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.

COP10: WHO Framework Convention on Tobacco Control

Martin Vickers Excerpts

Thursday 18th January 2024 Westminster Hall

[Dame Andrea Leadsom]

No, to put it simply—and I do not know if that is the case. I am grateful to my right hon. Friend. As he knows, I always listen carefully to his usually very wise words, so I will take that away and get an answer for him.

We should be proud of our record on keeping tobacco control at the top of not just the national agenda, but the global agenda. We are a world-leading trailblazer in tobacco control, and our delegation to COP10 will proudly set out our unique and sovereign approach. My firm belief is that our policy could save countless lives in this country and, through our example, overseas. Crucially, we are using the conference to showcase UK plc to the world.

I say to the hon. Member for Linlithgow and East Falkirk (Martyn Day) that I have been delighted with the collaborative, cross-party approach that colleagues in the devolved Administrations have taken to our smoking and vapes Bill. However, importantly, at an official level, there has recently been an agreed approach to the COP10 delegation. I hope that reassures him that all views from all parts of the United Kingdom are carefully being taken into account.

COP10 will be a forum in which we can exchange ideas with countries such as Canada and Australia. We will back other countries in their efforts to kick the habit, but we will also present our case as strongly as we can. We are going beyond the convention in certain areas, and we have a different view in others. All colleagues should be reassured that we alone will decide what those views are, through our sovereign Parliament.

[Martin Vickers (in the Chair)]

Andrew Lewer has two minutes to wind up.

NHS Long-term Workforce Plan

Martin Vickers Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

The question started by saying that we do not want plans for the future, we want to deal with the present, and finished by asking if we can have a plan for the future rather than for the present. The plan sets out significant additional numbers. Significant investment is going into eye services here and now. Let me give the House one example: at King’s Lynn hospital, in addition to our investment in a new hospital to replace the reinforced autoclaved aerated concrete hospital, and in addition to the new diagnostic centre, I had the opportunity in the summer to open a new £3 million eye centre, which is doubling the number of patients who receive eye care in King’s Lynn. That is just one practical example of our investment in eye services now.

[Martin Vickers (Cleethorpes) (Con)]

May I add my words of condolence for Lord Kerslake, who served on the greater Grimsby regeneration board, which oversees regeneration in the Grimsby-Cleethorpes area? We greatly valued his experience and advice. Following the question from my hon. Friend the Member for Scunthorpe (Holly Mumby-Croft), it is important that we tie in dentists—and I would suggest GPs—to NHS services, but could they also be directed to areas of greatest need, such as northern Lincolnshire?

[Steve Barclay]

The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien) is looking at how we deliver more services within the existing contract, and at what incentives and reforms can be put in place to ensure that the parts of the country that find it hardest to recruit dentists are best able to do so, through both our domestic supply and international recruitment.

Oral Answers to Questions

Martin Vickers Excerpts

Tuesday 24th January 2023 Commons Chamber

[Maria Caulfield]

As the hon. Gentleman knows—we discussed the issue over the telephone last week—the decision was taken to wind down the Rosalind Franklin Laboratory because the number of PCR tests has reduced significantly and NHS laboratories can take that capacity. There is a residual service and additional use of the laboratory is being considered.

[Martin Vickers (Cleethorpes) (Con)]

I recently met a dentist in my constituency whose practice group operates over 19 sites where the rate for units of dental activity ranges from £25 to £36. He is convinced that there needs to be a uniform UDA rate to attract NHS dentists to areas such as Cleethorpes. Can the Minister consider that?

Urgent and Emergency Care

Martin Vickers Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

One of my reasons for going out with the London Ambulance Service—among others—over the summer was to answer the charge about what Ministers were doing, and to observe at first hand the challenges that the service had been facing. As the hon. Lady will know, performance has improved since the summer, but the service remains challenged. That is why we are considering a range of measures, such as boosting emergency departments, looking at pre and post-cohorting, looking at how we work with the taskforce, and looking at single points of access. One issue that paramedics emphasise to me is the need for, in particular, a better way for frail elderly patients to gain access to a single point for social care provision. We are working closely on that range of measures with colleagues in the London Ambulance Service.

[Martin Vickers (Cleethorpes) (Con)]

In recent weeks I have been supporting a constituent who has complained to the East Midlands Ambulance Service. The complaint centred on the fact that it took nine hours and 26 minutes following a 999 call for an ambulance to arrive at the home of my constituent’s mother. When she arrived at Scunthorpe Hospital, it took another two hours and seven minutes before she was handed over to the hospital staff. I find it particularly disturbing that the letter from the chairman of the East Midlands ambulance service, after explaining the procedure and protocol that was followed, says:

“I can confirm that the 999 call had been responded to appropriately.”

