Dental Healthcare: East Anglia

Peter Dowd Excerpts

Wednesday 11th December 2024 Westminster Hall

[Peter Dowd (in the Chair)]

I will call Jerome Mayhew to move the motion and the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

I beg to move,

That this House has considered dental healthcare provision in East Anglia.

It is lovely to see you in the Chair, Mr Dowd. I am grateful to colleagues from East Anglia for supporting this debate and, I hope, making some interventions. I am also grateful to the Minister for Care for coming yet again to Westminster Hall, because this is not the first time that we have had a debate on dentistry in the east of England, and in East Anglia in particular. The reason for those numerous debates is the significant problem of access to NHS dentists in particular, but also to private dentists.

Peter Aldous, who I am sorry to say lost his seat at the recent election, was a doughty campaigner on the issue. I pay tribute to him for the numerous debates he brought forward. Most recently, in September, the hon. Member for Norwich South (Clive Lewis), who is not here today, held a debate on the topic. Time is short, so I will not focus on the need as much as I normally would, but the Minister has been here before and knows very well how significant the need is for increased access to NHS dentistry in East Anglia.

I will give highlights, however, because the Secretary of State for Health and Social Care has described Norfolk not only as a dental desert, but as the “Sahara of dental deserts”. The Minister—the noble Baroness, Lady Merron—confirmed in the other place on 25 November that the Norfolk and Waveney area has

“the worst ratio of NHS dentists to patients in England”.—[Official Report, House of Lords, 25 November 2024; Vol. 841, c. 479.]

In my last debate in this forum, I was shocked to report that in Norfolk and Waveney the ratio of dentists per 100,000 population was 39, when the national average was 52. Now I have to update those figures, because the Secretary of State has recently confirmed that the figure of 39 has dropped to 36 per 100,000 of population, while the national average has increased to 53. It is getting worse, not better.

The data from this month is even more concerning. The British Dental Association confirms that there are 3,194 NHS dentists in the east of England, which are the statistics we previously used. BDA’s further analysis last month reveals that that equates to just 1,096 full-time equivalent dentists in NHS roles. If those figures are run through the population, there are 17 full-time equivalent NHS dentists per 100,000 population in the east of England. Those are truly shocking figures.

The issue can be sliced and diced in another way. The amount of money that the Government spend on people’s mouths in the east of England makes for sobering reading. The national average is £66 per mouth spent on dental treatment by the NHS. In the east of England, that figure is just £39. What is it? Is it that our fillings and dental work are cheaper in the east of England, or are we doing less? It is not due to less demand; we have the greatest demand. We had more than 1,000 people presenting in the past year at NHS A&E with significant dental problems. I believe I am right in saying that dental concerns are the single biggest reason why primary school children present at hospitals.

Rare Autoimmune Rheumatic Diseases

Peter Dowd Excerpts

Tuesday 10th December 2024 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to see you in the Chair, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon) for bringing this issue before us today, because it is one of those subjects that does not get the attention that it needs. It is really important to tease out some of the issues, because there is a danger that they could be forgotten if we do not. The hon. Gentleman pushes this matter time and again.

The whole question of rare autoimmune rheumatic disease needs to be set in the context of the wider issue of rare diseases, which are conditions that affect less than one in 2,000 people. There are 7,000 rare diseases, affecting one in 17 people, which is 3.5 million people. They can be of a genetic or non-genetic origin and they affect adults and children. Some 75% of rare diseases affect children and more than 30% of children with a rare disease die before their fifth birthday. That is a sobering statistic.

We have to put the issue into that context: it affects the lives of so many people, not just those who are directly affected by the particular disease, but their family members and friends. A disease can also have an impact on someone’s work-life balance and their job, as well as more broadly. There are challenges, but I thank the Rare Autoimmune Rheumatic Disease Alliance for bringing those groups together to push for this issue. It believes, as we all do, that getting together gives us more strength. I support that, and I have no doubt that the Minister supports that too.

We do not want rare diseases, particularly this type of disease, to be left at the back of the queue. The Government acknowledge that, so I am not pointing the finger at them, or at health professionals. Many people with this type of disease say that they do not get the support they need, but they do not blame individual clinicians, practitioners or healthcare workers; they blame the system in so far as it does not bring those professionals together in, for example, the clinical networks that the hon. Member for Strangford referred to. This is not a finger-pointing exercise, but it is important that where we can identify, and have identified, problems in the system, it is our responsibility to try to fix those problems.

The hon. Gentleman also touched on the need for defined, measurable and identified standards to reduce inequalities in healthcare provision. RAIRDA is working with others to set out key statements that it believes will form the quality standards for the future. It has set out the challenges, such as the challenge of focusing on this issue and the points that the hon. Gentleman raised that the time from symptoms to diagnosis can be from two and a half years to as much as five years, and potentially beyond.

There is also a challenge with access to specialist knowledge and expertise, and the hon. Gentleman’s valid point, which I repeat, about the need for those specialist networks. There is the challenge of getting support out to the people—the professionals—dealing with our constituents in one way fashion or another. I know the UK rare diseases framework, and the England rare diseases action plan in my case, has been trying to help patients to get a diagnosis faster but we need to do more.

There has been a push to raise awareness among professionals, but we need to do more there. We need better co-ordination of care and improved access to specialist care, treatment and drugs. We also need to focus on the needs of the various nations. Although they all face similar problems, it is important to have a focus at a national and potentially regional level.

