National Cancer Plan

Martin Vickers Excerpts

Tuesday 4th February 2025 Commons Chamber

[Andrew Gwynne]

As my hon. Friend says, tackling health inequalities is a key priority for this Government, in relation to our health mission but also more generally, when it comes to some of the big conditions such as cancer. In areas such as his and mine, the prevalence of cancer is greater, because of the industrial legacy, and also because the prevalence of smoking is still much higher than the national average. I commend the work of his local diagnostics team, and we need much more of that best practice to be spread across the areas that need it the most.

[Martin Vickers (Brigg and Immingham) (Con)]

I welcome the Minister's statement. He will be aware that a routine prostate cancer screening programme would save many lives. Can he give any indication of when it will be introduced?

[Andrew Gwynne]

I am grateful to the hon. Gentleman for that question, and also for the written parliamentary questions about prostate cancer that he and a number of other Members have tabled. According to the current guidance, screening for prostate cancer is not recommended in the UK because of the inaccuracy of the current best test for prostate-specific antigen. Indeed, it could actually harm men, as some might be diagnosed with a cancer that would not have caused them problems during their lives. However, I am looking at this carefully, and I know that further information has gone to the National Institute for Health and Care Research so that it can, perhaps, reach a different conclusion. Obviously, as technology and other mechanisms advance, this may well be an area where we can make inroads, but I am happy to work with the hon. Gentleman to ensure that every opportunity is met.

Speech and Language Therapy

Martin Vickers Excerpts

Monday 27th January 2025 Westminster Hall

[Several hon. Members rose—]

[Martin Vickers (in the Chair)]

I remind hon. Members that they should bob—as indeed they are doing—if they wished to be called to speak.

--- Later in debate ---

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

I thank my hon. Friend the Minister for giving way, and my apologies, Mr Vickers; I had to leave earlier for a ministerial appointment.

In 2018 my father suffered a stroke, and the staff at my local hospital, the George Eliot, could not do enough for him—they were absolutely fantastic. I know that my father stayed in hospital longer than he needed because that was the only way in which he could access the speech and language therapy that he needed, as well as the help to enable him to swallow. It was fantastic to see him recovering that speech because of their intervention. As he had served for nearly 50 years as a volunteer magistrate, it is wonderful to see him now being able to challenge my ideas and give his comments on my contributions in this House.

Last week, I held a consultation event in my constituency where a dietician told me that she felt there was not enough ability for her and her team, as well as speech and language therapists, to give help in the community. She was quite excited about our ideas for virtual wards and asked me, on her behalf, to plead with the Minister to ensure that we give recognition to putting more speech and language therapy in the community. I know that my dad would have been very pleased to receive that.

[Martin Vickers (in the Chair)]

Order. Interventions should be brief— I was very generous.

[Stephen Kinnock]

I thank my hon. Friend for that wonderful example of the personal experience that so many Members on all sides of the House have of this service, which can be life-changing for so many people. I pay tribute to her father for coming through in the way that he has, and I also pay tribute to all those in the community care services. The care that he received was obviously vital and life-changing for him, and that is wonderful to hear.

My hon. Friend raises an interesting point on virtual wards. It is absolutely right that we build on the innovation and opportunities that they offer. Later in my speech I will say a word or two on the three big shifts that we will put at the heart of our 10-year plan: from hospital to community, from sickness to prevention and from analogue to digital. I think the virtual wards are a great illustration of how we can bring those three seismic shifts together to transform our health and care system. I can tell my hon. Friend that the 10-year plan is the right forum and opportunity for that, and I encourage her and all Members to get involved in that plan, which can be accessed at change.nhs.uk. Hon. Members may also wish to organise roundtables and discussion fora in their constituencies to talk exactly about the kind of innovations that we are looking to bring to the fore.

It would be remiss of me not to pay tribute to Mikey Akers; he is an outstanding young man and truly an example to us all. Of course, I also pay tribute to Chris Kamara and the whole team campaigning with such vigour and verve on this vital issue. I would of course be delighted to meet Mikey, Chris and the team at a mutually convenient time to discuss the project and how to take it forward.

As our debate today has shown, speech and language therapists work with people of all ages, providing specialist care and support. Their work takes place across a range of different settings in health, care and education. It responds to a wide range of communication needs, from those of children whose speech is slow to develop to those of older people whose ability to speak has been impaired by illness or injury, for example as a result of Alzheimer’s, a stroke or head injury. Speech and language therapists also support patients who have difficulties with eating, drinking and swallowing.