Needless to say, my constituent, who is a retired senior police officer and well aware of pressures on the emergency services, would not agree that it was dealt with appropriately. If I forward the details to my right hon. Friend the Minister, could he follow up with the East Midlands ambulance service and come back to me? Hopefully, that will mean the service provided to my constituents by the ambulance service can be improved.

[Steve Barclay]

I am very happy to ensure that that specific case, which is obviously concerning, is looked at. As my hon. Friend will know from my earlier remarks, we are boosting the number of 999 call handlers—those numbers are up and there are around 350 more call handlers than in September 2021—and we are also training more paramedics. Numbers are going up, but obviously demand has increased exponentially as well.

Oral Answers to Questions

Martin Vickers Excerpts

Tuesday 14th June 2022 Commons Chamber

[Sajid Javid]

I thank the hon. Lady for raising the importance of getting vaccinations right. She will know that we rely on the independent advice of our clinicians—the committee known as the JCVI—and I think it is right that it is independent. Ultimately, it decides on its advice, and it is for Ministers whether to accept it. However, she has made an important point about unpaid carers, and I will ask the JCVI to see if that can be properly considered in the autumn booster review.

[Martin Vickers (Cleethorpes) (Con)]

T6. 2002 I heard what the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), had to say about dentistry earlier, and I recognise the work she is doing to improve the situation. However, in northern Lincolnshire, like many other areas, we have very severe gaps in provision. Could the Minister outline what is being done to ensure that newly qualified dentists actually work in the NHS for a considerable time and that new practices are established in the areas where the need is greatest?

[Sajid Javid]

I am happy to respond to my hon. Friend. He is right that we of course want to ensure that everyone has timely access to NHS dentistry and that the profession is an appealing career choice. Health Education England has a dental education and reform programme, which will help retain new dentists in the NHS by placing training in areas of greatest need, and offer more flexibility and more career pathways. I can also tell him that, in Lincolnshire, commissioners are already looking at ways to support NHS dentistry through support such as the golden hello incentives.

NHS Dentistry: Lincolnshire

Martin Vickers Excerpts

Wednesday 20th October 2021 Commons Chamber

[Maria Caulfield]

My right hon. Friend makes an excellent point, which I was going to address. Officials tell me that the areas where we are seeing significant gaps are referred to as “sheep” and “seagulls,” with the sheep being rural areas and the seagulls being coastal stretches. They are the two areas of the country with a significant shortfall in NHS dentistry provision, and they are the two areas on which we will particularly focus.

[Martin Vickers (Cleethorpes) (Con)]

My constituency contains both sheep and seagulls. One of the problems, of course, is that rural villages and market towns are attracting increasing populations and we are seeing massive planning applications. I cite Barton-upon-Humber in my constituency as one example. What work is the Department doing with local authorities to make sure that, where there are major planning applications, public services and particularly dentistry are sufficient to meet the need?

[Maria Caulfield]

My hon. Friend makes a good point, and across Government Departments we are discussing the provision of both general practitioners and dentists for new developments. I am keen that dentistry is on a par with GP provision, because it is often an afterthought. I am keen that we push it up the agenda, and this debate helps.

Covid-19 Update

Martin Vickers Excerpts

Thursday 22nd July 2021 Commons Chamber

[Nadhim Zahawi]

That is a very important question. The JCVI is constantly reviewing the data from other countries that are vaccinating all children of 12 to 15 years old. Its concern has been centred around vaccinating healthy children. There is a very rare signal of myocarditis on first dose. The JCVI is awaiting more data on second dose. It will continue to review that and will come back to us, and, of course, we will come back to the House.

[Martin Vickers (Cleethorpes) (Con)]

In north-east Lincolnshire, the infection rates has been hovering at around 1,000 per 100,000 for the last couple of weeks, which is of obvious concern to my constituents. I am in regular touch with the Northern Lincolnshire and Goole NHS Foundation Trust, which is doing an excellent job, but could the Minister reassure my constituents that if additional resources are required by the trust, the Department will provide them? The trust has had a big expansion in demand for A&E over the last few days and the trust management asks whether the Department could step up the campaign to encourage people to use the 111 service.

[Nadhim Zahawi]

My hon. Friend’s constituency of Cleethorpes has now done 122,397 cumulative total of doses, which is a tremendous achievement. I will take away his request and come back to him once I have had the chance to discuss it with NHS England.

