Hospice Funding
Peter Aldous Excerpts(1 day, 17 hours ago)
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Peter Aldous (Waveney) (Con)
I congratulate my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) on so ably leading this debate and setting the scene.
While it is important to recognise the great work done across the eastern region by East Anglia’s children’s hospices, in the Great Yarmouth and Waveney areas, as represented my right hon. Friend the Member for Great Yarmouth (Sir Brandon Lewis) and me, there is at present a hospice vacuum. Throughout the rest of Suffolk and Norfolk, there are locally based hospices well embedded in and providing great services for their communities.
The good news is that plans are being carefully prepared to fill this vacuum and this void. A local partnership is evolving to build a local hospice led by St Elizabeth hospice, including the local NHS, councils, a community interest company, volunteers and fundraisers. For it to be successful, to open the hospice and then to run it, the national Government must join this partnership, and I hope my hon. Friend the Minister, who is currently not in her place, will in her summing up accept this invitation. The Waveney and Great Yarmouth areas desperately need a hospice. We have an ageing population and pockets of deprivation, and as Chris Whitty has highlighted, there are acute health inequalities in coastal communities that a hospice can help level out and remove.
As I have mentioned, a well-researched case for the hospice has now been prepared, though it is important to recognise the work done by so many over the years in supporting those in need of end of life care and their families—from the late Margaret Chadd, who founded East Coast hospice and had the vision of building a hospice on land bought at Gorleston, to Roberta Lovick, who founded the Louise Hamilton Centre, from which such great support is provided to patients with life-limiting conditions and their families; the James Paget University Hospital, where the Louise Hamilton Centre is based; and East Coast Community Healthcare, the Lowestoft-based community interest company that, in partnership with St Elizabeth, operates six specialist beds in Beccles Hospital, as well as providing care both in people’s homes and in care homes.
Building on the work of these local people and organisations, a framework is emerging through which a local hospice can be built. The cornerstone of this is, as we have heard, the Health and Care Act 2022, which sets out the legal requirement for ICBs to commission palliative and end of life care. The Norfolk and Waveney ICB has responded by carrying out a review of palliative and end of life care. This was completed last autumn, and it highlights the need for nine urgent and six medium to long-term actions. Last March, St Elizabeth hospice merged with East Coast hospice, and straightaway set about conducting a feasibility study into the viability of building up hospice facilities on the Gorleston site.
The study has just been completed, and the conclusion reached is that a hospice should be built in stages. Expressions of interest are now being invited from architects. That is an exciting landmark for which so many people have strived for many years. St Elizabeth is confident that it can successfully fundraise for a hospice capital appeal, but it is for the ongoing revenue cost of providing core clinical services for a full in-patient unit, as well as outreach community services, that national Government support is required. The Norfolk and Waveney ICB—indeed, all ICBs—need central Government support and a fundamental rebalancing of national policy, so that they can meet the projected growth in demand for palliative care.
It is good news that after so many false dawns over so many years we now have a coherent and well thought-through plan for filling the hospice void in the Waveney and Great Yarmouth area, but while we should be sanguine, we should also be realistic. We are not even at the starting point of the rest of England, as we have heard from other colleagues who have a hospice up and running—we do not. That is why the Government need to join the partnership that has evolved, and support Norfolk and Waveney ICB so that it can commission hospice services on a long-term, multi-year basis. I urge the Government to join us on that exciting journey.
Oral Answers to Questions
Peter Aldous Excerpts(1 month, 2 weeks ago)
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Helen Whately
I am not going to pre-empt the publication of targets for the coming year, but, as I have said, we will continue to learn lessons from the progress that we have made this year, including on ambulance response times, which are down by over a third. Anyway, I will take no lessons from Labour, because we know the state of the NHS in Wales.
Peter Aldous (Waveney) (Con)
The Minister for Social Care (Helen Whately)
We are making great progress on our 10-year vision for adult social care reform. We have introduced the first ever national career structure for care workers, and we have introduced new assessments by the Care Quality Commission, which will shine a light on how well councils are delivering their social care duties.
Peter Aldous
I am most grateful to my hon. Friend for that reply. In Suffolk, where the population is increasingly elderly, social care is under enormous pressure, and it is a significant challenge to recruit carers, pay them fairly and provide them with a proper career path. Therefore, I heard what my hon. Friend said, but will she consider commissioning a long-term workforce plan for adult social care equivalent to that for the NHS?
Helen Whately
My hon. Friend is right about the importance of the social care workforce: social care is its workforce. I can assure him that we already have a plan for the care workforce, set out in the “People at the Heart of Care” White Paper, and now we are putting it into practice. Our care workforce pathway is already being implemented, our new accredited qualification for care workers will be launched later this year, and we are backing social care with up to £8.6 billion in extra available funding.
NHS Dentistry: Recovery and Reform
Peter Aldous Excerpts(2 months, 2 weeks ago)
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Victoria Atkins
The right hon. Lady will know that part of the focus of the long-term workforce plan is to train people where they are most needed. I will happily arrange for her to meet the relevant Minister. On registration, the current system is not like a GP practice where, once a family is registered, they can only go to that GP. The whole reason that we have been encouraging dentists to update their details on the NHS website is so that people can move around to visit different dentists to get the treatment they need. Today’s plan will help turbocharge those efforts.
Peter Aldous (Waveney) (Con)
I welcome this recovery plan, which provides the foundation for putting NHS dentistry on a sustainable long-term footing. I urge my right hon. Friend to continue her negotiations to replace the existing NHS dentistry contract as soon as possible, and to provide funding to the Norfolk and Waveney integrated care board so that the University of Suffolk can open a new treatment and training facility in our area, to replicate the innovative service that is about to open in Ipswich.
