is clear that the understanding and capacity that maybe should be there in the health sector is not there. Mindful that the Minister is not responsible for the Department for Work and Pensions, does she think that within the Department there should be a better understanding when assessing those with osteoporosis to ensure they can gain the benefits in the system that the Government have set aside and have a better quality of life?

[Judith Cummins]

I thank the hon. Gentleman for that important intervention. Osteoporosis suffers from some mystery, and any light that we shine on the condition is welcome. It is entirely possible for someone with osteoporosis to work and have a very full life, given detection and treatment.

Fracture liaison services are integral to that. They are essential because throughout our lives our bones continuously renew themselves in a process called bone turnover. With osteoporosis, bone turnover becomes out of balance. Bones lose strength and become more fragile, bringing an increased risk of fractured bones time and time again. The FLS can identify osteoporosis at the first fracture through methods including DEXA scanning, and offer treatment that can reduce the risk of further fractures. The FLS also systematically monitors patients after an osteoporosis diagnosis to ensure they get the best out of their treatment plan. With the FLS, patients who would otherwise face a fracture or multiple fractures can continue to lead healthy and fulfilling lives.

With osteoporosis designated as the fourth most consequential health condition when measured in terms of disability and premature death, we have to question the Government’s current record on assessment, treatment and prevention. There is a postcode lottery for access to these vital life enhancing and lifesaving services, with only 57% of the eligible population in England currently having access to the FLS. What we desperately need is a central mandate requiring integrated care boards to invest in established FLS for everyone.

Let me stress not only the moral imperative of acting on this issue, but the clear financial argument for establishing 100% FLS coverage in England. One million acute hospital bed days in England alone are taken up by hip fracture patients. Research shows that FLSs reduce the refracture risk by up to 40%. Applying that to the national picture, we find that a staggering 750,000 bed days would be freed up over five years, saving the NHS £665 million. This would have a significant and positive impact on the social care system. For every pound invested in FLS, the return is more than threefold. With the NHS in crisis, the Government must be bold and recognise the value of services such as FLS.

The future of the NHS lies in prevention, but this argument extends beyond the NHS. Every year, 670,000 people of working age suffer from fractures due to osteoporosis, and a third of those will leave the workplace permanently owing to the impact of chronic pain. We also know that every year 2.1 million sick days are taken in England as a result of disabilities caused by fractures. Any Government would surely understand how consequential this is for our economy. A new analysis provided for the Treasury shows that universal access to FLS can prevent up to 750,000 sick days every year, and that is why trade unions, the TUC, the Federation of Small Businesses and other business groups have joined the campaign to extend FLS access to everyone aged over 50.

It is clear that the Chancellor cannot succeed in addressing labour shortages without taking decisive action on FLS. To provide this vital support—to provide 100% FLS coverage in the UK—would cost an estimated £27 million per annum, which is less than 2% of the UK’s current expenditure on hip fractures. Preventive osteoporosis treatment not only presents a sound financial case for the NHS, but presents a strong business case by ensuring that so many women can continue to work. Improved osteoporosis treatment does not just mean that people can work for longer; it means—perhaps much more important—that those living with osteoporosis can enjoy a higher quality of life beyond their work.

It is time to do away with the stigma because, with people in the UK living to an older age than ever before, 50 has become the new 40. Osteoporosis is no longer an old person’s condition. We have allowed it to become accepted as a natural part of ageing, but it does not have to be. In this country, we have a choice: to diagnose and treat it, or to simply continue to ignore it. This is an opportunity to address old prejudices. Osteoporosis is one of many conditions, mostly experienced by women, that have historically been swept under the carpet. In the 19th century, during the period of its earliest identification, studies crudely described the condition in terms of women tripping over “their long skirts”. Even today, people refer to osteoporosis in crude and demeaning terms such as “a dowager’s hump”. Raising awareness of this long-overlooked condition is essential, and I am grateful for the opportunity provided by today’s debate to further demystify osteoporosis as a health issue which affects so many people across this country.

After centuries of inattention in the world of medicine, we now have revolutionary new technologies and systems such as DEXA scanning and FLS. These services have the potential to transform the lives of so many women throughout the country—women who have so much to offer, who should not be left undiagnosed, but whose quality of life is left literally to crumble along with their bones; women who are left to suffer in pain when treatment can and should be made available. The decision to provide full FLS coverage is not only fiscally responsible and right, but it would be an historical leap forward in terms of women’s healthcare. Today, two thirds of those who need anti-osteoporosis medication are left untreated. That is roughly 90,000 people, every year, missing out on necessary treatment due to Government inaction. This is life-changing medicine. As many people die from osteoporosis-related issues as die from lung cancer or diabetes, so FLS and fracture prevention need to be part of the mandated NHS core contract. We must establish new guidelines to support the establishment of FLS across England.

