Access to NHS Dentistry

Judith Cummins Excerpts

Thursday 10th February 2022 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Efford. It is also a pleasure to follow the hon. Member for Waveney (Peter Aldous), with whom I co-sponsored today’s debate. I thank the Backbench Business Committee for granting valuable time for this valuable debate.

I have spoken many times in this place about my serious concerns about the state of NHS dentistry in England. Covid has had a devastating impact on our NHS dental services. According to the British Dental Association, it has caused more than 40 million NHS dental appointments to be lost since the start of the pandemic, which amounts to a whole year’s worth of dentistry in pre-covid times—a year’s worth of dentist appointments lost to the people and the system. Even before covid began, enough dentistry was commissioned for only half the adult population in England to see an NHS dentist just once every two years. With capacity now even more severely limited by covid, access problems have reached an unprecedented scale in every community, with existing inequalities in access and outcomes widening even further.

I received a briefing from Bupa, which tells me that across its 306 practices with an NHS contract in England it has a growing number of loss-making sites. It points out that these NHS practices would not be sustainable if they were independent—they are kept afloat by Bupa’s private practices. To be clear, that is private healthcare subsidising the NHS. The current dental contracts make dentists’ work highly stressful and do not allow them to provide the quality of care that they want to provide for their patients. According to the BDA’s surveys, that is the No. 1 reason why dentists are leaving the NHS or reducing the amount of work they do in it.

Only last week, I spoke to the owner of a dental practice in my constituency—he is my dentist—who told me that he has just learned that one of his dentists is leaving NHS practice to move to private dentistry. He also told me that the recent £50 million funding announcement for urgent dental care is virtually unusable, as it requires either persuading an already overstretched workforce to work overtime or recruiting new staff or hiring expensive locums—all of which has to be delivered by March 2022. It is just unworkable.

Bupa said the same about the funding package. To qualify for the funds, dentists must first have met their NHS contract thresholds, a system that excludes practices that have dealt with large numbers of patients with urgent needs, or faced higher staff and patient sickness, or who have struggled to recruit staff who are prepared to do NHS work. Only 134 of Bupa’s 306 practices were eligible under the criteria. Of those 134, only two so far have felt able to take up the extra funding.

It is clear that this funding package is not new funding—it is drawn from the £169 million that was clawed back from contract holders in 2020-21 for not meeting contractual targets. In my view, clawback is a failure of the system. It is not a failure of the NHS to spend money allocated through budgets but a failure to properly target resources to where they are needed, such as in my constituency in Bradford South and in the district of Bradford. The Government should not expect applause for creating a pot of funding for urgent care that simply cannot be spent in the time allocated, or in the areas where it is needed most, because of the strings that have been attached.

The BDA estimates that it would take £880 million per year just to restore NHS dental budgets back to 2010 levels. Chronic underfunding and the current contract are to blame for the long-standing problems with burnout, recruitment and retention in NHS dental services, with almost a thousand dentists leaving the NHS in England in the last financial year.

I know that the Minister is committed to reform, but I stress the urgency of this work. The Minister said earlier this week that the Government had

“started work on dental contract reform.”—[Official Report, 7 February 2022; Vol. 708, c. 780.]

The process has been under way since 2011. It is simply no longer good enough to say, “We’re working on it.”

I urge the Minister to commit today to a firm date when dentists will see the end of units of dental activity and a better contract, focused on prevention and increasing access. That needs to be rolled out now, as the targets set in the current contract are leading to the wrong outcomes. Unless what the Government are seeking is the ultimate demise of NHS dentistry, we really need to see a change in the contract. NHS dentistry was in trouble before covid-19 and is now facing an emergency.

In Bradford, almost 1,000 children under the age of 10 had to be admitted to hospital to have decayed teeth removed under a general anaesthetic in 2019-20. Thousands of children in Bradford and across the country are waiting in pain, taking painkillers and potentially multiple rounds of avoidable antibiotics to control their infection while they await surgery. No figures for the size and length of waiting lists for hospital tooth extractions in children or vulnerable adults are currently collected, but I am told that people are routinely waiting as long as two to three years—that is two to three years in acute pain. I hope that the Minister will touch on this issue in her response and explain why data on this crucial service for some of the most vulnerable people in our society is not routinely monitored and collected.