Victoria Atkins
I understand my hon. Friend’s point, and I commend him for his work to ensure that his constituents receive the care and help that they deserve. On training, I hope he has drawn out from the plan the emphasis that we are putting on long-term ambitions. We understand that we need to train more dentists and get internationally trained dentists registered in our system. We recognise the critical role that dental hygienists and therapists can play as well.
Community Pharmacies
Peter Aldous Excerpts(7 months, 1 week ago)
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Peter Aldous (Waveney) (Con)
I beg to move,
That this House has considered community pharmacies.
It is a pleasure to serve with you in the Chair, Sir Mark. I thank the Backbench Business Committee for granting this debate, the purpose of which is threefold. The first is to thank community pharmacists for the great work that they have been carrying out in towns and cities for around 175 years. It was in 1849 that John Boot opened his first shop in Nottingham. More recently, the sector stepped up to the plate and was a key player in delivering the covid vaccination roll-out.
Secondly, I wish to acknowledge and support the Government for recognising in their delivery plan for recovering access to primary care, published in May, the key role that community pharmacists have been asked to play in the future of planning care.
Thirdly, and probably most urgently, there is a need to address the enormous pressures that community pharmacists currently face. If that is not done, the sector could cease to exist in large swathes of the country and will be in no fit state to perform the role for which it has successfully auditioned. There are clear comparisons to be drawn with the current state of NHS dentistry, and it is vital that action is taken to prevent a repeat of that particular nightmare.
A community pharmacy, previously known as the chemist’s in the UK and still known as the drugstore in the US, is a retail shop that provides pharmaceutical drugs as well as other personal products. There will be a qualified pharmacist available to issue medical prescriptions and to provide advice and guidance to customers on prescriptions and over-the-counter drugs, as well as on general health problems. Community pharmacies should be distinguished from the solely dispensing pharmacies located in medical practices and hospitals.
In my research for the debate I noted, as I have over the years, that in some places and at some times, relationships between GPs and community pharmacists can be fraught and strained. That needs to be addressed if the Government’s plans for improving access to primary care are to be successfully delivered.
In preparing for the debate I visited the Kirkley pharmacy at Kirkley Mill in Lowestoft and Boots in Beccles. I thank them both, as well as Tania Farrow and Kristina Boulton from Community Pharmacy Suffolk, for their advice, information and support.
Community pharmacies are made up of privately run businesses and corporate chains. It is important to emphasise that both those groups are going above and beyond what any business could reasonably be expected to do to keep their shops open. It is the framework within which they have to operate that is at fault, not them. The private businesses often work ridiculously long hours for no reward in the service of their local communities, and the corporate chains use retail sales to subsidise the pharmacy side of their operation. It is clear that if reform is not carried out urgently, the steady stream of closures will turn into a torrent.
On 19 July, my hon. Friend the Minister—it is great to see him in his place—confirmed, in answer to a written question that I had submitted, that in the first six months of this year, the number of pharmacies in England reduced by 222. Yesterday, I was advised that Boots has announced that its shop in Orwell Road in Felixstowe, in the constituency of my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), will close on 18 November.
While their number is falling by the day, there are approximately 10,800 community pharmacies in England. As I have mentioned, they do great work, and it was in recognition of that that the Government announced on 9 May that community pharmacies will play a central role in the delivery plan for recovering access to primary care, with £645 million being provided to support a pharmacy-first service.
That will include expanded treatment options for seven common ailments, including earache, sore throats and urinary tract infections. Community pharmacists will also be able to assess patients and supply certain prescription-only medicines without a prescription from a GP. That vote of confidence is welcome, but there is a concern that, due to a real-terms reduction in funding, about which I shall go into more detail shortly, there is an element of robbing Peter to pay Paul.
We now need the detail of how pharmacy-first will work, so that integrated care boards such as the Norfolk and Waveney ICB can set about its implementation. There have been no further details since May, and I will be grateful if my hon. Friend the Minister can advise us when further information will be published.
An important part of the future of community pharmacy is for pharmacists to be independent prescribers. By 2026, newly qualified pharmacists will be able to start work having received the necessary training to become independent prescribers as part of their qualification. There is a need to ensure enough support to enable existing community pharmacists also to be trained as independent prescribers.
To become independent prescribers, pharmacists will need the support of a designated prescribing practitioner as part of their training. Sufficient investment is needed to ensure that that can happen, as designated prescribing practitioners will be required to support both those studying for their foundation pharmacist year in 2025-26 and the existing community pharmacists wanting to be trained as independent prescribers. Both will require 90 days in a prescribing environment.
Community pharmacists are under extreme pressure on multiple fronts—financial, workforce and regulatory, with many rules dating back to the 1930s. Medical supply instability is particularly acute. That puts operational pressures on pharmacists, imposes financial burdens on their businesses and creates worrying delays for their patients. Two of the biggest and interlinked challenges facing the sector, and indeed the whole of primary care, are access to services and the sustainability of the workforce. An increasing number of pharmacies are now providing core hours only, due to workforce challenges and financial sustainability. That means that fewer are offering services in the evening, at weekends and over bank holidays, and, in some cases, they are having to close much earlier during the day.
While the introduction of pharmacists working in general practice is to be welcomed, it has had the negative consequence of making it more difficult for community pharmacies to recruit pharmacists. A lack of access to pharmacy services cascades through other parts of the health system—to general practice, to the number of calls to NHS 111, to appointments to out-of-hours services and to visits to A&E.
Funding has been cut by 30% in real terms over the past seven years. As a result, so as to remain viable, community pharmacists are cutting back on the discretionary services that they provide. That ultimately leads to permanent closures—461 by Lloyds and 300 announced by Boots in June.
