Children’s Cancer Care: South-East

Paul Beresford Excerpts

Wednesday 13th March 2024 Westminster Hall

[Sir Paul Beresford (Mole Valley) (Con)]

I congratulate the hon. Member for Twickenham (Munira Wilson) on obtaining this debate. It is a little interesting that we are having it before we have got the report. We cannot really add to or comment on the report, because we do not have it, but one thing that we will all agree on is that there is no doubt that a centre is required, so, like everybody here, I am waiting for the report with considerable interest.

I listened to the story from the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) about Jackson. It is always a delight to hear these stories—cancer treated by St George’s, with a delightful story to follow it. Equally, however, every hospital that I know of that treats cancer and children’s cancer has similar stories, and St George’s has more than just the few that she has given.

I am a huge supporter of St George’s Hospital. As Members will know, I spent a considerable number of years on its health board when St George’s was being rationalised, reorganised and rebuilt. St George’s is world-class in many respects, although not all, right across the spectrum of medical treatment. The rebuilding that taken place at St George’s has centred on making the buildings as welcoming as is feasible for adults and children and for medical and surgical care. I know St George’s well; it is a delightful, functioning national health service hospital that gives much to our community and that will, if the hon. Member for Twickenham has her way, give much to the whole south-east.

However, access to St George’s is by tube and then by foot or by bus. If someone goes by car, they then have to hope they can park. Hon. Members have said that parking spaces are easily available, but I can remember sitting for ages in the car park at St George’s, especially in the morning, and not being able to park. Some of the consultants I know at St George’s drive in hours early just to get a space for their car in the consultants’ car park. So parking at St George’s is not as simple as has been said.

Public transport to St George’s from many areas of the south-east would be a nightmare. Those coming from the coast would have difficulty; they would not even know where Tooting is, let alone St George’s in Tooting.

[Dame Siobhain McDonagh]

Shame!

[Sir Paul Beresford]

I apologise to the hon. Lady. I will write to people who say they do not know where Tooting is to explain, and I will give them a picture of her.

I have also got to know the Evelina hospital, which is an absolutely amazing place. It is not designed and built for adults; it is designed and built for children. When you walk in the front door, it strikes you that it is a children’s hospital. You immediately go into a tall, spacious atrium, which goes right up, floor after floor after floor—I hope the hon. Member for Twickenham went up and looked down into it when she visited. It is a magnificent building, and one whole floor has been left, waiting for building, in case the report comes forward and says that the Evelina is the choice for the cancer centre. The Evelina also sits next to St Thomas’ Hospital and has access to it. There are specialist carers, along the lines people have been talking about, from St Thomas’ Hospital if required.

It is correct that anyone travelling to the Evelina has to come into central London. Driving in is a problem but, as I understand it, the hospital is prepared to provide specific parking. The hon. Member for Mitcham and Morden mentioned specific parking at St George’s, so the two hospitals are doing the same thing. For special cases, the Evelina will provide special cars for individual patients.

We await the report. It will put the cases together, and we will see what the experts say. I am the nearest thing to an expert here, which is a great big smile, but I have treated children, and treating children, especially east end children, is an art. That is why I would like us to look very strongly at the Evelina if it comes through as the choice. It would be best for kids, and kids are who we are looking at now—kids with cancer and the accumulated diseases and conditions that go with cancer. I am sorry to disagree with just about everyone here at the moment—I emphasise “at the moment”—but, as far as I am concerned, the Evelina is the choice, and I await the report.

--- Later in debate ---

[Sarah Olney]

The hon. Gentleman is absolutely right.

[Sir Paul Beresford]

I suggest that my hon. Friend the Member for Sutton and Cheam (Paul Scully) gets a new “A to Z”; the journey is not that much more difficult.

[Sarah Olney]

I am grateful to the hon. Gentleman, but my personal experience is that it is a lot easier to get from anywhere in the surrounding counties to the outskirts of London than from the outskirts of London to central London.

As I was saying, the Evelina’s parking facilities are, in the hospital’s own words, “very limited”. Patients are advised that there is often a queue for parking, which of course can only add to the stress of parents trying to get their children into hospital for urgent treatment. Given that the Evelina sits in central London just over the river from here, I am concerned about its ability to significantly expand parking provision.

The Evelina also sits within the congestion charge zone, meaning that any family member who wishes to visit an in-patient will be charged between £15 and £17.50 every time they come to the hospital. I acknowledge that TfL will reimburse the cost to patients with compromised immune systems, for families visiting on a regular basis who are not covered by the exemption, the expense could become significant; there is also a significant additional administrative burden for those families.

Admission to hospital can be a terrifying prospect for a young person. Parents often take shifts, keeping their child company during an unimaginably difficult time. If each day they drive to and from the ward, they could end up paying more than £100 a week in congestion charges alone. The NHS was founded on the principle that everybody should have easy access to life-saving medical treatment, regardless of their economic circumstances. I believe that St George’s meets that criterion in a way that the Evelina simply cannot. Both are world-class hospitals and both teams provide an excellent standard of care, but St George’s offers both parents and children a solution that truly meets their needs.

--- Later in debate ---

[Dame Andrea Leadsom]

I will give way first to my hon. Friend the Member for Mole Valley (Sir Paul Beresford).

[Sir Paul Beresford]

Knowing quite a number of consultants at St George’s, if they heard that they were at a standstill position and not building on what they have now, they would be insulted.

[Dame Andrea Leadsom]

I will also take the intervention from my hon. Friend the Member for Woking (Mr Lord).

NHS Dentistry: Recovery and Reform

Paul Beresford Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

I heartily recommend the recovery plan to the hon. Lady, because it offers 2.5 million more appointments and has a long-term ambition for the prevention of tooth decay in children. In addition, it has that long-turn vision about increasing training places for our dental professionals by 40% by 2031.

[Sir Paul Beresford (Mole Valley) (Con)]

As you are aware, Mr Speaker, I have a declared interest in this particular topic.

As my right hon. Friend the Secretary of State is aware, dentistry in England is a seller’s market. It is estimated that there are 5,000 dentist vacancies in England. When I came here in the early ’70s with my dental degree, like very many colleagues from Australia, New Zealand and so on, I presented at the General Dental Council, who said “welcome” and stamped my hand, and I went off and worked on the national health service the next day.