I support the hon. Gentleman, who made important points. We will no doubt come back to this issue. I know that the Minister will respond, as he always does, constructively and positively, so I look forward to hearing what he and Members from other parties have to say. I will finish by saying to the hon. Gentleman that at no point during my contribution did I mention either Shakespeare or Sophocles.

Suicide and Mental Health of Young People: Tatton

Peter Dowd Excerpts

Tuesday 26th November 2024 Westminster Hall

[Peter Dowd (in the Chair)]

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

[Esther McVey (Tatton) (Con)]

I beg to move,

That this House has considered the matter of suicide and mental health of young people in Tatton constituency.

It is a pleasure to speak under your chairmanship, Mr Dowd. I would like to convey my appreciation to the Minister for replying to this extremely important and sensitive debate on the management of withdrawal from antidepressant medication, specifically selective serotonin reuptake inhibitors, and the profound impact that that process can have on the mental health and suicide risk of young people.

I would like to begin by conveying my sincere thanks to my constituent, Gina Russell, who met me and bravely shared the experience of her daughter, Olivia, who tragically took her life in September 2021, following withdrawal from SSRI medication. Olivia’s mum is unable to be with us in Westminster Hall today. However, I know that she and her family are watching this debate at home, as they are determined to help prevent others having to suffer the same fate as Olivia.

I would also like to place on record my thanks to the charities Mind, Rethink Mental Illness, PAPYRUS Prevention of Young Suicide, as well as to The Children and Young People’s Mental Health Coalition and the House of Commons Library for the information provided to me before this debate. While the information was insightful, it was deeply disturbing, as it revealed that Olivia’s experience of declining mental health as medication was withdrawn was far from unique and was a known risk, which made me determined to pursue this debate on behalf of her family and thus bring Olivia’s story and her family’s suffering to a wider audience.

Let me start by painting a picture of Olivia, who was an intelligent, creative and hard-working 25-year-old who had just left Tatton to live in London. Her parents remember her as wonderful and vibrant—a loving daughter and a loving younger sister to her brother, Luke; a cherished and adored granddaughter; and a loyal, kind and supportive friend. She lit up a room and was admired by all who knew and loved her.

In November 2020, during the pandemic, Olivia became anxious. She began taking an SSRI—citalopram—to manage her anxiety. Initially, Olivia responded well to treatment. However, when the time came to discontinue the medication in June 2021, she experienced a rapid decline in her mental health, which was far worse than what she had previously faced. She then resumed SSRI treatment in August 2021, finally taking her life in September 2021. When she first came off her medication it was without consulting her GP, because she was feeling better. She should have been warned about stopping taking the antidepressant. The family was later to discover that citalopram is one of the most difficult antidepressants to come off.

Tragically, the Royal College of Psychiatrists suggests that between a third and half of people who take antidepressant medications experience withdrawal symptoms to some extent. The severity and duration of these symptoms, and whom they affect, is not certain. In Olivia’s case, the withdrawal symptoms were severe and the resulting deterioration in her mental state ultimately led to her taking her own life. Members should bear in mind that suicide remains the leading cause of death among young people under 35 in the UK, and the mental health of young people has declined alarmingly in recent years.

Mental Health Support

Peter Dowd Excerpts

Thursday 10th October 2024 Westminster Hall

[Several hon. Members rose—]

[Peter Dowd (in the Chair)]

Order. This is clearly a popular subject. Lots of people had indicated previously that they wished to speak; there are obviously people who wish to speak who had not indicated beforehand, and others will want to intervene. The Minister and Opposition spokespersons have 10 minutes each. Having done the calculations, we will regrettably introduce a formal three-minute time limit on Back Benchers. You will be able to see the time on the screen, and regrettably I will have to cut you off in your prime if you go over three minutes. Just bear that in mind, please. I am sorry for the tutorial, but it is worth having, I suppose. Please bob if you do want to speak.

[Helen Maguire (Epsom and Ewell) (LD)]

It is an absolute pleasure to serve under your chairmanship, Mr Dowd, as I speak for the first time in Westminster Hall. I thank the hon. Member for Ashford (Sojan Joseph) for securing this important and timely debate on World Mental Health Day, and for speaking so well.

Mental health can affect any of us at any time, young or old. Unfortunately, too many people simply do not get the support they need and some go on to take their own life. Speaking personally, husbands of two friends of mine, a friend’s brother and a friend have taken their life, destroying families who are left behind figuring out how to cope.

Since becoming the MP for Epsom and Ewell, I have been shocked by the lack of mental health support, but also amazed at the ingenuity of local residents to provide it in its absence. I had the pleasure of meeting Charley Moore the other day—a Surrey female firefighter and founder of an all-female support group in Epsom and Ewell called Grow and Glow. She had a mental health crisis last year and found it very difficult to access support. She found many mental health groups for men, but she could not find any specifically for women, so she set one up.

I was also proud to meet two mental health charities the other day that were recognised at the BBC Surrey and Sussex Make a Difference Awards last week in my constituency. One was We Power On, which is a men’s mental health “walk and talk” support group set up by Chris Waller after he and his friend reconnected during lockdown and discovered that they were both struggling with their mental health. He won the bravery award. He takes people out at the weekend, walking on the lovely Epsom downs and sharing their experiences.

The other charity, Joe’s Buddy Line, was set up by Ivan Lyons, who won the community award and is one of my constituents. Ivan’s son was an award-winning radio producer on Capital Radio. Sadly, in 2020, Joe took his own life. Through Joe’s Buddy Line, Joe’s family advocate for mental health to be treated equally and with the same seriousness as physical health. The charity provides mental health support, advice and resources for schools. It is encouraging schools to put a mental health policy in place in every single school, giving teachers the support that they need to support the young people of today. The charity has highlighted to me that currently it is not a statutory requirement for a school to have a mental health policy. Such a policy would foster a whole-school approach, so today I am calling for a statutory requirement for all schools to have a specific mental health policy.