The 30% real-terms funding reduction, accompanied by inflationary pressures and workforce shortages, has driven up costs and has led to reduced hours and permanent closures. The £645 million for the new common conditions service announced in May is welcome, but it does not address the underfunding of existing core services. There is a need for a stable, long-term and sustainable funding commitment that can be delivered through a review of the community pharmacy contractual framework. This means not only additional funding, but alignment of care pathways and provision of incentives within primary care systems. The funding crisis has knock-on implications, including pharmacists being unable to spend as much time with patients as they would like, as well as the withdrawal of services such as free deliveries, particularly to care homes, and monitored dosage system boxes, which are important to many people.
To address these pressures and ensure that community pharmacies can realise their full potential, Community Pharmacy England has come forward with its own six-point plan. First, as I mentioned, pharmacy funding should be reformed to give pharmacies a long-term, economically sustainable funding agreement.
Secondly, a common conditions service should be developed and implemented so as to allow patients to have walk-in consultations for minor conditions. That would provide accessible care and ease pressure on general practice.
Thirdly, community pharmacies should look to build on other clinical service areas, such as vaccinations, women’s health and long-term conditions management for, say, asthma and diabetes, using independent prescribing rights. In this way, pharmacy can do a great deal in key NHS priority areas and will help to get the health service back on a sustainable footing.
Fourthly, the medicines market must be reformed so as to get out of the situation we are now in, where pharmacies are dispensing some medicines at a loss and patients are facing long delays for medicines.
Fifthly, regulatory burdens should be reviewed and where necessary removed, so as to make running community pharmacies easier and to limit the increasing cost of service provision.
Sixthly and finally, a long-term plan for the community pharmacy workforce should be produced to ensure that pharmacies can keep their doors open and to enable them to retain pharmacists in local pharmacies.
In many respects, this debate is a trailer for the main attraction next Tuesday, when Community Pharmacy England launches its vision for community pharmacy, as prepared by the King’s Fund and the Nuffield Trust. In the delivery plan for recovering access to primary care, the Government undertook to continue to engage with the sector, with specific reference to the piece of work that is being published next Tuesday. I urge the Government to adhere to that commitment, which is vital not only to rebuilding primary care but to giving community pharmacies a sustainable and viable future, thereby ensuring that after 170 years they can remain part and parcel of the fabric of our towns and cities.
Several hon. Members rose—
Peter Aldous
This has been a very informative and helpful debate. We clearly have an enormous challenge in this country in improving access to primary care, and the key role played by the community pharmacy in addressing that challenge will be vital. We have heard about the three shortages that the industry faces, and I urge the Minister to reflect on those: the shortage of funding and finance, the shortage of staff, and the shortage of medicines.
The right hon. Member for Knowsley (Sir George Howarth) highlighted the impact of community pharmacy closures on deprived areas. It is clear from the maps that have been produced that the impact is disproportionate, including in some coastal communities, such as the one I represent. He also highlighted the key role that community pharmacies play in treating the long-term health conditions found in such areas.
My hon. Friend the Member for Winchester (Steve Brine), the Chair of the Health and Social Care Committee, rightly showed that this issue is on its register. I looked at the registers in the Select Committee report and I look forward to the amber and red warnings turning into green notices in due course. He highlighted the importance of PrEP being available for community pharmacies—the Terrence Higgins Trust brought that to my attention—and I welcome the update that the Minister provided.
The hon. Member for Bradford South (Judith Cummins) clearly emphasised the importance of a prevention-first approach. We got the first-hand knowledge that is so important in forums such as this from the hon. Member for Coventry North West (Taiwo Owatemi). I was particularly struck by her emphasis on the importance of using technology and the specific problem with the manufacture of generic medicines—she made her point very well. The shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), reinforced the potential of the sector and what an alternative Labour Administration would do.
The Minister highlighted the whole range of work that community pharmacies can do. He touched on the closures but said that there are actually more community pharmacists now than in 2010. I just highlight, from talking to community pharmacists, that when there are closures, getting consolidation of the sector across the country, so there is an even spread and we retain community pharmacies within 20 minutes of people, is not straightforward with the current regulations. I urge the Minister and his Department to look at that.
The Minister also said there has been an 82% increase in registered pharmacists since 2010, but a lot of that increase may have been in hospitals and medical practices. The feedback that I get from community pharmacists is that they have challenges with recruitment and retention in their settings, and we need to address that. I was heartened by what the Minister said about regulatory reform; it appears that the Government are embracing that particular challenge.
Let me say, in the few seconds I have left, that this debate has served the purpose of highlighting the key role of community pharmacies and the challenges they face. I urge the Minister to continue to engage with the sector—I know he will—particularly when the extra report is produced on Tuesday.
Question put and agreed to.
Resolved,
That this House has considered community pharmacies.
Dental Services: East of England
Peter Aldous Excerpts(11 months, 1 week ago)
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Peter Aldous (Waveney) (Con)
It is a pleasure to serve with you in the Chair, Sir Mark. I congratulate my hon. Friend and neighbour the Member for South Norfolk (Mr Bacon) on securing and leading the debate. That said—some faint praise there—it is easier for an MP to secure a debate on NHS dentistry in this place than it is for one of our constituents to actually see an NHS dentist.
As we know, the east of England is the most arid region in the country. That is certainly the case with rainfall and probably also with NHS dentistry. As we have heard, it has been the No. 1 item in many of our inboxes over the past two years. There are no signs of that abating, though, from what the Minister has said, I get the sense that the first steps are being taken to provide an improved service. There is much work to do and I await the Government’s plan for NHS dentistry. I am very much aware of the hard work that my hon. Friend has been carrying out and I hope he will be able to provide a publication date when he responds. I want to highlight what I believe should be included in the NHS dentistry plan, with a slight slant towards the east of England.
The first item is, of course, that NHS dentistry requires fair funding. The British Dental Association has estimated that we would need £1.5 billion a year to restore budgets to their 2010 level. I recognise that that will not be achieved overnight, but there does need to be a meaningful start.