Now, and for decades, the General Dental Council has required graduates from world-class dental schools—every bit as good as the ones we have here—to wait, to pay and to sit what is called an overseas registration exam. Currently, the waiting list for the exam is 2,000 overseas dental graduates, many of whom are every bit as good as those we produce in this country. The GDC could change that overnight by accepting graduates automatically from known and trusted international schools. Will my right hon. Friend please have a small chat with the chairman of the General Dental Council?

NHS Dentistry

Paul Beresford Excerpts

Thursday 20th October 2022 Commons Chamber

[Sir Paul Beresford (Mole Valley) (Con)]

First, I must congratulate my hon. Friend the Member for Waveney (Peter Aldous). This is the second time that I have heard him pronounce on NHS dentistry—I think he has done it more often than that—and he is becoming something of an expert. I wonder whether the British Dental Association might give him an honorary medal or something for that. I also have an interest—a very part-time interest—that means that I have to speak on this; otherwise, the profession would ask me what the heck I was doing. I welcome my hon. Friend the Minister to the Government Front Bench to become our voice on dentists and dentistry. It might not last as long as he anticipated a few days ago, but it is a dubious honour and one in which he will find many friends and many on the other side of the argument.

The problem we face is that there are not enough dentists. Many suggestions will come from the debate, so I will just skip through a few. The problem is not so much that there are not enough dentists—there are not enough dentists prepared to do NHS dentistry. That has been exacerbated by covid, but it is far from new. It has been a problem to a greater or lesser degree for more than five decades. I arrived in this country in 1970, produced my certificate from my university in New Zealand, got it rubber-stamped by the General Dental Council and went straight into business. I cannot see why we cannot do that now. I was one of a stream of New Zealand and Australian doctors and dentists. Once we moved into the common market, that stream was shut off.

The practice of dentistry is complex and intricate if it is done properly. A small group of members of the all-party parliamentary group for dentistry and oral health recently visited King’s College dental school. I think it was enlightening for many to discover how complex and difficult dentistry is. The staff provided our members with a high-speed drill with a tungsten carbide bit and virtual molars. It is just as well that they were virtual molars—I have never seen so much tooth destruction in my life.

As I said, the problem has been exacerbated by the covid backlog, and that will be with us for some time, but we are—I hope—looking at the long term and the short term. I will touch on the short term. Some with dental interests such as the organisation My Dentist are campaigning to increase the number of NHS dentists and other groups providing facilities, surgeries and so on. But there are—I hope that the Minister is aware of this—many dental firms working hard to pull dentists out of the NHS and into the private sector.

As has been said, we must maximise the output from our dental schools. I am sure this has been done. I have heard calls for new dental schools; we have heard one today. Dental schools are enormously expensive organisations to build, stock and run. I was just in New Zealand, where there is a new school on the same site as the old one. It is fantastic, but it took years to build, stock and run it. A new school probably takes two to four years to set up and then it is four to five years before the graduates emerge. As with how a person gets their driving licence and then learns to drive, a dentist gets their certificate from the school and then starts to learn dentistry. In the short term, it would be faster and more productive if the General Dental Council were given the ability to enable overseas dentists with good English from competent overseas dental schools to enter the United Kingdom as practising dentists, without having to go through the insulting rigmarole and costs of further exams. It is an insult to most people from most of the top university dental schools to have to sit examinations here when the competence of their own schools is at least as good as those here. It would take only a small movement to enable that to happen.

A large-ish number of elderly-ish dentists who are about to retire have pulled out of dentistry because of the bureaucratic overload. Many have retired because of the strain of the job. The regulatory strictures of the Care Quality Commission in particular have added to that. Of course, that applies to small practices. The CQC is necessary. We must have it, but its extensive, detailed, time-consuming form filling has been the final straw for many dentists, especially those in small practices. Many have just retired in disgust. For my tiny part-time practice, I pay an independent company £150 a month to help me ensure all regulations are met and documented as met. It is time-consuming, expensive and unnecessary. I would therefore rather like to see an opportunity for the GDC, with outside help, to look at the bureaucratic requirement and consider whether it could ease and reduce the strain on practitioners. When it has finished with that for the dentists, it could also start looking at how hospitals and medical surgeries are treated.

Negotiations on the revision of the contract have been mentioned. It is a massive gripe among the profession in England, because of the use of the semi-mythological coinage called “units of dental activity”. They are a mythical thing. How many dentists get them to actually come together and work, and balance them so they are fair, is beyond me. Negotiations on the revision of the contract have been going on for many years. There have been many trials and heaps of tribulations. Over the past decades, dentistry has moved forward. Materials and techniques have been developed and adopted. The service available on the NHS dental menu has enlarged with that, but I question that some items on the menu are not strictly health, especially when alternatives are an option and would ease the strain on NHS dentists. If we accept that there is an NHS dental emergency, then I suggest the Government, for a short period of time, run a simple separate contract on a reduced NHS menu of strictly dental health items. A simple fee per item would remove arguments about those mythical units of dental activity. A simple contract could specifically target the NHS patients looking for a check-up and simple dental health care, particularly if it involves pain relief. At the same time, we ought to accept, because of the change in the nature of dentistry, that mixed private and NHS services are here to stay and should be encouraged, as that actually helps the NHS service.

Finally, on two really positive points, one has already been mentioned and that is teaching children, even little children, how to brush their teeth. When I first came here, I spent a lot of time in east London. When I mentioned a toothbrush, the blank stares made it quite apparent that they just did not have a toothbrush, let alone use one. The excitement, in the schools that I and other dentists have been into, of little children with toothbrushes and toothpaste is really worth watching. And the mess is phenomenal!

My final point is on fluoridation. We have now got to the stage where we can install fluoridation in our water supplies. We are an absolute disgrace in the western world. Much of the western world has 60%, 70% or 80% of their water supplies fluoridated, while we have 10%. The obstructions have been taken away and I ask the Minister to rapidly move forward with that. The payback period will be obvious after about two years and will make a tremendous difference, along with toothbrushing, as it progresses. We can be a nation with some of the best teeth in the world if we have 100% fluoride and if we teach every child, “This is a toothbrush and this is toothpaste—get on with it!”

