Oral Answers to Questions

Tim Farron Excerpts

Tuesday 29th October 2019 Commons Chamber

[Tim Farron (Westmorland and Lonsdale) (LD)]

Last week in the Queen’s Speech debate, I mentioned a constituent of mine, Liz, who had declined the offer of palliative radiotherapy treatment simply because it would involve a four-hour round trip to get from the Lakes to Preston. Does the Minister agree that it is wrong for cancer patients to be forced to choose shorter lives because they cannot cope physically with the longer journeys?

[Caroline Dinenage]

The hon. Gentleman is absolutely right to raise this matter, and I know that he is meeting the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), shortly to discuss the details of that individual case. More broadly, the long-term planned commitment to spend that additional £4.5 billion- worth of investment in primary and community health services will definitely help those services to be delivered much closer to people’s homes.

The National Health Service

Tim Farron Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is an honour to follow the hon. Member for Crawley (Henry Smith), who made some excellent points. I am not alone in this debate in wanting to peddle a manifesto, but in my case it is the manifesto of the all-party parliamentary group on radiotherapy, which I hope I can encourage Members of all parties to take very seriously. Fifty per cent. of people with cancer—which we have already established is going to be half of us at some point during our lives—need radiotherapy, yet only 5% of the cancer budget is spent on radiotherapy. As the hon. Gentleman mentioned, the NHS long-term plan rightly identifies the need to diagnose more cancers earlier. Early diagnosis is massively important. The United Kingdom stands below average among European countries for cancer survival for nine out of 10 cancers, and has the second-worst survival rate in Europe for lung cancer. Only in September, The Lancet demonstrated that we have the worst survival rate for cancers across a range of comparable countries.

Poor survival rates are, in part, down to late diagnosis, but they also are down to poor access. The increase in early diagnosis that I hope will result from the NHS long-term plan’s success will of course increase demand for radiotherapy. There is no provision within the NHS long-term plan to provide that radiotherapy to deal with the extra demand that ought to be created if it is successful.

Radiotherapy is used for curative purposes eight times more than chemotherapy, yet, as I said, it gets only a fraction of the investment. The all-party group discovered during our inquiry that 20,000 people in the United Kingdom who would benefit from radiotherapy treatment are not getting it, and nor are 24% of people living with stage 1 lung cancer. That is largely down to poor geographical access to radiotherapy treatment. Despite the fact that all 52 cancer centres in England are enabled for precise SABR—stereotactic ablative radiotherapy—technology, only 25 of them are commissioned to deliver it. That means that 27 of the cancer centres in England using the tariff are being rewarded for using less effective radiotherapy and penalised for using more effective radiotherapy. Fixing that would be free, by the way, but for months and months NHS England has been refusing to deal with it.

The all-party group found that, when new satellite centres from existing large cancer centres are built, there is an average 20% increase in demand for them. That proves that there is unmet demand in our communities for radiotherapy. People live too far from the radiotherapy centre. I therefore ask Ministers to consider our local proposal in South Lakes for a satellite centre at Westmorland General Hospital in Kendal. We have been campaigning for that for many years. We have an excellent cancer treatment centre at the Rosemere centre in Preston. There is nothing wrong with the Rosemere centre whatsoever; it treated my dear late mother. The only problem is that it is too flipping far away for those of us who live in the Lake district and the Yorkshire dales.

I accompanied a young woman called Kate on one of her many trips to Preston to get treatment. It was a three-hour round trip, and she lives at the south end of my constituency. Only last week, I went to a prostate pals meeting in a pub in Kendal, where there were several men who are making four-hour round trips every day for six weeks, which is often debilitating financially as well as physically. That is why we desperately need that cancer centre at Westmorland General Hospital in Kendal, linked to the Rosemere satellite. Longer journeys mean that people have shorter lives. An older lady called Liz diagnosed with skin cancer told me, again not very long ago, that she was choosing to decline the radiotherapy treatment that had been recommended by her oncologist. Why? Because of her age, she just could not cope with the journey. So Liz made the conscious choice to have a shorter life because the journey that she would have to take to get the treatment was too long.

Will the Minister accept the radiotherapy manifesto in full to enact all the things that are set out within it, as agreed cross-party? I am bound to ask, on behalf of the people of my communities in South Lakes, that we invest now to end the long, long wait for people to have a radiotherapy satellite unit at our hospital, the Westmorland General in Kendal.

Community Pharmacies

Tim Farron Excerpts

Wednesday 2nd October 2019 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a pleasure to serve under your chairmanship, Sir David. I thank the hon. Member for Halifax (Holly Lynch) for bringing forward this issue, which is important for the whole country. Community pharmacies play a vital role wherever they are, but that is especially so in large dispersed rural communities such as mine.

As we have heard, many of those community pharmacies are in increasingly marginal positions and are at risk of closure—indeed, many have closed. That is tragic for them, their patients and the communities that they are at the heart of. It is also a tragic wasted opportunity. The Government should make far better use of our community pharmacies to secure their futures and to benefit patients. The Government could provide sufficient funding for pharmacies so that they can provide an agreed range of patient services to prevent ill health and to keep people who are living with chronic conditions from getting worse, as hon. Members have mentioned.

