Smokefree Future

Mary Kelly Foy Excerpts

Thursday 11th January 2024 Westminster Hall

[Mary Kelly Foy (City of Durham) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank the hon. Member for Harrow East (Bob Blackman) for securing the debate, and I declare my interest as a vice-chair of the APPG on smoking and health.

The Government’s announcement of their smoke-free generation policy was welcome after several years of inaction on tobacco from successive Conservative Governments, which have left us playing catch-up to achieve the Smokefree 2030 ambition. Indeed, regulations to protect children from taking up vaping and smoking in the first place would already be in the law today if the Government had accepted my amendments to the Health and Care Bill three years ago. Nevertheless, I welcome the commitment to curb youth vaping with tighter rules around packaging and promotion. The right balance needs to be struck to ensure that vapes are used only by adults who want to quit smoking.

In the north-east, the most disadvantaged place in England, we know better than most that smoking is not only the greatest cause of preventable deaths, but responsible for half the difference in life expectancy between the most and least advantaged in society. Smoking rates are a clear expression of the health inequalities that divide our country. That is why my colleagues and I show up time and again to demand that real and bold action be taken to make smoking history. Children of parents who smoke are three times more likely to take up smoking themselves, more likely to suffer significant income loss and more likely to live a shorter life.

It is high time to break the mould. The Government now need to make the best use of the additional funding that they have attached to the smoke-free generation policy. The Fresh tobacco control programme in my own region is a long-standing example of how budgets can be pooled and partners can work together to bring about positive results. I would be delighted to welcome the Minister to Durham and the north-east to learn more about the work of Fresh, which has been so crucial in reducing smoking rates far more rapidly than the national average.

Preventing the next generation from starting to smoke is not enough. There are 6.4 million adult smokers who need support to quit. The additional funding being provided to stop smoking services is vital, but we cannot ignore the threat to NHS provision of tobacco dependence treatments for in-patients, mental health patients and pregnant smokers. In November, the Health Service Journal revealed that NHS trusts were being told that they could raid these budgets to fund urgent and emergency care. At a time when the roll-out of those programmes has already been cut and is well behind schedule in many areas, the Government pay lip service to the need for prevention if we are to reduce pressure on our NHS. It is yet again a Cinderella service, trumped by the need to do more to treat those who are already sick.

What is more, funding for financial incentives to support pregnant smokers to quit and for the Swap to Stop vape campaign is only guaranteed for two years. We need a long-term and sustained commitment to protect our most vulnerable from the harms of tobacco smoke, including unborn babies. I hope the Minister can ensure that those schemes will be funded for at least the full five years needed.

While the measures announced by the Government, which the APPG and Action on Smoking and Health have long called for, will have an important impact, they are not enough to achieve the Smokefree 2030 target of a maximum 5% smoking rate. We need further action. Of course, more action means more funding, which is where the APPG’s recommendation of a “polluter pays” levy on tobacco manufacturers comes in.

As always, more money is needed if we are serious about a smoke-free future. Why, then, are we not seriously considering making the polluter, the tobacco industry, pay to address the damage that its products are inflicting on our communities? The industry makes vast profits in Britain every year. Why is it not being made to pay, instead of the taxpayer? As the APPG report makes clear, a levy on the industry would raise the funding necessary to achieve a smoke-free future for all, not just the most advantaged.

Ahead of the spring Budget, will the Minister commit to discussing the APPG’s proposal of a “polluter pays” levy on tobacco manufacturers? Would she discuss this with Ministers responsible for tobacco policy in His Majesty’s Treasury? As health inequalities worsen and lives remain at risk, the Government must make up for their lost time with bolder action. They must make the polluter pay.

NHS Dentistry

Mary Kelly Foy Excerpts

Tuesday 9th January 2024 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

It was music to my ears when my hon. Friend the Member for Ilford North (Wes Streeting) announced that a Labour Government will introduce 700,000 extra appointments each year, get more dentists into the communities such as mine that need them the most and ensure that everybody who needs an NHS dentist can get one, because I am fed up with the state of NHS dentistry. I am fed up that my constituents cannot get an appointment, fed up that people in Durham have resorted to DIY dentistry and fed up that Tory Governments have sat on their hands for over 13 years.

To be clear, NHS dentists are not to blame for the crisis. We know they are trying their best. It is Ministers on the Benches opposite who are to blame, and they cannot say they have not been told. I have raised this important issue for the last two years and other Members have done so for so much longer. Last May, I raised, as a point of order, that the Prime Minister may have made several inaccurate statements regarding the number of NHS dentists. For instance, in Prime Minister’s questions on 3 May, he stated that

“there are more than 500 more dentists working in the NHS this year than last year.”—[Official Report, 3 May 2023; Vol. 732, c. 111.]

