Oral Answers to Questions

Wera Hobhouse Excerpts

Tuesday 1st November 2022 Commons Chamber

[Steve Barclay]

Very much so. The hon. Member for Ilford North (Wes Streeting) asked about a taskforce. With our colleagues in NHS England, we launched a “delayed discharge” taskforce with a “100-day challenge” over the summer; we have also set up an international recruitment taskforce within the Department to prioritise the establishment of a “clearing house for care”. I will not add further to my answer, other than to say that this is a key area of focus.

[Wera Hobhouse (Bath) (LD)]

T3.   I recently visited a local GP surgery which is short of a third of the staff that it needs. Surgeries are finding it increasingly difficult to retain staff owing to stress and burnout. Do the Government recognise that it is stress and burnout that make it so difficult for us to retain GPs in their profession, and for them to retain their staff? If so, what on earth are they going to do about it?

[Steve Barclay]

The wellbeing of staff—especially in the NHS, and especially after the pressure of the pandemic—is a crucial issue, and one on which I have focused in particular since returning to the Department. I look forward to having discussions about it with the hon. Lady.

NHS Dentistry

Wera Hobhouse Excerpts

Thursday 20th October 2022 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

I have been horrified—honestly horrified—to hear reports of people pulling out their own teeth because they are unable to see a dentist. Unfortunately, that is now a reality as a result of Government underfunding of dentistry over many years. In my constituency, only three in 10 patients have seen an NHS dentist in the past two years and only six in 10 children have been able to see a dentist in the past 12 months, although the NHS continues to recommend that all under-18s see a dentist at least once a year.

The way in which the Government have let the NHS dentistry system collapse is a national scandal. Nearly a quarter of all British people have failed to secure a local NHS dentist appointment in the last year. Of those, one in five have resorted to what we now call DIY dentistry, which is terrible. Our public services are so starved of funding that people are being forced to stop trying, or to pay for private treatment. The British Dental Association says that we are facing an “existential threat”. People’s health is at risk if they do not have access to dentistry. Tooth decay is the No. 1 reason for hospital admissions among young children. Oral cancer is one of the fastest-rising types of cancer, and claims more lives than car accidents in the UK: we should remember that.

People in deprived communities are the most likely to suffer. Healthwatch research shows that those on lower incomes are worst hit by appointments shortages. The problem has been made worse by the pandemic, which increased the backlog, but the problem was there before. Limited access to such primary care means that problems cannot be caught early. People should not be facing a choice between being left in pain and paying for private care as we head into this difficult winter. We must do all we can to make sure that they can access the right services and that we address these profound health inequalities.

One of the major reasons for the backlog is staff shortages in the NHS. The number of NHS dentists is falling: one in eight is approaching retirement and 14% are close to leaving the profession. My constituents have been particularly affected: nearly 15% of dentists have been lost from Bath clinical commissioning group since 2016. At a time when demand for NHS services is increasing, we urgently need a strategy to plug these very big staffing gaps.

The Government admit that they do not know how many dental practices applied to access the extra £50 million of funding announced earlier this year. To me, that means that they are asleep at the wheel. The Government must make sure that we have enough dentists if support for the sector is to be effective. We need increased numbers of dentist training places in the UK and continued recognition of EU trained dentists’ qualifications. Dentists must be incentivised to take NHS payments and there needs to be more funding for the sector to meet patient demand. Everyone in the UK should be able to access a dental health check-up on the NHS. Proper workforce planning for health and social care must be written into law, including projections for dentists and dental staff.

The crisis facing NHS dentistry is on an unprecedented scale. Although it has been worsened by the pandemic, the emergency is not new. Most importantly—I am repeating what many have said this afternoon—the Government must reform the NHS dental contracts, which create absurd disincentives for dentists taking on new NHS patients. A review was promised earlier this year. Where is it? Oral health cannot be treated as an afterthought and my constituents cannot wait any longer.

[John Glen (Salisbury) (Con)]

I rise to speak on behalf of a number of dentists in my constituency. Nicola Jones, an oral surgeon at Salisbury District Hospital, contacted me to say that the lack of available NHS dentists is causing significant challenges in the constituency. I recognise that from my mailbox over recent weeks. I met Matthew Clover, a specialist orthodontic practitioner, in February. He took me through the challenges of the “units of dental activity” model: it does not discriminate properly when it comes to the classification of the different activities that he has to undertake.

The challenges derive primarily from the lockdown two years ago and the interruption to supply: 38 million appointments were lost. I welcome the Government intervention earlier this year to provide the additional £50 million and 350,000 additional dental appointments. I also welcome the Government’s statement in July, but this is an opportunity for the new Minister to challenge his officials and work with industry representatives to find a deeper and more enduring set of changes that address some of the ongoing challenges that have existed for a very long time.

I would not suggest that I have anything like the expertise of my hon. Friend the Member for Waveney (Peter Aldous), the hon. Member for Bradford South (Judith Cummins) or, particularly, my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who has a lifetime of experience at policy level and as a practitioner. But I am aware that since 1951 there has been a model of co-payments, in which dentists act as independently contracted professionals to the NHS but also typically receive an income from private practice work as well.

[Wera Hobhouse]

The hon. Gentleman makes a very good point that, basically, private patients have been cross-financing NHS patients, but that model is no longer sustainable.

[John Glen]

I respectfully say to the hon. Lady that my mother is a resident of Bath and has received excellent service from her NHS dentist. Although I recognise this problem exists in different spots of intensity across the country, it needs a comprehensive solution.

The fundamental point is this: how can the model of rewarding dentists incentivise the maximum amount of engagement? All dentists start their professional life wanting to help people and wanting to do as much good as they can. I totally embrace what my hon. Friends the Members for Mole Valley and for Gloucester (Richard Graham) said about the need to deal with the oral health and education of young people, including how to clean their teeth at an early age. There will need to be a focus on how those practices can be embedded in a funding model that has to pay some respect to the geographic coverage of a dentist, while ensuring that each cohort of the population has access to basic dentistry.

