Community Pharmacies: Devon and the South-west

Richard Foord Excerpts

Tuesday 17th December 2024 Westminster Hall

[Richard Foord (Honiton and Sidmouth) (LD)]

It is an honour to serve under your chairship, Mr Betts. Growing up, people used to talk about going to the chemist, and at the time I saw that alongside going to the butcher or shoe shop—it was where we went to buy stuff. What I did not realise was how crucial pharmacies are to prescriptions and thus to people’s health and wellbeing, and I am ever so aware of that now that I represent a constituency in Devon.

Under the previous Government, in the last two years alone, Devon has seen the closure of nine pharmacies, leaving the county with just 133. For the people I represent in Honiton and Sidmouth, that translates to just 16 pharmacies per 100,000 people—even fewer than in West Dorset. That is partly because income for pharmacies has stagnated, particularly what they receive from the NHS, and that is combined with rising costs, including energy bills and wages, as well as the cost of medication. Altogether, it makes for an unsustainable financial model. Yet pharmacies provide over 1.3 million consultations each week for people’s health concerns, which is keeping people out of the NHS and saving 38 million GP appointments every year. Just last month, a pharmacist in Devon noted that his team spends over two hours per day providing free, unfunded clinical consultations, and those prevent health conditions from deteriorating, and prevent hospital visits and additional strain on the NHS.

[Edward Morello]

My hon. Friend raises a very important point: under the current funding model, pharmacists are reimbursed only if the consultation results in a prescription being issued. That results in a medicalisation of the process, which means that pharmacists are less likely to provide other sorts of solutions, such as community care. Does my hon. Friend agree that the model is fundamentally flawed and creates a medicalisation issue?

[Richard Foord]

It is flawed, particularly for those parts of the country that are rural and coastal, such as those represented by my hon. Friend and myself. In Honiton and Sidmouth, the average age of my constituents is 56. I went to a meeting of the all-party parliamentary group on ageing and older people last week, and we hosted Sir Chris Whitty, the chief medical officer for England. He described how, while in some societies people move away from the coast and rural areas to seek comfort and care in towns and cities, in England we do quite the reverse. That makes it even more crucial that we maintain our pharmacies in those rural and coastal communities.

In short, we are calling for the Government to provide funding to halt the closures and stabilise the sector, ensuring that rural communities such as those in Devon are not left behind. We want to see the role of pharmacists expanded to give them greater prescribing rights and allow them to take on bigger public health responsibilities.

[Lloyd Hatton (South Dorset) (Lab)]

It is really important that we widen the discussion to talk about not only stemming the loss of pharmacies, but how we can put pharmacies back. In the south-west, community hospitals would act as an excellent venue for them. Does the hon. Member agree that we should be looking at community hospitals as a potential venue for new pharmacies, so that they are a bit of a one-stop shop where people can access healthcare and advice?

[Richard Foord]

I think the hon. Gentleman has come up with an absolutely brilliant idea. Community hospitals are potentially hubs where pharmacies might sit in the future. I pay tribute to my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this debate; she has done a great thing by doing so.

[Mr Clive Betts (in the Chair)]

We now move on to the Front Benchers. The two Opposition spokespeople have no more than five minutes, and then the Minister will probably have about 10 minutes left.

Oral Answers to Questions

Richard Foord Excerpts

Tuesday 19th November 2024 Commons Chamber

[Andrew Gwynne]

My hon. Friend raises a real issue about how we join up the whole of the patient journey. Once diagnosed, patients need appropriate treatment and wraparound care. I am more than happy to meet him and his constituent.

[Richard Foord (Honiton and Sidmouth) (LD)]

At the weekend in Devon, I met a psychiatric nurse who previously worked in London and has been recruited to the south-west. She does not have a start date, and is still subject to routine checks after waiting months. Can the Secretary of State expedite these routine checks, given waiting lists for mental health?

[Wes Streeting]

Absolutely. That is a good example of why investment needs to be matched with reform to speed things up, improve productivity and get staff to the frontline, where they want to be.

NHS Dentistry: South-west

Richard Foord Excerpts

Tuesday 12th November 2024 Westminster Hall

[Richard Foord (Honiton and Sidmouth) (LD)]

I beg to move,

That this House has considered NHS dentistry in the South West.

It is a pleasure to serve under your chairship, Mr Vickers. I am grateful to the Chairman of Ways and Means to have been granted a debate on NHS dentistry in the south-west of England, which has particular problems.

I know that the new Minister will have encountered enough problems with NHS dentistry as it is, but the south-west is a special case. To illustrate: if we were to go back to 2015, 51% of adults in the south-west could see a dentist. That was also the case across England at the time, with 51% of patients who wished to see an NHS dentist having access to one. By 2024, however, that figure has declined sharply. Now, the current average across England is 40%, and in the south-west it is just 34%.

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

I thank my hon. Friend for securing this important debate. In Somerset, the percentage of adults who have seen a dentist has dropped by 20% over the past decade. Does my hon. Friend agree with me that we should guarantee access to an NHS dentist for everyone needing urgent and emergency care?

[Richard Foord]

That is exactly what is needed for urgent and emergency care. My hon. Friend draws attention to Somerset; the situation is bleak in Devon too. In Devon in 2015, 55% of adults were able to see a dentist, but that has since dropped to just 37% today.