I sat down with one of my local pharmacists in Kendal a few weeks ago. He told me that the Government have an opportunity to commission a national minor ailments service provided by community pharmacies. The key objective would be to use the talents and expertise of our pharmacists and, in doing so, to remove pressure from GPs and A&E departments in other parts of primary care in the NHS.

Pharmacists in my area serve communities as diverse and widespread as Sedbergh, Hawkshead, Ambleside, Staveley, Windermere, Milnthorpe, Kendal, Kirkby Lonsdale and many others. All the pharmacists I speak to fear that their numbers may be further whittled away by the Government, either by design or by attrition. The Government and people in the sector have talked about there being 3,000 fewer pharmacies. On behalf of local pharmacists and their patients, I say that that would be unacceptable. We want clarity from the Government on the number of pharmacies that they envisage, and we want a commitment to maintain the number that we have.

In the past, Health Ministers have expressed admiration for the French community pharmacy model, which pays for community pharmacies across the board to provide more patient services, such as conditions tests, smoking cessation and blood tests. Will the Minister commit to commissioning such services from community pharmacies across England comprehensively, not just case by case?

Community pharmacies would also be aided by having greater flexibility to dispense authorised medication when the pharmacist is away for a short time, perhaps visiting a local care home. The Government should also consider allowing big national pharmacy chains to share their automation platforms for prescription assembly with smaller independent community pharmacies to reduce costs across the board.

There is also the issue of fair payments. Many independent pharmacies in the south lakes are in danger of going out of business because of reductions in payments for prescriptions by NHS England. Often, the money that pharmacies receive from the national health service does not even cover the cost of the drugs being dispensed. In one shocking case, a pharmacist in my constituency in a relatively small Lake district village, who I have visited regularly, received in one single month £5,000 less in NHS payments than they had to pay out in wholesale drug payments. And that is on top of that pharmacy losing on average 10% of its NHS income each year over the last three years. That is utterly unsustainable, but it is replicated across our communities. So I ask the Minister to intervene personally to put this matter right.

We see a picture of a community pharmacy network that is full of wonderful, talented, highly skilled and dedicated professionals, who provide vital services to patients and their families, and that is part of the glue that holds communities—particularly rural communities—together, but it is being let down by an unambitious approach to community pharmacy from Government, which undervalues what these pharmacies do and, even more importantly, undervalues what they could do.

Therefore, I ask the Minister to consider the proposal in my early-day motion—which, thanks to the non-Prorogation, is still alive—for an essential community pharmacy scheme, to support community pharmacies in rural areas such as mine and to keep them open and thriving. Moreover, will she heed the calls from pharmacists across the country, who are merely calling for fairness in payments and for the ability to use their skills to serve their patients and communities, removing debilitating pressure from other parts of the NHS?

Social Care Funding

Tim Farron Excerpts

Tuesday 1st October 2019 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

I am grateful to my right hon. Friend for giving way. He rightly points out the importance of unpaid carers. Any new consensus, which must come, should make clear provision to support those who do the caring— 12,000 unpaid carers in my constituency alone. If they were to cease caring—if we do not care for the carers—the social care burden on the taxpayer more generally becomes even more unmanageable.

[Sir Vince Cable]

Indeed. My hon. Friend is right, and he reinforces the central point I am making.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Stephen Hammond]

I do not always agree with the hon. Gentleman, but he is right to make that point. I know from very personal experience that dementia affects people in different ways, which is why I am proud to be part of a Government who are committed to delivering in full on the challenge on dementia 2020, to make England the best country in the world for dementia care.

[Tim Farron (Westmorland and Lonsdale) (LD)]

The huge rural area covered by the Morecambe Bay NHS Foundation Trust has and needs three hospitals, but it is funded as if it had only one. As a result, the trust has been fined more than £4 million in debt interest over the past three years. That money could have been spent on nurses, paramedics or doctors. Will the Minister intervene to stop this at once?

[Stephen Hammond]

I met the hon. Gentleman recently to talk about ambulance provision in his constituency and the Morecambe bay area, and I hope he is now satisfied with the progress we are making on that. I will look into the individual case he mentions and respond to him.

Non-invasive Precision Cancer Therapies

Tim Farron Excerpts

Thursday 18th July 2019 Commons Chamber

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a great pleasure to follow my hon. Friends the Members for Easington (Grahame Morris) and for Chichester (Gillian Keegan), who are vice-chairs of the all-party parliamentary group on radiotherapy, of which I am honoured to be the chair.

Many of us know too well the pain, hardship and heartbreak that cancer causes. As my hon. Friend the Member for Easington said, it is widely accepted that half of us will get cancer in our lifetime. While I am on my feet, there will be people getting their diagnosis and families coming to terms with it, and lives turned upside down. Most of us have been affected by cancer in some way; cancer took my mum, far too young. But increasingly cancer is a condition to be overcome, not a death sentence. Advances in medical science mean that there are often a host of possible treatments when the diagnosis comes.

Perhaps the form of treatment of which we hear the least is radiotherapy. It is widely accepted that 50% of those who suffer from cancer will require radiotherapy at some point in their treatment. However, in its recent radiotherapy specification, NHS England reduced the figure for cancer patients needing radiotherapy to 40%. It reached that figure on an interpretation of the Malthus model; if only 40% of cancer patients need radiotherapy, then the current level of investment will be just about adequate, as everyone who could benefit from radiotherapy would receive it, so we might as well conclude this debate and go home—only that figure is wrong, as NHS England has had to admit.