Too many people are simply suffering and too many lives are being lost, yet some of that is preventable. Early intervention and prevention are absolutely key. First, to ensure that our young people get the support they need before they reach crisis point, we need to equip them with the tools they need to build resilience to cope with modern life. We must ensure that no one feels alone in their mental health journey, and we need to normalise conversations about how we are feeling mentally. I am absolutely proud that in my constituency, individuals such as Ivan, Chris and Charley are taking the initiative to champion mental health support for everyone and fill in the gaps that they have identified in the services. Let us not forget—

[Peter Dowd (in the Chair)]

Order. Please sit down. May I reiterate that this is a very sensitive subject, and I do not want to have to stop people in mid-flow when they are talking? This is a very sensitive issue and it would sound rude, so I exhort hon. Members to keep to the three-minute limit. It is regrettable, as this is a very important subject, but please keep to the limit, because— I reiterate—this is such a sensitive subject, and I do not want to cut people off at a sensitive point.

--- Later in debate ---

[Dr Opher]

Absolutely; I fully agree with that.

I want to make a couple of comments about the state of mental health services, for which there are extraordinary waits: a patient of mine had to wait six months following a suicide attempt. That is simply not good enough. In Stroud, we have to wait four years for neurodiversity assessments because we do not have enough resource. In my opinion, we need to move the resource into the community.

I also support what my hon. Friend the Member for Ashford said about health and education. We need mental health support teams in our schools, and we must spread SEND provision evenly.

The Under-Secretary of State for Public Health and Prevention is with us, so I want to talk about the prevention of mental health issues. There is quite a lot of evidence about promoting maternal and infant mental health, and also about parenting and bullying at school. Using arts and culture is an incredibly strong way of improving mental health.

I was impressed with what my hon. Friend the Member for York Central (Rachael Maskell) said about the community basis of mental health treatment. For many lower-level conditions, there is no need for consultant-led care. Support that takes place in the community costs much less and can be really effective.

The CAMHS waiting list is appalling, and we have a crisis with SEND and delays with education, health and care plans. We do not have enough educational psychologists either. I want to stress what my hon. Friend the Member for Ashford said about care co-ordinators. Young people’s social prescribers are very effective and tend to de-medicalise things that can be supported in the community.

I am really impressed that we are going to get 8,500 more mental health workers. I am also impressed by what they will be doing in schools. We need to improve the physical health of people with serious mental illness, reduce the number of SSRI antidepressant medications, and promote social prescribing, the arts and community care in our mental health services.

[Peter Dowd (in the Chair)]

Can I just remind Members about modes of expression? I will be diplomatic about it.

[Lola McEvoy (Darlington) (Lab)]

I rise to speak about this issue on World Mental Health Day. I have championed it many times across my career and I will continue to do so in my time in this place.

My constituents—and, I am sure, those of all hon. Members—want something that we used to take for granted: a happy, decent life, with a better future for their children. For too many in Darlington, that is not the reality, and I believe that the current mental health crisis is a product of our times. I will focus my brief contribution not on those with severe mental illness, who are often in crisis, but on those who are struggling with day-to-day poor mental health.

I agree with the hon. Member for Hinckley and Bosworth (Dr Evans), who advocated a cross-departmental approach. Poor mental health is pushing people out of work, and that is a huge issue for the Treasury and the Department for Work and Pensions. A lack of child mental health support and a failure to tackle the online safety crisis for children is leading to school refusals, which is an issue not only for the Department for Education but for the economy and for future generations. Loneliness is impacting the physical health of our older people, which is an issue for the NHS. The lack of opportunity, quality work, maternal mental health services, veteran support and childcare support is driving people in my constituency to despair.

I have mentioned this before, but I will mention it again on this day: within my own network, I have lost seven men to suicide. Only one of them had a severe mental illness. In my region, we have the highest rate of male suicide and the lowest wages. I ask that we, as a Government who are committed to equality of opportunity for our regions, consider my constituency and my region for a cross-departmental pilot to tackle poor mental health before we lose any more people to avoidable deaths.

[Peter Dowd (in the Chair)]

I now come to the Opposition spokespersons.

--- Later in debate ---

[Dr Spencer]

I thank the hon. Gentleman for sharing something so personal in his intervention, and for sharing his experience of the impact of suicide. Many Members have shared personal experience in this debate. That is very important.

I am mindful that there will be people in the Gallery or watching at home who may be affected by the topics we are discussing, and I take a moment to point out that there are a variety of services to help people in their recovery, if one can call it that, after a loved one has tragically died from suicide, or to help people who are in crisis, such as local crisis services, the Samaritans or Mind. There is a variety of third sector and charity helplines that can help. Men’s Sheds is one organisation I know of that is very helpful. I am really pleased that the hon. Gentleman raised this issue.

I will finish with a few questions for the Minister. The Government do not have a mental health care and treatment strategy or a psychosis strategy and, following an answer to a written parliamentary question I tabled, I understand that there are no plans for a mental ill health strategy to be brought in. Given today’s debate, I wonder whether the Minister will reconsider that position. What are the Government’s plans on taking forward our suicide prevention strategy, or a specific psychosis or mental ill health strategy—however he wants to cut the cloth?