The variety of support that speech and language therapists provide means that they play a key role in a wide range of care pathways. A speech and language therapist is a core part of the multidisciplinary stroke rehabilitation team, providing long-term rehab for stroke patients. It is not just patients they support—a speech and language therapist also works with a patient’s family or carers on how best to facilitate communication and support the patient, sharing their expertise to upskill the support network of the person they are caring for.

Another example of the work of speech and language therapists is the role they play in supporting autistic people. They can offer interventions to improve communication skills where needed. For individuals who are unable to speak, speech and language therapists can design alternative communication systems.

Moreover, as part of a wider multidisciplinary team, speech and language therapists also contribute to a young person’s education, health and care plan. A therapist will carry out a detailed assessment of an individual’s speech, language and communication abilities, which will help to determine the additional support they may need to access education.

However, it is the key role that speech and language therapy plays in care and support pathways that creates complexity in funding and commissioning models for it. In some cases, full care pathways are commissioned as opposed to individual services within a particular pathway, while in some areas community health services are commissioned using block contracts. Both these things create challenges in clearly identifying specific funding streams for specific services.

Speech and language therapy is generally commissioned locally by integrated care boards and in some cases by local authorities. Funding is allocated to ICBs by NHS England. The allocations process uses a statistical formula to make geographical distribution fair and objective, so that it more clearly reflects local healthcare needs and helps to reduce health inequalities. This process is independent of Government, and NHS England takes advice on the underlying formula from the independent Advisory Committee on Resource Allocation. NHS England is also continuing to work with ICBs to develop their financial plans.

NHS planning guidance sets priorities for systems, and the Secretary of State has confirmed that this key document will be published in due course—indeed, imminently. Each ICB will then commission the services they need for their local area, taking into account their annual budget, planning guidance and the wider needs of the population they cover. Local commissioners are responsible for ensuring that their offer is tailored to the local population and that their communities are able to access the specific support they need. NHS England continues to work with ICBs to develop their financial plans, to ensure that communities can access the healthcare support they need when they need it. A complex patchwork quilt of systems and processes needs to be gone through by the people who know best about what is required in their community—those at the coalface—to deliver the care that is needed.

That said, I reassure hon. Members that the Government are committed to funding the NHS properly. We recently provided a £26 billion boost for health and social care at the Budget through the policies and choices that the Chancellor laid out. We have been clear that funding must go hand in hand with reform, and we will ensure that every penny of extra investment in the NHS is well spent.

The community health services data plan, published by NHS England last year, goes some way to improving data about community health services. The plan sets out how the NHS aims to improve the quality and relevance of data, and the timeliness of its publication. It will improve our understanding of demand and capacity across community health services, including speech and language therapy, with high-quality data to generate helpful insight to shape interventions and improvements to services.

Data and clear funding lines are not the only challenge facing speech and language services. Our children and young people are stuck on waiting lists, some for more than two years. More than 65,000 children and young people were on a waiting list for speech and language therapy in November 2024. We know that more than 23,000 have been on those waiting lists for longer than 18 weeks. That is simply too long. Waiting times for adults are not as bad as those for children and young people, but there were more than 23,000 adults on waiting lists for speech and language therapy in November 2024.

We hear a lot about the increasing demand for speech and language therapy, and about the fact that our existing workforce are struggling to meet the increase in referrals—pretty much every hon. Member said that in the debate. The reason for the increase in waiting times is multifaceted. Although services are still recovering from the pandemic, there has also been an increase in demand, and analysis from the Royal College of Speech and Language Therapists shows that demand is increasing faster than the workforce are growing.

Speech and language therapy covers a broad spectrum of support. Therapists are often dealing with complex long-term cases, requiring a resource-intensive approach to supporting their patients, and referral pathways are often complex. Those referral pathways, and the services offered, also vary regionally.

As my hon. Friends pointed out, we are coming off the back of 14 years of failure, which have led to serious workforce challenges, and the reality is that we have a mountain to climb on recruitment and retention. The speech and language degree apprenticeship is now in its third year of delivery and offers an alternative pathway to the traditional degree route into a successful career as a speech and language therapist. We think that that has had a positive impact on recruitment, but much more needs to be done. We want to remove the barriers to training in clinical roles, which is why eligible students get a non-repayable grant of £5,000 a year. Further financial support is also available for childcare, dual accommodation costs and travel, but we know that that does not go far enough.