Do Not Attempt Resuscitation Orders: Guidelines

Martin Vickers Excerpts

Wednesday 21st July 2021 Westminster Hall

[Hannah Bardell (in the Chair)]

Given the extreme heat, both in London and here in the Boothroyd Room, if Members want to speak or intervene without their jackets, that is permitted. I am sure the public will have sympathy. I have also advised the Doorkeepers that they may take their jackets off. Members will also be aware that social distancing is no longer in operation, but I remind them that Mr Speaker has encouraged us to wear masks between speeches and interventions.

[Martin Vickers (Cleethorpes) (Con)]

I beg to move,

That this House has considered guidelines for Do Not Attempt Resuscitation orders.

It is a pleasure to take part in this debate under your chairmanship, Ms Bardell. I will be fairly brief. I welcome the fact that hon. Friends have come along, and I am very happy to take interventions from them.

I requested this debate to raise the important matter of the use of do not attempt cardiopulmonary resuscitation and do not attempt resuscitation orders, which have been widely reported as being overused in recent years, particularly over the course of the covid-19 pandemic. I do not have a science or medical background. I am generally happy to defer to the opinions of the experts, who are far more qualified than me to speak about a patient’s condition. However, we have had a year of frequent and extremely worrying cases, some of which were highlighted by an article by Camilla Tominey in The Daily Telegraph on 12 June. I thank Ms Tominey for providing me with other articles. As a result of reading them, I felt compelled to raise this matter in the House today.

As a result of those reports, there are many people who have real concerns about this issue. Will they be consulted? I do not doubt that the medical professionals involved feel that they are doing their best and that they are acting in the best interests of their patients, but decisions of this kind must be made only after discussions with the patient or, if the circumstances demand it, their next of kin.

The Care Quality Commission published a report on 18 March following concerns raised at the beginning of the pandemic about the use of blanket DNACPR decisions across groups of potentially vulnerable people. It found that almost 10% of DNACPR decisions had been made and communicated inappropriately, involving potential breaches of the individual’s human rights.

Concerns have been raised by other Members during questions to the Prime Minister, the Leader of the House and the Health Secretary. Indeed, last week, when I questioned my right hon. Friend the Health Secretary, he said that a ministerial oversight group had been established to follow through on the CQC recommendations. I hope the Minister will be able to give more details about the work of that group. Many colleagues will have heard and read deeply saddening stories from constituents and citizens across the UK who have been impacted by this seemingly widespread approach.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this issue forward. When I saw it on the agenda for Westminster Hall, I just knew that I had to be here. As light is spread, Members like me had the same idea. That is why I wanted to be here. During the first wave of the pandemic, there were ongoing issues with DNAR orders. It has been stated that human rights may have been violated in over 500 cases. That is an enormous amount. Every one of us knows people who have found themselves in those difficult positions. The hon. Gentleman made a critical point: when decisions are made for DNAR orders, full protocol must be followed. Most importantly, the next of kin, who really need to know what is going on, have been ignored. That cannot happen again.

[Martin Vickers]

The hon. Gentleman makes some powerful points, particularly, as I just mentioned, about the involvement if not of the patient themselves, certainly of the next of kin.

There have been examples of elderly people who reported that they felt pressured into signing these orders against their will. On 16 June, the Daily Mail reported that research carried out by the University of Sheffield found that 31% of the patients in its study who were admitted to hospital for covid were issued with do not resuscitate orders. That is unacceptable. Decisions of that nature are for the individual. They have the right to make their decisions without feeling unduly pressurised.

There have also been reports of care home residents having these orders imposed without consent and some reports speak of “blanket use”, which again is completely unacceptable.

Another report was of a 76-year-old man being issued a DNAR order following a heart attack, from which he made a full recovery. The order had not been discussed beforehand, but when his wife protested, she was reportedly told to “let him go with dignity.” The situation was only put right after the intervention of a more understanding member of staff and the order was revoked.

Throughout the pandemic, there have also been distressing reports of disabled people being denied vital medical treatment. According to the charity Mencap, a number of disabled people have died prematurely when intervention could have saved their lives. However, such intervention was denied owing to DNAR orders that should not have been in place.

Suffice it to say that some of the stories I have heard are frankly sickening, especially those involving the disabled or those suffering from mental illness. Having said that, I do not want to identify individuals in specific cases, although one widely reported case referred to a former Member of the European Parliament, which is sort of halfway to identifying the person involved. However, as I say, that case has been public for some time. She was admitted to hospital in Oxford for an operation on a broken pelvis. After being discharged, she was, of course, shocked to discover that a DNAR order had been in place, without her knowledge or consultation. In the event, her heart stopped during the procedure, supposedly owing to the fact that she suffers from Parkinson’s disease.

I am sorry to say that, as a result of reports I have read, I am able to come to no other conclusion than that clinicians are making assumptions regarding their patients’ quality of life and chances of survival that frequently are harsh and unnecessary. It is evident that a robust response is required from the Department of Health and Social Care. Any delay is unacceptable.

