Covid-19: Dental Services
Scott Mann Excerpts(3 years, 3 months ago)
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Mr Deputy Speaker (Mr Nigel Evans)
Order. Scott, you sound like a Dalek, and I do not mean that unkindly. There is clearly a communications problem. We will switch to the next speaker and then we will get you back, Scott.
Scott Mann
Apologies from North Cornwall, Mr Deputy Speaker. I thank the hon. Member for Putney (Fleur Anderson) for bringing forward this very important debate. In the three minutes that I have got, I would like to address the wider issues around covid and NHS dentistry in places like Cornwall, the 2006 contract, and the challenges of recruitment and retention in rural areas.
We have exceptionally long waiting lists for NHS treatment in places like North Cornwall, with many people waiting years on the NHS list, and at the moment we have a limited number of dentists providing that NHS work. Many of the practices and dentists in my constituency are servicing more than 8,000 or 9,000 patients. That is not sustainable in the long term. Population growth in Cornwall has compounded that issue. Having met many dentists in my constituency, I am aware of the problems, and I look forward to working with the diligent Minister on the Treasury Bench to resolve some of them. The 45% target should be looked at again, because meeting those demands in the current environment is quite tough.
Those local issues are magnified in the national picture. Normally, someone presenting to an NHS dentist needs emergency work, which takes quite a lot of time. The contract is onerous. The 2006 contract was not great when it was introduced, but with time it has become less and less effective. It needs to be reviewed. I know Cornwall is not unique, but the problems become more acute the further one gets from the big cities. We do not want oral health inequalities across the country. The levelling-up challenge is an economic one, but we need to be aware that there are health shortcomings affecting those who live remote areas.
Looking at solutions, I have picked up on the fact that we used to have a scheme to recruit dentists in the short-term from the Commonwealth. Now that we have left the European Union, we can look again at the rules that apply, and I think we should do so. We should also look again at the 2006 contract and work with the General Dental Council to see whether we can fast-track people becoming dentists and working in practices.
We should consider how we can manage costs. Someone who earns £100,000 a year has as much chance of having an NHS dentist as someone on a low income. We could handle that better. All power to the Minister—I know she gets this. I look forward to working with her to get better dental health outcomes in North Cornwall.
NHS Dentistry and Oral Health Inequalities
Scott Mann Excerpts(3 years, 5 months ago)
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Judith Cummins
I certainly agree with my hon. Friend about access to PPE and the fact that dentistry is very much seen as the Cinderella service of the NHS.
Clearing the backlog will be a considerable challenge. Even in the best of circumstances it would take years, but unfortunately we are not in the best of circumstances. As people who have tried to get dental appointments since June know, dentists are operating with considerably reduced capacity. About 70% of practices are operating at less than half their pre-pandemic capacity. The primary reason for that is the requirement for a period of fallow time after each appointment to allow any aerosols that may have been produced by treatments such as drilling or even scale and polish to settle, and then for a long deep clean to take place. The fallow period can be for up to one hour.
In October, the number of NHS treatments carried out was a third the level of the year before. In the BDA’s members survey published earlier this month, 87% of dentists in England cited fallow time as a top barrier to increasing patient access. That could be significant reduced. The number of patients seen could be increased by installing high-capacity ventilation equipment. However, the price of such equipment and ventilation is estimated to start at about £10,000, and the cost is considerably more for larger practices with a high number of surgeries.
The British Dental Association members survey shows that the majority of dental practices in England are not currently in a financial position to afford such an outlay for investment. However, the practices least likely to have had the appropriate equipment tend to serve the most deprived communities, and are also the least likely to be able to afford that investment, increasing oral health inequalities further. That vicious cycle of underinvestment in our most deprived communities feeds inequalities in health outcomes.