The training and retention of our talented NHS staff are absolutely key to our mission of rebuilding a health service that is fit for the future. A central part of the 10-year plan concerns our workforce and how we ensure that we train and provide the staff, technology and infrastructure that the NHS needs to care for patients across our communities.

This summer, we will publish a refreshed long-term workforce plan to deliver the transformed health service that we will build over the next decade and that will treat patients within the 18-week constitutional standard once again. We will ensure that the NHS has the right people in the right places, with the right skills to deliver the care that patients need when they need it. We must acknowledge that tackling this will take time, but we are committed to training the staff we need to ensure that patients are cared for by the right professionals and in a timely manner.

Community health services, and speech and language therapies in particular, speak to the three seismic shifts that will drive our 10-year plan: shifting healthcare from hospitals to communities, focusing on prevention, and embracing digital care. Effective, user-centred services are invariably delivered by multidisciplinary teams that are based in the communities they serve. The early language and support for every child—ELSEC—programme provides an example of different professions coming together to support children and young people, with local authorities, schools and the health and care system working together in the community. In our view, that is a potential building block for how our neighbourhood health service should work.

Nine regional pathfinder partnerships are trialling new ways of working to better identify and support children in early years settings and primary schools. We have asked the pathfinders to consider how to make the model sustainable after the project period. The therapy assistant roles have the potential to attract individuals to train to become speech and language therapists through the apprenticeship route. The ELSEC workforce model focuses on recruiting pre-qualification speech and language therapy support workers into the workforce to improve the capacity and knowledge of staff who support children with emerging or mild to moderate speech, language and communication needs in early years and school settings.

That will be important, because we hear a lot about the challenges our workforce face in meeting the increasing demand for speech and language therapy. Across all community health services, increasing demand and workforce availability are frequently cited as the main reasons that systems are struggling to reduce waiting times and get on top of the demand. The interim programme evaluation is due to be published in February, at which point we can explore insights into the effectiveness of ELSEC delivery at a local level. Reporting data shows that therapy support teams have supported around 13,000 children so far, and just over 1,000 staff in settings have been upskilled in delivering interventions. That is an encouraging set of achievements, and I will continue to work with my ministerial colleagues and officials across my Department and the Department for Education to support this important programme.

I referred earlier to our ambition to build a neighbourhood health service. We are firmly committed to moving towards our vision for such a service, and community health services will be an essential building block of it—keeping people healthy at home and in their communities, and providing more preventive, proactive and personalised care. Later this year, we are going to trial neighbourhood health centres, which will bring together a range of services and will ensure that healthcare is closer to home and that patients receive the care they deserve.

We have heard about the importance of adequate funding and timely access to speech and language therapy services for children and adults with communication and swallowing needs. The importance of such services is not in doubt, nor is the life-changing impact that timely access to high-quality services can have, from helping a child to develop the right skills to engage with education to supporting adults to regain their ability to speak. Speech and language services are facing challenges, but sustainable, accessible and high-quality community health services are vital, and I will continue to work closely with NHS England, the Department of Health and Social Care and the Department for Education on this critical issue.

Hospice and Palliative Care

Martin Vickers Excerpts

Monday 13th January 2025 Commons Chamber

[Martin Vickers (Brigg and Immingham) (Con)]

First, I congratulate the hon. Member for Wimbledon (Mr Kohler) on securing this debate. As a member of the Backbench Business Committee, I can tell him he made a very convincing argument for this debate.

Like others, I suspect, one of my aims this evening is to praise my local hospices, Lindsey Lodge in Scunthorpe and Saint Andrew’s in Grimsby, which both provide care to my constituents. I have particular affection for St Andrew’s, as my father passed away in its care, and my mother actually died on the day she was supposed to move in. That was more than 30 years ago; I have seen how they have developed in the years since, and they continue to provide absolutely superb care. Of course, demand is increasing: demographics have changed, and people are living longer. Hospices do actually ease the burden on the NHS.

