NHS Staffing Levels

Rachael Maskell Excerpts

Tuesday 22nd November 2022 Westminster Hall

[Margaret Greenwood]

The hon. Lady makes an incredibly important point. There can be no more poignant and devastating example of what this crisis is leading to.

The Health and Care Act is a privatising piece of legislation that opens the door to private companies having a greater say in the delivery of health care. Guidance by NHS England, while the Act was going through Parliament, stated that it would enable integrated care boards to delegate functions to providers, including devolving budgets to provider collaboratives. Provider collaboratives are partnership arrangements involving at least two trusts, and they can include representation from the private or independent sector.

As we now know, the delegation of commissioning from ICBs to provider collaboratives will definitely go ahead. That represents not only the opportunity for the privatisation of the NHS, but clearly has implications for NHS staff. I am concerned that a situation may well arise where a provider collaborative decides to commission services from the private sector, instead of from the NHS provider that is currently delivering the service. In that instance, NHS staff may well find that their jobs are lost from the NHS, and that equivalent work is available only in the private sector, on poorer pay and conditions of service.

The Health and Care Act, which was passed by the Conservative Government earlier this year, has the potential to undermine national collective bargaining, and the pay and terms and conditions of NHS staff. It also undermines the concept of the NHS as a publicly owned organisation that has served us so well since 1948. The Act prohibits the chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions, if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service, because of the candidate’s involvement with the private healthcare sector or otherwise. However, that is clearly open to interpretation. It by no means rules out people with interests in private healthcare from sitting on those sub-committees.

If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government did not legislate for that, despite an amendment in my name calling for it, which had cross-party support.

Private companies can also have influence through integrated care partnerships, which are required to prepare a strategy setting out how the assessed needs of its area are to be met. ICBs must have regard to a strategy drawn up by an ICP, which I am concerned might be influenced by private companies. Of course, the responsibility of a private company is to make money for shareholders; it is not to support a publicly owned, publicly run national health service.

Other provisions in the Act also have serious implications for staff. The Act allows for a profession that is currently regulated to be removed from statutory regulation. That is deeply concerning. Once a profession is deregulated, we can expect the level of expertise in that field to decline over time, alongside the status and pay of those carrying out those important roles. Deregulation also brings with it serious long-term implications for the health and safety of patients.

The Act also provides for the revoking of the national tariff and its replacement with a new NHS payment scheme. Engagement on the NHS payment scheme is still under way, with a statutory consultation due to begin shortly. I have long been concerned that, given the requirement in the Act for NHS England to consult with each relevant provider before publishing the NHS payment scheme, including private providers, this may well be a mechanism through which the Government will give private health companies the opportunity to undercut the NHS. If that happens, I believe that one of the inevitable outcomes would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector.

In that event, NHS staff may then find themselves forced out of jobs that are currently on “Agenda for Change” rates of pay, pensions and other terms and conditions, with only private-sector jobs with potentially lesser pay and conditions available for them to apply for if they wish to continue working in the health service. Just like the provision around provider collaboratives, that would appear to hold risk for NHS staff and their pay and conditions. As such, I would be grateful if the Minister will guarantee that the pay rates of “Agenda for Change”, pensions, and other terms and conditions of all eligible current NHS staff will not be undermined as a result of the adoption of the NHS payment scheme. Can he also confirm that trade unions, staff representative bodies and all the royal colleges will be consulted before the NHS payment scheme is published, as Ministers in the other place assured us during the passage of the Act?

I understand that the Government are to publish a comprehensive NHS workforce plan next year, including independently verified workforce forecasts of the number of doctors, nurses and other professionals we will need in five, 10 and 15 years’ time. Such a plan is long overdue, so can the Minister provide some further details about when we will see it? Will that plan also include details of the numbers of staff we will need in the social care sector, where there is also a workforce crisis that is intricately linked to that in the NHS? Will the Minister set out what measures he is taking to address the staffing crisis this winter?

