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Category: Health

  • Matt Warman – 2022 Speech on Visas for International Doctors

    Matt Warman – 2022 Speech on Visas for International Doctors

    The speech made by Matt Warman, the Conservative MP for Boston and Skegness, in Westminster Hall on 2 November 2022.

    I beg to move,

    That this House has considered visas for international doctors.

    It is a pleasure to serve under your chairmanship, Mr Stringer.

    This is a debate about doctors, but I want to begin with the story of a hypothetical patient. Let us call her Marjorie and say that she lives in Skegness. She is in her 80s or thereabouts. She is registered with a local GP practice, and she has a trainee doctor as her GP. They have a really good relationship and know each other well. They have the continuity of care that means that Marjorie’s needs are looked after. For a couple of years, Marjorie has gone back and forth to her doctor with little ailments, as people often do. In her final consultation, her doctor mentions that she will be moving on relatively soon.

    Thereafter, Marjorie finds herself with another GP, and the continuity of care is broken. Marjorie struggles to get the type of relationship that she built up over the past few years, and she finds herself bouncing in and out of hospital. She is fine, but not as well as she would be if her care had been provided by a doctor who was able to make sure that they knew each other well. The reason for the break in continuity of care is that the doctor she had in training was an international medical graduate who was being trained at the surgery in Skegness. Unfortunately, for a whole host of reasons, the surgery was not registered to take international medical graduates once they had qualified, and it was not what is called a sponsoring practice—it was not able to say that it would sponsor the visa for that doctor.

    The reason I make that point in such a way is because the people who are suffering as a result of the approach we currently take to visas—on one level, they are doctors who are dealing with the immensely stressful visa process—are ultimately patients, who should be our priority. The doctor I mentioned is one of 40% of trainee GPs who come from abroad. While they are training, their visas are sponsored by Health Education England.

    Margaret Ferrier (Rutherglen and Hamilton West) (Ind)

    A result of the difficulties around trainee GP visas is that many IMGs feel that they have no choice but to take on other roles within the NHS, or they leave the NHS altogether. Many may even return home. Does the hon. Member agree that this is yet another area where the Home Office must look at the bigger picture, rather than trying to plug gaps on an ad hoc basis?

    Matt Warman

    Ultimately, this is where we need joined-up government, whereby the Home Office and the Department of Health and Social Care deliver on the same priorities, and I really do think that they can.

    As I say, 40% of trainee GPs come from abroad. In the final months before they qualify as GPs, the last thing they should be doing is dealing with the stress of a potential visa application and considering whether the practice where they might want to apply for a job is registered on the programme, and whether they can reasonably jump through the Home Office hoops at that precise moment. We are increasing stress for doctors, and we are increasing the risks for patients at the same time.

    The hon. Lady alluded to figures from the Royal College of General Practitioners which show that some 30% of GP trainees are considering not working as GPs when they qualify for these visa-related reasons, and some 17% think they might have to leave the UK either temporarily or, at worst, permanently. That is some 1,200 doctors who are considering not working in the health service as a result of this system. In Lincolnshire alone, a third of practices have thought about registering as a visa-sponsoring practice, but just one in 10 have actually done it. We are really limiting the options for GP trainees and for the health service.

    This is a political choice, and it reveals an inequality between different sorts of doctors. It will probably take a hospital doctor five years to qualify. After those five years, they will qualify for indefinite leave to remain in a much easier way. Because GP trainees take just three years to complete their programme, they need to go through this visa process, because three years is not five years, and the Home Office has decided that five years is what is required.

    There are other associated problems. When it comes to applying for a visa, the GP practice that needs to register will consider whether that process is worth while. It may, in theory, be worth while in advance, and some practices do register in advance, but many do not. They then find themselves confronted with a brilliant candidate, and they try to register, but with the best will in the world, the timescales are very tight for doctors to apply for visas when they have a job offer from a practice that is already registered. There are lots of things to line up, and it is stressful for practices and for doctors. Even if there were no backlog in the Home Office, it would be a very tight timescale.

    Mrs Pauline Latham (Mid Derbyshire) (Con)

    I thank my hon. Friend for giving way and congratulate him on securing this important debate. I have recently returned from an International Development Committee visit to Jordan, where I spoke to a number of highly educated Jordanians, as well as Syrian refugees. Some of the Jordanians were already doctors and nurses, and the Syrian refugees in the camps in Jordan cannot get an education beyond the age of 18 but wish to become doctors, engineers and so on. They speak amazing English and would love to train here in the UK.

    At the moment, Germany is hoovering up a huge number of these doctors and people who would like to study to become doctors, to satisfy the demands of its health service. Does my hon. Friend agree that it would be helpful for the Minister to consider opening up more visa routes for brilliant young medical students from countries such as Jordan that have long been strong international partners of the UK, in order to ease some of the workforce pressures on our NHS? It is important that we increase the numbers, and that would be one way of doing it.

    Matt Warman

    I absolutely agree with my hon. Friend that increasing all those routes is hugely important. Of course, we would all like to see more doctors trained in this country, and the Government have gone some way towards doing that, but where people want to work abroad, Britain should be as attractive a place as we can be. That is why, on the GP point specifically, the Government should be removing every single barrier in that visa process.

    The most straightforward thing we could do, which would remove the need for a practice to register as a visa-sponsoring practice, is simply to say that when a GP qualifies in this country, they get the indefinite leave to remain that other doctors get. These are people in whom the UK has already invested. They are already here; they already have a visa. The extension of that visa into another form seems simply to be a bureaucratic hoop that we are putting in their way as doctors and in the way of GP practices. We are putting extra bureaucracy into a system, while on the other hand the Government say, “We desperately need people to come to this country to work in the NHS, and we will try to do everything we can.” The health service does hugely good work to try to recruit such people and specifically encourages them to train as GPs, but then we put an additional barrier in their way.

    The response from the Government in the past has been, “Actually, the visa process registration is not terribly onerous and GP practices can do it.” They point to the numbers that have and do, which is fine as far as it goes, but it does not answer the question of why we put a barrier in the way in the first place. It should not be a cost of doing business when we say that we really want to make it as easy as possible.