However, a freedom of information request obtained by the British Dental Association threw the Prime Minister’s comments into doubt. According to the FOI response, the number of dentists is in fact down by 695 compared with the previous year, and there were fewer dentists undertaking NHS work than before the pandemic, bringing the workforce down to levels not seen since 2012-13. Unsurprisingly, the Government did not correct the record, and that says it all.

Everyone knows that NHS dentistry is in crisis—our constituents tell us regularly—but the Government continue with their “It’s all fine” attempt at message discipline. Why do they not just accept that vast areas of our country are now described as dental deserts and do something about it? I hoped that the Chancellor would have offered something—just anything—for NHS dentistry in the autumn statement, but dentistry was not mentioned in the Chancellor’s speech or the policy report. Not a penny was put forward, even though the Government announced a recovery plan in April last year. That recovery plan, as we have heard, still has not been published. Even worse, perhaps, was the sinister announcement, confirmed in the answer to a written question I tabled in November, that the Government would withdraw free dental care for the long-term sick.

Last year, I led an Adjournment debate on one such dental desert—my constituency, City of Durham—and I want to repeat what my constituents shared with me so that Ministers know what people are going through. One constituent told me that they had moved to Durham four and a half years ago, but could not find an NHS dentist. They were told that, after a kidney transplant, it was vital they had regular dental check-ups to monitor their health, but then they broke their tooth and could not afford to fix it. Another constituent told me she had to borrow money to afford a private appointment; after becoming pregnant, the exemption she got from dental charges was worthless because there were no appointments available. A young girl from my constituency tripped over and shattered her teeth, and her family could not find a dentist to help her. It was only after I reported the case on social media that a local dentist kindly offered their assistance. Another was unable to find an NHS dental appointment, so out of frustration decided to go private. Following that, they were diagnosed with oral cancer.

Why is this happening? A visit to a dental practice in my constituency provided some answers. The practice had just one dentist working two days a week seeing NHS patients and it had 10,000 patients on its books. In the north-east, almost 97% of surgeries are not accepting new adult patients. It does not take a genius to work out why my constituents cannot see a dentist.

The situation nationally is diabolical. Rotten teeth is the No. 1 reason why children aged between six and 10 are admitted to hospital, with an average of 169 children undergoing tooth extractions every working day. It is clear that a preventive approach to healthcare has eroded in Britain. Fundamentally, this is because of austerity. For over 13 years, the Government have hollowed out our welfare state.

[Peter Gibson]

The hon. Lady and I share the same integrated care board. If this is to do with austerity, why has she not engaged with our local ICB to ask it about the underspend and the provision in her constituency?

[Mary Kelly Foy]

I do speak to the ICB whenever I need to and it has told me, as I am about to say, that our welfare state, of which the NHS is a part, has been hollowed out. The system is wrong. Austerity has caused these problems: it is not the pandemic; it happened many years before then.

Supporters of austerity often say they do not want to burden future generations with debt, but austerity and preventive healthcare are incompatible; we cannot have both. The healthcare problems this Government have caused our constituents—issues that could have been prevented with funding and investment—will now be more expensive to resolve down the line. Conservative Members have saddled future generations with poorer health, poorer opportunities and ultimately a poorer country, and it is time for them to go.

Building an NHS Fit for the Future

Mary Kelly Foy Excerpts

Monday 13th November 2023 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

Last week, we heard the longest King’s Speech in years, but it had very little in it. However, there was a silver lining: the announcement that the Government will bring forward legislation to create a smokefree generation. The devil will be in the detail, of course, and this certainly does not let Ministers, past and present, off the hook on the NHS. We see that if we just look at the state of NHS dentistry, an issue I have raised, and will continue to raise, in this place. Numerous Labour and other Opposition Members have also raised it in today’s debate.

I want to focus on smoking because it may be the single largest driver of health inequalities in England. Professor Chris Whitty argues in his latest report that central and local government has a key role to play in reducing smoking. It is an issue that the overwhelming majority of medical professionals agree on, as, I hope, do the majority of MPs. I have long taken an interest in the issue; as a councillor, I held the portfolio for health and wellbeing for nearly a decade, and this included chairing our tobacco control alliance. Working together with communities and local authorities to tackle tobacco harm, I saw at first hand just how much can be achieved with a comprehensive approach that drives change, through a multitude of initiatives. So although I welcome the Government’s proposals to create a smokefree generation and to curb youth vaping, the smokefree ambition must be delivered for everyone, not just the next generation. The measures announced to date have not gone far enough, not by any measure. As I walk through certain areas of my constituency, I continue to be struck by the number of people who still smoke. More than 117,000 people have died prematurely from smoking in the north-east since 2000; it is our biggest preventable killer and it is devastating for the thousands of families whose loved ones are lost each year. It also has significant implications for our health services and economic costs for our communities. It is estimated that smoking costs County Durham almost £190 million each year, £22 million of which is spent on healthcare. So preventing ill health is key. The concept that prevention is better than cure is a pretty old-fashioned idea, but it works. After 13 years, Ministers have finally picked up on that with their smokefree announcement.