In August, the Minister publicly stated that the Government would make an announcement on establishing more fracture liaison services by the end of this year. In September, the Minister in the other place said that the autumn statement would include

“a package of prioritised measures to expand the provision of fracture liaison services and improve their current quality.”—[Official Report, House of Lords, 14 September 2023; Vol. 832, c. GC241.]

I understand that, since then, there has been a walking back of this commitment. On behalf of the 90,000 people missing out on life-saving, life-changing medication, I yet again ask the Government to hold their nerve and act quickly.

Now is the time for this Government to turn their back on outdated attitudes towards osteoporosis, now is the time to protect women whose quality of life would otherwise be left to crumble along with their bones, and now is the time to commit to 100% FLS coverage across England. By ensuring that every person in the UK has access to fracture liaison services, we have the power to make this vision of life-saving early intervention and prevention a reality.

Oral Answers to Questions

Judith Cummins Excerpts

Tuesday 17th October 2023 Commons Chamber

[Mr Speaker]

I call Judith Cummins with the final question.

[Judith Cummins (Bradford South) (Lab)]

Having 100% fracture liaison services coverage in England would prevent an estimated 74,000 fractures, including 31,000 hip fractures, over five years. Will the Minister finally commit to 100% FLS coverage across England?

[Steve Barclay]

In the interests of brevity, I will actively look at that issue and write to the hon. Lady about it.

Community Pharmacies

Judith Cummins Excerpts

Thursday 14th September 2023 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Mark.

I congratulate the hon. Member for Waveney (Peter Aldous) on securing this important and timely debate. I say “timely”, because only last week I delivered a petition to Parliament on this very subject, with the support of hundreds of people in my constituency. I know the strength of feeling across Bradford South on this issue, and about the value people place on community pharmacies.

I speak in defence of funding for our community pharmacies’ core services, which have been cut in real terms in recent years. Furthermore, I reiterate the point made by my right hon. Friend the Member for Knowsley (Sir George Howarth) that our remarks cover many of the same areas, because they are so important to our constituents.

Community pharmacies are essential pillars of our national health service. The Government’s independent review described the open secret that community pharmacies are an “under-utilised resource”. As many of my constituents have put it to me, they are far more than just a place to get medicines; they are part of the very fabric of our local community. They are valued. Community pharmacies offer vital, immediate face-to-face services, often supplementing GP services, though without some of the vital resources that they need and deserve. When this country faced the covid pandemic, community pharmacies were there for us all. They stepped up bravely, maintained access to vital medicines, provided healthcare advice and delivered a record number of vaccinations. Now is the time to both thank them and show them that we value our community pharmacies, and not to abandon them to what one of my local chemists described to me as “funding starvation”.

After 13 years of under-investment, the NHS is at breaking point, and pharmacies are suffering from lack of funding. More than 700 pharmacies closed permanently between 2015 and 2022, and over 40% of these closures took place in the 20% most deprived areas of the country—cuts, yet again, where services are most acutely needed. In the words of one of my Bradford South chemists, James Currie, this

“is yet another clear demonstration by this Government of their detachment from the realities and needs of the communities we serve.”

Pressures on pharmacies have been worsened by a workforce crisis, with an estimated shortfall of 3,000 community pharmacists in England. I will be grateful if the Minister clarifies how the additional roles reimbursement scheme will be “carefully managed” to ensure that we are able to recruit, train and, importantly, retain the pharmacists we so desperately need. We know that pharmacy funding was cut by 30% in real terms between 2015 and the beginning of this year. More and more work is now being piled on our community pharmacies, without adequate additional resources—a familiar pattern for our public services in the UK today. That has created a serious funding black hole, with an annual shortfall in England of an estimated £67,000 per pharmacy.

The pattern of reckless under-investment is simply not sustainable, so it was welcome news that NHS England’s delivery plan for recovering access to primary care said that further funds will be devoted to community pharmacies to expand their services. The new Pharmacy First common conditions service is a strong step towards easing pressures on GP services, but pharmacies are already overstretched and support for their delivery of core services is still inadequate. I ask the Minister to clarify the extent to which the additional investment will be earmarked for addressing existing pressures on core services.

In preparing for the debate, I found it useful to look back at the Government’s independent review of community pharmacies, published seven years ago. In the report, it was made clear that community pharmacies would be urgently required to help deal with

“immediate financial and operational pressures”

in the wider health service. Seven years later, however, the NHS is still struggling to deal with an historic backlog. I am sure that all right hon. and hon. Members present will recognise that community pharmacies are part of the wider solution to this very serious problem.