Professional Medical Indemnity Insurance

Paul Beresford Excerpts

Thursday 16th June 2022 Commons Chamber

[Sir Paul Beresford (Mole Valley) (Con)]

I am delighted to see my hon. Friend the Minister on the Front Bench. She and I have vied in the Chamber a few times, but we are on the side. I hope that we will be on the same side on this issue.

I apologise for the topic being niche, and I obviously have a declared interest. As a very part-time practising healthcare professional and a very full-time MP, I have been under considerable pressure on two issues relating to professional medical indemnity. The whole of the medical and dental professions seem to be on my back at various times. All registered healthcare professionals in this country are required to have indemnity insurance to be allowed to practise. As my hon. Friend the Minister will be aware, her Department has a couple of consultation documents relating to indemnity and it is, I understand, currently considering responses. Bearing in mind the time available—that has lengthened, but I assure her I am not going to fill the time, much to the relief, I suspect, of Madam Deputy Speaker as well—I will raise two key issues. They are from my own personal experience, and particularly from the experience of other medical and dental professionals who have been pressing for action.

I have a closer link than most with the first subject, having been a board member of Dental Protection, which is a subsidiary of the Medical Protection Society. I obtained my own personal indemnity cover through Dental Protection for many years, from when I first started practising in the United Kingdom. Later, I moved from discretionary to contractual insurance indemnity through MIA insurance and, more recently, through Densura, which is part of Lockton.

As I am sure the Minister will be aware, there is a distinct difference between the two types of organisations offering indemnity. Dental Protection is one of the three discretionary mutual membership organisations. They are not insurance companies. There are now several contractual insurance companies, such as the British Dental Association and Densura. They are insurance-based companies and they source their indemnity through huge multinational insurance companies, such as the Royal and Sun Alliance.

I understand that Dental Protection and the Medical Protection Society still maintain their cover as discretionary. That allows them to apply discretion to accept or reject any particular case that is brought to them. I realise that that is not commonly used, but it is a major and important contractual difference, in that that does not apply to the insurance companies, which are bound by contract. I believe that that discretionary section should not be allowed. In effect, discretion means that, if a self-indemnified professional is challenged and sued, and seeks assistance from their indemnity provider, it is possible for Dental Protection, MPS or either of the other mutual societies to use their discretion for whatever reason and decline the indemnity for the professional.

I reiterate that that is uncommon, but I can recall a number of cases in discussion with the professional media over past years. I also reiterate that, although it is uncommon, it is damaging. One particular case sticks in my mind. A dentist was abandoned—that is exactly what he was, abandoned—by his indemnifier. Despite considerable financial difficulties, he funded his challenge to the claim through the courts. He won the case. Despite that victory and despite being awarded costs, I very much doubt that he recovered 100% of his costs. It should also be remembered that, if a claimant has a genuine claim and indemnity is withdrawn, there is a reasonable possibility that the claimant, particularly if the claim is large, will not receive the appropriate reimbursement if the clinician has insufficient funds to meet it. That has happened.

I understand that the Secretary of State for Health and Social Care has announced, following the Paterson breast surgery inquiry, that professional medical indemnity will be reformed and that discretionary indemnity will, as I hope, come to an end. I reiterate yet again that, although it is uncommon, the cases I know of or have been told about would have been covered by the insurance indemnity providers by contract. Those have been rejected by mutual indemnity societies exercising their discretion, resulting in both patients and professionals being distinctly disadvantaged. I therefore anticipate, as indicated by the Government in 2018, that discretionary indemnity will be ruled out of order and abolished. I certainly hope so.

The second area on which I wish to touch is the subject of a consultation document, published at the end of January, entitled “Fixed Recoverable Costs in Lower Value Clinical Negligence Claims”—a mouthful if ever there was one. I understand that the consultation concluded on 24 April. This is particularly relevant to dentists, who remain the principal group who purchase their own indemnity cover, through subscription or premium, as the case may be. Increasingly inflated claimant legal costs will, I believe, seriously increase the cost of that indemnity.

It has been brought to my attention that a number of claimant solicitors have been grossly inflating their costs because it is seen, to put it bluntly, as an easy cash cow. Some of those cases have been challenged by costs draftsmen, and when that happens it is not uncommon for the claimant solicitor to reduce their bills by 20% to 30%. To my mind, that suggests that the bills are being inflated, to put it simply and bluntly, as a try-on.

I have obtained a large number of examples, but will draw the Minister’s attention to only two, which I consider to be classic examples of opportunistic abuse of the system. One case, which concluded in 2019, resulted in a claimant award of £9,250 and a clinician solicitor cost of £10,042.80. The claim submitted by the claimant solicitor, however, was nowhere near that £10,000. Instead, it was for £87,297.89. The second claim, which also goes back to 2019, resulted in damages of £5,000 for the claimant, and the indemnity legal costs were similar to those for the first case, at £8,225.40. The claim for the claimant solicitor costs, however, was £72,886.23. That is quite outrageous.

Not all claimant solicitors are grossly inflating their costs—I must rush to point that out—but they are sufficient now to drastically affect indemnity subscriptions or premiums. Annual indemnity cover for the average full-time NHS dentist now costs in the region of £4,000. Many pay more. It is a substantial sum, especially to an NHS dentist at a time when the profession is under huge pressure, with a shortage of dentists and a considerable number of vacancies. The prospect of rapidly increasing costs to a beleaguered profession calls for prompt ministerial action. I await.

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

I thank my hon. Friend the Member for Mole Valley (Sir Paul Beresford) for securing this important debate. It is a niche area, but it is also a very important one relating to patient safety. Indemnity cover supports professionals in carrying out their practice. Even in the safest healthcare system in the world, mistakes will happen and it is important that patients are covered. Like my hon. Friend, I declare an interest: as a practising nurse, I have to have indemnity cover in order to maintain my registration.

Patient safety is the priority. Our focus is on making the NHS the safest healthcare system in the world. We are redoubling our efforts to deliver that, including in underpinning quality and safety. The national patient safety strategy, which was published in 2019, sets out exactly how we aim to do that. It is also important to learn the lessons when things go wrong. We want to make, and are making, changes to the culture of the NHS, to learn from mistakes and to be honest and open when mistakes happen.

