World Menopause Month

Judith Cummins Excerpts

Thursday 21st October 2021 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to speak in this important debate. I thank the Backbench Business Committee for the opportunity to highlight World Menopause Month and the critical issues associated with menopause, and I thank my hon. Friend the Member for Swansea East (Carolyn Harris) and the Chair of the Women and Equalities Committee, the right hon. Member for Romsey and Southampton North (Caroline Nokes), for securing the debate. I will speak on one aspect of menopause: its link with osteoporosis. I do so as co-chair with Lord Black of Brentwood of the all-party parliamentary group on osteoporosis and bone health.

Menopause is an important time for bone health. When women reach the menopause, oestrogen levels decrease, which causes many women to develop symptoms such as hot flushes and sweats, as we have heard today. According to the Royal Osteoporosis Society, the decrease in oestrogen levels causes loss of bone density, so the menopause is an important cause of osteoporosis. Everyone loses bone density and strength as they get older, but women lose more bone density more rapidly in the years following the menopause, and they can lose up to 20% of their bone density during this time. With that loss of bone density comes reduced bone strength, and a greater risk of breaking bones.

Now for some facts about osteoporosis. Half all women and one in five men over 50 will break a bone as a result of poor bone health. As someone very wise put it to me yesterday, that is literally every other person. Osteoporosis causes more than half a million broken bones every year, which equates to almost one broken bone every minute. Breaking a bone usually means significant short-term pain and inconvenience, but it does not stop there. Many people with osteoporosis who break a bone live with long-term pain and disability, especially if their backs are affected. The reality of broken bones and the fear of falling have an impact on people’s everyday lives and activities, preventing them from doing the things they love and, essentially, from being the people they are.

Yesterday was World Osteoporosis Day, and the Royal Osteoporosis Society marked the day by releasing findings from a new survey of over 3,000 people with osteoporosis, the 2021 “Life with osteoporosis” survey.

[Peter Dowd (Bootle) (Lab)]

I am pleased to be a member of the all-party parliamentary group on menopause, led by my indefatigable hon. Friend the Member for Swansea East (Carolyn Harris). I am also pleased that my hon. Friend the Member for Bradford South (Judith Cummins) has raised the significant links between osteoporosis and the menopause. Does she agree that the four actions called for by the Royal Osteoporosis Society in its manifesto for a future without osteoporosis, including an expansion of the fracture liaison services, are not too much to ask for the 3.5 million people affected by the curse of osteoporosis?

[Judith Cummins]

I could not agree more wholeheartedly with my hon. Friend. Yesterday I had the honour of supporting the ROS, and a group of fantastic and passionate patient advocates who had helped with its report so enthusiastically, in delivering the report to the doorstep of No 10. Following that, we had a meeting with the Minister’s counterpart, the Minister for Care and Mental Health, the hon. Member for Chichester (Gillian Keegan), who received the report on behalf of the Government. I hope that both Ministers, working together with us, will carefully consider the points raised in the report—alongside the ROS’s new policy manifesto, to which my hon. Friend just referred—and will make sure that the needs and wellbeing of all those with osteoporosis, as well as women as they approach and go through the menopause, are at the heart of the Government’s health policies.

I have visited my local fracture liaison service at Bradford Royal Infirmary. It is an excellent and award-winning service. I spent time with the team discussing how good their work was at a local level, and how we could make improvements at a national level. We discussed the inconsistencies in terms of delivery of treatment across the country to which my hon. Friend referred. But one of the astounding things that stood out was their pride, their enthusiasm and their dedication to providing such excellent treatment for the people of Bradford in respect of a disease which, although important, is rarely spoken about.

Significant harm could be prevented if we put prevention at the heart of primary care. Digital solutions which could support that already exist, but they are not properly integrated into IT systems in our GP surgeries. Such systems could easily identify people at risk of osteoporosis before that all-important first fracture. Those who experience early menopause—before the age of 45, and especially before the age of 40—are at particular risk of osteoporosis and fractures in later life. They are advised to take HRT at least up until the normal age of menopause, which is around the age of 50.

I am proud to stand here today to help break the silence of this silent disease, a disease that affects so many women—young women in today’s society; women who have much to offer, women who should not be left undiagnosed, women whose quality of life is left literally to crumble, women who are left to suffer in pain—when in fact this is a treatable condition, because our bones are alive and can be built back stronger with the right treatment. I hope that the Minister will see why it is essential that, around the time of the menopause, women are properly supported to assess their risk of osteoporosis and fractures. I welcome her to her place, and I would also welcome any further conversations with her and her counterparts to ensure that we have the right policies in place to support women at this important time.

[Mr Deputy Speaker (Mr Nigel Evans)]

Just to talk through the timings, the wind-ups will start no later than 4.36. There will be six minutes for Marion Fellows, eight minutes for the other two Front Benchers and the last two minutes for Carolyn Harris.

Motor Neurone Disease (Research)

Judith Cummins Excerpts

Monday 12th July 2021 Westminster Hall

[Judith Cummins (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between debates. I remind Members participating physically and virtually that they must arrive for the start of debates in Westminster Hall. Members are expected to remain for the entire debate.

I must also remind Members participating virtually that they must leave their camera on for the duration of the debate, and that they will be visible at all times, both to one another and to us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks at [e-mail]. Members attending physically should clean their spaces before they use them and as they leave the room. I also remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall.

[Martyn Day (Linlithgow and East Falkirk) (SNP) [V]]

I beg to move,

That this House has considered e-petition 564582, relating to research into motor neurone disease.

Motor neurone disease is a rare disease that is sadly all too common. It is the most common neurodegenerative disease of midlife, and many younger people are also affected. It is currently a terminal and incurable progressive condition. Progression is rapid, with one third of people dying within a year of diagnosis. Because people with the condition generally die so quickly, only 5,000 people in the UK live with the disease at any one time. However, MND is not rare. One in every 300 people across all communities develop MND in their lifetime, and about 200,000 of the current UK population will die of MND unless effective treatments are found. It is diagnosed in 200 Scots every year, and more than 1,500 people in the UK.