I want to highlight two further points on funding. As I understand it, the annual budget for NHS dentistry is of the order of £3 billion; just over 10% of that is due to be clawed back because it has not been spent. I do not know whether the Minister has given an assurance elsewhere, but that money must remain ringfenced for NHS dentistry. The fact that there is money not being spent shows that the whole system is broken. We saw that at the beginning of January 2022, when the Government announced £50 billion of funding for what was described as a dentistry treatment blitz; only 30% of that was spent. There is a lot of work to do on the funding side.
I turn to funding issues from the east of England perspective. The British Dental Association carried out some work before the pandemic that showed that spending on NHS dentistry in England lags way behind that in Scotland, Wales and Northern Ireland. Homing in on what is happening in England, some recent research commissioned by the University of East Anglia and carried out by Health Economics Consulting very much showed that the east of England is the poor relation compared with the rest of the England.
The research showed that, for 2018-19, in the midlands, spending on NHS dentistry was £78 gross expenditure per head. In the north-west, it was £75; in the north-east and Yorkshire, £70; in London, £69; in the south-east and south-west, £69. The east of England is the tail-end Charlie, at £39 per head. There are a great many steps that we need to be taking to address that particular inequality.
My second point is about contract reform. The 2006 contract is discredited, and needs to be replaced. From what I can gather from what the Government and the BDA say, we have moved beyond what I would describe as the “talks about talks” phase of negotiations, and they are in meaningful discussions. This must not just be a tinkering with the contract—it must be a complete root-and-branch reform.
Some of the ingredients we need for a new contract include a clear break with the units of dental activity system of funding; and we must discard the straitjacket on how many patients NHS dentists can see. If they do not see enough, they get fined; if they see too many, they have to pay for it. We must also ensure that more complex and lengthy treatments are properly rewarded and that NHS dentists are not discouraged and penalised for performing them; we must prioritise prevention; and, particularly from the east of England’s perspective, somehow we must find a way of motivating NHS dentists to come and work in rural and coastal areas.
My third point is about recruitment and retention. Another plan that we are awaiting is the Government’s workforce plan for the NHS and the care sector, and dentistry must feature extremely prominently in that plan. In the short term, we need to recruit more dentists from overseas. We have a situation in the Lowestoft area—actually, it is in Beccles, where there is an NHS dental contract with a group called the Dental Design Studio. That group has been trying for some months to recruit three dentists from overseas. I think they are moving forward, but progress on the overseas registration examination, as carried out by the General Dental Council, is fairly slow. I have liaised with the Minister on the issue in the past and there is a backlog of applicants that needs to be addressed as quickly as possible.
Moving on from that, we need to train our own dentistry practitioners, which means hygienists and support staff as well as dentists. With that in mind, the University of Suffolk has set up a community interest company with the objective of carrying out both treatment and training, with the creation of hubs. The initiative is up and running, but it needs additional funding so that it can be rolled out further across the region. I ask the Minister to do all he can to provide that funding.
In the longer term, there is the issue of a dentistry school; we do not have one in the east of England. Both the University of Suffolk and the University of East Anglia have thrown their hats into the ring. What the Government need to do is just to assess strategically which regions need dentistry schools, but I believe there is a very big vacuum in the east of England. UEA and the University of Suffolk probably need to get together to come forward and put one case, rather than competing with each other.
My fourth point is about prevention. As we have mentioned, the new NHS dental contract must have an emphasis on prevention and the NHS needs to work closely with local councils in promoting better public health. I will quickly highlight fluoridisation. It is not a particular issue in the east of England, but I remember that in one of the many debates that we have had on NHS dentistry in this very Chamber, my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is a practising dentist, highlighted the situation in Birmingham, where he, as a dentist, can tell which part of the city someone comes from by looking at their teeth, because he knows whether the water is fluoridated in that particular area. Fluoridisation is a compelling issue that needs to be addressed.
Let me also highlight children’s dental health. Two years ago in Lowestoft, an organisation called Lowestoft Rising got together with some local councillors and bought toothbrushes and toothpaste for the under-sevens. It was an extremely successful project and very quickly parents were coming back and saying, “Can we have more?” Unfortunately, more was not available, but it was suggested to me that we should perhaps consider zero-rating toothbrushes and toothpaste for under-sevens. Longer term, we need to look at that very closely.
My final point is about accountability and transparency. There needs to be improved accountability and transparency with NHS dentistry. We have made a significant step forward with the transfer of procurement from NHS England to the new integrated care boards. In the Norfolk and Waveney area, that happened from 1 April, and it is important that dentistry is properly represented on those ICBs. Judging from the feedback that we have had from the Norfolk and Waveney ICB, it is very much getting to work on the problem. It is producing a one-year plan for short-term interventions and next March it will look to produce its long-term dental strategy. From my perspective, I can cite one major improvement. If I have a complaint about NHS dentistry, I can now go to the local NHS commissioners, who I go to on other issues and who give me very good, quick and proactive responses.
To conclude, in geographical terms East Anglia is probably the largest dental desert in the UK, and we need, metaphorically at least, to bring in the irrigators and sink the boreholes with immediate effect. There has been some preparatory work that will enable us to improve the situation, but we need the Government NHS dentistry plan as soon as possible. The plan will cover the whole of the UK, but it must also address the specific problems in the east of England—our historical poor funding, the challenge in recruiting and retaining dentists in our region, and the lack of training facilities. I look forward to the Minister’s response. He impressed me with the way he went about this task, but the plan that he produces needs to be ambitious, visionary and innovative, not just a sticking plaster.
Matt Warman
It is a surprising number. As I am sure my hon. Friend knows, the water companies have raised issues that are legitimate to some extent, but the overall public good from increasing that number is obvious and would pay real dividends relatively quickly. It would be public money well spent.