It is high time that we broke the cycle of crisis after crisis, followed by rushed solutions. Fair funding for community pharmacies will not only help support the local communities they serve, but strengthen the wider national health service and enable a vital and much-needed “prevention first” approach.

Oral Answers to Questions

Judith Cummins Excerpts

Tuesday 6th June 2023 Commons Chamber

[Steve Barclay]

We are making significant progress. The hon. Gentleman specifically mentions GP referrals, and there were more than 11,000 urgent GP referrals for suspected cancer per working day in March 2023, compared with just under 9,500 in March 2019, so we are seeing more patients.

Let me give an indication of how we are innovating on cancer. We have doubled the number of community lung trucks, which means the detection of lung cancer at stages 1 and 2 is up by a third in areas with the highest smoking rates. In the most deprived areas, we are detecting cancer much sooner, and survival rates are, in turn, showing a marked improvement.

[Judith Cummins (Bradford South) (Lab)]

6. What steps he is taking to improve healthcare for women.

[Sarah Owen (Luton North) (Lab)]

14. What steps he is taking to improve healthcare for women.

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

This is the first Government to produce a women’s health strategy in England. We are making huge progress on the eight priorities in our first year, from introducing the hormone replacement therapy pre-payment certificate, which is reducing the cost of HRT for women, to the £25 million roll-out of women’s health hubs across the country. We will be announcing our second-year priorities in due course.

[Judith Cummins]

Half of all women over 50 will experience bone fractures due to osteoporosis, and many of these will be serious hip fractures. As many women will die from these fractures as from lung cancer or diabetes. Can the Minister explain why not even one of the 63 key performance indicators set by NHS England for integrated care boards sets a target for fracture prevention?

[Maria Caulfield]

I thank the hon. Lady for her work in this space. She is campaigning hard on this issue. I reassure her that osteoporosis is in the women’s health strategy and is a priority area for us. We are already working to make sure that women’s vitamin D status is known, and to make sure that we fill gaps. NHS England is expanding fracture services for high-risk women with osteoporosis, and it is working to prevent falls. The women’s health ambassador is raising the profile of osteoporosis so that women who are at higher risk can take action to prevent fractures and falls in the first place.

Reforms to NHS Dentistry

Judith Cummins Excerpts

Thursday 27th April 2023 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

I beg to move,

That this House has considered progress on reforms to NHS dentistry.

I thank the Backbench Business Committee for once again granting this important debate, and my co-sponsor, the hon. Member for Waveney (Peter Aldous), for all his work in helping to secure it.

When preparing for the debate, I thought it was useful to consider and reflect on the foundations of our NHS in the Beveridge report, which was published 80 years ago last November. Although it would be an understatement to say that the world has changed since its publication, the identity of this country is still proudly centred around our national health service—an idea so powerfully contained in the pages of the report. For the great British social reformers of the 20th century, dentistry was not some Cinderella service of secondary importance. Beveridge concluded that no one could seriously doubt that a free dental service should become as universal as a free medical service. Eighty years after the report’s publication, it is time that the House reaffirmed our commitment to universal dental care in this country.

It is worth noting that the Beveridge report, in its proposition for universal access to NHS dentistry, was published by a multi-party coalition Government. As I stand here today, Members on both sides of the Chamber will agree that the crisis in NHS dentistry deserves the same cross-party attention that it was afforded 80 years ago, because the system has decayed: access has fallen to an historic low, and inaction over the past 13 years has caused untold damage. There can be no more half measures or excuses. Now is the time to establish a new preventive dental contract that is fit for the 21st century.

The words of my campaigning over the past eight years now serve as a compendium of forecasting doom. In 2016, I warned of a mounting crisis and drew the Government’s attention to a digital report warning that half of dentists were thinking of leaving the profession. Between 2017 and 2019, I warned that 60% of dentists were planning to leave NHS dentistry. In 2020, after years of repeated warnings, I once again informed the Government that 58% of the UK’s remaining dentists were planning on moving away from NHS dentistry within five years. The Government once again fudged and ignored, and more than 1,000 dentists left the NHS.

This NHS dental crisis has been a devastating slow-motion car crash of the Government’s own making, yet year after year, Minister after Minister, they have assured me of their commitment to reform. Last year, when I pressed the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), for action on this matter, she informed me that she had started work on a dental contract reform. However, just yesterday, we became aware that after 13 years in power, the Government are once again starting with an announcement of a plan to publish a new plan to improve access to NHS dentistry—a plan for a plan.

We would all welcome further clarification on what that plan might involve. I can only hope that sustained campaigning on this issue by me and other Members will mean that the plan will result in positive change for my Bradford South constituents.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

I congratulate my hon. Friend on securing this excellent and incredibly important debate. In Newcastle, where NHS dentistry access has become almost impossible for so many of my constituents, a whole generation of young people and children are growing up without access to an NHS dentist. Does she agree that that is causing immense suffering now and storing up not only pain and suffering but additional costs for the future?