Secondly, when does he expect the Mental Health Bill to have its First Reading in this place? All Members are going to want to extensively debate and scrutinise that Bill. When does he expect it to come forward? What is his appraisal of the challenges that the Bill needs to answer when it comes to the interaction between the Mental Health Act 1983 and the Mental Capacity Act 2005 and the deprivation of liberty safeguards? What about the MM case on deprivation of liberty in the context of a restricted patient in the community, and the interaction with the Children’s Act 1989 on when children can choose a nominated representative? I realise he may not have the answers to that immediately, but I would be grateful if he could write to me. Community mental health teams are the core of psychiatric teams in the community and our psychiatric care and treatment service. What is his plan to support them?

Finally, what is his appraisal of integrated care systems and their commissioning of mental health services? The hon. Member for Hastings and Rye (Helena Dollimore) mentioned the challenges with her ICS. What is the Minister’s appraisal of that commissioning and how integrated care systems can be held to account to make sure that is being delivered?

[Peter Dowd (in the Chair)]

I want to give the sponsor an opportunity to wind up at the end. I call the Minister.

--- Later in debate ---

[Andrew Gwynne]

I am reluctant to commit Ministers to roundtables when I am covering another portfolio, because then they will do the same when they cover me in Westminster Hall debates, but I will say that we take this agenda incredibly seriously. When we were in opposition we gave support to the then Government, and I assure the hon. Gentleman that we will do everything we can to support people who have eating disorders and to get the right provision and support at the right time to the people who need it.

As I was saying, the covid-19 pandemic has exacerbated the need for mental health support. Around 345,000 children and young people were on a mental health waiting list at the end of July this year, with more than 10% of them having waited for more than two years. Some groups of children and young people are disproportionately impacted by mental health problems largely driven by a complex interplay of social and environmental determinants of poor mental health, as we heard in the debate.

We are committed to reforming the NHS to ensure that we give mental health the same attention and focus as physical health. It is unacceptable that too many children, young people and adults do not receive the mental health- care that they need, and we know that waits for mental health services are far too long. We are determined to change that, which is why we will recruit 8,500 additional mental health workers across child and adolescent mental health services. We will also introduce a specialist mental health professional in every school and roll out Young Futures hubs. We are working with our colleagues at NHS England and in the Department for Education as we plan the delivery of those commitments.

Early intervention on mental health issues is vital if we want to prevent young people from reaching crisis point. Schools and colleges play an important role in early support, which is why we have committed to providing a mental health professional in every school. However, it is not enough to provide access to a mental health professional when young people are struggling; we want the education system to set young people up to thrive, and we know that schools and colleges can have a profound impact on the promotion of good mental health and wellbeing. Doing this will require a holistic approach, drawing in many aspects of the school or college’s provision. I know there are many schools that already do this work, and my Department is working alongside the DFE to understand how we can support best practice across the sector.

As I have said, our manifesto commits us to rolling out Young Futures hubs. This national network will bring local services together and deliver support for teenagers who are at risk of being drawn into crime or who face mental health challenges. The hubs will provide open-access mental health support for children and young people in every community.

On other aspects of our plans, the mental health Bill announced in the King’s Speech will deliver the Government’s manifesto commitment to modernise the Mental Health Act 1983. It will give patients greater choice, autonomy, enhanced rights and support, and it will ensure that everyone is treated with dignity and respect throughout their medical treatment. It is important that we get the balance right to ensure that people receive the support and treatment they need when necessary for their own protection and that of others. The Bill will make the Mental Health Act 1983 fit for the 21st century, redressing the balance of power from the system to the patient and ensuring that people with the most severe mental health conditions get better and more personalised care. It will also limit the scope to detain people with a learning disability and autistic people under the 1983 Act.

Finally, Lord Darzi’s report identified circumstances in which mental health patients are being accommodated in Victorian-era cells that are infested with vermin, with 17 men sharing two showers. We will ensure that everyone is treated with dignity and respect throughout their treatment in a mental health hospital, and we will fix the broken system to ensure that we give mental health the same attention as physical health.

If I have not answered Members’ questions, those Members will be written to by the relevant Minister. I again congratulate my hon. Friend the Member for Ashford on securing the debate.

[Peter Dowd (in the Chair)]

I call Sojan Joseph to wind up very briefly.

Preventable Baby Loss

Peter Dowd Excerpts

Wednesday 4th September 2024 Westminster Hall

[Several hon. Members rose—]

[Peter Dowd (in the Chair)]

I remind Members that if they wish to speak, they should bob—as some of you have done. Thank you for that.

Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders

Peter Dowd Excerpts

Wednesday 22nd May 2024 Westminster Hall

[Peter Dowd (in the Chair)]

Before I call Andrew Selous to move the motion, I will give a little clarity. As is the convention for a 30-minute debate, there will not be an opportunity for the Member in charge of the debate to wind up, but we have a spare 10 minutes and the previous debate finished a bit early, so there will be a little more flexibility—but do not abuse that. A couple of Members want to intervene or speak, so there is some flexibility, at the discretion of the Member in charge and the Minister, to bear that in mind.

[Andrew Selous (South West Bedfordshire) (Con)]

I beg to move,

That this House has considered the Major Conditions Strategy and people with Ehlers-Danlos syndrome and hypermobility spectrum disorders.

I am delighted to serve under your chairmanship, Mr Dowd. I am extremely grateful to colleagues across the House who have turned up to attend this important debate. We understand that anywhere between 135,000 and up to 300,000 people in the United Kingdom have Ehlers-Danlos syndrome. Those are only the diagnosed ones, and we think that that is the tip of the iceberg. If we take that higher number, in rough terms, that is about 460 per constituency for all of us—that is only those with a known diagnosis.