There are legal requirements in place. All regulated healthcare professionals in the UK must hold adequate and appropriate indemnity to be able to practise. Healthcare professionals both in the NHS and in the independent sector need to have that in place. As my hon. Friend has said, the type of indemnity varies: it could be discretionary or it could cover all eventualities. Sometimes, when a claim is made where discretionary indemnity is in place, it is not paid out.

Most staff in the NHS benefit from state indemnity for clinical negligence. Decisions about state indemnity arrangements are a devolved matter, and they vary across the four nations. Broadly speaking, however, where state indemnity is in place in primary and secondary care, it provides cover for NHS professionals carrying out NHS work. Patients can be assured that, if something goes wrong, it will cover them, and cover is available to provide compensation where needed.

For work that is not covered under a state indemnity—many professionals, including dentists and GPs, provide NHS services under an NHS contract rather than being direct employees—discretionary indemnity is available. There have been problems with that, which the Paterson review very much highlighted. Although the Government did not accept all the recommendations in the Paterson review, we accepted a number of them partially. I am concerned about some of the issues that my hon. Friend raised in his speech, so we will be reviewing the Paterson recommendations shortly. I am keen that, where we have introduced measures in the NHS to improve an indemnity, the independent sector takes them up. We want to give the independent sector a chance to make those changes, but if it does not, we will have no hesitation about taking action.

[Sir Paul Beresford]

The Minister is absolutely right that every medical practitioner has to have indemnity. If a case arises in which there is a challenge to the clinician, if the indemnity is covered by a society that has discretion, and if that discretion is exercised, the cover that is insisted on by law is annulled.

[Maria Caulfield]

My hon. Friend is absolutely right. We have looked into reform: between 2018 and 2019, we consulted on whether to change the legislation to require all healthcare professionals to hold regulators’ insurance, rather than the discretionary indemnity. Unfortunately, covid came along and disrupted much of that work, and the response to the consultation was not published, but I am very happy to look at it again.

My hon. Friend is right that there is a gap in the system, not only for patients who may need compensation to deal with whatever outcome has happened as part of their care, but for healthcare professionals who need cover for a specific reason. Publication of the consultation that we ran in 2018 and 2019 was delayed, initially because of Paterson and then because of covid, but we hope to publish it fully this year. I will take the response very seriously; I hope to work with my hon. Friend on it so that, if changes to legislation are needed in relation to discretionary indemnity, we can make them.

The gap in the market that means that discretionary payments may not pay out will sometimes affect healthcare professionals admitting when mistakes have been made and learning from them. It does not help patients either. I very much take on board my hon. Friend’s points and am happy to work with him, because we remain committed to supporting healthcare workers across England in the clinical negligence sphere.



In 2019, in our response to concern about the rising costs of clinical negligence we touched on fixed recoverable costs—the second point my hon. Friend talked about. We recognise that costs are a significant part, albeit not the largest part, of lower level compensation payment to patients. Very often, legal fees make up a large percentage of the cost, and although we are improving patient safety we are not seeing clinical negligence costs fall in parallel. There is no correlation. To manage the rising costs of clinical negligence, we have consulted on fixed recoverable costs and capping them for the lower level of compensation payments. Such measures would not cap the compensation paid to patients, but they would cap the cost of the lawyers. We would do this in part to reduce costs, so the money could be spent on frontline services for patients instead, and in part because we recognise that legal costs can increase the cost of insurance for healthcare professionals who need indemnity cover.

The consultation on fixed recoverable costs finished recently and we are working our way through the responses. We hope to introduce measures fairly soon, and I will set out the detail as soon as I can. The Health and Social Care Committee carried out a review of patient safety and the cost of clinical negligence, and this is one area where, when I was before the Committee a few months ago, we promised reform. I am very committed to doing that.

We are also committed to acting on the recommendations of the Paterson inquiry, which looked at discretionary indemnity and highlighted the points my hon. Friend made about potential gaps in clinical negligence indemnity, in particular in the independent sector. I am committed to ensuring that lessons are learned from the inquiry, that the report is taken up and that we address those gaps. We have to look across healthcare, both the national health service and the independent sector, and consider a range of options. We will build on the work that we were doing before the inquiry and the consultation we started then, but also take forward the inquiry findings.

I hope that I have reassured my hon. Friend that by introducing the changes to fixed recoverable costs for clinical negligence with a value up to £25,000, we will not affect the payments to patients when claims are made, but instead tackle rising legal costs. I am happy to look into the indemnity issue he raises, because there is a gap and I recognise the points he made.

Question put and agreed to.

Access to NHS Dentistry

Paul Beresford Excerpts

Thursday 10th February 2022 Westminster Hall

[Peter Aldous]

I am grateful to my hon. Friend for re-emphasising that.

[Sir Paul Beresford (Mole Valley) (Con)]

Birmingham is an interesting case. Not all of Birmingham is fluoridated, so when a child arrives, dentists can tell which part of Birmingham they have come from. No cavities, no fillings—fluoridated. Fillings and cavities—non-fluoridated.

[Peter Aldous]

I thank my hon. Friend for re-emphasising that case.

--- Later in debate ---

[Sir Paul Beresford (Mole Valley) (Con)]

I am delighted that we are being guided by you, Ms Ali. As a dentist—extremely part time—I am fascinated by the interest in this issue. I hope that some dentists read Hansard and find out that somebody actually cares about them. One of my hon. Friends asked why they were leaving the profession. It is a tough job—a really tough job. If I want relief from a couple of hours of dentistry in a week, I come into the House of Commons—it is a lot easier.

I thank my hon. Friend the Member for Waveney (Peter Aldous) for his introduction to the debate. It was a real expedition, right across the whole scene. I will suggest that we create an honorary degree in dental administration especially for him, because he covered it so beautifully.