[Rachael Maskell (York Central) (Lab/Co-op)]

The reality is that today, we are training NHS professionals in the same professional silos as we did 100 years ago. Medicine has moved on massively, so in light of the fact that a new workforce plan is being drawn up, is it not right that those professions are revisited to ensure we have a workforce fit for the future, as opposed to doing things just because we have done them for so many years?

[Margaret Greenwood]

As ever, my hon. Friend makes an interesting and detailed point born of her experience. The Minister should take note.

To conclude, since 2010, Conservative Governments have let the crisis in NHS staffing develop. Instead of doing the important business of Government and bringing forward a timely workforce plan and a properly funded training regime, they have focused their energy on not one, but two, major reorganisations of the national health service designed to open it up to privatisation. Instead of tending to the needs of the workforce and the needs of patients, they have been priming the pump for shareholders. The NHS must remain a comprehensive universal service, publicly owned, paid for through direct taxation and free at the point of use for all who need it. That very concept is under threat: it has been reported this week that NHS leaders in Scotland have discussed abandoning the founding principles of the NHS by having the wealthy pay for treatment, thus creating a two-tier system. Not only would that be a betrayal of its founding principles, but it would also bring in costly administrative processes that are not currently needed, as patients would need to be means-tested.

The NHS is also under threat from this Conservative Government’s failure to get a grip on the staffing crisis, and from their privatisation agenda. This attack on the fundamental principles of a comprehensive, universal, publicly owned national health service, free to all who need it and paid for through direct taxation, has left patients neglected and staff overworked and underpaid. Patients, the NHS, and all who work in the service deserve better. The Government must come forward as a matter of urgency with a credible plan to put things right for NHS staff and set out how they are going to deal with the crisis this winter, and Ministers must give NHS workers a fair pay rise, protect NHS services, and ensure staff safety.

--- Later in debate ---

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to speak under your stewardship, Mr Hollobone. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for initiating the debate.

Where do I begin on this subject? It is difficult to know because Members have brought forward a plethora of information, but I will start with the House of Commons Library briefing, which is always a good source of information, and its research is based on independent sources. It says that the Health and Social Care Committee has said:

“The National Health Service and the social care sector are facing the greatest workforce crisis in their history.”

The NHS, which is the best part of 80 years old, is facing the worst crisis in its history, with a vacancy rate of 9.7%, which is 132,139 members of staff.

There is significant shortfall in staff across the piece. The hon. Member for Westmorland and Lonsdale (Tim Farron) talked about vacancies in pharmacy, dentistry, radiology, podiatry, ambulance staff, back-office staff—as those people who are at the heart of the service and keep it going are disparagingly called—cleaners and porters. Everybody says the whole NHS is under huge stress.

[Rachael Maskell]

I want to highlight the neuroradiology profession and the reality that staff shortages have an impact on clinical outcomes. Hardly any of our NHS trusts have neuroradiologists, but they could save 9,000 lives lost to strokes by being able to advance new techniques. Does my hon. Friend agree that it is important to look at the clinical outcomes that health professionals could bring?

[Peter Dowd]

My hon. Friend is right: it is crucial that we do that. A whole range of issues are beginning to affect staffing. For example, there is a £9 billion maintenance backlog in the NHS. Patients are being treated in hospitals that are not, in certain situations, fit for purpose and, importantly, staff have to work in those environments. In many cases, radiology equipment is not up to date, so staff and patients are either working or being treated in an environment in which the conditions and the equipment are not good. That goes to the heart of the staffing crisis as well.

There are lots of suggestions about how the Government could get to grips with the situation. Community Pharmacy England has plans to “resolve the funding squeeze”, which seems pretty straightforward, to

“tackle regulatory and other burdens”

that are affecting staffing, to

“help pharmacies to expand their role in primary care”

and to

“commission a Pharmacy First service”.

All those things go to the heart of enabling staff to feel wanted and that they are working in an environment where they are treated properly.

Of course, we then get people leaving in droves because of pay. I looked at some of the figures in relation to the pay restraint that we have had for the past few years: since the Government came to power in 2010, for all intents and purposes there has been either no pay increase or an increase of 1% here and 2% there.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 1st November 2022 Commons Chamber

[Steve Barclay]

Alongside the Government, no one wants to see better patient outcomes more than GPs themselves. By their training, they are evidence-led, so I look forward to discussing with the GP workforce how we can work together in a constructive spirit to deliver on whatever the evidence is showing. As I said, there is a body of evidence around continuity of care, but it is more weighted towards those with more complex needs, and not every patient prioritises that in terms of access to their GP.