Peter Aldous
In this place, fluoridation is recognised, but the feedback I get from water companies is that conspiracy theories on the internet cause them concern. Does my hon. Friend agree that there is a need for the Government to lead a public awareness campaign on the benefits of fluoridation to dispel these urban myths?
Matt Warman
I was the Minister responsible for 5G during covid, and we all remember that, apparently, 5G caused covid—I should be very clear that it did not. However, there is a clear dilemma for the Government as to how much they engage with genuinely fringe conspiracy theories and risk giving them a degree of salience and credibility that they simply do not deserve. I encourage the Minister and his colleagues in the Department for Environment, Food and Rural Affairs simply to get on with it and engage, where necessary, with people who are genuinely worried. However, we sometimes have to acknowledge that the extremities of the internet are not a place where rational debate can always be had, be it on 5G and covid or on fluoridation and tooth decay.
I will make two other points before I end my jaunt to the east of the England. The first is that I know the Minister is looking—as we do with GPs and the NHS more broadly—at what work can be done by people who are not fully qualified dentists to help the nation’s oral health. Along with the expansion of people who have trained abroad, I think that would be welcome and could make a difference, but it is not a silver bullet either.
My final point is that, although my secret shopping exercise was valuable and instructive, it is a huge sign of failure, because the data about which dentists are accepting patients should be freely and easily available so that constituents can easily see which practices are offering help. Given the structure of NHS dentistry, we will always have some dentists with open lists and some with closed lists, even in a healthy system. Easy access to that information would benefit our constituents and NHS England.
I know that the Secretary of State is a huge fan of data and is making such information as open and as easily available as possible, and I hope it can form part of the eagerly anticipated dentistry plan, which is coming “soon”—I think that is the current Government parlance. In a world where the autumn runs into February, I would hope that “soon” is well before the summer. I know it will make a difference in the medium term, but the biggest frustration for all our constituents is the fact that there is no silver bullet.
I hope the dentistry plan includes, for instance, the experimental ways of employing dentists that some trusts are using up and down the country, because that will provide some of the interim measures that I hope will come before the opening of the three dental schools that we have secured in this debate alone. Those will make a huge difference, but it takes time to train dentists, and constituents need solutions as quickly as possible. In pursuing that, we will save people from turning up at A&Es and emergency dental appointments, which will come as a consequence of failing to deliver the basic services I know the Minister is keen to offer as quickly as possible.
Reforms to NHS Dentistry
Peter Aldous Excerpts(12 months ago)
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Peter Aldous (Waveney) (Con)
I thank the Backbench Business Committee for granting this debate. It is the third in a trilogy that the hon. Member for Bradford South (Judith Cummins) and I have secured, and that in itself tells a sad and sorry story. Complaints about access to NHS dentistry have been the No. 1 item in my inbox for getting on for two years and, while there is a particular challenge in Suffolk and Norfolk, I am conscious that this is very much a national crisis.
The fundamental causes of the collapse of NHS dentistry go back over 25 years, with a gradual withdrawal of funding by successive Governments and the poorly thought-through 2006 NHS contract. Covid was the final straw that brought the edifice crashing down. The challenge now in front of us is to put NHS dentistry on a secured long-term footing, but in a way that enables our constituents, many of whom are in acute agony, to see a dentist straight away.
Sir Peter Bottomley (Worthing West) (Con)
I thank my hon. Friend for his part in securing successive debates. On emergency dentistry, in my constituency people are asked to travel an hour and a half by public transport for emergency treatment. Great changes have happened in the last three months, but we must improve on that in the next three months so that that no longer happens.
Peter Aldous
I think we all have tales of constituents who have had to go a long way to see an NHS dentist, if they can find one at all. In Lowestoft, people have had to travel to Basildon, which is not straightforward by public transport.
The task of delivering the plan for NHS dentistry is on the shoulders of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien). From my perspective, the purpose of the debate is to be constructive and to provide him with ideas and suggestions that could be included in his plan. It should be ambitious, visionary and innovative, not just a sticking plaster to get us through the immediate crisis.
To achieve that, and to ensure that our constituents are able to see a truly local NHS dentist quickly, three immediate short-term challenges need to be addressed. First, the up to £500 million due to be clawed back into the main NHS budget should remain available exclusively for NHS dentistry this year. Secondly in the short term, there is a need to recruit more dentists from overseas to address the acute shortage of NHS dentists. I acknowledge the measures that the Government put in place, as the Minister set out in his answer to my question on Tuesday, but more needs to be done to eliminate the queue as quickly as possible. Thirdly in the short term, the 2006 NHS contract needs replacing, and we must move completely away from the discredited UDA system.
In the longer term, the ingredients for rebuilding NHS dentistry and transforming it into a system fit for the 21st century of which we can justifiably be proud, are as follows: first, as I mentioned, we need to put in place that new contract, and address the current contract’s fatal flaw. It should facilitate a focus on prevention and should motivate dentists and dental practitioners to work in rural and coastal areas such as Suffolk and Norfolk. Secondly, a long-term fair funding system should be put in place. I acknowledge that Governments do not like ringfencing, but NHS dentistry must be provided with an assurance that the funds are available to make the long-term strategic investment that ensures that service will be both resilient and robust.
Thirdly, the recruitment and retention arrangements need to be significantly improved. Dentistry must feature prominently in the Government’s forthcoming NHS and social care workforce plan. Many colleagues, including myself, have highlighted the need for dentistry schools in their areas. Locally, both the University of East Anglia and the University of Suffolk have come forward with proposals. In East Anglia, my sense is that a vacuum must be filled, but I am mindful that a strategic approach right across the country needs to be pursued on where dentistry schools are best located. I would be grateful if my hon. Friend the Minister could commit to carrying out such an assessment. In the meantime, I urge him to immediately support the University of Suffolk’s dental community interest company, which has the twin benefits of providing much needed NHS dental treatments and training in such areas as dental therapy and hygiene.
