Eye Health: National Strategy

Neil O'Brien Excerpts

Wednesday 17th May 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Harris. I must begin by thanking the hon. Member for Battersea (Marsha De Cordova) for bringing forward this very important debate. She is a very strong advocate for improving eye health in England. Likewise, I thank other hon. Members who made important points in the debate, including the hon. Members for Ealing Central and Acton (Dr Huq), for Lewisham East (Janet Daby), for Vauxhall (Florence Eshalomi), for Mitcham and Morden (Siobhain McDonagh) and for Sheffield Central (Paul Blomfield) and my hon. Friend the Member for Hendon (Dr Offord). I will try to address the points that have been made as I go through my speech.

I am haunted by the point made by my hon. Friend the Member for Hendon about wondering whether life would be worth living. To address the question directly: yes, of course. This is a hugely important issue for us, for exactly the reasons he set out. As the Minister for both primary and secondary eye care services, I reassure the whole House that I am working actively on the issue.

Since we last debated the topic in December, I met with the hon. Member for Battersea to discuss how we can make progress on all those things. Although I am unable to say exactly in what form the output of that work will come out, I reassure her that we are looking at pace at absolutely all the different issues she raised, both previously with me directly and in this debate.

I also met with Louisa Wickham, the new national clinical director for eye care—the lady who my hon. Friend the Member for Hendon asked about—to talk about NHS England’s eye care transformation programme. To address another question that was raised, I also met directly with the eye care sector, which talked passionately about how it is ready to deliver more out-of-hospital care to alleviate secondary care pressures. That is an exciting opportunity that we are keen to seize.

Although it is not the main topic of today’s debate, the future of sight testing in special schools is a very important area of concern to a number of hon. Members present, and to me as well. I recently convened a roundtable of experts to discuss the future of sight testing in special schools, and I will continue to engage with NHS England on their proposals for the future. I hope that it will not be too long before I am able to update the House on that.

I am absolutely seized by the arguments I have heard today—and earlier—from the hon. Members for Lewisham East and for Mitcham and Morden, and from the experts and people in special schools who have seen the advantages of the service. I join the hon. Member for Mitcham and Morden in paying tribute to Tina Harvey for her work. Some of the people in those special schools are just totally inspirational.

[Janet Daby]

I thank the Minister for seeking to address special educational needs ophthalmology in schools. Can he say when the outcome of the roundtable on what the future will be like for ophthalmology in schools is expected? It is due to come to an end in July but, in actual fact, in previous years there were promises that it would be a long-term service.

--- Later in debate ---

[Neil O'Brien]

I expect that to be something we can come back on imminently.

I will come back on to the main topic of today’s debate. While I acknowledge that we must go much further to address the current and future capacity challenges facing eye care services, I highlight some of the excellent work already being done by doctors and nurses across the NHS. Our existing prevention and early detection measures are already playing a key role in preventing avoidable sight loss, and there has been progress over recent years.

One of the most important things we can do in terms of prevention is take action to reduce obesity and smoking, which are both massive risk factors for sight loss. We have made good, long-term progress in reducing smoking rates among adults, which have come down from about 21% in 2010 to 13% now—the lowest on record. Of course, that still means that we have one in seven adults smoking, which is why on 11 April I announced a package of new measures to achieve our ambition to be smoke-free by 2030. We are also working with the food industry to ensure that it is easier for people to make healthier choices, and supporting adults and children living with obesity to achieve and maintain a healthier weight.

In terms of the vital screening services raised by various hon. Members, I have talked previously about the success of the diabetic retinopathy screening programme, which provides screening to over 80% of those living with diabetes annually. Between 2009-10 and 2019-20, the number of adults aged between 60 and 64 registered annually as visually impaired due to diabetic retinopathy fell by 20%. That is real progress. The success of our screening programme has also been recognised by the World Health Organisation as a service that other countries should aspire to achieve.

As Members have heard me say before, one of the best ways to protect our sight is by having regular sight tests. That is why the NHS continues to invest £500 million a year in delivering over 12 million NHS sight tests, and provides optical vouchers to help with the cost of glasses for eligible groups.

As for secondary care services, when an issue with eye health is detected, it is vital that individuals get timely diagnosis and treatment. The pandemic had a huge impact on ophthalmology, as it did right across the NHS. We set ambitious targets to recover services through the elective recovery plan, supported by more than £8 billion between 2022 and 2025, in addition to the £2 billion through the elective recovery fund and the £700 million targeted investment fund last year. That will drive up elective activity and get through the backlog more quickly.

We know that NHS eye care teams continue to work hard to provide care as quickly as possible. The average waiting time is reducing; it was down to 11.3 weeks in March, compared with 12.9 weeks in September last year. Progress has also been made in reducing the number of patients waiting the longest for ophthalmology treatment. The number of patients waiting 78 weeks or longer was reduced by more than 85% between September 2022 and March this year.

A large proportion of the patients who are waiting for more than 78 weeks are waiting for corneal grafts. NHS England is working with NHS Blood and Transplant to increase the supply of corneal graft tissue. For patients who are waiting more than 52 weeks, NHS England’s elective recovery team are working hard to support local systems to increase capacity and provide care as quickly as possible. Surgical hubs and the independent sector are also being used to increase delivery, particularly of cataract surgery. In 2021-22, nearly 500,000 cataract procedures were provided on the NHS—more than pre-pandemic.

The hon. Member for Ealing Central and Acton made a point that I felt a bit ambiguous about, in so far as she raised the use of the independent sector. As she knows, Opposition Front Benchers also support the use of the independent sector to try to plough through the elective backlog. On the other hand, there is an important point about ensuring that trainees can get sufficient cataract surgery training and can have a broad range of clinical experiences as they are trained. The NHS has been working with the Royal College of Ophthalmologists to support that, because there is a genuine issue. We are working on that, even though we think it is right to use the independent sector to get through the backlog more quickly and save more people’s sight.

One of the most important points that the hon. Member for Battersea made was about more fundamental reforms to eye care services. She mentioned that ophthalmology is the busiest outpatient speciality and has a number of capacity and workforce challenges that are likely to grow. Predictions from the Royal College of Ophthalmologists say that demand for services will increase by 30% to 40% over the next 20 years, in line with an ageing population. In the light of those predictions, consideration has been given to how we can increase capacity to ensure that we have sustainable eye care services fit for the future. No one should have to face losing their sight due to delays in accessing care.

NHS England’s transformation programme has been considering what services could be safely moved out of hospital. The hon. Member is right to say that image sharing between primary eye care providers and secondary care specialists, through telemedicine hubs, could allow more patients to be seen in the community, which is a very exciting opportunity. A pilot that we are running in north-central London has already shown the potential for that model to improve the triage of patients into secondary care. NHS England plans to support a number of other integrated care systems to adopt the eye care referral model, aligned to their local commissioning arrangements.

[Marsha De Cordova]

On the way in which we can join up primary and secondary care and ensure that MECS are being commissioned across all ICBs, does the Minister agree that that measure should be consistent and must take place, so that across all our ICBs, MECS would be available in the community?

[Neil O'Brien]

The hon. Lady has read my mind, because I was about to come on to MECS. We will produce standard service specifications for MECS to reduce the variation that she rightly raised, as well as driving forward the integration of those new technologies into local ICSs.

As well as making the best use of our clinical capacity, we have to invest in growing the future workforce, as the hon. Member for Sheffield Central (Paul Blomfield) said. That is why we have taken steps to increase the ophthalmology workforce. We increased training places in 2022, and more places are planned for this year. In addition, there will be improved training for existing ophthalmology staff so that they can work at the very top of their clinical licence to further increase capacity and support the flow and delivery of care.

I recognise the important role of research and innovation in understanding sight loss and making available new treatments—a point that several hon. Members raised. That is why we continue to invest significantly in vision research. As I highlighted in a previous debate, the National Institute for Health and Care Research has invested more than £100 million in funding and support for eye conditions research over the past five years, and the NIHR Moorfields Biomedical Research Centre was awarded £20 million last year for another five years of vision research leadership.

[Marsha De Cordova]

I know that the Minister is coming to the end of his speech, but I do not want to let him sit down without pressing him for a timeline for the workforce plan. Will it cover ophthalmology and eye care? He said that he met Louisa Wickham, the eye care transformation lead, but will he confirm that all the investment in that space will continue and will not come to an abrupt end?