The proposed new dental contract goes some way towards dealing with some of the challenges of the UDA model, but it probably does not go far enough. I urge the Minister to go beyond what his officials may be suggesting to him, to think radically and to take this opportunity to ask, “How can we reset after the dislocations caused by covid?” I urge him to come up with something that incentivises dentists to offer an holistic service to people of all means and to help those communities that have cold spots of dentistry supply.

I would like to make a few observations about supply and, again, my hon. Friend the Member for Mole Valley made some very good points about streamlining bureaucracy to ensure more people qualify as dentists in this country. Of course, it is right that we have ongoing quality assessments through the CQC, but that organisation’s focus, as across all industries, needs to be on where there are vulnerabilities and risks. When we think about NHS medical and dental services, I feel we are continually trying to be perfect and to remove all the risk, which sometimes has a cost because it involves using resources to fill in bureaucratic processes that might not necessarily, in most cases, give us much return.

My message to the new Minister is to build on the good start made by his predecessor in the summer, but to consider a more radical and fundamental review of the UDA funding model, to consider the volume of patients and to consider the real dynamics of the choices a dentist makes about how to maximise the number of patients they see who cannot afford to make a contribution.

I feel hopeful that the enthusiasm to provide the service I saw from my dentist in Salisbury means there will be a solution. I wish the Minister well, and I acknowledge the contribution of my hon. Friend the Member for Waveney, who showed a mastery of this subject.

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[Peter Dowd]

I am grateful to the right hon. Gentleman, who reinforces the point that I am trying to make. We are being contacted by constituents, as I have just set out. We are being contacted by Bupa—I suspect that Members will have had a briefing. We have had a briefing from the British Dental Association. We have had contact directly from dentists. They are all saying exactly the same thing and the Government have to listen. Not only do they have to listen—it is dead easy to do that—but they have to act. The Government have to put their hand in their pocket. So let us stop pretending that £50 million just before the summer is going to do anything in any significant or substantive way to resolve this problem—it is not.

The hon. Member for Bath (Wera Hobhouse) referred to an existential threat, and there is one—dentists are telling us that, as is the BDA. In practical terms our constituents are saying that to us, because their experience shows that there is an existential threat. The contract is a discredited one and it needs to be put right; it puts targets ahead of patient care. But this is also down to the fact that, whether we like it or not, and whether the Government like it or not, cuts in dentistry have not had any parallel to any other cuts in healthcare. We are talking about cuts of more than 25% between 2010 and 2020. That factors in and it creeps up on us year after year until we get to the situation where access to dentistry is the No. 1 issue raised with Healthwatch.

[Wera Hobhouse]

I was pleased to hear that the mother of the hon. Member for Salisbury (John Glen) has had excellent NHS dental care in Bath, and of course dentists are excellent practitioners and professionals. The thing is that his mother will have been a long-term NHS patient and the problem is that dentists do not take on new NHS patients, because the dental contract completely disincentivises them to do so.

[Peter Dowd]

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

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

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

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

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

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

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[Will Quince]

I certainly do welcome that, because this is not just about commissioning, but about accountability and oversight.

Our changes will allow NHS commissioners to have more flexibility in commissioning, and I think that is really important, because if they have that flexibility in commissioning additional dental services, they are the ones who know the local need within their area. I want to see far more responsive management of contracts, so if they have underperforming practices and practices that can do more, we should enable such practices to do that. For example, a high-performing practice should be able to deliver beyond its existing contract to make up for the fact that a neighbouring practice is not doing so. That addresses some of the points made by my hon. Friend the Member for Waveney about the clawback of UDA funding at the end of the year, and then its not necessarily being spent on dentistry. As part of that, I also want and expect more transparency. We will make it a requirement for NHS dentists to update the information on their NHS website, so people can see which dentists are accepting new NHS patients for treatment.

On that point, I want to bust the myth about being registered with a dentist. There is no such thing as being registered with a dentist or a dental list. People approach an NHS dentist for specific treatment. They go on their list, register and have the treatment. They can have an ongoing relationship with a dentist, but anyone can book an appointment with any dentist with an NHS contract, regardless of where they live in the country. It is important to get that message out, because when our constituents say to us, “I can’t get a dentist locally”—I want to address that point—I want to ensure that they know that they could travel to a neighbouring town or city. They could travel half way across the country if they wanted to, for example if they had relatives there, if there was a NHS dentist who had capacity to see them.

[Wera Hobhouse]

Does the Minister recognise that because of the abnormalities of the dental contract, and dentists not knowing which patients they are getting, NHS dentists would rather take a patient whom they already know, and whose history of dental problems or otherwise they know, rather than taking somebody they have never seen? There is a disincentive to take on new patients, but there is a continuity for those who are already with an NHS dentist.

[Will Quince]

Of course I take that point—it is a fair one—and when those who seek NHS treatment have an ongoing relationship with a dentist, they are more likely to get seen. When considering reforms to the system we will certainly take that point on board.

Vaccine Damage Payment Scheme: Covid-19

Wera Hobhouse Excerpts

Tuesday 6th September 2022 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

My constituent did what she believed was right by getting vaccinated, but was one of those who had a blood clot after vaccination. The clot caused her to have a stroke and now she is unable to work. Her family are very concerned that she is going to be classed as not disabled enough to get a damages payout. Does the right hon. and learned Member agree that we need to look at these rare and few cases where people have suffered but might be falling through the net?

[Sir Jeremy Wright]

I am sorry to hear about the hon. Lady’s constituent and I agree with her. It is important that we do something differently for what she rightly says is a relatively small number of cases. If she bears with me, I will come to the exact point she makes about disablement, as it seems to be a deficiency of the scheme.