The lack of access to NHS dentistry is impacting some regions more than others. Yorkshire and the Humber is currently the worst performing area in terms of child oral health, with more than one in seven children in the region suffering from decay by the time they are just three years old. That is more than double the rate in the east of England, where only one in 15 children are affected by that age. According to a recent survey by mydentist, nearly 10% more people were able to access routine dentistry in the south of England than in the north.

Since the current Government took office, their unspoken policy has been to rely increasingly on rapidly rising patient fees while they drastically cut Government funding for dental services. Net funding to NHS dentistry fell by around one third in real terms in the last decade. An acceptable level of access can be secured only by prolonged and serious commitment, and proper, long-term funding to and for NHS dentistry. We need, in essence, a new deal that treats dentistry as an equal member of the NHS family, not a Cinderella service. I ask the Government to commit to a properly funded all-age NHS service.

However, I believe that we can and must go further. We must work to achieve a fully-funded dentistry service, with NHS dentistry available to all. As the chair of Healthwatch England, Sir Robert Francis, QC, said:

“We won’t build back a fairer service until access to NHS dentistry is equal and inclusive for everyone.”

I agree with Healthwatch, and believe that the guiding principle in NHS dentistry must be that good oral health must not be restricted by either postcode or wealth.

Health Inequalities: Office for Health Improvement and Disparities

Judith Cummins Excerpts

Wednesday 26th January 2022 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

I beg to move,

That this House has considered the Office for Health Improvement and Disparities and health inequalities.

It is a real pleasure to be here under your stewardship this afternoon, Mr Twigg. I thank all those who have come along—all on the Labour side of the House—to debate this important issue, which affects so many of our constituents. I thank the organisations that have provided me with information to help me articulate my points, including the Royal College of Physicians, the Inequalities in Health Alliance, the British Heart Foundation, Cancer Research UK, Maternity Action, the Royal College of Paediatrics and Child Health, the NHS Federation, the UK Vaping Industry Association, Kidney Research UK, the Health Foundation, the Terrence Higgins Trust, Global Blood Therapeutics, the Local Government Association, the Institute of Alcohol Studies, the Children’s Alliance and, as ever, the House of Commons Library, which brings much of this together. I do not believe I have missed any organisation out. If I have, I apologise.

Each organisation made helpful and constructive comments about the matter we are debating today. The extent of health inequalities is remarkably wide—in fact, I felt I understood the extent of such inequalities, but the information from those organisations has widened my knowledge significantly. Each of the organisations had the decency to send me information, so I will read out comments from each of them, if I may.

Alongside its key ask for a cross-governmental strategy to reduce health inequalities, the Inequalities in Health Alliance also asks the Government to

“commence the socio-economic duty, section 1 of the Equality Act 2010”

and to

“adopt a ‘child health in all policies’ approach.”

The Health Foundation notes:

“Public health funding grants to councils have been reduced by £700 million in real terms from 2015/16 to 2019/20. In the Spending Review published in October 2021, the Government said it would maintain the public health grant ‘in real terms’ until 2024/25, but has yet to confirm the amount for 2022/23.”

We are only a couple of months away from the beginning of that financial year. The Terrence Higgins Trust asked me to ask whether the Minister can confirm when local authorities will have their public health grant allocations published. Other organisations also asked that question.

The Institute of Alcohol Studies said:

“People from the most deprived groups in England are 60% more likely to die or be admitted to hospital due to alcohol than those from the least deprived… We believe that for any levelling up agenda to be comprehensively successful, it must address alcohol harm as a top priority.”

The LGA said:

“Councils have seen a significant reduction to their public health budgets in the period between 2015/16 and 2019/20. The recent announcement of a real-terms protection of the public health grant is welcome, but is unlikely to address the impact of the past reductions to funding.”

Cancer Research said that its modelling estimates suggest that

“30,000 extra cases of cancer in the UK each year are attributable to socio-economic deprivation. The two biggest preventable causes of cancer—smoking and overweight and obesity—are more prevalent in deprived groups.”

Kidney Research said:

“Around 3 million people in the UK have kidney disease and every day, 20 people develop kidney failure…. There is also a gender bias associated with kidney disease—women are more likely to be diagnosed with kidney disease and are at higher risk of developing end stage renal failure than men.”

[Judith Cummins (Bradford South) (Lab)]

My hon. Friend is making an excellent speech. On that point, I want to ask him about gender inequality in terms of health. As a member of the all-party parliamentary group on osteoporosis and bone health, he will know that fracture liaison services are key to prompt and timely diagnosis of osteoporosis, but only 51% of NHS trusts in England have an FLS and only 41% of all NHS trusts have permanent and sustainable funding in place for their FLS. That means that every year an estimated 900,000 people miss out on the medication they need to prevent avoidable fractures. Does he agree that this health inequality, or postcode lottery, needs to end?