Currently, the only drug available to directly affect MND is called Riluzole, or Rilutek, but I am told that it has limitations, so it is hardly surprising that the petition achieved more than 110,000 signatures. The petition calls on the Government,

“to significantly increase targeted research funding for motor neurone disease”.

It seeks

“new investment of £50m over 5 years”

to kickstart an MND research institute, which the petitioners argue

“would lead to better, faster and more definitive research outcomes and hope for those with MND.”

In their response, the UK Government recognise the immediate challenges faced by people with motor neurone disease and reiterate their commitment to supporting MND research, which is welcome and I hope gives some encouragement that common ground may be found to take the issue forward. I will return to the Government response to the petition in more detail shortly, with some questions that I hope the Minister will address when responding to today’s debate. First, I want to pay tribute to the amazing work carried out by the petitioners and the charities and individuals involved in tackling MND on a daily basis.

George Wilson “Doddie” Weir created the petition and is one of rugby’s most recognisable personalities, earning 61 caps for Scotland during a successful playing career. He represented the British and Irish Lions on their successful tour to South Africa in 1997, and won championships with his two club sides, Melrose and Newcastle Falcons. In June 2017, six months after receiving his diagnosis, Doddie revealed he was suffering from motor neurone disease. From then, his mantra has been “I’ve just got to crack on.” Five months on from going public, Doddie and his trustees launched and registered the charity, My Name’5 Doddie Foundation, with a shared vision of a world free of MND. The No. 5 is special for the foundation. It features in its name and is a reference to Doddie’s playing number for his clubs and the jersey he wore when he earned 61 caps for Scotland.

On meeting Doddie, albeit virtually, last week, I was struck by the positivity and the energy that he continues to have four and a half years on from his diagnosis. Doddie is not the only high-profile personality to succumb to this terrible disease and face up to it. The most recognisable scientist of modern times, Stephen Hawking, defied it for 55 years. Rob Burrow, another rugby great, was diagnosed with motor neurone disease in December 2019, just two years after ending his playing career by captaining Leeds to a record-extending eighth super league grand final. He described the disease as follows:

“First it comes for your voice. Then it takes your legs. It tries to rob you of your breath. But it can’t sap your spirit.”

Inspirational as these people are, that does not portray the difficulties of living with MND. Everyone living with it is inspirational. They understand that what is holding back progression in the development of effective treatment and a cure is a lack of targeted funding.

I have heard testimonies from Emma, a young mother diagnosed with MND at 37, who can no longer stand, and David, diagnosed in 2012, who accepts that he is lucky because of the slow progression of his MND. Both consider themselves lucky still to have a voice. Indeed, everyone I met during my research for today’s debate is excited about the progress made thus far, but they also know that MND research is disparate and needs to be targeted. I urge the Government not to dampen the growing expectancy that currently exists among the MND community and to meet the requests of the petitioners.

I would now like to go through the official Government response to the petition in some detail, and to comment and question the Government on it. The response stated:

“Over the past five years, the Government has spent £54m on MND research, through the National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI) via the Medical Research Council.”

Yet according to a written parliamentary answer of 14 January this year, the National Institute for Health Research

“funded no Motor Neurone Disease-related projects”

during 2019-20. Can the Minister provide details of any MND-related projects or programmes that received funding from the NIHR over the past five years? The same answer detailed £5 million of MND-related projects funded by the Medical Research Council during 2019-20. Can the Minister provide details of any other MND-related projects or programmes that have received funding from the MRC over the past five years?

Analysis carried out by the Motor Neurone Disease Association, MND Scotland and the My Name’5 Doddie Foundation shows that the figure of £54 million of Government spending over the last five years, which is repeatedly cited in written parliamentary answers, includes general neurological research that often has no tangible link to MND. The same analysis shows that funding for targeted MND research stands at less than £5 million annually, which is more in line with the £5 million allocated in 2019-20 that was detailed in the parliamentary answer of 14 January.

Another passage says:

“The Government remains strongly committed to supporting research into dementia and neurodegeneration, including MND.”

While funding into dementia research is much needed and very welcome, it is reported that, in about 5% of cases of motor neurone disease, there is a family history of either MND or a related condition called frontotemporal dementia. Frontotemporal dementia is just one of the many clinical features of MND, yet dementia features 10 times in the UK Government’s response to this petition. It is therefore understandable that the MND research community, who are all experts in their field, appear to be united in their assertion that MND research should not be adjoined to dementia research. Therefore, I wholeheartedly agree with Ammar Al-Chalabi, professor of neurology and complex disease genetics at King’s College London, when he says that it is no longer appropriate for MND to be tagged on to dementia research initiatives.

Another passage in the response says:

“The UK Dementia Research Institute has significant investment in MND research, with a particular focus on the mechanisms that cause the disease.”

Again, this is positive, but can the Minister give details of that significant investment in MND research? Additionally, the statement talks of research that focuses on the causes of the disease, not treatments. That is an area that needs to be focused on. The MND research community have called for targeted funding for MND research because it understands the substantial progress that has been made in establishing much of the basic science around MND and have identified the need to progress to research into treatment.

Another passage in the Government response said that the 2019 Conservative manifesto committed to doubling funding for dementia research, including MND research, including MND research, and the Government are putting plans in place now to deliver that commitment. I checked that manifesto and there is no mention of MND nor of neurodegeneration; there is only mention of dementia. Can the Minister detail what the plans are specifically for MND and say how much funding will be targeted on MND research?

In another passage, the Government response says:

“The Government has been working to establish a rich ecosystem for neurodegeneration research in the UK. Significant elements are the UK Dementia Research Institute, Dementias Platform UK, NIHR Dementia Translational Research Collaboration, and Join Dementia Research.”