I have mentioned the VDPS and, of course, all help for those injured by vaccines is welcome. However, in my view there are three things wrong with the scheme and I will say something about each of them. The first is that it simply takes too long to pay out. The VDPS is a no-fault scheme, but it requires, not unreasonably, a causative link between vaccination and injury to be established. The problem is the time it seems to take to establish that link in the minds of the scheme’s administrators, even in cases such as that of the Scotts, where consultant opinions are clear and unequivocal. The Scotts’ application under the scheme was submitted on 3 June 2021, and was finally approved on 20 June 2022. According to the latest figures that I have—it may well be that the Minister has more up-to-date figures—there are 2,407 applications to the scheme related to covid-19 vaccines, and cases are currently being processed at the rate of 13 a month. At that rate, it would take more than 15 years to process all the cases.

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[Jim Shannon]

I thank the right hon. and learned Gentleman for his words of wisdom. Minister, there is an easy option sitting before us. I agree with the right hon. and learned Gentleman: in my book, I believe if we can do it the easy way then we should. Let us address the issue in a way that gives the Government less hassle, satisfies the needs and requests of our constituents, and ensures that we can move forward.

In terms of clotting, as of June this year there were 444 cases of blood clots out of 49 million doses of AstraZeneca given. There is still evidence that not all those were caused by the vaccine. Regardless of that, why should we not be speaking out on behalf of those who have been impacted? There is no amount of money in the world that can fill the void of loss—it cannot be measured in pounds and pennies—but we must do our best to ensure that the process of vaccine damage payments is timely and simple.

That is what we are asking for; I do not think we are asking for the world, but for something that can be done very easily—in my simplistic way of looking at things—by Government. They can do it in a way that can give succour right away and thus do away with the thoughts and process of litigation, which would be long, laborious and much more expensive.

[Wera Hobhouse]

Is the problem not the fact that those affected cannot go to court because of the civil immunity that the manufacturers and suppliers of the covid vaccine have received?

[Jim Shannon]

It certainly is. Things are never straightforward and there are complex issues. However, today our request is quite simply on behalf of those who have contacted the hon. Member for Central Ayrshire and each and every one of us. We have them in Northern Ireland as well; some of my constituents have been impacted. I think it is really important that we do that.

Ambulance and Emergency Department Waiting Times

Wera Hobhouse Excerpts

Wednesday 6th July 2022 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered waiting times for ambulances and emergency department care.

It is a pleasure to serve with you in the Chair, Mr Stringer, and I am pleased to see so many Members here to discuss the highly concerning issue of the unacceptably long waiting times patients in our constituencies endure to access emergency care.

Our urgent and emergency care system provides a vital service supporting a significant number of patients with a huge variety of medical conditions, ranging from acute emergencies and trauma to mental health crises, the care of our homeless population and care of elderly patients. Emergency care should be there for all of us when we need it. Few of us plan to attend emergency departments, but we are all potential patients.

Covid-19 has had a detrimental effect on our ambulance services. More and more people are calling ambulance services or attending A&E because they are having difficulties accessing other, more appropriate parts of our health system. National NHS performance figures illustrate that our healthcare service does not have the capacity to meet demand, and during May 2022, only 60% of patients were seen, admitted or discharged within four hours of their time of arrival. We should all be worried by those figures, which demonstrate that the health service is unable to meet the needs of patients with current levels of resource and capacity.

I want to share the example of the Royal United Hospital in my Bath constituency. It demonstrates the severity of the problem and the way in which hospitals have to step in because the Government are not willing to accept that there is a real crisis. There have been several cases in Bath in which residents waited many hours for an ambulance. Recently, an elderly man was forced to sleep on the floor of a local church as it took 12 hours for an ambulance to arrive—12 hours. A GP surgery ran out of oxygen for a patient due to the time it took for the ambulance to arrive. Ambulance handover delays are a significant patient-safety risk at the RUH, and up to 90% of the causes of delay are linked to the availability of beds in the hospital.

The RUH has consistently been running with a bed occupancy of over 90% for the past year, which is significantly impacting the hospital’s ability to move patients out of the emergency department. The hospital is one of the most challenged in the south-west for “non-criteria to reside”—in other words, medically fit for discharge—patients, and NHS England is reporting that the RUH has 24.3% of its beds occupied by patients who are medically fit, which is the third highest figure in the south-west. That is driven by gaps in the domiciliary care and social care markets.

My local authority, Bath and North East Somerset Council, has been short of 1,600 hours per week, community teams are struggling to recruit and our local care group has a vacancy rate of more than 30%. The RUH is working with the council to develop its own in-house domiciliary care to try to plug the gaps, but the recruitment crisis remains acute. NHS England is assessing the trust and is trying to help to reduce the bed gap at the RUH. The hospital recently launched a “home is best” transformation programme that aims to increase the number of patients who go home instead of into a community hospital bed. Our hospitals are trying all this, yet there is a crisis. It is important that we recognise that, and that the Government recognise it and step in on behalf of the hospitals.

Our hospital in Bath is also working out ways to reduce the number of patients who need to go into the emergency departments in the first place, and has launched a same-day emergency care offer for frail patients. However, nationally, the lack of staffed beds has resulted in staggering numbers of patients waiting beyond 12 hours after the decision is made by the A&E doctor. There have been more patients waiting 12 hours or more from the decision to admit this year than there were in the entire reporting period leading up to 2022. In May, there were more than 19,000 patients waiting 12 hours or more from the decision to admit, yet research from the Royal College of Emergency Medicine shows that that number is only the tip of the iceberg. We know that far greater numbers of patients endure waits of 12 hours or more if the clock is started as soon as they set foot in A&E. Many more patients endure extremely long waits but are not captured by the current metric. We need to understand the true scale of the problem. If we do not know about the extreme delays that our patients are enduring, we cannot take action. Transparency is key, and reporting metrics from the moment of arrival at the A&E department must be the starting point.