[Judith Cummins]

My hon. Friend makes an important point. I will specifically cover access to NHS dentistry for children later in my remarks.

On the Government’s plan for a plan, experience suggests that positive change for my constituents may well be wishful thinking. My constituents are suffering and take no solace whatever from the Government’s commitment to plan for a plan for reform. The contract has been in place since 2006, and the Government have been undertaking a review of the process since 2011. After 12 years, it is still a work in progress.

[Wera Hobhouse (Bath) (LD)]

The British Dental Association has shown that over half of dentists have reduced their NHS work since the start of the pandemic. Official workforce data counts people, not how much NHS work they do compared with private work. Does she agree that it is important that the Government collect that data?

[Judith Cummins]

I absolutely agree with the hon. Member’s important remarks. Collection of data is paramount for solving the issue.

The dodging of responsibility for more than 12 years is nothing short of a disgrace. Now, we all bear witness to the human consequences of this crisis. The victims of Government negligence are—as they almost always have been—the most vulnerable people in our society. In Bradford, 98% of dentists are now closed to NHS patients. As I informed the Prime Minister just last month, 80% of practices are now refusing to accept children as new NHS patients.

The lack of access is having crushing consequences. In the financial year of 2021-22, 42,000 NHS hospital tooth extractions were carried out for 0 to 19-year-olds—an 83% rise on the previous financial year. A dental nurse has recently spoken of routinely extracting up to 10 teeth from a single child, so children are routinely losing half their teeth. This dental crisis is now ultimately a crisis of inequality. The rate of tooth extraction is more than three times higher in Yorkshire and the Humber than in the south-east of England. Children living in our country’s most deprived communities face an extraction rate three and a half times greater than those living in the most affluent areas.

In care homes for the elderly, the access crisis has been just as devastating. In 2019, 6% of care homes reported that they were unable to access NHS dental care services, but by 2022, that figure had risen more than four times to 25%—a quarter of all care homes.

As this Conservative Government continue to mull over minor reforms, they fail entire generations of people, who deserve a reasonable standard of care. No more are the cradle-to-grave principles of the NHS.

A 21st-century Britain requires a 21st-century approach. We need more than mere revision of the contract. My right hon. and learned Friend the Leader of the Opposition has spoken of the need for a new healthcare system that is just as much about prevention as about cure. It is a concrete fact that no dental treatment is stronger than protecting a healthy and original tooth, but in 2021-22 tooth decay was again the most common reason for hospital admission of children between six and 10 years old. For zero to 19-year-olds, hospital tooth extractions cost our NHS a shocking £81 million a year. In 2022, instead of children visiting the dentist on a regular basis, it cost our NHS an average of more than £700 for a single minor extraction of a child’s tooth in hospital.

We are paying for the cost of catch-up with our failure to prevent tooth decay, so prevention should be at the heart of our Government’s agenda for dental reform. We owe that to the generations of people currently being let down by the system. This country once had a strong school dental service. With the current shocking rates of tooth decay among children, now is the time to resurrect that policy as an interim prevention measure. It is not only the right thing to do but a sensible option for the country’s finances. Care homes would benefit from a dental contract that commissions stronger community dental services, as used to happen.

By using integrated care systems, upskilling care workers, and further involving local authorities, access can be increased and the pressure on dental services reduced. Prevention really is better than cure. We have a duty to ensure that taxpayers’ money is spent effectively in areas right across the country. A decade of savage cuts by the Tory Government has left long-term damage. An estimated £880 million a year is now required just to restore to 2010 levels of resources. There will be no escaping the need for more investment, but it must be thoughtful investment. One answer could be the introduction of a prevention-focused capitation-type system, where lump sums are provided to NHS dental teams to treat sections of the population.

Successful targeted investment is possible, and in 2017 I developed a project in Bradford with the former Health Minister, the hon. Member for Winchester (Steve Brine). I thank the hon. Member, who is now the Chair of the Health and Social Care Committee and who is present in the Chamber. He worked with me on the pilot scheme, which invested over £250,000 of unused clawback over three years into my constituency of Bradford South. That went straight back into local services and ensured that patients were able to access roughly 3,000 new NHS dental appointments in an area with high dental deprivation—targeting extra resources straight into an area where they were needed.

Although that was never meant to be a long-term solution, it proved that targeted investment is possible. Where there is a will, there is a way. With a staggering 10% of this year’s £3 billion national budget for NHS dentistry set to be returned, the system is clearly broken. Taxpayers’ money is returned not because people are not desperate for NHS dentists, but because the Government continue to push an underfunded and unworkable system. They lack the will to act and to find a way forward to protect dental health in this country. Now is the time to put “national” back into NHS dentistry.

