Health and Care Bill

Nick Fletcher Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Dame Diana Johnson]

I rise to speak to amendment (a) tabled by the Government in lieu of Baroness Sugg’s amendment—Lords amendment 92—which would continue the telemedicine service for early medical abortion that was introduced during the covid pandemic. First, I pay tribute to the noble Baroness Sugg for her persistence and her work in the other place.

This is about how we best provide essential healthcare to women, and remember that one in three women will have an abortion during their lifetime. It is about making access as straightforward and women-centred as possible. The Secretary of State recently made a pledge in his speech to the Royal College of Physicians when he talked about the need to

“empower patients and fulfil the promise of the technological leaps we’ve seen throughout the pandemic.”

Scrapping telemedicine abortion at this stage goes completely against what the Secretary of State was talking about. This is also about trusting women, as the Chair of the Women and Equalities Committee, the right hon. Member for Romsey and Southampton North (Caroline Nokes), has talked about and as my hon. Friend the Member for Birmingham, Yardley (Jess Phillips) has said today.

Such is the strength of the evidence that the Welsh Government recently announced that they will be making telemedicine for abortion permanently available. This sends a clear message that, while women in Wales can be trusted to use a healthcare service in a way that meets their needs, women in England cannot. Not only will there be unequal abortion access between the devolved nations, but this decision will lead to health inequalities within England for the most vulnerable and marginalised. I struggle to see how the decision to bring this service to an end after August is in line with the Government’s commitment to put women at the centre of their own healthcare, as detailed in the vision for the women’s health strategy.

Telemedicine has already enabled an estimated 150,000 women to access abortion care at home. Its removal means that every woman, regardless of her personal circumstances and health needs, will be forced to attend a clinic. Lords amendment 92 would ensure that women can continue to access a consultation with a clinician by telephone. To make it crystal clear to everybody, very importantly, face-to-face consultations will still be available. We have heard concerns about younger people, and face-to-face consultations will be available—

[Nick Fletcher (Don Valley) (Con)]

Will the right hon. Lady give way?

[Dame Diana Johnson]

I am going to carry on because I know time is short.

Those consultations will be available if the clinician feels that that is appropriate or the woman wants to see somebody face to face. Let us all be clear: this is about choice. The continuation of telemedicine means that a woman would not have to travel long distances to attend a clinic if, for example, she lived in a remote area or had to make arrangements—

[Nick Fletcher]

Will the right hon. Lady give way?

[Dame Diana Johnson]

I am talking about women’s experience, so I will continue, if the hon. Gentleman does not mind.

The woman may have to make arrangements if she has childcare or caring responsibilities, or she may have to take time off work. In the case of a coercive and controlling relationship, she would have to explain where she is going to a perpetrator, such as the Mumsnet user who said she had to visit a hospital to access abortion care and was “terrified” of her abusive ex-partner finding out where she was. She spoke of having to construct “various lies” about where she was that day and why she had to have someone look after her children.

I referred to NICE and the World Health Organisation in an intervention, but we should be aware that since telemedicine was introduced the risk of complications related to abortion has reduced, as women are able to access care much earlier in their pregnancy. I will rehearse the long list of supporters of the measure continuing: The Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Royal College of General Practitioners, the British Medical Association, the Royal Pharmaceutical Society, the Faculty of Sexual and Reproductive Health, the TUC, Women’s Aid, Rape Crisis, Karma Nirvana, the Terrence Higgins Trust, End Violence Against Women, Mumsnet, and many others. What I find most disappointing is that the Government are going against a wealth of robust and widely accepted peer-reviewed evidence from medical professionals and women’s charities, and appear to give greater weight to anecdote, erroneous opinion and misinformation focused on campaign groups with extreme views who bombarded a consultation. Sadly, that further emphasises that this is not an evidence-based policy decision.

Men’s Health Strategy

Nick Fletcher Excerpts

Tuesday 22nd March 2022 Westminster Hall

[Graham Stringer (in the Chair)]

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

[Nick Fletcher (Don Valley) (Con)]

I beg to move,

That this House has considered the potential merits of a men’s health strategy.

It is a pleasure, as ever, to serve under your chairmanship, Mr Stringer. Although this is only a 30-minute debate, I would still like to extend my thanks to the Backbench Business Committee for granting the time to discuss this extremely important issue. I am pleased that the Minister for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), will respond, given her very positive contribution to the Westminster Hall debate on prostate cancer earlier this month. I am confident that she will give a positive response today.

Over the past year, the all-party parliamentary group on issues affecting men and boys, which I chair, has continually heard from a range of national and international experts that there is a need for an improved focus on and a far more co-ordinated and strategic approach to men’s health in England. This approach has been adopted elsewhere, in countries, such as Australia and Ireland, which have their own men’s health strategies, as does the World Health Organisation in Europe. We all agreed that there are serious challenges in men’s health.

It is important to place on the official record that nearly one in five men do not live until they are 65, with an increasing gender age gap; that 13 men take their own lives every day; that men in some parts of Kensington and Chelsea live 27 years longer on average than those in some parts of the north; that one man dies of prostate cancer every 45 minutes; that nearly 6,000 men die an alcohol-related death every year; and that two thirds of men are overweight or obese.

The troubling matter for me is that the situation is not improving but seems to be getting worse. The time has come for the Government to take a fresh and strategic approach that is in keeping with their positive levelling-up agenda and their What Works approach to policy making. The Government approach to men’s health is based on individual conditions and is disease-based. However, as well as not having the impact that we would hope for, such an approach looks only at the outcomes of poor men’s health, not at the causes. To me, that is key.

