Dental Health: Older People

Debate between Steve Brine and Andrew Selous

Wednesday 27th February 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

I realise that a debate on older people’s dental health is merely of passing interest to you, Mr Deputy Speaker, as you are many years from it being of direct interest, but I hope you enjoy my response.

I congratulate my good friend, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), on securing time for this debate and on setting out his case so clearly. I will do my best to answer his points in the time available. As he knows, I will write to him on anything I do not answer.

Oral health has improved significantly over the 40 years that I have been alive. At the start of the NHS—it is worth noting this incredible statistic—40% of the population had no natural teeth. The figure is now—answers on a postcard—6%. These massive improvements are to be celebrated but, of course, with improvements come new challenges.

As we are all aware, older people—we categorise those aged over 65 as older people for the purpose of this conversation—make up an increasingly large proportion of the population. By 2032, we project there will be 13.5 million people aged 65 and over in our country. Older people are retaining far more teeth, often heavily filled, than previous generations. As people age, so do their fillings and all the other bits of their bodies, and ongoing restorative work is needed.

Many older people live independently and are in full charge of their oral health, as are working-age adults, but we recognise that frail older people—those with additional needs, often living in care homes or supported to remain at home, as my hon. Friend set out—can face real barriers to accessing the appropriate care and support they need to maintain good oral and dental health.

My hon. Friend set out some of the reasons why good oral health is an essential part of active ageing. We know that poor oral health can affect an individual’s ability to eat, which can lead to an acute episode and an encounter with the tertiary sector, or even to speak and socialise. Obviously, poor oral health hits their confidence and then it spirals. For older adults who are frail, good oral health is particularly important to maintaining hydration and the ability to eat comfortably and easily, which helps them to stay healthy and independent for as long as possible, and even to stay well in a care home setting.

As we set out in our 2017 manifesto, we are committed to improving the nation’s oral health, from children right the way through to older people. The NHS long-term plan, published last month, set out our plans specifically to ensure that individuals in care homes are supported to have good oral health. My hon. Friend raised that point.

The long-term plan national implementation framework, due to be published later this spring, and the national implementation plan, due to be published this autumn, will provide further information on how the LTP will be implemented, but I will now turn to the five specific issues raised by my hon. Friend.

[Andrew Selous]

The Royal College of Surgeons obviously raised concerns about people who use domiciliary care agencies. While there is still time, will it be possible for the NHS long-term plan to address that issue, too, so that we look after all older people whatever type of care they receive, not just those in care homes?

[Steve Brine]

I will touch on that, but I take my hon. Friend’s point. I will make sure it is flagged up in writing as a note from me, the Minister, to the relevant officials as a response to this debate.

In 2016, the National Institute for Health and Care Excellence published its “Oral health in care homes” report, which was an important piece of work. As we know, it set out a number of recommendations for care homes to help maintain and improve oral health and ensure timely access to dental treatment for their residents. In dental health, as in every other part of health, prevention is better than cure.

I completely agree that we expect care homes to follow NICE guidance and NICE recommendations in this area, as in every other. Alongside the importance of appropriately trained staff, my hon. Friend makes an important point about the role regulators can play in this area.

The Care Quality Commission is responsible for this area, as it is for many other areas of policy, and it is currently looking in depth at oral health for older people in residential care settings, and much needed that is, too. So last autumn, the CQC’s dental inspection teams joined adult social care inspectors on visits to about 100 care homes to gain a better understanding of the oral health care support for residents. I know that the CQC intends to publish the findings later this year. I have asked to be kept updated on the progress of this work and to have early sight of its findings. I will update the House and my hon. Friend in particular on this, given his interest and the fact he is a member of the Health and Social Care Committee. I will make sure the rest of the Committee are aware of this as well.

We should also recognise and highlight the ongoing work of NHS England and Public Health England, which I sponsor within my portfolio, to improve the oral health of vulnerable older people. As is referred to in the long-term plan, NHS England considers oral health for older people, particularly those in care homes who may be vulnerable, an important issue. I have asked also to be kept updated on progress as NHS England takes forward action on this and other areas highlighted in the plan.

Public Health England has published “Commissioning better oral health for vulnerable older people”—a snappy title—which is designed to support commissioners of services to improve the oral health of vulnerable older adults so that they can lead a healthy, long and meaningful life outside the acute sector. My hon. Friend highlighted the Mouth Care Matters programme, which, as he says, is a local training initiative from Health Education England offering support and training in oral healthcare for the elderly and for hospital staff looking after patients who may need help with mouth care. I know the programme has been very successful locally in Kent, Surrey and Sussex. Decisions on whether to extend the training more widely are for HEE, but I would hope the success of the programme to date means that HEE is able to take it forward to new areas in the longer term, including to his county. I cannot give the nationwide answer that he asked for in his speech, but I suggest that the early signs are positive.