I am grateful to Dr Emma Reinhold, who is herself a GP no longer able to work because she has EDS. She sent me this quote by Professor Rodney Grahame, who is well respected in the field:

“No other condition in the history of modern medicine has been neglected in such a way as Ehlers-Danlos syndrome.”

Ehlers-Danlos syndrome is a group of 13 genetic disorders in which connective tissue is abnormal. That results in fragile and hyperextensible tissues throughout the body, which can lead to a range of very debilitating symptoms. The effect on the body is widespread and not limited to one body system, as connective tissue is everywhere in our bodies. It is a complicated condition and can come with many comorbidities, which can include pain, gut issues, nutrition, cardiovascular autonomic dysfunction, postural tachycardia syndrome, low blood pressure, mast cell issues, musculoskeletal issues, and head and neck issues. Special considerations for children and women’s health, and anaesthetic and surgical considerations are issues as well. EDS can lead to physical disability and reduced quality of life. Some rarer types can be life-limiting. Hypermobility spectrum disorders have similar symptoms to the most common type of EDS, and are treated in the same way.

I am very grateful to Ehlers-Danlos Support UK; I publicly acknowledge the support it has given me for this debate. It supports people across the United Kingdom who live with Ehlers-Danlos syndrome and hypermobility spectrum disorders. It is a wonderful charity and has been a big driver behind the debate. It wants us to come here and make a difference, and that is my plea to the Minister.

Tackling Obesity

Peter Dowd Excerpts

Tuesday 27th February 2024 Westminster Hall

[Sarah Dyke (Somerton and Frome) (LD)]

It is a pleasure to serve under your chairship this afternoon, Mr Dowd. I congratulate the right hon. Member for Bexleyheath and Crayford (Sir David Evennett) on securing this important debate. Whenever possible, I like to talk about the accomplishments of my constituents. One constituent of mine made an outstanding contribution to tackling obesity eight years ago, and I am glad that the hon. Member has recognised their efforts, because that constituent is the former Chancellor, who introduced the soft drinks levy in 2016.

That policy has meant a 46% fall in average sugar levels per soft drink product since 2015. Sales have not been affected; actually, they have increased by 14.9% over 4 years. That levy has been a remarkable success. The Medical Research Council estimates that it has prevented about 5,000 cases of obesity in year 6 girls, and 5,500 hospital admissions for children with tooth decay within five years. This is unambiguous and indisputable. Interventionist health policies are the only way to solve our obesity crisis, because the food system in this country is rigged against us.

This is not just a crisis. In Somerset, 34.6% of children leave primary school overweight or obese, but 21.8% of five-year-old children start primary school overweight or obese. In 2021, 60% of adults in Somerset were overweight or obese. We should be one of the healthiest countries in the world—we have an NHS that covers every citizen, a mild climate and a high level of economic development—but we are not. Thirty years of failed Government obesity policies tell us that we must change. A University of Cambridge team analysed 30 years of Government obesity policies in England—14 obesity strategies with 689 individual actions. Eight per cent fulfilled seven criteria identified by researchers as necessary for successful implementation, and 29% did not meet a single criterion.

We have tried blaming the individual, and it has not worked. It is not just remiss; it is wrong. The charity Beat reported that

“strategies harmful to people with eating disorders appear…to be ineffective at reducing obesity.”

By refusing to change the system and telling people that they are to blame, we are killing people who are already vulnerable, and there is a consensus. Polling last September from the Food, Farming and Countryside Commission and More in Common showed that 77% of participants wanted Government to put health standards over cost, and 67% thought that the Government were not doing enough to safeguard children against unhealthy food and drinks. The status quo simply cannot continue. Our farmers are underpaid, undervalued and underused in a food system that does not prioritise healthy local food of high standard. Small and medium UK agrifood businesses cannot compete with cheap, ultra-processed food. Our NHS staff are so overwhelmed in dealing with the results of obesity that they have little time or budget to deal with the causes.

We Liberal Democrats want a robust, thorough obesity and food strategy that meets all seven standards specified by Cambridge. We want junk food advertising restricted on TV and online, as the right hon. Member for Bexleyheath and Crayford has mentioned. We want public sector food procurement strategies that benefit the farmers and local businesses producing the food. We want to extend the “polluter pays” principle that we have for water companies. We want to make junk food giants either change their ways or pay their way.

As a serving Somerset councillor, I know how vital it is to empower local authorities to develop and manage tailored strategies in their areas. We should give local authorities more power over planning to prevent high streets being clogged up with cheap fast food outlets, and to restrict junk food advertising. Let them develop food partnerships with farmers and agrifood businesses. We must have a new, interventionist approach to our food system. All other approaches have failed. It makes economic sense, environmental sense and moral sense. Let us make a better food future.

[Peter Dowd (in the Chair)]

I am going to give Members five minutes each. The Opposition spokespersons will have five, and the Minister will have ten.

--- Later in debate ---

[Amy Callaghan (East Dunbartonshire) (SNP)]

It is a pleasure to serve under your chairship, Mr Dowd. I congratulate the right hon. Member for Bexleyheath and Crayford (Sir David Evennett) on securing this debate. In the context of the ongoing Tory cost of living crisis and an increasingly unhealthy population, it is important that it takes place, so I welcome his bringing it to the Chamber. Huge financial pressure and high food prices are forcing families to eat less healthily, getting cheaper calories from unhealthy foods. There is a clear link between deprivation and obesity, which is why tackling health inequalities and poverty are top priorities for the SNP Scottish Government.