The Government may once again list the challenges that stand in the way of re-establishing a truly universal dental care system. We are in a time of extraordinary change, with unprecedented cost of living crises, war on the European continent, and a society impacted by a deadly virus. Our health system is undoubtedly challenged, but 80 years ago the Conservative-Labour coalition Government published a guiding principle of NHS dental reform, just as this country fought for its very freedom and independence. In Sir William Beveridge’s own words:

“A revolutionary moment in the world’s history is a time for revolutions, not for patching.”

It is time for real change, not empty promises. This is the time for a Government dedicated to acting in the public good, to revitalise and resurrect NHS dentistry once again, ending the shoddy record of this Government’s patching of our NHS dental services.

[Mr Deputy Speaker (Sir Roger Gale)]

I call the Chairman of the Select Committee.

--- Later in debate ---

[Judith Cummins]

Thank you, Mr Deputy Speaker. I thank all 19 Members for their contributions and interventions, for which both I and the hon. Member for Waveney (Peter Aldous) are immensely grateful. Although the contributions are too numerous to mention, I will highlight the one from the hon. Member for Winchester (Steve Brine), the Chair of the Select Committee, which encapsulated many of the common themes. He spoke on a wide range of issues, including the lack of access to NHS dentistry and the problems, not only in his constituency, but right across the country, of the retention of NHS dentists and the lack of transparent data. He also talked about the need to have dentists represented on ICBs.

Many Members raised those common issues of access, including my hon. Friend the Member for Bootle (Peter Dowd), who spoke of a lack of funding. He posed two crucial questions: does the Minister accept that there is a problem?; and, if so, what progress has he made in resolving it? My hon. Friend then concluded that the situation has worsened since last year. Clearly, the need for full-scale reform has been recognised right across the House today, as we all know that change is needed. The fact that 90% of NHS dentists are no longer accepting new adult patients reflects the severity of this crisis. We have reached the point where the patching of our services is no longer possible and many of our constituents are simply suffering with the inadequacies of the current system. We need fundamental NHS dental reform now, not a plan for a plan. Minister, the promise of reform and this plan must come with real action and a firm date of publication.

Question put and agreed to.

Resolved,

That this House has considered progress on reforms to NHS dentistry.

NHS Dentistry

Judith Cummins Excerpts

Thursday 20th October 2022 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

I thank the Backbench Business Committee for granting this important debate and I thank my co-sponsor, or co-conspirator, the hon. Member for Waveney (Peter Aldous).

If you might indulge me this once, Madam Deputy Speaker, I did, in preparing for this debate, look up my past remarks on this issue; a sort of compendium of forecasting doom for NHS dentistry that, as it turns out, is entirely accurate. As we have heard, Members from across the House and across the country are raising concerns on behalf of constituents who are simply unable to access an NHS dentist. The current system remains unfit for purpose. Recent BBC research found that in the south-west, the north-west and Yorkshire and the Humber, just 2% of dental practices were taking on NHS patients.

[Peter Dowd (Bootle) (Lab)]

Is my hon. Friend aware that not a single dental practice in either the current former Prime Minister’s constituency or the Health Secretary’s constituency is accepting new NHS patients? Should it not spur on the Government that the former Prime Minister’s constituents and the current Health Secretary’s constituents cannot get access to NHS dentistry?

[Judith Cummins]

I am indeed aware of that fact, as my hon. Friend the Member for Bolton South East (Yasmin Qureshi) raised it with me yesterday. Sadly, she cannot be here today to make that very point, so I thank my hon. Friend for doing so.

In Bradford, 98% of dentists are closed to NHS patients, forcing people to go either to accident and emergency or to go private, whether they can afford to or not, often taking out a payment plan because they do not have the luxury of an NHS dentist available to them. In Bradford, 16% of three-year-olds and over a third of five-year-olds are now suffering with visible signs of tooth decay. In Yorkshire and the Humber, over 2,700 children under 10 had teeth extracted in hospital between 2020 and 2021. In fact, children born in Bradford are eight times more likely to be admitted to hospital with dental decay before their sixth birthday than if they were born in the former Prime Minister’s region. The truth is that NHS dentistry in its current form is just not working anywhere for anyone.

How did we get to this position? The answer is threefold: a contract not fit for purpose, dramatic underfunding and an exodus out of the NHS workforce. During my time in this place, Minister after Minister after Minister has stood here accepting that fundamental reform of the contract is needed. And yet we are still waiting. After years of delay, the Government announced in July some small contract changes, but unfortunately those quick wins completely failed on the fundamentals. NHS dentists in my constituency tell me that the financial uplifts are minor to the point of insignificance. The Government are conducting a polish and a clean when what is needed is root canal treatment. Will the Minister tell us exactly why the Government have not delivered the long-awaited full-scale contract reforms? Is it still their intention to conduct those reforms? If so, when can we expect them? If not, why not?