We need to address and prevent the underlying causes and barriers that have a negative effect on men’s health, while also making the health system more responsive. For instance, if we continue to address suicide, alcoholism and obesity as separate issues, we will fail to see that they are often a result of similar circumstances. Why are men who live in economically disadvantaged areas dying from a whole range of illnesses far earlier than men who live in wealthy areas? There is no innate biological reason for that. We need to strategically join the dots on the causes, not place the outcomes in separate buckets labelled condition A, B or C, as is currently the case.

A men’s health strategy would ask more questions of the health sector. What of the gender age gap? It is a well-known fact that women live longer than men. Why is that? It was not always so. This is not something that we should just shrug our shoulders at and accept as normal. I want all men to have a long life and for those lives to be lived in a state of wellbeing. I am sure that nobody in the country would disagree with that ambition.

Another issue is that despite making up 75% of all suicides, men make up only 34% of those referred for specialist therapy. Why is that? Is it because they are not being referred or because suicidal men are not accessing the health system in the first place? It could be a combination of the two, of course, but why are men not getting the support they need, and what is being done to address that? We need to look at this at a systemic level. Of course, men need to adapt and help themselves, but the final responsibility has to be on society and the health system to change to help men.

During the APPG’s evidence sessions, the experts raised a number of points that struck home. When I visit my GP, which is thankfully rarely, I always notice how few other men of working age are there. We have to work out why and address that. Is it hard to get time off work? Are GP opening hours flexible enough? Do men fear that their bosses or workmates will raise questions about whether they are healthy and fit enough to do their job? Do they just get on with it? It could be all or none of those reasons.

Campaigns to encourage men to access the health system are necessary and welcome, but deeper issues need to be addressed. We also need to ensure that we do not look at men’s health from a negative perspective. Our approach should be based on the needs of men and boys, rather than on men and boys having to accept what they are given. That is the positive What Works approach taken by a number of men’s health strategies around the world. I hope that the Government can draw comfort from the fact that they do not need to start from scratch in devising a strategy, because strategic work is already being done in Ireland, Australia and elsewhere.

In addition, a host of leading men’s health experts and charities in the UK are ready and able and want to help the Government. The Government should look at the great work that is being done on men’s health in Leeds—everything good in life starts in Yorkshire. The Government could also harness the knowledge, expertise and help provided by a number of great, growing and pioneering organisations that support men’s health, including, to name a few, Andy’s Man Club, UK Men’s Sheds, Prostate Cancer UK, Lions Barber Collective, Men Walking and Talking, MANvFAT, Mates in Mind, Football Fans in Training, and Black Men’s Health UK.

In addition to their great work, all of those organisations know that men do talk and take action on their health when the right environment is created. Many of those initiatives also prove the importance of taking support to where men are, not to where it is thought that they should go—many experts have made that point. I am sure that those organisations are all on stand-by to help the Government, as are a number of health bodies, such as the Men’s Health Forum and the Patients Association, which support the proposal to create a strategy, with the former leading a national campaign.

Since becoming a Member of Parliament in 2019, I have been struck by how the Government are taking a fresh, constructive and positive look at all policy areas. Old ways of thinking are no longer taken as read. We can see that in the field of women’s health, where the Government are introducing a strategy for the first time, which I am sure all of us in the House support. To be clear, that is not a reason in itself for a men’s health strategy, but it does signal the need to have a consistent, cross-Government approach that takes into account specific, gender-based aspects affecting the health of women and men. Without a change in policy, it would be incumbent on the Government in the coming months to explain, with hard evidence, why and how their current approach is improving men’s health.

My concluding point is that a men’s health strategy would benefit not just men and boys but the women and girls with whom they share their lives and society. They all have fathers, uncles, brothers, cousins. This is a strategy for the nation as a whole. It would also be cost-effective, saving the health service millions of pounds in treating illnesses, and helping employers in reducing sickness levels. It is a win-win situation and would lead to a healthier, happier and more productive society for all. The Government have an ideal opportunity, with the coming White Paper on disparities, to start the ball rolling, and I am confident that they will take it. I look forward to hearing the Minister’s comments on this incredibly important issue.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank my hon. Friend the Member for Don Valley (Nick Fletcher) for securing this important debate, which provides us with an opportunity to discuss the health issues that affect men across the country. Although I am passionate about tackling the health inequalities that women face, there is no doubt that men also face specific issues.

I thank my hon. Friend for his work as chair of the APPG on issues affecting men and boys. It does a huge amount of work in this area and its report, “The Case for a Men’s Health Strategy”, is compelling reading. I thank him and all the members of the APPG for their work on that. He has discussed with the Secretary of State for Health and Social Care the potential merits of a men’s health strategy, and further meetings are planned as part of an ongoing discussion.

I do not want to generalise and put people in different categories, but there is a difference in the way in which women and men access the healthcare system. More than 100,000 women replied to our call for evidence. They told us that they often access healthcare but feel that they are not listened to and that it is a challenge to get the services they want. Men, on the other hand, often do not access healthcare services at all, and that is a significant barrier. They do not come forward for a variety of reasons, and my hon. Friend touched on some of them, including ease of access to services and sometimes the attitudes of employers or colleagues on seeking help. There are different barriers that certainly make a difference. It is true that the average male life expectancy in the United Kingdom is below that of women, although women spend a greater proportion of their lives in ill health and disability.

We also know that male and female life expectancy differs depending on where they live. We are absolutely passionate about ending that. It should not matter where someone lives or where they come from. Everyone should have the same health outcomes. A man in Blackpool can expect to live over 10 years less than a man in Westminster. We will publish our health disparities White Paper later this year to seek to address the gaps in life expectancy for men and women. I am particularly keen that the issues my hon. Friend has raised today are looked at as part of the health disparities White Paper, because he has provided some stark statistics that absolutely need to be tackled if we are to improve outcomes for men in particular.