[Rachael Maskell (York Central) (Lab/Co-op)]

The Health and Social Care Committee report showed that continuity of care was best for patient safety, which is so important, but in order to deliver that, there needs to be some headroom at practice level to bring about a reorientation of local services. How will the Secretary of State create that headroom, and will he adopt the report’s findings in full?

[Steve Barclay]

I know that the hon. Lady has a lot of expertise in this area, and she raises a valid and important point. That is why, through the GP contract framework for 2020-21, we announced a number of new national retention schemes and continued support for existing schemes to retain more GPs. It is also why, at the other end, we are boosting training numbers, to get more GPs into the pipeline.

NHS Dentistry

Rachael Maskell Excerpts

Thursday 20th October 2022 Commons Chamber

[Peter Dowd]

That is a point well made. Another factor is that there are deep inequalities in access to dentistry. In my constituency, it is difficult to get to see an NHS dentist for love or money. I am not blaming the dentists; they are doing a fantastic job in the circumstances. They are going over and above their duty. I put on the record my thanks—as I am sure we all would—to my dentist practice, which I have been with for over 45 years. Dentists are doing a fantastic job, but they have both their hands tied behind their back at the moment. That has to change.

Some 91% of people, including 80% of children, are not able to access a dentist, and 75% of dentists are reducing their NHS engagement. The new contract announced before the summer did not really do anything and there was no new money with it. There is a significant gap—potentially as much as £750 million—in the resources that dentists need.

Another aspect is dentists’ morale, with 87% having experienced stress, burnout or depression in the last 12 months. That is a dreadful situation to put a committed profession in. We have a scenario in our country in which dentists who trained for seven or eight years—possibly more—and practised for many years are now getting to the stage where the majority are stressed, burned out or depressed. That is dreadful. According to one study, half of them are considering changing career. Some of them are seeking early retirement or going fully private. They are getting stressed out because they just cannot move the dial. They are waiting for the Government to move it, but the Government are not moving it.

Children in my constituency are three times more likely to have their teeth extracted in a hospital because they do not have access to a dentist. My right hon. Friend the Member for Knowsley (Sir George Howarth) and the hon. Member for Bath referred to oral cancer. That is identified very early on—and who does the identification? Surprise: it is often the dentist. We need substantive support from the Government, not tinkering around with the contract. We need them to provide adequate funding.

Dentists must not be an afterthought. They are a vital component of the health of the nation. We must build on the historical commitment to prevention; that is key—as the saying goes, prevention is better than cure. Dentists have had enough; they are under pressure. My constituents have had enough; they are under pressure. The Government have to do something about it.

In the debate before the summer, I referred, in relation to the lack of substantive action by the Government, to a rejigging of what Ian Fleming said about crisis: if once is happenstance and twice is coincidence, three times is friendly fire and four times is enemy action. We are now in a situation where the Government are perceived as the enemy because of their lack of action.

[Rachael Maskell (York Central) (Lab/Co-op)]

I apologise that I was not able to be here for the whole debate; I have been in a Bill Committee. In York, people have to wait six years to see a dentist. Of course that is completely unacceptable, but my real concern is that, with the transition of dental services into integrated care systems, ICSs will not have the powers—the levers—to make the difference on training, funding and the contract and, ultimately, dentistry will be pushed into a tug of war between ICSs and the Government.

[Peter Dowd]

I am glad that my hon. Friend raised that matter because it is something that I was going to raise. The health service, because of the reorganisation, is in an element of flux. It is feeling under a bit of pressure. Potentially, people are having to reapply for jobs in the broader sense in the NHS because of the reorganisation. That is a fact. I am not sure whether we should be having a reorganisation of the NHS in the post-covid environment, but that is a different argument for a different day. The broader dissonance in the system now multiplies the problems that we are having in dental practices, because they are getting pushed further away, which is why practices need representation on these boards. I am glad that my hon. Friend highlighted that point.