    Equally, it should not be a reasonable thing to put different sorts of doctors on different sorts of levels. It is not reasonable to say to people that, just as they have gone through the most stressful part of qualifying with exams, they should also be thinking about their immigration status. That calls into question their probity when we have things such as the General Medical Council making sure that they are upstanding members of our communities, and many of them have tens of thousands of patients to testify to that.

    I do not think it really washes when the Government say that we need to put barriers in place, and I do not think that the Department of Health, where the Minister was previously a Minister of State, would agree, in an ideal world, with the Home Office stance. We could work together across Government to try to secure a sensible outcome.

    I have talked about GPs, but there are broader issues around visas for doctors, many of which come back to the Home Office backlogs that I know my right hon. Friend the Minister is working really hard to address. There is a good argument for simply scrapping visa fees altogether for people coming to work in the health service. That is an argument for another day, but when it comes to GPs I think that lowering the five-year limit for indefinite leave to remain to three years is the neatest way to address the issue.

    On the broader issues, ultimately this comes back to how many doctors we are training in the UK. We all want, as I said to my hon. Friend the Member for Mid Derbyshire (Mrs Latham), to see more people trained in this country. That is what we are doing and that is what the Government continue to pursue, but until we reach that moment—the NHS has never reached entire self-sufficiency in the UK—we should make it as easy as possible for doctors, dentists, nurses, people working in social care, and all those who work in different parts of the health service, to come to the UK. It is not primarily a question about backlogs; it is a question about process. At the moment there is a degree of bureaucracy that simply does not need to exist.

    Steve Brine (Winchester) (Con)

    It is great to hear my hon. Friend making such an eloquent case, as always—more so than I can. The issue matters for all the reasons he has set out, but would he agree that because of the retention challenge in the health service, the more we pour in at the top is sometimes, in part at least, offset by those who go out at the bottom? There is a wider picture here to do with pension pots—the whole retention piece is part of the wider jigsaw, which I appreciate is not the remit of this Minister, but perhaps was in his previous job.

    Matt Warman

    I thank my hon. Friend for that intervention. It is always tempting to ask the Minister to go and have a word with his former self, but we cannot do that. I think he has read the last couple of points that I want to make.

    There are a number of relatively low-hanging pieces of fruit that the NHS has repeatedly asked for. I want to thank the RCGP, the British Medical Association, the radiologists, the British Dental Association, and also groups such as EveryDoctor, which have helped me with this debate and have identified the fact, as my hon. Friend implied, that there are a small number of things that could and should be sorted as quickly as possible. Busting the barriers around pensions and the bureaucracy around visas are things that would make a real difference to recruitment and retention across the health service. There are plenty of things that are difficult when it comes to addressing the NHS’s challenges, particularly as we approach winter. On the narrow point of GP provision, we have a visa process that puts pressure on, in particular, small GP practices, where the added burden of registering as a visa sponsoring practice is even greater now as they are under such huge pressure. It is also a burden on GPs at what is a particularly stressful point in their careers.

    I know the Minister will make entirely legitimate points around putting a process in place, but the reality is that there is a political choice to be made to ease some of those burdens. There is a powerful, compelling case to be made for doing a small number of easy things that could address the GP crisis in particular, which, as my hon. Friend the Member for Winchester (Steve Brine) alluded to, is acute.

    I appeal to the Minister and the Government to work as closely as they can with the Department of Health and Social Care to understand these challenges and see what can be done, and I urge my right hon. Friend to take seriously the suggestion that if someone qualifies as a medical doctor in this country, and in particular as a GP, they should have indefinite leave to remain. At the moment, it effectively comes with that if they qualify in a hospital but not in general practice. That is an inequality that the Minister can look to fix, and I hope he will do so as soon as is practicable.

  • Steve Baker – 2022 Speech on Derry Addiction Centre

    Steve Baker – 2022 Speech on Derry Addiction Centre

    The speech made by Steve Baker, the Minister of State at the Northern Ireland Office, in Westminster Hall on 2 November 2022.

    It is a real pleasure to reply to this debate, Mr Gray, and I am genuinely very pleased that the hon. Member for Foyle (Colum Eastwood) has secured it; in this, we can make common cause. I am also pleased to see the former Secretary of State, my right hon. Friend the Member for Skipton and Ripon (Julian Smith), in the Chamber today. I pay tribute to all the work he did to get the New Decade, New Approach agreement in place.

    The Government welcome this opportunity to make it clear that we are committed to supporting the Derry/Londonderry addiction centre and providing it with £1 million from unique circumstances funding under the New Decade, New Approach agreement. The hon. Gentleman particularly mentioned Northlands. I will come back to that, but I know it is a very valued service, and it seems to me a very sensible approach to use Northlands to deliver what is required.

    Health is, of course, a devolved matter in Northern Ireland. The issue of a lack of clarity came up, but we are absolutely clear that health is a devolved matter, and we would like it to be governed, and governed well, in Northern Ireland. It is therefore for the relevant Northern Ireland Executive Department—in this case, the Department of Health—to formulate its proposals on how to use the allocated £1 million of unique circumstances funding to support those experiencing addition in Northern Ireland.

    Before I go any further, I want to say that I am personally very committed to this issue, as I know the hon. Member for Foyle and other Members present are. A few years ago, I had the opportunity to participate in an inner-city challenge with the Centre for Social Justice, which saw me spend three days and two nights in rehab with some very serious ex-offenders, including people convicted of murder. It felt like a much longer time. I went through with them, in their counselling sessions, what it means for them to be addicted and how they had come to be in the circumstances they were in. I was particularly moved by the service user’s account that the hon. Gentleman shared.

    Given the social problems that our country faces—indeed, that all countries face—with drugs, we need to get alongside people where they are and lift them up. It is too easy for people to see the tremendous consequences of addictions on our society and rush to condemn, but people in the grip of an addiction need treatment and sympathy. That is one of the things I saw when I was with those people in that centre. Indeed, I have stayed in touch with one of them, and I was in touch with him last night when preparing for this debate. He has completely rebuilt his life, become a good father and got into work. It is an amazing thing to see.