The APPG on radiotherapy recently held a number of evidence sessions, in part to get to the bottom of this inconsistency. We heard from a wide range of experts, including one of the authors of the Malthus model, who explicitly stated that NHS England’s interpretation of the model underestimates the number of patients requiring treatment, because it takes into account only those patients whose initial treatment is radiotherapy, not those who need it after the initial point. When pressed, NHS England accepted that, acknowledging that the 40% estimate was not accurate and fell shy of the true figure. This matters, because the real figure is roughly 50%, which means that NHS England is not commissioning sufficient radiotherapy treatment to meet the needs of cancer patients. The Government must plan on the basis of true demand, not of a figure discredited by the experts and now disowned by NHS England. The Royal College of Radiologists has confirmed that this combination of factors means that, as my hon. Friend the Member for Easington said, 20,000 people in Britain are not receiving the radiotherapy that they need.

The major issue in my patch is access. Those needing radiotherapy across our communities in south Cumbria have to travel to the Rosemere unit in Preston. That unit is excellent. The staff are wonderful and the kit is brilliant. There is only one thing wrong with Rosemere: it is far too far away. The National Radiotherapy Advisory Group has said that it is bad practice for people normally to have to travel more than 45 minutes to receive radiotherapy treatment. I drove Kate from Kendal to her treatment in Preston the other week; it was a three-hour round trip. She had been doing that every day for six weeks. For those living in Garsdale, Langdale or Coniston, those trips could be five or six hours, or far longer on public transport, every day for weeks. Those are ludicrous distances to travel to receive vital treatment, and that is why we want a satellite of the Rosemere unit to be based at Westmorland General Hospital.

I spoke to one lady over 80 years of age who was recommended a course of radiotherapy. She decided to forgo that treatment because of the distance she would have to travel. She did not have the option of a shorter journey, so she has instead taken the option of a shorter life. And she is not alone.

A group of leading UK professionals at the British Institute of Radiology met to discuss their experience of setting up satellite centres. They calculated an average 20% uplift on top of the projected figures for those using the service, while the centres of which they were satellites saw no decline in numbers. That means that in areas such as mine, where access to radiotherapy is poor, 20% of people who should be getting radiotherapy are not getting it, but if a satellite centre was built, they would get that treatment. This is not about convenience; it is about saving lives.

My hon. Friend the Member for Easington has already raised the problems with commissioning. I will simply say that 100% of radiotherapy centres in the UK are equipped with SABR—stereotactic ablative body radiotherapy—technology. That is the best technology, giving the most focused and concentrated treatment that is most effective at killing cancerous tissue and causing the least damage to surrounding healthy tissue. That means fewer treatments, fewer side-effects and better results. The scandal, however, is that only 25 of those 52 centres are commissioned to use it.

Is it any wonder that cancer survival rates in this country are among the worst in Europe? We have the second lowest survival rate for lung cancers and below average survival rates for nine of the 10 main cancers. Do not hear me wrong—I know that radiotherapy is not the only solution. Surgery is vital, as are drugs and chemotherapy. We are very proud of the battle we won to deliver chemotherapy to Kendal—countless people have benefited from that—but when chemo improves survival by 2% whereas radiotherapy improves survival by 16%, we need to think carefully about the disparity in investment.

The simple fact is that radiotherapy lacks the financial backing to be heard. Drugs companies lobby passionately and legitimately for the treatments they provide. Radiotherapy has no such lobby. The all-party group has been struck by the realisation that we are the entire UK radiotherapy lobby, along with those people who work in the industry. Radiotherapy has become a Cinderella service because it lacks a champion. We invite the Minister to become that champion.

Finally, enthusiastically we welcome the Government’s focus on earlier cancer diagnosis, but earlier diagnosis will increase demand for radiotherapy. When tumours are spotted earlier and are smaller, they will need more precise and focused treatment—they will need radiotherapy. Twenty thousand people a year are missing out on radiotherapy already, but if we do not invest now, as more and more cancers are diagnosed earlier, that figure will rocket and this secret scandal will become painfully public.

Our cancer survival rates are distressingly low. Radiotherapy is, after surgery, the most effective cure for cancer—far more so than drugs. It has been left behind in terms of investment for many years under many Governments. This is the moment when that shameful state of affairs must end. People should have the best treatment for their cancer, and where at all possible they should have it close to home—because shorter journeys equals longer lives.

[Several hon. Members rose—]

NHS Workforce: England

Tim Farron Excerpts

Wednesday 17th July 2019 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate the hon. Members for Wolverhampton South West (Eleanor Smith), for Lincoln (Karen Lee) and for St Ives (Derek Thomas) on their eloquent speeches.

The crisis in the NHS workforce is deeply concerning. Its effects are felt nationally, locally and personally. Like others here, I want to pay tribute to the people working at every level of my national health service within the south lakes: the hospital in Kendal, Westmoreland General Hospital, and the district generals that we travel to in Barrow and in Lancaster. Of course, there are the GPs, dentists, paramedics and those providing mental health services. They do an outstanding job, but it is particularly challenging in rural areas, where we have specific problems with workforce planning and supply, which are at the heart of the problems that we are challenged by.