[Neil O'Brien]

I am happy to confirm that the workforce plan should be out pretty shortly, and that it will look across the entirety—

[Marsha De Cordova]

You have been saying “shortly” for a while.

[Neil O'Brien]

Until there is a date, there is no date, but it will be fairly soon.

[Dr Huq]

The Minister says he is open to the idea of more research. Charles Bonnet syndrome is recognised by the NHS, but it is seen as a side-effect of sight loss. Will he commit to some proper research on that?

Just to correct the record, I agree that it should be all hands on deck to clear the backlogs. I was not saying that it is either/or; it is about joining forces on cataracts.

[Neil O'Brien]

Very good. As a first step towards the research that the hon. Lady calls for, I commit to doing my own research on the syndrome that she describes, which sounds incredibly disturbing for those who suffer from it.

I hope that the range of work that I have outlined reassures hon. Members that we acknowledge and take seriously the hugely important challenges faced by eye care services. We are working at pace on these issues, and we will be doing more. I thank all hon. Members who have taken part in the debate for raising these important issues.

Dental Services: East of England

Neil O'Brien Excerpts

Tuesday 16th May 2023 Westminster Hall

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

I start by thanking my hon. Friend the Member for South Norfolk (Mr Bacon) for securing this important debate. It was reminder of what a brilliant speaker he is. Dentistry is the number one issue that I am working on; I have had two meetings on it already today. It is something that we are working on at pace. I know there are challenges accessing dentistry across the country, and recently there have been particular issues in my hon. Friend’s constituency. We are committed to tackling those issues, not only in the east of England but right across the country.

My hon. Friends are quite right about the scale of the challenges, which are particularly acute in the east of England. Colleagues who are here today, and others from the east of England, are first in my mind when I think about those who are contributing ideas to our forthcoming dentistry plan. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) talked about how we get students to do more for NHS dentistry. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) talked about how we must encourage preventative work, particularly for children—I completely agree with him.

My hon. Friend the Member for Waveney (Peter Aldous) talked about the challenge of under-delivery, the need to have proper rewards for complex types of treatment and how we incentivise dentists to move to areas such as the east of England. Those are all things that we are working on. My hon. Friend the Member for Broadland (Jerome Mayhew) talked about the unjustified variations in coverage and investment around the country, frozen in time by the 2006 contract. He also talked about the imbalances in training in different parts of the country. I was glad to hear various hon. Friends and Members talk about the importance of fluoridation. Across last year, we legislated to enable that to make progress for the first time since the 1960s.

My hon. Friend the Member for Boston and Skegness (Matt Warman) talked about how we must bust the backlog at the GDC. I met the GDC again yesterday to work on that. He also talked about the importance of accountability and greater transparency. Again, that is something that we are working on now. It would be remiss of me not to mention my hon. Friend the Member for North Norfolk (Duncan Baker), although the rules of this place do not allow him to speak in this debate. Hon. Friends from the east of England will not be surprised to hear that he, as the son of a dentist, is playing a leading role in pressing us forward to move even more quickly on dentistry.

My hon. Friend the Member for South Norfolk talked about fundamental reforms of the NHS dental contract. He is correct that we need to go further, but we have started to reform the contract for the first time since 2006, with the package of changes that we brought in last July. Those are an important first step in addressing some of the challenges facing the sector. We know, of course, that we need to go further. Those initial reforms have been received well by the profession and are starting to have a positive impact.

We created more UDA bands to better reflect the fair cost of work and incentivise NHS work. We introduced the first ever minimum UDA value to help to sustain practices where UDA vales are particularly low—the east of England is a good example of a place where that is the case. We allowed dentists to deliver 110% of their UDAs for the first time, to encourage more activity from those who want to do more. We made it a requirement for dentists to keep their availability for NHS patients up to date on the NHS website, which is an issue that a number of hon. Members have mentioned.

We also started the process of making it easier for dentists to come to work in the UK, and last month there came into force legislation that enables the General Dental Council to increase the capacity of the overseas registration exam, as hon. Friends have argued for in this debate. As some people have mentioned already, plans for a centre for dental development in Ipswich are advancing, and further plans are emerging elsewhere, including in Norfolk. We are also doing longer-term preventive work on expanding fluoridation; changing the law last year was part of that, and we also secured funding to expand fluoridation first across the north-east, subject to consultation later this year.

The reforms to split band 2 have been welcomed by the profession, as has the introduction of the 110% option. I am pleased to say that the proportion of the new band 2Bs is increasing and dentists are using the new flexibilities we introduced to prioritise those with higher needs. In terms of delivery, the number of patients seen in the year to March is up by nearly a fifth on a year earlier, but we must go further, and the changes we have made are just the start—I am under absolutely no illusion that there are significant challenges to address. The reforms that I have talked about and the forthcoming dental plan will draw on the ideas that hon. Members have put forward in this debate and offline. They will build on those initial banding changes and improve the payment model; ensure that we continue to improve access, particularly for new patients; look at how we address historical UDA variations; and look to make NHS work more attractive to ensure that NHS dentists are incentivised to deliver more NHS care.

The delegation, or devolution, of dentistry from NHS regions to ICBs, which various hon. Members have pointed out, is an improvement. It provides an opportunity for much closer integration with other local care services and much more accountability and transparency. People can much more easily go to see the person responsible for delivery in their area, and our dentistry plan will build on that.

I thank my hon. Friend the Member for South Norfolk for securing this important debate. I hope he is reassured that we have started to reform NHS dentistry and to improve services not just in the east of England, but in all areas. We will continue to build on those reforms in our plan for dentistry, on which we are working at pace.

Food Labelling and Allergies

Neil O'Brien Excerpts

Monday 15th May 2023 Westminster Hall

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

I thank my hon. Friend the Member for Don Valley (Nick Fletcher) for introducing this debate and for doing an excellent job of setting out the issues, and I thank all hon. Members who contributed. I found myself making copious notes; there was a lot for me to take away and work on. I also thank the thousands of individuals who signed the petitions that triggered this debate, which show the strength of the desire and the demand to improve treatment for those who suffer from allergies. Above all, I thank the victims’ families and friends who are here in the Public Gallery. I am terribly sorry for your loss; it was awful to hear about. I pay tribute to you and thank you on behalf of the Government for all the work that you have already done to improve safety and make sure that others do not suffer in the way you have suffered.

I will set out some of the work that is under way on different aspects of the issue in the Department of Health and Social Care and the Food Standards Agency. Food businesses are all under the same legal obligation to provide information at the point of sale indicating the presence of the 14 major allergens. Natasha’s law, which the Government introduced in 2021, requires all pre-packed direct-sale food such as grab-and-go sandwiches to have a label that shows the ingredients and allergens. That is important in helping people with allergies to feel confident that they are choosing safe food.

There are about 2.6 million people with food hypersensitivities in the UK. As hon. Members have pointed out, that number is rising. It includes people with food allergies, intolerances and conditions such as coeliac disease, which my mother suffers from, so I have some sense of the challenges facing people with that condition. The Food Standards Agency is working to address the needs of those consumers so that they can make safe and informed choices about the food they buy. For people with a potentially life-threatening reaction to certain foods, that trust is much more important.

The Carey family are already driving awareness on the issues that people with life-threatening allergies face. The FSA has met the Carey family several times in the past few years and it recognises the positive impact that the Owen’s law campaign is having. We need to consider changes to the law carefully to ensure that there are better safety outcomes for allergen sufferers and to avoid unintended consequences for consumers.

As hon. Members have mentioned, a workshop is taking place at the start of June with the families and others to look at how we can go further. To answer the question asked by my hon. Friend the Member for Winchester (Steve Brine), the FSA team have been over to Ireland to look at its law and study how it is working. I am not in a position to make an announcement today, but I am struck by the fact that everyone involved agrees that there is room to do better. Nothing is off the table at this point.

There are a number of issues relating to improving labelling for people with serious allergies. They are not arguments against doing anything; they are just issues that we must grapple with as we work out how to make progress. One is how we avoid potentially dangerous out-of-date information on menus, particularly for smaller restaurants, which change their ingredients more frequently. We cannot have false reassurance. When I worked in a Chinese restaurant, I was often sent out to a supermarket to find ingredients on the day, and that would often change what was in what we were serving up. Small businesses absolutely cannot have out-of-date information on menus.