    In thanking the staff of Northlands, and all staff across the UK who deal with addictions, including in Wycombe, I particularly want to acknowledge the point that the hon. Member for Foyle made about the countless people who are grateful. That needs to be understood by everyone. Genuinely, countless people are affected by addictions, because the consequences that spread out as people suffer under addictions are enormous and almost impossible to see. Those consequences spread and spread, generationally as well as geographically, so it is really important that we understand addictions and deal with them. As such, I am personally committed that this money needs to get into Northlands and to deliver against NDNA.

    I stress that the Government stand ready to provide the funding once we have received and approved the Northern Ireland Executive Department of Health’s proposals for the Derry/Londonderry addiction centre. As I said earlier, Northlands seems a particularly sensible way to proceed. The Northern Ireland Office continues to engage with counterparts in the Executive to make that happen.

    We do not have an Executive, and we are moving towards declaring an election, as is our legal duty. We fervently hope that a functioning Executive will be in place as soon as possible. Our officials have been advised by the Northern Ireland Department of Health that, at this stage, it is too early to state what impact, if any, the absence of an Executive will have on the delivery of its proposals. However, NIO officials will keep that aspect under review with the Department of Health.

    The hon. Member for Foyle asked four specific questions. First, what happens if we do not have an Executive? We will have a response plan, and we will take the steps necessary to ensure that public services continue. However, as he knows, we do not wish for direct rule any more than he does; we wish to have a functioning, stable and high-quality devolved Government. We have to proceed with great caution. I know that he will not expect me today to pre-empt announcements that we will make in due course.

    Secondly, the hon. Gentleman asked whether we are still committed. I think I have made it absolutely clear that, personally and as a Government, we are absolutely committed. Thirdly, he raised the impact of instability, which is very real and very much felt in people’s lives. I absolutely appreciate the strength of feeling and the real concern of Unionists, in particular my friends in the Democratic Unionist party. I am a proud Unionist and a proud Brexiteer, and I very much regret that we have the problems we have with the protocol, which are keenly felt by the DUP.

    Let me take this moment to put it on the record that everyone needs to understand that we will be challenged to deliver a devolved Government until the issue of the Northern Ireland protocol is resolved. That, I am afraid, puts things firmly in the hands of the European Union. Until it is willing to negotiate on the basis of regard for the legitimate interests of Unionism—a point I have tried to make clearly, but respectfully so—we will not be able to satisfy the DUP or many Conservative MPs that we have made progress. If we cannot satisfy the DUP, it clearly has the power and the opportunity to prevent a devolved Government from being formed. I wish to be respectful about that, just as I have been respectful—I think famously—to the EU and Ireland about their legitimate interests.

    The hon. Gentleman asked about the impact of instability specifically in relation to the addiction centre. Here we see the impact of political instability, which causes real harm to real lives, not just for those who are addicted, but for their family and the many people who suffer the consequences of addiction.

    Fourthly, the hon. Gentleman asked what we will do. We will of course proceed to govern as best we can in the absence of devolved institutions, within the bounds of not wishing to institute direct rule. We will announce our response plan in due course. I hope that we will be able to satisfy the hon. Gentleman. As he has raised the issue, I will certainly make it my priority to investigate what is happening with the centre.

    This debate is an excellent example of democracy working. We have so many things before us at this time, but this debate secured by the hon. Member for Foyle on behalf of those he represents has raised the matter up my priority list. Working with my officials, I will try to ensure that we drive it forward.

    I have a few words to say about addiction, which is a complex and multifaceted issue that affects the whole of our society. It takes a terrible toll on family and friends. It is therefore vital that people in Northern Ireland and indeed across the UK are able to access the right addiction and support services at the right time. As I said, it is a devolved matter, but the Government are committed to providing the additional funding. That commitment reflects the Government’s strong desire to see improved health outcomes for everyone across Northern Ireland.

    The Government’s commitments under the New Decade, New Approach agreement include making £40 million available for a range of projects focused on addressing Northern Ireland’s unique circumstances. The unique circumstances projects are aimed at supporting community and reconciliation initiatives to remove barriers, to bring the people of Northern Ireland together, and to build a safer and more secure society in Northern Ireland.

    One of the projects identified was the Derry/Londonderry addiction centre. The Government are steadfastly committed to providing £1 million in funding as a non-Barnett addition to the Northern Ireland Executive’s block grant. We of course continue to urge all those involved to form an Executive to deliver the proposals but, as I said, I appreciate why that has not proven possible so far. Funding for unique circumstances projects is an important component of the New Decade, New Approach agreement, and the Government remain focused on ensuring the investment of this funding for the benefit of the local community.

    It may help to say a little more about the context of New Decade, New Approach. The agreement was reached between the UK Government, the Irish Government and Northern Ireland parties in January 2020, and it enabled the restoration of the Northern Ireland Executive after a three-year hiatus. Again, I pay tribute to the former Secretary of State, my right hon. Friend the Member for Skipton and Ripon, for his leading role in that work. The agreement contains commitments for the UK Government, the Irish Government and the Northern Ireland Executive to fulfil. This Government have delivered over half of their commitments under the New Decade, New Approach agreement and we will continue to implement the remainder of the agreement to support a stronger, more prosperous and inclusive Northern Ireland in which everyone can participate and thrive.

    The agreement was accompanied by a £2 billion financial package, consisting of £1 billion of additional funding and a £1 billion Barnett-based investment guarantee. It is the largest deal from a Northern Ireland talks process to restore the Northern Ireland Executive. The UK Government have now honoured the £1 billion Barnett-based investment guarantee, as set out in NDNA. The investment guarantee was that the Executive would get a capital department expenditure limit Barnett consequential of at least £1 billion over a five-year period, from 2021 to 2024-25. That has been honoured as, based on the spending review 2021 settlement, the Northern Ireland Executive will receive over £1 billion by 2024-25 in additional CDEL Barnett consequentials.

    We expect that £769 million from the £1 billion financial package in the agreement will have been spent by the end of the current financial year. The release of funding has been tied to the delivery of reform and transformation of Northern Ireland’s public services, which I will now discuss in a little more detail.