There are several key elements to workforce planning, including accessible and high quality training, as well as affordable training, as has just been mentioned so eloquently. Effective recruitment is another. Alongside both of those is the issue of staff retention. The Secretary of State must surely be held to account for each of those. The huge shortages in the NHS workforce are felt heavily in numerous areas of healthcare provision in the local communities in Cumbria, and I briefly want to touch on a few of them.

The provision of ambulances and ambulance crews has been hit particularly hard. It is vital that we recruit and deploy more paramedics and ambulance technicians. Rural communities such as mine suffer because of the sheer distances that ambulances have to travel to reach patients. According to the review of NHS access standards, it is the responsibility of ambulance trusts to respond to category 1 calls within seven minutes on average. That is a tall order when there are half the number of ambulances per head in the north-west of England as there are in London, despite the fact that my constituency alone is bigger than the whole of Greater London. It leaves communities living in fear for their safety and takes a serious toll on the physical and mental health of our outstanding ambulance crews. Our local paramedics and ambulance technicians are being pushed beyond their capacity. As a result, I have had an influx of local people contacting me about having to wait hours for an ambulance to arrive to give them the treatment that they so desperately need. That is why local health campaigners have been calling on the Government to deliver two new fully crewed ambulances to south Lakeland to stem the crisis and ensure the safety of the community. It is not right that people in Grasmere, Dent or Hawkshead might be an hour away from the nearest available ambulance.

We met the Minister to raise the issue a few weeks ago. He was incredibly helpful and I thank him for his time and his response. I very much welcome the commitment to procure additional emergency ambulances. I understand that as a result of our campaigns an additional £8 million has been allocated to the North West Ambulance Service. That could be good news for south Cumbria, but only if the ambulance service allocates it in the way that we have asked. Ministers should be held to account for whether the ambulances materialise.

Mental health is another element of workforce planning that I want to raise—particularly provision for children. Four years ago the Government promised a bespoke one-to-one eating disorder service for young people in Cumbria. For young people in south Cumbria that promise remains nothing more than words. The specialists have not been recruited and the service still does not exist. I should love it if the Minister would tell me exactly when we can expect our young people to have access to the service. When will the promises be kept?

I welcome the Government’s commitment to preventive healthcare, set out in the NHS long-term plan. However, again, promises are not being fulfilled. In our area, cuts to the public health budget mean that the NHS in Cumbria currently spends only £75,000 a year on tier 1 mental health preventive care for children. That works out at just 75p per child per year. Proper investment in public health would ensure enough money for a mental health professional for every school and college, if we could recruit them, keeping young people mentally healthy and making sure that problems did not become so severe further down the line. It would also ease the burden on our massively oversubscribed local child and adolescent mental health services, and relieve the pressure on our brilliant but overworked teachers.

In our area, there is a problem with people moving out of NHS provision to work privately, particularly in the delivery of dental services. More than half of adults in Cumbria have not had access to an NHS dentist in the past two years, while one in three children locally does not even have a place with an NHS dentist. Much as with ambulances, the impact of the lack of a workforce of sufficient size is felt particularly acutely in rural areas. Insufficient NHS dentistry provision has resulted in families having to make ludicrously long journeys to reach the nearest surgery with an available NHS place. Often, people are unable to make those long journeys, or to afford to make them.

[Mike Hill (Hartlepool) (Lab)]

The hon. Gentleman raises an important issue about dentistry. There are frightening figures about my constituency showing a lack of take-up of NHS dental treatment among children in particular. That is a real worry. I wonder whether it is reflected in the hon. Gentleman’s constituency and whether he agrees that we need at least to tackle NHS provision for dental treatment for young people. It is important.

[Tim Farron]

Yes, the hon. Gentleman makes an extremely important point. I am certain it is felt across the country. If it is made too difficult to get to the nearest NHS dental surgery—if that is 60 or even 100 miles away, as has been the case on occasion for constituents of mine—people go without treatment, and so do their children.

Last November I managed to secure the agreement of the commissioners to increase the value of the contracts to NHS dentists in Kendal so they could see and treat more patients. “Brilliant,” we thought, “that is really good news.” When NHS England contacted our local NHS dentists they found that not one of them was able to take up their offer. I was told that the practices were already working to capacity within the staffing resources they had available, and were reporting difficulties in recruiting additional staff. Those staff exist, by the way. They are working in the private sector. The treadmill of a contract that is unfair to patients and dentists, and not fit for purpose, keeps them out of the NHS. As the hon. Member for Hartlepool (Mike Hill) says, that hits young people particularly.

The reasons for those difficulties include a contract that pays a set amount for a particular type of treatment, regardless of the number of teeth that a dentist treats. A dentist will get paid, on average, £75 for an entire course of treatment including six fillings, three extractions and a root canal. That is not enough to cover overheads. That is a serious disincentive to people entering NHS dentistry. It hits all areas, but particularly deprived areas, and has a massive impact on the size of the workforce. According to the Department’s website, the Secretary of State for Health and Social Care is responsible for

“oversight of NHS delivery and performance”

but if he is unable or unwilling to intervene to correct such absurd commissioning we have to ask what real power he has to perform the role. That is the kind of systemic problem that adds up to the workforce crisis we have all talked about and which proper accountability would go some way to solving.

The website states that the other part of the Secretary of State’s role is

“oversight of social care policy”.