There is also a need to improve the accountability and transparency of NHS dentistry. The move to integrated care boards that happened throughout much of the country on 1 April, including locally with the Norfolk and Waveney integrated care board, is very much a step in the right direction. In our local area it is taking steps to put in place a long-term plan and to ensure proper representation from dentists.
Finally, at the heart of any health strategy must be prevention. Such an approach will help spare people from hours of agony and ultimately impose less of a burden on the public purse. I will briefly outline three possible strands to intervention. First, the Government must press ahead with plans to fluoridate the water supply. All the evidence is that that will bring significant results. Secondly, we must come up with a strategy for promoting better oral healthcare for children. In 2021, with support from local councillors, Lowestoft Rising provided free toothbrushes and toothpaste to the under-sevens. The take-up was high and the feedback was extremely positive, and it recommended that such products should be exempted from VAT. I urge my hon. Friend the Minister to promote that policy with the Treasury. Thirdly, as we have heard, we must not forget the elderly, particularly those in care homes, and that must be covered in the new dental contract.
In conclusion, the emergence of dental deserts across the country, which are now joining up to create an area of Saharan proportions, is a crisis that must be tackled head-on with proper funding, root-and-branch reform and bold and imaginative policies. My sense and my hope is that the Minister is up for the challenge, and I look forward to the publication of the Government’s NHS dentistry plan. As I have said, this is the third Backbench Business Committee debate that the hon. Member for Bradford South and I have secured, and I hope that a fourth will not be necessary.
Oral Answers
Peter Aldous Excerpts(12 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
We do not plan to debate any of our existing standards. We have some of the strongest standards for control anywhere in the world. We have no plans to get rid of any of those things.
Peter Aldous (Waveney) (Con)
Notwithstanding the work that the Government have done, the feedback that I am receiving from Suffolk-based NHS dentists is that there is still a very long waiting list for overseas dentists waiting to take the overseas registration examination, with more than 3,000 applicants and only 150 exams taking place each month. I urge my hon. Friend to leave no stone unturned in working with the General Dental Council to eliminate the waiting list as quickly as possible.
Neil O’Brien
We are leaving no stone unturned. Last month, we passed legislation enabling the GDC to increase the capacity of the ORE. We have also made it easier for overseas dentists to start working in the NHS: as of 1 April, no dentist will need to pay an application fee. We also want to radically reduce the time that dentists spend in performers list validation by experience, and we will set out further steps in our dentistry plan.
Oral Answers to Questions
Peter Aldous Excerpts(1 year, 3 months ago)
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Peter Aldous (Waveney) (Con)
Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
The Government are working to improve access. We have made initial reforms to the contract and created more unit of dental activity bands to better reflect the fair cost of work and to incentivise NHS work. We have introduced a new minimum UDA value to help sustain practices where they are low, and we are allowing dentists to deliver 110% of their UDAs for the first time to deliver more activity. Those are just the first steps; we are planning wider reforms.
Peter Aldous
On 20 October, the House passed a motion highlighting the continuing crisis in NHS dentistry and calling on the Government to report to the House in three months’ time on their progress in addressing this crisis. That time has now elapsed. I am grateful to the Minister for that update, but can he confirm that the Government will be producing a comprehensive strategy for the future of NHS dentistry, and can he inform the House when it will be published?
Neil O’Brien
It was very useful to meet my hon. Friend the other day, who is a great expert on this issue. As he knows, we are working at pace on our plans for dentistry. As well as improving the incentives to do NHS work, we are working on the workforce to make it easier for dentists to come to the UK. We laid draft secondary legislation in October to help the General Dental Council with that. We are working on our plans for a centre for dental development in Ipswich and elsewhere in the east of England, as he knows. Although we have not yet set a date to set out the next phase of our plans, my hon. Friend knows from our meeting that this is a high priority area for us and that we are working on it at pace.
NHS Dentistry
Peter Aldous Excerpts(1 year, 6 months ago)
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Peter Aldous (Waveney) (Con)
I beg to move,
That this House is concerned by the growing crisis in NHS dentistry; notes that nine out of ten dental practices in England do not accept new NHS patients; regrets the number of dentists moving away from NHS practice; welcomes the Government’s commitment to levelling up health outcomes and dental health across the country; calls on the Government to take urgent steps to improve retention of NHS dentists and dental accessibility for patients; and further calls on the Government to report to the House on its progress on the steps it has taken to address the NHS dentistry crisis in three months’ time.
I thank the Backbench Business Committee for granting this debate, and the hon. Member for Bradford South (Judith Cummins) for her work in helping to secure it. I also highlight e-petition 564154, signed by 11,067 people, calling for an independent review of the NHS dental contract.
Colleagues have been securing debates on the state of NHS dentistry for the past two years. This crisis has been brewing for a long time, and the situation can be likened to that of a house built on shallow and poor foundations that has come crashing down with the earthquake of covid. The King’s Fund describes NHS dentistry as being on “life support”, while the British Dental Association describes it as undergoing a “slow death”. In its monthly report for October, Healthwatch repeats that NHS dental care continues to be one of the main issues it hears about from the public, who across the country are clamouring for NHS dentistry that is both affordable and accessible.