I have had so much correspondence from my constituents on this subject, and the decline, as I see it, is a direct result of 14 years of Conservative neglect of our health services and of NHS dentistry in particular. I find it really troubling that the situation is affecting people in some of the most vulnerable categories, such as older people and children,

Children in Devon are missing out on crucial dental check-ups. Once upon a time, they used to have check-ups twice a year; now, it is not possible for children to be registered for NHS dentistry in many dental practices. It is therefore no surprise that tooth decay is now the leading cause of hospital admissions for five to nine-year-olds in the country. I talked to one primary school and was told that pupils are going to hospital in Bristol to have their teeth removed—often between four and 10 teeth at a time. The number of NHS dentists in Devon has dropped from 549 to 497, so the reality is that NHS dentistry is simply no longer available for all.

[Perran Moon (Camborne and Redruth) (Lab)]

I entirely accept the points that have been made about Devon and Somerset. In Camborne, Redruth and Hayle, we have some of the most deprived areas in the country. I have met people who have chosen to access dental care privately at the expense of heating their homes or eating food. This is where we are today: we are in a dental emergency across the south-west, and in Cornwall, the situation is now critical. Does the hon. Gentleman agree that we cannot wait any longer for emergency dental care across the south-west?

[Richard Foord]

The hon. Gentleman is right. We want to move NHS treatment back into primary care and away from the most critical acute care, yet it seems to me that primary care services are moving in the other direction.

[Wera Hobhouse (Bath) (LD)]

Royal United hospitals in Bath saw nearly 260 people last year with serious dental issues such as abscesses, largely because those people could not get a preventive care appointment from a dentist in their community, forcing them to go to A&E. Does my hon. Friend agree that a lack of NHS dentistry drives up costs because people go to A&E when it should only be there for emergency cases?

[Richard Foord]

I agree that emergency care should not suddenly become the routine. It is there for the most critical cases, but we have not seen that, given the drying up of NHS dentistry provision in our towns and villages.

[Sarah Gibson (Chippenham) (LD)]

Does my hon. Friend not agree that part of the problem is that we are only talking about emergencies? The Secretary of State, in his first week in the job, talked about working hard to look at preventive medicine. That should apply to dentistry as well. Does my hon. Friend not agree that we need to look at a serious timeline for reviewing the dental contract? We cannot only talk about emergencies all the time.

[Richard Foord]

My hon. Friend makes an excellent point. Prevention is clearly cheaper than dealing with the problems down the line. There is no better example than offering check-ups for children’s dentistry.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

I find it absolutely shocking—I am sure my hon. Friend will agree—that the recommendations of a report published 15 years ago by the previous Health and Social Care Committee have still not been implemented.

[Richard Foord]

The hon. Member for Tiverton and Minehead has clearly done her homework. It is quite staggering that recommendations from that long ago are still not implemented.

[Caroline Voaden (South Devon) (LD)]

Lord Darzi said in his review of the NHS that

“urgent action is needed to develop a contract that balances activity and prevention, is attractive to dentists and rewards those dentists who practise in less served areas”

such as mine in South Devon, where not a single dentist is taking on NHS patients any more. Would my hon. Friend agree that we urgently need a timeline for this work to be done?

[Richard Foord]

Yes, I think so. My hon. Friend is right to point to some of the recommendations in the Darzi report. I was encouraged to see reference to neighbourhood hubs, where perhaps we can have delivery of primary care, such as NHS dentistry, nearer to the constituents we represent.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for securing this debate. Does the hon. Member not agree that the story in the south-west is being replicated across all of the United Kingdom of Great Britain and Northern Ireland? He may not be aware of a survey of almost 300 dentists in Northern Ireland that found that almost nine in 10 intend to reduce or end their health service commitments in the coming year. That could be the end of NHS dentistry. Is he experiencing the same thing in the south-west? If he is, Government must really grasp this issue, and, as the hon. Member for South Devon (Caroline Voaden) said , get it done.

[Richard Foord]

I am glad that the hon. Member for Strangford made that point, because I did not know about the situation in Northern Ireland. It sounds like some regions of the UK are not getting the attention that they require when it comes to NHS dentistry.

I want to share the story of two of my constituents, Mike and Shirley. I have received correspondence from them and many other residents, such as Martin Loveridge, who has had a similar experience. Mike and Shirley are hard-working people. Mike is almost 75 and retired after more than 50 years in horticultural work. Shirley, aged nearly 70, is still taking on part-time cleaning work to make ends meet. In 2023, their dentist in Sidmouth finally went private, driven away by the broken dental contract that we have heard described. The impact of that shift has been devastating.

Shirley developed a dental abscess. Anyone who has had a dental abscess will know what excruciating pain it can involve. Years ago, Shirley suffered from a similar infection, which led to sepsis. This time, instead of receiving urgent care from the NHS, Shirley faced the following choice: either wait in pain or go private. Plainly, this incident is a stand-out case, given that it was crucial that she received NHS treatment for sepsis, but typically, it would cost them £1,200 in dental fees—a sum that is simply unaffordable for people in Mike and Shirley’s position. Mike has not seen a dentist since May 2022 because he simply cannot afford it. Mike and Shirley tried to get NHS dentistry—they went to NHS England, Healthwatch Devon and the complaints department of the Devon NHS—and they had people admitting to them the dire state of the system, but they were offered no real solution. They spent hours on “Find a dentist”, an NHS website just for that purpose, but they were referred to a clinic that was 80 miles away, an impossible journey for them.