    The agreement reflected the unique challenges faced by Northern Ireland. The aims of the financial package were to provide immediate support to the health service and to address budget pressures, to enable investment to transform public services, to turbocharge infrastructure delivery in Northern Ireland, and to address Northern Ireland’s unique circumstances. The Government’s substantial package played a vital role in supporting the incoming Northern Ireland Executive and in promoting economic growth. Of course, we are deeply disappointed at the continuing lack of a fully functioning Executive, but we will continue to press forward to serve the people of Northern Ireland.

    The £769 million spent so far has been used to bring to an end the nurses’ pay dispute in January 2020, with £200 million used over three years to deliver pay parity with nursing counterparts in England and Wales; to provide a one-off funding settlement to the Northern Ireland Executive of £350 million in 2021-22 to relieve budgetary pressures and deliver effective public services in Northern Ireland; and to drive the transformation of public services by providing £142 million to support the Northern Ireland Executive in its transformation programme. The Executive have so far directed the transformation funding towards improving health outcomes. The NDNA transformation projects are embedded in the Northern Ireland Department of Health’s rebuild framework, “Building Better, Delivering Together,” which progresses health and social care system rebuilding work in Northern Ireland.

    The funding has supported the Northern Ireland Executive in delivering a fleet of low-carbon buses for Belfast and the north-west, with £50 million invested in low-carbon transport. Government funding under NDNA means that 100 zero-emission buses have been produced by Wrightbus in Northern Ireland. The funding also led to the opening of the Northern Ireland graduate medical school in Derry/Londonderry to students in September 2021. So far, we have invested £11.5 million, with another £48.5 million to be invested, to deliver a brand-new facility and investment for the north-west of Northern Ireland. The training of more doctors will also help address the shortage of medical professionals in Northern Ireland in the long term.

    Turning to the unique circumstances money, the Government have committed £140 million to address Northern Ireland’s unique history. That consists of £100 million for legacy implementation and £40 million for those unique circumstances. The £40 million in Government funding has been reserved for the themes set out on page 53 of NDNA, in annex A.

    The funding is to be deployed in areas including mental health, which I am sure will matter to everyone here; tackling paramilitarism; and tackling deprivation and improving opportunity—of course, one of the major factors leading to deprivation is addiction. The funding is also to be deployed on a culture and community fund; support for marking the 2021 centenary and related projects; support for languages and broadcasting; support for the armed forces and veterans; a fund to promote the competitiveness of Northern Ireland’s economy; additional funding to support the Derry/Londonderry addiction centre; and the UK contribution to the international fund for Ireland.

    As I run through those commitments, I think the whole House will appreciate the extraordinary work led by the former Secretary of State, my right hon. Friend the Member for Skipton and Ripon, with all the relevant parties, to deliver so much for Northern Ireland. What we now need to do is press forward.

    The five parties reached the NDNA agreement, leading to the restoration of the Northern Ireland Executive in January 2020. The funding allocations were later agreed by the previous Secretary of State with the First Minister and Deputy First Minister. Good progress continues to be made, and funding has been approved across a range of projects, including on tackling paramilitarism, support for veterans, the Veterans Commissioner, NIO centenary projects, and so on.

    On tackling paramilitarism, the Government’s funding has helped to support the Executive’s Communities in Transition project, which is designed to support and empower those communities that have been most impacted by paramilitarism, criminality and ongoing coercive control. Many Members present will appreciate the interaction between drugs and paramilitarism; I do not wish to get into that in great detail, but the two subjects are closely related. By tackling paramilitarism and criminality, we will help to deal with the problem of addictions.

    The Government’s commitment to veterans under the agreement resulted in the appointment of Mr Danny Kinahan as the first Northern Ireland Veterans Commissioner in September 2020. As with the release of all Government funding, we undertake robust assessments and business case approvals before funding is provided.

    Despite the absence of a Northern Ireland Executive, the Government continue to deliver on their NDNA funding commitments. That includes releasing the remaining £276 million of funding, including £103 million to drive public service transformation; £48.5 million to help fund the graduate medical school at the Magee campus in Derry/Londonderry; £100 million to address the unique history of Northern Ireland, including legacy; and £24.5 million of the £40 million reserved for the 13 themes referred to on page 53 of NDNA, in annex A.

    The Government’s financial package was accompanied by stringent financial conditions to deliver a greater level of accountability for public spending, and to ensure that the Northern Ireland Executive build sustainable public services for people in Northern Ireland. Members will know that that is extremely important at the moment. It included the creation of the independent Northern Ireland Fiscal Council in 2021. That body is an important component in delivering greater accountability for public spending, and it is already playing a valuable role in Northern Ireland.

    Earlier this year, Parliament passed the Northern Ireland (Ministers, Elections and Petitions of Concern) Act 2022 to implement the institutional reforms agreed in NDNA. These reforms have included enabling Northern Ireland Executive Ministers to continue in office for a defined period to allow time for Executive formation—although I lament that in this case that has not worked—reforming the petition of concern mechanism used in the Northern Ireland Assembly, and updating the ministerial code of conduct with regard to the expectations and behaviour of Ministers.

    The Government’s priority continues to be a return to a fully functioning and stable devolved Government as soon as possible, and to ensure the necessary delivery of public services for the people of Northern Ireland. We regret that the parties failed to elect a Speaker and form an Executive before the 28 October deadline. In line with his legal obligation, my right hon. Friend the Secretary of State will soon confirm the date of the next Northern Ireland Assembly election, as required by law. Following that election, and regardless of the result, the Northern Ireland parties really do need to come together to restore the devolved institutions and lead the people of Northern Ireland through the challenging times ahead. I think we all appreciate the significance of that to people in Northern Ireland; the hon. Member for Foyle made very clear the real impact on people of not having an Executive to deliver.

    The significance of NDNA in this context cannot be forgotten. The agreement shows how collaborative working and compromise can create the right conditions for stability—

    James Gray (in the Chair)

    Order. I am sorry to stop the hon. Gentleman, but I must now suspend the sitting until half-past 2 this afternoon.