Let me start very simply. I will not go through all the bits and pieces that everybody else has talked about; I will just cruise across the surface. We have three different groups of dentists: fully private, fully NHS, and mixed. The last group is the largest by far; and, to a considerable degree and in spite of some of the accusations today, that is by patient demand. It is what the patients want. It is not always the case that they feel forced into it because they cannot get the service elsewhere. The comment was made that we do not have enough dentists, but the BDA says that we have. I do not agree with the BDA, but this will not be the first time. We do need more dentists. If we had more dentists, we would get over the problem that my hon. Friend the Member for Broadland (Jerome Mayhew) had of finding someone to live in his little rural area, because if they were looking for a job and there were not jobs in the other areas, they would go there.

It is worth pointing out that dentists working in the NHS are not actually in the NHS; they are independent dentists working for the NHS. That makes quite a difference to the relationship and makes it somewhat more difficult for the Minister to influence dentists as she might well like to. It is also worth pointing out that a number of dental plan organisations are encouraging dentists to abandon the national health service and provide services within their private plan system. I still get dental magazines as a bit of light relief—well, lightish relief—and every one that I get has advertisements promoting dentists coming out of the national health service, for all sorts of reasons, some of which are fictitious.

Covid, in spite of what one hon. Gentleman said, has been a huge problem—not just for medical services but for dentistry. With the initial lockdown, all dental surgeries were required to close. Emergency clinics were set up and they were successful, but extremely limited—“a bit brutal” would be one way to put it. Fortunately, the closure of surgeries was relatively short-lived. After a period, they reopened—understandably, under heavy covid hygiene procedures. Those procedures really jammed up the works. This is of course understandable, because at that stage we did not have vaccinations, and with the aerosol spray from the dentist working on the patient’s mouth, you could almost see covid spread across the room. The cleaning down and waiting time between patients—fallow time—really damaged productivity. But we are getting past that now. I hear the Prime Minister is going to tell us that we are all lovely, everything is fine, covid has gone and so on. That is slightly tongue in cheek—sorry, I should not really say “tongue in cheek”, should I? By the way, the hon. Member for York Central (Rachael Maskell) talked about dentistry and teeth being part of all health. The chief dental officer has a lovely saying, which is that we should put dentistry, or the mouth, back in the body. That is really important.

The combination of the restrictions, all the rules and then, as I have discovered, the extremely heavy regulation requirements of the Care Quality Commission meant that a considerable number of dentists thought, “I have had enough” or, “I’ve possibly had enough,” and then said, “I’ve had enough,” and retired. Progressively, the surgery cleaning down and fallow time has been better understood by dentists and they have been quicker at it and faster, but I still feel that there is an opportunity now, with what the Prime Minister is going to tell us, for us to cut that out. The Government do not always do very nice things for dentists, but one nice thing that they did for dentists was that they gave them the inoculations early on. They gave them not just for the dentists but for all the staff, even down to the cleaner. That is vital, because it will, I think, give us an opportunity to remove the fallow time—get rid of it.

For decades pre-covid, there was a shortage of dentists. There was certainly a shortage of dentists providing NHS services in particular areas. The way to get around that, as I have said, is to have more dentists. If we have more dentists for fewer jobs, they will go to other areas to work. Dentists are independent, so they have an opportunity to change that. Sourcing and increasing the number of dental practitioners is slow and relatively limited.

The most obvious solution is dental schools; we have touched on that. Every second place in the country wants a new dental school next to its hospital. I am sure that would solve the problem, but goodness knows how we would afford it, let alone get the people to teach in them. We have to remember that the basic dental degree takes five years, and the practitioner that comes out after five years needs a two-year apprenticeship before I would let them loose on my cat or dog, let alone one of my children.

Another way to get dentists is to attract them from overseas. My hon. Friend the Member for Waveney mentioned that; it is a great source. When I came here, every second dentist had an Australian accent. The practice I worked at for many years—quite a big one in south-west London—was staffed only by Australians and New Zealanders, and occasionally a South African. The principal got into real trouble with the Commission for Racial Equality. He rang up the agency and said, “I want another dentist. Can you find one? They’ve got to come from Australia or New Zealand.” He was told, “That’s racist. You can’t do that,” but there were hundreds if not thousands of them coming over from the Commonwealth.

The problem with people coming over here has been touched on: they have to go through courses and all the rest of it to become registered. We did not have that then and we do not have to have it now. Wherever the school is, it is the school that needs to be assessed. If the school passes its assessment, any student that passes and becomes a qualified dentist should be allowed in—just like that. That is what happened when I came. I handed over my certificate and the General Dental Council, bless it, stamped it and said, “Thank you very much. Off you go.” We should be doing that.

I had a complaint from the GDC that the people it sent out to assess the University of Otago in New Zealand, for example, did a quick tour of the dental hospital and then disappeared off to the vineyards. I am sure there was no truth in that. But we could get dentists from the Commonwealth, and we could keep bringing people in from the EU. People from the Commonwealth stopped coming when we joined the EU and they went to the United States. I ran a big function here for Otago graduates, and a vast number of professors of dentistry from Otago University came over from the United States. Normally, they would have come here; normally, we would have had them. Normally, we understand their English a little bit better, even if they are Australian, than the Americans do. That has to be an attraction. We should still be able, as I have said, to get European and Scandinavian dentists. That has to continue, because it would help massively.

We have to recognise that we will not have an instant or even a fast solution to the problems laid out today. Everybody has laid out problems, and a few people have come up with ideas. I am sorry for the Minister, because she is getting hammered for the problems, and she will not be able to provide a fast solution. It is not a case of money; it is a case of having the dentists to do the work.

Our best long-term hope, which one or two people have touched on, is prevention. The chief dental officer and others have an ongoing campaign to teach children, especially little children in day nurseries and so on, about toothbrushing. Having worked in the east end for some time, I know that when we ask a child, “What’s your toothbrush like?”, they sometimes say, “What’s a toothbrush?” We have to get that across to the kids. Kids love brushing their teeth. The mess is phenomenal, but they love it. The campaign is really starting to work. Wales and Scotland are ahead of us on that, but we are catching up, and it is making a noticeable difference. We can actually see the difference.