In Suffolk, there are 70 dental practices with NHS contracts, but not one is taking on new patients. Locally, there has been some welcome support in that, in Lowestoft, a local practice was granted additional units of dental activity that allowed it to see emergency patients until the end of September, and in July the Dental Design Studio was awarded a contract to deliver NHS dentistry for up to eight years. However, very quickly both practices were fully booked up and have had to turn away patients. There is a need for root and branch reform, and I shall briefly set out the issues that need to be included in a blueprint plan for NHS dentistry.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my hon. Friend on securing this debate. Would he agree with me that the fundamental problem with NHS dentistry at the moment is the 2006 contract and the units of dental activity? Does he share my disappointment at the statement made in the summer about how to resolve the situation based on the consultation launched last year, and furthermore, does he hope that UDAs will be expunged from all of this so that dentists can be properly rewarded for the job they do and thus return to the NHS?
Peter Aldous
I thank my right hon. Friend for that intervention, and I agree wholeheartedly with him on that point. I will come on to it as I set out what I believe needs to be done to improve the situation, but I think he and I are very much on the same page on that issue.
First, I will address the issue of funding. There is a need to secure a long-term funding stream. In recent years, the NHS dental budget has not kept up with inflation and population growth. Since 2008, NHS dentistry has faced cuts with no parallel elsewhere in the NHS, and the British Dental Association states that it will take £880 million per annum to restore the service to 2010 levels. I acknowledge the budgetary challenges that the Chancellor faces, but the reform process is doomed from the start without an appropriate level of investment. There is a need for a protected budget, and any funding that is clawed back must be kept in dentistry.
Secondly, a strategic approach should be adopted towards recruitment and retention, with a detailed workforce plan being put in place.
Jeff Smith (Manchester, Withington) (Lab)
I congratulate the hon. Member and my hon. Friend the Member for Bradford South (Judith Cummins) on securing this debate. There is a crisis in south Manchester and across the country in trying to access NHS dentists. There are highly trained dentists from abroad who can help. I have some constituents who were trained at the dental faculty of the University of Hong Kong, which is among the top three faculties in the world—it has an English curriculum—but they cannot get registered or access the licence exams. I understand that the Government have said they are going to simplify the registration process. Would he join me in urging the Government to act very quickly to make that happen?
Peter Aldous
I thank the hon. Gentleman for his intervention, which came at an appropriate time. Indeed, he may well have been reading my speech, because that was the next point I was coming to. In the short term, we need to be stepping up recruitment from abroad. Although the legislation tabled earlier this month to streamline the process of recognising overseas qualifications is welcome, that will not address the problem on its own, and I hope that when he responds to the debate, the Minister will address that issue. In the longer term, we must improve dentistry training ourselves and ensure that it is available throughout the country. In that regard, the proposals being worked up by the Universities of East Anglia and of Suffolk are to be welcomed.
Thirdly, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, there is a need for a new NHS dental contract. It is welcome that discussions have started on revising the contract, but there is a worry that the Government are looking only at marginal changes, when ultimately a completely new contract is required. At present, the NHS contract is driving dentists away from doing NHS work. Its target-based approach is soul destroying for so many, and it needs to be replaced with an agreement that has prevention at its core.
That leads me to the fourth and penultimate component of a new system of NHS dentistry: the public promotion of the importance of good oral health, and looking after our teeth from the cradle to the grave. Denplan proposes that the Government and NHS should lead a public education campaign to emphasise the importance of oral health. There should be provision in the aforementioned new contract for dentists to go into schools, as well as into care and nursing homes. When economic conditions allow, let us be imaginative and exempt children’s toothbrushes and toothpaste from VAT. That can embed good oral healthcare at an early stage of life. It is welcome that the Health and Care Act 2022 facilitates the roll-out of water fluoridation projects, and the Government should work proactively with water companies to ensure that is universal.
Finally, there is a need for clear transparency and full local accountability for overseeing and commissioning NHS dentistry services. I acknowledge the hard work and great effort of those working at NHS England, but we need to replace a system that is inaccessible, opaque, and confusing. The Health and Care Act provides us with the means of doing that, and it is welcome that from next April, many integrated care systems will be taking on responsibility for local NHS dentistry. That is the right approach, as good oral healthcare is essential for good general health and wellbeing, and inextricably linked to primary, mental and emergency care. It is vital that those involved in dentistry are represented on integrated care boards.
Across the country there are a multitude of dental deserts. If we do nothing, if we apply the odd sticking plaster here and there, those will turn into one large Sahara. We owe it to those we represent to ensure that does not happen. That means that we need as a matter of urgency a blueprint plan for new NHS dentistry. That will not be delivered in one fell swoop, but we need clearly to lay down the route path and start taking meaningful strides down it. With that in mind, the motion calls on the Government to embark on that journey and report back on their progress in three months’ time.
Several hon. Members rose—
Peter Aldous
We have had a full and productive debate. I will quickly run through a few points—I apologise if I miss any hon. Members. The right hon. Member for Knowsley (Sir George Howarth) rightly highlighted the importance of addressing oral cancer quickly. I take on board his proposal for the short-term fast-tracking of emergency support. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) suggested a short-term simple contract to get on top of the backlog. The hon. Member for Bradford South (Judith Cummins) highlighted how £50 million was made available but that the system is so broke we spent hardly any of that.
My hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) highlighted that the problem is not just in England but in Scotland. The hon. Member for Blackburn (Kate Hollern) mentioned the importance of workforce planning. My hon. Friend the Member for Gloucester (Richard Graham) mentioned the importance of the local NHS being involved. The hon. Member for Bath (Wera Hobhouse) highlighted the alarming rise of DIY dentistry.
It was good to have my hon. Friend the Member for Salisbury (John Glen) in his place for the debate. He emphasised the importance of the short-term UDA model. We have been going back to 1951 as a basis, and we need to bring that right up to date. The hon. Member for Bootle (Peter Dowd) is right that we have been here before. There is now a need for action. My hon. Friend the Member for North Devon (Selaine Saxby) mentioned dentists getting on the buses—an interesting way to improve accessibility. My hon. Friend the Member for Loughborough (Jane Hunt) again highlighted the short-term arrangements.