We have heard lots of interesting contributions. The right hon. Member for Bexleyheath and Crayford touched on junk food advertising, and I discussed that exact issue with the University of Glasgow earlier this afternoon. We need to be incredibly mindful of where, what and when we are advertising; otherwise, we will have an often detrimental impact on health inequalities.

The hon. Member for Somerton and Frome (Sarah Dyke) spoke a great deal about child obesity, which I will come on to. I very much agree with her on that point, but I would welcome an intervention from her on how the Liberal Democrat party’s abandonment of free tuition is impacting household budgets, and thus people’s ability to access healthy foods.

It was hugely welcome that the hon. Member for Putney (Fleur Anderson) mentioned the Daily Mile, which originated in Stirling. It was nice to hear a non-Scottish Member cast light on a project that originated in Scotland, so I certainly welcome that comment.

Obesity is a problem that is escalating on a global scale, but sadly the effects are being felt severely in Scotland. According to a survey, 67% of adults are deemed overweight and a third of children are at risk of becoming overweight. That same survey found that obesity was more common in households with lower incomes—a correlation we know and recognise all too well. That is why I and my SNP colleagues are consistently calling on the UK Government to take action to tackle the cost of living crisis, improve universal credit and reverse their policies that deny families crucial support.

The Scottish Government do not have the levers to be able to do those things at the moment. They therefore mitigate the bad political decisions made in this place, reducing family household costs by providing free prescriptions, free school meals, free childcare, free period products, free university education and free bus travel for those under 22 and over 60; freezing council tax; providing the young carer grant, the Scottish child payment, and both adult and child disability payments; and mitigating the bedroom tax, the rape clause, the benefits cap and real-terms cuts to social security.

Earlier today I met Professor Iain McInnes of the University of Glasgow, whose project, “Creating Healthier Places: A Place-Based Approach to Research & Partnership”, factors access to healthy foods into its research on 20-minute neighbourhoods. It is a fascinating project, and I urge the Minister to have a look at it—I think she would be just as impressed as I am.

Through the best start grant and best start foods applications, the Scottish Government have also provided over £180 million to low-income families to help with expenses during their children’s early years. The eligibility for best start foods will be expanding so that a further 20,000 people can access support to buy healthy food. Such steps are essential to ensure that support is there for the least well-off families to be able to make healthy food choices.

In my constituency, new data from Cancer Research has shown that 22.5% of four to five-year-olds are overweight or obese—that is four to five-year-olds who are already increasing their risk of serious illnesses. That is not a choice by those children or their parents, but a symptom of families not having the resources to provide healthy options. It is a symptom of 14 years of austerity. It is a symptom of being tied to this broken Westminster system.

I know that the Minister cares deeply about these issues and will give a compassionate and considerate response. I simply urge her to mirror some of the policies the Scottish Government are taking on tackling health inequalities. That is why in Scotland, all pupils in primaries 1 to 5, all children in additional support needs schools, and eligible pupils in primary 6 through to S6 can benefit from free school meals—the most generous free school meals offer anywhere in these isles, saving families—

[Peter Dowd (in the Chair)]

Order. I call Preet Kaur Gill.

Osteoporosis

Peter Dowd Excerpts

Thursday 26th October 2023 Commons Chamber

[Judith Cummins]

The hon. Lady raises some important points. I agree that screening and prevention are key to tackling osteoporosis, and I congratulate her and Southend on getting their FLS up and running. It will make a real difference to the lives of people in Southend.

[Peter Dowd (Bootle) (Lab)]

My hon. Friend is doing a fantastic job in this policy area. Given only half of NHS trusts have a fracture liaison service, does she agree that it is vital that that 50% figure grows week in, week out, to ensure that everyone gets get that service?

[Judith Cummins]

My hon. Friend makes a valuable intervention. He has been a staunch advocate for those suffering from osteoporosis and has backed the Better Bones campaign, for which I am very grateful. I agree that this issue is all about ensuring equity in access to NHS services, including FLS.

Podiatry Workforce and Patient Care

Peter Dowd Excerpts

Tuesday 20th June 2023 Westminster Hall

[Peter Dowd (in the Chair)]

I will call John McDonnell to move the motion, and I will then call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[John McDonnell (Hayes and Harlington) (Lab)]

I beg to move,

That this House has considered the podiatry workforce and patient care.

The background to this debate is a meeting I had with a number of local podiatrists representing the Royal College of Podiatry, so let me thank them for the briefing that the royal college has sent me. I want to talk about the development of a workforce strategy for podiatry.

To explain for those who may take an interest in the debate, podiatrists are highly skilled healthcare professionals. They are trained to assess, diagnose, prevent, treat and rehabilitate complications of the foot and lower limbs. They manage foot, ankle and lower-limb musculoskeletal pain, and skin conditions of the legs and feet. They treat infection, and assess and manage lower-limb neurological and circulatory disorders. They are unique in working across conditions and across the life course, rather than on a disease of a specific area.

A podiatrist’s training and expertise extends across population groups to those who have multiple chronic, long-term conditions, which place a high burden on NHS resources. The conditions largely relate to diabetes, arthritis, obesity and cardiovascular disease. In addition to delivering wider public health messages in order to minimise isolation, promote physical activity and support weight-loss strategies and healthy lifestyle choices, podiatrists keep people mobile, in work and active throughout their life. They contribute to the wellbeing of our economy and workforce.