Social care policy is key to NHS workforce planning and supply in England. We all recognise that social care provision is in crisis, and that the crisis gets worse the longer we do not address it. As it grows, so does the pressure on the NHS, which is left dealing with the serious health problems of those who did not receive the routine care they needed. The Government cannot go on delaying simply because of the personal embarrassment of having failed so far. To be fair, they are not the only ones responsible. Neither are they the only ones who can come up with a solution. We need to reach across divides and look for a cross-party solution.

I have written to the Secretary of State for Housing, Communities and Local Government and to the hon. Member for Denton and Reddish (Andrew Gwynne), the shadow Secretary of State, to invite them to join me so that between us we can constructively use this deadlocked Parliament to reimagine and then redesign a social care system that could provide us with the care we might want for our parents, ourselves or, indeed, in the future, our children. I hope that we can work together to create a new deal for social care and a chance to turn this logjammed Parliament into one of the most productive in history.

The lack in the workforce has a profound impact in each of the areas I have talked about. Common themes and problems emerge: there is a lack of planning, as well as short-sightedness and a failure to invest in preventive care or to understand that providing healthcare is harder in rural areas, as are recruitment and retention. The Government must plan to overcome those specific challenges as part of their overall strategy. The Government, in not taking responsibility for the workforce crisis, are creating huge problems for generations to come. We need accountability, both for the current workforce crisis and to ensure that we invest in long-term solutions beyond the next Prime Minister, the next Government and even the next generation.

NHS Dentists: Cumbria

Tim Farron Excerpts

Wednesday 3rd July 2019 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

I beg to move,

That this House has considered the provision of NHS dentists in Cumbria.

It is a pleasure to serve under your chairmanship, Sir David. I am grateful for the opportunity to raise an issue of enormous importance to my constituents and many others around Cumbria.

NHS dentistry in Cumbria has reached breaking point. More than half of all adults in our county have not had access to an NHS dentist in the last two years, while one in three of our children does not even have a place with an NHS dentist. In rural areas such as ours, lack of access to an NHS dentist results in families having to make ludicrously long journeys to reach the nearest surgery with an available NHS place. Often, people are not able to make, and simply cannot afford, those journeys for a simple check-up.

[Jim Shannon (Strangford) (DUP)]

The hon. Gentleman refers to his constituency, but the problems occur across the United Kingdom of Great Britain and Northern Ireland. Does he agree that the lack of dentists in rural areas is incredibly disconcerting? Perhaps we need to look at bigger incentives for those willing to open a rural practice, and incentivise those training in dental surgery, since one in five has to wait three months to have dental surgery. In other words, a rural strategy is needed.

[Tim Farron]

The hon. Gentleman makes a good point; in a moment I will come to some answers to those problems. The challenge is especially acute in rural communities when it comes to attracting and retaining dentists to work in NHS practices in places that are relatively close to people’s homes.

[John Woodcock (Barrow and Furness) (Ind)]

I congratulate the hon. Gentleman on securing this debate on all our behalves. The problem affects not just rural areas but more remote urban areas such as Barrow. Does he share my huge concern that people in Barrow face a 90-mile trip to Whitehaven if they want access to a new NHS dentist? That is the longest trip in England, for a town where more a third of young people suffer tooth decay, compared with 5% in more affluent areas.

[Tim Farron]

The hon. Gentleman makes an excellent point, which I will come to. He is absolutely right that the distance from the nearest available treatment affects urban as well as rural areas. It is a problem across the country that relates specifically to the NHS dental contract, which I will come to in a moment.

According to the most recent data available, taking a child living in Windermere to their nearest NHS dentist will involve a 60-mile round trip to Morecambe in Lancashire. That will mean a three to four-hour journey by public transport, with multiple changes. However, poor signposting by the NHS—it was not easy to decipher—means that that place is not obviously available. The nearest place advertising for new child NHS patients is in Appleby, which is an 87-mile round trip—two hours in the car or a five to six-hour round trip by public transport. It was only with the help of the British Dental Association that we managed to identify availability at the far-distant yet ever so slightly closer practice in Morecambe.

I am sure hon. Members will agree that this is beyond ridiculous. NHS dentistry is a public service. It should not take scouring the internet forensically with a fine-toothed comb and with the expert help of a national professional body to find a space for a child with an NHS dentist. That space has already been paid for through our taxes. Let us imagine for a moment the outrage if it were similarly impossible for people to get access to a GP.

For adults, the situation in Cumbria is even worse. I was appalled to discover that the nearest practice with available NHS provision for a new adult patient in Windermere involves a 98-mile round trip by car to Wigton—a six-hour round trip by public transport, involving three different trains and bus rides. The nearest practice that is adverting is even further away and involves a 104-mile trip, there and back, to Alston, taking over six hours by public transport. After that, the next option listed involved going 123 miles there and back to Blackpool.

Despite those obstacles, families in our communities are still trying to secure places at dental practices but are refused. In Sedbergh, Windermere, Grange, Ambleside and Kendal, dentists are working to their full capacity and even beyond, and are doing a brilliant job, but they simply do not have the numbers or the funding to meet demand. The Government have, cleverly or accidentally, dodged confronting the extent of the problem by doing away with official waiting lists. For the last six years, the NHS has held no waiting lists locally or nationally, and patients cannot depend on their clinical commissioning group or NHS England to support them in their quest to find a dentist who will treat them or their children. Will the Minister rectify that and ensure that reliable and up-to-date waiting lists are kept from now on?