Finally, the Minister said that his door is always open. I welcome that. I hope that he will be in his place for some time, because the last thing we need is more change. If the motion is agreed to, when we come back in three months it must be a question not just of what we will do but of what we have done.
Question put and agreed to.
Resolved,
That this House is concerned by the growing crisis in NHS dentistry; notes that nine out of ten dental practices in England do not accept new NHS patients; regrets the number of dentists moving away from NHS practice; welcomes the Government’s commitment to levelling up health outcomes and dental health across the country; calls on the Government to take urgent steps to improve retention of NHS dentists and dental accessibility for patients; and further calls on the Government to report to the House on its progress on the steps it has taken to address the NHS dentistry crisis in three months’ time.
Dental Training College: East Anglia
Peter Aldous Excerpts(1 year, 6 months ago)
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Jerome Mayhew
I am grateful to my hon. Friend for that intervention, and I agree entirely. There can be collaboration between the university in Norwich and the University of Suffolk, which is based in Ipswich. People can start training in Norwich and, once they are qualified, have career and professional development taken care of by the proposed unit in Ipswich. I will come on to that in further detail.
To return to the plans of the University of East Anglia, its idea is that students would work in the community for at least one day a week throughout their five-year training course. In that way, dental students will increase the capacity of associated NHS practices right from the get-go. Too often, it is suggested that a dental training school is too long term to solve the problems now. In a sense, it is, of course, but under this plan, we would have increased capacity right from the first year of the students’ five-year course.
There are more benefits, too: students would not only increase the capacity, but develop employment relationships locally, increasing their stickiness, and provide training income to stretched NHS practices. For that reason, MPs from North Norfolk, North West Norfolk, Mid Norfolk, South Norfolk and Norwich North all support the proposal. If there were an East Norfolk constituency, I am sure that that Member would support it as well.
Peter Aldous (Waveney) (Con)
I speak as an MP with a foot in both camps: I am a Suffolk MP but I also represent the Norfolk and Waveney integrated care system area. Does my hon. Friend agree, as my hon. Friend the Member for Ipswich (Tom Hunt) said, that it is very important that the two proposals being put together by the University of Suffolk and the University of East Anglia are collaborative and worked on together, so that they come through with a solution for the whole of East Anglia?
Jerome Mayhew
I am grateful to my hon. Friend. The only phrase that I would pick him up on is that he has “a foot in both camps”. I do not think there should be two camps. This is an East Anglian solution, whereby the proposals are complementary and, in time, they should both be implemented.
Jerome Mayhew
My hon. Friend is entirely right. There is a further point to be made about the collaboration between the University of East Anglia and the Norfolk and Norwich University Hospital, because they also have the Norwich research park co-located. I am thinking particularly of the Quadram Institute, the sole focus of which is world-leading research on the gut microbiota. I cannot pretend to know exactly what the gut microbiota are, but I know that they start with the mouth. There is huge capacity for proper, hard research in the area, and it could be assisted by a dental training school in Norwich. That is the first solution.
The second solution, which is also needed, is for the dental school in Norwich to complement the University of Suffolk’s plans to build a centre for dental development in Ipswich to support further career development in the region, attracting and retaining newly qualified dentists. My hon. Friends the Members for Bury St Edmunds (Jo Churchill), for Waveney (Peter Aldous) and for Ipswich (Tom Hunt) and others have all pushed for that.
The truth is that we need both to attract qualified dentists in the short term and to find a long-term solution to the wider training problem. It may be that an assessment is made nationally that there is no need for additional dental training seats, but people are human. We have to look beyond the empirical analysis and recognise that training needs to be offered in a location of real shortage. That location is East Anglia, and Norfolk in particular.
As a Conservative, I believe that people should have power over their own lives and that communities should not be dictated to by national Government. Rather, they should be empowered to come up with their own solutions to their local needs. We know what the problem is, and we have a solution to fix it locally; we just need the Government to trust the people to let us get on and do it.
We simply need more dentists and dental technicians in East Anglia. We recognise that budgets are tight and that timings may have to be stretched. We accept that short-term fixes are sometimes more powerful arguments in politics than long-term solutions. We simply ask the Minister to agree to meet the University of East Anglia team to learn at first hand how we can make East Anglian dentistry better, and to be inspired by their practical vision.
Madam Deputy Speaker (Dame Eleanor Laing)
I cannot quite tell whether the hon. Gentleman wishes to contribute.
Peter Aldous (Waveney) (Con)
I will contribute very quickly, Madam Deputy Speaker, if you will give me the opportunity.
My hon. Friend the Member for Broadland (Jerome Mayhew) has set out a great vision of a future in which East Anglia, Norfolk and Suffolk have high-quality dentistry schools. That is great, but we need a bridge to get to that future, because two dentistry schools will take some time to set up. Does he agree that we need to look at other strands to address the crisis in NHS dentistry in East Anglia, including recruitment and retention in the short term, making it easier for people from overseas to come and work in local dentistry; contract reform, which I think my hon. Friend referred to; a fair, long-term funding settlement; a focus on prevention; and improved local accountability through the fledgling integrated care systems?
Jerome Mayhew
Thank you for that clarification, Madam Deputy Speaker.
Does my hon. Friend agree that all those aspects are very important, but that perhaps there is another proposed solution that he has not mentioned? As we have learned today, there are inducement payments for teachers in special areas that are struggling to recruit. Perhaps we could apply the same approach to dentists in special areas that are struggling to recruit.
Peter Aldous
I thank my hon. Friend for that intervention and apologise for hijacking his debate. Yes, I agree wholeheartedly. This is a multifaceted challenge; there is no one solution and no one golden bullet. We need to address all the points, and he is right to raise that one.