Smoking is a deadly addiction, one that can lock people into a cycle of poverty and is difficult to break out of without support. We also know that regions with the highest rates of poverty have the highest rates of smoking in England and that smoking is one of the leading drivers of health inequalities in constituencies up and down the country. Not only do men and women in the most deprived areas have shorter life expectancy overall, but they live a larger number of years suffering from ill health. So far, the Government have wasted too much time. In 2021, I tabled amendments to the Health and Care Bill to tackle smoking and youth vaping. My proposals included a levy on tobacco companies’ profits to fund stop-smoking activities; inserts in packs containing health information, with links to smoking cessation services; and a ban on tactics such as branding and sweet flavourings to market vapes to children. To my amazement, not only did the Government fail to adopt my amendments, but they voted them down. Those were common-sense proposals that enjoyed cross-party support and the backing of health campaigners. If passed then, the amendments would have been law today. Instead, the Government chose inaction. I hope that the amendments will return in whatever the Government put before the House. Since then, tobacco companies have made record profits, leaving taxpayers and their families to pick up the pieces. We cannot afford to waste any more time.

Last week, the all-party parliamentary group on smoking and health published its latest recommendations for a smokefree future. The plans called for further regulations, such as increasing the funding levied from the tobacco industry on a polluter-pays principle—a measure that could raise up to £700 million a year. The APPG report shows that the polluter-pays levy is popular, feasible and supported by voters of all political parties, as well as the majority of tobacco retailers. Tobacco manufacturers make an estimated £900 million profit in Britain each year, with an average net operating profit margin of about 50%, compared with the less than 10% average for British manufacturing. Ministers must take the APPG’s recommendations into consideration.

While the measures that the Government have announced are a step in the right direction, the devil will be in the detail. To ensure that we have the best possible legislation, I hope that the Minister will work with the APPG. We know that a strong cross-party consensus for legislative measures can make a real difference. We have seen it all before. When a Labour Government banned smoking in enclosed public places in 2007, it was a measure that had once seemed inconceivable. Now it is baffling that we did not do it earlier.

In the seven minutes I have been speaking for, at least one person has lost their life due to smoking and tobacco use, which means that as MPs we have a responsibility to stand up on this issue. As health inequalities worsen and lives remain at risk, the Government must make up for their lost time with bolder action. They must ensure that the latest Tory turbulence and the exit of yet another Health Secretary does not thwart progress. They must get on with the job.

Under-age Vaping

Mary Kelly Foy Excerpts

Wednesday 12th July 2023 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

I declare my interest as a vice-chair of the all-party parliamentary group on smoking and health. I thank the Labour Front Bench for choosing this topic as their second debate on their Opposition day today.

I welcome the motion, which gives a clear indication that the shadow Front Bench and the next Labour Government take this issue seriously. Given Labour’s polling right now, I think this will be policy next year, if not before.

I have repeatedly made clear my concern about the need to tackle youth vaping. In 2021, as we have heard, I tabled amendments to the Health and Social Care Bill to standardise the packaging of vapes. These amendments would have removed child-friendly branding and prohibited free distribution—in other words, free samples—to children. As Members may recall, the amendments had strong cross-party support. However, the Government did not adopt my amendments. In fact, they voted against them, and I am still in the dark as to why. Perhaps the Minister might explain in winding up.

Nevertheless, the Government must take forward these measures without further delay, because marketing addictive substances to children is unethical. Although it is vital to strengthen regulation on vaping, we must not forget that smoking still remains a far greater risk. Smoking is killing too many of our loved ones. There have been 117,000 smoking-related deaths in the north-east since the turn of the millennium. This is a public health emergency, and the Government are dithering yet again. We have waited since 2017 for the promised update to the tobacco control plan. We heard, just a few weeks ago, Ministers’ proposals for achieving their smoke-free 2030 ambition. They will not achieve it because their proposals do not go far enough and their actions are not bold enough. As we have heard, the Khan review found that we will miss the target by at least seven years without bold action. In the poorest areas of the country, the target will not be reached until 2044.