Ministers from the Department have rightly offered reassurance. However, it is time we saw action. Best practice guidelines are already in place, having been set by the Resuscitation Council UK. However, the examples I have given clearly show that the guidance does not appear to have been adhered to by some clinicians.

[Sir David Amess (Southend West) (Con)]

I congratulate my hon. Friend on securing this debate. Does he agree that when a loved one is admitted to hospital or a care home, whatever their age, when DNAR is discussed with their friends or relatives it has to be handled very carefully, because it could be a great shock? Also, was he aware that a former colleague of ours has said, following my raising this subject at business questions two weeks ago, that her husband had a DNAR order placed upon him without her express consent?

[Martin Vickers]

My hon. Friend makes some important points. I was unaware of the particular case that he mentions, but it is yet another example of what is happening without the approval of the patient or their family.

As I say, Ministers from the Department of Health and Social Care have quite rightly offered reassurance, but clearly some clinicians appear—I say “appear”—to be treating the guidance merely as a tick-box exercise. However, we are talking about life and death decisions.

Decisions regarding our own mortality can be uncomfortable, obviously for ourselves but also for our loved ones. This issue highlights the need for a cultural shift to ensure that everyone feels supported to hold open and honest conversations about what they would like to happen at the end. These conversations need to take place as early as possible, as we approach old age or learn that we have significant health problems. It is only by doing so that we can be sure that our wishes and those of our loved ones are honoured, as well as reducing the distress of the relatives of patients who have chosen to have DNACPR orders in place.

I would be interested to hear from the Minister what she proposes to do to support health and care clinicians, professionals and workers in holding conversations about these orders, and the importance of their involving patients and their families.



Earlier, I referred to the ministerial oversight group. Will the Minister confirm that the Government are thinking about that recommendation? I stress that the group must include health and social care providers, including those in the palliative and end-of-life sector, as well as those involved in local government and voluntary and community organisations. I would be grateful if the Minister confirmed that.

To conclude, the overuse of these orders over the course of the pandemic is a national scandal. Reports suggest that there are people who are not with us today who otherwise would have been. Likewise, some of the lucky ones who have made a full recovery did so despite having one of those orders attached to them. We all recognise that our medical professionals face extremely difficult decisions. This issue deals with profound matters: the relationship between doctor and patient, and for many like me, who regard human like as sacred, the orders go against our deepest religious and spiritual beliefs and cannot be dealt with in a matter-of-fact way. I know that the Minister and her colleagues will take this matter extremely seriously and will want to provide the reassurance and confirmation that it will not be allowed to go on.

Oral Answers to Questions

Martin Vickers Excerpts

Tuesday 13th July 2021 Commons Chamber

[Mr Mark Harper (Forest of Dean) (Con)]

What recent discussions he has had with the Chancellor of the Exchequer on funding for a plan to reform social care for (a) older people and (b) people of working age.

[Martin Vickers (Cleethorpes) (Con)]

What progress he is making on bringing forward plans to reform adult social care.

[The Secretary of State for Health and Social Care (Sajid Javid)]

I want people to be able to get the care they need when they need it and to have the choices they want. I want people to live their life in full and to live independently as part of a community for as long as possible without facing an astronomical care bill. We are committed to social care reform, and we will bring forward proposals this year.

--- Later in debate ---

[Sajid Javid]

First, my right hon. Friend is right to bring to the House’s attention the way that the Government are also working on social care for working-age people. He is also right to point out—I was thinking about this the other day—that around 55% of total adult social care spending is for working-age adults, and it is important that we continue to provide that support. He will be pleased to know that I am working with the current Chancellor and other Cabinet colleagues on bringing forward a more sustainable long-term plan, and I hope he will support it when it comes forward.

[Martin Vickers [V]]

I welcome what my right hon. Friend has said so far and the moves he is making to deal with the social care issue. One thing that elderly people particularly are worried about when they are in care or in hospital are the recent reports of “Do not attempt cardiopulmonary resuscitation” orders. Will my right hon. Friend give an assurance that they will only be put in place with the authority of the patient or their next of kin? Is he making inquiries into recent reports of their widespread use?

[Sajid Javid]

My hon. Friend will be interested to know that the Department commissioned the Care Quality Commission to review the DNACPR decisions that were being made during the first wave of the pandemic. That review was published in March, and the Department then established a new ministerial oversight group that will be responsible for delivery and the required changes that were recommended in the review. We want to ensure adherence to the guidance throughout the system whenever DNACPR orders are used. The first meeting of this new group will take place on 8 June.