[Peter Dowd]

My hon. Friend is completely right and she has been a real champion of osteoporosis services, pushing them in her own area and as chair of the APPG. One figure shows that half of women over the age of 50 suffer a broken bone due to osteoporosis. That is the kind of stark figure that we have to face. I thank my hon. Friend for that intervention.

The NHS Confederation has made comments similar to those I have mentioned:

“The number of people waiting for planned NHS care in England has grown to record levels, with more than 5.6 million people currently on the waiting list and over 7 million ‘missing patients’ anticipated to come forward... Inequalities are now becoming evident in the backlog, with evidence suggesting that waiting lists have grown more rapidly in more deprived areas during the pandemic.”

Maternity Action says:

“Vulnerable migrant women face charges of £7,000 or more for… maternity care. Charges are levied on women with insecure immigration status, including destitute asylum seekers whose claim has been refused and who are not in receipt of Home Office support, women whose relationship has broken down and who were dependent on their partner for their immigration status, women on fiancee visas and women who have been unable to afford to renew their visas. This policy disproportionately impacts on minority ethnic women, who make up 85% of women using Maternity Action's Maternity Care Access Advice Service, which advises women”

on such matters.

The British Heart Foundation said:

“The prevalence of heart failure, stroke, and mini stroke in adults with learning disabilities in England is higher than the general population, and circulatory diseases are one of the main causes of death in people with learning disabilities. For the most part, this can be attributed to differences in the social determinants of health.”

The Royal College of Paediatrics and Child Health said:

“Child health outcomes in England are some of the worst in Europe… Our State of Child Health 2020 report reveals a widening gap between health outcomes across nearly 30 indicators. It shows that children living in more deprived areas have worse health outcomes than their peers living in less deprived areas… The COVID-19 pandemic has also highlighted and accelerated the devastating impact of health inequalities.”

Tourette’s syndrome

Judith Cummins Excerpts

Tuesday 25th January 2022 Westminster Hall

[Judith Cummins (in the Chair)]

Before we begin, I remind Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with current Government guidance and that of the House of Commons Commission. I will call Conor McGinn to move the motion and then I will call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Conor McGinn (St Helens North) (Lab)]

I beg to move,

That this House has considered the treatment and study of Tourette’s syndrome.

It is a pleasure to serve under your chairmanship, Ms Cummins. I am delighted to have secured this debate on Tourette’s syndrome and how a lack of provision for research, diagnosis and treatment is impacting on individuals and families across the United Kingdom.

First, it is worth explaining what Tourette’s syndrome is. In short, it is an inherited neurological condition that causes involuntary and uncontrollable motor and vocal tics. Tics usually start in childhood, around the age of six or seven, and can fluctuate in severity and frequency, potentially occurring in nearly any part of the body and in any muscle. This can be painful, as one might imagine, and of course very debilitating, even disabling. Tourette’s is not often experienced in isolation. Up to 85% of those with Tourette’s syndrome will also experience co-occurring conditions and features, which might include attention deficit hyperactivity disorder, ADHD, or obsessive compulsive disorder, OCD, and indeed anxiety. These can be equally challenging, if not in some cases more challenging to manage than tics.

By far the biggest misconception about Tourette’s is that it is a condition that simply makes people swear or say socially inappropriate things. Involuntary swearing is a symptom of Tourette’s syndrome, but it affects only a minority. Ninety per cent. of people with Tourette’s do not have this symptom. However, having secured this debate, in my experience it is the single factor that those I have spoken to—colleagues in this place and others—commonly think of as the defining characteristic of Tourette’s. That goes to the heart of the challenge that we have in addressing some of the misconceptions about this condition.

Despite Tourette’s syndrome affecting the quality of life of over 300,000 people here in the UK—including, figures indicate, approximately one school-age child in every 100, most of whom are undiagnosed—this is a condition that, although relatively prevalent, remains widely misunderstood. Indeed, it is often deeply stigmatised and mocked throughout society. The stigma cannot be overstated, and the impact of it is very real. A recent study published in the Journal of Developmental and Physical Disabilities in 2021 outlined just how many participants faced discrimination in numerous aspects of life: 75% in education, 71% in their social lives, 61% on public transport and 54% in employment. A 2017 study concluded that people with Tourette’s are over four times more likely than the general population to take their own lives.