We must encourage as many smokers as possible to quit their use of cigarettes, the most lethal consumer product, by any means that suit them, including the use of nicotine vapes. The Association of Directors of Public Health North East has made its position on vaping very clear, reassuring both the public and healthcare professionals that vaping poses only a fraction of the risks of smoking while, at the same time, stating clearly that vapes should not be accessible or appealing to young people.

Three quarters of adults in Great Britain support measures to prohibit vapes that appeal to children and the promotion of vapes in shops, which is currently legal. We have a lot of evidence to support the fact that vapes play a very important role in helping adult smokers to quit, but they should never be marketed towards children. As I mentioned earlier, marketing an addictive substance to children is unethical. Let us remember that nicotine carries health risks. Vaping may be preferable to tobacco as a cessation aid, but we have to remain vigilant to the risks to oral and respiratory health.

Underage vaping has increased by 50% over the past three years, and it is happening under the Government’s watch. They have had several opportunities to act: I tabled amendments to the Health and Social Care Bill; the Khan review was based on research and evidence; and ASH, Fresh, Cancer Research UK and others have provided evidence. There is no excuse for this delay. The first duty of a Government is to protect their citizens; Ministers are failing in their duties to our young people. Since Conservative Members voted down Labour’s amendments to tackle youth vaping, countless children have no doubt fallen victim to the disgraceful and unethical marketing of vapes allowed by this Government. How many more children must become addicted to nicotine before Ministers finally take action?

Oral Answers to Questions

Mary Kelly Foy Excerpts

Tuesday 11th July 2023 Commons Chamber

[Steve Barclay]

As my hon. Friend knows, I have already met her to discuss this scheme, and the impediment was the business plan that came forward from the local trust—further work was being done on that. She is right to highlight our capital investment more widely. This Government have committed to investing in the biggest ever hospital building programme, with more than £20 billion. That is in addition to our long-term workforce plan—the first time the NHS has done this—in which we are making a further £2.4 billion of investment.

[Mary Kelly Foy (City of Durham) (Lab)]

Is the Minister aware that the NHS North East and North Cumbria mental health and wellbeing hub is due to close this September? With mental health care in crisis in County Durham, that is an insult to the health and social care staff who desperately rely on those services. Will the Minister reverse that decision?

[Steve Barclay]

There are two issues here. One is how much investment we are prioritising towards mental health; the other is how local commissioners choose to prioritise services within those communities, and whether we try to run all of those decisions from the centre in Whitehall or embrace the 42 integrated care systems and allow them to make commissioning decisions. The bottom line is that we are spending much more on mental health, with an increase of £2.3 billion compared with the position four years ago. That is allowing us to replace 500 dormitory beds and provide 100 mental health ambulances, three new mental health hospitals, 160 projects such as crisis cafés to support accident and emergency, and £75 million to help those with mental health challenges get back into work, which is one of the best prevention measures we can take for people who are suffering with their mental health.

Smokefree 2030 Target

Mary Kelly Foy Excerpts

Tuesday 20th June 2023 Westminster Hall

[Mary Kelly Foy (City of Durham) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma, and to follow my co-sponsor of this debate, the hon. Member for Harrow East (Bob Blackman). He is also the chairman of the all-party parliamentary group on smoking and health, of which I am a vice-chair. I declare that interest.

As we have heard, the measures announced by the Minister in April were a step in the right direction. However, they fell very short of the comprehensive strategy outlined by the APPG and the Khan review, and it has taken far too long—almost four years—for the Government to get going on this. In the meantime, tobacco continues to kill an estimated one person every five minutes in Britain. The deaths are disproportionately concentrated in regions such as the north-east—regions that have some of the highest rates of poverty and, in turn, the highest rates of smoking in England. In the north-east, nearly 13,000 people died prematurely from smoking between 2017 and 2019. This has an economic cost for our communities of over £100 million in healthcare costs and £64 million in social care costs. All the while, tobacco companies make record profits, leaving the taxpayer and families to pick up the pieces.

We are fortunate in the north-east to have a highly effective regional tobacco control programme—Fresh—funded by all the local authorities in the region and the local integrated care board, and it has proven successful over the years. Just yesterday, it launched a new behavioural change campaign called “Smoking Survivors”, which features two women from the north-east who have quit smoking and survived cancer. However, national funding for behavioural change campaigns such as that fell by around 90% between 2008 and 2018. Although regional activity is vital, we need strong leadership from the Government if we are to see every region be smoke free by 2030.

Like the hon. Member for Harrow East, I welcome the Minister’s recent announcement on tackling youth vaping, but why did it take so long for the Government to act? When the Health and Care Act 2022 was going through Parliament in 2021, I tabled amendments that would have given the Government powers to prohibit child-friendly branding on e-cigarette packaging and to ban the free distribution of vapes to under-18s, which, as we know, has strong cross-party support. To my amazement, not only did the Government fail to adopt my amendments, but they voted them down.