[Max Wilkinson (Cheltenham) (LD)]

I thank my hon. Friend for securing this important debate. Cheltenham, similarly, is a dental desert. My residents often find themselves referred out of our region and into the midlands for treatment, to places as far away as Malvern, if they are not lucky enough to get somewhere in the constituency of the hon. Member for Gloucester (Alex McIntyre). Does my hon. Friend agree that that is simply wrong and unacceptable? Will he join me in thanking community campaigners in Gloucestershire, including Councillor Paul Hodgkinson, the health lead for the Lib Dems on Gloucestershire county council, who are trying to fight this at the local level?

[Richard Foord]

My hon. Friend is right to draw attention to community campaigners, but frankly it should not require grassroots organisations to self-organise and mobilise; as representatives and as Government, we should be able to provide that in this, the sixth richest economy in the world.

[Carla Denyer (Bristol Central) (Green)]

I thank the hon. Member for arranging this debate and for his forbearance on the incredible number of interventions. Does he agree that to solve this problem once and for all, and not just deal with the emergency situations that have been mentioned, the Government need to move towards a model similar to that for GPs, in which dentists are reimbursed for their work and rewarded for caring for patients and taking a more preventive approach?

[Richard Foord]

Dentists need to be rewarded under an NHS dental contract that recognises that not everyone has the same ability to pay. Frankly, if a little money were invested early in preventive measures, some of our constituents would not cost the system nearly so much later.

At a Westminster roundtable on dentistry last year, it was made plain that the issue was about not so much a shortage of dentists, but a need to attract private practising dentists to NHS work. Many dentists, even those who would ideally prefer to work within the NHS, avoid NHS work or leave it, because the current system is not fit for purpose.

On Remembrance Sunday, I was talking to a couple near the war memorial in Sidmouth. They were both veterans. Between them, they had served for 62 years, and they were unable to get NHS dental appointments. They felt that they had dedicated their lives to public service and this was how the state was rewarding them.

[Clive Jones (Wokingham) (LD)]

I thank my hon. Friend for securing this important debate. I am sure that the issues in the south-west are similar to, and as challenging as, those in Wokingham in Berkshire. Commons Library data states that only 32.6% of children in Wokingham have seen a dentist in the past two years, compared with a 40.3% figure for the whole of England. Both figures show the Conservative party legacy of rotten teeth, fillings and agony. Arborfield and Swallowfield in my constituency are without dedicated dentists. That simply is not good enough. Does he agree that NHS primary care needs to be properly funded?

[Richard Foord]

I am appalled to hear about those examples from my hon. Friend. The really disappointing thing is that some of the expense of secondary care could be avoided with a little more investment upstream in primary care.

There is a clear disparity between the work that dentists do in the NHS and in private practice. There is so much more emphasis in private practice on preventive care. We need to see that same level of preventive work happening in the NHS.

At an Adjournment debate last week in the main Chamber, it struck me that although many of us were there seeking to draw attention to NHS dentistry, not a single Conservative MP attended. I thank the Minister in the new Government for showing more commitment to NHS dentistry than the last administration, yet we have further to go. The Government prioritised the NHS in the Budget, allocating it an additional £25.7 billion. However, we needed more reference to dentistry in the Budget. The Labour party’s manifesto talked about a dental rescue plan that would provide 700,000 more appointments and, most critically, focus on the retention of dentists in the NHS. We urgently need that.

We urgently need a dental rescue package to bring dentists back to the NHS, particularly in the south-west, where we have a dental training school in Plymouth. We understand that dentists, once trained, often stay where they went to university, so we need more dentists to be attracted to the south-west and to stay once they are there.

[Dan Aldridge (Weston-super-Mare) (Lab)]

It is important to look at the role of public health in local government as well. Better Health North Somerset has a great programme led by Catherine Wheatley that is all about promoting oral health, which the hon. Gentleman mentioned, in early years and for children and young people. One thing I have noticed is that what works and good practice is not often shared between integrated care boards across local areas. With the strength of feeling here, demonstrated by the amount of south-west MPs that have attended this debate, there is a real opportunity for us to collaborate and share what works. That would be really useful.

[Richard Foord]

I agree. One way in which we can share best practice is by thinking about not only training places, but the recognition of qualifications. After the UK’s exit from the European Union, we saw a breakdown in the number of EU dentists wanting to stay or being attracted here. With fewer eastern European dentists, in the south-west of England, for example, we need to look again at dental qualifications and whether there are some dentist qualifications we might recognise that might make it more attractive to be a practising dentist in the UK.

The rural south-west of England needs to be able to expect the same level of NHS dentistry provision that we see in urban areas across the country. Will the Minister commit to the reform of NHS dentistry so that constituents such as Mike and Shirley do not have to go into the red or forfeit heating their homes to get dental care that avoids them going to acute hospitals such as the Royal Devon and Exeter hospital at Exeter?

[Martin Vickers (in the Chair)]

I remind Members that if they wish to speak, they should bob. If they could limit their contributions to an absolute maximum of four minutes, we will probably get everyone in. But it is going to be a squeeze, particularly if there are too many interventions.

--- Later in debate ---

[Dr Simon Opher (Stroud) (Lab)]

Thank you, Mr Vickers, for chairing this essential debate about dentistry in the south-west. My mailbox is full of people complaining about the lack of NHS dentistry, and we have heard all the horror stories. As a GP, I see people staggering into my surgery holding their face. I know no more about teeth than anyone else here, but we GPs have to try to treat them with painkillers and antibiotics, because there is nothing else available. We must change that.