Given that four dementia-related organisations are mentioned in a response to a petition calling for targeted research funding for MND, does the Minister accept that the lack of a pioneering MND research institute, which would attract targeted funding, remains a barrier to progress in finding effective treatments and a cure for MND?

Another passage in the Government response says:

“It is not usual practice to ring-fence funding for particular topics or conditions.”

However, it appears from the Government response that funding for dementia has been ring-fenced. In addition, recent global efforts to find a vaccine for coronavirus, including involvement with numerous research institutes, show how quickly progress can be made when funding is ring-fenced for conditions. Those efforts also enabled the fast development of a coronavirus vaccine. People living with MND need fast development of an effective treatment and a cure because of the rapid progression of this disease. Considering recent scientific developments, the UK Government’s levelling-up agenda and the current economic climate that puts charitable funding at risk, the time is right to increase significantly targeted research funding for MND and invest £50 million over five years to kickstart a pioneering MND research institute.

In conclusion, the research for new therapies requires a truly multidisciplinary and pan-national approach, spanning the entire translational pathway. Establishing a virtual MND translational research institute, which the petitioners call for, will deliver that. There is no doubt that extra MND research funding from the UK Government is needed to support effective patient treatment and medicines, in the hope that a cure for MND can be found soon, because that is what the petitioners and the sufferers of this disease need.

[Judith Cummins (in the Chair)]

I am looking to call Front-Bench speakers from about 5.25 pm, so if Members could limit their contributions to between four and a half minutes and five minutes, I would be very grateful and we can get everybody in.

Menopausal Symptoms: Support

Judith Cummins Excerpts

Wednesday 9th June 2021 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to be called to speak in this important debate and I thank my hon. Friend the Member for Swansea East (Carolyn Harris) for securing it. I know that menopause is shrouded in mystery and certainly used to be a taboo topic, but this is changing and it needs to, as its impact can be complex and numerous as regards health outcomes for women. I will speak on one aspect of menopause—its link with osteoporosis. I do this as co-chair, with Guy Black, Lord Black of Brentwood, of the newly formed all-party parliamentary group on osteoporosis and bone health.

A key factor in women’s health is the protection of bones. Menopause is a crucial time to protect our bone health. When women reach the menopause, oestrogen levels decrease, which causes many to develop the well-known systems of hot flushes and sweats. According to the Royal Osteoporosis Society, a decrease in oestrogen levels also causes a loss of bone density—so the menopause is an important cause of osteoporosis.

Everyone loses bone density and strength as they get older, but women lose it more rapidly in the years following the menopause, losing up to 20% of their bone density during this time. With that loss comes reduced bone strength and a greater risk of breaking bones. According to a survey by the ROS, a fifth of women who have broken a bone break three or more before their osteoporosis is diagnosed. Breaking a bone normally means significant short-term pain and inconvenience, but it does not stop there. Many people with osteoporosis who break a bone live with long-term pain and disability, especially if their back is affected. The reality of broken bones and the fear of falling impacts on everyday activity, stopping people from doing the activities they love. As women lose the protective effect of oestrogen at the menopause, it is a critical time for their bone health and a time to consider many factors, whether that is positive life changes to help maintain bone strength, having a health bone assessment or considering whether osteoporosis drugs are needed to strengthen bones and reduce the risk of fractures. A number of medications are available for those with a significant fracture risk, including hormone replacement therapy, which, crucially, reduces bone loss and the risk of fractures.

It is tragic that the loss of bone strength, and the associated pain and disabilities that fractures cause, is preventable in so many cases, and that is why it is important that around the time of menopause women receive the support needed to consider whether they have a fracture risk that needs treating with osteoporosis medication. To support this, the Royal Osteoporosis Society is calling for GP surgeries to be incentivised routinely to use digital tools to assess risk and prevent fractures, as recommended in the NICE guidelines. Frustratingly, accessible digital solutions already exist and are not integrated properly into IT systems in GP surgeries.

Sadly, many GPs and other healthcare professionals lack the confidence to manage osteoporosis, missing opportunities to identify people at risk early and to prevent that important first fracture. A recent study showed that 75% of older women seen in primary care at high risk of fractures were not given the medication they needed, due partly to a failure to diagnose osteoporosis. These IT solutions can identify people with risk factors for developing osteoporosis before that first fracture. Patients found to be at higher risk can be offered anti-osteoporosis treatment proactively, with a personalised pain management plan comprising medication, lifestyle advice, vitamin D supplementation and fall prevention strategies. That is why it is essential that around the time of menopause, women are properly supported to assess their risk of osteoporosis and fractures. Provided that we support GPs with education and training, including on menopause and bone health, test those at risk and provide preventive medication such as HRT and vitamin D, the vision for early intervention can become a reality.

[Ms Nusrat Ghani (in the Chair)]

I now call Alex Davies- Jones.

Oral Health and Dentistry: England

Judith Cummins Excerpts

Tuesday 25th May 2021 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Bardell. I congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on securing this important debate.

As the Minister knows all too well, I have spoken on this issue many times in this place, but the problems facing NHS dentistry have never been more serious or the need for action more pressing. The flurry of reports and media coverage in the past couple of days confirms the urgency of the crisis before us. Last week’s Insight report from the Care Quality Commission questioned whether enough NHS dental capacity is commissioned, and challenged commissioners to ensure that everyone, especially those who are vulnerable, have access to NHS dental care.

Yesterday’s report by Healthwatch England stressed that the dental crisis shows no signs of slowing and rightly called for a radical rethink of NHS dentistry and a rapid, radical reform of the way that dentistry is commissioned and provided. Today’s analysis by the British Dental Association warns that the extreme pressures of trying to hit unrealistic activity targets and working long hours in heavy-duty PPE have led to an unprecedented crisis in morale among the dental workforce, with almost half of NHS dentists saying it is likely that they will reduce their NHS commitment or leave the profession altogether in the next 12 months. Unless we urgently act to avoid the looming exodus of dentists in the NHS, the consequences for patients will be dire.