The Department is already taking action to address conditions that affect men in particular, including suicide, heart disease and cancer, and other risk factors such as smoking. Although I do not want to generalise, we know that some men are less likely than women to seek help or to talk about suicidal feelings, and they can be reluctant to engage with health and other support services. Men are around three times more likely to die from suicide than women, and suicide prevention requires co-ordinated action and a national focus on men’s low uptake of services to help with suicide prevention more broadly.

Over the coming year we will review the suicide prevention strategy for England and focus on high-risk groups, including middle-aged men. I encourage the APPG to take part and scrutinise that to make sure that it addresses the very important issues that my hon. Friend has raised. We are making funding available. Almost £5.5 million is available this financial year through a suicide prevention grant to support the voluntary sector in particular.

I was interested to hear about the work in Yorkshire. My hon. Friend is right that part of the failure of NHS services to reach out to men is that we often expect men to come to those services. Organisations such as Men’s Sheds, where services can be brought to men, are often more effective, so I very much take his point and it is something that we need to look at.

Heart disease is one of the leading causes of death in men. The long-term plan is committed to several key ambitions to improve outcomes for individuals with cardiovascular disease, including enhanced diagnostic support in the community. I hope that our community diagnostic centres will bring healthcare into communities so that men are able to go for tests, screening and appointments slightly more easily than at present. Our ambition is to prevent 150,000 heart attacks, strokes and dementia by 2029, and we hope that our initiatives will improve outcomes for men.

Although smoking rates have fallen consistently across the population, the rates for men remain consistently higher than those for women. Men, however, generally report more success when they attempt to stop smoking, but it is still the case that smoking rates are higher for men than for women. We are undertaking an independent review of our tobacco control policies, led by Javed Khan. The review will make a set of policy recommendations that will give us the best chance to reduce smoking and achieve the Government’s smoke-free 2030 ambition. Again, I encourage the APPG to look at that work and to feed into it.

Finally, I will touch on cancer, because we know that lung cancer outcomes in particular are poorer for men than for women. We are trying to target our diagnostic services towards high-risk groups. One of our most successful areas has been our targeted lung health checks, which took place in 23 locations last year, with a further 20 being rolled out this year. We are using low-dose CT scans and are targeting, in particular, individuals who have smoked for a long time, those in high-risk groups and those in high-risk areas of the country. We are seeing remarkable success rates, with lung cancer being identified at stages 1 and 2 when it would otherwise have taken months for those individuals to show symptoms. Those checks will seek to improve the lung cancer outcomes for men.

[Nick Fletcher]

I believe that a lot of smoking, obesity and alcohol problems stem from men being lonely. Many years ago, there was an advert that said that “You’re never alone” with a certain brand of cigarette I think that many men use those things as comforts and to pass the time. When men are feeling low, they might drink or go to the fridge. The men’s health strategy should look at that, and take an overarching view of all the issues, bringing them together. Clubs such as Andy’s Man Club are a fantastic place for men to talk and to feel valued and part of society, so that they do not feel lonely. When men do not feel lonely, perhaps they do not need to reach for those items that otherwise help them get through the day. I take on board what the Minister said about getting GP and health services to those clubs—that would be a fantastic thing to do. We should then automatically see a reduction in the issues that we are testing for now, such as cancer. However, I do also welcome the centres that the Minister has spoken about.

[Maria Caulfield]

My hon. Friend is absolutely right. Although we are focusing on trying to diagnose lung and prostate cancer as early as possible, encouraging men to come forward and making them aware of the signs and symptoms, he is right that prevention—reducing smoking, alcohol and obesity—will help keep men healthier for longer. He is right that if men are lonely or do not feel like they have other avenues to meet people and get involved in society, they will reach out to smoking or drinking. Often, gambling is a way to meet people down the betting shop; a racecourse near me is very popular indeed. Men do have a different way of dealing with their emotional problems. They will not often talk about them, but meeting other people is a way of coping with some of the issues they face.

I have touched on several separate issues, which is exactly what my hon. Friend said we should not be doing. However, there is a golden thread running through all of them. The health inequalities for some groups of me, whether in life expectancy, life outcomes or accessing healthcare, are different from the issues and challenges that women face. We should not be dismissive of that, because those challenges are equally important.

I want to reassure my hon. Friend that the health issues facing men are being taken seriously. He has met the Secretary of State already and will be having further meetings. I think that today’s debate, in addition to our previous debate on prostate cancer, is the start of the conversation about how we improve outcomes for men. There are specific issues that they face, but there are also common threads that run through those issues. If we do not tackle those, we will not improve the overall health and life expectancy of men. I look forward to working with my hon. Friend further and to taking up some of the challenges that he has raised.

Question put and agreed to.

Covid-19: NHS Support for Prostate Cancer Patients

Nick Fletcher Excerpts

Thursday 10th March 2022 Westminster Hall

[Nick Fletcher (Don Valley) (Con)]

It is a pleasure to serve under you, Ms McDonagh. I congratulate my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) on securing the debate, and I thank Prostate Cancer UK for our wonderful badges and for all the work it does. It is an honour to speak in the debate, and I note that March is both Ovarian Cancer Awareness Month and Prostate Cancer Awareness Month.

I would like to start by stating that we have no men’s health strategy in this country, but we should do. I refer to the great work done by the all-party parliamentary group on issues affecting men and boys, which I have the honour of chairing. To date, we have issued two reports that show the need for a men’s health strategy, which would provide an overarching and joined-up plan to end the gender age gap. That is desperately needed in the UK, where one in five men will die before their retirement. One man commits suicide every 2 hours, and 86% of homeless people are men. Some 95% of prisoners are men, and 97% of fatal accidents at work happen to men. These are appalling statistics.