Such delays mean that emergency services are not able to respond to 999 calls from critically ill patients. Instead, they are being held in stacks of hundreds each day, and staff are forced to prioritise among even the most serious cases. Staff have to wait with the patients in corridors, and sometimes even outside the hospital, unable to have them treated and unable to respond to new emergency calls. We must think very carefully about what that means. Behind every statistic is a patient. Those patients are stuck and have no choice but to wait for a bed to be freed up so that they can be admitted and can receive the care they need. Unfortunately, some patients end up on trolleys in crowded corridors with many other patients. We should be treating patients with dignity. We know that crowding is dangerous and is linked to avoidable harm and, in some cases, death.

The pressure that the NHS faces, which has been building over recent decades, has real detrimental consequences on the emergency medicine workforce and patients. Staff are considering reducing hours, changing careers or retiring early. Additionally, emergency staff face constant abuse from those left waiting, which is hugely distressing. The more people leave, the more pressure is created.

The Royal College of Emergency Medicine’s “Retain, Recruit, Recover” report detailed findings from its survey of emergency medicine clinicians. It found that 59% of respondents experienced burnout during the second wave of the pandemic, and described their levels of stress and exhaustion from having worked the second wave as higher than normal. The report found that operational pressures, patient safety and staff wellbeing are intrinsically linked. In 2021, the Royal College of Emergency Medicine highlighted a UK-wide shortfall of 2,000 to 2,500 whole-time equivalent emergency medicine consultants. The needs of our population’s health and wellbeing are greater now than they have ever been. We cannot afford to lose even more of the workforce at this critical time of need.

It is clear that this very serious issue is a matter of life and death for many patients. Among those who are suffering from serious but not necessarily prioritised issues, it is elderly and frail patients who are being hit the hardest. Although it is easy for the Government to point the finger at hospitals and management, it is clear that this issue needs to be addressed centrally at Government level. It is not exclusive to Bath or north Shropshire; it is a national problem, as the range of MPs in the debate demonstrates.

What is more, the consequences of a failed social care system, which does not allow for the timely discharge of patients who are medically fit to leave hospital, has resulted in further crowding and corridor care in our hospitals. The chief executive of NHS England recently acknowledged the important role that social care plays in supporting patient flow through hospitals. The Government must outline the steps they will take to ensure the social care system is adequately equipped ahead of next winter.

Last autumn, the NHS published a 10-point plan for the recovery of the urgent and emergency care system. It has no targets or timelines, and it lacks any indication of how progress will be reported. It details only how the whole system will work together to recover urgent and emergency services, focusing on immediate and medium-term activities. The plan aimed to

“mitigate against the current pressures felt across systems and improve performance in all settings”—

great words, but where are the outcomes? All that is happening is that the situation is getting worse.

The NHS standard contract 2022-23 was recently amended to change the way in which 12-hour waits in A&E are calculated. As a result, A&E is now collecting 12-hour data from the patient’s time of arrival, not from the decision to admit. Despite that, the Government and NHS England have not indicated when the data will be publicly available. Publishing the figures nationwide will allow for transparency across the system, so perhaps the Minister will tell us when that will be publicly available. That should lead to improvements.

The Liberal Democrats have been sounding the alarm bells for months, calling for an urgent investigation into England’s ambulance services and a review of ambulance station closures, but the Government keep turning a blind eye to the crisis. We are calling for more investment in local ambulance services, an urgent campaign to recruit more paramedics, and enabling trusts to restore community ambulance stations in rural areas in Devon, where waiting times are unacceptably long.

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

I found on the doorsteps in my part of Devon over the last month that pretty much every door I knocked on had somebody behind it with an anecdote about how ambulance waiting times had affected them personally. In south-west England we have the longest waiting times in the country. One paramedic told me that despite his very best efforts to treat patients, there were times when he came across very undignified scenes. He talked about one example of how he came across a lady who had fallen down and had to wait 14 hours for an ambulance to arrive.

[Graham Stringer (in the Chair)]

Order. I realise that the hon. Gentleman is new, but interventions should be short and to the point. I did not want to interrupt him, but I ask him to remember that interventions should be as brief and to the point as possible.

[Wera Hobhouse]

Thank you, Mr Stringer. I think every one of us has such stories from the doorstep. Almost everybody knows of a loved one or a friend who has waited an unacceptably long time. That is why it is so important that we get the urgent review that Liberal Democrats have been calling for.

We are calling for a formal inquiry. The Government need to fund thousands of extra beds to stop handover delays in A&E so that ambulances can get back on the road as soon as possible. Will the Minister comment on a formal inquiry into the crisis?

[Ian Paisley (North Antrim) (DUP)]

Fifty per cent. of the entire Northern Ireland budget is spent on the health service, which is a higher proportion than in the rest of the UK. But this is not just about the money. Does the hon. Member agree that it is about how the money is spent and managed, and that that is critical to any review?

[Wera Hobhouse]

Indeed. Not everything is always about money; it is also about proper management. At the heart of it all is transparency. We need to have the figures and to understand what the problems are. I echo the Royal College of Emergency Medicine: unless we have transparency, we cannot get to the bottom of the problem.

The Royal College of Emergency Medicine has already stated that A&E departments are not confident they will cope this winter. The Government simply cannot ignore this looming crisis on top of the existing challenges we face. They are running the NHS into the ground. With A&E wait times measured in hours instead of minutes, people are no longer confident that they can get urgent medical help when they need it. The Government need to start working with NHS staff to draw up a robust plan now to tackle the crisis in ambulance waiting times and emergency care, and start delivering. Thousands of lives depend on it.

[Several hon. Members rose—]

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[Edward Argar]

That is exactly what we are doing: we are leading and putting forward measures. Disappointingly, Labour voted against that extra funding.

[Wera Hobhouse]

Will the Minister give way?

[Edward Argar]

I just want to finish this point, but I will give way to the hon. Lady because it is her debate.

My hon. Friend the Member for Broadland (Jerome Mayhew) and others are right in their analysis that this is about patient flows. It is about a whole-system approach and the challenges across the system. My hon. Friend asked what the solution is to making the join-up work better. A key element of the solution is the new integrated care boards and integrated care systems, which genuinely seek to bridge the gap between two parts of the system, to which the hon. Member for Bath—health and social care. They both have, for want of a better way of putting it, different DNA. The NHS, since the legislation in 1946 and its implementation in 1948, has been essentially a vertical system, whereas we have retained local care by local councils on a social care level. This is an attempt to integrate them far more effectively.