As the Minister will remember, one of Dr Khan’s must-do recommendations was raising the age of sale for tobacco beyond 18, so I was disappointed not to see that included in the April announcement. The all-party group has already urged the Government to launch a public consultation on raising the age of sale, and I urge them to do that too.

I will end with a few questions for the Minister, which probably echo what the hon. Member for Harrow East asked. Will the Minister commit to consulting on a “polluter pays” levy to raise funding for a comprehensive tobacco control strategy?

Will the Government consider measures to address the affordability, accessibility, appeal and advertising of vapes, which were recommended by ASH in its response to the Government’s call for evidence on youth vaping? Once again, I highlight the fact that big tobacco companies rigorously lobby against vaping regulations, so I would like the Minister to take note of that.

Will the Minister confirm that a consultation on raising the age of sale will be considered? Finally, will he reassure the House that a comprehensive strategy to address smoking and vaping will be delivered—if not through the tobacco control plan, as promised by his predecessors, then in the forthcoming major conditions strategy?

[Mr Virendra Sharma (in the Chair)]

I urge Members to stick to about five minutes.

Hospice Services: Support

Mary Kelly Foy Excerpts

Wednesday 14th June 2023 Westminster Hall

[Mary Kelly Foy (City of Durham) (Lab)]

I thank the hon. Member for Eastleigh (Paul Holmes) for securing this important debate. I extend my condolences to him for the loss of his manager Sue.

I start by giving my heartfelt thanks to all those who work in hospices. Ensuring that people can pass away in comfort and dignity is an extremely honourable profession, and it means a great deal to people, as we have heard. The cost of living crisis is affecting hospices up and down the country, and we need to take it seriously. Even before the cost of living crisis began, working in a hospice was challenging. The Government should not be making it harder.

The Minister should be concerned by what hospices such as the brilliant St Cuthbert’s Hospice in my constituency are saying. Inflation, for one, is a real concern. What St Cuthbert’s is receiving from the integrated care board does not even come close to either wage inflation or general inflation. It is seeing a massive rise in its energy costs, by tens of thousands of pounds. As we have heard, a care home cannot reduce its energy consumption.

The marketplace for specialist staff is currently extremely competitive. The absence of a proper workforce plan from the Government is not helping. It should be noted that despite the challenges it is facing, St Cuthbert’s Hospice continues to run at 100% satisfaction. I know the Minister will mention the £100 million announced in the spring Budget, but that falls short of what is really needed. Hospices are collectively budgeting for a deficit of more than £180 million this year.

Where is the support for energy bills? Hospices need to be able to offset their costs. After all, it does not reflect well on a society when the Government do not prioritise end of life care. Patients require the utmost dignity, and the Government should be ensuring that their dignity is prioritised.

Mental Health Treatment and Support

Mary Kelly Foy Excerpts

Wednesday 7th June 2023 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

As we have heard today, England is in the midst of a mental health crisis, and that is certainly true in the north-east. I join my hon. Friends the Members for Middlesbrough (Andy McDonald) and for Darlington (Peter Gibson) in calling for an independent inquiry into the Tees, Esk and Wear Valley NHS Trust. The testimonies I have heard have shocked me. I know that I can speak only in broad terms, but they include serious cases of improper care and misdiagnosis, and of putting people on waiting lists despite their feeling suicidal.

The Care Quality Commission reports that we have seen raise concerns about risk assessments, communications and record keeping, and a lack of observation. There have also been concerns raised about the lack of beds for children, as well as poor staffing levels, high staff turnover and a lack of neurodiversity training. Horrifically, young people have even taken their lives while in the care of the trust. We owe it to them, and all those who have been harmed, to investigate what is going on within the trust. Will the Minister commit to an independent, judge-led inquiry into the trust? She can either respond to me now or I can wait for her response in her closing speech. One thing is clear: this cannot go on.

I want to highlight the crisis in children’s mental health. In my region, children spent over 1,000 hours in A&E because they were in a mental health crisis. There are over 30,000 children on waiting lists. Across England, one in six children aged five to 16 are likely to have a mental health issue. Children’s happiness and sense of wellbeing continues to decline. With mental health trusts raising the threshold of how ill under-18s must be, we have seen a quarter of a million children being denied help for their mental health. Poor mental health compounds. Left untreated, it can spiral out of control, as we have heard many times today. No one should be in a mental health crisis, let alone children. The Government must invest in children’s mental health today—no more delays and no more referrals. The Minister must allow children the happiness that they deserve.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Before I call the shadow Minister, I must say that I am very disappointed that seven Opposition Members who spoke in the debate are not back in the Chamber for the wind-ups, as well as about three Government Members. I must emphasise again that it is really important for people to get back to hear what the shadow Minister has to say, as well as the Minister. I hope that message will be conveyed back to those Members who are not here. I will say it again in the hope that they are back by the time the shadow Minister has finished his speech.