Far worse than the awful numbers is the sobering fact that 30 men die every day from prostate cancer, which amounts to 11,900 deaths a year. Let me explain what those numbers mean. There are 430 male MPs in this House, out of a total of 650 Members. Some 16.7% of all men will get prostate cancer, which means that 71 male Members of the House will get it. That is more than 11% of all Members—more than one in 10 of us.

Many deaths could be avoided if we had a prostate screening programme. The UK has a policy that we do not need to have a national screening policy for men to check whether they have prostate cancer. Until now, the NHS has taken the view that screening for prostate cancer would not meet the national and international criteria laid down for a viable and valuable screening programme. Instead, the NHS adopts a wait-and-see policy. However, medical science has progressed, and the historical objections are no longer valid.

The data shows that the age of 50 onwards is the danger zone for men. Only four cases of prostate cancer per 100,000 happen in men aged 40 to 44, but the figure rises to 6,285 for men aged 60 to 64. Men between 50 and 80 are most at risk. The data shows beyond doubt that a man of African heritage is twice as likely as a Caucasian male to contract prostate cancer. Research from 1995 showed a drop of 44% in mortality over 14 years when screening takes place, and another trial showed a reduction of 21%. Whichever figure we take, it is a staggering number of lives that could have been saved—2,000 lives or more every year.

The issue has been the effectiveness of screening and the cost, but medical science has moved on. A simple prostate-specific antigen blood test is inexpensive, costing literally pennies, and it will help to identify high antigen counts so that we know who is most at risk. These men can then be monitored and retested after a further three months. The relatively few men who still have a high number of antigens can then be given an MRI scan to confirm beyond doubt whether they have prostate cancer or not. Those who are diagnosed can then be treated, thousands of lives will be saved, and thousands of lives will be longer and will be quality lives.

Does screening work? The current breast cancer screening programme is believed to save 1,300 lives a year. Around 2,600 women are diagnosed with cervical cancer each year and 690 women die of it each year. It is estimated that 83% of cervical cancer cases would be avoided if all women used the cervical cancer screening programme. Screening works well for breast cancer and cervical cancer. It is proven to work. So why do we not have a screening programme for prostate cancer?

Implementation of a prostate cancer screening programme would obviously be beneficial for the men involved, but it would also be beneficial for their family, their friends and the country at large. Early diagnosis will save the economy money, as it will enable those affected to continue working rather than being dependent on the welfare state. It saves the NHS money in avoiding the expensive treatments that would be needed for advanced cancer. Wives will not lose their husbands, children will not lose their fathers, and friends and other loved ones will not be emotionally scarred by grief.

What can be said against introducing a national screening programme for all men between the ages of 50 and 80? The criteria for a screening programme have been met: it would extend many thousands of lives; it would save the NHS money; prevention is better than cure; and it causes no harm, instead providing a real benefit at a reasonable cost.

I have two asks today: can we seriously consider putting in place both a national prostate screening programme and a men’s health strategy? These initiatives will save money, but much more importantly they will save lives.

Oral Answers to Questions

Nick Fletcher Excerpts

Tuesday 1st March 2022 Commons Chamber

[Maria Caulfield]

While I recognise that the waiting times in Hull are some of the highest in the country, I am sure the hon. Gentleman will welcome the investment that the Government are putting into his constituency to change that. The Royal Infirmary and Castle Hill Hospitals have £60 million of funding, and his own hospital recognises that it will provide some of the most modern facilities in the country. That includes £2.8 million for new respiratory wards, £1.6 million for new specialist theatre facilities, and £1.1 million for oxygen resilience wards, ensuring that his local hospital is able to tackle some of those health disparities.

[Nick Fletcher (Don Valley) (Con)]

In addition to regional disparities, will the Minister look into disparities between men and women’s health? Men die four years earlier than women on average, 75% of suicides are by men, and during the time taken for oral questions, one man will die from prostate cancer. Through my work as chair of the all-party group on issues affecting men and boys, we have taken evidence that points to the need for a men’s health strategy. The Government have done much over the years to reduce the gender pay gap. Will the Minister help me to reduce the gender age gap?

[Maria Caulfield]

I absolutely take the point that my hon. Friend makes around the disparity in life expectancy between those in the most and the least deprived areas, which is greater for men. We will be publishing the health disparities White Paper, and we will focus on any disparities, including those that affect men.

Dentist Industry and NHS Backlogs

Nick Fletcher Excerpts

Monday 7th February 2022 Commons Chamber

[Andy Carter]

I absolutely agree with the hon. Gentleman. That is the purpose of this debate: to highlight to the Minister the concern that I and other Members around the country have that NHS dentistry is on the brink and that there has to be radical change.

As well as talking to dentists, I have spoken to constituents who have written to me, completed an online survey that I placed on my website or messaged me directly following publicity in local newspapers about this debate. This topic matters not only so that people can access urgent treatment for toothache. More and more studies are confirming what dentists have always argued: that tooth decay and gum disease are increasingly linked to a heightened risk of serious health problems such as stroke, heart disease and diabetes. A healthy mouth is the gateway to a healthy body. Neglecting oral health can sabotage our long-term overall health. As the hon. Gentleman indicated, this topic really does matter to many, many people.

One of the first issues I want to highlight is the challenge people face when they move house. Finding NHS treatment can be almost impossible as a new resident in a location. I wanted to say, “getting on to a surgery’s list,” but it is clear from speaking to dentists that the notion of getting on to a list does not exist anymore; there are no such things as dentists’ lists today.