On access to dental services currently, NHS England is legally responsible for commissioning services to meet local identified need, and that includes the commissioning of domiciliary care services, where appropriate. However, it is important to say that where residents can, the care home and the local NHS work together, often very successfully, to ensure that dental services are provided in the most appropriate setting for those residents, whether that is within the care home itself or in a dental practice, or provided by the community dental service. Often people in care home settings will enjoy the trip out to the dentist; it is part of their socialisation and their routine, and we should not overlook that.

I note my hon. Friend’s concerns about the availability of oral health data, particularly for the older age groups. I agree that the adult dental health survey is an important tool for understanding oral health changes over time. I can reassure him that although there is not yet a date set for the next survey, no decision has been taken to discontinue this important source of information. I take this debate as a bit of a nudge to ask more questions about this. If my hon. Friend looks at my track record, for example, on the cancer patient experience survey, which I was clear was an important tool to give me information about cancer patients’ experience, he will see that I place value on such patient health surveys. In the shorter term, I agree that the regularly published NHS dental statistics on numbers of people seeing an NHS dentist could provide more helpful information by analysing the data by age. I am going to ask my officials to work with NHS England and NHS Digital to pursue this further, and I will ensure that my hon. Friend is kept informed on that point.

My hon. Friend made a point about the social care Green Paper, which remains very much a priority but is not yet in reach. The Green Paper will cover a range of issues that are common to all adults with care and support needs, and will bring forward proposals to ensure that we have a social care system in which people know that the care they receive will help them to maintain their independence and wellbeing, and that we have a social care system that we can be proud of. We will publish the document shortly, and it will set out proposals to reform the adult care system. I take the points made by my hon. Friend about the importance of including dental and oral health in the Green Paper. I will make sure that a copy of this remarks is sent to the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage).

In the remaining few minutes, I wish to touch on the prevention Green Paper. We set out our prevention strategy last year, and it is one of the Secretary of State’s three priorities. We are now in the process of developing the prevention Green Paper, which is an exciting piece of work with which to be involved. It will be called “Prevention is better than cure” and will do exactly what it says on the tin. I will engage with key dental stakeholders—including the British Dental Association, Mr Deputy Speaker, so there is no need to tweet me—in the coming weeks. I look forward to those engagements.

In conclusion, although I am disappointed not to have heard from the hon. Member for Strangford (Jim Shannon) during my speech, I know he has already intervened, and I am pleased that we have had the opportunity to discuss these issues. I think this is the first time I have responded to an Adjournment debate on this subject, and I have responded to quite a few. I hope I have been able to demonstrate the Government’s commitment to improving oral health. Of course there is more to do, and that commitment absolutely includes work on the oral health of older people in care homes, as set out in the long-term plan, and in domiciliary care settings. Our plans to engage in the coming weeks with key dental stakeholders on the development of the prevention Green Paper are honest and sincerely meant. I will continue to watch the work of the CQC and the outputs of its report with interest, and I will follow up on the dental survey so that we have the key data we need to improve services for the people we are here for—our constituents.

Question put and agreed to.

Oral Answers to Questions

Debate between Steve Brine and Andrew Selous

Tuesday 15th January 2019 Commons Chamber

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

9. What steps he is taking to reduce obesity.

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

This Government are taking bold, world-leading action on child obesity that meets the scale of the challenge that we face. We have a soft drinks industry levy, a sugar reduction programme already working, measures on banning energy drinks, calorie labelling consulted on, and a consultation on restricting price and location promotions of sugary and fatty foods which I launched on Saturday.

[Andrew Selous]

The introduction of a 9 pm watershed on the marketing of junk food to children is the No. 1 ask of the Obesity Health Alliance, supported by Cancer Research UK, Diabetes UK and many of the royal colleges. When will we see that consultation launched?

[Steve Brine]

I am glad that my hon. Friend mentions CRUK, which has launched a powerful new marketing campaign that Members will see around Westminster and in the media over the rest of this month. We will launch the consultation on further advertising that was in chapter 2 of the child obesity plan, including the 9 pm watershed, very shortly. We are working hard to ensure that the remaining consultations announced in the second chapter are right. I want to get them right and, when they are ready and we are satisfied that they are the right tools to do the job that we want to face this enormous challenge, we will publish them.

Diabetes

Debate between Steve Brine and Andrew Selous

Wednesday 9th January 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

It is nice to see you in the Chair, Mr Robertson. I thank all Members for their contributions and my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) for securing the debate. He introduced it with his usual flourish, and I know that people watching will have been interested in what he said and the issues that he raised.