Our second hope, of course, is fluoridation. In other countries—Australia, New Zealand, Canada and so on—fluoride is in between 60% and 80% of water supplies. It makes a huge difference, and with no possible detriment to health. In this country, 10% of water supplies are fluoridated. It is pathetic. The Bill going through at the moment represents an opportunity to change that, but some nations have suddenly realised the real difference that can be made. New Zealand, if I dare mention that country again, is thinking of saying that every single water supply throughout the nation—it is a biggish country, about the same size as this one, but the population is tiny—will be fluoridated. That is a dramatic step, but we could do it. If we did, along with promoting fluoride toothpaste and teaching kids how to brush their teeth and cut down on sugar, then instead of being one of the worst dental states in the western world, we could be one of the best. It is a real opportunity and something we could achieve.

I know that the Minister cannot do anything overnight, and we have to accept that—

[Rushanara Ali (in the Chair)]

Order. Can I ask the hon. Gentleman to wrap up his speech?

[Sir Paul Beresford]

I am wrapping up right now.

I know that the Minister cannot do anything overnight, but I wish her the best of luck with the struggle.

NHS Dentistry: Bristol and the South-west

Paul Beresford Excerpts

Monday 24th January 2022 Commons Chamber

[Darren Jones]

That sounds very sensible, and no doubt it would be a great levelling-up opportunity for the Government to ensure that dentists trained and qualified in the south-west stay there. I do not want to put particular pressure on this Minister, because this has been a long-running failure over many years.

[Sir Paul Beresford (Mole Valley) (Con)]

I have an interest here, clearly, but why should dentists, or any profession, be forced to stay and practise in the area they trained? No other profession has that. It would be a very unfair liability and tie on the dentists.

[Darren Jones]

I am not sure that was the suggestion from my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard); it was merely an opportunity for those who train in the south-west and who wish to stay there to do so, and I would support that.

Ministers’ long-running failure to tackle this issue is resulting in hundreds of thousands of people across the country, not least many thousands of children, being unable to access NHS dentistry until it becomes an emergency and a hospitalised problem. That is unacceptable; it no doubt costs the Government more to treat problems instead of trying to prevent them, and I call on them to put in the work to fix this problem now. I look forward to hearing the Minister’s responses to my questions.

[Sir Paul Beresford (Mole Valley) (Con)]

I listened with interest to the hon. Member for Bristol North West (Darren Jones). He mentioned the word “prevention”, but did not go into the prevention the Government are doing at the moment. There is enormous work being undertaken in schools, not just in England, but in Wales and Scotland, and the results are very positive. They are teaching children, from a very tiny age right through to infants school, how to look after their teeth, how to brush their teeth, what a toothbrush is, what toothpaste is, how to use fluoride and so on.

The hon. Gentleman failed to mention the fact that the Health and Care Bill currently going through the House of Lords will introduce an opportunity for fluoride and fluoridation. The roughly two-year payback will make a dramatic difference. Rather than complaining now, he should be campaigning as hard as he possibly can to ensure that fluoride is brought into his area as soon as possible. That will make a dramatic difference.

Finally, the hon. Gentleman mentioned dentists coming in from overseas. Those in the Commonwealth, new and old, will now be in a position to come here, once the immigration Bill is through and the General Dental Council gets the slight change in legislation it needs to bring the dentists in. They will come here, because this is an attractive area to work in national health, privately and in research.

UK Vaccination Strategy

Paul Beresford Excerpts

Monday 8th November 2021 Commons Chamber

[Sir Paul Beresford (Mole Valley) (Con)]

After the earlier debate, I think I must make it absolutely clear that I occasionally practise dentistry, and that that is relevant to some of the points I am making today.

The previous Secretary of State for Health and Social Care, some considerable time ago, set out a change of direction for our health service that was based on prevention. Shortly after that, our health services—indeed, the world’s health services—were brutally assaulted by the arrival of covid from China.

I do not wish, in my few words this evening, to run a one-man inquiry into covid or into the way the UK or any other country handled it. I wish to push the Government to jump on the opportunity that I believe now exists because of the attitude of the majority of the population towards the preventive nature of vaccination.

Even detractors of the Government must give considerable credit for their willingness to invest in prospective vaccines and for the fact that there has been and still is a massive programme of preventive vaccination against covid and flu. I believe this is an opportunity for this country to continue to lead by building on the very best practice and collaboration fostered during the covid pandemic, to utilise vaccinations to save lives and to avoid damaging people. That would reduce the demand on our health services and would introduce a reduction in the financial demand on them.

We should be rapidly moving towards a broader and more robust, proactive approach to vaccination. That would protect us against future public health threats and against existing vaccine preventable diseases, especially respiratory diseases. I am looking to Health Ministers for clear leadership on vaccination to ensure that our health services continue to see it as a top priority. We must drive uptake across all ages, setting clear targets for adult vaccination, to bring it into line with our already great achievements on childhood vaccination. Such an approach could and should create an environment where the value of vaccines is recognised for our health and for our socioeconomic progress. It will keep our population out of our health services and keep them in their homes, in work and—dare I say—play, and keep our children safe and in education.

My first personal recognition of vaccination came with the polio epidemic that hit the world from to 1949 to 1952, sweeping through selective population centres and leaving as its most tragic sign children—sometimes permanently and sometimes temporarily—in wheelchairs, on crutches or in leg braces, and with deformed limbs. For children with polio in the late 1940s and early ‘50s, the disease caused paralysis in one in 1,000 cases among children aged five to nine. Polio also hit adults, and there were many deaths. Rescue came in the form of vaccination delivered in three doses of injections with stainless steel needles. My early childhood memory of the needles is that they looked like stainless steel 3-inch nails. They had to be thick enough to allow boiling water through them for sterilisation, and they were re-sharpened on leather strops. Subsequent improvements brought about a liquid dose and, ultimately, an impregnated sugar cube.