[Wera Hobhouse]

It is not very helpful that we are entering into a party political ding-dong. There is a crisis, and we owe it to our constituents to face it. We are asking the Government, who are in charge, to do something about it.

[Edward Argar]

I am grateful to the hon. Lady, but when hon. Members raise party political points, it is incumbent on me as Minister to respond and to put the facts on the record. I will turn to the specific points she has raised. I will also turn, in that context, to the various points that she and the hon. Member for North Shropshire (Helen Morgan) made about various tangible suggestions from the Liberals on the issue.

The hon. Member for Bath is right to have secured and introduced the debate, because this issue is one of growing concern, understandably, and not just for all our constituents but for those who work on the frontline of our NHS. I think it was the hon. Member for Weaver Vale who highlighted the challenges faced by those staff, who want to be there and want to help. When someone rings for an ambulance, it is not a case of making an appointment with their GP; they are deeply concerned for their health, or the health of someone else, in an emergency. All those staff want to do—I have met many of them—is be there for those people, and the hon. Gentleman was right to highlight that issue.

As the hon. Member for Bath will be aware, the pandemic has caused significant strain across the NHS and the social care sector, and emergency care performance, as hon. Members have been open in acknowledging, is recognised as a whole-system issue. The challenges in performance can be traced along the entire patient pathway. Indeed, as I think the hon. Lady acknowledged in her Adjournment debate in the main Chamber on 31 March, although there are elements of that that we need to look at, we also need to look at the issue as a whole. She was right to say that.

For example, as hon. Members have said, the problems and delays in discharging patients home or to community services once they have recovered have a genuine impact on hospital bed occupancy—taking up beds that could otherwise be used by patients who need them. I want to give my hon. Friend the Member for Broadland a slightly more optimistic picture, which is in no way to diminish the challenge that remains. The number of beds taken up by people who are clinically fit to be discharged is not 20,000; it hovers at around 10,000. We have set up a national discharge taskforce, which is working actively with trusts and across local systems, particularly those that are most challenged, to support that discharge work. The situation is not as acute as he suggested, but it remains challenging because every one of those beds could be used to admit patients from an urgent and emergency care setting, or indeed to tackle elective backlogs and waiting lists.

--- Later in debate ---

[Wera Hobhouse]

I thank everybody who have taken part in today’s debate to highlight the deep crisis over ambulance and emergency care services. We owe it to all our constituents to ensure that the crisis is fixed, because it can be a matter of life and death. Last but not least, I want to thank the incredibly hard-working doctors, nurses, paramedics, ambulance drivers, reception staff and call handlers who work in our emergency care and ambulance services. They are doing an impossibly difficult job at a very difficult time. We cannot ignore the workforce crisis, and the stress and impact on the lives of the current workforce. We owe them our support here, and I want to assure all of them that all of us here will not go away until we see real progress and real improvement.

Question put and agreed to.

Resolved,

That this House has considered waiting times for ambulances and emergency department care.

Access to NHS Dentistry

Wera Hobhouse Excerpts

Thursday 10th February 2022 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I congratulate the hon. Member for Waveney (Peter Aldous) on securing this debate. He is almost an hon. Friend: we work on many cross-party issues together, so even though we are on different sides, I call him my friend.

It is important to say that this is not a debate to criticise dentists. It is about criticising a system that does not work. I want to pay tribute to all the dentists in my constituency, who have worked very hard, particularly during the pandemic, to keep the oral health of my constituency in as good shape as possible, but they have really struggled.

Oral health is an essential component of everybody’s health and wellbeing. Dentists play a crucial role in the early detection of a number of diseases, as we have heard, including mouth cancer. Problems accessing NHS dental services are on an unprecedented scale in every community. Morale among NHS dentists is at an all-time low, and 40 million NHS dental appointments have been lost since the start of the pandemic. All this has been made worse by the pandemic, but the dental crisis in our country far predates covid. It is a result of chronic underfunding and an unsustainable target-based dental contract.

My constituents have been contacting me about access to NHS dental services since I became elected. The biggest concern is that they simply cannot find an NHS dentist. One constituent told me:

“My disabled partner and I have been told that our dental practice will no longer do NHS dentistry for us after 35 years. We are on income support and cannot afford the private fees that are quoted to us.”

Another constituent told me that they could not find a dentist in Bath that could take their child. The closest practice they could find was a 40-minute car journey away. When another constituent needed fillings, she was given two temporary ones and told that anything more would incur private fees. She told me she was afraid to eat. This is the extent of my constituents’ misery.

According to a Healthwatch survey carried out in November, no NHS dentists in Bath and North East Somerset reported that they were taking on NHS patients. No practices reported that they were able to take on children under 18, and no practice reported that it would be able to take on new patients in the next three months. What is happening in Bath is happening across the country.

The single biggest problem with dentistry in the UK is that it has become privatised over decades. I do not want to accuse any particular party of this. It has been going on for a long time, and that privatisation has started to take over. There are around 12,500 dental practices in the UK, of which 30% are private, 15% are mostly private, and 15% are evenly mixed. That means that just 40% are NHS practices, but many of these have elements of private provision.

Fewer than 40% of adults in Bath and North East Somerset have seen an NHS dentist in the two years leading up to June 2021. Those who cannot afford private dental care often do not go until it is too late, and they end up needing emergency care. It is not that there are not any dentists in the UK. I know that there is a problem with the distribution of dentistry, but the biggest problem is that, increasingly, dentists do not want to work for the NHS.