In my quest to help residents, I have spoken to NHS England, Warrington clinical commissioning group and the regional dentists’ team. They have all pointed me to an NHS website that lists details of dentists who are accepting patients in my local area. The reality is that the website is massively out of date. In most cases, surgery information has not been updated for about two years. Despite being assured that there are dentists accepting new patients in Warrington, it is simply impossible to find them. As my hon. Friend the Member for Worthing West (Sir Peter Bottomley) indicated, it is like looking for a needle in a haystack.

On Friday, I had it confirmed by constituents I spoke to that NHS England could not provide them with the details of any dentist in Warrington, Cheshire or Merseyside who was accepting new NHS patients. They could provide details of emergency dental treatment services available in Manchester or Liverpool, but NHS England confirmed that no dentists are currently taking on new NHS patients across an area with a population of about 1.8 million people. I am afraid, Minister, that the signposting we are offering online is woeful and urgently needs to be updated.

In early January, I heard from many people living in Appleton, who had received notice from their local practice that after many years of providing NHS treatment, it would no longer be offering services through the NHS. On Friday last week, I met Paul and Paula Green, who have been patients at Appleton Park dentist surgery for many years. They are two of about 8,000 local people who received the notification that their provider was changing the way it offers services, and that the only way they could continue to get treatment at the local practice was to become part of a dental plan or to pay for their treatment. Mrs Green has been at the same surgery for about 50 years. In fact, the whole family are patients. They were suddenly informed that treatment provided by the NHS would no longer be available from the end of March. They will have to look further afield for a practice—there are no other practices in the village—and there is no guarantee that they will be taken on by any practice in Warrington, Cheshire or Merseyside.

Many of those 8,000 people will be left without an NHS dentist. Some could even be mid-treatment. They have paid their national insurance and their taxes, in many cases over many years, but now they cannot get NHS treatment. Understandably, they are pretty cross. They are cross with the dentist for making this change. They are cross with the regional NHS team. They are cross with me as their Member of Parliament. They are cross with the Government. They want to know what the Minister is going to do to help them find an NHS dentist who can look after their family’s oral health.

Myriad factors are driving practices across the country to make such moves, and I will cover a couple of the main issues that I hear when I talk to owners and senior dentists across my constituency. One of the first issues I want to discuss is the need—much like in many other sectors—to bolster and boost skills. Dental practices stand or fall based on the quality of their people, and if a dental practice cannot recruit enough good staff with the right level of training, that practice obviously has a serious problem. However, unfortunately, research suggests that this is a common problem for small and medium-sized dental practices right across the UK. Most dentists are SMEs: they are run by a senior dentist, receiving payment from the NHS to provide services through an annual contract, which I will discuss in more detail shortly.

The problem is that the UK does not seem to be producing sufficient numbers of dentists with the skills that those SMEs need. On top of that, the difficulty with dentistry is that when people graduate, they tend to work where they qualify or where they live, and they are not necessarily going to dental schools in the north of England—in fact, most of the dental schools in this country are in the south or the midlands. We are simply not training enough people in the regions who want to become dentists, who want to take on those NHS contracts, and it is not sufficient to say that we pay trained professionals well. We seem to have a lack of supply and over-demand.

What is the sector looking for? By widening access and participation in training, the Government need to create more flexible entry routes, including for overseas dentists, as well as develop training places for dental professionals right across the UK. This is not just about dentists: it is about upskilling dental technicians and dental associates by providing them with more training, so that they can provide a greater range of services. There are many vacancies for salaried dentists available in the UK—anyone who searches online can find details in pretty much every town around the country—but the problem is particularly bad in small towns and villages across the north of England, and the ability to track new entrants into NHS roles is limited, particularly when dentists working in the private sector can earn much more than they do in the NHS.

There is also an immediate need for dentists from outside the European economic area, and we should be making much more of our fantastic links to the Commonwealth countries, where there is often a surplus of trained dentists. Will the Minister look to extend the General Dental Council’s recognition of dental qualifications to schools outside the EEA? When needed, candidates could work in a provisional registration period with close supervision and training for a year before registration with the GDC is granted, a measure already used for overseas doctors by the General Medial Council, but not currently employed by dentists. I ask the Minister to look at recruitment, with a target to increase the number of UK dentist training places and incentives for NHS dentists to move to areas where there is less access to NHS provision.

I mentioned the NHS contract earlier, and I want to move on to that topic now. One of the main points that I have heard from dentists is that urgent attention needs to be paid to the 2006 NHS dental contract. Without fail, every dentist I have spoken to has said that the current system of renumerating dentists purely on activity is simply not fit for purpose. It has received criticism from dentists; from Governments of both political persuasions; from the Health and Social Care Committee; from the chief dental officer for England and Wales; from the British Dental Association; from patient groups; from all the major providers of dentistry in the UK; and, I think, from numerous Health Ministers who want to see changes. I suspect that my hon. Friend the Minister also wants changes to be made to the dental contract.

[Nick Fletcher (Don Valley) (Con)]

A dentist in my constituency, Matt Hooper, has contacted me several times regarding this matter. He says that morale in dentistry is extremely low at this moment in time, specifically due to the contracts that my hon. Friend is discussing. Does he agree that we really need to value our dentists? When most of us are going about our day-to-day business, we do not think twice about our dentists, but when we get toothache, all of a sudden they become our best friends. We need to make sure that they are there for us.

[Andy Carter]

My hon. Friend is absolutely right: many of the dentists I have spoken to say that working with these activity targets is like being on a treadmill. It wrongly puts the focus on meeting targets, rather than delivering the sort of patient care we need to be delivered in our dentists’ surgeries.