  • Colum Eastwood – 2022 Speech on Derry Addiction Centre

    Colum Eastwood – 2022 Speech on Derry Addiction Centre

    The speech made by Colum Eastwood, the SDLP MP for Foyle, in Westminster Hall on 2 November 2022.

    I beg to move,

    That this House has considered delivering on New Decade, New Approach commitments to a Derry addiction centre.

    It is a pleasure to serve under your chairmanship, Mr Gray. I will begin with a quote from a service user of the Northlands addiction centre in Derry, which has served the people of our city for almost 50 years. It reads:

    “My mother on one side of me, crying her heart out, my elder sister on the other side with a Kleenex in one hand and her head in another. I didn’t know how I felt. I didn’t know how to feel. I was numb. No tears, no emotions, just nothingness. All I could do was stare at a spot on the carpet and try not to look up and see the hurt and pain in my mum’s face.

    That was over two years ago, and thankfully, I haven’t had to lift a drink since I came in here. Today though, I can feel, I can cry, and I can see what my mother and my sister meant all that time ago. I can see for myself the hurt and the pain and the despair my drinking was causing to my family and myself. Today, the difference is, I can do something about it. I am learning about myself and this horrible disease every day of the week, and for today anyway I didn’t drink, and for me as an alcoholic, that’s a miracle. The treatment in Northlands along with the help of AA since then has given me my life back; it’s given me a life!”

    That is just one of many thousands of stories from people in the city of Derry and right across Northern Ireland who have been affected by the disease of alcoholism and drug addiction, and who have been helped by the wonderful volunteers and staff at the Northlands centre in Derry.

    Jim Shannon (Strangford) (DUP)

    I commend the hon. Gentleman for bringing this issue forward. I talked to him at the airport on Monday, and today as well. Unfortunately, what he is referring to in his constituency is replicated across Northern Ireland and in my own constituency, where there are addiction and drug issues, and where young people are committing suicide. I know that is replicated in the hon. Gentleman’s constituency, so I commend him for securing the debate.

    My understanding is that the Department of Health is holding the money up. Does the hon. Gentleman feel that, through this debate and through the Minister, we might be able to ensure that the money that was promised can be allocated to the maiden city, and to the hon. Gentleman’s constituents, to make things better for them? There seems to be a wee hold-up.

    Colum Eastwood

    The hon. Gentleman is absolutely right to say that the impact of the disease of addiction is felt keenly right across our constituencies. Of course, it is important to say that the Northlands centre, which is referred to in the New Decade, New Approach agreement, serves people from right across Northern Ireland. Every single constituency is affected by it.

    Now that I see the former Secretary of State, the right hon. Member for Skipton and Ripon (Julian Smith), in the Chamber, I might say a word about how we got to this point. For three long years, we did not have an Executive—it feels a bit like we are approaching that period again. During the long hours of torturous negotiation, there was a lot of publicity around a couple of issues, but some of us were focused on a lot more. We wanted to see an Executive back, but an Executive that actually worked on issues that matter to people.

    Late one Friday night, the right hon. Gentleman and I had a long discussion about what it would take to get us back into the Executive if we had a successful negotiation. People will understand that, for me, one of those things was the expansion of the Magee university campus. Another was the Northlands centre, which, after many decades of work, has a strong proposal for a world-class addiction centre in Derry. True to his word, as always, the former Secretary of State got that commitment into the New Decade, New Approach agreement. I was very grateful for it, as were the people of Derry.

    However, as we know in Northern Ireland, words on a page are not enough. What we need is money in a bank account and proper commitment. To be fair, we had that commitment from the previous Government in the form of New Decade, New Approach, and I have had support from the current Government. We now really need an Executive in Stormont to deliver that. Unfortunately, even when we had an Executive—and we had a Minister up until last Friday—we still could not get the money out.

    There are a number of things that I would like this Government to commit to now. What we need is an understanding of what happens if we do not have an Executive. I think all of us in the Chamber want to see an Executive as soon as possible. I would love to see all parties commit to get into government urgently—to get round the table and do the job that we were all elected to do. However, I want the Minister to answer a number of questions for me in the event that that does not happen.

    Are the British Government still committed to delivering on the Derry addiction centre aspect of NDNA? We hear an awful lot about all the commitments, but this is a very important commitment for many people. What is the impact of the political instability on this particular proposal, and how will this Government act if we do not have a functioning Executive? As much as we all will it and want it, if we do not get to the point of having a functioning Executive, will those people who rely on this world-class service, and those who do not even know that they are going to rely on it, be able to access it?

    Mhairi Black (Paisley and Renfrewshire South) (SNP)

    Last year and the year before, on average almost every day in Northern Ireland somebody died because of the way that they misused alcohol. Does the hon. Member agree that if that number of deaths were caused by any other issue, Government would absolutely be on top of it and we would have the Executive up and running and functioning? Does he agree that there is no excuse for the lack of clarity from Government?

    Colum Eastwood

    The hon. Member is absolutely right; one person every single week dies from alcohol-related disease in Northern Ireland. If we add in drug-related deaths, we are talking about 10 deaths a week. Imagine the outcry if that was happening in full public view; we would be rushing to deal with the issue at every level of Government. Frankly, there is no excuse any more for anybody to stand in the way of this commitment.

    New Decade, New Approach was an international agreement, signed off by two Governments and supported by five political parties. Some of us actually went into government on the basis of this and other commitments. Everybody in the Chamber knows about the cost of living crisis and the time it takes to access the health service. We should all know about the impact of drug addiction and alcoholism in our communities. We should be rushing to get this money out the door and spent.

    Northlands has a very proud record. I want to put on record just how grateful the people of our city, and the people of Northern Ireland, are to all the staff and volunteers at Northlands, as well as all the people who put their money in the boxes to support that wonderful service. Over the past five years alone there have been 1,186 weeks of treatment for hundreds of people attending the six-week residential programme at Northlands, and 12,886 non-residential counselling slots have been used. On average, over 35% of people for whom the data is available in that period are in recovery, with an average of under 10% in relapse management.