As I said in the debate before the summer, we do not want any more excuses from the Government. We do not want any more prevarication, any more procrastination, any more pretext or any more self-exoneration. I hope the Government and the Minister, whom I welcome to his place, really get the sense of the frustration and, in certain situations, anger in the Chamber today. They really must pull their finger out—if not people’s teeth.

Liver Disease and Liver Cancer: Diagnosis

Rachael Maskell Excerpts

Tuesday 11th October 2022 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this important debate, as well as on the important work that she and my hon. Friend the Member for Caerphilly (Wayne David) do with the APPG.

While there are multiple causes of liver disease, such as from viral hepatitis, obesity and alcohol, I particularly want to focus on alcohol. Successive Health Ministers will know that, over a period of time, I have consistently raised concerns about the absence of a comprehensive alcohol strategy. This afternoon we have heard only too clearly why that is so important. For too long, alcohol has been promoted as a social norm, and not to imbibe as an anomaly, yet the scale of alcohol harm, psychologically and physically, is off the radar. It is something that is causing me significant concern, whether it is used for pleasure or to address pain. It must become a priority of this Government.

In a city where I see more and more licensing of premises, I am aware of the impact and harm that that is having on livers. We see it in the statistics. My discussions with the British Liver Trust over the summer highlighted the fact that more and more people with liver harm were younger and sicker. Our excellent public health team in York says that it is their No. 1 concern. When we match that against the fact that 90% of liver harm is preventable, we realise that there must be a more comprehensive strategy. As the profile of those with liver disease changes, so must investment in prevention, diagnostics and disease management.

Astoundingly, since 2010 hospital admissions for liver disease have risen by a staggering 45%. NHS Humber and North Yorkshire ICS currently has no clinical pathway for the early detection of liver disease. I have written to express my concern, and the ICS tells me it will respond on 4 November.

There are many causes of liver disease and cancer, but prevention and early detection can make a significant difference to outcomes. In Yorkshire and the Humber, our pressurised NHS is seeing a 13% increase on the national average for admission rates due to liver disease, and rates are 38% higher for alcohol-related liver disease. In York, alcohol is a major factor in A&E attendance. For women in York, admissions due to liver disease are 30% higher than the national average. As we focus on York being a drinking capital, we have to look at those correlations.

Over the covid period, many people turned to alcohol as a means of addressing other needs. When so many people are dying from alcohol-related disease, the Government must turn their attention to that matter—not least because we know the impact it has on the most deprived communities, as we have heard. In York, the mortality differential is 10 years between the most deprived communities and the wealthiest. One in four with alcohol-related liver disease will die in hospital within 60 days of detection.

I know from working on a ward specialising in hepatology how important this subject is, but also how tragic it is for families. That is why I urge the Government to focus attention on this public health matter in a way akin to Dame Carol Black’s work on drug-abuse harms. There were 4,859 drug deaths in 2021. I am not belittling that statistic at all, but the fact that there are 10,000 liver deaths—over double—really demands the Government’s attention and a strategy. However, there is none in place.

That is why the Minister has a unique opportunity—one that she must take hold of. Ministers can turn their attention to so many things, but getting on top of this issue, driving a strategy that makes that difference and ensuring that every community has a diagnostic centre, as York longs to, could make a serious difference to our communities and our nation. I trust that she will embark on an alcohol strategy and ensure that there are community diagnostic centres, that alcohol harm is properly addressed and focused on, and that we also understand and focus on non-alcohol related fatty liver disease. We have an opportunity to double down on tackling liver disease, and I trust that this Government will not let this moment pass.

[Mr Clive Betts (in the Chair)]

To co-operate with the timing, we head to the Front Benches, with five minutes for the Opposition, 10 minutes for the Minister and a couple of minutes at the end for the mover to wind up.

Urgent and Emergency Care

Rachael Maskell Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

I am happy to join my hon. Friend in thanking the paramedics in Medway, in Maidstone and beyond for all their fantastic work, especially given the pressures the system has been under during the summer. As for levelling up, a number of Members have raised with me the need to ensure that developers are making a sufficient contribution as part of their housing plans, and I shall be happy to draw that to the attention of my colleagues in the Department for Levelling Up, Housing and Communities.