Let me quickly talk through the dental contract; I then have a couple of positive stories, which will perhaps stimulate the Minister in respect of what could lie ahead. As has been said, the current dental contract nationally has an £86 million underspend, which is absolute madness, but it is because the contract is incredibly restricted and restrictive. The funding for units of dental activity is very poor.

[Richard Foord]

The £86 million underspend relates to the south-west in particular.

[Dr Opher]

Yes, but that is even more shocking, is it not?

There are also disincentives in the contract for dentists to take on new NHS patients. When we look into it, there are all sorts of other things. For example, a dentist cannot provide urgent NHS dentistry unless they have used up their quota of UDAs, which are issued to dentists at the start of the year. The whole system is crazy, which is why there has been such a massive saving. As we have heard, dentists are leaving the profession, and it is clear that we are not training enough. I accept what the hon. Member for South West Devon (Rebecca Smith) said about how dentists are trained and where they are likely to end up working, because that is incredibly important.

As to solutions, we must have prevention. Dentistry is exceptional because dental treatment is preventive in its own right, so as soon as NHS dentistry is stripped away, there are immediately problems. We also have to make sure that young people’s diet is better. Dentist Cerri Mellish and I have developed a project in our area. Cerri sees young pre-school children who are under five. She has a quick look in their gobs and if there are signs of decay, they are whipped out and the children are given treatment. If there are any other signs of problems, she can give them fluoride enamel. These types of innovative solutions are really important.

One thing that happened with the pandemic was that NHS dentists stopped registering new patients. The pandemic started in 2020, so almost all pre-school children are likely not to be registered with a dentist, which is a real disaster. We should remember that two thirds of general anaesthetics used for children are used for dental reasons, and a general anaesthetic is not without risk.

--- Later in debate ---

[Richard Foord]

I acknowledge what the Minister said about the Conservative Government’s legacy for NHS dentistry, which is apparent for us all to see. The Health Service Journal revealed last month that in Devon and Cornwall, the wait for an NHS dental appointment for a new patient is 1,441 days—almost four years. Many of my constituents cannot wait that long. I hope the Minister has heard not only the examples of pain and suffering set out today but some of the prescriptions proposed by the Liberal Democrat spokesperson and other MPs from across the west country.

Question put and agreed to.

Resolved,

That this House has considered NHS dentistry in the South West.

NHS Dentistry: Rural Areas

Richard Foord Excerpts

Tuesday 5th November 2024 Commons Chamber

[Sarah Gibson]

I agree. Hold on. [Interruption.] Sorry.

[Richard Foord (Honiton and Sidmouth) (LD)]

Will my hon. Friend give way?

[Sarah Gibson]

Yes—thank you, Richard.

[Richard Foord]

My hon. Friend is making an excellent speech. She has mentioned ICB commissioning. I wrote to the Minister to ask whether there were set criteria for knowing where a patient is on the waiting list, and I understand that that is entirely in the gift of individual practices. Does my hon. Friend think that it ought to be for ICBs, or for NHS Devon in my case, to determine where people are on the waiting list for NHS dental care?

[Sarah Gibson]

rose—

NHS Winter Readiness

Richard Foord Excerpts

Wednesday 30th October 2024 Westminster Hall

[Richard Foord (Honiton and Sidmouth) (LD)]

It is an honour to serve under your chairship, Sir Roger. I, too, pay tribute to my hon. Friend the Member for North Shropshire (Helen Morgan) for securing and speaking in this debate on a day when she, as the Liberal Democrat health spokesperson, has a lot else to do.

As we face another winter, our NHS is under severe strain. In east and mid Devon, where I am from, the situation is all too apparent. We have five community hospitals across Axminster, Honiton, Seaton, Ottery Saint Mary and Sidmouth, where we see hard-working staff do their absolute level best to deliver a whole range of vital services, such as audiology, X-ray and rheumatology. The hospitals have had their services reduced or even removed over time, which has led to the overburdening of the large acute hospitals.

The unfortunate reality is that the NHS is struggling in terms of acute hospitals like the Royal Devon and Exeter hospital in Exeter. The statistics in the south-west from last winter illustrate that well. Across Devon, 33% of patients in A&E waited more than four hours in February last winter, which is well above the national average. That means that rather than ambulances being out in the streets and lanes saving people’s lives, they spend 30 minutes or more waiting in queues outside, with 31% of ambulance arrivals at the RD&E last winter unable to offload patients in a timely manner. That might suggest to some that we need to put more money into ambulances and acute care, but that is not borne out in the research as the exclusive solution to the problem.

A King’s Fund report recently found that the failure to grow and invest in primary and community health and care services ranks as one of the most significant and long-running failures of health policy over the past 30 years. Today, we heard a Budget from the Government that pledges more funding for the NHS; we worry about what that might mean in respect of the absence of support for social care. Because the system is reactive, we spend increasing amounts on acute hospitals and crisis response rather than on the proactive primary and community care that could reduce hospital demand in the first place. That imbalance means that funding is funnelled into hospitals, where people go once they are very ill, and it leaves the community services that could prevent crises unable to do the preventive work they should be doing.

Our community hospitals in places like mid and east Devon are proof that effective healthcare is not just about big hospitals. I would like to see localised, specialised care that prevents and treats issues early and close to home. Community hospitals should offer more than just treatment; they are also about routine check-ups and screenings. They are places that people go to manage chronic conditions and to receive other ongoing care.