Dental Care: Durham

Mary Kelly Foy Excerpts

Wednesday 24th May 2023 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

Vast areas of our country are increasingly described as “dental deserts”, places where not a single dental practice is accepting new NHS patients, and County Durham is one such place. We in Durham have witnessed dental services decay at an alarming rate. In my constituency today, there will be children sat in classrooms struggling to concentrate because of something as preventable as toothache. So it is hardly surprising that tooth decay is now the leading reason for children being admitted to accident and emergency in our country.

This scandal is not unique to Durham or the north-east; it is a problem everywhere. In 2023, dentistry is available on the NHS on paper but not in practice. The British Dental Association has described NHS dentistry as entering its final act. The horrifying experiences of my constituents, which I will outline, will certainly strengthen that claim, but before I turn to my constituents, let me state a chilling fact: Britain has poorer oral health than any other developed economy.

[Peter Gibson (Darlington) (Con)]

The hon. Lady raises an important point about children’s dentistry. Does she agree that prevention is better than cure? Would she welcome a return to dentistry in schools?

[Mary Kelly Foy]

Of course, prevention is better than cure, and that is one of the reasons why so many children have to go to A&E. If problems were identified and prevented in young children, there would not be the cost implication for services further down the line. In an ideal world, we would have dentists in schools.

As I said, Britain has the poorest oral healthcare among developed countries. Can the Minister honestly say that we have genuine preventive oral healthcare in our country? Over the past 13 years, dentistry has become unaffordable and unavailable for many of my constituents. Nearly 400 have contacted me in dismay at their recent experiences. I thank them for their contributions and I hope the Minister can give them some reassurance today.

My constituents know that the problem is not with the dentists themselves. They know that dentists are trying their best for their patients. The problem lies at the Government’s door. In the time that I have, I can share only a portion of the pain and suffering that my constituents have had to endure. One moved to Durham over four and a half years ago but still cannot find an NHS dentist, despite being told after a kidney transplant that it was vital that they had regular dental check-ups to monitor their health. Now they have a broken tooth and simply cannot afford to fix it.

Another constituent told me how she had to borrow money to afford a private appointment. She is now 30 weeks pregnant and exempt from dental charges, but her exemption is worthless as there are no appointments available for her. A young girl in my constituency tripped over and shattered her teeth. Her family contacted me because they could not find a dentist to help her. Luckily, after I reported the case on social media, a local dentist was kind enough to help her out, but our health system should not be based on charity. Constituents have also contacted me about do-it-yourself dentistry. In case the Minister is unaware, that is when people fit their own fillings and extract their own teeth without anaesthetic or any professional training.

I have raised the alarming experience of my constituent Ray in the Chamber before, but I do so again because his case underlines why access to dentistry should be not a luxury, but an integral part of our health system. Ray was unable to find an NHS dental appointment, so, out of utter frustration, he decided to go private. Following his appointment, Ray was diagnosed with oral cancer, for which he is now receiving treatment. As there is a cost of living crisis, we have a duty to ask, what if Ray had not been able to pay for private treatment? What if the cancer had continued to go undetected? Frankly, Ray might not be here today. It is morally wrong that Ray was put in that position. No one in my constituency —or anywhere, for that matter—should be put in that position.

Why is this happening? My visit to a dental practice in Gilesgate this week provided some of the answers. The practice has just one dentist working two days a week seeing NHS patients, and it has 10,000 patients on its books. It does not take a genius to work out why my constituents cannot see a dentist. It is clear why dentists are closing their doors to NHS patients, and it is certainly not because of a lack of demand. The problem, which the BDA has identified, is that the unreformed NHS dental contract means that dentists are pushed into the private sector to keep their practices afloat financially. As one dentist said to me:

“Every day I’m providing some treatment for nothing or at a loss—working the best I can, caring for NHS patients the best I can within the dental contract.”

He also went on to say that the Government are clearly winding down NHS dentistry in the hope that the public will accuse dentists of being greedy.

The exodus of dentists is clear for all to see—except, it seems, the Government, who continue to deny there is a crisis in NHS dentistry.

--- Later in debate ---

[Mary Glindon (North Tyneside) (Lab)]

I thank my hon. Friend for securing this important debate. Given that dentists are so hard pressed and are trying their best to fit in NHS patients, in light of all the problems they are facing, does she agree that they deserve our greatest respect, admiration and thanks? I am very fortunate that I have been at my dentist’s practice for 52 years, but they are struggling.