Scott Mann (North Cornwall) (Con)
I thank the hon. Lady for securing this very important debate. It sounds like Bradford has a similar challenge to Cornwall. We have had a longstanding shortage of provision for NHS dentistry in Cornwall, particularly around recruitment and retention. I had a very constructive meeting with the Minister on this issue recently. Can we work together across the House to put together a programme of work that the Government can adopt to ensure that places such as Bradford and Cornwall get proper NHS provision?
Judith Cummins
Of course, I welcome cross-party work on this. I am vice-chair of the all-party parliamentary group for dentistry and oral health. I would very much welcome the hon. Member as a member of the APPG, and look forward to sorting out dentistry, including NHS dentistry, once and for all, with a particular view to addressing the difficulties his constituents face.
I ask the Government to step in now and provide capital funding to invest in new ventilation equipment to help to reduce these fallow times. It is simply not good enough to say that dental practices must fund this themselves. We all know how precarious their funding is, and how hard it has been hit by the pandemic. This is a matter of public health, and it is the Government’s responsibility to safeguard and protect that. To avoid that responsibility would be a matter of gross negligence on the Government’s part.
In recent years, neither NHS England nor the Department of Health and Social Care has extended any capital funding to dental practices. The situation we now find ourselves in requires a change of approach. Local dentists have contacted me about the importance of maintaining temporary contract provisions that have been in place during the pandemic. Alan McGlaughlin, a dentist in my constituency, told me:
“Our fear is that NHS England may ask us to achieve more than the notional level of 20% of contracted targets for next year. This will be impossible due to allowable body flow in through the door and the cleaning and fallow periods required. I hope the NHS will allow for this issue and only then can we settle into a positive routine for the care of our patients.”
Can the Minister confirm that this target will not be increased, putting practices under impossible pressure?
Turning to secondary care, the pandemic has had a significant effect on waiting times for dental procedures in hospital. Thousands of children and vulnerable adults who require dental treatment under general anaesthetic are waiting in pain for treatment. There have been countless horrifying reports in recent months. The BBC has reported on a patient who suffered eyesight damage after not receiving treatment for a fractured tooth, which became an abscess. Meanwhile, the Daily Mail has reported the case of a seven-year-old girl who was left in severe pain for months after she was unable to get an appointment. Even before the pandemic, the waiting time for this kind of treatment was around one year. That is set to become significantly worse, given the backlog and reduced operating capacity.
I recently tabled a question asking for how many children planned dental admission to hospital has been suspended or cancelled since the start of the covid-19 outbreak. The Department responded that data was not available in the format requested. I find it simply unbelievable that the Department of Health and Social Care does not hold this information, so perhaps the Minister can answer that question. If she cannot do so today, I would welcome an answer later on.
As well as the pain and suffering that such delays cause patients, including problems eating, speaking and sleeping, they contribute to the impending public health crisis of resistance to antibiotics, as people require multiple courses of antibiotics while waiting for surgery. I understand that eight organisations, including the British Dental Association, Mencap, the Royal College of Surgeons, and the British Society of Paediatric Dentistry, wrote to the Secretary of State about this in mid-September, but have yet to receive a response, so would the Minister ensure that they receive a response as soon as possible?
I have focused on the practical problems that dentists and patients are facing as a result of the pandemic, but I would now like to turn to the effects that this is having on oral health inequalities. The covid pandemic has exacerbated socioeconomic, ethnic and regional inequalities across the country, and will worsen oral health inequalities too. According to the Association of Dental Groups, access to treatments for poorer patients has fallen by 39% over the past 10 years. Regions such as Yorkshire and the Humber have struggled for years with an acute crisis in access to NHS dentistry. I have raised this many times with various public health ministers, and while we have taken some small but important steps to improve things—especially when the hon. Member for Winchester (Steve Brine) was Minister—for which I am very grateful, the situation is still fundamentally inadequate.
Inequalities in access to dentistry inevitably lead to inequalities in oral health outcomes. A child in Yorkshire and the Humber is five times more likely to be admitted to hospital for a tooth extraction than a child in the East of England. In Bradford, 36% of children have tooth decay, compared with just 7% in the best performing area of the country.