I stress that we have excellent healthcare staff in Devon—in the community hospitals, in primary care, in GP surgeries and in the acute hospitals—but year after year they are asked to do more with less. With more community-based teams, working closely with social care providers, we could avoid many of the delayed discharges we see in the acute hospitals. More than one in eight acute beds in England is essentially blocked, with 14,000 patients clogging the system. I do not mean to put it in those terms—I know that individuals filling acute beds because they are unable to be discharged sometimes feel like a burden, and I do not want that to be the case—but the fact of the matter is that there are acute beds that could be released for other needy patients.

Winter brings respiratory infections, flu and respiratory syncytial virus, all of which hit the elderly, the young and those with long-term health conditions the hardest. Flu vaccine uptake in the south-west is not where it needs to be, at only 46.5% last winter, and I urge people with long-term conditions to get vaccinated. When flu and other winter illnesses surge, the community health services and facilities can pick up some of the slack and reduce some of the pressure on hospital beds.

If we can shift to a focus on community help, it will be about preparation. I know it is challenging—it must be, or we would have done it in the last three decades—but we now need a concerted effort from national and local leaders to support that shift and support people in managing their own health before they are in crisis, so as to relieve the pressure on acute hospitals.

NHS: Independent Investigation

Richard Foord Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

I am delighted to see my hon. Friend in her place. She might be from the wrong side of the river, but she is absolutely right about the importance of prioritising children’s health. As the Prime Minister said this morning, it is shocking that the No. 1 cause of hospital admission among children aged between six and 10 is tooth decay. I was criticised by the shadow Secretary of State, who said that I called our children “short and fat”; she is more outraged by my calling out the scourge of childhood obesity that her Government fuelled than she is by the scourge of child obesity itself. That is why we will act and why the Conservatives failed.

[Richard Foord (Honiton and Sidmouth) (LD)]

I welcome the fact that the Health Secretary talks about a shift from hospital to community care; that builds on Lord Darzi’s finding that 13% of beds are occupied by people who are waiting for care in more appropriate settings. Caring for patients in community hospitals is much more cost-effective than caring for patients in big acute hospitals like the Royal Devon and Exeter hospital where I live. What thought has the Secretary of State given to the use of community hospitals that have lost beds in the last decade, such as Seaton, Axminster, Honiton and Ottery St Mary?

[Wes Streeting]

The hon. Gentleman is absolutely right about the value of community hospitals, step-down accommodation and care close to people’s homes—or, better still, wherever possible, in their homes, so long as it is clinically safe and the right support and care is available. The shift from hospital to community will be at the heart of our 10-year plan for reform and modernisation. Like lots of his colleagues on the Liberal Democrat Benches and lots of those on the Government Benches behind me, the hon. Gentleman has already done a good job of putting his local lobbying of Ministers on the record in the House.

Unpaid Carers

Richard Foord Excerpts

Tuesday 3rd September 2024 Commons Chamber

[Richard Foord (Honiton and Sidmouth) (LD)]

Does my hon. Friend agree that one other Department that might be quite interested in a cross-Government strategy is the Treasury? My constituent Amanda had a civil penalty applied on the basis that she misrepresented her earnings, which has made her frightened to go back to work or to work more hours. Does my hon. Friend agree that it is damaging to the economy if we have people not going out to work?

[Wendy Chamberlain]

I agree with my hon. Friend. If the Government’s aim is to grow the economy, they must, in addition to other measures, be targeting those people who are economically inactive not because they cannot work as a result of their skills, knowledge or capacity, but because their caring responsibilities prevent them from doing so.

I am conscious of your direction, Madam Deputy Speaker, so if the House allows I intend not to take any further interventions. Otherwise, I will not get through the remarks that I want to make.

I want to mention Fife Young Carers, which supports 207 young people in North East Fife, and about 1,300 overall across Fife. Some of those carers are as young as five years old. Caring for a loved one as a child has a significant impact on their education. In the last Parliament, the all-party parliamentary group on young carers and young adult carers carried out an inquiry that found that young carers are missing on average 27 days of school each year and are 38% less likely to go to university than their peers. We know that how children do in school has a vital long-term impact on their future employment—indeed, the Education Secretary was talking about that the other day—and just about everything in their future. The position of young carers gives us a clear example of how the lack of an overarching strategy fails unpaid carers.

Earlier this year, I wanted to question the then Government over the exclusion of young carers from carer’s allowance, building on a question asked by the hon. Member for Slough (Mr Dhesi). The reason that the DWP gave me was that supposedly young carers in education can rely on educational grants for support. I therefore asked the Department for Education about support for young carers. It turns out that there is no specific support for them because they are not considered to be part of a vulnerable group. It means that the DWP can abandon financial support of young carers to the Department for Education, which seems to think that young carers can rely on their parents for income. That shows what happens and how support for arguably an incredibly vulnerable group can get lost without overall leadership.

Yet more Government Departments have a role in the health and wellbeing of unpaid carers. According to Carers UK’s 2023 state of caring report, 50% of unpaid carers are lonely and 58% of carers had to cut down on their hobbies and leisure activities. Caring for a loved one should not mean being isolated from your own support networks or having to give up the things that bring meaning and joy, but clearly it does for many, either because they cannot find the time in the day for themselves between work—if they can stay in it—and caring, or because often they simply cannot afford to participate any more. This is the moment for the Ministry of Housing, Communities and Local Government to get involved, with its overarching responsibility for leisure and the services provided at local level. I am talking about respite breaks, which the hon. Member for Strangford (Jim Shannon) mentioned, support services, and access to local leisure facilities. A cross-Government strategy could also engage the Scotland, Wales and Northern Ireland Offices, and ensure that similar priorities are discussed in intergovernmental meetings with the devolved nations.