On the back of receiving news from constituents who contacted me that a surgery in Appleton was to close, I went to see Dr Mansour Mirza, who runs Appleton Park dental surgery. He talked me through his decision to give notice to the NHS. He was handing back a contract worth hundreds of thousands of pounds which his practice had had for many years. I want to thank Dr Mirza for being so open and so frank with me about the decision that he had to take earlier this year. Providing the treatment that he is required to deliver under the contract just does not add up. It costs him more to provide the services than he is paid. No one can survive over the long term if that is the case, so it is hardly surprising that his contract, like many others around the United Kingdom, is being handed back to the NHS.

I am also grateful to David Flattery, a dentist who lives in Lymm and owns and manages a practice in Altrincham, for his insights. He says that the incentives to take on new NHS patients at his practice are slim to none, owing to the workload and the quotas that he has to meet under the “units of dental activity” system. When he explained how the system works, with units attributed to particular types of treatment, I came away scratching my head. Dentists are effectively paid the same for delivering a check-up as they are for root canal work, although one of those procedures involves a tremendous amount more work than the other. That makes little sense.

The Minister will know that UDAs simply do not work, and it is time to replace the contract with a more modern system which reflects dentistry in the 21st century. Dr Miraz told me that his private work had been subsidising the NHS contract for many years, and that despite wanting to continue, he simply could not afford to provide the NHS services that he had signed up to. Shockingly, the regional NHS team did not seem to want to find a solution: they have simply left people without access to any NHS dentist.

There is a real fear that NHS dentistry will disappear in the months and years to come. Dentists want to do the job of dentistry. It seems from what I have heard about the experience of dentists working through the pandemic that the likelihood of having payment clawed back by the NHS has grown. In the current quarter, dentists need to deliver 80% of their contracted UDAs, at a time when the prevalence of covid and the omicron variant is at its highest point in the entire pandemic, but the targets that have been set for dentists have risen during that period. If patients cancel or staff are sick and dentists cannot deliver that 80% of UDAs, the dentists lose funding, which means that they cannot pay the salaries of their staff, meet the rent, or provide future services for children or those with the lowest earnings. I believe that dentists are conscientious and caring healthcare professionals. They want to treat their patients, but they also want to be treated fairly by the NHS. Mr Flattery told me:

“If we really want to incentivise prevention, we need to see change urgently. ‘Incentives’ to just drill and fill is what the industry has been arguing against for many years.”

The latest NHS dental statistics show that in NHS Warrington clinical commissioning group, only 33.6% of child patients were seen by a dentist in the 12 months to June 2021, a fall from 54% patients the year before.

Public Health

Nick Fletcher Excerpts

Tuesday 14th December 2021 Commons Chamber

[Nick Fletcher (Don Valley) (Con)]

I want to speak directly to all the points raised, very quickly.

Being able to take a test instead of self-isolation is a positive move. Nobody likes wearing a mask, but most can see the benefits of them so I am okay with that. After careful consideration, in my opinion NHS frontline staff should have the vaccine; they have a duty to do no harm, and while we know the virus can still spread, the chances are reduced. I have spoken with local health professionals and there is understandable concern from NHS employees who are pregnant so I ask that those members of staff are given the assurance they need from the Secretary of State and the chief medical officer that this vaccine is safe at whatever stage of their pregnancy. On the concern that many health professionals will leave the profession, I have been assured that would not be the case, at least in Doncaster, as most frontline workers have seen the devastating effect of covid and have been vaccinated.

Many Conservative colleagues are struggling with the idea of vaccine passports and I understand their concerns, but this not a vaccine passport; it is covid status certification. It allows negative lateral flow tests or proof of vaccination. It is also only for venues that carry higher risk, and I personally think it would be selfish for anyone not to take a test before attending a live event anyway. Many complain about long queues when boarding a plane, but who would want to get on a plane where there is no security? I feel that this is the same.

It is not as though people who have not had the vaccine are putting just themselves at risk. Those who are not vaccinated and who require hospitalisation when ill with covid are blocking beds and causing huge backlogs in elective care. Two thirds of patients in Doncaster Royal Infirmary with covid are unvaccinated; that is just not fair on the person who has been waiting for a hip operation for 18 months or any other elective procedure. Preparing oneself for major surgery only for it to be cancelled because another bed has been taken by someone who is unvaccinated is hugely frustrating.

I will vote with the Government today but I ask that they do not take my vote for granted and that, if we see no real increase in hospitalisations, the legislation will expire on 26 January and they will not seek to extend it. Working from home is not being voted on today and is only guidance, but it will cause much disruption to small retail so I hope that the Government will keep a close eye on that.

Finally, I ask my constituents to understand that I am voting on these measures today not because I have been whipped to do so but because, after careful consideration and speaking to many local professionals, I believe this is the right thing to do.

Health and Social Care

Nick Fletcher Excerpts

Friday 3rd December 2021 Commons Chamber

[Edward Argar]

I remember that Adjournment debate very clearly. My hon. Friend made an incredibly moving and powerful speech, highlighting Jessica’s situation, what happened to her and her circumstances. My hon. Friend made the point about the importance of early diagnosis and a holistic approach to a patient’s symptoms, and then diagnosis and treatment. The investment that we are putting into diagnostic hubs will help to do exactly that and bring those diagnostics to the heart of our communities, allowing more people to be seen more quickly.

[Nick Fletcher (Don Valley) (Con)]

I thank my hon. Friend for the £700 million that he has announced this morning; my Don Valley constituents will be pleased to hear that. While I have the Minister’s attention, will he thank all the volunteers in Doncaster and all the constituents who have come forward to have their jab? And is there any chance of a new hospital?