St Andrew’s has 133 permanent staff, but more than 400 volunteers. As it happens, I visited St Andrew’s last Friday—the meeting was scheduled some weeks ago, but it was convenient timing for this debate. I do have a specific question for the Minister relating to St Andrew’s, which I will come to later. Voluntary donations in areas such as north-east Lincolnshire are crucial, as they are elsewhere. However, with relatively low incomes and very low property values, when people leave a legacy of a share in their property, perhaps, that does not realise the same sort of return as it would in many other parts of the country.

I could provide a whole list of what St Andrew’s hospice delivers; instead, I will give one or two significant statistics. It delivers more than 3,000 adult in-patient bed nights and 694 children’s hospice at home sessions; it has physiotherapy, creative therapy and social work contacts; it provides spiritual care for its patients and their families. The cost of operating all parts of the charity in 2024-25 is more than £18,000 a day; only four years ago, it was £14,000 a day—a significant rise, as Members will appreciate. Some 80% of that cost has to be earned or raised by the hospice, which, in times of economic challenge, is increasingly difficult. Its statutory income for ’24-’25 is expected to be only 21.5% of its total income. Currently, for every £1 of statutory income, St Andrew’s has to raise £4.60, posing a considerable financial challenge for the hospice, the volunteers and the fundraisers.

As we know, healthcare inflation runs ahead of general inflation, and hospices have to try to keep pace with statutory salary increases related to the national minimum wage. As with the social enterprises that provide social care in north-east Lincolnshire, hospice staff do not automatically get the increases that go to NHS workers, and the gap is inevitably widening. I raised this matter with the Secretary of State at health questions last week, and I think it will be a growing problem with further NHS wage increases later this year, as the gap between NHS workers and those providing care in hospices and social enterprises widens; it will be about 10% by the time the next increase comes. Needless to say, that is causing difficulties for those employees.

I have a specific question for the Minister, which I will write to him about in the next day or two—I do not expect him to have all the details of St Andrew’s in his pack. St Andrew’s gets only 21% of its income through statutory contributions, which I understand is about 12% below the national average; this has come about because of a whole series of historical adjustments. My plea to the Minister is that St Andrew’s is brought up to the national average as soon as possible.

Oral Answers to Questions

Martin Vickers Excerpts

Tuesday 7th January 2025 Commons Chamber

[Wes Streeting]

I agree with my hon. Friend. I am proud that this Government have taken quick action within our first 100 days. Thanks to the Employment Rights Bill, which is UK-wide legislation, this Labour Government in Westminster are giving the Scottish Government the tools they need to do the job of establishing fair pay for care staff. If they do not do it, Anas Sarwar and Jackie Baillie will.

[Martin Vickers (Brigg and Immingham) (Con)]

In north-east Lincolnshire, a social enterprise employs 800 staff providing health and social care. I have been approached by many staff who are unhappy that they have not benefited from the increases that NHS staff have gained. They have the support of the Royal College of Nursing and are looking for the Government to provide Care Plus Group, which employs them, with the resources to ensure that they are recompensed to the same level. What is the Secretary of State able to pass on to them?

[Wes Streeting]

I am grateful to the hon. Member for that question. With our fair pay agreements, we will be bringing together government, public and private sector employers and staff trade unions to negotiate the future for fair pay agreements that will benefit care workers across the system and give them the professional status and career progression they deserve. The Chancellor, through the Budget, also took steps to ensure that we could invest in our social care services. I am deeply saddened that the Conservative party has not supported that investment.

Hospice Funding

Martin Vickers Excerpts

Thursday 19th December 2024 Commons Chamber

[Karin Smyth]

I thank my hon. Friend for his contribution and, indeed, for his singing. Those events bring joy to people at a particularly difficult point in their life, and they are very welcome.

[Martin Vickers (Brigg and Immingham) (Con)]

Any increase in funding for the hospice movement is of course welcome, but let us be honest: it is giving with one hand and taking with the other. The two excellent hospices that serve my constituency—St Andrew’s in Grimsby and Lindsey Lodge in Scunthorpe—tell me they want certainty. The Minister says they will be told early in the new year. Can the Minister give a categorical assurance that in the first half of January hospices will be told how much extra they are getting from the £100 million she mentioned?

[Karin Smyth]

I thank the hon. Gentleman for welcoming the announcement. As I said, we will be working with the sector in the new year and then we will make allocations accordingly.