Bradford South has faced serious challenges with access to NHS dentistry for a long time. The triple whammy of chronic underfunding, the failed dental contract and the pressures of the pandemic means that the kind of problems that we have long seen in my constituency, and West Yorkshire more widely, have now reached almost every community in England. However, I look forward to meeting the Minister and her team again to examine the data and the outcomes of the extended pilot project to increase access to dentists in Bradford.

The BDA estimates that 30 million NHS dental appointments have been lost since the start of the pandemic. That is an unprecedented backlog that would take years to clear, even under the very best of circumstances, but considering the growing crisis in access throughout the country, the Minister must do all she can to support NHS dental teams as they work to meet the extraordinary challenge. Unless we make NHS dentistry a place where people want to work, the crisis we are seeing now will become a permanent state of affairs.

First and foremost, on dental contract reform, I will not outline yet again all the reasons why the current contract needs to be abandoned. I know that I would be preaching to the converted, as the Minister and colleagues on both sides of the House agree with me on that. I welcome the Minister’s recent assurances that a reformed system might be rolled out next year. I stress that it is crucial that new contractual arrangements are rolled out no later than April 2022, as we simply do not have the luxury of more time. The issue is now so urgent that there can be no more kicking the can down the road.

It is also essential that the new system does not simply tinker around the edges of the current discredited contract. We need to see a decisive break from units of dental activity, which are completely incompatible with providing safe, sustainable services for patients as we emerge from the pandemic. The new contract must have prevention at its heart and ensure that dentistry is available to all. Secondly, we must support dentists to see as many patients as safely as they can, but in a way that is sustainable. I am sure the Minister will be telling us later how activity targets imposed by the Government in January and increased further in April have helped to improve access to NHS dentistry. I am sure that, faced with severe financial penalties, which could destabilise or even bankrupt their practice, NHS dentists have seen more patients since the targets were introduced. However, we must question at what cost—to both patients and to the workforce—these targets were met.

The BDA members’ survey indicates that more than 90% of dentists had to take extra measures to meet their targets, with large proportions forced to reduce the amount of private work they do, which, in the long term, subsidises the NHS side of their businesses. They had to cancel annual leave and work extended hours in heavy duty PPE, and I am sure that the Minister agrees that that is not sustainable in the long run and explains the rock-bottom morale of the workforce. More importantly, patients pay the price for this extreme pressure to clock units of dental activity.

Dentists report being forced to prioritise routine appointments over dealing with a huge backlog of urgent care, which is much more time consuming and complex but counts roughly towards the same target. The current 60% target in England is four times higher than the 15% dentists in Northern Ireland have been asked to deliver, and three times as high as the 20% that dentists in Scotland will be asked to deliver later this year. The Labour Government in Wales rightly recognised that targets were not the best way to support dentists in seeing more patients and did not introduce them.

Ultimately, the extreme nature of the target in England drives dentists out of the NHS. Access to dental services will be reduced permanently and it will be the patients who, in the long term, pay the price for what, in the short term, might look like a policy that benefits them. It would be much more effective and, crucially, more sustainable to follow the actions of the Welsh and Northern Irish Administrations and help dentists reduce the gaps they need to keep between patients by helping them to upgrade their ventilation equipment. Many have already done so, but nearly 70% of practices report that they now face financial barriers to further investment in this area. Can the Minister outline why England remains the only part of the UK not to even investigate the merit of providing capital investment to help increase access safely?

Can the Minister also set out her plans to change the current high-intensity infection prevention and control measures? Fallow time and having to work long hours in heavy duty PPE is exhausting and demoralising for dental staff, as well as reducing access for patients. Most colleagues have focused on high-street dentistry, but we should not forget that we are also facing a major backlog in secondary dental care services. In Bradford, almost 1,000 children under the age of 10 had to be admitted to hospital to have decayed teeth removed under general anaesthetic in 2019-20. The pandemic has certainly not reduced the need for such operations but most of those procedures have been on hold since it started. That has led potentially to tens of thousands of children and adults with special needs waiting in pain, in many cases much longer than a year. Can the Minister tell us how many are currently on the waiting list for hospital dental procedures and how she plans to tackle unacceptably long waits for those operations?

Finally, I urge the Minister not to treat dentistry as an afterthought in reforms of the healthcare system. Changes to primary care commissioning in the upcoming Health and Social Care Bill must not lead to a postcode lottery or further cuts to extremely overstretched dental budgets and dental services. They must be represented in the governance structures of the integrated care system. Beyond the measures on fluoridation, the White Paper barely mentioned dentistry at all, which, in itself, is quite telling. To turn the page on the access crisis we are currently seeing, we must finally stop treating dental services as a Cinderella service of the NHS and give it the priority it deserves.

Covid-19 Update

Judith Cummins Excerpts

Tuesday 9th February 2021 Commons Chamber

[Matt Hancock]

Yes, absolutely. I want to thank everybody across Norfolk and Waveney for the work they have been doing to roll out this vaccine. It is a critical part of the country in terms of the covid response, and the work done locally has been absolutely exemplary. I commend my hon. Friend on the part that he has played and the leadership he has shown in Lowestoft in making that happen; the uptake has been superb. I have seen some of the reports locally, and the emotional impact on people of getting vaccinated is absolutely fantastic. I will absolutely take away the points my hon. Friend has made.

[Judith Cummins (Bradford South) (Lab) [V]]

Despite assurances from the Secretary of State and Ministers, it is now clear that the newly imposed NHS dentistry targets are in fact actively undermining patient access to urgent treatment during the pandemic, as I warned they would. Last week, a whistleblower at the UK’s largest dental chain with over 600 practices, mydentist, sent me an internal memo that advised them to prioritise routine check-ups over treatments in order to meet the new targets. Will the Secretary of State look at this urgently and agree to revise these targets to ensure that they do not undermine patient care, as the system as it stands incentivises routine check-ups above those in severe pain?

[Matt Hancock]

I want to thank our nation’s dentists, who have worked incredibly hard to get dentistry services going again. It is very important that we support them and that the financial incentives underpin the need to restart as much as is possible.