[Mrs Sheryll Murray]

Will the Minister explain how some small outlets in my constituency list the allergens on their menus when, as he says, doing so is an obstacle?

[Neil O’Brien]

To reiterate what I said at the start of my remarks, I am mentioning some of the issues that we have to solve, not presenting them as insuperable obstacles to doing what a lot of people are calling for.

Another challenge that we have to grapple with, and are grappling with, is how to avoid some smaller businesses taking away a lot of choices for people with allergies by simply labelling too many items as containing allergens. Such businesses may have small kitchens that work with lots of different products and multiple allergens. We cannot take away lots of choices for people with allergies; we want them to have the freedom of choice that everyone expects to enjoy, but to have safety at the same time.

[Dr Cameron]

The Minister is making some good points, but on his last point, even if some outlets are being over-cautious, surely it is more sensible to be over-cautious than to put people’s lives at risk.

[Neil O’Brien]

That is a perfectly reasonable point. Of course, safety has to come first; I am merely laying out some of the challenges that we are grappling with as we think about Owen’s law and how we go further.

Even as we work on these issues and think about how we go further in providing information, we are getting on with improving training and knowledge for people in the food industry. Since September 2020, 380,000 people have signed up for allergy training through the FSA, which is a huge improvement in the provision of information and the correct treatment of people with severe allergies. Over the past 22 years, the FSA has invested about £22 million into researching these issues. Its scientific and social research, which improves the understanding of the views of those who are affected, of food businesses and of other key stakeholders, underpins our approach. To underline what I said a few moments ago, although I am not making an announcement today, nothing is off the table. We continue to look at and work on these issues at pace.

Let me turn to some other issues that have been raised in the debate. We have heard the calls for an allergy tsar, a form of leadership to advocate on behalf of those with serious allergies and their families. We already have parts of that leadership role in place, although, to address the point made by the hon. Member for Hammersmith (Andy Slaughter), that responsibility is not squarely on one individual’s shoulders. We will look closely at the proposal and at how we get to a more joined-up approach. The hon. Member asked directly whether I would meet with expert groups and those representing families who have been affected. The answer is yes, absolutely. I am extremely keen to meet and learn from those who have done lots of work on the subject.

It is worth setting out a bit about how the current NHS England operation works and what it is doing, although I recognise that that operation is not what those who are campaigning for a single joined-up tsar are asking for. In NHS England, there is a clinical reference group chaired by the national specialty adviser, Dr Claire Bethune. The group provides clinical advice and leadership on specialised immunology and allergy services. Its members include clinicians, commissioners, public health experts and patient and public voice members to try to capture the insights of those who are most affected by the issues. The members use their combined knowledge and expertise to advise NHS England on the optimal arrangements for the commissioning of specialised services. That advice includes the development of national standards in the form of service specifications and policies. As hon. Members know, those are tremendously important in defining what NHS services must be available.

The CRG is in the process of commencing a review of the current service specification for specialised allergy services. The output of that review will be an updated specification that makes reference to up-to-date guidance and takes account of the very latest evidence to clearly define the standards of care for commissioned specialised services, including transition into adult services.

The CRG is just one tool that we have at our disposal to address the multifaceted challenges that people with allergies face. Officials across Government are working with the National Allergy Strategy Group to consider how we can work more effectively together through things like an expert advisory group for allergy. The arguments that I have heard today will strike a chord with many people listening across the country. I am certain that it is right that we continue the conversation about how to work in a more joined-up way in future.

On ensuring that we have the right mix of staff to support people with allergies, in recent years there has been a 100% fill rate for doctors going into the two most relevant training pathways, allergy and immunology. NHS England will continue to identify priorities for investment in this space, in line with the expressed service priorities of the NHS across all medical specialties and the wider workforce. That work will be complemented by the forthcoming long-term workforce plan that we have commissioned NHS England to develop for the next 15 years, which we have committed to publishing shortly. It will include projections for the number of doctors, nurses and other professionals that will be needed in five, 10 and 15 years’ time, taking full account of improvements in productivity and the need for particular specialisms and skilled people to deal with things like immunology and allergy.

Most people with an allergy can be cared for in primary care settings, with services planned and commissioned by their local ICB. Specialised allergy services, however, are also provided for patients with the most severe allergic conditions, or those who have common allergic conditions for which conventional management has failed or for whom specialised treatments are required. In the current financial year, 2023-24, those services are jointly commissioned by NHS England specialised commissioning integrated care boards, in line with the published service specification.

All patients have access to those specialised services. Specialised services are required to be compliant with the service specification, including the need to have physicians, dieticians and nurses who are specially trained in allergy or have had long specialist expertise in the practice of allergy management and have up-to-date, continuing professional experience. All that work is serving to improve the lives of millions of people who have been affected to a greater or lesser degree by allergy.

There is clearly much more that remains to be done. The Government and those who have personal experience and great expertise working together will be central to driving forward continuing improvements, building on the work that has already been done and the changes that have been made. In future, we want to work closely with those who are most affected to improve the care and service provision for those who have serious allergies, so that they can live full, meaningful and safe lives.

Health Inequalities: North-west London

Neil O'Brien Excerpts

Monday 15th May 2023 Commons Chamber

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

Well, how to follow that? I pay tribute to the hon. Lady for securing this important debate and for her wide-ranging speech. It was so wide ranging that I think I will struggle to follow or match it, but I will do my best. It was a speech with everything from Tina Turner and Bruce Springsteen to loneliness and ethnic minority participation in clinical trials. Let me try and structure my response by starting with the health service, working back to primary care, and then addressing public health.

The first and most central thing is, of course, to have a high standard of healthcare. That is why, between 2010, when we came into office, and the end of this Parliament, we will have increased spending on healthcare by 42%, even when adjusted for inflation. That has enabled us to hire about 37,000 more NHS doctors than there were in 2010, and 52,000 extra nurses. That is a huge increase in resource and people, enabling us to start hacking through the covid backlog. We have already eliminated the two-year waits and have very nearly eliminated the 78-week waits. We are now moving on to eliminate shorter waits as we work through and cut the NHS waiting lists.

Of course, that is downstream—that is secondary care, hospitals and treating disease—and we all agree that the name of the game is to try to prevent disease and to treat things upstream, which is why we made further investments in primary care last week. In general practice, we have about 2,000 more doctors than we had in 2019 and about 25,000 more other clinicians. Compared with 2017, total spend on general practice is nearly a fifth higher. So more resource is going into that primary care.

We also see primary care doing more than ever. GPs are doing about 10% more appointments every month than they were before the pandemic, in 2019. That is the equivalent of about 20 extra appointments per practice per working day, which is a huge increase in output. That is partly because of the extra resource and partly because GPs are working extremely hard, and I pay tribute to everyone in general practice for doing that. That activity in general practice is a big part of the prevention story, helping people to stay healthy and to stay out of hospital.

However, as the hon. Lady alluded to, a lot of health is about the social determinants of health and about getting further upstream and tackling the underlying causes of the disparities that she talked about with great passion and understanding. Taken together, the public health grant, the drugs grant and the Start for Life grant will grow by about 5% in real terms after inflation over the next two years, enabling us to do more, particularly on problems such as drug dependency and drug addiction, which are particularly serious across all of London.

Part one is to have the funding there for those streams, but we have also been making major institutional changes to public health. We have set goals to increase healthy life expectancy and to the narrow gaps between different parts of the country. We have created the Office for Health Improvement and Disparities, and we and the NHS have created the Core20PLUS5 framework, which is a way of thinking about and tackling disparities. We have also put a new duty on integrated care boards to have due regard to disparities and to try to tackle them.

In quite specific ways, we have been taking action—this is of course relevant to north-west London—to tackle the problems of particular ethnic minority groups. In particular, we have been driving up vaccine uptake, particularly in groups where there is a degree of hesitancy, through targeted advertising and outreach to faith groups and local community groups, and I pay tribute to everyone who has been involved in that in the NHS.

We have been tackling the challenges thrown up by energy, which I will come back to, and by social housing—the hon. Lady was quite right to raise that issue in relation to west London. I pay tribute to my right hon. Friend the Secretary of State for Levelling Up, Housing and Communities for the vigorous action he is taking to tackle some of these challenges through the Social Housing (Regulation) Bill and extending the decent homes standard to the private sector, and the action he is taking to make developers pay to clean up the mess they have caused and to make sure we never have a Grenfell again.

