Future of the NHS

Yasmin Qureshi Excerpts

Thursday 23rd February 2023 Commons Chamber

[Yasmin Qureshi (Bolton South East) (Lab)]

I thank my hon. Friend the Member for Jarrow (Kate Osborne) for securing this important discussion; a discussion that, after 13 years of Tory managed decline of our public services, is crucial. I declare an interest as the chair of the all-party parliamentary group for dentistry and oral health, and as a member of the all-party parliamentary group for whistleblowing.

We have heard discussion of various issues facing the NHS, and I know that many colleagues will talk further about them. I will focus on one aspect of the NHS that is not discussed so much: oral health and dentistry. When I was chosen as the chair of the APPG late last year, I said that I would focus on putting the mouth back in the body, and giving oral health parity with mental and physical health in our political discourse.

I start by asking Members to ponder what they think is the No. 1 cause of admissions to A&E for children. It is not broken bones, soft tissue damage or even respiratory diseases; it is tooth decay. We have children in hospital waiting rooms just so that they can be seen for tooth decay. I do not think any of us should stand by and watch that happen.

Let us assess the facts of the dentistry crisis. We have lost 40 million NHS dental appointments since the start of the pandemic, and NHS dentistry is in a wider crisis. The net amount that the Government spent on dentistry in England was cut by over a quarter between 2010 and 2020. We are losing dentists from the profession because they are taking early retirement or changing careers altogether.

I know that the Chair of the Health and Social Care Committee, the hon. Member for Winchester (Steve Brine), is conducting an inquiry into this, and I have already told him my views. We want the Government and the Minster to step up and support our NHS dental practices, and to ensure that patients can access them. I am pleased to see that the Minister responding today has dentistry as one of his responsibilities. I hope that he will be able to answer some questions about this issue. I give praise where praise is due: before Christmas, the Government tweaked the NHS contract to incentivise dentists to carry out complex care. That is a good, genuine starting point; but it is only a starting point.

What people do not seem to realise is that our oral healthcare is in fact connected to our general healthcare. For example, researchers at University College London have found links between severe gum infections and type 2 diabetes and cardiovascular illness. To not treat that properly and in time is not only a serious healthcare issue but is a false economy. We can and must support our NHS dentists to take a preventive approach to oral healthcare, so that in the long run we can save the NHS money and stop people’s suffering. The principle is the same with tooth decay in children; a routine check-up twice a year will save the NHS money in the long run, and at the same time get rid of pain and other problems.

We have a system in our country where some dentists are completely private, but a number of them are mixed practices. The problem we are having—and what does not make sense—is that there are dentists who are not fulfilling their required units of dental activity as per the NHS dental contract, while at the same time offering private appointments on an early and more frequent basis. I will give an example. I was contacted by a constituent who was trying to get an appointment with an NHS dentist. I made six phone calls to dentists in my constituency who were supposed to be NHS dentists. I was unable to get a single appointment with any of them. Obviously, I did not tell them I was a Member of Parliament; I thought that was a fairer way of finding out what their response would be.

I know that this experience is not unique to Bolton; colleagues from across the House—and across the United Kingdom—will have had the same problem of constituents contacting them about being unable to get an NHS appointment. I know from speaking to the chief dental officer that many dentists are not fulfilling their contractual requirements, and are instead returning the NHS money. We need to stop this problem. We are told that one of the reasons dentists are doing it is that NHS work is so low paid that they have to finance their practice by doing private practice work. I recently spoke to some dentists and they said that the amount of money they receive has not changed much over the past 20 years. Perhaps we need to revisit dentists’ contracts and ensure that they are properly renumerated so that they do not have the incentive to return NHS appointments to the local commissioning group or the NHS.

The other group of people who have been completely forgotten include dental hygienists, dental therapists, orthodontists, dental technicians and many others who work alongside dentists to address oral health issues. At the moment, none of them is considered to be an NHS worker. They are employed by dentists, who set their contractual terms and conditions, which are not as good as those offered by the NHS. They need to be classified as NHS staff. Will the Minister meet me and an alliance of dental professionals to discuss that issue and what we can do to address it?