We took the matter into our own hands locally. The Westmorland Gazette and I rang round our local dental surgeries to see whether there was availability, and found that in Kendal, not one of the 10 dental practices in our biggest town had a single space available for an NHS patient. Some 33% of new patients tried and failed to get a dentist appointment in the wider Morecambe bay CCG area last year. That is the equivalent of nearly 16,000 people. When we include those already on the books with a dentist, that figure rises to 18,000 people, and they are just the ones who have tried. That is a disgrace, and the situation is only getting worse.

The consequences should not be underestimated. Children across Cumbria have some of the worst dental health in England, with one in three suffering tooth decay by the age of five. In some areas, almost 20% of children under three have tooth decay, and a fifth have tooth decay when they are still toddlers. Often, that does long-term damage to their oral health before they even have the opportunity to make decisions for themselves. If children cannot see a dentist in a regular and timely way, preventable conditions become emergency conditions and the pressure is piled on NHS services, along with all their other responsibilities.

Nationally, tooth decay is the leading reason for hospital admissions among young children, despite being almost entirely preventable. In 2017-18, over 45,000 children were admitted to hospital to have multiple teeth extracted under general anaesthetic because of tooth decay. Children face completely unnecessary pain and distress, and the NHS faces a £36 million annual spend for that dental work. Dentistry in Cumbria is understaffed, underfunded and overstretched. Although this a local problem, it is a symptom of a systematic one, the effects of which are felt right across the country.

The primary cause of the increasing problems with dental access in Cumbria and across England is the way that this Government choose to commission dentistry. The NHS dental contract is completely perverse. Based on units of dental activity, it sets quotas on the number of patients an NHS dentist can see and the number of dental procedures they can perform in any given year. If a dentist delivers more than they have been commissioned to do, not only are they not remunerated for the extra work, but they have to bear the cost of any materials used, any necessary laboratory work or other overheads from their own pockets.

That is not the only issue. Last November, I managed to secure the agreement of health bosses to increase the contracts of local NHS dentists in Kendal, so that they could see and treat more patients. It was great news—I thought. However, when NHS England contacted our local dentists, it found that not one of them was able to take up its offer because, as it told me,

“the practices are already working to capacity within the staffing resources they have available, reporting they are having difficulties recruiting additional staff.”

Additional resources were made available, but there were not the dentists to provide the service for local people.

The problem is at least in part the result of the contract, which pays a set amount for particular types of treatment, in some cases regardless of the number of teeth the dentist is treating. In practice, that means that a dentist gets paid an average of £75 for an entire course of treatment, including six fillings, three extractions and a root canal, but that is not enough to cover their overheads. They get paid exactly the same amount of money for a single filling. That acts as a serious disincentive for dentistry, full stop, but especially in more deprived areas, where evidence shows that more significant treatment is often required.

Perhaps the most significant issue with the current dental contract is that it totally fails to provide any serious recognition or budget for preventive work. The work of educating adults, parents and children to maintain good dental health receives no funding, despite the fact that that would significantly ease the burden on dentists and the NHS as a whole further down the line. Indeed, check-ups are the smallest and least-remunerated part of the unit of dental activity worksheet. As a consequence, there is no massive incentive to up the number that a dentist does.

None of that is helped by the Government’s decision to cut £500,000 in the last few months from Cumbria’s public health budget this year, undermining vital preventive work, especially in our schools. Nor does it help that we are currently in limbo when it comes to the future of emergency dental services under the soon to be defunct Cumbria Partnership NHS Foundation Trust. Will the Minister tell me which trust will be responsible for emergency dentistry in south Cumbria after October?

Morale among dentists practising in the NHS is at an all-time low. The latest British Dental Association membership survey shows that nearly three in five dental practitioners in England are planning to scale down or leave NHS work entirely in the next five years. Those with the highest NHS commitments are the most likely to want to leave. In recent months, I have received countless letters at an increasing rate from residents, many of them very elderly, asking where they can go for dental treatment, as their current dentist has gone private and they have effectively been kicked off the list. A lot of parents have contacted me saying that they have been asked to pay now that they have been kicked off their local dentist’s NHS list. If they pay, the dentist might provide NHS provision for their children. It strikes me that that is a form of bribery. Many parents cannot afford to pay for themselves just so their children can get free care. That is not right.

The current system also fails to use the skills of all dental staff to their full potential. The NHS dentist contract restricts the initiation of a course of treatment to dentists alone. I met the British Association of Dental Therapists, which explained that dentists often refer the patient to a therapist to carry out the treatment if it is within the remit of their qualification. The fact that that can be begun only by a dentist creates a bottleneck that prevents patients from receiving the treatment that they need when they need it. The dental therapists made the case to me—and, I believe, to the Government—for reforming the system to allow them to initiate a course of treatment, ease some of the burden on dentists, and enable patients to be seen more quickly. I ask the Minister to action that request, or at least to look into it as a matter of urgency.

I welcome the Government’s steps to reform the system by beginning to carry out a few pilots and trials in different forms of commissioning, but the pilots have not gone far enough, there are not many of them, and the proposed systems do not provide a complete break from the old “unit of dental activity” system. Rather, they blend it with new systems. In the face of the crisis that we have on our hands, I am afraid that a piecemeal change is simply not enough for the people of Cumbria. We need total system reform. The Government need to sit up, take notice and change the contract so that people get the dental treatment they need. The current system is unjust, not fair to dentists and patients, and not fit for purpose. It is not good enough for Cumbria.