It is of course challenging to deliver services given that there are so many aerosol-generating procedures, and I will ask the dentistry Minister, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), to speak to the hon. Lady and perhaps meet her to discuss these ongoing challenges.

Covid-19: Dental Services

Judith Cummins Excerpts

Thursday 14th January 2021 Commons Chamber

[Judith Cummins (Bradford South) (Lab) [V]]

I will start by commenting on the imposition of activity targets. On 17 December 2020, during a statement on coronavirus, I called on the Secretary of State to reverse this shocking and unacceptable decision. With a new national lockdown that could well last months, this situation is now more acute than ever. In his response, the Secretary of State said that an

“agreement…has been reached with the dentists”—[Official Report, 17 December 2020; Vol. 686, c. 410.]

However, that is not how the dental profession interpreted the end to negotiations. The BDA has made it clear that it could not agree to such terms and that new contract requirements had been imposed on them. That in no way, shape or form constitutes an agreement. In the interests of accuracy, will the Minister clarify today that no such agreement was reached and that these targets have been imposed on dentists against their will?

Dental practices are now being asked to deliver 45% of their annual UDA target in order to receive their usual contract value. Surely the Government must recognise that this is simply impossible during a national lockdown. Many contract holders will hit a financial cliff edge and be required to return the majority of their contract value. Other practices will be forced to prioritise routine work such as check-ups for lower-risk patients, at the expense of urgent care and preventive work, simply to survive financially. For some years now, the Government have accepted that the dental contract needs reforming and that we need to move away from flawed UDAs. It is therefore unbelievable that the Government have decided to enforce a system based on UDAs in the middle of a pandemic. These are the wrong targets at the wrong time, and the Government should think again.

Unfortunately I know all too well about the crisis in access, because barely a week goes by when I do not have a constituent contacting me because they are unable to get a dental appointment for either themselves or their families, and often they are in severe pain and discomfort. Just last week, I was contacted by a nurse at a mental health hospital who is unable to get dental appointments for her patients. The shortage of community dentists, who are too thinly stretched, and high street practices that have to prioritise reaching UDA targets means that these vulnerable patients have no access to dental treatment at all.

That is one shocking example of what many Members know is true: it is increasingly difficult for our constituents to get an NHS dental appointment at all. The choice the Government now face is to either allow the situation to keep getting worse or to act now and bring in a new contract that does away with UDAs, to ensure that every patient gets the care and treatment they need.

Covid-19 Update

Judith Cummins Excerpts

Thursday 17th December 2020 Commons Chamber

[Matt Hancock]

I think the moment when we see contact rates of more than 90% should be one where everybody comes together and says thank you and well done to everybody at NHS Test and Trace and all their partners, whether they are in the public sector or are the brilliant private sector partners that we all support.

[Judith Cummins (Bradford South) (Lab) [V]]

Happy Christmas to you and yours, Madam Deputy Speaker. The Secretary of State will know the significant effect that the pandemic has had on NHS dentistry. There is a backlog of more than 19 million appointments. It is therefore shocking and unacceptable that NHS England has just decided to impose a new activity target on dentists in England, which many simply will not be able to meet under new covid restrictions. NHS England’s own data show that nearly 60% of dental practices will be hit by severe financial penalties. Dentists will now need to prioritise check-ups rather than dealing with the backlog of patients needing treatment while others may be forced to close entirely—a straight choice between staying financially liable or treating those in pain with more complex problems. Will the Secretary of State reverse this decision, which threatens patient safety and access and could lead to the demise of NHS dentistry as we know it?

[Matt Hancock]

I am very glad to be able to reassure the hon. Lady that the agreement that has been reached with the dentists is all about ensuring that while we support our NHS dentists we see them do as much as they can to look after people and help them get the treatments they need. This is a good, balanced programme and I am sure it will be implemented well by the dentists.

NHS Dentistry and Oral Health Inequalities

Judith Cummins Excerpts

Wednesday 25th November 2020 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

I beg to move,

That this House has considered access to NHS dentistry and oral health inequalities.

It is a pleasure to serve under your chairmanship, Mr Gray. I am delighted to have secured this debate on access to dentistry and oral health inequalities. I have spoken about this issue many times in this place, and it is more urgent now than ever. I will shortly turn to the effects of the coronavirus pandemic on dentistry in this country and, in particular, on access and oral health inequalities, but first I would like to set the scene a little.

In 2017, I held an Adjournment debate entitled “Access to NHS Dentists”. In that debate, I said:

“Millions of people each and every year are being left without access to an NHS dentist.”—[Official Report, 12 September 2017; Vol. 628, c. 812.]

I urged the Government to get on with dental contract reform and bring forward a coherent strategy to tackle the inadequacies and inequalities in the dental health system. That was three years ago, and of course no one could have foreseen the events of this year, but I am making the point at the outset of this debate that NHS dentistry in this country was already in a sorry state before covid struck. It was therefore extremely vulnerable to what has happened since March, the effects of which have been disastrous. The crisis in access that people were experiencing prior to March has been turbocharged. Solving it now requires the Government to dramatically change their approach to oral health treatment and prevention. In discussing the impact of covid on dentistry, I will focus mainly on England.

[Barry Gardiner (Brent North) (Lab)]

My hon. Friend is a student of the Old Testament, and she will know Proverbs 25, verse 19:

“Confidence in an unfaithful man in time of trouble is like a broken tooth”.

We are certainly in a time of trouble. It is not for me to call the Prime Minister an unfaithful man—

[Barry Gardiner]

But the lack of support for dentistry and dental technicians has certainly resulted in a few broken teeth. What does my hon. Friend believe is the single most important thing that the Government can do to support dentistry and the oral health of the nation?

[Judith Cummins]

The single most important thing that the Government can do is reform the dental health contract with a view to more prevention.