    Julian Smith (Skipton and Ripon) (Con)

    Will the hon. Member talk a little more about the team behind Northlands? I recall from my time as Secretary of State that it is not a commercial or money-making enterprise; it is local people who understand the specific issues with addictions in Derry and are passionate about those priorities. They are deeply impressive, and I think it would be useful for the Minister to hear a bit more about the people behind Northlands.

    Colum Eastwood

    I am grateful for the right hon. Member’s intervention and I want to put on record my gratitude to him for getting the commitment in writing in the agreement. He went to meet the people behind the Northlands centre—people like Denis Bradley and many others, who over many years gave of their time, expertise and love for the people of our city and the people who have been struggling with this disease. The House would not believe the number of people who are very grateful for the work they have done.

    It is also important to say that in our city and in other parts of Northern Ireland, we are faced with another problem: the grip of paramilitarism. Paramilitaries use drug addiction and abuse to coercively control communities in a way that needs to be tackled. In my view, the best way to tackle it—because we have tried everything else—is to deal with the root cause, which is addiction. Organisations such as the Northlands centre do that in a way that needs huge support. What better way to do that than to get this money into that organisation’s bank account and to get this project delivered?

    Before I finish, I ask again: will the Government continue to be committed to funding this service? What will happen if we do not see an Executive formed as a matter of urgency? Will this Government step in if we do not get a Health Minister at Stormont? I hope that we do, and I assume the Minister is going to talk about the need for an Executive. He has no bigger supporter in that call than me, but if we do not get an Executive, what are this Government going to do? Of course, it was this Government who committed to getting this money to Northlands and getting the project up and running. I am grateful to the Minister for being here, but I will be even more grateful if we can get this money spent, as has been committed to.

  • Colm Gildernew – 2022 Comments on Tackling Child Waiting Lists

    Colm Gildernew – 2022 Comments on Tackling Child Waiting Lists

    The comments made by Colm Gildernew, the MLA for Fermanagh and South Tyrone, on 27 October 2022.

    Fresh figures released by the Department of Health today on the number of children waiting to see a consultant are staggering and reinforce the immediate need to fix the health service.

    It’s totally unacceptable and deeply concerning that children are waiting four years to see a consultant.

    We need an Executive formed today and parties working together to deliver a three-year budget and invest the extra £1 billion needed to start to cut chronic waiting lists.

    I echo the call from the Royal College of Physicians today for more investment in the health service and for parties to get back around the Executive table.

    The DUP has an opportunity to form a government and get on with the job people elected us to do and that’s to live up to their commitment to make health a priority.

  • Will Quince – 2022 Speech on NHS Dentistry

    Will Quince – 2022 Speech on NHS Dentistry

    The speech made by Will Quince, the Minister of State at the Department for Health and Social Care, in the House of Commons on 20 October 2022.

    I thank the hon. Member for Denton and Reddish (Andrew Gwynne) for his kind words. He will be pleased to know that, despite what he said, I scribbled my own speech today and I can confirm that it will be a fudge-free zone. In fact, I have not had any fudge for about three years and I do not intend to start now—not least because it would not be great for my teeth.

    I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) on securing time for this hugely important debate. I thank the Backbench Business Committee for allowing the time and all right hon. and hon. Members who have made constructive contributions to the debate. It would be remiss of me not to thank all those who work in NHS dentistry, not just for their work throughout the pandemic, but for the work that they continue to do serving people up and down the country.

    In the relatively short time that I have available—I am conscious that there is another important debate to follow—I will endeavour to respond to as many of the points, themes and questions raised as possible. I hope that right hon. and hon. Members know me well enough already, however, to know that my door is always open. I have never turned down a meeting with a parliamentary colleague and I do not intend to start now. This is an important issue and I hope that we can continue to talk about it at length, even if not in this Chamber.

    As the new Minister—or new new Minister—for primary care and therefore dentistry, I have spent the first few weeks in post learning more about NHS dentistry, including by meeting dentists; meeting people at the coalface and the grassroots is really important. Of course, I have my constituency experience too. Despite the events of today, I very much hope to be here for some time to come.

    Let me say at the outset, in response to I think nearly all of the contributions made today, that I get it—I really do get it. I know that in many parts of our country access to NHS dentistry is difficult or far more difficult than it should be, and I want to make it clear that dentistry is an incredibly important part of the NHS. The Government and I are committed to addressing the challenges that NHS dentistry continues to face across the whole country, and as the hon. Member for Denton and Reddish rightly pointed out, it is in our ABCD strategy.

    I turn to some of the themes raised. The first is access, which was raised by my hon. Friend the Member for Waveney, the right hon. Member for Knowsley (Sir George Howarth), my hon. Friends the Members for Mole Valley (Sir Paul Beresford), for Gloucester (Richard Graham) and for Salisbury (John Glen), the hon. Member for Bootle (Peter Dowd) and my hon. Friend the Member for North Devon (Selaine Saxby). Access to NHS dentistry varies across the country—we know that—and it was an issue, as the hon. Member for Denton and Reddish rightly pointed out, even before the pandemic, but the pandemic has exacerbated it and added further pressure to the system.

    The Government are taking a number of important steps that will improve dental access for patients and make NHS dentistry a more attractive place for dentists and their teams to work in. I will outline just some of those. These changes include improvements to the current NHS dental contracts—I will come on to that in a moment—and of course to the recruitment and retention of dental professionals. I say dental professionals specifically because this is of course about far more than just dentists, as important as they are. As the hon. Member for Denton and Reddish pointed out, rightly, we have seen an additional 539 more dentists returning to NHS dentistry last year, which of course means they are able to treat more patients, but I recognise the point he rightly made, and we do need to go further and faster.

    On the steps taken, notwithstanding the points made by the hon. Member for Bradford South, we made £50 million of extra funding available for NHS dental services at the end of 2021-22, which provided more appointments and increased capacity in NHS dental teams. I noted her points, and we have learned from that. Given that experience, I would certainly want to do things a little differently if we considered such a proposal again. We announced a package of improvements to the NHS dental system on 19 July, as a number of Members have pointed out, which was set out in our plan for patients. These are an important first step to system reform and are designed to improve access to dental care for patients, particularly patients with the most complex treatment needs.