There are many root causes and solutions to the problems faced by unpaid carers, and they span all Government Departments. The Minister is here as the Minister for Care, but I hope that he is also aware of the impact of all the cross-Government issues that I have set out on the health of unpaid carers. I am sure that he has learned much in recent weeks. Last year’s “State of Caring” report on health found that 82% of unpaid carers said that the impact of caring on their physical and mental health would be a challenge. It found a significant impact on mental health, with 79% saying that they were stressed or anxious and 49% saying that they were depressed. It is therefore no surprise that research carried out by Dr O’Dwyer at the University of Birmingham has found that unpaid carers are a group at high risk of suicide. That is particularly true for parent carers of children with a long-term illness or disability. Of the participants in her study, 41% of unpaid carers had thought about killing themselves.

It is clear that we need vital preventive healthcare for unpaid carers, but clearly that is not in the remit just of the Department of Health and Social Care. Again, I reiterate why we need a cross-Government strategy. I appreciate that even if a strategy were announced this evening, it would not just be in place overnight—it could not be and it should not be. Its goals need to be co-designed with unpaid carers and the organisations that represent them. It needs organisation, buy-in and leadership. For it to work and take meaningful action, it ought to be sponsored at the highest level of Government and engage all the Departments that I have mentioned. It needs ringfenced funding. It will not surprise the House that I have mentioned funding. The last strategy was supported by £255 million in funding. That may sound like a big figure when we keep being told that difficult decisions have to be made, but it is nothing compared with the economic value of unpaid care, which, as I have said, amounts to £190 billion per year.

I do not want to pre-empt the goals of the strategy—they need to be designed with unpaid carers themselves—but a first priority should be, as my hon. Friend the Member for Harrogate and Knaresborough said, the proper identification of unpaid carers. Unpaid carers may not recognise themselves as such or know what support services are available to them. Professionals and organisations play a vital role in identifying them, through GPs, hospitals, local authorities, workplaces and educational settings. A national carer’s strategy will provide leadership and strategic direction. It will put the needs of unpaid carers at the highest level of Government. Morally, practically and politically, it is the right thing for the Government to do.

I do not particularly like the title of this debate on the Order Paper. The word “potential” was inserted to keep me in line with the rules on neutrality in debate titles. It makes it sounds like the merits of the strategy are arguable, which clearly they are not. I chose to read “potential” in a different way: a national carer’s strategy has an abundance of potential to create improvements that have not yet been realised. I look forward to hearing the Minister’s remarks.

Dentistry: Access for Cancer Patients

Richard Foord Excerpts

Wednesday 17th April 2024 Westminster Hall

[Richard Foord (Tiverton and Honiton) (LD)]

It is an honour to serve under your chairship, Mr Dowd. Since being elected to represent Tiverton and Honiton almost two years ago, one of the issues that has appeared most regularly in my inbox and mailbag is access to NHS dentistry. It is common across the country for someone to have difficulty accessing new NHS dentists if they are not already registered, but that is particularly difficult in some parts of the country, including in Devon, which is often regarded by many as a so-called “dental desert”.

In recent months, we have heard the Government suggest that a way to address the difficult shortages of dentists is to try to attract qualified dentists into an area regarded as a dental desert. For example, we have seen the proposal to pay one-off incentives to qualified dentists to move into a dental desert such as Devon, but the truth is that this is still very difficult. I appreciate that the new proposal has not come in yet, but given that it is a one-off incentive, there is still no long-term incentive for dentists to move into dental deserts. That is difficult for many of my constituents, but it is more deeply worrying for those who are living with cancer. This is not a hypothetical scenario; it is the experience for people in rural communities such as Devon where finding a new dentist is impossible.

I will recount a real-life story from one of my constituents who was caught in just that scenario. Robin Whatling lives in Tiverton and is aged just 55. He is struggling with advanced cancer. Because of the treatment and medication that he is on, his bones and teeth are weaker than they would otherwise be, which means that regular check-ups are more important for him.

Robin’s wife, Sharon, contacted me last December and told me how, after booking a check-up, he received an abrupt phone call just a few days before it was due to happen. He was informed that the practice was no longer treating NHS patients and that if he wanted to go ahead with his appointment, he would need to go private. That is clearly a massive issue for a couple like Robin and Sharon. Due to Robin’s vulnerable state, Sharon has had to go part-time to become his carer. That means that she is not able to work the hours that she used to, which would have possibly afforded her more money to pay for private healthcare treatment.

Instead, the couple pursued the idea of finding an NHS dentist. They were held on the phone for three hours before being cut off. In the end it all became too much, and Rob ended up removing one of the teeth that was causing him pain by himself at home. I do not need to tell the House that that is a shocking, appalling situation to have to contend with while suffering advanced cancer.

Despite years of working hard and paying into the system, this couple are now left adrift with no support or access to dental care. In some of the correspondence that Members receive, we have constituents who rage at us with anger, but this couple approached me with great modesty and humility. They absolutely were not seeking to score any sort of political point. They just wanted to let me know, in a very factual way, the experience of a rural couple contending with cancer and trying to find NHS dentistry on the state.