During the initial period of lockdown, between March and June, all routine dental care in England was paused and urgent dental care hubs were set up to provide emergency treatment to patients. That period of closure has clearly led to an enormous backlog of patients requiring treatment. The British Dental Association estimates that in April and May only about 2% of patients were able to access dental care, compared with last year, and that between March and October 19 million appointments were lost. One local Bradford dentist told me:

“Our phones are ringing hot with new patients who have no dentist access, which has certainly been made worse by this year’s lockdown. On top of this we are facing significant staffing pressures, due to increased triage requirements and the need to thoroughly clean the practice between patients.”

Just yesterday, I was contacted by one of my constituents who has been trying to get a dental appointment for five months and is living with gum disease and toothache. That is simply unacceptable.

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

I am grateful to my hon. Friend for securing this debate and for all her campaigning work on dentistry services. In York, it is really challenging to get registered with an NHS dentist, let alone access their services. One of the things that has exacerbated that during the pandemic is access to personal protective equipment for people who are overseeing our oral health. Does my hon. Friend believe, as I do, that oral health has not been seen as an equal partner in the provision of healthcare? We seriously have to address that, including access to PPE.

[Judith Cummins]

I certainly agree with my hon. Friend about access to PPE and the fact that dentistry is very much seen as the Cinderella service of the NHS.

Clearing the backlog will be a considerable challenge. Even in the best of circumstances it would take years, but unfortunately we are not in the best of circumstances. As people who have tried to get dental appointments since June know, dentists are operating with considerably reduced capacity. About 70% of practices are operating at less than half their pre-pandemic capacity. The primary reason for that is the requirement for a period of fallow time after each appointment to allow any aerosols that may have been produced by treatments such as drilling or even scale and polish to settle, and then for a long deep clean to take place. The fallow period can be for up to one hour.

In October, the number of NHS treatments carried out was a third the level of the year before. In the BDA’s members survey published earlier this month, 87% of dentists in England cited fallow time as a top barrier to increasing patient access. That could be significant reduced. The number of patients seen could be increased by installing high-capacity ventilation equipment. However, the price of such equipment and ventilation is estimated to start at about £10,000, and the cost is considerably more for larger practices with a high number of surgeries.

The British Dental Association members survey shows that the majority of dental practices in England are not currently in a financial position to afford such an outlay for investment. However, the practices least likely to have had the appropriate equipment tend to serve the most deprived communities, and are also the least likely to be able to afford that investment, increasing oral health inequalities further. That vicious cycle of underinvestment in our most deprived communities feeds inequalities in health outcomes.

[Scott Mann (North Cornwall) (Con)]

I thank the hon. Lady for securing this very important debate. It sounds like Bradford has a similar challenge to Cornwall. We have had a longstanding shortage of provision for NHS dentistry in Cornwall, particularly around recruitment and retention. I had a very constructive meeting with the Minister on this issue recently. Can we work together across the House to put together a programme of work that the Government can adopt to ensure that places such as Bradford and Cornwall get proper NHS provision?

[Judith Cummins]

Of course, I welcome cross-party work on this. I am vice-chair of the all-party parliamentary group for dentistry and oral health. I would very much welcome the hon. Member as a member of the APPG, and look forward to sorting out dentistry, including NHS dentistry, once and for all, with a particular view to addressing the difficulties his constituents face.

I ask the Government to step in now and provide capital funding to invest in new ventilation equipment to help to reduce these fallow times. It is simply not good enough to say that dental practices must fund this themselves. We all know how precarious their funding is, and how hard it has been hit by the pandemic. This is a matter of public health, and it is the Government’s responsibility to safeguard and protect that. To avoid that responsibility would be a matter of gross negligence on the Government’s part.

In recent years, neither NHS England nor the Department of Health and Social Care has extended any capital funding to dental practices. The situation we now find ourselves in requires a change of approach. Local dentists have contacted me about the importance of maintaining temporary contract provisions that have been in place during the pandemic. Alan McGlaughlin, a dentist in my constituency, told me:

“Our fear is that NHS England may ask us to achieve more than the notional level of 20% of contracted targets for next year. This will be impossible due to allowable body flow in through the door and the cleaning and fallow periods required. I hope the NHS will allow for this issue and only then can we settle into a positive routine for the care of our patients.”

Can the Minister confirm that this target will not be increased, putting practices under impossible pressure?

Turning to secondary care, the pandemic has had a significant effect on waiting times for dental procedures in hospital. Thousands of children and vulnerable adults who require dental treatment under general anaesthetic are waiting in pain for treatment. There have been countless horrifying reports in recent months. The BBC has reported on a patient who suffered eyesight damage after not receiving treatment for a fractured tooth, which became an abscess. Meanwhile, the Daily Mail has reported the case of a seven-year-old girl who was left in severe pain for months after she was unable to get an appointment. Even before the pandemic, the waiting time for this kind of treatment was around one year. That is set to become significantly worse, given the backlog and reduced operating capacity.

I recently tabled a question asking for how many children planned dental admission to hospital has been suspended or cancelled since the start of the covid-19 outbreak. The Department responded that data was not available in the format requested. I find it simply unbelievable that the Department of Health and Social Care does not hold this information, so perhaps the Minister can answer that question. If she cannot do so today, I would welcome an answer later on.

As well as the pain and suffering that such delays cause patients, including problems eating, speaking and sleeping, they contribute to the impending public health crisis of resistance to antibiotics, as people require multiple courses of antibiotics while waiting for surgery. I understand that eight organisations, including the British Dental Association, Mencap, the Royal College of Surgeons, and the British Society of Paediatric Dentistry, wrote to the Secretary of State about this in mid-September, but have yet to receive a response, so would the Minister ensure that they receive a response as soon as possible?