[Mary Kelly Foy]

I could not agree more with my hon. Friend. The dentists that I have spoken to recently all want to help NHS patients, but the way the contracts are designed, it is not worth their while, and of course they have to make a living.

I mentioned that I made a point of order yesterday regarding the Prime Minister, who has repeatedly claimed that there are “500 more dentists” in the NHS. However, following a freedom of information request, we now know that the number of dentists in the NHS fell by nearly 700 last year. The number of dentists has also fallen since the pandemic and is at its lowest level in a decade.

Diagnosing the causes of the problem is not complicated. As I mentioned at the beginning, Britain has poorer oral health than any other developed economy. The system is also dysfunctional, and practices have handed back a record £400 million-worth of funding back to the Government because they do not have the capacity to meet the required targets.

[Mr Kevan Jones (North Durham) (Lab)]

Does my hon. Friend and neighbour agree that we have to see what the need is in each area? I contrast the current approach with when Labour were in power in Durham: we brought in new capacity where we knew that areas did not have access to NHS dentistry.

[Mary Kelly Foy]

I thank my right hon. Friend for the intervention. We all know that there is huge demand and such a lack of NHS dentists out there that it is, I guess, a question of political will whether this problem is solved or not.

The absence of oral healthcare from our national debate about the future of the NHS is alarming. Dentistry is integral to our national health and therefore must be key to the NHS. Without proper investment in preventive healthcare such as dental check-ups, we cannot quickly treat oral cancers, nor can we stem the flow of people with dental problems into our already overcrowded accident and emergency departments.

I would be grateful if the Minister responded to the following questions. First, will he ensure that dentistry is properly represented in the governance structures of the NHS? Dentistry must be at the centre of the policy-making process, not an afterthought. Secondly, will the Government publish a comprehensive national dental strategy, one that is focused on prevention and tackling health inequalities? Thirdly, will he undertake meaningful reform of the NHS dental contract, which would stem the flow of dentists out of the system? Fourthly, will he work with the BDA on the previous points?

Finally, as I have said, I raised a point of order yesterday on the Prime Minister’s claim that there are 500 extra dentists in the NHS. There are in fact 700 fewer dentists, not more. Unless I have missed something today, the Prime Minister has not corrected the record, as he is obliged to. Will the Minister finally correct the record on behalf of the Prime Minister?

I could have spoken for hours this evening, reading out the correspondence I have received from constituents. Each constituent’s experience reflects a serious failure by this Government, so I implore the Minister not to insult the intelligence of the people of Durham, but to take this opportunity to accept that there is a crisis in NHS dentistry and to commit finally to meaningful reform.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

Let me come directly to the questions asked by the hon. Member for City of Durham (Mary Kelly Foy). She called for a comprehensive dental reform plan. Yes, we will do that, and we will do it soon. She called for an overhaul of the 2006 contract. Yes, we will do that. Will we work with those at the BDA? Yes. In fact, I met them yesterday. We are keen to draw on their expertise.

I congratulate the hon. Lady on securing the time for this important debate. It is absolutely my top priority right now to work at pace to try to address the significant problems in dentistry. I am not here to say that there is no problem; I am here to try to fix the problem as quickly as possible. We could debate the figure on dental activity all day, but the bottom line is that it is not high enough and we need to get it higher. To come directly to her point about correcting the record and so on, the latest published figures show that there are 1,473 more dentists than there were in 2010—about 6.5% more.

[Mary Kelly Foy]

NHS dentists?

[Neil O’Brien]

NHS dentists, yes. Activity is definitely going up—about a fifth more patients were seen in the year ending March than in the year before that—but it is still too low. That is a point on which we absolutely agree.

We have started—only started—to reform the contract. We have introduced more bands for units of dental activity to better reflect the fair cost of work so that there is fairness for dentists, and to incentivise more NHS work. We introduced the first ever minimum UDA value to help sustain practices where UDA values are low. That has implications for under-delivery in some bits of the country.

We are for the first time allowing dentists to do 110% delivery of their UDAs so that those who want to do more NHS dentistry can do more, with a requirement to update their availability on the NHS website. We have also started the process of making it easier for dentists to come to work in the UK. Last month, we brought into force legislation enabling the General Dental Council to increase the capacity of the overseas registration exam. We are also working with local partners around the country who have various ideas about creating new centres for dental development so that, in areas that do not have a dental school, we can get more people to train and remain, and dentists flow to the bits of the country where there the need is most acute.