Podiatry is intrinsic to multiple care pathways too, and podiatrists liaise between community, residential, domiciliary, secondary care and primary care settings. They specialise in being flexible and responsive, ensuring focused patient care, irrespective of the clinical setting. Podiatrists are at the forefront of delivering innovation in integrated care. They deliver high-quality and timely care, as well as embracing safe and effective technologies that lead to improved patient outcomes.

The role of podiatrists in managing diabetic foot complications is key. They play a vital role in the prevention and management of diabetic foot complications, which, at the last estimate, cost the NHS in England £1 billion a year. In the three-year period from 2017-18 to 2019-20, there were over 190 minor and major amputations per week in England. Of the people affected, 79% will be confined to one room within a year, with 80% tragically dying within five years. That is a shocking outcome for patients, and it is even worse than the outcomes for the majority of cancers we seek to deal with.

The impact of lower-limb amputations on patients’ quality of life and chances of survival are shocking, so we must do everything we can to prevent diabetic foot complications. We have to act in a timely and targeted manner to ensure that people have the best possible chance of living long and fulfilled lives.

It is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer, infection and amputation free.

[John McDonnell]

What I have discovered on my journey of finding out about podiatry, which I knew very little about before I met podiatrists in my constituency, is that of course people need professional care, and that care needs to be properly funded. There are volunteers, but we should not have to rely solely on volunteers; we need professionals leading the way. Podiatrists are skilled and trained in the prevention and management of diabetes-related foot complications. That is why many of us believe that they must be at the heart of the NHS plan to eliminate unnecessary amputations and the consequent avoidable deaths.

As I said, the broader cost of diabetic foot ulcers to the NHS is more than £1 billion per year—the equivalent of just under 1% of the entire NHS budget. Effective and early intervention for diabetic foot complications prior to ulceration could save thousands of lives and millions of pounds each year.

The situation in my area in Hillingdon exemplifies what is happening elsewhere in the country, which the hon. Member for Strangford (Jim Shannon) has mentioned. Hillingdon’s community podiatry service is part of the Central and North West London NHS Foundation Trust. It is suffering from severe workforce issues, which is having a detrimental effect on the people delivering the service and those suffering from foot ulceration, infection and amputation.

The service is currently failing to meet its timescales for seeing patients at high risk of developing a foot ulcer. What should be a team of 13 clinical podiatrists is now just 3.5 full-time equivalents and three support workers. The immediate concern is the pressure that puts on the staff who remain and the impact it has on the patients who need a minimum of weekly wound re-dressings to enable healing and prevent infection and life-changing amputation. The opportunities to prevent life-changing and life-threatening complications are minimised by the shortage of staff.

We also have concerns that support workers are being asked to triage and treat people beyond their scope of practice due to the staff shortage. That is not a criticism of them, but it is the reality. We should be filling the service with professionals who are fully trained to deal with the range of complications that they might come across. The workforce challenge facing podiatry is the real issue.

There is a need for focused recruitment. As I said, it is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer and amputation free. In the absence of that, there will be a greater risk of premature disability and death. There are currently just under 10,000 podiatrists registered with the Health and Care Professions Council. That is just one per 5,500 residents in England, and that number is due to decline as a result of demographics.

Following the removal of NHS bursaries for student podiatrists in 2016, the number of undergraduates studying podiatry has declined by 38%. Prior to that, the student bursary was set at £9,000 a year and it covered the cost of tuition for a year. In 2020, in a welcome move, the Government reintroduced student bursaries, but at £5,000. That has caused a slight improvement in recruitment to the profession, but it falls far short of ensuring the future of the podiatry workforce that will be required to deal with the oncoming wave of severe diabetic complications coming out of the pandemic.

Another issue is that the average age of podiatry students on graduation is 32. The majority of students are pursuing a second degree, and the need for a second student loan is having a damaging impact on universities’ ability to recruit undergraduates to train as podiatrists. By leaving it up to the market, we face the prospect of not training the workforce required to meet the needs of an ageing population.

The other issue raised with me is the limited career progression in NHS settings. Of the podiatrists currently qualified in England, approximately 40% work in the national health service. It is projected that many of those podiatrists not heading for retirement are likely to move to work in the private sector in the next five years. The reasons cited for that include lack of career development opportunities; repetitive workloads, with limited skill mix; and high demand and low capacity to meet it, leading to what people consider are unsafe staffing levels and to staff burnout.

Expansion of the podiatric workforce across primary, community and secondary services may address some but not all of those issues. Support for workforce growth is critical, but support for those already qualified to progress to advanced clinical practice and consultancy is also critical to workforce retention and ensuring adequate capability in senior clinical, leadership, education and research roles.

We need policy to ensure closer working across providers and the delivery of a foot health strategy. There is significant opportunity to expand the foot health workforce to include non-registered roles, supported by qualified, expert podiatrists. There is also opportunity to consider alternative workforce models that are inclusive of podiatrists working in private practice or the wider foot health workforce in the third and voluntary sectors, for example. A clear workforce strategy is desperately needed now. It needs to explicitly underpin how the foot health workforce is optimally configured, funded, implemented and trained and what the core outcomes of foot health services must be to meet the needs of our future population.

Currently, there is no workforce strategy, no clear statement of aim, and no standardised set of core outcome measures informed by public health or policy. Clear foot health policy is urgently needed to maximise all the benefits that podiatry can offer across an integrated care system, before the profession becomes—as we predict it will—unsustainable, with staffing levels even more unsafe and avoidable patient harms, amputations and deaths relating to lower-limb disease rising dramatically.