[Edward Argar]

I will certainly join my hon. Friend in paying tribute to all the volunteers and all those who have come forward for their jabs. For a brief moment, I thought that that was where he was going to end, but he is a proud champion of Doncaster, just as you are, Madam Deputy Speaker, and it would have been very strange were he not to conclude by lobbying once again for the new hospital that he wants. I pay tribute to him for that.

Access to Salbutamol Inhalers

Nick Fletcher Excerpts

Monday 29th November 2021 Westminster Hall

[Stewart Hosie (in the Chair)]

Before we begin, I remind Members that they are expected to wear face coverings when they are not speaking in the debate, in line with current UK Government guidance and that of the House of Commons Commission. I also remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the estate, which can be done at the testing centre in Portcullis House or at home. Please also give each other and members of staff space when seated, and when entering and leaving the room.

[Nick Fletcher (Don Valley) (Con)]

I beg to move,

That this House has considered e-petition 578676, relating to access to salbutamol inhalers.

It is a pleasure to serve under your chairmanship, Mr Hosie. I begin by thanking the creator of the petition, Brian McElderry, who took the time to speak with me recently, and Elaine Cunningham, whose daughter Lauren Reid died as a result of suffering an asthma attack while working in a commercial kitchen because she did not have access to her inhaler. I am also grateful to Asthma UK, which supports the petition and provided many of the statistics that I will reference.

More than anything else, Lauren was known for her generosity. On the day she died, she called her gran to say that she was buying lunch for 10 of her co-workers. She was a beloved Rangers fan and she loved music and, of course, cooking. She was devoted to her job and worked so hard that she finished her apprenticeship a year early. She was only 19 years old.

Lauren had suffered from asthma since she was an infant. At 16, she became an apprentice at a restaurant in Glasgow and, three years later, she was a fully qualified chef. Her mum has talked about how Lauren kept her inhaler with her almost everywhere she went; but with severe asthma, one attack can have life-changing consequences.

We do not know why Lauren did not have her inhaler with her, or what triggered the attack, but on this occasion she did not have it when her asthma flared up. The first Elaine knew of the incident was when she received a call from Lauren’s boss to say that Lauren was struggling to breathe and needed her inhaler. The asthma attack led to cardiac arrest and, although her manager gave her CPR, she could not be revived.

Lauren was hospitalised with severe brain damage. Her friends and family stayed by her bedside round the clock but, a few days later, Elaine had to make the heartbreaking decision to turn off her daughter’s life support after doctors said that she would never recover. Since then, Elaine has been campaigning for Lauren’s law, which would legally require salbutamol inhalers to be stored in commercial kitchens.

The UK has one of the highest rates of asthma in Europe, which costs the NHS £3 billion every year. Sadly, we also have one of the highest asthma death rates generally—nearly 50% higher than the European average—and for people aged 10 to 24, it is the highest. Unfortunately, the rates of asthma nationally are going up, not down.

In the UK, 200,000 people suffer from severe asthma. In Scotland, where Lauren lived, one in 14 people receive treatment for asthma and in England, the figure is one in 11. Those statistics demonstrate that asthma is a relatively common condition and, although it is manageable for most people, it remains a serious risk for those who have it. Most people with asthma are acutely aware of that and carry their inhalers with them, but Lauren’s story shows that one attack without an inhaler on hand is enough to cause serious harm or even death. We have all forgotten something in our time.

Working in a commercial kitchen poses more of a risk for people with severe asthma than most other settings, which is why the inhalers would be only for staff, not restaurant customers. Asthma UK considers a high-risk environment to be one where the triggers for an asthma attack on the respiratory system are exponentially greater than in normal environments.

In commercial kitchens, that includes the presence of inhalable materials such as powder, flour, dust and sometimes toxic fumes. Heat and humidity are also known to cause asthma attacks. Compounding those issues is the fact that stress can make a person more likely to react to asthma triggers; I think most people would agree that professional kitchens are not known as a calm environment. One might be tempted to argue that if kitchens are such a dangerous place, perhaps people with asthma should not work in them, but I do not think that is the only or best solution to the problem.

Inhalers are an effective way to treat asthma attacks. They are self-administered and do not require any previous training. Adding one to the first aid kit that professional kitchens already have would be an easy way to make them a safe environment for employees with asthma. At the same time, salbutamol inhalers are a prescription medicine, so keeping an emergency one on hand is not as simple as picking up a spare one from Boots. Keeping asthma inhalers in commercial kitchens would require an exemption from prescription control, which would have to be granted by passing legislation.

The salbutamol inhalers currently in use have been licensed for more than two decades. Their risks are well known. Side effects are typically mild and do not last long. When the Medicines and Healthcare products Regulatory Agency, whose representatives I met last week, looked at the effect of salbutamol inhalers on children, for instance, it found that they would not cause serious harm if accidentally given to a child without asthma or one whose sudden breathing difficulties were not caused by asthma.

Although overuse of salbutamol inhalers can sometimes cause problems, the petition seeks to keep them in kitchens only for emergency use, and their stocks could be easily monitored. We have a precedent for this already. Since 2014, an amendment to the human medicines legislation has allowed schools to store emergency inhalers for asthmatic students.

Asthma is not an uncommon condition, and working in the food industry should not be impossible for people with asthma. Keeping asthma inhalers in commercial kitchens would be a simple, inexpensive way of reducing the chance that anyone else will suffer the same experience as Lauren. I am therefore asking my hon. Friend the Minister whether the Government will commission research on the benefits and risks of requiring salbutamol inhalers to be kept in professional kitchens. That research could then be reviewed by the MHRA, which would make its own recommendation on whether to change the law. I know that that is a long process and today’s debate will not cause any immediate change, but I do hope that it raises awareness and is the first step towards creating Lauren’s law.