The British Dental Association has laid bare the facts. Oral cancer is one of the fastest-growing types of cancer and it is killing more people than car accidents every day. Dentists can play a key role in diagnosis and referral, and if oral cancer is diagnosed early, survival rates can be as high as 90% compared with just 50% if diagnosis takes place at a later date.

Let us say it as it is: NHS dentistry is in crisis. It is another example of the Government continuing to let people down and stand by as our vital services crumble. The NHS dental budget has been cut in real terms by £1 billion while the Conservatives have been in power. That is a shocking legacy of neglect. My constituents were not party political about this, but I am going to be: this Government have presided over the crumbling and decay of NHS dentistry, and have paid lip service to proposals to do bits and pieces that do not amount to contract reform. So I urge the Minister, for the sake of Rob, Sharon and everyone who is trapped in a situation like this, to take on board the urgency of the issue of NHS dental care for cancer patients and those who might become cancer patients.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Stretford and Urmston (Andrew Western) on securing this really important debate on behalf of Michele and all the other petitioners. I would of course be delighted to meet Michele to hear her views, and I particularly take note of her call for all cancer patients to be advised of the potential impact of cancer treatment on their oral health. That is a really solid and actionable thing that I undertake to take away today. I look forward to meeting Michele and the hon. Gentleman in due course.

I wish to take this chance to pay tribute to the Mouth Cancer Foundation, the Oral Health Foundation and Dentaid, to name just a few of the excellent charities that provide support and advice to so many.

I thank all Members who have spoken in what has been an excellent debate. I say to the hon. Member for Tiverton and Honiton (Richard Foord) that I fully appreciate the challenges in Devon. He will no doubt welcome the fact that a mobile dental van, which will be quite a boost for very underserved and geographically distant areas, will be forthcoming for Devon in the near future. In addition, one of the real problems in Devon—this is not the hon. Gentleman’s fault at all—is that in his area on average only around 57% of commissioned units of dental activity are actually undertaken by dentists. I am sure he might like to talk to his local integrated care board about that, if I can help in any way, I would be delighted to.

As I will come on to talk about, our dental recovery plan attempts to incentivise further NHS dentists to really ramp up delivery. In fact, we have already seen hundreds of thousands of new dental treatments just since 1 March, when the plan went live. Unfortunately, the data is not publishable as yet, but I feel really optimistic. I totally understand what Members say about it being not good enough—I totally get that—but we are seeing rapid improvements and I encourage the hon. Gentleman to talk to his local ICB.

[Richard Foord]

On the Minister’s point about only 57% of the units of dental activity being taken up in Devon, is that not a workforce issue?

[Dame Andrea Leadsom]

No. How it works is that the ICB commissions dentists to provide NHS dentistry, and the NHS contractor undertakes to fulfil a number of units of dental activity. If they do not do that, for whatever reason, at the end of the financial year the ICB claws back the money they gave the NHS dentist to fulfil that contract. I am not judging anything; I am merely giving the hon. Gentleman information that I hope is helpful to him.

Dementia Care in Hospital

Richard Foord Excerpts

Wednesday 6th March 2024 Commons Chamber

[Theresa Villiers (Chipping Barnet) (Con)]

My constituent Lisa Rutter is the founder of the charity Dementia Club UK, which hosts events in Barnet for people with dementia and their families, to provide support, advice and much-needed time out of the house to socialise with other people who are coping with similar life experiences. This work gives Lisa great insight into dementia care and the pressures on unpaid carers, and she asked me to meet a group of carers over Zoom to hear about their relatives’ traumatic experiences when admitted to hospital. I found the meeting deeply disturbing, which is why I applied for this debate.

In the time available, I can only include brief points about each case. I cannot hope to convey the emotional impact of the stories as told by the carers themselves, and I cannot hope to get across their real distress and anger that their loved ones had been let down, but I hope to give the House an indication of the seriousness of the problem.

I will start with Lisa’s own story. Her mother, Tasoulla Gavriel, was admitted to Barnet Hospital with covid in November 2020. Sadly, she died shortly afterwards. Tasoulla was a lovely lady, and I met her on a number of occasions. She was assessed by the hospital to be an eight on the Rockwood scale, meaning that she was viewed as severely frail and approaching the end of her life. Lisa believes that this diagnosis was entirely wrong. Her mother was sitting up and alert when admitted, and she did not have serious comorbidities, apart from advanced dementia, which meant she needed help with eating.

When Lisa was told by the hospital that her mother needed an oxygen mask, she asked for Mrs Gavriel to be put in hand mittens to prevent her from pulling off the mask and harming her treatment. The hospital refused, on the basis that this did not accord with hospital policy because it amounted to a deprivation of liberty. The hospital decided that it was neither proportionate nor in Mrs Gavriel’s best interests for her to be given mittens. That is despite mittens being used when Mrs Gavriel had been admitted the previous year for a hip operation. Lisa sincerely believes that mittens could have saved her mother’s life.

Another deeply distressing aspect of this case is that covid visitor restrictions meant that Lisa had only very limited time with her mother in hospital. I raised this in Parliament at the time, urging visitor restrictions to be eased for patients with dementia. I very much welcomed the subsequent introduction of greater flexibility for people to spend time with their loved ones in hospital. We must never again return to restrictions of the sort we saw during the pandemic.

