Osteoporosis

Debate between Judith Cummins and Peter Dowd

Thursday 26th October 2023 Commons Chamber

[Judith Cummins]

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

[Peter Dowd (Bootle) (Lab)]

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

[Judith Cummins]

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

NHS Dentistry

Debate between Judith Cummins and Peter Dowd

Thursday 20th October 2022 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

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

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

[Peter Dowd (Bootle) (Lab)]

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

[Judith Cummins]

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

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

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

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

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

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

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

Liverpool Port Access: Rimrose Valley

Debate between Judith Cummins and Peter Dowd

Wednesday 7th September 2022 Westminster Hall

[Peter Dowd]

My hon. Friend has hit the nail on the head. We want to ensure that air quality is as good as it can possibly and practically be, given the set of circumstances. It is the role of us all, including the Government, to maintain that. I will touch on that later, but it is a very important point. I repeat that all these themes are inextricably linked.

Rimrose Valley was a lifeline for the thousands of people surrounding it during the covid-19 pandemic and the lockdown restrictions. It was a huge asset to the community during that time. Many homes around there do not have the luxury of a garden or a yard, so large public green spaces were essential. We all know that that is what the Victorians recognised—they certainly did in Liverpool, Birkenhead and such places. They built massive parks to ensure that people could get out, have a walk, enjoy themselves and get some respite from the places where they may have lived or the work that they may have done. There is a tradition in Britain of having large, open spaces, especially in some of the bigger cities, such as Liverpool.

Nearby communities were severed in two—I am reminiscing again—when another National Highways road, the A5036 trunk road, was built in the 1970s. Known as Princess Way, it is closer to the docks, and communities have never recovered from it. The proposed route would compound their misery, as the two roads would feed into that section of the road, splitting the community yet again. It is a case of history repeating itself, with absolutely no lessons learned or care for the potential damage caused. It is a “computer says no” approach to road planning.

The proven theory of induced demand shows that building more roads stimulates more traffic and does not necessarily tackle the underlying problems. To some extent, we have seen that locally with the bypass at Broom’s Cross, which alleviated congestion temporarily but is now another congested road at peak times. This is not about being anti-road or nimbyism; it is about ensuring that due diligence is undertaken when any project of this nature is proposed. I know that the Minister will be well aware of that, given the schemes in his own constituency.

Let us move on to the issue of the port of Liverpool, which is the elephant in the room—and it is a particularly large elephant. The port of Liverpool has been permitted an expansion, with little thought given to the infrastructure needed to support it. If there is to be an expansion, rightly or wrongly—I do not judge that at the moment; it is not for me to make that judgment—let us at least have the foresight to ensure that the environmental impact on communities is a significant factor in the design of any scheme that seeks to accommodate it. We do not want retrofitting, but if we are going to have a retrofit, it has to be proper and appropriate. As my hon. Friend the Member for Sefton Central has touched on, decades of activity have had a negative impact on surrounding communities, with increased air pollution from heavy goods vehicles and ships at the port. Additionally, the port generates noise and light pollution, which is a blight on citizens who live alongside the port. We have to mitigate that as much as possible.

Despite the port owner’s claims that it is neutral about the type of port access scheme or project, a freedom of information request submitted by campaigners reveals that the Peel Ports Group has “worked tirelessly” with National Highways in the lead-up to the project being announced. It has a vested interest. I am not criticising that, but it would perhaps be one of proposal’s bigger beneficiaries and, whether we like it or not, many people are asking how it can be right that a private company potentially gets to determine or have a massive say in how public money is spent. If there is to be a port expansion, let us make sure that an access project to the port is as environmentally friendly as practically possible. This is not about being anti-business; it is about balancing the needs of the various interested parties. That balance has not been met, and the environmental impact is being felt by the local community of thousands of people.

The road proposal conflicts with the Government’s own policies. Let us take the climate emergency as an example. The transport sector is the single biggest contributor to climate-wrecking CO₂ emissions in the UK. It is the only sector that has seen emissions go up, not down. CO₂ emissions stem from both the construction and subsequent use of roads. In my view and that of many other people, the project would be used to support port-related HGV traffic—the worst polluters on our roads—without a real assessment of alternatives that are as sustainable as they are practical.

[Judith Cummins (Bradford South) (Lab)]

On that point about wider issues to do with transport funding, does my hon. Friend agree that there seems to be a lack of equity in transport funding across the country? I am thinking of my own patch in particular. Bradford is not included in the Northern Powerhouse Rail; we are without full station access. Does he think that this a problem throughout the nation?

[Peter Dowd]

I am pleased that my hon. Friend raises this issue. She has spoken many times on transport issues and, to be frank, she really does now what she is talking about. I may come to that issue later, and I am pleased that she has highlighted it.

The issue of pollution flies in the face of the climate emergency declaration. It is apposite that my hon. Friend the Member for Sefton Central has noted the public health crisis in air quality. He referred to 40,000 deaths a year and related illnesses. Public Health England has said that that needs to be tackled. Protection of green spaces is seen as vital, and the Government’s own 25-year environment plan sets out targets, yet in certain situations National Highways is, in my view, ignoring those objectives.

On levelling up, the north receives on average about seven times less expenditure per capita than the south. If the Government are serious about levelling up, they need to reflect that in projects such as this and give the community the budget it needs to do the job. That is the point that my hon. Friend the Member for Bradford South (Judith Cummins) is making.

Health Inequalities: Office for Health Improvement and Disparities

Debate between Judith Cummins and Peter Dowd

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.”

World Menopause Month

Debate between Judith Cummins and Peter Dowd

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.