--- Later in debate ---

[Nick Fletcher]

I thank all Members for contributing, and the Minister and you, Mr Hosie. I thank the petitioners and the MHRA for meeting me. Most of all, however, I thank Elaine, Lauren’s mum. As I said when I met her, I cannot promise that Lauren’s law will become legislation, but we have a wonderful Minister who has given a wonderful speech and an awful lot of work is going on to look after people with asthma.

I am sure that if Elaine continues to campaign, with the support of many Members, including me, Lauren’s law will be passed. The loss of a daughter is something that no one should go through, but by raising the issue I hope that Lauren’s memory will be a lasting one that gives many people the opportunity to work safely in commercial kitchens doing what she loved so much.

Question put and agreed to.

Resolved,

That this House has considered e-petition 578676, relating to access to salbutamol inhalers.

Down Syndrome Bill

Nick Fletcher Excerpts

Friday 26th November 2021 Commons Chamber

[Nick Fletcher (Don Valley) (Con)]

It is a pleasure to follow my hon. Friend the Member for Gedling (Tom Randall) and to be in the Chamber for my first sitting Friday. It is a completely different experience—it is lovely to see the House being so collegiate—and it is fantastic to be supporting the Bill from my right hon. Friend the Member for North Somerset (Dr Fox). Few private Members’ Bills receive so much support and the fact that this Bill has done so is testament to how welcome it is. I have met some of the fantastic families who have campaigned on this issue and I know that the Bill is the culmination of years of work.

Over the past few decades, we have seen significant progress in how we support those with disabilities to live fulfilling lives—notably, through the Equality Act 2010. However, the term “disabled people” refers to such a large and varied group that legislation for those with disabilities needs to be more targeted if it is going to address people’s individual needs. The Autism Act 2009 was a decade ago and it is time that we did the same for those with Down’s syndrome. This Bill will help people with Down’s syndrome and their families to receive public services that are suited to their needs in every interaction that they have with local and national government, from jobcentres to social care.

One area where that is particularly relevant is in education. The Down Syndrome Bill will allow parents to choose the best school for their children—whether it is a mainstream school or a special needs school—because, wherever their child attends, the local authority will have to ensure that the education provided is adapted to their needs. As research suggests that children with Down’s syndrome have significantly better educational outcomes in mainstream schools, the Bill could have a transformative impact for some children.

Social care for people with Down’s syndrome is another area that will see a change because of this Bill. Although social care has often been in the news during the pandemic, the coverage has tended to focus on social care for older people. Nevertheless, a significant percentage of people who require social care are of working age and, especially in the case of people with Down’s syndrome, their needs are different from those of older people in care.

People with Down’s syndrome are living longer than ever, which is a wonderful thing, but it does not mean that a care home for a 75-year-old man with dementia is suitable for a 45-year-old woman with Down’s syndrome. I am therefore pleased that, under the Bill, people with Down’s syndrome will be entitled to age-appropriate social care.

The Bill will not solve all the challenges faced by people with Down’s syndrome when interacting with Government bodies, but it will hopefully be a step forward that leads to a marked improvement on the present situation. Once again, I commend my right hon. Friend the Member for North Somerset for introducing the Bill.

Oral Answers to Questions

Nick Fletcher Excerpts

Tuesday 19th October 2021 Commons Chamber

[Gillian Keegan]

I thank the hon. Gentleman for his question. He is right to identify this concern. Compared with the general population, people with learning disabilities are three times more likely to die from an avoidable medical cause of death. That is why these annual health checks to ensure that we get early diagnoses for these people are so important. That is why I am delighted that many people are coming forward and that the NHS is two years ahead of its plan here in England. Hopefully, others will follow that lead.

[Nick Fletcher (Don Valley) (Con)]

4. What plans his Department has to build a new hospital in Doncaster.

[The Minister for Health (Edward Argar)]

We have now received applications from trusts to be one of the next eight hospitals in our new hospital programme, which will be the biggest hospital building programme in a generation. I understand that an expression of interest has been submitted, proposing developments at the Doncaster Royal Infirmary site. Although I cannot comment on this particular application at this stage, I can tell my hon. Friend that we aim to make our final decision in spring next year.

[Nick Fletcher]

It appears that every time that I am fortunate enough to ask a question relating to health and social care, another disaster has happened at Doncaster Royal Infirmary. This time, it is a second water leak in the women’s hospital. Given that there is a maintenance backlog of £514 million and the newest part of Doncaster Royal Infirmary is older than the town of Milton Keynes, does my hon. Friend agree that a new hospital is not a “nice to have”, but an absolute necessity for the people of Doncaster? Will he please also visit Doncaster Royal Infirmary, although, with ceiling collapses and water leaks, he may need to bring a hard hat and some wellies?

[Edward Argar]

I cannot comment on the selection process while it is under way, but my hon. Friend is a strong and powerful advocate for his constituents and for a new hospital in Doncaster. He has met me a number of times and continues to raise this matter in the House. I should perhaps have taken him up on his offer of a visit in the summer, when it was sunny, but I am still certainly happy to take him up on that offer.

If I may briefly be indulged, Mr Speaker—we do not often have the opportunity to do this from the Front Bench—let me say that I am grateful to the hon. Member for Tooting (Dr Allin-Khan) for her kind words about our late colleagues, James Brokenshire and Sir David Amess. The last time I saw David was a few weeks ago, when he posed for a photo that he wanted with me and then tried to impress on me the question of whether I would come to the wonderful town of Southend.