In Western countries, if not almost worldwide, polio, along with smallpox and yellow fever, has been pushed mostly into history. Ideally, most, if not all, vaccination programmes should be administered to a high percentage —probably more than 95%—of the population. We have a very effective routine immunisation schedule—at least, it is effective, or fairly effective, for children, with vaccinations at eight, 12 and 16 weeks and 12 months. To my dismay, it appears that there has been some slippage in the routine childhood vaccinations for the under-fives. These children should receive 10 vaccines in total, which provide protection against such hideous diseases as tetanus, polio and meningitis, along with many others. I am not sure of the latest figures, but I am sure the Minister can update us on them. The latest I could find were from 2018-19 and they showed that the uptake of the first dose of the measles, mumps and rubella vaccine had fallen to 90.3%. I believe that was the fifth year in a row that it had dropped. Although I accept that 90.3% is a high figure and that the percentage changes may seem small, we must recognise that the impact must not be underestimated, particularly if this turns out to be a trend. The UK has lost its World Health Organisation measles-free status, and this comes three years after the virus was eliminated in the United Kingdom. Astonishingly, during 2018 there were nearly 1,0000 cases, which is more than double what the figure was in 2016.

There are a complex number of reasons for that, but one of the biggest factors, as we have seen in the covid battle, has been the appalling misinformation on vaccine dangers on social media. That has certainly affected the uptake of covid vaccines. I still find it incomprehensible that some individuals I know of quite high intelligence are absorbed into believing this appalling misinformation. Some parents think that these childhood infections are trivial. Such a view needs to be vigorously countered at every opportunity; anyone seeing a child deformed by polio or with badly affected eyesight from measles really needs to wake up.

There have been some great successes. Recently data indicated that the HPV vaccination given to girls has bought about a dramatic drop in cervical cancer. Now that it is available to boys, I hope that we will see a similar dramatic drop in years to come in oral and head and neck cancers. Those cancers hit males more than females—I could warn a few fathers on that. HPV types 16 and 18 cause cervical cancer, penal cancer and between 60% and 80% of oral, head and neck cancers. The treatments for head and neck cancers—particularly surgical treatments—which of course I have seen, are debilitating and often leave hideous damage to the patients.

There has been a call for all hospital and care home staff to be vaccinated against covid. This is no different from the requirement when I became a dentist in this country: dentists and surgeons were required to have the BCG—Bacillus Calmette–Guérin—injection and vaccination before they were able to work. If I had an elderly relative who was to go into a care home and the choice was between two homes, both being identical except one had all staff vaccinated and the other did not, the choice would be obvious.

Much has to be done to promote vaccinations through hospitals, GPs and pharmacies, and by any other means that the Minister might think up. The promotion of and reminder about vaccines has already been undertaken with covid; this approach could and should be applied to all vaccines. New contact methods through the likes of the NHS app and social media should be used. I believe there are financial encouragements for GPs and pharmacies to promote such vaccinations—please, step that up. That approach could be applied to more than just covid and flu.

It appears to me that there is no promotion of vaccination against shingles among the over-70s. Anyone who has seen a patient who is over 70, 80 or 90 with shingles will know what a ghastly, debilitating condition it is. Perhaps when the Minister replies she can give the House some glimpse of the Government’s thinking, even if at this stage it is speculative. In future, we must use vaccinations extensively, because that is the goal of the original set-up for prevention.

Oral Health and Dentistry: England

Paul Beresford Excerpts

Tuesday 25th May 2021 Westminster Hall

[Sir Paul Beresford (Mole Valley) (Con) [V]]

I am delighted to serve under your guidance, Ms Bardell. I congratulate the hon. Member for Bedford (Mohammad Yasin) on obtaining this debate. His speech was a barrage of negativity, and it is not all negativity in this field. I am a practising dentist—part-time at the moment; very little. I am a member of the British Academy for Cosmetic Dentistry, the British Fluoridation Society and the British Endodontic Society. That is wet-finger dentistry, though in a glove.

For decades, the dental profession, especially NHS dentists, has felt that dentistry as a health service has, as far as the Department is concerned, been seen as a Cinderella service, or an expensive minefield, or both. This has gone on for decades under Governments of various and even mixed complexions. However, I believe this has markedly improved with my hon. Friend the Minister and the current chief dental officer. There has been a visible change of attitude. Both ladies recognise the importance of improving the oral health of the nation and of the status of dentistry as a health service. To use the chief dental officer’s banner statement, at last

“Putting the mouth back in the body”.

Covid has had a dramatic effect on the ability to provide dental services, whether NHS or private. Waiting lists for all dental patients have dramatically exacerbated, and we have just heard a tirade on this. Covid meant that for a period all dental surgeries were closed. Only emergency services and specialised clinics were open. When the surgeries were permitted to start resuming covid protection, actions such as furloughed time, PPE and so on added to the delays, complications and diminished throughput. Clinical teaching of final year students was diminished, such that there is doubt that some of them are ready to graduate.

All the dental team should have been double vaccinated by now, whether private, mixed practices or NHS. The R factor is going down. An increasing proportion of patients have been vaccinated. Dentists are following a careful triage system. Deaths are down, hospitalisations are down and the 21 June release is still on, we hope.

My hon. Friend the Minister can see my request coming like a big balloon because I have already discussed it with her. The time has come for a road map to release dentists from PPE and all the restrictions. We need a return to the pre-covid treatment of patients and we need SAGE to look at it and get on with it. That will be the biggest single action in enabling dentists to get this backlog into line.

My second wish is a push at an open door with the Minister. Dental care is preventable, but while there has been progress, we are badly behind, especially in caries prevention for children. Pre-pandemic, these children occupied 177 clinical general anaesthetic extraction cases in hospital—a complete waste of our services. The latest figure that I have seen is that 23,529 children between the ages of five and nine were admitted to hospital because they had tooth decay.

I first started practising dentistry in a deprived area in east London. The state of dentition there shocked me, especially the state of children’s dentition. It was not the deprivation that caused the poor dentition; it was the diet and the almost complete lack of oral hygiene. Put simply, kids and parents did not toothbrush. Some parents did not even know that toothbrushes existed. And if you went into the supermarket, the shelves were packed with biscuits and cakes, whereas there was little meat or vegetables; go to less deprived areas and it is the other way round. So, it is not the deprivation; it is the shoppers—the parents.

The Minister will know where I am going with this. She and the chief dental officer are already embarking on teaching children in teams throughout the country to brush their teeth. Coincidental with this, most children are accompanied by their parents, some of whom are stunned to see this little thing called a toothbrush. But the message is getting through; as the hon. Member for Bedford said, we are starting to get some progress, and it is happening quite quickly.