The current crisis will not improve unless we make it viable for dentists to provide NHS treatments and make NHS dentistry a place where people want to work. Bath and North East Somerset, Swindon and Wiltshire CCG has lost 9% of its NHS dentists in the last year alone—the highest proportion in the south-west and over twice as high as the national average. Dentists in my constituency have told me that they want to provide NHS treatment but just cannot make it viable under the current conditions. They are hugely worried about the increase in the percentage of the pre-pandemic treatment levels that they are now expected to meet, and the mental health toll on our dentists is enormous.

The Minister has committed to reforming the system. This is welcome, but the pace of change is too slow and practices cannot increase the number of patients they are seeing on promises alone. Not only must the Government reform the current contract; it must do so urgently. The bottom line is funding. The Government must provide adequate resources as a matter of urgency to reverse the alarming decline of NHS dentistry and guarantee its long-term sustainability.

The current situation is nothing short of a scandal and simply unacceptable. Healthy teeth should not be a privilege only for those who can afford to pay for private dental care. More than 70 years ago, the founding fathers of the welfare state envisaged a country where the gross injustices between rich and poor would be eliminated for good. Let us not turn our backs on the principles on which our NHS is based. Oral health is as much a matter of access and equality as the rest of NHS care. To the hon. Member for North East Bedfordshire (Richard Fuller), we Liberal Democrats absolutely understand the importance of being prudent with the public purse, but equality should never be sacrificed on the altar of balancing the books.

--- Later in debate ---

[Peter Dowd]

I will come back to that in a minute. I am an optimist—hope springs eternal, as Alexander Pope said—and I hope the Minister will accept that there is a crisis. Perhaps then we can all move on, in a very collegiate way, as the hon. Member for Thirsk and Malton (Kevin Hollinrake) says, towards finding a solution, which he knows I am more than happy to do.

[Wera Hobhouse]

For the purpose of giving everybody a voice, would it not be most collegiate if we actually acknowledged that the dental contract was introduced under a Labour Government? It is important to address that, but it is also important to address the fact that the bottom line is public funding for a good service.

[Peter Dowd]

Frankly, the coalition, including the Liberal Democrat party, which the hon. Lady serves, could have sorted that problem out in the last 10 years, but they dithered, ducked and dived. Let us not go there. She is on dodgy ground in relation to that, I have to say.

Facts are stubborn, and here are a few. The Government have cut dental budgets by a third in real terms over the last decade. They are making a meal out of their recent time-limited £50 million injection into the service, or the so-called dental treatment blitz—a blitz that will barely blow the top off a toothpaste tube. I suspect that that £50 million—a veneer if ever there was one—is unlikely to be fully spent.

The bottom line is that we are in a crisis. The British Dental Association estimates that it will take £880 million a year to put things back to where they were in 2010—that is a fact, and it does not account for the huge impact of the pandemic. We also need to address the chronic underfunding and to have a clear commitment to ending the system based on units of dental activity that has been going on since 2011—it has been discussed today so I will not go into it any more. It has been over a decade, and the Government really need to get a grip of that.

In my constituency, 5% of dentists in South Sefton CCG stopped providing NHS services in the last two years. That vastly underestimates the loss of local provision, as most dentists tend to reduce the size of their NHS contract gradually before they quit the NHS completely. Across the country, 40 million NHS dental appointments have been lost since the pandemic. That is a whole year of dental provision. Without better support from the Government and, crucially, an end to the chronic underfunding, and without a clear commitment to and progress on contract reform, there is no way dentistry will be able to recover.

The covid alibi is beginning to wear a bit thin. This is all about pre-covid. Covid has exacerbated the situation, but pre-covid is also significant. Enormous backlogs began pre-covid. Let us get a grip of that. I ask hon. Members across the way to press the Minister and ask the Secretary of State and the Prime Minister—their colleagues—to listen to the facts, because, unless Members opposite can get that message across to an indurate Government, things can only get worse. No more excuses, no more prevarication, no more procrastination, no more pretext or self-exoneration—as I have heard today. The Government need to pull their finger out. We need action now. There is no excuse for letting the opportunity go by.

In closing, perhaps I can re-jig what Ian Fleming said to make a point about the Government’s lack of action in this crisis. He said:

“Once is happenstance. Twice is coincidence. Three times is enemy action.”

Which one does the Minister think it is? I cannot speak for the dental profession, but I think I know which one it is, and it is not one of the first two.

Children’s Mental Health

Wera Hobhouse Excerpts

Tuesday 8th February 2022 Commons Chamber

[Dr Allin-Khan]

My hon. Friend is right to remind us that adverse childhood experiences and inequalities, including health inequalities, lead to worse mental health outcomes in later life and stop children from achieving their full potential.

Imagine being a mum or dad whose child is self-harming or presenting with symptoms of depression, anxiety or phobia, and being without specialist support for extended periods. We all agree that the pressure that that puts on families and parents is just so crippling. The number of children who needed specialist treatment for severe mental health crises between April 2021 and October 2021 was 77% higher than in the same period in 2019.

This is the UK in 2022. The bar to being seen by a specialist is high, the delays are long and three quarters of children were not seen within four weeks of referral. That time is one of anguish for them and their family. Does the Minister believe that making 369,000 children wait for vital mental health support is acceptable?

According to the latest report by the Children’s Commissioner, waiting times depend on where people live—so much for levelling up—and when they are eventually seen, services may be hundreds of miles away. It is making the situation so much worse. Ask any parent or any young person; they will tell us that the uncertainty and paucity of mental health services damages mental health, exacerbates mental health conditions, allows symptoms to persist and makes conditions harder to treat down the line. Ultimately, it also costs more.

[Wera Hobhouse (Bath) (LD)]

The mental health disorders with the highest mortality rate are eating disorders. What the hon. Member says is particularly true for eating disorders: the longer somebody waits for treatment, the longer the disorder persists, which makes it worse. We really need to look at prevention and early intervention in all our services. Does the hon. Member agree that instead of saving money at the wrong end, it makes absolute sense to put money into early intervention and, better still, prevention?