Oral Answers to Questions
Scott Mann Excerpts(3 years, 6 months ago)
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Fiona Bruce (Congleton) (Con)
Scott Mann (North Cornwall) (Con)
Danny Kruger (Devizes) (Con)
Helen Whately
The infection control fund is being distributed in two equal instalments, the first of which has already been paid to local authorities. My hon. Friend’s local authority, Cheshire East Council, will be receiving £4.7 million in total, so it should already have received £2.35 million to go towards the extra costs for care providers and others in infection prevention and control.
Scott Mann
As always, I commend the Department and the Secretary of State on their work during the pandemic. Although not every part of the response has been perfect—and we never expected that it would be—I am convinced that the Department has done its utmost to protect the public. I do have some concerns, however, about the transmission between care homes. What measures has the Department taken to prevent cross-contamination of covid between care homes, particularly from staff who work in multiple locations?
Helen Whately
I thank my hon. Friend for his comments, but most of the credit should go to those working in social care, who have been looking after some of the most vulnerable people in our society in such difficult circumstances. He is right that it is really important that we ensure that there is no transmission between one care home and another, which is why we are requiring care homes to make sure that their staff work in only one setting and are providing additional funding to enable them to do this.
Coronavirus
Scott Mann Excerpts(3 years, 7 months ago)
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Matt Hancock
Obviously, I talk to the Scottish Government, who are responsible for local action in Scotland. We work as closely as we can to try to bring both the UK capacity and the local capacity to bear. We have put much more testing in Aberdeen, which is right, and I support the Scottish Government in the action that they take to bring down the number of cases there.
Scott Mann (North Cornwall) (Con)
May I congratulate the Secretary of State on the biggest testing regime in this nation’s history? Twenty million tests is a monumental feat. That said, it would be wrong of me not to highlight the calls that my office received at the tail end of last week and yesterday, with people in Cornwall unable to access tests. What progress is he making on expanding the number of tests in Cornwall so that my constituents can access them?
Matt Hancock
There have been more than 600 tests a day in Cornwall over the past couple of days, so people in Cornwall can access tests—and it is very important, if they have symptoms, that they continue to do so—but of course I acknowledge the challenges that have been faced as well. We want to increase testing capacity right across the board. Sometimes we have to discuss difficult issues in this House, but I am pleased to say—especially with so many people having gone to Cornwall over the summer, because, as I can personally attest, it is such a wonderful place to have a summer holiday—that the case rate in Cornwall has stayed really low. I pay tribute to everyone in Cornwall for the work that they are doing on social distancing, on hands, face and space, and on being cautious and careful to stop the spread of the virus. Let us hope that that remains the case.
Coronavirus Update
Scott Mann Excerpts(3 years, 9 months ago)
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Matt Hancock
It is vital that all those things are brought together at both a national and local level, and they are. The actions that have been taken under the NHS test and trace programme, whether national or local, and the interaction of the two, are testament to the fact that we are increasingly integrating national and local work and ensuring that the best high-quality data available is shared.
Scott Mann (North Cornwall) (Con)
In the unlikely event that there is a local outbreak in a town or village in Cornwall in the summer, could the Secretary of State outline what a local lockdown might look like for local people and anyone holidaying in Cornwall?
Matt Hancock
Yes. Local action can be anything from action in an individual business premises, an individual farm, as we saw in Herefordshire over the weekend, or an individual GP surgery, up to a group of organisations or, if necessary, a whole city. The approach we take is that, for an individual premises, that is largely a decision for the local director of public health to take, but of course, once we get up to the level of a whole city, that has to be a decision taken nationally by the Government. We will publish more details of this escalation procedure in due course.
Coronavirus
Scott Mann Excerpts(3 years, 10 months ago)
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Matt Hancock
We are having such discussions—I have had conversations with my German, French and Italian counterparts on exactly this subject—but the most important thing is that we will not let those discussions get in the way of the much more advanced discussions we are having directly with the vaccine producers to make sure that even if the two great British vaccine hopes do not come off, or if one from somewhere else in the world comes off first, we have access to a vaccine for citizens across the UK.