It is important to put on the record that the issue here is not a shortage of dentists. The number of registered dentists is at a record high. We have the dentists, but they are working in private practice. Until the Government fix the problems with the contract, which sees highly qualified and experienced dentists squeezed out of the system, they are simply pouring water into a bucket with a giant hole at the bottom of it.

My next point is on funding cuts. We saw funding to NHS dentistry fall by around a third in real terms over the last decade and that was before the cost of living crisis. In January, the Government announced a £50 million catch-up fund for dentistry, funded from clawback, that gave practices three months to offer urgent care appointments to deal with the pandemic backlog. I warned the Government at the time that their strategy was flawed and that the funding to tackle the covid backlog would prove to be unusable and the system unworkable. ITV recently revealed that approximately £14 million of the promised £50 million was actually spent. That is just 28% of the funding allocated, which delivered only 18% of the 350,000 appointments it was meant to. In Yorkshire and the Humber, my region, only 16% of the allocated funding was actually spent. The shortfall was clawed back by the Government once again and not reinvested back into dentistry in my region. That is less than a third of the money spent, not because it is not needed, but because the Government set up a system that was unworkable.

We need targeted funding to address an acute problem in areas of high need. The successful Bradford project that I developed with former Ministers back in 2017 really worked. It was a transformative project that meant we got 4,200 extra NHS dental appointments for people who had not had a dentist appointment for over two years. In the long term, however, we need fundamental change, and a comprehensive reform of the contract to push prevention is absolutely critical to that reform. Good oral health must not be restricted by either postcode or wealth. Going to A&E cannot be an alternative to NHS dentistry.

Although I welcome the Minister to his new role and, indeed, welcome the Secretary of State’s new emphasis on dentistry in her ABCD of priorities, whoever the Secretary of State is, in whatever Government, they should learn the lessons of targeting and invest in NHS dentistry, as prevention really is better than the cure. We simply cannot go on like this. The public are fed up to the back teeth with inaction and excuses.

Oral Answers to Questions

Judith Cummins Excerpts

Tuesday 19th July 2022 Commons Chamber

[Maggie Throup]

The hon. Gentleman is right and, as I said to the hon. Member for Hackney South and Shoreditch (Dame Meg Hillier), we know that there is more work to be done and we cannot rest on our laurels. We know that covid-19 vaccinations are our best line of defence and that the more people who come forward and take up their first jab, the more people are protected. That evergreen offer is still there, so if anyone has not had their first jab or has not come forward for their second or their booster, I encourage them to come forward now. It is never too late.

[Judith Cummins (Bradford South) (Lab)]

6. What steps he is taking to help improve access to GPs.

[Kate Hollern (Blackburn) (Lab)]

18. What steps he is taking to help improve access to GPs.

[The Secretary of State for Health and Social Care (Steve Barclay)]

We know that general practices are still under significant pressure and demand for their services is high. We are investing at least £1.5 billion to create an additional 50 million appointments a year by 2024, and of course not all appointments are, or should be, with GPs.

[Judith Cummins]

Last week, hospital clinicians raised with me their serious concerns that they are seeing incoming case notes of vulnerable and frail patients marked with

“telephone consultation during covid-19 pandemic”,

but those consultations were just in the last few weeks. This is clearly unacceptable and is leaving many of my constituents with the very real possibility of either a missed diagnosis or a misdiagnosis. What action is the Secretary of State taking to guarantee face-to-face appointments that are easily available for the elderly and vulnerable patients who need them?

[Steve Barclay]

The number of face-to-face appointments is increasing and in May 2022, excluding covid-19 vaccines, 64% of appointments were face-to-face, up from 55%. But the hon. Lady is right to say that patients should have the choice, and that is why the NHS access improvement programme has been supporting practices experiencing greater access challenges. Indeed, one of the first visits I did in my new role was to a GP practice to look at the practical measures it was putting in place to facilitate greater access for its patients.

Covid-19: Deteriorating Long-Term Health Conditions

Judith Cummins Excerpts

Thursday 10th March 2022 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is always a pleasure to serve with you in the Chair, Mrs Cummins. I thank the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for opening the debate and for putting a lot of material as well as a lot of data before us to consider, which is incredibly useful. I am also indebted to the Backbench Business Committee for allowing today’s debate to go ahead.

Even pre-pandemic, there were many challenges for people with long-term health conditions and their management. There was a really good focus on the acute phase, but as people moved into the more chronic phase of their illness, the amount of rehabilitation and support individuals received waned. It was dependent on geography, where someone lived, and on how many in-person interventions they had. Through that time people’s baselines lowered as their function decreased, but it did not need to decrease. That is why it is so important to look at the issue today.