[Rachael Maskell (York Central) (Lab/Co-op)]

The Secretary of State is right to talk about the back door rather than focusing on the front door when it comes to the crisis in social care. About a quarter of the patients in our hospital in York are experiencing delayed discharges. However, if we do not pay care staff, we will never resolve the issue. What consideration has the Secretary of State given to putting those staff on a national pay scale, using “Agenda for Change” as a model?

[Steve Barclay]

This obviously involves debates with Treasury colleagues about pay—not just on the social care side, but in respect of the NHS and the interplay with pensions—but it is not just about that; it is also about ensuring that we have the right data, and through the integrated care systems we are acquiring much better data to improve our ability to join up what is being spent on delayed discharge within the NHS with what is being done in the social care setting. I am sure Members will agree that not only is it often very damaging for frail elderly patients to spend a long time in hospital, but hospital is usually the most expensive place in the system for them to be. It is not just a question of having more money, although that is often the default; it is a question of thinking about how to get flow into the system in a way that will deliver not only patient care, but a more efficient service.

Ambulance Pressures

Rachael Maskell Excerpts

Monday 18th July 2022 Commons Chamber

[Steve Barclay]

My right hon. Friend, partly through the direct experience he brings to these issues, highlights the integrated nature of the challenge we face and in particular the importance of getting the right domiciliary care and care home support in place. Part of that challenge in the coming weeks, ahead of any autumn and winter pressure, will be to understand what the capacity is and what the constraints on it are, so that through the integrated care boards we can better focus on unlocking that capacity to relieve the pressure on ambulance handovers, as he sets out.

[Rachael Maskell (York Central) (Lab/Co-op)]

Older and more vulnerable patients can become medically compromised very quickly in extreme heat. In Yorkshire, category 1 calls can be waiting for 9.5 minutes over the expected time, category 2 calls can be waiting for 18 minutes over, and those with other medical conditions can be waiting 2 hours 41 minutes over. People clearly need support and assessment far earlier. What is the Secretary of State doing to deploy first responders in such areas so that people can get a medical assessment and early intervention far quicker?

[Steve Barclay]

I broadly agree with the hon. Lady on providing targeted support, particularly to those in domiciliary care; we are working with those in primary care on that. In coming days, that will happen specifically through local resilience forums, but in the medium term it will be more through the integrated care boards. That is part of a wider package of support measures that need to be put in place. It will include working with primary care, looking at mental health support, and looking at what can be done to raise productivity through better use of innovation and technology. We will look at all the interventions available across the board to assist us in dealing with the pressures that she highlights.

Ambulance and Emergency Department Waiting Times

Rachael Maskell Excerpts

Wednesday 6th July 2022 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to see you in the Chair, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this debate, which we all, across the House, recognise is needed, as are the solutions.

The issues in York are no different from those that I have heard about today from Members of all parties. We know the diagnosis of what is wrong: we do not have the staffing or the capacity and our hospitals are running hot the whole time. In York, we have been in OPEL 4—that is the operational pressures escalation level—for a considerable amount of time. We are all wrestling with sufficiency in the ambulance service.

The statistics I have heard this morning map on to many of the statistics in York. In May, handover took more than an hour in 752 cases—24.6% of arrivals—and then there are the trolley waits for hours on end. The mean waiting time for non-admitted patients was four hours and 18 minutes in A&E, while for admissions it was nine hours and 22 minutes. There are then the challenges on the wards as patients progress through their journey. We know that there are challenges across the system, but receiving timely emergency care is the most important thing and what we are focusing on today.

Before proposing a couple of solutions to the Minister, I want to reflect on the impact that this situation is having on staffing. We have heard about the need for a workforce plan, which is crucial, but retaining staff is important too. Many people are leaving because the pressures are bearing too heavily on them. Working long hours is one thing—it is almost a social contract that people have to acknowledge, wrongly, I say, as part of working in the service, in either an emergency department or an ambulance service—but on top of that there is the trauma that people face. We cannot describe the impact that has on individuals.