So action is being taken across a wide range of areas. Let me just delve into a few of them in the time remaining. On drugs, the Home Office, the Ministry of Justice and the Department of Health and Social Care are investing about £900 million extra in the drugs strategy, which will grow local authority funding for treatment by about 40% between 2021 and 2024-25, and create about 50,000 extra places in treatment. As well as that investment in more treatment for people with drug addictions, we are increasing access to naloxone, which helps treat overdoses, and looking at spreading new technologies and new treatments, such as slow-release buvidal. When I visited a health centre in Brixton I saw the effect that some of these new drugs can have on improving treatment for those who have serious drug dependencies.

However, again on the point about getting upstream, our Start for Life programme is a major investment in new and expanded family hubs in about 75 local authorities. Its universal offer in those areas combines peer support for breastfeeding, help for those who are difficult to help and lots of face-to-face support with issues such as mental health. Right from the very start, as the hon. Lady mentioned, this is about trying to improve the disparities that emerge at an early stage.

Across the course of life we are taking action to prevent some of the most important major conditions, and our major conditions paper, which succeeds the health disparities White Paper will say more about this. The NHS long-term plan already announced the ambition to prevent 150,000 heart attacks, strokes and dementia cases by 2029. We supplied about 220,000 blood pressure monitors to those with high blood pressure. We are modernising and updating the NHS health check and creating a digital version. We have already pretty much got back to pre-pandemic levels of health check. We will be setting out more about the prevention of these major conditions in that forthcoming paper.

[Dr Huq]

The Minister is giving a constructive response with a lot of numbers in it. Is there a date for the major conditions strategy? I have asked him before and we have sparred on this question. At the time of the health disparities White Paper, the Secretary of State at the time—just two Secretaries of State ago—said that we should level up health as well as levelling up economically. The strategy does feel like a watering down, and it is yet to see the light of day. Do we know when it is coming out?

[Neil O’Brien]

There is not actually a date for that paper yet, but it will be out relatively shortly. We are tackling the major conditions because these health disparities that we are all concerned about are not mediated by magic; they are mediated by physical things that happen. First among them is probably smoking.

Smoking rates are highest in the poorest places, and that is a powerful driver of all of these other major health problems. I am proud to say that we have the lowest rate of smoking on record in England—just 13%, down from 21% in 2010—and that has happened because we have doubled duty on cigarettes and introduced the minimum excise tax on the cheapest cigarettes, and we have recently announced measures to go further. We are offering a million smokers help to “Swap to stop”, as they say, by giving them free vape kits, because that is so much less harmful, and we will also be introducing a financial incentive to quit, worth about £400, for all women who are pregnant and smoking. A shocking number of people still smoke in pregnancy, particularly in areas of higher deprivation. That builds on some of the things that the NHS is already doing, including the roll-out of carbon monoxide testing for people who are pregnant and smoke, and some of the innovative things that have been done at a local level.

The other big way that these health inequalities are mediated is through obesity. There are much higher rates of obesity in poorer places, for the reasons that the hon. Lady set out. She already mentioned some of the things. She talked about the so-called sugar tax—the soft drinks industry levy, as not a single person ever calls it—which has cut average sugar content in affected drinks by about 46% since we brought it in. We have introduced calorie labelling for out-of-home food in cafés and restaurants, and brought in location restrictions for less healthy food from October 2022. We are bringing in an advertising watershed in 2025. We spend about £150 million a year on healthy food schemes, such as school fruit and veg, nursery milk, Healthy Start and so on. We spend about £330 million a year on school sport and the PE premium. Through the youth investment fund, we are spending about £300 million on 300 new facilities for youth activities. We are also investing about £20 million a year on the national child measurement programme, which is all about trying to note these problems at an early stage and nip them in the bud.

In the hon. Lady’s speech, she talked about the challenges thrown up by the Russian invasion of Ukraine and the effect that has had on the cost of living. Again, we are taking decisive action. We are spending about £55 billion to help households and businesses with their energy bills, which is among the highest and most generous support plans in Europe, paying about half of people’s bills over the winter. On top of that, we have action directly to help with the cost of living for people who are less well off, including the £900 cost of living payment for about 8 million poorer households and the largest ever increase to the national living wage for 2 million workers. In total, we are spending about £26 billion on cost of living support next year. We are taking action on energy, but also at the same time taking further action both to improve the quality of rented and social housing through the Social Housing (Regulation) Bill and to invest more in energy efficiency so that people’s homes are cheaper to heat.

I have tried to tackle some of the subjects that the hon. Lady raised in her speech, which I thought was really interesting to listen to and covered many subjects. I will not be able to tick all of them off this evening, but it was a pleasure to hear about some of her thoughts and ideas, and a pleasure to commend to the House some of the action we are taking.

Question put and agreed to.

Vaping: Under-18s

Neil O'Brien Excerpts

Tuesday 2nd May 2023 Westminster Hall

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

I thank my hon. Friend the Member for Penrith and The Border (Dr Hudson) for securing this very important and timely debate on youth vaping, and for his excellent speech. Lots of Members have made important contributions to policy in this area, and I pay tribute to them for that, as well as for their contributions today.

Until recently, our regulations—including on the minimum age of sale, advertising restrictions and the cap on nicotine levels—have been reasonably effective at keeping the rate of vaping among under-18s low. However, over the last 18 months we have seen a surge in the use and promotion of cheap, colourful products that do not always comply with our regulations, and there has been a sharp increase in the number of children vaping. NHS figures show that 9% of 11 to 15-year-old children used e-cigarettes in 2021—up from 6% in 2018. That is a big concern, because there is every reason to think that the rate has continued to go up.

We know that vapes are not risk-free. Nicotine is highly addictive and can be harmful, and there are unanswered questions about the effects of long-term use, as the hon. Member for Newport West (Ruth Jones) pointed out. Our message is very clear: vapes should not be used by people under the age of 18, or by non-smokers. That is why I announced on 11 April that we are stepping up our efforts to stop kids getting hooked on vaping. First, we launched a call for evidence on youth vaping to identify opportunities to reduce the number of children accessing and using vape products, and to explore where the Government can go further. That call for evidence explores a range of issues, including how we ensure regulatory compliance, the appearance and characteristics of vapes, the marketing and promotion of them, and the role of social media. My hon. Friend the Member for Eastbourne (Caroline Ansell) rightly talked about them being stacked up like sweeties, and that concerns me, too. On the other hand, my hon. Friend the Member for Northampton South (Andrew Lewer) warned that this is not a straightforward matter to regulate, and pointed out the need to avoid counterproductive changes that stop people swapping from smoking to vaping.

Our call for evidence will also seek to ensure that we understand the vaping market better. It will look at such issues as the price of low-cost products. The call for evidence also considers the environmental impact of vapes, particularly the disposable ones that have become so appealing to young people.

[Ruth Jones]

The Minister is talking about the environmental impact. How closely is he working with Department for Environment, Food and Rural Affairs colleagues to ensure recycling, and to ensure a circular economy in the precious metals mentioned, which must be brought back into the economy?

[Neil O'Brien]

Closely. I am also listening to my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who has led discussion on the subject through her ten-minute rule Bill. She is right to be concerned about the environmental impact of disposable products. The proportion of young people using those disposable products has gone up from 8% in 2021 to 52% by 2022. Clearly, they are an important part of youth vaping.

[Gareth Johnson]

We have heard a few calls for vaping products to be placed with tobacco products. Does the Minister agree that there is a danger in connecting vaping with tobacco to such a degree? It is not surprising that a disproportionately high number of people in this country believe that vaping is just as bad as smoking. People are put off going from smoking to vaping as a consequence. Should we not separate vaping from smoking wherever possible?

[Neil O'Brien]

My hon. Friend is right, and I will come to that in a moment. The call for evidence that I talked about will be open for the next eight weeks, and we hope that everyone concerned will take the opportunity to share their views and put evidence in, to shape our future approach.

[Caroline Ansell]

In the review, will there be any consideration of the role of Trading Standards?