I echo the remarks of the hon. Member for Bromley and Chislehurst on prevention. Of course, prevention is always better than cure, and having a strong public health strategy is crucial. In the acute and early intervention phases, many people missed out during the pandemic. We think about delays in diagnosis, the scale of treatment that people had because clinicians were placed elsewhere, and the value of input. We have talked about strokes today, and people having fewer rehabilitation sessions and less intervention from some of the leading clinicians, which meant they did not leave hospital at the same level that perhaps they did pre-pandemic. We need to pick that up now.

Early discharge has put more pressure on achieving a good baseline for somebody to move into the more chronic phase, the longer phase, of their rehabilitation. We know that once somebody goes home they do not have the physio nagging them every day and telling them to do certain things, so their function deteriorates unless there is good community intervention, which is what I want to focus my remarks on today.

We are talking about a broad range of conditions—neurodegenerative and other neurological conditions. The hon. Member for Bromley and Chislehurst set out some of those, but we can think about motor neurone disease, where time is simply not on your side, or Parkinson’s, where intervention is really important to ensure people maintain function.

We have learnt a lot about respiratory conditions over the last two years with covid, and suddenly lungs have come into central view. Cystic fibrosis has been mentioned. Chronic obstructive pulmonary disease is a condition that really does need good management in the community. There are cardiovascular, psychological and other conditions. We must remember that comorbidity is an issue that impacts on and intersects with many conditions. Somebody who has a combination of COPD and Alzheimer’s will often not remember or be able to steer the management of their condition. As a result, they are perhaps more susceptible to getting an infection and then finding it difficult to clear their lungs or to follow whatever treatment is prescribed, so they are more at risk and early morbidity is a serious risk factor. Therefore, we need to consider these issues in that context.

As I said, intervention at the acute phase of a disease can be intense, but it is about what happens next. We know that often there are not enough rehabilitation beds available to continue someone’s treatment. I have always argued that the convalescent stage is also really important for people to build their confidence, which is often what is needed after the acute stage. That is where the biggest challenge lies.

As the hon. Member for Bromley and Chislehurst outlined, some services have been able to be delivered through new mechanisms, such as Zoom, that simply were not there before. However, as a physiotherapist myself who spent 20 years working in this area, I must say that I would find stroke rehabilitation very difficult on Zoom, and anything involving respiratory medicine as well, because it is all about diagnosing and treating people through the physiotherapist’s hands. Body-to-body contact is absolutely crucial in the development of interventions. Clearly, the lack of it has impeded people’s rehabilitation and had an impact on it. It is not just physiotherapy or occupational therapy that are affected; other services, from dietetics right through to psychological therapies, are also affected. For somebody who is already impaired, face-to-face contact is vital, particularly if they are neurologically impaired and have just had a new diagnosis. Therefore, the risks of a patient regressing and not reaching their baseline, and then regressing further from that, are even greater.

The NHS is in some ways now coming under greater pressure than it did during the covid period. My concern is that the focus, politically and clinically, will be on the elective list and those numbers—we will drive up those numbers for sure and the Government will look at them—and will move on to dealing with acute care as it appears and to dealing with the elective backlog. GPs will of course make the same call, saying, “Look at our waiting lists, look at what is happening here.” Consequently, people with long-term conditions will be squeezed out of the system. That is why I am really grateful to the hon. Member for securing this debate. People absolutely need intervention. Without it, their progress and even their functions will decrease, and that will put even more pressure on both social care and the health system. The debate today is therefore really timely, allowing us to consider the new pathways that need to be created in order to support people with long-term conditions. They have been the poor relation for some time and we cannot let that situation continue.

In the last decade or so, Labour in particular has been looking at pathways that could be developed, such as the expert patient, which enabled people to have control and management of their own disease. Enabling the patient to lead wherever possible is really important. New technology has come on board. Under this Government there has been a particular focus on how new technology can help to provide support, measure things and move medicine forward. All those interventions are absolutely welcome, but they should not detract from the importance of the physical interventions that are necessary. We must ensure we maintain that baseline, so that if somebody does regress, we can give them an injection of rehabilitation to get them back up again to their normal functioning. It is really important to do that in a timely way.

I very much look at this issue from a physical perspective because of my professional background, but I recognise that people with other clinical expertise and competencies will look at their particular field and the need that particular types of intervention. As the hon. Member said, it is right that people have the correct balance between physical and psychological health, and they have to be brought into one space. Sadly, if someone has a physical diagnosis, the psychological aspect is often left behind, because doctors are looking at the primary root of someone’s condition. We must look at people far more holistically than we do currently.