National Insurance Contributions: Healthcare

Martin Vickers Excerpts

Thursday 14th November 2024 Commons Chamber

[Karin Smyth]

The hon. Lady tempts me to make specific commitments, which I am not prepared to do, as I am sure she understands. She is right that people are expressing concerns about some of these decisions. That is because they are in such a precarious situation as a result of what we have inherited from the past 14 years. As the Prime Minister and the rest of the Government have been clear throughout the election and afterwards, we have a 10-year plan because it will take a long time to fix the foundations and build up the sector to make it more resilient and sustain it for the future. We want to fix those foundations, and we will talk closely with everyone affected over the coming months, but this will take a long time. Those providers are precarious because of the mess that we inherited.

[Martin Vickers (Brigg and Immingham) (Con)]

Earlier this week, I received a letter from the Lincolnshire and Nottinghamshire air ambulance, a charitable healthcare provider. The national insurance changes will add £70,000 a year to its costs, and if it is forced to close, lives will be lost. May I urge the Minister—I know she will want to protect this service—to do all she can to ensure that that air ambulance and others across the country are not hit by this tax?

[Karin Smyth]

I assure the hon. Gentleman that since we were elected, the Government have already taken action to secure extra investment in the health and social care system, and we are committed to building a thriving health and social care system for the rest of the 21st century.

Breast Cancer: Younger Women

Martin Vickers Excerpts

Tuesday 12th November 2024 Westminster Hall

[Martin Vickers (in the Chair)]

I will call Vera Hobhouse to move the motion, and I will then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention in 30-minute debates.

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered breast cancer in younger women.

It is a pleasure to serve with you in the Chair, Mr Vickers. I thank the Minister for being here to respond.

Every woman deserves a fair chance against breast cancer, no matter her age. It is the most common type of cancer in the UK. Most women who are diagnosed are over 50, and it is therefore a disease often associated with older women, but young women are at risk, too. Breast cancer in younger women is often caught later when it is more advanced. That is because there is no routine screening and too often symptoms get dismissed as something less serious. That must change. Awareness and early detection are crucial, no matter your age.

The issue arose for me during a constituency surgery when my Bath constituent Lucy shared her story, which resonated with me because my nephew’s mother died many years ago of breast cancer aged 35. In 2021 Lucy, who was 38, had two young children and was diagnosed with primary breast cancer. She underwent a mastectomy, chemotherapy and radiotherapy before being given the all-clear. In 2024, when she was 41, a self-initiated MRI scan tragically came back showing that her cancer had returned, leading to a diagnosis of secondary breast cancer, which is currently incurable. In both cases she found it a struggle to be diagnosed.

The first time, despite her mother having had breast cancer and Lucy presenting with a lump, at least three different doctors told her that it was likely to be hormones and nothing to worry about. It was not until she requested the biopsy, which ultimately came back showing it was cancer, that the diagnosis was made. The second time she repeatedly voiced concerns about a symptom that she was experiencing, but she was repeatedly assured that it was just a side effect of the treatment. Still concerned, she approached the GP, who did some initial tests but ultimately suggested that her worries were anxiety-driven. After that appointment she came out and sobbed in her car.

Searching for peace of mind, Lucy then paid privately for a breast MRI, which tragically revealed that the cancer had returned, but by then it was too late. In both cases—first by requesting the biopsy and secondly by initiating an MRI—it was up to Lucy to fight for a diagnosis.

NHS Dentistry: South-west

Martin Vickers Excerpts

Tuesday 12th November 2024 Westminster Hall

[Richard Foord]

I agree. One way in which we can share best practice is by thinking about not only training places, but the recognition of qualifications. After the UK’s exit from the European Union, we saw a breakdown in the number of EU dentists wanting to stay or being attracted here. With fewer eastern European dentists, in the south-west of England, for example, we need to look again at dental qualifications and whether there are some dentist qualifications we might recognise that might make it more attractive to be a practising dentist in the UK.

The rural south-west of England needs to be able to expect the same level of NHS dentistry provision that we see in urban areas across the country. Will the Minister commit to the reform of NHS dentistry so that constituents such as Mike and Shirley do not have to go into the red or forfeit heating their homes to get dental care that avoids them going to acute hospitals such as the Royal Devon and Exeter hospital at Exeter?

[Martin Vickers (in the Chair)]

I remind Members that if they wish to speak, they should bob. If they could limit their contributions to an absolute maximum of four minutes, we will probably get everyone in. But it is going to be a squeeze, particularly if there are too many interventions.