As I have said, tooth decay is essentially highly preventable. Water fluoridation is the single most effective public measure that could be taken to prevent tooth decay. At the moment, implementation of fluoridation is in the power of local authorities. Little progress has been made. We lag behind every other western nation. Most of our western nation comparators have a fluoridation rate of domestic water supplies of between 60% and 80%, but we have a rate of only 10%. It is the system; the costs are to the local authorities and the cost-benefits are to the national health service.

The process of consultation over fluoridation is lengthy and tedious, and it is providing a platform for protesters of the same type as the anti-vaccination people. Some of the things that they say are quite extraordinary. I had to listen to a man explaining to me that he had done some research. He said that he had been to a town with young people and no fluoride, and to a town with older people with fluoride, and the venereal disease rate in the town with young people was higher than that in the town with older people. Therefore, according to him, if we put fluoride into the water supply, people got venereal disease. And to my astonishment, there were other people there who actually believed that nonsense.

To make a more practical point, there are considerable difficulties for both local authorities and water companies, in that their boundaries are rarely, if ever, coterminous. So, it makes eminent sense for the implementation process for the new schemes of fluoridation to be put in the hands of central Government and driven by central Government, which is the Minister’s proposal.

In doing so, however, I hope that the Government will curtail the procedures on consultation. In every period of consultation, in every place of consultation, the same thing is said by the same people, and I believe that the same nutters come out. If we continue with that process, we will have a repetition of the scaremongering stories from people who are basically cranks.

The safety, efficiency, cost-effectiveness and benefit of fluoride in water supplies, whether it is achieved naturally —as is the case in many parts of the world—or artificially, is proven to be workable and to achieve dramatic reductions in tooth decay. With this proposed step and the Government’s determination, rather than our lagging behind the rest of the world we could actually lead, and I hope that we move to do so.

[Hannah Bardell (in the Chair)]

Before I call the next speaker, I ask Members to keep their remarks to within eight minutes, to allow equal time, and I hope to call the Opposition spokespersons by 10.35 am.

A Plan for the NHS and Social Care

Paul Beresford Excerpts

Wednesday 19th May 2021 Commons Chamber

[Sir Paul Beresford (Mole Valley) (Con) [V]]

Mr Deputy Speaker, with your ceiling of three minutes, I am going to focus on one aspect of one Bill—namely, the proposal to change the approach to the fluoridation of community water supplies. I am a dentist and a member of the British Fluoridation Society. It is therefore with considerable enthusiasm that I support the proposed change of the procedure for introducing fluoridation of domestic water supplies. Our western nation comparators have between 60% and 80% of their domestic water supplies fluoridated. This country has a shameful 10%.

When I first came to this country as an ethnic minority immigrant, I worked in the national health service in a deprived area of London. I was appalled by the general state of my patients’ teeth, particularly by the state of children’s teeth. Trying to maintain children’s dentition was and still is, as a colleague put it, like trying to fill a bath with the plug out. Far and away the biggest reason for referral of children for general anaesthetics to hospitals in England is to remove rotten teeth. In 2019, hospitals throughout England carried out an average of 177 operations a day on children and teenagers, just removing decayed, rotten and abscessed teeth that should not be in that state. The annual cost is more than £40 million.

Tooth decay is essentially highly preventable. Water fluoridation is the single most effective public measure that could be taken to prevent tooth decay. Implementation of fluoridation is in the powers of the local authority, but little progress has been made since that was introduced in 2013. The costs are to local councils and the cost benefits are to the national health service. The process of consultation is lengthy and tedious, and it is enabling a platform for protestors of the same genre of the anti-vaccination people.

On a more practical point, there are considerable difficulties for both the local authorities and the water companies in that their boundaries are rarely, if ever, coterminous. It makes eminent sense for the implementation process for new schemes of fluoridation to be put in the hands of and driven by central Government. In doing so, I hope the Government will curtail the procedures on consultation, as they only permit continuous reception and repetition of scaremongering stories from people who are basically cranks.

The safety, efficiency, cost-effectiveness and benefits of fluoridated water supplies, whether natural—and they are in many parts of the world—or as an additive, have been proven worldwide for what must be approaching 100 years. With this proposed step and Government determination, rather than lagging behind the rest of the world, we could actually lead.

Covid-19: Dental Services

Paul Beresford Excerpts

Thursday 14th January 2021 Commons Chamber

[Sir Paul Beresford (Mole Valley) (Con)]

Three minutes means that I cannot answer the hon. Member for Putney (Fleur Anderson). I congratulate her on obtaining the debate. I am chair of the all-party group for dentistry and oral health. I have a surgery in the Putney constituency—she did not visit me. Sensibly, dental surgeries, after the initial lockdown, have remained open, but, as she has mentioned, there are costly new anti-covid requirements. Currently, the figures of the backlog of appointments are staggering and, in response to those figures, new NHS targets have been set. Understandably, they are high. I have seen the British Dental Association’s sponsored letter. I went for a pinch of salt when it arrived on my desk. I understand that 60% of the practices are actually meeting those targets and that those that are unable to meet the targets can obtain dispensation. Scaremongering on safety in surgeries is just that—scaremongering. Dentists are medical professionals. They are overseen by the Care Quality Commission and by the General Dental Council. Safety is paramount. Most alarming—and this has been mentioned—is the drop by a third, as I understand it, of oral cancer detection and referral.

My next concern is that many of the clinical teaching staff at our hospital dental schools were drawn away to assist in urgent dental care and covid patient care. As a result, many of our final-year students are facing graduation with a clinical educational deficit.

However, I think it is worth looking forward. First, I thank the Minister for helping to move inoculations for dentists and all staff into category 2, which is a recognition of the dangers of the aerosol dispersal spray. Secondly, can she look into the long fallow time? Other nations have managed to make this somewhat shorter and safe. Next, we need to look after the children who require hospital general anaesthetics. In the long term, that has to mean prevention, and the very best long-term means of prevention is to introduce fluoridation into water supplies, particularly in deprived areas. While this backlog must—and in time, will—be cleared, prevention has to be the long-term aim. Caries is preventable, and it is something we can do something about in this nation as is progressively being done in others, by teaching children to brush their teeth and to use a fluoride toothpaste, and putting fluoride into the water supply.