Urgent action is needed to roll out a system that fairly rewards dentists for the work they do, includes incentives for preventive work and allows all dental practitioners to use their skills to their full capacity. If we want our NHS dentists to feel that their vital work is valued and not to feel encouraged to move into working privately or give up the profession altogether, we need to take swift, far-reaching action. We need a funding system that does not feel like a treadmill, that rewards preventive care and that is not riddled with unfairness, idiosyncrasies and perverse incentives.

Those of us living in Cumbria are seeing the colossal impact of the current system on the health of children and adults alike, and we are further affected by the huge distances that we have to travel to get care, if we are lucky enough to stumble across an NHS dentists with available space. My question to the Minister is this: what action will she take to provide my constituents with the NHS dental healthcare that they desperately need and that their taxes have already paid for?

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

It is a pleasure to serve under your chairmanship, Sir David. I thank the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing this debate. He raised some important issues about dentistry, some of which are national problems that I have been looking at since I came into this role about three months ago, and some of which are pertinent to both the urban and rural areas of Cumbria—I know that there are problems in the constituency of the hon. Member for Barrow and Furness (John Woodcock) relating to geography and economics. I will talk a bit about what we are doing nationally, but of course there are some distinct issues to do with the geography in Cumbria.

Cumbria has struggled to attract dentists. The hon. Member for Westmorland and Lonsdale has raised that issue, which I take very seriously, on many occasions. National access to NHS dentistry is high, but I know from my conversations with colleagues from across the House that there are notspots, and that in isolated areas it is very difficult to get to a dentist. We are taking steps to address that issue to ensure that everyone has access to an NHS dentist. It is NHS England’s responsibility to commission dentist services to meet the needs of local people, and it has been actively looking into dental access issues in Cumbria. Its regional team covers my constituency, so it is looking at Lancashire and south Cumbria together. It has urgent work in hand to explore and implement schemes to improve local access.

In south Cumbria, NHSE will be working to help practices that are under-delivering on their contracted levels of dental services. If despite that support a practice remains unable to deliver its full contracted level of dental activity, the unused funds will be diverted into other local practices. NHS England believes that that could support care for about 3,000 patients. Alongside that, work is being taken forward across Lancashire and south Cumbria to integrate dental services within primary care networks. It is important that dentists are part of the integrated primary care network team, enabling oral health advice and prevention work to be offered across the primary care network. Oral health needs, including gaps in services and access difficulties, must be part of the wider health picture. The hon. Gentleman touched on that when he talked about access to GPs.

That is the local action. I want to touch on what we are doing nationally.

[Tim Farron]

The Minister made a very interesting point about people who under-deliver on their contract. It is important that we do not misunderstand what that means. A dental surgery can be working flat out, but if it is, for example, spending more of its time doing preventive work or reacting to people who want consultations and so on, it gets only one unit of dental activity for that. It could be absolutely full to the brim but be doing the lower-tier work just because that is how it is, reactively. That dental surgery is not failing or not working hard enough. It is doing the preventive stuff that we want it to do more of, but the UDA system, with its perverse incentives, does not reward that.

[Seema Kennedy]

The hon. Gentleman anticipates my speech: I will talk about contract reform later. He knows much better than me that the problem with the previous contract was that it was introduced with perhaps a bit too much haste, and we are now living with the consequences. We are mindful that we need a contract that works well and is sustainable for the future.

Nationally, we are introducing so-called flexible commissioning, which allows local NHS commissioners to commission a wider range of services from dental practices. That is expected to make NHS dentistry more attractive to new performers. Another key recruitment and retention challenge—of course, this is not confined to dentists; it applies to a whole range of healthcare and other professionals—is the growing demand among younger dentists for more varied portfolio careers. NHSE is working closely with Health Education England and a wide range of stakeholders to make portfolio careers a reality for dental professionals, allowing dentists to move between specialities such as prevention, restorative work, oral health and special care dentistry.

We want UK-trained dentists in the NHS, and we want them to stay in those careers, but dentists from overseas also play an important part in delivering NHS care. I am pleased that the NHS and the Government have taken steps through the launch of the EU settlement scheme to maintain that essential supply of dedicated and skilled workers, including European economic area-trained dentists, when we leave the EU. Last summer, doctors and nurses were removed from the tier 2 cap, leaving more places for other highly skilled professionals, including dentists.

The interim NHS people plan, which was published early last month, commits to creating a capable and motivated multidisciplinary dental workforce of a sufficient size to meet population health needs. The full people plan will be published later this year.

We are working closely with NHSE to reform the current dental contract. Feedback from dentists who are testing the prototype contract suggests it is a more satisfying way of delivering care. It supports a better skills mix, allowing dental care to be supported by a wider range of staff, such as therapists and hygienists. At a meeting a couple of weeks ago with a wide range of dental stakeholders, I announced that a further 28 dental practices had joined the programme, bringing to 102 the number of practices that are testing the new prevention-focused way of delivering care. NHSE is considering carefully when that approach can be rolled out more widely across the NHS. It is important that we get the new contract right, but I am hopeful that the roll-out will happen as soon as possible.