Some of the group I spoke to did not want to be named, so I will simply refer to them as Carers 1 to 5. Unlike the others, Carer 1 is not a constituent and his experience does not relate to my local Barnet Hospital, but I do not want to leave him out. He emphasised how crucial it is that people with dementia continue to move and walk, if they are to stave off further loss of cognition, but he told me that staff at the hospital to which his wife was admitted refused to help her to walk. Even more worrying, he had to intervene twice to prevent a nurse from giving her the wrong dose of medication. Had he not spotted the mistake, a potentially lethal dose could have been administered.

[Richard Foord (Tiverton and Honiton) (LD)]

I congratulate the right hon. Lady on securing this significant debate, as dementia is going to affect so many people’s lives in the coming decades, as more and more people are of retirement age. In Devon, the dementia specialist Jonathan Hanbury has suggested that we should place more funding and focus on community hospitals, community treatments and community services, so that people can keep their brain agile further upstream. He suggests that the NHS’s focus on funding for acute hospital services and expensive drugs misses the value of prevention. Does the right hon. Lady agree?

[Theresa Villiers]

Those are very valid points. It is important to keep people out of hospital for as often as possible, but that is particularly the case with dementia patients, given the dislocation and insecurity that comes with moving them to a different environment. Measures to keep people healthier for longer and to deliver care via the primary care system rather than in acute hospitals are an important way to address some of the problems I am outlining.

--- Later in debate ---

[Helen Whately]

I have very little time, so I am afraid I will not give way.

My right hon. Friend the Member for Chipping Barnet talked about the social care workforce, another subject close to my heart. We have a strategy for the care workforce. We are building care as a career, in particular to boost recruitment and retention among our home-grown workforce. We recently published the first ever national career structure for care workers, and we are launching a new national qualification to boost the supply of care workers.

Avoiding admission is another priority for me. Clearly, some people should be—absolutely must be—in hospital for the treatment they need, but we know that patients with dementia in particular can deteriorate in hospitals, so we are doing more work with the national health service and social care to avoid admission when it is not truly necessary by putting in place alternatives or, at the other end, supporting earlier discharge through the roll-out of the Hospital at Home initiative, or virtual wards, under which we committed to at least 10,000 hospital-at-home beds or equivalent as part of emergency care recovery plans. The NHS has over-delivered on that, so we now have more than 11,000 Hospital at Home beds, which help people who would otherwise be in hospital receiving acute care. They receive that care and are able to recuperate at home, avoiding the risk of a longer hospital stay and deconditioning.

My right hon. Friend talked about dementia research and the new treatments coming onstream. The Government have committed to doubling our investment in dementia research during this Parliament, and we are on track to do that with our dementia mission. We are also working very closely with NHS England to be ready for the breakthrough treatments lecanemab and donanemab coming onstream. I should be clear that we know very well—I have received clinical advice on this—that those treatments have quite significant side effects, so they will not be suitable for everybody and I put a note of caution there. We are waiting to hear whether they are approved by the Medicines and Healthcare products Regulatory Agency and the National Institute for Health and Care Excellence. In the event of approval, NHS England is taking steps to be ready to put in place the levels of diagnosis required to be able to support those treatments.

That goes hand in hand with the work that we are doing with NHS England to improve the diagnosis rate for dementia. We have a target dementia diagnosis rate of 66.7%. That dropped during the pandemic because dementia services and assessment had to be closed, but it has been gradually building up, and I expect NHS England to get back up to that level during the course of this year. That is really important, because having a diagnosis helps people—the individual with dementia and their carers, for example—to access the support and back-up that they should be receiving.

I am conscious of the clock ticking, so I have tried cover some of the territory that my right hon. Friend set out in her speech, which I thought was very powerful in raising these significant issues for those with dementia receiving care in hospital, their carers and loved ones. I completely agree about the importance of dignified treatment and treating those with dementia with dignity at all times. I know that that can be particularly challenging in hospital, but we have to ensure that that is the case.

We will ensure that we get all the necessary care in place outside hospital, which avoids unnecessary admissions; support people to be discharged from hospital quicker; get ready for the arrival of new dementia treatments; and raise awareness about the significant proportion of dementia cases that can be prevented or at least delayed by looking after our health. In fact, the risk factors for dementia are similar to those for heart disease and other things, and there is relatively low awareness of that. We will see more people with dementia in the years ahead, but we can do more to raise awareness of how people can maintain their health and stave it off.

[Richard Foord]

Will the Minister give way?

[Helen Whately]

I am just coming to a close.

I thank my right hon. Friend for securing the debate. I will continue my work to pursue the topics that we have discussed this evening.

Question put and agreed to.

Oral Answers to Questions

Richard Foord Excerpts

Tuesday 5th March 2024 Commons Chamber

[Richard Foord (Tiverton and Honiton) (LD)]

Wendy Hart had a high white blood cell count when she was discharged from the Royal Devon and Exeter Hospital. Her husband, Terence, described a dreadful, pointless 60-mile round trip home and back to hospital before Wendy died of sepsis. Will the Minister consider distances between acute hospitals and rural communities when reviewing hospital discharge guidance?

[Helen Whately]

I am very sorry to hear about what happened to the hon. Gentleman’s constituent. I send my condolences to her family and loved ones. Clearly, it is very important that discharge decisions are led by clinicians, who can make a clinical decision about whether somebody is medically ready to be discharged. I have no doubt that the family may well take up that decision with local NHS organisations.