I have focused on the practical problems that dentists and patients are facing as a result of the pandemic, but I would now like to turn to the effects that this is having on oral health inequalities. The covid pandemic has exacerbated socioeconomic, ethnic and regional inequalities across the country, and will worsen oral health inequalities too. According to the Association of Dental Groups, access to treatments for poorer patients has fallen by 39% over the past 10 years. Regions such as Yorkshire and the Humber have struggled for years with an acute crisis in access to NHS dentistry. I have raised this many times with various public health ministers, and while we have taken some small but important steps to improve things—especially when the hon. Member for Winchester (Steve Brine) was Minister—for which I am very grateful, the situation is still fundamentally inadequate.

Inequalities in access to dentistry inevitably lead to inequalities in oral health outcomes. A child in Yorkshire and the Humber is five times more likely to be admitted to hospital for a tooth extraction than a child in the East of England. In Bradford, 36% of children have tooth decay, compared with just 7% in the best performing area of the country.

[Robbie Moore (Keighley) (Con)]

I thank the hon. Lady for securing this debate. This has been a big issue for many of my constituents across Keighley and Ilkley, in terms of the outreach programmes that are done by dentists and hospitals, ensuring that those children with tooth decay get the appropriate education about how to treat and look after their teeth. Does she agree that the Government could provide more emphasis on that?

[Judith Cummins]

I absolutely agree that prevention work is key to solving much of our dental crisis, particularly for children. I am also concerned about the effect of the pandemic on the oral health of vulnerable groups, including pregnant women, people who have been shielding and people with dementia. They are highly unlikely to have received any dental care since March. Inevitably, problems will have built up. In the case of pregnant women, who under normal circumstances would be able to receive treatment for up to 12 months after the birth of their baby, will the Minister outline what provisions are in place to ensure they will be able to receive their NHS dental treatment free of charge despite the backlog in treatment?

Finally, I would like to make a few points about the long-term future of dentistry in this country. Dental practices across England—and with them the very fabric of dental care for millions of people—are facing an existential threat. We are at a crisis point for dentistry. Most British Dental Association members believe they can survive only for 12 months or less in the face of lower patient numbers and higher overheads. The Government could take several immediate steps to protect dental practices and improve oral health outcomes.

First, the Government should look at what immediate financial support can be given to dentists and dental practices. For instance, why are dentists among the only businesses on the high street that continue to pay business rates? Secondly, in terms of access to both primary and secondary care, dentistry is severely limited for the foreseeable future, and emphasis on investment in oral health and prevention is needed now more than ever.

The Government must now commit to investing in preventive schemes that are proven to work. That includes supervised tooth brushing for children, which the Government committed to consult on by the end of 2020. I would welcome the Minister’s assurance that that will still go ahead.

On the topic of prevention, I must mention the dental contract. For some time, there has been widespread, cross-party agreement that the dental contract needs reform. Units of dental activity have always been a poor way to measure meaningful dental health care. Their continued presence in the contract would be a disaster in the present circumstances. Despite the wider challenges the Government are facing, now is the right time to do this. Working with the BDA and others, Government must introduce a new contract that focuses on prevention, supports best patient care and improves access, especially for those who need it most.

I have spoken about the real challenges dentists are facing as a result of the coronavirus pandemic, but the problems in our dental health system reach back far beyond that. The pandemic has shown how fragile the system is and the effect on patients when it collapses. I urge the Government to invest in dentistry, prioritise prevention and work to close the inequalities that I have outlined. Anything less than that will let down the most vulnerable people, who need an NHS dental service that is fit for purpose.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Judith Cummins Excerpts

Committee stage & Committee Debate: House of Commons
Wednesday 25th November 2020 Public Bill Committees

[Carolyn Harris]

I welcome the comments from both the Minister and the hon. Member for Sevenoaks. We would welcome the opportunity to work with the hon. Lady to ensure that we strengthen the Bill. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Judith Cummins (Bradford South) (Lab)]

I beg to move amendment 3, in clause 1, page 1, line 23, after “age,” insert “including by requiring and recording proof of this information,”.

It is a pleasure to serve under your chairmanship, Ms Rees. First, I thank the hon. Member for Sevenoaks for introducing this Bill and successfully bringing it to Committee. It is long overdue. I thank her from the bottom of my heart.

I stand in support of the Bill’s principles and I want to reiterate a point made by my hon. Friend the Member for Swansea East. My amendments seek to enhance the Bill and close the gaps in the wording. This amendment is a probing amendment and it deals with ensuring that a framework for age identification is present when practitioners are assessing a client for a non-surgical cosmetic procedure.

I am concerned that, as currently worded, the Bill leaves open to interpretation what reasonable steps a practitioner must make to establish the age of the person receiving the procedure. I want the Bill to make it clear that practitioners must request proof of age before any procedure is undertaken, verify the authenticity of that document and ensure that it is recorded, to ensure that there is no doubt about a client’s age. We need clear and explicit guidelines to ensure that vulnerable young people do not fall through the net.

My hon. Friend the Member for Swansea East and I established and became the co-chairs of the all-party parliamentary group on beauty, aesthetics and wellbeing. I am worried about how few protections there are for children under 18 years of age when it comes to non-surgical cosmetic procedures.

I was also in attendance at our inquiry into ethics and mental health. It will be no surprise that all our expert witnesses agreed that young people are at their most vulnerable in their teenage years. They are faced with many pressures, including societal pressures, which make ideal beauty standards the norm, especially in this age of social media. We must ensure we put safeguards in place to protect our young people.

I ask the hon. Member for Sevenoaks and the Government to consider this amendment to ensure that proper mechanisms are in place to strengthen the process of age verification for non-surgical cosmetic procedures and to improve the accountability of all practitioners. The amendment requires the practitioner to formally log and prove a client’s age.

Like my hon. Friend the Member for Swansea East, I welcome the opportunity to adapt the wording of the amendment should the hon. Member for Sevenoaks be unable to accept it. I ask that this amendment be considered.

[Ms Dorries]

Again, I thank the hon. Lady for moving the amendment. I understand that it will not be pressed to a Division, but I give her my absolute assurance that all comments made in the Committee today will be taken away and reviewed by my hon. Friend the Member for Sevenoaks and me before we move forward on to the next stage of the Bill. I thank all hon. Members for their contributions today.