[Neil O'Brien]

Absolutely, and I hope people will put in evidence on that. I will touch in a moment on something else we are doing. In the speech I mentioned, I announced the new specialised illicit vaping flying squad, a team to tackle under-age vape sales and illicit products that young people are accessing. It will hold companies to account and enforce rules.

My hon. Friend the Member for Rugby (Mark Pawsey), the chair of the all-party parliamentary group for vaping (e-cigarettes), said that we must enforce the rules, and he is absolutely right. That is why we are providing £3 million in new funding to Trading Standards, which will help share knowledge and intelligence around the country. The squad will undertake test purchasing, so that we find out who is selling to young people. It will disrupt illicit supply, and will also do work on organised crime gangs. It will remove illegal products, not just from our shelves but at our borders. It will undertake more testing to ensure compliance with our rules, bolstering the capacity of Trading Standards. Companies that fail to comply with the law will be held accountable.

It is important that we teach young people about the risks of vaping. That is why we have published new content on the potential risks of vaping for young people on the FRANK and Better Health websites. We have also provided extra input into educational resources produced by partners, including the PSHE Association.

[Mark Pawsey]

The Government has an objective to be smoke-free by 2030—that is, to get down to 5% of people smoking. Is the Minister concerned that if we continue to talk about the dangers and harms that may be associated with vaping, we are in grave danger of providing a disincentive for smokers to switch to a much safer alternative?

[Neil O'Brien]

My hon. Friend has pre-empted my next paragraph almost perfectly. I was about to say that although we want to ensure that children do not take up vaping, vaping can play an important part in achieving our ambition of a smoke-free England by 2030. Vaping is a double-edged sword. On the one hand, we do not want children to develop an addiction to any substance at a young age, but on the other, it is substantially less harmful than smoking, as my hon. Friend the Member for Dartford (Gareth Johnson) said. It is 95% safer than smoking.

[Rachael Maskell]

Will the Minister also put in place services, similar to smoking programmes, to support people who are now addicted to vaping, to enable them to come off vaping?

[Neil O'Brien]

Absolutely, and I will touch on that in just one moment. Vapes—

[Dr Caroline Johnson]

Will the Minister give way?

[Neil O’Brien]

I think I should try to answer the last intervention before taking another one; I will come back to my hon. Friend in a second. Vapes are not yet being used widely enough to reach their full potential as a quit smoking aid, so on 11 April, I announced new funding for a new national “swap to stop” programme—the first of its kind anywhere in the world. We will work with councils and others to offer 1 million smokers across England a free vaping starter kit. Smokers who join the scheme, which will run initially over the next two years, will join on one condition: they must commit to quitting smoking, with support. We will provide additional support to help them quit vaping after they have quit smoking. We will target the most at-risk communities first, focusing on settings such as jobcentres, homelessness centres and social housing providers. I do not know whether my hon. Friend still has a burning question.

[Dr Johnson]

Yes, and I thank the Minister for giving way; he has been extremely generous with his time. He has talked about the importance of educating children about the risks. Does he agree that a key problem is that many young people and children who use vapes do not believe that they are harmful at all?

[Neil O’Brien]

My hon. Friend is quite probably right. There is a lack of understanding of some of the risks, and of the effects on mental health and wellbeing. I am very, very worried when I hear about young people at school smoking, and about the disruption that various hon. Members have raised in this debate.

I conclude by thanking all Members here for highlighting concerns about these issues, and for their contributions, not only in the debate but over a longer period. That has had an effect on Government policy, and will continue to. The Government are committed to doing all we can to prevent children and young people from vaping, while also ensuring that we use the full potential of vaping as a tool to help smokers quit.

Question put and agreed to.

Reforms to NHS Dentistry

Neil O'Brien Excerpts

Thursday 27th April 2023 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for securing this debate, and I thank other hon. and right hon. Member for their persistence in pursuing this matter and ensuring it remains a priority. It is worth repeating that this debate is about the progress on reforming NHS dentistry. The two colleagues I mentioned made the case for this debate:

“Underfunding and the current NHS dental contract are to blame for long-standing problems with burnout, recruitment and retention in NHS dental services. Morale amongst NHS dentists is at an all-time low and we are facing an exodus of dentists from the NHS. Reform of the dysfunctional NHS dental contract is a matter of urgency—a reformed service won’t work if there is no workforce left by the time it’s finally introduced.”

To solve the problem, it is crucial to accept that there actually is a problem, and it is important to recognise the extent of that problem. The first question I want to ask the Minister is whether he accepts that there is a problem with access to NHS dental services.

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

indicated assent.

--- Later in debate ---

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

I thank my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) for securing this important and timely debate as we work on our dental plan and the NHS workforce plan. We have had some excellent and useful contributions, and all the ideas that have been put forward are extremely timely.

The hon. Lady said it is time for real change, not patching, and I completely agree. The Chair of the Select Committee, my hon. Friend the Member for Winchester (Steve Brine), made too many important points to list, but he made an important point about the need for greater transparency on data and delivery, and I completely agree.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) listed some of the problems that are firing our ambition to fundamentally change the system. My hon. Friend the Member for Waveney made a series of important points, and I am grateful for his contribution not only today and in previous debates but outside the Chamber. He has many thoughtful observations to make about ringfencing, changing the UDA system, fluoridation and so on, and all those ideas are flowing into our work. The right hon. Member for Kingston upon Hull North (Dame Diana Johnson) was the first in this debate, but not the last, to emphasise the importance of where dentists do their training and foundation training to getting more dentists into under-served places, which we are looking at.

My hon. Friend the Member for Hartlepool (Jill Mortimer), like my hon. Friend the Member for Waveney, talked about the perverse effect of the contract bands. That was brought home to me by the conversation she engineered for me with some of her local dentists. I found that conversation incredibly useful. Their passion for NHS work and dentistry shone forth, and it brought home the central role of local commissioners in making the choices of the kind she raised in this debate.

The hon. Member for City of Durham (Mary Kelly Foy) talked about the importance of prevention, not just treatment, and we are thinking about that. My hon. Friend the Member for Broxtowe (Darren Henry) raised the important issues for Sacha and Joan, and I am happy to meet him and his local ICB to talk about how we can address those cases.

The hon. Member for Bootle (Peter Dowd) asked whether we have gone far enough. No, we have not, hence the need for a dental plan. My hon. Friend the Member for Milton Keynes North (Ben Everitt) emphasised the need for housing plans to take better account of the need for primary care facilities and dentists, which we have discussed outside the Chamber. Some places do it well, but that does not happen everywhere, including in his local authority.

The hon. Member for York Central (Rachael Maskell), as always, made interesting comments about prevention among young people, which we are certainly looking at. My hon. Friend the Member for Barrow and Furness (Simon Fell) was the first person to mention that the overseas registration exam is much too long-winded, and that it takes people much too long at the moment. The legislation to enable that to change came into force last month, and we now need the GDC to move quickly to address the backlog and those problems.

It is always a pleasure to hear the hon. Member for Strangford (Jim Shannon) speak in a debate to bring a UK-wide perspective, and he asked a straight question about how we are engaging with the profession. We are generating these ideas by talking directly to dentists. My right hon. Friend the Member for Tatton (Esther McVey) said that dentists had told her that the 2006 contract had never worked, and I have certainly heard that from many dentists.

I am happy to meet my hon. Friend the Member for Bolsover (Mark Fletcher) and his ICB to discuss the recommissioning of services. He raised the issue of Bupa, and I agree that having a three-way meeting would be useful. My hon. Friend the Member for Don Valley (Nick Fletcher) got to the nub of the issue when he talked about basic incentives.

When I visited my hon. Friend the Member for North Devon (Selaine Saxby), I was once again reminded of the particular challenges of coastal communities, and that is especially true in dentistry. We have talked about this before and are thinking about how to get dentists to go places that are historically under-served.

My hon. Friend the Member for Broadland (Jerome Mayhew) raised the same point, as well as a deep question about the historical allocation of funding in dentistry. We are certainly looking at that. I reassure him that we are also looking at the whole issue of centres for dental development, and the proposals emerging in his area are extremely interesting.

Last but not least, my hon. Friend the Member for Keighley (Robbie Moore) mentioned our new requirement for dentists to keep their records on the NHS website up to date. We are keen to drive that forward and to ensure that records are accurate for exactly the reasons that he mentioned.