[Dr Allin-Khan]

I entirely agree. It has been a pleasure to work alongside the hon. Member in looking at eating disorder issues over the past couple of years; she is a powerful advocate. She reiterates my point that prevention is better than cure. We know that in the pandemic, eating disorders have increased. Young people who feel the loss of their sense of control through fear can, in trying to understand what is going on in their lives, develop habits that are unfortunately very difficult to break. We know that the earlier someone can intervene when there are such issues, the better the outcomes will be.

Sometimes the damage, especially the damage done by waiting, is permanent. Imagine if we treated childhood cancer like we do children’s mental illness: waiting for symptoms to get worse before seeing a specialist, waiting for months or even years for treatment and leaving patients and parents to rely on charity. There would be an outcry, yet that is what the Government are doing with children’s mental health. When the Minister responds, I invite them to tell the House what new measures the Government are taking, what new money is being allocated to CAMHS, and where it is going. How many mental health staff will be recruited? How will they deal specifically with the impact of the pandemic on mental health? How will they tackle the deep-rooted mental health inequalities on the lines of place, race, class and income?

--- Later in debate ---

[Wera Hobhouse (Bath) (LD)]

I am speaking today, as I have done before, as the chair of the all-party parliamentary group on eating disorders. Eating disorders are the mental health disorders with the highest mortality rate. My hon. Friend the Member for Twickenham (Munira Wilson) talked today with a breaking voice about cases in her constituency and the hon. Member for Birmingham, Yardley (Jess Phillips) talked about the terrible things happening to our constituents that we see and hear about; I worry about the lives of a number of young people I know and about their families, who are worried sick about losing them. That is what we are talking about today.

Eating disorders are complex and potentially life-threatening, and the number of cases has increased fourfold in the last two years. They have no single cause and often start at school age. Recovery from an eating disorder takes on average three times as long as having the disorder itself. The fact that eating disorders all too often go undiagnosed—we have heard again and again about how long waiting times are—and that people are waiting so long to get treatment adds to the problem.

Eating Disorders Awareness Week is fast approaching. This year’s focus will be on training doctors to recognise these disorders. A 2019 report from the Parliamentary and Health Service Ombudsman identified a “serious lack of training” about eating disorders, which received just a few hours of attention on medical courses. That means that children, who often cannot adequately express their needs or condition, have been left on their own with these complex and debilitating conditions. Three years on, very little has changed.

Moving forward, we must recognise the importance of prevention and early intervention, which dramatically improve the chances of recovery. School counselling is an ideal form of early intervention. Scotland, Wales and Northern Ireland all have statutory school counselling services. England does not. Meanwhile, community services and the voluntary sector face a backlog of people desperate for urgent help. Our voluntary sector, such as the regional eating disorders charities network, has taken on the lion’s share of school counselling and shouldered the burden of addressing the mental health of our children. We must recognise the invaluable work that they are doing and make sure that they get more funding. Some £11 million has been allocated to improve eating disorder services, but only £1.1 million has been spent on the frontline. I have raised that worrying statistic with the Minister before, and I urge her to listen. We must make sure that every penny that the Government make available actually gets to the frontline.

NHS Dentistry: Bristol and the South-west

Wera Hobhouse Excerpts

Monday 24th January 2022 Commons Chamber

[Darren Jones]

I absolutely agree, and I thank my hon. Friend for her contributions, not least as a leading voice on healthcare policy, knowing that prevention is more important than cure.

A third constituent of mine rang over 25 practices across the south-west, but was unable to secure an appointment as an NHS patient—something that has affected patients who were pregnant as well as everyone else. Southmead in particular is now left without any NHS dentists at all.

[Wera Hobhouse (Bath) (LD)]

The number of child patients nearly halved in 2021 compared with 2019, with a 42% decrease in the south-west, including my constituency and his. Is the hon. Member as concerned as I am that the most worrying part of these statistics concerns the loss of access to dental treatment for children?

[Darren Jones]

I do share that concern, because we know that children in particular are seeing the dentist on a fewer and fewer occasions, and I understand that the tooth extraction rate for children is increasing significantly because of a lack of prevention.

--- Later in debate ---

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

It is a pleasure to respond to this important debate and I thank the hon. Member for Bristol North West (Darren Jones) for securing it. I acknowledge many of his points but reassure him that dentistry is an absolute priority for the Government. He said he has previously tried to make contact with Ministers; he has not formally asked me for a meeting but I am happy to meet him should that be of assistance.

Let me touch on two of the main reasons why patients up and down the country currently struggle to see dentists. The first relates to covid. This is not a lame excuse for why there are currently difficulties: dentistry and dental services have gone above and beyond during covid. I am sure my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is a dentist, will back me up when I say that many dentistry procedures are aerosol-generating, so significant infection-control measures have been in place to protect patients and dentists and their teams.

At the start of the pandemic, when we first went into lockdown, only urgent procedures were allowed, so no routine procedures could be carried out. It was not until 8 June 2020 that infection-control measures allowed the reintroduction of some routine care. Even then, dental practices were able to work at only 20% of normal activity. That has of course had knock-on effects throughout England in respect of patient access to routine care.

Later that year, infection-control measures allowed up to 45% of normal activity, but it was not until last year that that proportion went up to 60%. Just before Christmas, NHS England and the chief dental officer wrote to practices to say that they could go up to 85% of normal activity and 90% of orthodontic activity. They are still not up to 100% of activity so they are literally treading water to try to keep the service going. I pay tribute to all those who have done such significant work to try to deliver services to the patients who have needed them.

Urgent care has been back at pre-pandemic levels since December 2020, so the backlog is in respect of routine services, whether fillings, caps, crowns or routine dental-hygiene work. Covid has significantly contributed to that backlog.

[Wera Hobhouse]

I understand from the dentists I speak to in my Bath constituency that the Government funding provided per patient just covers hygiene, not any of the repairs or dental work the Minister has just mentioned. Can she confirm or deny that?