I therefore have three key asks. First, I ask the Government to reinstate the £9,000 bursary for student podiatrists. If podiatrists are to be able to support the millions of people who will require their expertise, the Government must reinstate the full podiatry student bursary of £9,000 a year. That is essential if the workforce is to be secured and expanded for future generations. In the absence of long-term funding confidence, allied health professions such as podiatry are unable to commit substantial and consistent investment towards maximising recruitment and retention, both of which will be crucial in securing the future viability of this vital profession.

My second ask is for national collection of podiatry vacancy rates and inclusion of podiatry in workforce planning. Publishing a national workforce plan that considers future need for allied health professionals such as podiatrists must be a priority for the Government. That plan must take into account current trends in recruitment and retention and, for future needs-based public health, comorbidities and their impact on disease prevalence. A national workforce plan will also act as a crucial evidence base for the allocation of long-term workforce funding.

My third ask is for the guidance on integrated care system membership to be strengthened to include allied health professionals. The absence of national guidance or recommendations regarding which organisations and individuals should be included in integrated care partnerships has resulted in a patchwork of involvement for allied health professionals, including podiatrists, in integrated care decision making. Without their meaningful engagement in those discussions, there is a danger that the invaluable contribution podiatrists can make to the delivery of care might simply be overlooked. Strengthened national guidance on the make-up of integrated care partnerships, to include representation of allied health professionals such as podiatrists, should be developed and implemented at the earliest opportunity.

I conclude by thanking the professionals who work in my constituency, as well as those who work nationally. I recognise the pressures they are under and the valiant way that they cope with them.

[Peter Dowd (in the Chair)]

I remind the Minister that the debate must conclude by 4.41 pm.

Reforms to NHS Dentistry

Peter Dowd Excerpts

Thursday 27th April 2023 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

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

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

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

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

indicated assent.

--- Later in debate ---

[Peter Dowd]

I am pleased that the Minister nods and recognises that. The second is whether he acknowledges the extent of the problem with access to dental services. What progress has actually been made—that is what the debate is about—and has it been significant enough? The Minister accepts that there is a problem, but I am still not convinced, on the evidence we have, that the progress has gone far enough. That is my view. The hon. Member for Hartlepool (Jill Mortimer) talked about the 2006 contract, which we all know needs to be redesigned. The Labour Government recognised, in good faith, as early as 2009 that it had to change. We are now 13 years on, so we have to get to grips with it now. I do not point the finger in that regard, but that is the context for the debate today. Actions speak louder than words. Have there been sufficient actions to resolve the problem that the Minister recognises? I am not convinced there have been.

We had a debate in Westminster Hall on 10 February last year—over 12 months ago—in which I asked Conservative Members to

“press the Minister and ask the Secretary of State and the Prime Minister—their colleagues—to listen to the facts, because, unless Members opposite can get that message across to an indurate Government, things can only get worse.”—[Official Report, 10 February 2022; Vol. 708, c. 473WH.]

Let us take a rain-check a year or so on. Have things stayed the same? Have they got better? Have they got worse? In my view, and that of many others, things have not stayed the same and they have not improved substantially, so it does not take Hercule Poirot to work out that things have deteriorated. I accept, in good faith, that Conservative Members have lobbied the Government, but I am sorry to say that, looking at the situation on the ground in my constituency—and, no doubt, in other Members’ constituencies—their exhortations have fallen on nearly deaf ears, or at least have not been listened to sufficiently.

From Monday gone, there has been an 8.5% increase in NHS patient charges for dentistry in England—during a cost of living crisis. That increase will hit millions of people on modest incomes, including patients in my constituency, and that is those who can actually get to see a dentist. Many statistics have been mentioned today and I could rehearse them, but I will not do so for purposes of brevity. Everybody gets the gist that things are in a grim state.

One statistic I will mention is that dentistry is now the No. 1 issue raised with Healthwatch, with four in five people—79%—who contact it saying they found it difficult to access timely dental care. The British Dental Association has said:

“The Government’s support package for NHS dentistry launched in November consists of marginal changes that will do little to arrest the exodus of dentists from the service or address the crisis in patient access.”

On top of that, we have low morale in the service and dentists quitting in great numbers. I do not think it goes too far to say that we are facing meltdown. The BDA sees an existential threat; I say meltdown—we all get the gist.

Despite the £3 billion dentistry budget, some 10% of the money allocated will be returned, not because of lack of demand but because of dentist shortages. That is the irony. The money is returned, but that must be set in the context of underfunding over many years, on top of which is the poor contract. Retention issues are borne out of burn-out and consequent recruitment issues in NHS dental services. The BDA is right to say that marginal changes will not sort out the problem. I am pleased that the Chair of the Select Committee is on board on that.

First, fundamental reform of the contract is needed. Despite discussions between the BDA and NHS England, the fact remains that unless there is a substantive and substantial change to the contract, matters will continue to deteriorate. Second is the question of resources. It will take up to half a billion pounds annually to restore the funding of NHS dental services to 2010 levels. After a decade of attrition, that is the situation. In real terms, net Government spending on NHS dental services was cut by a quarter between 2010 and 2020. Again, I am not finger-pointing; it is just something that we have to factor in as we try to resolve the problem. Of course, as has been mentioned, the question of prevention has a crucial role to play, as it always does in health services. That, too, must be a priority for the Government.

Having heard what hon. Members, the British Dental Association and the NHS Confederation have said, and what constituents in their droves are telling us, I really hope that the Minister will take action and get to grips with this major problem with provision in this crucial part of the NHS. I started with the issue of progress being made. The question is: can we really say that we have made sufficient progress after three Backbench Business debates? Alas, at this stage, I do not think that we have done.