Some of those reforms are starting to have effects. It is good that the reforms to split band 2 have been reasonably well received, as has the 110% option. The splitting of band 2 is being used and the proportion of band 2bs is going up. As I say, activity is going up, which is encouraging, but it is not high enough and needs to be higher still. The reforms that we have talked about so far have just been a start. I am under no illusions about the significant challenges to address, not just in Durham but across the whole country.

The forthcoming dental plan will build on those initial steps to go further on improving the payment model and those initial banding changes, especially focusing on improving access for new patients, which is a particular problem. We want to consider how we address historical UDA valuations—they are stuck in time in 2006 and are, in some cases, unfair—and look fundamentally at how we make NHS work more attractive.

--- Later in debate ---

[Neil O’Brien]

My hon. Friend is quite right. Some of those disparities, which can occur from one end of the street to the other, are extremely hard to justify, hence the introduction of the minimum UDA rate and why we are looking at going further. He is completely correct. Funnily enough, as well as coming to improving access to treatment, I was just about to respond to his earlier point about prevention and his rather brilliant idea about what more we could do in schools. We are, following the conversations we have had, actively considering that.

I thank the hon. Member for City of Durham for her important work in securing this important debate.

[Mary Kelly Foy]

It feels as if the Minister is coming to the end of his speech, but I would really like him to correct the record. In my point of order yesterday, I said that the Prime Minister has on seven occasions said that there are 500 more NHS dentists, when there are in fact 700 fewer dentists. If the Minister has met the British Dental Association, it will have pointed that fact out to him. Could he please correct the record, or may I ask you, Madam Deputy Speaker, for advice on how we can encourage the Prime Minister to correct the record before the House rises tomorrow?

[Neil O’Brien]

I have already read out the statistics. I will not read them out again, and I do not think there is a need to correct the record. The statistics that the hon. Lady is drawing on are incomplete, because there is effectively a two-month lag between activity and the need to report that activity. Drawing on such incomplete information does not give the full picture, so I caution her against doing so.

First, I encourage the hon. Lady to wait for the official data in the usual way. Secondly, we are looking to improve that official data by, indeed, working with and responding to concerns raised by the BDA. I do not think that headcount is a sensible measure with the workforce. There are more people doing NHS work than there were in 2010. What we are really interested in is the total amount of activity, which is best measured by the total number of UDAs being delivered. As I have said, that total amount of activity is going up. In the last month for which we have data, it had gone up from 85% in March 2022 to about 101% in March 2023, but it is still not high enough. Although the trend is positive and dentists are doing more NHS work, the point of agreement here is that that needs to improve further.

Reforms to NHS Dentistry

Mary Kelly Foy Excerpts

Thursday 27th April 2023 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

Across Durham and the whole country, dentistry is in crisis. It is a system in need of urgent reconstruction, not tinkering. To be clear, the problem has not been caused by NHS workers or dentists. It has been caused by the Conservative Government, who have ignored the concept of prevention rather than cure. Dentists have told me that the key issue is the chronic underfunding of NHS dentistry. Let us not forget that it has been subject to cuts unparalleled elsewhere in the NHS.

There is a real recruitment and retention crisis in the workforce, but the situation cannot be improved by simply recruiting more dentists. The fact is that NHS dentists are made to work in a fundamentally flawed system that does not have prevention at its heart. I fear that if NHS dentistry continues down this road, England may have an entirely private dental provision, and the facts speak to that. In August last year, the BBC showed that eight in 10 NHS practices were not taking on children as patients, nine in 10 practices were not accepting adult patients, and a third of council areas were not taking on adult NHS patients. How can we have a preventive approach if my constituents cannot get to see a dentist? In addition, tooth decay is the most common reason for A&E hospital admissions in young children. That is a disgrace.

Nothing could reflect the current crisis more than DIY dentistry. People are fitting their own fillings and extracting their own teeth without anaesthetic or professional training. This week alone, I have been contacted by eight constituents who have performed DIY dentistry. The situation is compounded by the cost of living crisis, which is blighting the lives of ordinary people. If someone needs to choose between eating and heating, they will probably not want to fork out for an expensive root canal; they will probably choose to have an extraction instead or do it themselves. This is a stark example of health inequalities.

I have some questions for the Minister. When will the Government adopt a preventive approach to health and social care, particularly to dentistry? When will the Government provide NHS dentistry with the funding it desperately needs? Has the Department had meetings recently with the Treasury to discuss funding? When will the Government work with the British Dental Association to reform the current dental contract, to stop the exodus of staff from the NHS?

In 1948, Labour recognised that it was vital to integrate dentistry within the NHS and that oral health is not an optional luxury but integral to our national health and key to the NHS. How we tackle it must therefore be a priority, not an afterthought. Only a Labour Government can save dentistry from the rot and decay that has set in under the Tories’ watch.