What hurts the most is hearing the radio and knowing that there is another call, another person, another life that could be saved, but being tied down and unable to reach that call, or turning up incredibly late to see a patient, knowing that the life chances of that person in your hands have been changed because of the minutes or even hours of delay. Those are the pressures that bear down on our incredible NHS staff, making the job intolerable and eventually breaking them.

We have to look specifically at what we are doing for staff so that they can carry on with their jobs. Some 69% of emergency responders said that their mental health deteriorated during the pandemic, while just 26% described their mental health as good or very good. We know about the impact this situation is having on people day in, day out, while working those long hours. It is unsustainable. We are seeing that in the retention rates. My plea to the Minister is to introduce a good mental health support programme for staff to maintain that sufficiency. That means fixing the system as well; we cannot have one without the other.

I want to pick up on something I am very mindful of, having spent time talking to paramedics. A constituent contacted me about the poor mental health of their patients, its increased acuity and the impact of that on the service. I have met a group of campaigners who are calling for a specific mental health service with a specific phone number—instead of people having to call 999 or 111—through which people can be triaged by mental health experts and put in the right place in the service. It is about building a proper acute mental health service around people, because A&E may not be the right place for them, yet where else can we take them? It is important not only to look at the whole clinical pathway for people in crisis but to ensure that paramedics can focus on and spend their time on people with acute physical illness. I would like the Minister to reflect on the opportunity that that could bring.

In the short amount of time I have left, I want to touch on an issue in Germany, where they are doing medical thrombectomies in ambulances at the side of the road, as opposed to losing precious time taking people to A&E departments. We can do a lot more to reformulate the way our acute services work to take medicine to the patient, as opposed to taking the patient to hospital. [Interruption.] The Minister is nodding, so I will stop there but I look forward to his response.

Draft Mental Health Bill

Rachael Maskell Excerpts

Monday 27th June 2022 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op)]

I welcome the Bill. The acuteness of people’s mental health challenges while in the community is escalating before appropriate intervention is taken. How will the Bill ensure that earlier interventions are made, so that people do not have to go into secure accommodation for their safety?

[Sajid Javid]

Once the Bill is law, it will require the use of secure accommodation to be limited to those who absolutely need to be detained, either for their protection or for the protection of others. Alongside the Bill, we need to make sure that the right resources are there. I mentioned earlier the extra resources that are going in, to a record level, including today’s announcement of the £150 million.

NHS Dentistry in England

Rachael Maskell Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for St Ives (Derek Thomas) for opening the debate and making many of the points that I intended to make. The simple fact is that we do not have time for further delay. We have four and half weeks left until the summer recess, and our constituents want answers. They want answers because they need to see a dentist but they are experiencing the deficit of NHS dentistry across the country. I would add to the list of areas mentioned that Yorkshire is also deeply affected, and my city, York, is struggling.

In 2009, Labour committed to reform the dental contract, realising that it was not going to deliver what it aspired to. The coalition Government followed in 2010 with a similar commitment, yet here we are in 2022 still making the same argument that we desperately need reform. As has already been said, this is not just something that has emerged through the pandemic; it is an issue that predates us. That is why it is essential that we have a pathway from today showing how we are going to move out of the crisis. Our constituents deserve to know what the Government’s agenda is.

Two years ago, NHS dentistry fell by 13%. Since covid-19 there has been a mass exodus in my city of York, but I realise that has also occurred across the country. Last April, NHS dentistry fell by a further 19%. It is believed that since the start of the pandemic, NHS commitments have fallen by 45%. Next year, 75% of dentists are planning to make changes and reduce their NHS commitments. Of those, some 45% say they will go fully private and 47% say they will change career or take early retirement, so if we wait another 12 months we will be in a deeper mess than we are now.

Since the start of the pandemic, we have lost 43 million dental appointments, 30 million of which were for children. In my constituency, 41% of children have not seen a dentist in the last year—they are the children who are now presenting in more acute services, requiring even more expensive interventions.