We have to keep these issues high on the agenda. They affect a lot of people and we talk about them a lot in Parliament; I cannot think of a Health oral questions that I have been involved in as a Minister when diabetes has not come up. There is a reason for that: because it affects so many of us and our constituents. We must keep raising it.

This is a timely debate. We published the long-term plan for the NHS on Monday. Diabetes features prominently in the plan, which is no accident. We would expect it to, and if it did not, we would have a debate on why not. However, more than that, the plan has a strong focus on prevention and on building a health service for the needs of the 21st century that supports people to manage their own health—not only for diabetes but across the piece—and wellbeing.

We really support that agenda in this Department and with this Secretary of State. That matters for patients—our constituents—with diabetes and others. Chris Askew is a very good man and chief executive of Diabetes UK, and his welcome for the long-term plan and the diabetes sections within it greatly attests to that.

We have heard some excellent contributions. I very much enjoyed listening to the intervention from my right hon. Friend the Member for Wantage (Mr Vaizey) and his suggestion about Brine labelling; my right hon. Friend the Member for Ludlow (Mr Dunne), who gave us insights about his two-year-old daughter; and my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who talked about the food industry and child obesity. We also heard speeches from the right hon. Member for Knowsley (Mr Howarth), who talked about an artificial pancreas, which was very interesting, and from the hon. Member for Workington (Sue Hayman). I should be able to cover all those items. If I do not cover everyone’s points, I will of course write to them, as is my usual practice.

I have to say that I particularly enjoyed the contribution from my hon. Friend the Member for Rochford and Southend East (James Duddridge). It was a very powerful and insightful speech, as it always is from him, and it was delivered from the heart. He made the very good point that we are all different. That is one of the challenges not just for diabetes care, but for healthcare generally. Healthcare is not an exact science. I say that not as a doctor, but as someone who spends a lot of time with doctors.

My hon. Friend also made a point about the complexity of diabetes. In reality, it is a spectrum. We have heard a lot of talk this morning about type 1 diabetes—from the right hon. Member for Knowsley, for instance—and about type 2 diabetes from many others. But increasingly we hear about—it is not a new term—type 1.5 diabetes, otherwise known as LADA, or latent autoimmune diabetes in adults. As I understand it, that is not a clinical definition, but is generally used to describe a slow-onset form of type 1 diabetes that is often mistaken for type 2 diabetes. There are many support services for that condition, and people are increasingly talking to their doctors about it. There is lots of clinical debate around it, but the topic has been around since the 1970s. That goes to the heart of my hon. Friend’s point. Diabetes is a complex condition. There is a spectrum for diabetes, as there is for many other conditions.

I, too, pay tribute to the NHS staff, to the diabetes nurses and the doctors, but also to the support groups. My constituency has the Winchester and Eastleigh diabetes support group, which I spoke to recently. We will all have those groups in our constituencies. As MPs, we are very used to having in front of us people who are far more expert on the subject that they have come to talk to us about than we are—every single one of my constituency surgeries is an example of that—but never is that more true than when we talk to people with diabetes, who have a great and expert knowledge of their condition and the management of it. If they do not, we need to help them to have better, expert knowledge of their condition, because that is as much in our interest as it is in theirs.

There are a couple of points to touch on. My right hon. Friend the Member for South Holland and The Deepings, in introducing the debate, and my hon. Friend the Member for South West Bedfordshire touched on the food and drink industry and healthier eating. It is important that we build on the world-leading action set out in both chapters of our childhood obesity plan. We have already seen real success. More than half of all drinks in the scope of the soft drinks industry levy are being reformulated. That is equivalent to removing some 45 million kg of sugar every year, as a result of the so-called sugar tax. And some products in the sugar reduction programme are exceeding their first-year targets. For example, a 6% reduction is being achieved for yoghurts.

We will consider further use of the tax system to promote healthy food—the challenge that my hon. Friend put to me. He mentioned sugary milky drinks. The Treasury was very clear, when former Chancellor of the Exchequer George Osborne launched the sugar tax, that in 2020—next year—we would review the sugar levy and whether to extend it to milky drinks. As the Minister, I for one will certainly be welcoming that.

As part of chapter 2, we have already held consultations on ending the sale of energy drinks to children and on calorie labelling in restaurants. We are reviewing the feedback and will formally respond in due course. We will very shortly be launching consultations on restricting promotions of fatty and sugary products by location and price, and we will be consulting on further restrictions, including a 9 pm watershed, at the earliest opportunity, with the aim of limiting children’s exposure to sugary and fatty food advertising and driving further reformulation. What I will say, in answer to the challenge that I have been given on those products, is that not everyone agrees that we should do this. Let us be honest: there are people in our party who do not. I challenge them to look at the challenge that we have in our country with obesity and what it is costing our country and our health service. If we believe in a publicly funded health service, we believe in a public health system that challenges these kinds of condition, so I say to my hon. Friends: keep raising the issue in the House. Next Tuesday they will have an opportunity to do so.