Dentistry was hit much harder than most other health services because of its fundamental nature: dentists are looking down people’s throats and creating a lot of aerosols, so of course during the covid pandemic the sector was particularly hard hit. We allocated £1.7 billion of funding to carry NHS dentists through the pandemic, which enabled many to survive, but dentistry was clearly hard hit, and it is a hugely important part of the NHS, as many Members have said.

The package of changes that we brought in last July were an important first step—only a first step—in addressing the challenges facing the sector. We have started to reform the contract, with the first significant changes since 2006, to make NHS dentistry more attractive. We have created more UDA bands to better reflect the fair cost of work and to incentivise NHS work. We introduced for the first time a minimum UDA value to help sustain practices where values are lower, and to address unfair and unjustified inequalities in UDA rates, which are now based on quite historical data. We have enabled and allowed dentists to deliver 110% of their UDAs for the first time to encourage more activity and to allow those who want to deliver more NHS dentistry to do so. We have also made it a requirement for the first time for dentists to keep their availability up to date on the NHS website.

We have also made it easier—a number of hon. Members have made this point today—for dentists to come to the UK. The legislation came into force last month to enable the GDC to increase the capacity of the overseas registration exam. As of 1 April, people will no longer have to pay the charges that they used to pay. The Chair of the Select Committee stressed how important it was for the GDC to respond to those increased flexibilities and to work at pace to get through the backlog, and we are actively in discussions with it about how best to do that. Plans are advancing for centres for dental development, as a couple of different hon. Members have mentioned, not just in Suffolk or Norfolk, but further afield, such as in Cumbria. We are watching those plans closely and working with local partners to see what is possible.

Hon. Members raised the matter of prevention. We have already started the process of expanding fluoridation across the entirety of the north-east, which would—subject to consultation—encompass about 1.6 million more people. We will be launching that consultation this year in order to provide the benefits of fluoridation to a large new area for the first time since the 1960s.

All these changes are starting to have some positive effects. In the year to March, about a fifth more patients were seen compared to a year earlier. In total there are about 6.5% more dentists doing NHS work now than in 2010, and UDA delivery is going up from that huge hit it took in the covid pandemic, but of course we must go further; I am the first person to say that. I can see that some of the reforms are working. The proportion of dentists making the new band 2b claims is increasing and it is great to see that practices are prioritising those with higher needs. But this is absolutely just the start and I know that we must go further.

[Rachael Maskell]

Will the Minister set out with great clarity the data that is required, so that we do not just measure how many people are working in NHS dentistry, but we understand the number of sessions they are providing, and we marry that up with need and demand in order to understand what gap is there?

[Neil O’Brien]

The hon. Lady is right; in dentistry, not only do we have headcount measures showing that six and a bit per cent. more dentists are doing NHS work, but we can see the amount they are delivering and we can see those UDA rates starting to go back up again. Of course, we want them to go up further, and I am keen to start publishing more data so that there is greater transparency about what is being delivered where.

There are further changes we must make. We are trying to drive activity back up to at least pre-pandemic levels and to address the fundamental shortfalls that were there even before the pandemic. When I speak to dentists, they have a keen sense of whether the payments they are offered under the 2006 contract make work profitable or unprofitable. Often, for some of those bands, they feel that they are not being fairly remunerated for the cost of the work they are doing. We need to make sure that they do feel fairly remunerated so that they are more attracted to doing NHS work. We could go further in addressing some of those historical, and potentially now unjustified, variations in UDA rates. In particular, the move to ICBs and away from regional commissioning provides an opportunity for not just more transparency, but much more accountability. Instead of a remote regional body, hon. Members will be able to talk to their local ICB about what it is doing to drive up delivery. When we arm Members of this House with greater transparency and greater data, they will be able to have those conversations about what we are doing collectively to drive up the levels of delivery.

[Mrs Hodgson]

I am listening intently to what the Minister is saying. When I go back to speak to my local dentists, what do I tell them about the “when”? He is saying all the things that we would like to do and the Government would like to do. We want to see all that happen, but when will this contract that has needed changing since 2010—[Hon. Members: “2006!”.] We had changing it in our 2010 manifesto; we said we would update it in 2010. The Government have had 13 years to fix this, so when is it going to happen?

[Neil O’Brien]

I have mentioned some things that are already changing—some of the first reforms to the contract since 2006 that we have started to bring in. We are working on the plan at pace. There is no date for its publication yet, but we are working on it at pace because we are conscious of the urgency.

I thank the hon. Member for Bradford South and my hon. Friend the Member for Waveney for securing this important debate. I hope they have been assured that we have started to reform dentistry, that we are seized of the importance of the issue, and that we recognise that we can and must go further to further strengthen NHS dentistry.

[Mr Deputy Speaker (Mr Nigel Evans)]

The last word goes to Judith Cummins.

Oral Answers

Neil O'Brien Excerpts

Tuesday 25th April 2023 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

3. What steps he is taking to tackle vaping by young people.

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

I recently announced new measures to tackle youth vaping, including an extra £3 million for a new enforcement squad to tackle underage sales and illicit vapes. We also launched a call for evidence to identify opportunities to reduce youth vaping, which covers everything from the appearance, marketing and price to the environmental impact of vapes.

[Bob Blackman]

We would all encourage people to vape instead of smoke, but we do not know the long-term health impact of vaping at all. Reports suggest that one in seven young people are taking up vaping directly and therefore becoming addicted to nicotine, the most addictive drug known to humankind. What measures will my hon. Friend take to make sure that young people understand the risks of vaping?

[Neil O’Brien]

I pay tribute to my hon. Friend’s work as chair of the all-party parliamentary group for vaping. He is right; as well as the measures I mentioned, we have updated the guidance on Talk to FRANK, to illustrate for young people the dangers of consuming lots of nicotine.

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

In 2021, the Government rejected my amendment to the Health and Care Bill to tackle smoking and youth vaping. England is now set to miss the Smokefree 2030 target by at least seven years, and countless children are now addicted to vapes. I welcome the U-turn, but what steps has the Minister taken to make up that lost time?

[Neil O’Brien]

We are taking action across the board on smoking. I think we are in agreement on what has to be done. That is why we recently announced that we are giving vaping kits to a million smokers to help them swap to stop. We are also bringing in new health incentives for all pregnant women so that we can help them stop—that is based on good local evidence. We are taking preventative action, and I think the hon. Lady and I both want the same thing.

[Rebecca Long Bailey (Salford and Eccles) (Lab)]

4. What assessment his Department has made of the impact of funding allocations for adult social care on charitable and not-for-profit providers.

--- Later in debate ---

[Mark Eastwood (Dewsbury) (Con)]

5. What steps his Department is taking to encourage people to stop smoking.

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

We have the lowest smoking rate on record in England, down from 21% in 2010 to 13% now, partly because we have introduced minimum excise tax on cheap cigarettes and double duty on cigarettes, but we know we have to go further. That is why we recently announced significant new funding to help a million smokers quit, through swap to stop, and introduced a new financial incentive for pregnant women. We are also consulting on new pack inserts, similar to those in Canada.

[Mark Eastwood]

As someone who was able to quit smoking using nicotine patches, following the advice at last year’s Emley show, I welcome the measures announced by the Minister earlier this month to help us achieve our Smokefree 2030 target. Does the Minister agree that, in order to help even more people quit, we should continue to pursue harm reduction strategies such as swap to stop? That will ensure that we maintain our position as a world leader in public health.

[Neil O’Brien]

I absolutely agree with my hon. Friend and congratulate him on quitting. The swap to stop scheme that we are rolling out nationally, which is the first of its kind in the world, is based on strong local evidence. We know it works from local pilots, which is why we are rolling it out at scale.

[Dan Jarvis (Barnsley Central) (Lab)]

Smoking remains the biggest preventable cause of cancer and we know that smoking cessation services are vital to kicking the habit, but smokers in England face a postcode lottery when trying to access them. What is the Minister doing to ensure that everybody who needs those services is able to access them?

[Neil O’Brien]

Absolutely. In total, public health grants will go up by 5% in real terms over the next two years. We want to reduce the postcode variation, because these are important services. I am keen to speak to anyone who wants to work with us at a local level.

[Mr Speaker]

I call the SNP spokesperson.