Scott Mann (North Cornwall) (Con)
It is fantastic news for the whole country that Oxford University has successfully trialled a drug to reduce mortality rates by up to one third for covid patients on ventilation. Can my right hon. Friend confirm that that will be made available soon so that the people of North Cornwall can benefit from it as part of the wider NHS?
Matt Hancock
I am delighted to say that, because we made the stockpile in advance, the treatment is already in place, as of yesterday afternoon, in Cornwall—in Treliske Hospital—and right across the country.
Social Distancing: 2 Metre Rule
Scott Mann Excerpts(3 years, 10 months ago)
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Edward Argar
My hon. Friend is absolutely right that if and when it is safe to reduce social distancing measures, that is what we should do, but it is for the review to report and advise us, and the Prime Minister, on exactly that.
Scott Mann (North Cornwall) (Con)
The Minister will be aware that many of my constituents’ businesses are based around tourism, and that many of those may not reopen again in the winter should they find that distances are not reduced. First, may I ask him to join our Cornish campaign—Think Local, Shop Local? Secondly, will he employ all possible counter-measures to ensure that our tourism and hospitality sectors can be protected throughout covid-19?
Edward Argar
My hon. Friend is absolutely right to highlight this. I am very happy to join him in supporting Think Local, Shop Local in Cornwall. I do not know if I qualify for these brief few seconds as an honorary Cornishman, but if I do, that would be a privilege. He and my hon. Friend the Member for St Austell and Newquay (Steve Double) have highlighted to me how important this sector is to their constituencies and their local economy, so it is right that we work to reopen businesses as soon as we safely can.
Oral Answers to Questions
Scott Mann Excerpts(4 years, 1 month ago)
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Jo Churchill
I gently refer the hon. Gentleman to the answer that I gave a few moments ago.
Scott Mann (North Cornwall) (Con)
Jo Churchill
Yes, they most definitely can. Many surgeries are making sure that “Digital First” is becoming part of their everyday offer to patients across the land. We have a real chance to ensure that we both protect the health of the nation and embrace digital technology to improve access to GPs still further.
Nursing Workforce Shortage: England
Scott Mann Excerpts(4 years, 1 month ago)
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Mohammad Yasin
My hon. Friend is right. Cuts to bursaries have impacted hugely on the recruitment of new staff. The Welsh Government did the right thing in a difficult situation. If we do not look after our staff, it will be hard for them to stay in the profession. That is why we have a shortage of nurses.
As a father of four children, I believe that financial barriers to education must be removed so that everyone who wants to go to university can do so, particularly those who want to become nurses. We should encourage young people to train in these critical professions. Why are the Government putting up barriers to young people who will go on to contribute such vital services to society and saddling them with huge debts before they have begun working?
This problem has been years in the making. Such stark shortages do not occur out of the blue. In England these shortages are due to the complexities of political decisions and structural issues.
Scott Mann (North Cornwall) (Con)
As has been mentioned, these issues are compounded in rural areas, where we have problems with recruitment and retention. A cottage hospital called Stratton in my constituency has just had its minor injuries unit closed overnight due to nurse shortages. What more can we do to promote staff retention across the whole of the UK?
Mohammad Yasin
The Government must listen to nurses and the Royal College of Nursing. They are pleading for the Government to act now. Getting nursing bursaries back in action might help, but the problem is now so deep that we must take urgent action to tackle it.
This problem has been around for a long time. It is not a short-term problem. It will affect us in the long term unless we act now. Who is responsible for the health and care workforce? It is shocking that no one is. There is no clarity in law on the role of and responsibility and accountability for growing and developing our health and care workforce, or the various layers that drive our health and care services.