--- Later in debate ---

[Judith Cummins]

I am happy with the assurances that we will be listened to and that our words will be considered throughout the passage of the Bill. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

[Laura Trott]

Clause 1 of the Bill creates a new criminal offence of administering in England botulinum toxin injections and cosmetic fillers to persons under 18. Currently, children and young people can access invasive cosmetic procedures on the commercial market without the requirement for any medical or psychological assessment. As the hon. Member for Bradford South said, that cannot be right.

--- Later in debate ---

[Judith Cummins]

Would my right hon. Friend’s amendment cover the eventuality that I described? That was related to me by the APPG’s most in-touch consultant, my daughter, who told us about her friend who, for her 16th birthday, had a lip filler injected by her cousin.

[Mr Jones]

That is the point. Part of this is about a process of education to teach people what the dangers are. These products are marketed and sold to people—especially young people—as if they are just like make-up.

Well, they are not make-up—this is a medical procedure that can have life-threatening consequences if it goes wrong. It is clear that some of the advertising on Facebook and other sites is directed at under-18s. The Minister mentioned body image, and the Mental Health Foundation’s report from last year on that issue shows that the marketing is for young people.

This is a probing amendment to get this issue on the record. We need to look at ways to ensure that young people are protected from advertising. It is not newspaper advertising; that is for old-fashioned people like me. It is advertising on Facebook, Instagram and elsewhere. I have raised this issue with Facebook. Of course, we get the usual guff from Facebook: “Oh well, we take them down.” I have even written to Sir Nick Clegg asking whether he will do anything about it. Getting an audience with or response from the Pope would be easier than getting a response from him. Those platforms are making money out of this, and they are targeting their adverts at young people, not older people.

Do not get me started on the Advertising Standards Authority, which is a completely toothless, useless tiger, frankly. It takes down some adverts, but they keep proliferating. The social media companies need to do something about it, because young people are being put at risk and because there is a market. Botox is supposed to be a medically controlled substance, but it is not; it is advertised. The way the companies get around that is that, although they cannot advertise botox, they can advertise a consultation, which just happens to be for botox. Facebook, Instagram and others could take down those adverts overnight and just stop them, but they are not doing that because there is clearly money to be made in this sector. Some of those issues will come out in the private Member’s Bill of the hon. Member for Bosworth on body image, but if we do not tackle them, this Bill could be enacted and the Facebooks of this world could still make money on the back of this sector.

The purpose of new clause 1 is to ensure some oversight over the effectiveness of the Bill. It calls for a report when it is under way so that we can assess whether it is effective. It also relates to advertising and promotion. By raising this issue with the Minister, I want to put on the record that there is an issue. I accept that advertising is not directly within her remit as Public Health Minister, but I want to see what more can we do not just on the targeting of under-18s, but on the broader issue of the way in which big business is trying to circumvent the law—advertising botox is supposed to be illegal.

There are two ways of doing that. The first is to stop the supply of botox from prescribers, and the second is to crack down on it very heavily. The Mental Health Foundation’s report on body image shows that, in this age of the internet and the internet of things, young people are in a terrible situation and are suffering due to their body image. That is reinforced by advertising. Botox is seen as a quick fix, but it is potentially dangerous. We need to try to stop this danger to our young people.

Dementia: Covid-19

Judith Cummins Excerpts

Thursday 12th November 2020 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Graham. I thank my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) and the hon. Member for Strangford (Jim Shannon) for securing this important debate, and I am pleased to follow the hon. Member for Eastbourne (Caroline Ansell).

I want to start by talking about my constituent Tracy Gothard. Tracy released a video of what happened when she visited her mum Doreen, who has dementia, in a nursing home in Bradford. In the clip, we see what so many of our families are currently going through. Hon. Members might have seen the footage. In it, Tracy and her sisters stand outside and speak to their mum in the car park through a closed window. Doreen asks Tracy to come inside and motions with her hand, to which her daughter replies “I can’t come in. We are not allowed yet because of that nasty bug.” Doreen’s face crumples, and she breaks into tears. It is a heartbreaking video, and I do not think that anybody can watch it and not be moved to tears.

The window meeting between Tracy and her mum was the first one that they had since August, when Bradford was placed under local restrictions. I asked Tracy what she would like me to say to the Minister on her behalf in this debate. She said:

“I’m begging from the bottom of my heart to give key worker status to just one family member, to help us see loved ones in care homes. This has now been ongoing for too long, and in my 51 years of life, I have never not seen my mum, especially at Christmas. I appeal to your better nature, on behalf of myself and thousands more, to not let this continue.”

Tracy speaks on behalf of everyone who has a loved one with dementia in a care home. Anyone who has cared for someone living with dementia knows that regular contact with family members keeps that spark inside alight. Digital visits are simply not appropriate, as people with dementia view the world differently. Memory clinics must reopen, and they need to be in person. As virtual memory clinics, they cannot simply replicate the quality and appropriateness of a face-to-face appointment for anybody living with dementia.

The Government need to recognise that family carers play an essential part in caring for people with dementia who live in care homes. When family carers are unable to visit and provide that care, the health and wellbeing of people with dementia can seriously decline at a rapid pace. I fully support the call by the Alzheimer’s Society and others to designate at least one informal carer per care home resident as a key worker, with access to testing, training, PPE and, when they come, vaccinations. The Government must urgently speed up their action on this issue, as time is not on our side. Will the Minister clarify whether an adult caring for an adult with dementia can form a support bubble with another household? The regulations are not explicit on that, and our carers need that support.

Finally, I want to quote from the hard-hitting report by the Equality and Human Rights Commission. It states:

“There is evidence that human rights standards may have not been upheld in the response to the pandemic, including in key decisions about hospital discharges, care home admissions, visits, access to critical care and prioritisation of testing, putting people with dementia and other care home residents at greater risk of harm.”

That should be a wake-up call to us all: inaction is not an option.