[Neil O’Brien]

I recently had a very productive meeting with my Scottish Government counterpart. As I mentioned, we have already doubled the duty on cigarettes since 2010 and have brought in a minimum tax for the cheaper cigarettes. Of course, tax is a matter for the Treasury, but we will always be interested in things that can drive down smoking.

[Wera Hobhouse (Bath) (LD)]

6. What steps his Department is taking to improve access to maternity care in the south-west.

--- Later in debate ---

[Christine Jardine (Edinburgh West) (LD)]

22. What progress his Department has made on improving access to NHS dentist appointments.

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

There are 6% more dentists doing NHS work than in 2010, and activity levels are going up. In March the number of patients seen over the past year was up by nearly a fifth on the year before. The initials reforms we have made to make NHS work more attractive are having positive effects but there is much more to do and we will be publishing a plan to improve access to dentistry.

[Rachael Maskell]

In York alone, practices are closing, turning private and handing back contracts. Units of dental activity are down 126,130 compared with four years ago and it can take five years to see a dentist. This is an unacceptable crisis after 13 years of complete failure. Will the Minister enable integrated care boards to have full flexibility to establish an under-18s NHS dental service in schools, along with a full elderly service and one for the most disadvantaged?

[Neil O’Brien]

We will look at all those things. We have introduced additional flexibilities, as the hon. Lady knows, and we are allowing dentists to do more to deliver 110% of their UDAs and bringing in minimum UDA values, but we are also interested in prevention and I would be happy to look particularly at what we can do for younger people.

[Christine Jardine]

Tooth care, like any other form of healthcare, should be universally accessible, but we know that we are facing a crisis across the UK, with one in five adults who could not get an appointment in the past 12 months carrying out dental work on themselves, or getting someone else to do it, which is quite horrifying. The problem is not confined to one part of the UK. In Scotland, 80% of dentists are no longer accepting new adult or child patients. We have a crisis across the UK, so will the Minister commit to introducing a national programme and to speaking to the Scottish and Welsh Governments to address the shortage of NHS dentists for all of us?

[Neil O’Brien]

I am happy to work with the Scottish and Welsh Governments. We are, as I said, driving up levels of delivery, and we will be publishing a plan to take that further.

[Kevin Foster (Torbay) (Con)]

Like other colleagues, I have been approached by constituents who are struggling to find an NHS dentist because their previous dentist has either retired or converted to private practice. When the Minister presents his new dental plan, will it include a target to ensure registrations are available, as well as to increase the number of appointments?

[Neil O’Brien]

My hon. Friend is right, and I am particularly seized of the issue of access for new patients.

[Simon Fell (Barrow and Furness) (Con)]

My constituents in Dalton-in-Furness were dismayed to find out that their dentist has closed. This follows the closure of Bupa in Barrow and in Millom, and Avondale in Grange-over-Sands has handed back its NHS contracts. What was a bad situation has got very bad indeed. I am meeting the ICB next week to talk about what it might be able to do, but will the Minister agree to meet me to discuss what levers he can pull to improve dental access in Barrow and Furness?

[Neil O’Brien]

I am very happy to meet my hon. Friend, and we have already talked to some extent. The minimum UDA value that we introduced particularly helps rural and coastal areas of the kind he represents, and I am happy to talk further, and to go further, on all these things.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

As in the NHS, workforce is the biggest single issue. The Nuffield Trust has identified that, post-Brexit, dentists are among the key staff we are losing. On top of that, while Scotland and Wales have childhood dental health programmes, England does not. When will England have a national childhood dental health programme, and when will the contract in England be reformed to reward preventive work, rather than just dealing with emergencies?

[Neil O’Brien]

We passed legislation last month to make it easier for international dentists to come to the UK by reforming the General Dental Council to speed up the flow from abroad. The hon. Lady mentions an additional service that is available in Scotland. Of course, Scotland has 25% more funding per head than the rest of the UK, which is just one benefit of being in the UK, and it is one reason why people in Scotland voted to remain in the UK.

[Jack Brereton (Stoke-on-Trent South) (Con)]

The lack of NHS dentists is a major concern in north Staffordshire. Does the Minister agree that we should set up a dental school at Keele University, which already has one of the best medical schools in the country?

[Neil O’Brien]

We are looking at the dentist, hygienist and therapist workforces as part of the long-term NHS workforce plan. I can reveal that this is not the first time my hon. Friend has lobbied me on this idea, and I am sure he will continue to do so.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

11. What progress his Department has made on improving access to NHS appointments.

--- Later in debate ---

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The British Medical Journal has warned that the comprehensive and progressive agreement for trans-Pacific partnership trade deal will make it harder for the UK to regulate tobacco and alcohol or banned products such as those containing harmful pesticides. Given that no health impact assessment has been carried out, The BMJ recommends that one should be performed now. Will the Secretary of State commit to assessing the deal’s threat to public health?

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

We do not plan to debate any of our existing standards. We have some of the strongest standards for control anywhere in the world. We have no plans to get rid of any of those things.

[Peter Aldous (Waveney) (Con)]

Notwithstanding the work that the Government have done, the feedback that I am receiving from Suffolk-based NHS dentists is that there is still a very long waiting list for overseas dentists waiting to take the overseas registration examination, with more than 3,000 applicants and only 150 exams taking place each month. I urge my hon. Friend to leave no stone unturned in working with the General Dental Council to eliminate the waiting list as quickly as possible.

[Neil O’Brien]

We are leaving no stone unturned. Last month, we passed legislation enabling the GDC to increase the capacity of the ORE. We have also made it easier for overseas dentists to start working in the NHS: as of 1 April, no dentist will need to pay an application fee. We also want to radically reduce the time that dentists spend in performers list validation by experience, and we will set out further steps in our dentistry plan.

[Kim Leadbeater (Batley and Spen) (Lab)]

T2. What is the Secretary of State doing to tackle the severe national shortage of desperately needed psychiatric intensive care beds, which means that people, including some of my constituents, have to travel hundreds of miles to see their loved ones?

--- Later in debate ---

[Mike Amesbury (Weaver Vale) (Lab)]

T4. Last week, I visited Leftwich Community Primary School in my constituency. The joint head teachers raised the desperate attempts that are made to secure NHS dentists for children and families in the community. Aside from publishing a plan, will Ministers intervene and make sure that that happens in Cheshire and Merseyside, and throughout the country?

[Neil O’Brien]

Absolutely. We have already taken action to increase the provision of dentistry, and that has begun to have an effect. Activity—the number of people seen—is up by a fifth over the past year as a result of the reforms that we have begun to make by reforming the old contract, but we must go further.

[Sara Britcliffe (Hyndburn) (Con)]

One of my constituents, Bethany Whitehead, suffers from functional neurological disorder, which often presents with a number of debilitating symptoms. Bethany has often been left waiting two to three years before seeing a consultant. Will the Minister meet me to discuss this further?

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

T5. As chair of the all-party parliamentary health group, I have heard from UK patients who struggle to access GP appointments from chain GP practices. Many of those practices have very low ratios of GPs to patients, including, in one case, only two GPs registered for 30,000 patients. Will the Department meet the APPG to address these grave concerns?

[Neil O’Brien]

We have increased real-terms spending on general practice by over a fifth since 2016, and as a result there are now 10% more appointments happening every month. We are grateful to GPs for that. We have more doctors and clinicians, but we want to keep going, and I am happy to discuss this with anyone who has useful ideas to keep us powering forward.

[Mr David Davis (Haltemprice and Howden) (Con)]

Yesterday, when the Prime Minister met business, the huge value of the NHS database was highlighted. Unfortunately, the previous occasions on which the NHS has tried to open its database have been unmitigated disasters. Will the Secretary of State give an undertaking to stick closely to the recommendations of the Goldacre report so that we can deliver the database while protecting the privacy of patients?

--- Later in debate ---

[Neil O’Brien]

I am very happy to meet the right hon. Lady as we work towards the workforce plan and the dental plan.

[Mr Speaker]

I call Mark Fletcher to ask the final question.

[Mark Fletcher (Bolsover) (Con)]

The Minister is aware that BUPA recently closed the dental practice in Bolsover, leaving a severe shortage of NHS dentistry in the constituency. I met the ICB yesterday to discuss the various options for the constituency, but will the Minister commit to meeting me and the ICB to talk through those options and see what we can do to maintain NHS dentistry in Bolsover?