To put the situation in York into context, 9,695 UDAs were delivered in March 2021, at a time when 45% of UDAs needed to be delivered. A year later, in April 2022, 8,730 UDAs were delivered, fewer than the year before, and yet the requirement was for 95% of UDAs to be delivered. Instead of the number of my constituents accessing NHS dentistry going up when the number of UDAs that were expected to be delivered more than doubled, it has gone down. With 965 fewer UDAs, despite a doubling of the expectation, will the Minister explain how my constituents are meant to get access to services?

Fewer than half my constituents have seen a dentist in the last year. Of course, dentists have offered them private dental plans but my constituents simply cannot afford that, not least because of the cost of living crisis and the housing crisis in my city. Some travel long distances and others get nothing at all, and we know about other health inequalities that are similarly embedded.

[Sir John Hayes]

It is the least well-off people who suffer most, as the hon. Lady rightly said. Working-class people cannot afford these expensive plans. Surely the answer is that we should train more of our own dentists and make it more attractive to work for the NHS, rather than go private. My own dentist is Turkish by origin. He is a fine NHS dentist, and I could not speak more highly of him, but we cannot simply import dentists; we need to train more.

[Rachael Maskell]

The right hon. Member is absolutely right that we have to train more dentists. One reason for that is that it takes about 10 years for somebody to be fully professionally competent and able to provide the highest level of dentistry. We must not look just at what is happening now, but into the future too.

Before we get to that point, we have to look at retention and at bringing people back from private contracts and services into NHS contracts. With fewer dentists available, the toll and the mental stress felt by those who have stayed in the NHS and remained committed to it is building. Some 87% of dentists experience mental stress, and 86% have experienced abuse as a result of people being so frustrated by the time they reach the dentist’s door. The people working in dental reception areas are at the forefront of that, and I know of a practice in York that cannot recruit anyone to be on the front desk. We need significant changes to be brought forward, and that will require money and dedication.

It is not just about the contract; it is also about having a complete strategy around dentistry. I have never understood why oral health was taken outside the wider NHS, and I believe that the solution to the problems we face is to have a proper NHS dental strategy and to put the NHS dental service back into the heart of the NHS. However, while we are working on those issues, we have to look at the crisis before us.

In Parliament last week I mentioned a practice that has been fantastic at accommodating people with dental needs throughout the pandemic. I said that three dentists were leaving that practice; I was wrong—it is now four. That is the pace of people leaving the profession. We have heard about the wider consequences for oral health, and particularly oral cancers, for which a delayed diagnosis means the worst prognosis. Therefore, it is absolutely right that we see a move on this issue.

I want to raise a couple of issues about dentists waiting to come to the UK. We know that 700 dentists are waiting to sit exams. The Government have had a consultation, which has closed, and we are awaiting a response. I am sure everybody in the House would want to accelerate legislation on that, but we need to know the Government’s plan. I hope the Minister will be able to tell us about that today.

However, 700 dentists will not fill the gap. Just last week, I was speaking to Ukrainians who have come to the UK. They want to work, they want to put their skills into practice and they want to have fast-track English language training so that they are competent in terms of their language skills. They want to see their qualifications passported, so that they can get to work and practise their profession. They do not want to deskill or de-professionalise. They want to learn the clinical language that they will require, and therefore to shadow dentists getting ready for practice. However, I have not seen a strategy from the Government on how we will work with refugees who have those skills and can put them to work. Perhaps the Minister will share that in her closing remarks, because it seems such a waste of talent when many refugees absolutely want to address that local need but cannot do so.

I turn now to the future training of dentists—a point raised by the hon. Member for St Ives. I have had discussions with Hull York Medical School, which is a fabulous partnership between the two cities, and it would be prepared to help support a dental school. Of course, that would need investment, so we need proper investment for the future. To look at how that would work, I spoke to the commissioners, and there certainly is an appetite in our city to host such a school in the future. That would be helpful in bringing dentists onstream, but we also must recognise that students currently in training are struggling to get placements in the NHS. Of course, the more dentists who leave, the harder it will be to train the current cohort. Unless we see a quick increase in the number of NHS dentists, we will be in even more difficulty. That is why the urgency is there now. We must build back an NHS service for the future to ensure that we have those professionals in place.