A nurse walking on to a short-staffed shift has no option but to carry on. The buck stops with them. They carry the professional, physical and emotional impact. Nurses have no power to recruit more staff. That is true of all professionals in our taxpayer-funded health and care services, including nurses, medics, physiotherapists, psychologists, social workers, support workers and many others. The Government should be accountable for the provision of the labour market that staffs our health and care services. The taxpayer must be assured that the services they have paid for are safe and effective.
The former MP for Wolverhampton South West, Eleanor Smith, who is also a nurse, was here last summer setting out the same concerns. This is the 37th debate on workforce issues in health and care services since 2017, and it will not be the last. In recent responses to parliamentary questions, the Government have considered the merits of safe staffing legislation and ways to close the workforce accountability gap. The Royal College of Nursing has been campaigning, along with several other health organisations, for accountability to be secured in legislation, so the Government’s consideration is welcome.
The long-term plan Bill is the way to make progress on that agenda, but it must include an explicit framework for the role of and responsibility and accountability for workforce supply and planning at all levels at which decisions are made across the system, including the Government. Achieving accountability in law provides an opportunity to safely staff our health and care services in the future. I hope the Minister will commit to safe staffing legislation for England and update us on what her Department is doing to ensure that the NHS long-term plan Bill is forthcoming. Will that Bill explicitly provide for accountability for workforce provision?
I suspect the Minister will want to discuss the Government’s promise of 50,000 more nurses over five years. We have heard a lot about that commitment but not in detail. How will 50,000 more nurses be recruited, especially when the Government appear to be ramping up the hostile environment rhetoric and making the UK as unattractive a place as possible to come and work? The loss of many NHS workers from the EU is a tragedy.
Bedford Hospital had to recruit 237 nurses from Australia, India and elsewhere to fill vacancies left largely by EU nurses who left because of their fears for the future and the ill treatment they received in the UK. It is a testament to the hard work of the hospital’s chief executive, Stephen Conroy, that, despite those staffing difficulties, the hospital is projected to reach full recruitment of band 5 nurses for the first time in many years, but that will be achieved only by recruiting nurses from overseas.
We also need to increase capacity in clinical placements, to support nursing students at universities. How will the Government achieve that? How many nurses do the Government expect to retain? When will the Government publish their plan in full? Will the Secretary of State report on progress made in this Parliament?
This year, the World Health Organisation is celebrating the first ever year of the nurse and the midwife, at a time when the spotlight is on the nursing profession across the globe. As their elected representatives, we must stand with them and celebrate this diverse and dynamic profession. I will do everything possible to ensure that our health services are staffed safely. It must be a priority for us all. The problems are well known. The evidence continues to mount. We need decisive action, but we are not getting it from a Government drowning in Brexit uncertainty. Nursing staff need action now, as do their patients. We cannot wait any longer.
Jim Shannon
I thank the hon. Gentleman for his intervention, and that is exactly what I am saying. I know that the Health Department in Westminster does not have responsibility for recruiting nurses in Northern Ireland. The Minister in Northern Ireland now has, and he has made the first step towards addressing that issue. It is hoped that over the next couple of years the number of vacancies—over 2,100 nursing posts, as well as 400-odd nursing assistant posts, making about 2,500 vacancies in total—will be addressed. We hope that the cost of agency staff and the extra financial burden created by the fact that agencies are profit-making organisations—this is how they make their money—will be addressed in a way that helps to reduce the shortcomings.
This situation means that nurses cannot simply work their 37.5-hour working week. They are called in on days off and asked, “Can you do the twilight shift? Can you give me a couple of hours?” That is not the fault of the ward sisters; they need the floors covered and are under pressure. It is simply that we do not have enough full-time working nurses in the NHS. That means that conscientious nurses, who do not want to leave the ward or the district short, are working additional hours themselves, and not in the short term to save money for a holiday or a renovation of their house. Instead, they are consistently working overtime to help on the wards, and so they are not getting their family time, their social time and—more importantly—their rest time
I have had glimpses of this situation. Some 6,500 nurses live in my constituency, so I have regular contact with them. I got a brief glimpse of the work of a nurse during my surgery and was in awe of how they stayed on their feet, and remained both sharp and compassionate —as they do. Doing all that with no rest is simply unsustainable. So, for a better system and a better caring system with better nurses, who are more able to work within that system, we need to address the shortage of nurses.