    A number of hon. Members raised the much criticised—and that is as far as I will go, the hon. Member for Denton and Reddish will be pleased to know—2006 contract. We are making improvements to ensure that dentists are more fairly remunerated, especially for more complex oral health needs. The one example we hear very often is of dentists getting paid the same for doing one filling as for six fillings. As numerous hon. Members have pointed out, we have also set a £23 minimum UDA value, notwithstanding the points made about the variation around the country.

    My hon. Friend the Member for Gloucester raised accountability locally, including to Members of Parliament. In part the answer to that is their coming within the remit and purview of integrated care systems. I have no doubt that my hon. Friend is well aware of the chief executive of his integrated care system, and will know how to contact and meet them on a regular basis.

    Richard Graham

    The Minister is absolutely right: not only do we know the chief executive, but all Gloucestershire MPs have had regular meetings with them, including one specifically on this issue. That is why I raised the importance of their being given the opportunity to take responsibility, which I hope my hon. Friend will welcome.

    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.

    Sir George Howarth

    The description that the Minister gave of the existence, or otherwise, of lists is accurate, but when anyone seeking to get NHS treatment in a dental practice rings up, they are most likely to be told by the receptionist that the practice is not taking NHS patients. The difference between the two situations, while technically correct, is not there in practice. Before he concludes his remarks, will he address the issue I raised about the short-term measures that can be, and I believe should be, taken to improve the situation?

    Will Quince

    I am conscious of your advice, Madam Deputy Speaker, but I am certainly willing to meet the right hon. Gentleman to consider what short-term measures we can take.

    There is so much I want to say about the contract and my ambitions for the future, but politics is the art of the possible and deliverable, and I will be honest and frank with the House, and with stakeholders across the sector, about what we can deliver. We will then work towards what is within the art of the possible. International dentists are a vital part of the UK’s dentistry workforce, and I am happy to meet hon. Members to set out exactly what we are doing. I hope to bring forward legislative changes later this year. On dental training, I would love to talk more about the Advancing Dental Care review and the centre for dental development, but that may have to wait for another day—you have advised me about the time, Madam Deputy Speaker.

    Prevention and oral health has been raised by many Members and is an important part of our strategy. I am looking closely at what more we can do with other Departments, especially around supervised toothbrushing, but also fluoridation, which was raised by numerous Members. Access to urgent care is important, and if people struggle to get an appointment they should call 111. This is the beginning of our work to improve NHS dentistry, not the limit of my ambition. This is just the start, and we are committed to long-term improvements, including changes to improve access to urgent care, and further work on workforce and payment reform. In the meantime there is lots we can do to improve access to urgent care, provide better access for new patients, and make important changes to workforce and payment reform. With that short response I hope I have assured hon. Friends and Members that action is being taken now to address the challenges of access to dental care, especially around recruitment and retention. I also want to reassure Members of my personal ambition and passion for bringing about the medium to long-term positive change that we want for NHS dentistry.

  • Andrew Gwynne – 2022 Speech on NHS Dentistry

    Andrew Gwynne – 2022 Speech on NHS Dentistry

    The speech made by Andrew Gwynne, the Labour MP for Denton and Reddish, in the House of Commons on 20 October 2022.

    I thank the Backbench Business Committee for granting this important debate, and congratulate the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) on having secured it. We support the motion in the form in which it has been moved; there is nothing in it that we disagree with. If some of the political arguments are removed from the debate, I think there is consensus across the House as to what the problems are and what needs to be done.

    Sir George Howarth

    I am sorry to interrupt my hon. Friend so soon. I agree with him about the motion, but I did make the point that there were some short-term measures that could, and should, be taken within the three-month period that the motion envisages before the Government report back on progress.

    Andrew Gwynne

    My right hon. Friend is absolutely right. There is no reason why the Government cannot expedite action on the issues he mentioned in his contribution and get those improvements in place.

    I pay tribute to my right hon. Friend and to my hon. Friends the Members for Blackburn (Kate Hollern) and for Bootle (Peter Dowd), as well as the hon. Members for Bath (Wera Hobhouse), for Mole Valley (Sir Paul Beresford), for Berwickshire, Roxburgh and Selkirk (John Lamont), for Gloucester (Richard Graham), for Salisbury (John Glen), for North Devon (Selaine Saxby) and for Loughborough (Jane Hunt), for their contributions.

    I welcome the Minister to his place. I am not sure how long he is likely to be at the Department of Health and Social Care, but I hope he is there long enough to implement some of the changes. I am all for a bit of stability in the Department. He is a good person and a good friend, and I wish him well. However, when he comes to the Dispatch Box, he will no doubt seek to deflect from the situation that has been described my Members across the Chamber by saying that we are here today because of the pandemic.

    The backlog has not helped—we all acknowledge that; it goes without saying—but the Government’s spend on general dental practices in England has been cut by more than a third over the past decade, with the number of NHS dental practices in England falling by more than 1,200 in the five years prior to the pandemic. My hon. Friend the Member for Bradford South (Judith Cummins) raised that, and it cannot be ignored. It creates the regional imbalances and dental deserts we have heard about. This is not a rural-urban thing; it is a rural and urban thing, sadly. My right hon. Friend the Member for Knowsley (Sir George Howarth), the hon. Member for North Devon (Selaine Saxby) and the right hon. Member for South Holland and The Deepings (Sir John Hayes) spoke about those dental deserts, which are very real.

    The Minister’s next line of defence, if I were to guess what the officials have put in his red folder, will be, “It’s all because of the dental contract.” There is some truth in that. It is 16 years since that dental contract was introduced, and it was introduced for a perfectly good reason. There was no golden age of NHS dentistry before it. There is a reason why people of my age have a mouth full of fillings and my children do not. It is not because I did not brush my teeth as much as my children do, and it is not because I ate more sweets than my children do. It is because the emphasis for paying dentists prior to the introduction of the changes was on early treatment that was perhaps not necessary—“drill and fill” is what they called it. We recognised in 2010 that the contract had not worked in the way we hoped it would, and we proposed changes. Of course, we lost that election, but after 12 years of this Government, I am afraid the line will not wash that it is solely the contract, because they have had plenty of time to make changes to that contract and have not.