Finally, we know that integrated care systems will be taking over the commissioning of dental services next year. My concern is that Government are waiting for that moment to act. We must see action now, because the integrated care systems will not be able to solve a problem that the national Government won’t.

--- Later in debate ---

[Maria Caulfield]

Absolutely. The whole point of the ICSs is that the commissioning service has not worked up until now. Some commissioners are very good at commissioning dental services, while others do not have anyone with dental experience on their boards and are not so good. ICSs will be accountable, which is the difference from what we have now. I will meet ICSs to ensure that they understand the responsibilities.

[Rachael Maskell]

rose—

[Maria Caulfield]

I will take one last intervention, because I am conscious of the time.

[Rachael Maskell]

I am grateful to the Minister for giving way. When I wrote to her, she kindly replied and said that York could well be one of the areas for a centre of dental development. I would like to know the timescale for such considerations, and what progress has been made since our correspondence.

[Maria Caulfield]

I met Health Education England this morning and we are working through that system. I will be able to update the hon. Lady shortly, because I am keen that we make progress.

A number of Members mentioned prevention. The Health and Care Act 2022 includes provisions relating to fluoridation as standard, and we are working to make progress since it became law recently. We are also working with education colleagues on supervised toothbrushing. As we speak, some of the 75 family hubs that are being set up in the most deprived parts of the country as part of the Start4Life programme are looking at initiatives such as supervised toothbrushing. Where it is not happening at home or where parents need more support, we are ensuring that children are getting that toothbrushing experience.

On the subject of upskilling dental teams, this is about more than just dentists. My hon. Friend the Member for St Ives (Derek Thomas) made the key point that it is about the whole team. At the moment, part of the contract means that only dentists can do certain work. We need to change that. Centres for dental development will be about not just training dentists but upskilling whole teams.

I hope that I have reassured Members from across the House that we are taking this issue extremely seriously. To answer the question put by my hon. Friend the Member for St Ives, the contract changes that we are going to announce will not be the end of it, because there is more reform that we need to do. The Secretary of State is looking at a wider piece of work to provide a long-term, sustainable solution. We are happy to work with the other three nations if they have suggestions and solutions. We are not precious about sharing best practice.

I say to the shadow Minister, the hon. Member for Enfield North, that it would be good if she could come to a dental debate with some suggestions and solutions, rather than constantly criticising. We are determined to solve this issue and I appreciate the urgency that every single one of my colleagues has expressed today.

[Rachael Maskell]

I raised the issue of Ukrainian refugees. The Minister seemed to indicate that she had a response, so could she provide it before she closes?

[Maria Caulfield]

The response is that every overseas dentist, apart from those in the European economic area, currently has to take the overseas registration exam, and that is without exception. That is the work that we are trying to do with the General Dental Council. We are enabling those from Ukraine or Afghanistan, or any refugee from any country, to take part in that process. I am very keen to see mutual recognition with some countries. We are working on that and will enable the legislation to make it happen, but it will be for the regulator to decide; it is not a Government decision.

I hope that I have reassured colleagues that we are on this and appreciate the urgency. I have no doubt that we will return to this Chamber to debate this matter further in the coming weeks and months.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 19th April 2022 Commons Chamber

[Sajid Javid]

Like many across the House I have been deeply disturbed by the reports we have all seen from Shanghai and my thoughts are with the people affected. It shows what a dangerous fallacy this whole idea of zero covid was, and it also shows that we are the most open country in Europe and that we have got the big decisions right. We did not listen to the Opposition when they said we should not open up in the summer, and we did not listen to them when they again called for restrictions in the winter. We are showing the world how to live with covid.

[Rachael Maskell (York Central) (Lab/Co-op)]

T3. My constituents have been forced on to private and unaffordable dental plans or they have to wait up to five years to see an NHS dentist. The situation is getting worse and worse, so I met with the groundbreaking Hull York Medical School to see if it can assist in training a future generation of dentists and it is keen to help; what is the Minister doing to work with medical schools?

[Several hon. Members rose—]