The reason I applied for and am leading today’s debate is to support my constituent Emma McNally, a St Helens mum who first wrote to me in July 2020. Her son was diagnosed with Tourette’s syndrome aged nine and could access regular appointments under the care of an excellent neurologist at Liverpool’s Alder Hey Hospital, which I know is familiar to the Minister. The retirement of the specialist in March 2020 left a gaping hole in provision locally and Emma’s son was discharged, with no one able to take him on. Unacceptably, to this day he has been left without the care he needs.

Emma’s journey—from local St Helens mum, living in Parr in my constituency, who contacted her local MP—to national campaigner and now the chief executive of the national charity for Tourette’s has done a great deal to highlight and raise awareness of this condition. Her e-petition on Tourette’s, submitted through the mechanism we have in this House, secured 71,000 signatures, which reflects the clear strength of feeling across the country for better care and services. She is fighting tenaciously on behalf of families around the country. Although her petition sadly fell just short of the threshold required for automatic discussion in this House, I am glad that we are having today’s debate, which goes some way to doing justice to her brilliant work and the importance of this issue. I have been contacted by more than 30 colleagues from all parties across the House, from all parts of the United Kingdom, who have expressed their support. I want especially to mention the Minister’s colleague and the erstwhile Parliamentary Private Secretary at the Department of Health and Social Care, the hon. Member for St Austell and Newquay (Steve Double), who has worked with me over the last year on this issue. He is prohibited from actively participating in this debate because he is now in the Government Whips Office.

The debate is long overdue. The last time the House met to debate Tourette’s syndrome was in 2010. Back then, the charity Tourettes Action held a list of 44 consultants in the UK with a special interest in Tourette’s syndrome. Now, there are only 17 who provide care in the NHS and will see children, and there are none in the north-west. I am sad to say that the picture for those living with this condition and their families has got worse over the last decade, and it should be getting better. We need to change this.

Families tell me that there is a significant and urgent need for specialist services and clinicians to bolster early diagnosis and rapid treatment. Early intervention in Tourette’s cases could reduce the more pernicious, longer-term strains on an individual’s mental and physical health and wellbeing, as well as on that of their friends, families, colleagues and teachers, by giving them a clear diagnosis and an idea of who to turn to.

Menopause (Support and Services) Bill

Judith Cummins Excerpts

2nd reading
Friday 29th October 2021 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

It is an honour to speak in the debate. I rise to support the Bill in the name of my hon. Friend the Member for Swansea East (Carolyn Harris), which I proudly put my name to. She has led the campaign on the Bill with her well-known enthusiasm, commitment and integrity. I am sure the whole House will join me in commending her on her approach.

[Hon. Members]

Hear, hear!

[Judith Cummins]

I will speak on one aspect of HRT and menopause: the link with osteoporosis. I do so as the co-chair of the all-party parliamentary group on osteoporosis and bone health. As I have said before, menopause is an important time for bone health. 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 bone density more rapidly in the years following menopause. With that loss of bone density comes reduced bone strength and a greater risk of breaking bones. One of the many reasons that I support my hon. Friend’s Bill is that it is essential that women are properly supported around the time of menopause not just to assess their risk of osteoporosis and fractures but to be given appropriate advice and medication, including hormone replacement treatment, which reduces bone loss and the risk of fractures.

HRT is available only on prescription, and currently those accessing it are charged every time. That must change. The Bill’s provisions would be incredibly effective for the majority of women who take HRT. A recent survey of 1,000 women by Newson Health found: just one in five do not receive HRT as a repeat prescription; 86% receive a prescription for three months or less at a time; and 20% spend more than £150 on their NHS HRT prescriptions each year. The Bill’s provisions would create a useful cost saving for so many women accessing this important treatment.

Importantly, the Bill would also legislate for menopause for the first time and revolutionise how those who go through menopause are treated. Access to HRT must be widened to tackle misconceptions and ensure that those going through menopause can access the hormones to protect their bones and ease their experiences. Better education is needed in schools and for healthcare professionals to ensure that menopause symptoms are easily recognised and not misdiagnosed, as my hon. Friend and many others have said.

I am proud not just to help break the silence on the silent disease of osteoporosis but to break the taboo on talking about menopause, which is shrouded in mystery for many despite affecting over half the population at some point in their life. I support this Bill, which would undoubtedly help so many women to keep their bones safe and well.

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.