Alongside that, we are committed to exploring what can be done on food labelling when we leave the European Union. My hon. Friend the Member for Ochil and South Perthshire (Luke Graham), who is no longer in his place, raised traffic light labelling. We cannot do that as a member state, but we will soon be free. Some companies have decided to take it on themselves. Kellogg’s, the cereal manufacturer, which has been mentioned this morning, announced just before Christmas that it intends to do that. I welcome that and give credit to Kellogg’s for doing it.

Wherever possible, the aim is of course to prevent type 2 diabetes from developing in the first place, which is emphasised in the NHS long-term plan. I am very pleased that NHS England and Public Health England, for which I have responsibility, and Diabetes UK, working hand in glove, have had great success in working on what is the first diabetes prevention programme to be delivered at scale nationwide anywhere in the world.

[Andrew Selous]

Will the Minister give way?

[Steve Brine]

Very briefly—be quick.

[Andrew Selous]

I, too, am very pleased that Kellogg’s has brought in traffic light labelling, but does the Minister agree that, with Kellogg’s Frosties at 37 grams of sugar per 100 grams, there is much more to do as far as Kellogg’s is concerned?

[Steve Brine]

Not only do I agree with my hon. Friend, but the company would agree with him. It is very aware of how much pressure that I and the Government are putting on it to change its products. I would say that it is top of my Christmas card list. Many other manufacturers have not yet made it on to my list, and I ask them to step up and raise their game to the level of the best. I am sure that they can.

In 2018-19, the diabetes prevention programme achieved full national roll-out, making England the first country in the world to achieve full geographical coverage. That is a great achievement, and the figures are good. As set out in the long-term plan, NHS England intends to double the capacity of the programme up to 200,000 people per annum by 2023-24. As my right hon. Friend the Member for South Holland and The Deepings said, it is a modest number in context, but it is also a big number. This is still the largest diabetes prevention programme of its kind. He asked whether we keep these things under constant review and whether we have the ambition to go further. You bet we do, and I think we need to.

There has been much talk this morning about technology. We are also developing an online, self-management support tool called HeLP, comprising a structured education course that has content focused on maintaining a healthy lifestyle for people with type 2 diabetes. That includes content on weight management and alcohol reduction—that can of course help with many health challenges—and cognitive behavioural therapy related to diabetes-related distress. NHSE hopes, once the tool has been developed, to roll it out in the summer of this year.

Childhood Obesity Strategy: Chapter 2

Debate between Steve Brine and Andrew Selous

Monday 25th June 2018 Commons Chamber

[Steve Brine]

There is no mention of breastfeeding in the plan, but that does not mean that I and my colleagues do not see it as a very important part of the early years programme. In areas that I represent, as well as, I am sure, in other areas represented by colleagues, local authorities are often actively engaged in making sure that breastfeeding is a very important part of a child’s start in life.

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

It was the drive and passion of Alderman Eric van der Burg, a right-wing politician, that led to results in bringing down child obesity in Amsterdam. What more do we need to do to get local authority leaders here to see that this is actually part of their core business, not a fringe activity?

[Steve Brine]

As my hon. Friend will remember from my speaking to the Health Committee, I have also been to Amsterdam, but unfortunately not for as long as the Committee members were. The whole-systems approach taken by Mayor van der Burg and Amsterdam is very impressive and has resulted in a 13% reduction in child obesity. Local authorities can learn from their attempts to market their cities, areas and regions, and I would suggest that having a good, healthy community and a good, healthy look when people walk out of the airport and do not see massive adverts for unhealthy fast food is an important part of that.

Oral Answers to Questions

Debate between Steve Brine and Andrew Selous

Tuesday 14th November 2017 Commons Chamber

[Steve Brine]

Respiratory illness affects one in five people in the UK, and it is responsible for around 1 million hospital admissions annually, so it is very much in our interest, as I said to my hon. Friend the Member for Erewash (Maggie Throup), to implement the outcomes framework. I look forward to having further discussions with the hon. Member for East Londonderry (Mr Campbell), and I am happy to meet him if he wishes.

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

Does the Minister, who cares deeply about these issues, share my concern that lung capacity often never recovers after being damaged in childhood? Is not that a powerful reason why we need to make significant progress on air quality issues?

[Steve Brine]

Absolutely. I have just returned from a meeting of G7 Health Ministers, and one of the subjects under discussion was environmental factors in climate change and its impact on human health. We had challenging discussions on many areas, but air quality and its impact on respiratory disease was not one of them.