It used to be the case that bank nurses were only used in an emergency, but now they are used ever more frequently and their use is becoming the norm. They are no longer just used in the emergency. Using them is now just the fall-back position: “Let’s just do it”. That is not good either for morale or for finances—the current finances clearly indicate that it is not. It is more costly to have agency staff in than it is to have nurses on full-time pay.
I will give another example, of a nurse who approached me in my office and asked me to clear up rumours about nurses, their employment and so on. She is a young nurse in her early 20s who has been working at the Ulster Hospital in Dundonald—the main hospital in my constituency—but she has been left as a staff nurse in charge at night on numerous occasions. What she said to me was simple; she just said to me, “Jim, keep the pay rise and please give me an extra nurse per shift.” That was her initial reaction, because she can feel the pressures of delivering this system, and was saying, “I physically can’t do it all for much longer”.
This is a lovely young girl who is dedicated and good at her job, but who knows that when she has kids she will not be able to work 60 hours a week. She is asking me to do something about that, and today I am on the path towards doing something; I am highlighting this issue. I am very happy to do so.
Scott Mann
The hon. Gentleman is making an excellent point about that young lady. There is one way that the NHS might be able to support her. NHS Property Services owns huge amounts of land around the country on the public estate, and I know that the Government are putting together a key worker policy, for there to be a 30% discount for local people in the housing policy, like a local homes discount. Does he think that if we included nurses within that category that we might be able to address some of the challenges that we face, by giving people discounts and getting them into the profession?
Jim Shannon
I thank the hon. Gentleman for that intervention. I was not aware of that proposal until now, but it certainly seems like a way of incentivising people—for some people. Let us be honest; it will not suit everybody’s circumstances, but it will suit some people’s. Whatever we can do to incentivise nurses to stay in the profession is good. I will give a third example, if I may, of the reasons why nurses are not staying in the profession, but some of the things that the hon. Gentleman referred to would be helpful.
I met one woman in her 30s in my office who wanted to go into nursing, but she could not do so because her tax credits would not allow to stop work while she got her national vocational qualifications and other qualifications. So, reluctantly, she gave up and we lost her. She is not the only one we have lost; we have lost many more than that.
I know that in Northern Ireland this issue is not the responsibility of the Minister who is here today, the Minister for Care, the hon. Member for Faversham and Mid Kent (Helen Whately); I understand that. However, will she ask the Minister who has the portfolio for tax credits to review the circumstances around tax credits and the circumstances of those nurses who are trying to get their NVQs, and have to stop work to do so? If we are losing nurses because of an anomaly in the system, let us try to address that anomaly, to allow us to retain the nurses who want to be retained.
My mother was a nurse. That was a long time ago; my mother is coming up to 89 now. I know that for her nursing was a vocation, as it is for many other people. In today’s busy life, it is important that we try to help those who want to be in nursing for the rest of their lives to retain their position. However, that was a young girl in her thirties in my office who wanted to go into nursing and unfortunately we lost her.
We lost someone who wanted to train as an intensive care unit nurse, because the current system could not work with her and her four children. Can we do better in helping mature people to come out of retail and enter education, while still having their children cared for? There are many such people across the nation and across my constituency. There are also a great many people who are former nurses, and we should try to recruit them back into the system as well. There comes a time in their life, perhaps when their children are a bit older and they find themselves with a bit more time on their hands, so what are we doing to attract the more mature nurse into the profession that they once wished they were in?
There must be a way of doing that. I believe that it is up to us in this House to address these two issues, which are so closely linked: getting more nurses; and making a clear way forward to allow mature people to choose nursing, not simply as their job but as their vocation and their calling.