[Maria Caulfield]

I will come to that in a moment, but let me first conclude on the impact of covid on dental services. The hon. Member for Bristol North West may be reassured to hear that the proportion of adults and children accessing dentists in Bristol, North Somerset and South Gloucestershire remains higher than the average for access to dentistry in England. It is probably no consolation to his constituents, but access is slightly higher.

Covid-19 Update

Wera Hobhouse Excerpts

Thursday 13th January 2022 Commons Chamber

[Sajid Javid]

First, I agree with every word my hon. Friend says about pregnant women. That is a message that has been reinforced to every NHS trust. I thank her for how she has campaigned on this issue and brought it to light, because that is making a difference. On the issue she raised about domestic certification, I share her instinctive discomfort, and I assure her and the House that as far as I am concerned we will not be keeping domestic certification in place a moment longer than absolutely necessary.

[Wera Hobhouse (Bath) (LD)]

May I, from the Liberal Democrat Benches, also pay tribute to the services of Professor Sir Jonathan Van-Tam? The Government are still ignoring people who are clinically extremely vulnerable, and their concerns at the lack of guidance and support. I raised this with the Secretary of State before Christmas and I still have many of my Bath constituents writing in about it. Two thirds of housebound people have not received the booster. What are the Government doing to ensure that the vaccines are accessible to everybody, including the housebound?

[Sajid Javid]

The hon. Lady talks about ensuring everyone gets access to the booster. The people at the top of the list should be those who are clinically extremely vulnerable, as long as the vaccine is something that can work for them. That is why, during the month of December, especially when we accelerated the booster programme, working mainly with GPs but also with others, those who are housebound or are in care homes were a priority and we saw the booster rate rise substantially.

I also point the hon. Lady to what I said in my statement about the 1.3 million clinically extremely vulnerable. The NHS has contacted them directly to ensure that they have access to the new antivirals that we have procured. I am sure that she would welcome that.

Public Health

Wera Hobhouse Excerpts

Tuesday 14th December 2021 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

Thank you, Mr Deputy Speaker. I might even stick to the four-minute limit.

No doubt we are at a pivotal point in the fight against covid, and my constituents in Bath, like many across the country, are doing their best to keep covid levels low in their community. I thank everyone for their efforts.

I am glad for the consensus in this place that getting vaccinated is the most important thing. What we are debating is the most effective way of getting the most people vaccinated, and I hope this debate does not distract from the fact that we all believe vaccines are the best way to beat covid. We will beat all the conspiracy theories about vaccines and about covid being an invention. I am glad there is consensus on the importance of us all getting vaccinated.

The Liberal Democrats have always supported mask wearing, which reduces but does not entirely eliminate the risk. It is important to wear a mask, and we deplored the fact that the requirement, which is not difficult, had been dropped, including in this House. Mask wearing is not just about keeping ourselves safe or even about keeping our loved ones safe; it is about keeping everyone safe. Yes, we enjoy our civil liberties and we should protect them, but they do not include the liberty to harm others. That is an important principle, and it is why we support these public safety measures.

Many of my constituents have been in touch with me to share their concern about the logistical difficulties of following Government advice. They want to do the right thing, but they often find it difficult. I met one of my constituents last week, and he has recently returned from Zambia, where his work is based. As Zambia is a red-list country, he was required to quarantine in a hotel for 10 days. He continually tried to book a quarantine hotel, but he was unable to do so because the hotels were fully booked. When he was finally able to book one, he received an email from Corporate Travel Management saying his booking had been cancelled due to an error on its part. Upon speaking to the call centre, a member of staff told him there was no problem.

The red-list system has now been dropped, but the stress and cost to people who tried to do the right thing has been considerable and needs to be addressed urgently. Will there be compensation for those who faced considerable cost and, as has already been asked, will those who are still in quarantine be released immediately?

Another constituent is housebound. Her son lives in Southampton and her multiple health conditions make it impossible for her to get to a vaccination centre on her own, which means she has not yet had a booster. Her story is all too common. The local clinical commissioning group says it is in the process of contacting people who are housebound, but many are still waiting to be contacted. Obviously they are very worried, so I hope the Minister is able to outline the steps being taken to ensure the housebound are able to receive their booster as a priority.

Lastly, another constituent was vaccinated abroad, yet is still unable to receive confirmation of his double-vaccinated status, because his vaccines are not recognised on the NHS app—a problem that has been noted since the summer. To make matters worse, my constituent and many others like him are not able to get their booster, because the system will not recognise them as having been doubly vaccinated.

The Government must address these issues as a matter of urgency. It should not be this difficult for those who are trying to do the right thing to follow the Government’s own guidelines. My constituents and many across the country want to do the right thing, but the Government must do their bit or people will lose further confidence at this already highly volatile time, when we need as many people as possible to have confidence in the system and the Government.

[Mr Deputy Speaker (Mr Nigel Evans)]

There is now a four-minute limit. I call Jane Stevenson.

Covid-19 Update

Wera Hobhouse Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

I understand the situation that the hon. Gentleman describes, and there will be others across the country in a similar situation, so we understand the importance of this issue. The JCVI, as he says, is looking at this, which I confirmed earlier, but I say to the hon. Gentleman that before we can deploy any vaccine in any particular age group, it needs to be approved by our independent regulator, the Medicines and Healthcare products Regulatory Agency, as safe and effective. At this point in time, we do not have that approval. The MHRA is actively looking at this, but those two things are crucial before Ministers can make a decision.

[Wera Hobhouse (Bath) (LD)]

I, too, had my booster vaccine last week. It was easy, and I had five different options near me, but that was here in London and after weeks of unsuccessfully trying in Bath to find anything near me or anything that was convenient with the times I had available. That is the experience of all my constituents in Bath. When will we have services that match those available here in London in constituencies such as Bath?

[Sajid Javid]

It is an important to make sure that capacity is increased throughout the country. I am pleased that the hon. Member has got boosted, by the way, but she is right to say that she, like her constituents, should be able to get it closer to home. With the plans that we have announced recently, and especially with the plans from this morning, I am confident that there will be many more opportunities to get boosted in Bath.