I want to touch briefly on three questions hon. Members asked. The first and most important was about children’s oral health. I heartily agree with the hon. Member for Westmorland and Lonsdale about the importance of children’s oral health and all the preventive measures the Department can take to protect children’s teeth. He rightly pointed out something that not all hon. Members are aware of: the biggest cause of emergency admission for children is poor oral health. Of course, that is entirely preventable. The Government are committed to that, particularly among deprived children. We have made the Starting Well approach available to other NHS England commissioners, and that is promoting increased access and early preventive care for very young children.

--- Later in debate ---

[Tim Farron]

Just so the Minister is fully aware of the facts—I know this predates her time in this role—the NHS talked in its long-term plan about its vision for early identification of conditions of all sorts, and about preventive care, and then literally a fortnight later, just before Christmas, the settlement for public health spending for Cumbria was reduced by £500,000. I would be grateful if the Minister intervened to ensure that that does not happen again, because it has a huge impact on our ability to keep children in good practice in their early years so they have good dental health.

[Seema Kennedy]

Of course, part of prevention comes from the public health budget. That now sits back with local authorities, which is where it was historically, and of course—the hon. Gentleman knows my constituency well, having grown up there—there are different needs in different areas. What the NHS does through the immunisation and screening programmes is also part of that aspect of preventive health, but I take on board his comments about the specific public health situation in south Cumbria.

I hope the hon. Gentleman is reassured that significant action is being taken locally in Cumbria and nationally, both now and for the future, to improve access to NHS dental services. The new prevention-focused dental contract in particular, which is a key part of our reforms, should attract people to and keep people in the dental profession, and make dentistry a more varied and rewarding career. It will ensure better access to dentistry in places such as Cumbria and across the country for all our constituents.

Question put and agreed to.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 18th June 2019 Commons Chamber

[Mr Speaker]

What is not rubbish is the very pithy line of questioning typically deployed by the right hon. Member for New Forest West (Sir Desmond Swayne). I will call the hon. Member for Westmorland and Lonsdale (Tim Farron) if his question consists of a sentence, rather than a speech.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Access to prescriptions is made much harder given the closure of 233 community pharmacies in the last two years, so will the Minister introduce an essential community pharmacies scheme to support rural pharmacies such as those in Cumbria and keep them open?

[Mr Speaker]

Well done.

Health

Tim Farron Excerpts

Tuesday 14th May 2019 Commons Chamber

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is an honour to follow the hon. Member for Chichester (Gillian Keegan), with whom I work closely and proudly on the all-party parliamentary group on radiotherapy.

When the NHS long-term plan was published, the emphasis on strengthening preventive care was a welcome step in the right direction. Good preventive care and public health are kinder and cheaper than the late interventions that are often caused by not addressing issues that could have been spotted earlier.

The Government’s actions since then suggest that their commitment to preventive care was little more than smoke and mirrors. Having loudly proclaimed their commitment to preventive healthcare, Ministers ever so quietly, ever so slyly, just before the Christmas recess, sneaked out £85 million-worth of cuts to public health budgets. That money is used for key services, as we have heard, such as preventive mental healthcare, preventive physical healthcare, “stop smoking” clinics, sexual health clinics, and drug and alcohol misuse services. The Government may say that public health spending is the decision of local authorities, but all they have done is give them the responsibility to care for their communities while leaching away much of the resource that would enable them to do so. Councils’ public health budgets, which fund school nurses and public mental health services, have been reduced by £600 million since 2015. In Cumbria, the public health budget is set to be slashed by half a million pounds, and it is one of the 10 local authorities receiving the least money per head from the Conservative Government. Cumbria’s spending is now set to drop to just £36 per head—barely half the national average of £63 per head, and ridiculously lower than that of the City of London, which receives £241 per head.

The impact of this has of course been tangible. School nurses not only provide a host of services but are a valuable source of health education for children and young people—a place to turn to as they try to navigate the complexities of adolescence. The removal from schools of health professionals who contribute so much to children’s health education means that children are vulnerable to slipping into bad mental, dental and physical health. In 2015, the coalition Government made a commitment to spend £25 million a year on Cumbria’s public health, but cuts to spending since then mean that Cumbria gets less than £18 million a year. Pernicious, heavy cuts to the public health budget mean that Cumbria now only spends a pathetic 75p per child per year on preventive mental health care.

In the face of this, young people themselves are determined to fight for better mental health provision. In my constituency, the CAMHS crisis service was not available at the weekend or after school hours in south Cumbria until our community campaign forced local health bosses to change this. But we still have an awfully long way to go. Proper investment in public health budgets would allow us to place a mental health worker in every school. The key to young people being resilient and healthy, and to making sure that problems do not become so severe further down the line, is surely to do just that.

The Government’s failure to take prevention seriously puts at risk a range of preventive health measures—physical as well as mental. I very much welcome the Minister to her new role. She is the most senior Blackburn Rovers supporter to sit on the Front Bench since Jack Straw; I hope she does far better than he. The question that she must answer is this: when the Government verbally prioritised preventive care but then cut public health by £85 million, were they being deliberately cynical or was it mere incompetence? Either way, will she fix this matter and restore public health funding to Cumbria and elsewhere so that we can tackle mental and physical health problems before they become tragically serious?