I therefore want to set out a four-stage rehabilitation service to support the physical and psychological needs of people living with chronic ill health. Taking that approach forward will need funding and a workforce plan, which the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), has been incredibly powerful in calling for. I see a concept in which the first phase looks at assessment and measurement, the second at self-management, the third at therapeutic interventions, and the fourth at the psychosocial support, which is also needed.

First, interventions clearly need to be individualised. Everybody is unique in their presentation. We need to recognise that there is an opportunity to develop the service not only in domiciliary settings, but in rehab settings and, for some, in group settings. We have lost some of the collective healthcare that is important for not only the socialisation of health, but the encouragement from one patient to another. We have to capture that again. Often, a patient will be encouraged by seeing somebody else doing what they want to do and that will spur them on to go that little bit further.

Secondly, we have to look at patient management and how people enter services. It should be a given that patients will continue with their interventions once they leave formal healthcare settings. We need to make sure there is a continuum of regular assessment and monitoring. For some individuals, some of that assessment and monitoring can be done at home, but some of it will need external intervention.

Thirdly, regular support may not always require an intensive burst of intervention—sometimes it will—but if it can enhance function, it does need to be examined. I looked at some statistics provided by the Chartered Society of Physiotherapy. Only 15% of people with lung disease deemed eligible for pulmonary rehab are able to access it, which is quite shocking and we really need to address that. Some 50% of people eligible for cardiac rehab cannot access it. From running cardiac rehab classes, I know how people gain confidence from rehab to do things they never thought they would be able to do. They no longer live in fear, but live a confident life.

One in five people receive post-hip fracture rehab on discharge. I know of many cases where all the money is spent on repairing somebody’s hip or getting them a new hip, then getting them up, standing and walking in hospital, only for them to go home and just sit in a chair. Those patients then become fearful, which means social care has to come in, costing the NHS and the care system. It also means that somebody loses their independence, which is the biggest cost of all. This issue needs to be addressed.

Some 44% of people with a neurological condition do not access the services they need. We have a big amount of catching up to do. The biggest thing is that if somebody loses their confidence there is a rapid decline. We must remember that many of these people are elderly and live on their own. They do not have the interventions and the injection of hope that they need. We are talking about life-changing events—people’s whole world is reoriented. We need to make sure that patients maintain social connection, where possible, and are able to access that support.

Waiting lists for elective treatment have become so long. I cannot remember if we are at 6.2 million people or more, but with those kinds of figures many people will need additional support—for example with their diet, or they may be less mobile—so as not to trigger other thresholds that further delay their surgery. It is important that people do not become sedentary and that they have the support they need. If people have a lung disease, it is important that they do not increase the damage to their lungs, lose function or become psychologically impaired, because it is then harder to regain function. We do not want to see people spiralling, which can happen very quickly. Once people get into that place—which is not a great place to be—it is much harder to get people back, so let us really focus on that area.

Fourthly, I want to talk about people living with chronic conditions. Often, people get locked into a space where their life has changed so much that they become more isolated. They lose those social connections, and they also lose their ability to move forward. That might be because, for instance, they have lost their speech, or they might not have the same ability to communicate with people in all sorts of ways. We need to look at how we bring social prescribing into this agenda, as well as the voluntary sector and community support, which is necessary. I want the Minister to look at different pathways to bring that whole family of measures together. Often, we have isolated that into the various parts of someone’s body or mind, as opposed to looking at the person holistically.

Of course, if someone is more isolated, they may experience more loneliness and that impacts on anxiety, depression, motivation and function. People’s skills and confidence then decline even further. We need to ensure the programme has the resources it needs. People are whole beings, and we need to recognise that in our health systems. For too long, we have talked about arms and legs or lungs and brains, but we do not talk about people, and it is people who need that support. If we can look at such a model, we need to think carefully about how we socialise our health system.

I have been looking, in a completely different context, at fostering. There is a programme called the Mockingbird programme. I do not know if the Minister has heard of it, but groups and different people come and support the family. It may be an individual, a partner and their carer, or a family unit. They get that more community- based support. In the context of fostering, it is different families, so there is that concept of a community raising a child. Why do we not look at that for later in life for people with chronic conditions and for how we can provide support? Carers are often with their partners for weeks at a time with hardly any social interaction, and that can be quite telling if someone has an acute psychological condition as well.

Much more can be done for carers, as well as patients, as we move forward. We need a strategy, a workforce plan and funding. In this new world of integrated care partnerships, we have an opportunity to deliver that. July is day one. That is the moment to break out of the past which has let down people with long-term health conditions and move into a new era. I very much hope the Minister will be able to bring that forward.

[Judith Cummins (in the Chair)]

I aim to start the Front- Bench speeches no later than 2.28 pm.