Hospice Funding

Martin Vickers Excerpts

Monday 22nd April 2024 Commons Chamber

[Peter Gibson (Darlington) (Con)]

It is a pleasure to follow the hon. Member for Enfield, Southgate (Bambos Charalambous); it is great to see him in the Chamber after his performance yesterday in the London marathon. I congratulate him on completing it.

It is a pleasure to be called to speak in this long-awaited debate, and I thank and congratulate my hon. Friend the Member for Hastings and Rye (Sally-Ann Hart) for moving the motion. I thank hospices around the country that have engaged with me in my preparation for today’s debate, and I thank the Hospice UK team—Toby, Katie and Olivia in particular—for their ongoing support for me and the all-party parliamentary group on hospice and end of life care, which I co-chair along with Baroness Finlay of Llandaff.

I draw the House’s attention to my entry in the Register of Members’ Financial Interests: I am a trustee of North Yorkshire Hospice Care, which operates both Herriot Hospice Homecare and Saint Michael’s hospice in Harrogate. I have served as a trustee of that hospice for over a decade, and have seen the difficulties that piecemeal commissioning causes for our precious hospices. To my mind, this debate is not simply about asking the Government for more money—we know that there are serious public financial challenges post pandemic—but an opportunity to discuss on the Floor of the House solutions to the challenges that our hospices face. I thank the Backbench Business Committee for allowing us to have this debate. The number of Members who wish to speak in support of their local hospices today is testament to how much each and every one of our communities values its local hospices.

This is a matter of life and death. The hospice movement is there to deliver good deaths; that might seem a strange thing to say, but palliative care delivered in the right environment—be that a hospice, a children’s hospice, or a person’s home through a hospice at home service—is a truly wonderful thing. Those precious final few weeks of a person’s life are imprinted into our memories, and it is right that those who are dying, and those who are loving, supporting and caring for them, do so in an environment where there is proper funding and commissioning, and where we can plan and prepare to provide continuing care.

[Martin Vickers (Cleethorpes) (Con)]

I thank my hon. Friend for his contribution, as well as the Members who made the previous contributions, both of which focused to some extent on palliative and end of life care. Two hospices serve my constituency, St Andrew’s in Grimsby and Lindsey Lodge in Scunthorpe; both provide an excellent end of life environment. Does my hon. Friend agree that if we are to defuse the movement towards encouraging assisted dying, we need to ensure that our hospices provide a service as an alternative?

[Peter Gibson]

I am very grateful to my hon. Friend for his intervention. I have my personal views about assisted dying, and I am sure that in the fullness of time, this House will debate that issue. This debate is not about assisted dying: it is about our hospices, and how we fund and support them. With the greatest of respect to my hon. Friend, conflating the two issues is not helpful.

Even post death, our wonderful hospice movement provides much-needed bereavement care to those who have suffered the loss of a loved one. The Health and Social Care Act 2021 made provision for the very first time for the commissioning of palliative care. That is a landmark. Integrated care boards around the country now have responsibility for commissioning palliative care to meet the needs of the community that they serve, which is a good thing. It ensures that local commissioners, working together with local providers and local representatives, can deliver the palliative care needs of their respective communities.

NHS Dentistry: Recovery and Reform

Martin Vickers Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

I hope the hon. Gentleman will publicise the new patient premium, because that is one of the levers through which we will unlock places for new patients. I remember that he has taken an interest in this issue. I very much understand the point about location. We have set strict criteria for how dental vans will be deployed, but the new patient premium is across the country. We want as many people as possible to see NHS dentists and fill those 2.5 million more appointments.

[Martin Vickers (Cleethorpes) (Con)]

I particularly welcome the initiative to improve services in coastal and rural areas. The Health Secretary and I are constituency neighbours, and she will know the complexities of delivering local services in what we know as greater Lincolnshire, because her constituency is in the east midlands and mine is in Yorkshire and the Humber. Can she guarantee that the whole of greater Lincolnshire, from the south of the county up to Barton-upon-Humber, will receive the benefits of the new proposals?

[Victoria Atkins]

I am delighted to inform my hon. Friend and neighbour that the new patient premium applies across England, and of course people can move to the dental practice that can offer them the services they need, so I trust that his constituents will be as happy as mine.