The second often overlooked issue is whistleblowing in the NHS. It remains the case that many people in the NHS—doctors, nurses and other professionals—talk about not only bad practices but bullying and harassment. However, the minute anybody raises an issue, their temporary contracts are not renewed and they are denied promotion and decent references. They are at a complete loss. When they try to take on NHS trusts, the trust bosses tell them, “We’ve got millions and millions of pounds in our legal funds. You are not going to be able to challenge us.” I have many friends in the medical profession, including nurses, and they have told me about what is happening. I know some who have actually been told, “If you take a case out against us, we have a bottomless pit of money.”

A recent letter in the BMJ said that the bullying and harassment that an NHS trust can inflict on a consultant are so extreme that life in the trust becomes unbearable. Even being proved right after an inquiry provides very little solace, as does anybody acknowledging what they have done wrong.

I ask the Department of Health and Social Care to consider the situation in Scotland, where a proper whistleblowing system has been set up by statutory law. There is legislation and guidance, and proper procedures as to who to go to, as well as an external person to appeal to if people are not satisfied. These things are very important. Whenever we hear news about big scandals in hospitals, we discuss it in Parliament, including in this Chamber, but then everyone forgets about it. It is a real problem. We are talking about the future of the NHS, and that means that we also need to address what happens when things go wrong in the NHS.

I hope that in his response the Minister will address how we can ensure that people can access NHS dentists, how we can make dentistry a real part of oral health, and how oral health can become part of the NHS generally. It should have the same presence as other parts of our health system. Finally, I also hope he will address the issue of whistleblowing. We need to make sure that we have good staff and that we maintain their confidence, and we need a proper system to deal with that.

--- Later in debate ---

[Alex Cunningham]

Thirteen years!

[Yasmin Qureshi]

You have been in power for 13 years!

[Rob Roberts]

How right he turned out to be. However, he is watching it, and my phone has not stopped receiving messages such as, “Don’t agree with that intervention from the Opposition”, and, interestingly, “Hancock is making sense!” in respect of my right hon. Friend the Member for West Suffolk (Matt Hancock). My fiancé is not by any stretch of the imagination a traditional Conservative voter, but he gets it—he understands.

On 5 July 1948, the NHS was founded under Labour Health Minister Aneurin Bevan, who built on the initial idea in the 1944 White Paper, “A National Health Service”, introduced by Conservative Health Secretary Henry Willink, which set out the need for a free and comprehensive healthcare service. Aneurin Bevan is rightly hailed as the father of the NHS, but it is the Conservative Minister years earlier who can arguably be called its grandfather. And as we are all aware, grandparents always treat the grandchildren a lot better than their parents do.

There are 40 MPs in this place from Wales, the home of Bevan, and 26 of them represent various Opposition parties, but there are zero here today to talk about health services and to defend the record not of the UK Government over the past 13 years—right hon. and hon. Members have taken aim at them this afternoon—but of Labour’s control in Wales over the past 25 years.

In 1948, average life expectancy was about 68 years old; today it is almost 85. That is a 25% increase in lifespan. In 1948, hospitals had a couple of X-ray machines. CT scanners did not come into use until the 1970s, while MRI scanners appeared in 1984. Ultrasound, which was previously an instrument used to detect the flaws in the hulls of industrial ships, was first used for clinical purposes in Glasgow in 1956 due to a collaboration between an obstetrician and an engineer.

A new CT scanner sets us back £1 million to £2 million. An MRI takes up to £3 million, and ultrasounds a few hundred thousand each. Each hospital has multiple numbers of those machines. Drugs and treatment developments cost literally hundreds of billions globally every year. We are keeping people alive longer, diagnosing them with ever more expensive machinery and treating them with ever more expensive medication and devices. In 1948, the population of the UK was just under 50 million. Today it is almost 68 million—an increase of 36%.

My right hon. Friend the Member for West Suffolk talked about data earlier. I am no healthcare specialist or expert data scientist, and I do not in any way have all the answers, but I like to think that I have a reasonable amount of common sense, and my common sense tells me that, when 36% more people are living 25% longer and are being diagnosed by expensive machines and treated by a pharmaceutical industry that costs hundreds of billions, we cannot keep running things based on principles devised 75 years ago.

The main point I want to get across in my short contribution is one of openness and debate. I have sat and listened to right hon. and hon. Members in this debate and others over the years talking about various elements of the NHS in England. It is all a Conservative problem, they say. Tories are destroying the NHS, they say.