[Neil O’Brien]

I have already met my hon. Friend, but I am very happy to meet him and his ICB to make sure that we commission the services that are so needed locally.

Bill Presented

Digital Markets, Competition and Consumers Bill

Presentation and First Reading (Standing Order No. 57)

Secretary Kemi Badenoch, supported by the Prime Minister, the Chancellor of the Exchequer, Secretary Michelle Donelan, Secretary Lucy Frazer, Kevin Hollinrake, Paul Scully and Julia Lopez, presented a Bill to provide for the regulation of competition in digital markets; to amend the Competition Act 1998 and the Enterprise Act 2002 and to make other provision about competition law; to make provision relating to the protection of consumer rights and to confer further such rights; and for connected purposes.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 294) with explanatory notes (Bill 294-EN).

Achieving Smokefree 2030: Cutting Smoking and Stopping Kids Vaping

Neil O'Brien Excerpts

Monday 17th April 2023 Written Statements

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

In 2019, this Government set the bold ambition for England to be smokefree by 2030—reducing smoking rates to 5% or less. To support this, the Government commissioned Dr Javed Khan OBE to undertake an independent review which was published in June 2022.

As I set out in a letter to colleagues on 11 April, I am pleased to be able to update the House on new action we have announced to help more people in England to quit smoking in order to meet our Smokefree 2030 ambition. We also announced further measures to protect children from the use of vaping products, in recognition of the sharp increase in vaping among children in recent years.

One in seven adults—5.4 million people—still smoke in England, and tobacco remains the single biggest cause of preventable illness and death. Up to two out of three lifelong smokers will die from smoking, and smoking substantially increases the risk of heart disease, heart attack and stroke. Smoking also causes seven out of 10 cases of lung cancer. Tackling smoking is one of the most evidence-based and effective interventions that we can take to prevent ill health. It will improve public health, reduce the burden on the NHS, and provides substantial benefits to our workforce and the economy.

Across the country, people are concerned by the increases in youth vaping among children. It is illegal to sell vapes to under 18s and this Government want to clamp down on those businesses that rely on children buying vapes and getting them hooked on nicotine. To help combat rising levels of youth vaping, the Government have now published a youth vaping call for evidence. The call for evidence aims to identify opportunities to reduce the number of children accessing and using vapes, exploring issues such as regulatory compliance, the marketing and promotion of vape products and the environmental impact of disposable vapes. We will explore where the Government can go further, beyond what the EU’s tobacco products directive allowed us to. I encourage colleagues from across the House to contribute and help inform our next steps. The call for evidence is available here:

https://www.gov.uk/government/consultations/youth-vaping-call-for-evidence/youth-vaping-call-for-evidence.

While we want to ensure children do not take up vaping, we would also like to exploit the potential of vaping as a powerful tool to stop adults smoking. Vaping is substantially less harmful than smoking and our most effective quit aid—particularly when provided alongside behavioural support. That is why last week I announced that we will be supporting a million smokers to “swap to stop”, with free vaping kit—the first national scheme of its kind in the world. The scheme will run over two years initially and be targeted at the most at-risk communities first—focusing on settings such as jobcentres, homeless centres and social housing providers.

I was also pleased to announce new action to tackle illicit tobacco and vaping, as well as underage sales. Later this year, His Majesty’s Revenue and Customs and Border Force will publish an updated strategy to tackle illicit tobacco. It will set out how we will continue to target, catch and punish those involved in the illicit market. This Government have also committed £3 million of new funding to create a specialised “illicit vapes enforcement squad” to enforce the rules on the sale of vapes, tackling illicit vapes and underage sales. This national programme will gather intelligence, co-ordinate efforts across the country, undertake test purchasing and develop guidance to build regulatory compliance.

Across England, nearly 9% of women still smoke in pregnancy. To tackle this, by next year we will offer a financial incentive to all pregnant women who smoke to support them to quit. In pilot projects these evidence-based schemes have already proven their value with a return on investment of £4 for every £1 invested. Most importantly, they unlock a lifetime of benefits for the child and their mother.

I also announced that the Government will consult this year on introducing mandatory cigarette pack inserts, to refresh the health messaging on cigarette packets with positive messages and information to help people to quit smoking. We are exploring how best we can use modern approaches within this, such as the use of QR codes, to make it as easy as possible to get help to quit.

On 24 January, my right hon. Friend the Secretary of State for Health and Social Care (Steve Barclay) announced our intention to develop a major conditions strategy plan to tackle preventable ill health and mortality in England. It will focus on tackling the most prevalent conditions that contribute to morbidity and mortality in our population—cancers, cardiovascular disease, stroke and diabetes, chronic respiratory diseases, dementia, mental ill health, and musculoskeletal conditions. Tackling smoking will be central to this strategy.

Through these actions, we have set out the Government plan to meeting our bold ambition to be smokefree by 2030 and respond to the Khan review. We are committed to doing all we can to give people the support they need to quit smoking, tackling the damage from the illicit market and minimising the growing threat of vaping by children.

However, we cannot do this alone. A close collaboration is needed right across the health system—including the NHS, local authorities and a range of public health stakeholders. We hope that together our efforts will act as a powerful catalyst to reduce health disparities and prevent smoking-related death, disease and despair.

[HCWS710]

NHS Dental Patient Charges

Neil O'Brien Excerpts

Monday 27th March 2023 Written Statements

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

The National Health Service (Dental Charges) (Amendment) Regulations 2023 (“the Amendment Regulations”) will be laid before Parliament to increase national health service dental patient charges in England from 24 April 2023.

NHS dental patient charges provide an important revenue source for NHS dentistry and are typically uplifted on 1 April each financial year. The most recent uplift was in December 2020, delayed from April 2020 due to the impacts of the pandemic. While there has been no uplift for two years, the cost of delivering NHS dental care has increased.

From 24 April 2023, dental patient charges in England will increase by 8.5%. This means that a dental charge payable for a band 1 course of treatment will rise by £2.00, from £23.80 to £25.80. For a band 2 course of treatment, there will be an increase of £5.50 from £65.20 to £70.70. A band 3 course of treatment will increase by £24 from £282.80 to £306.80.

Details of the revised charges for 2023-24 can be found in the table below:

Public Health Grant Allocations: Local Authorities

Neil O'Brien Excerpts

Tuesday 14th March 2023 Written Statements

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

Today I am publishing the Public Health Grant allocations to local authorities in England for 2023- 24, along with indicative allocations for 2024-25.

Funding for local government’s health responsibilities is an essential element of our commitment to invest in preventing ill health, promoting healthier lives and addressing health disparities and an important complement to our plans to invest strongly in both health and social care.

The 2021 spending review confirmed that the level of funding for the public health grant to local authorities would increase over the spending review period, and all local authorities received a 2.8% increase in 2022-23 taking the public health grant to £3.417 billion.

In 2023-24, through the public health grant and the pilot of 100% retained business rate funding for local authorities in Greater Manchester, we are increasing funding to £3.529 billion, providing each local authority with a 3.3% cash terms increase. To help local authorities plan ahead, we are also publishing today indicative allocations for 2024-25, on the basis of a further 1.3% cash uplift which would take 2024-25 funding to £3.575 billion. This will provide every local authority with real-terms funding protection in each of the next two years.

These allocations include baselining of local government funding of £1.4 million a year for their enforcement duties under the Botulinum Toxin and Fillers (Children) Act 2021.

The allocations I am announcing today are part of a wider package of investment in public health services. This includes additional targeted investment up to 2025 of £516 million going to local authorities to improve drug and alcohol addiction treatment and £170 million to improve the Start for Life services available to families with a majority allocated to 75 local authority areas, as part of the joint DfE and DHSC £300 million Family Hubs and Start for Life programme.

This overall funding package will deliver a real-terms increase of more than 5% in DHSC investment in local authority public health functions over the next two years, enabling local authorities to invest in prevention of ill health and in essential frontline services.

The 2023-24 the public health grant will continue to be subject to conditions, including a ring-fence requiring local authorities to use the grant exclusively for public health activity.

Full details of the public health grant allocations to local authorities for 2023-24 and indicative allocations for 2024-25 can be found on www.gov.uk and are attached. This information has been communicated to local authorities in a Local Authority Circular.

[HCWS633]