    We hear about the ABCD plan, and I certainly welcome the “D” in it; at least there is a recognition of dentistry. However, like my right hon. Friend the Member for Knowsley, I worry that this kind of “Sesame Street” strategy does not come close to tackling the scale of the emergency that is gripping dental care. All we have heard from the Secretary of State is sticking-plaster solutions that tiptoe around the edges while failing to address the root cause. That is apparent in the Government’s “hit and hope” approach to dentistry. The £50 million of emergency funding announced earlier this year is a prime example. As my hon. Friend the Member for Bootle said, it is a time-limited, inaccessible pot of money that has done precious little to improve access. In fact, figures obtained by the British Dental Association showed that just 17.9% of that funding was drawn down. This is indicative of a sector that has completely lost faith in the Government’s ability to act, and to be frank, I do not blame them, because when we do see action, it does not meet the scale of the crisis, and in some cases it makes things worse.

    As we have heard, the geographic, ethnic and socioeconomic disparities affecting access to NHS dentistry are becoming starker by the day. What does the new Health and Social Care Secretary do in response to that problem? She scraps the health disparities White Paper. It is beyond bizarre that in the face of such overwhelming evidence, the Government will not even consider possible solutions—let alone implement them.

    I fully support what the hon. Member for Waveney and other hon. Members on both sides of the House have said about education. Dentistry in schools, a prevention strategy and an emphasis on good oral health is absolutely crucial. We would support the Government in implementing that—hopefully sooner rather than later. The consensus and mood is there to get that done, so I hope the Minister will take that up and get going on that opportunity.

    As for many issues facing our NHS, much of the problem with NHS dentistry can be traced back to one thing: workforce. Several hon. Members raised that point. Any hope of an NHS recovery must be underpinned by a comprehensive workforce strategy. Where is that strategy? Was it accidentally shredded with the mini-Budget? I am sure the Minister will hail the fact that NHS stats show an increase of 539 dentists practising in 2021-22, compared with the year before. When we drill down beneath the surface, however, there is not much to be positive about.

    Those stats are rendered worthless by the fact that a dentist performing a single check-up on the NHS in a 12-month period is weighted the same as one with a full cohort of NHS patients. BDA survey data shows that for every dentist leaving the NHS altogether, a further 10 are significantly reducing their NHS commitment. No matter how much Ministers might try to fudge the numbers, they simply do not add up. We cannot afford more bluff and bluster. We need action, which the Opposition will support.

    The outgoing Prime Minister said that dentistry was in her top three priorities for her first 90 days. That now seems rather optimistic given that she is Liz of 44 days, but we really want the Government to act on that commitment. Can we have an update on how things are going?

    The Labour party will fund one of the biggest NHS workforce extensions in NHS history. We will double the number of district nurses qualifying every year, train more than 5,000 new health visitors and create an additional 10,000 nursing placements every year. We will fund this transformative expansion by abolishing non-dom tax status. We will give dentistry the staff, equipment and modern technology it needs to get patients seen on time. Labour has a plan. Where on earth is the Government’s?

  • Jane Hunt – 2022 Speech on NHS Dentistry

    Jane Hunt – 2022 Speech on NHS Dentistry

    The speech made by Jane Hunt, the Conservative MP for Loughborough, in the House of Commons on 20 October 2022.

    I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) on securing what is clearly an important debate.

    I take this opportunity to thank those in the dental profession in Loughborough and across Leicestershire for everything they have done over the past few years and particularly for the way they adapted to implement the huge changes needed to ensure the safety of their patients throughout the covid-19 pandemic. This year I have met with nearly all the dentists in my constituency, who have highlighted a number of issues they face and the impact they have on the profession and the patient experience more broadly.

    Richard Graham

    The points my hon. Friend is making are particularly important to constituencies such as hers, which have towns but are also rural.

    Jane Hunt

    I thank my hon. Friend, who is a true hero in every way.

    One concern is about the UDA system, with the recurring message being that the system in its current form is not fit for purpose. I welcome the package of initial reforms to the NHS dental contract announced in July, in particular the introduction of enhanced UDAs to support higher-needs patients.

    However, the reforms do not address my local dentists’ concerns that the current system is based on rewarding reactive treatment, rather than preventive, meaning that dentists are driven to do the minimum necessary to meet the terms of the target. That is a source of frustration for some, who have expressed their preference for being remunerated for using their initiative and working in the best interests of their patients.

    Furthermore, while it is welcome that a minimum indicative UDA value of £23 has been introduced, UDA payments are not rising in line with increasing overhead costs, which is devaluing contracts and, in some cases, leaving dentists out of pocket. That was highlighted recently during a conversation I had with Bupa in Loughborough. Bupa expressed that that is compounded by the fact that UDA payments vary geographically, so that a UDA is worth £36 in its Sheffield practices but only £24 in its Loughborough one. Finally, the reforms do not address the issue of dentists not being given leeway under their contracts for last-minute cancellations and no-shows, even though they can lead to missed targets. I ask that this be urgently reviewed, so that we do not punish dentists for trying their hardest to continue to provide the care needed.

    It is clear that there is still a way to go to make NHS dental contracts more attractive, both in terms of the nature of the dentistry performed and the level of financial reimbursement received for services performed. I fear that if the Government do not continue to work at speed, we will lose even more NHS dentists through early retirement, a reduction in time spent completing NHS work, or a full move into private practice. That would be detrimental to patient care and the availability of NHS appointments. I know that the former Minister of State for Health, my hon. Friend the Member for Lewes (Maria Caulfield), was working hard to review UDA contracts, and I would welcome confirmation from her successor that they will continue that hard work.

    As well as difficulties retaining dentists, I have been informed that locally, we are having difficulties recruiting them. One reason for that is that there is no dentistry school in the east midlands, our nearest being in Sheffield and Birmingham, and students are choosing to enter into the workplace close to where they study. That is causing supply issues in the NHS service, and has created a gap in the market that is being filled by private dentists with a focus on cosmetics. We therefore need to ensure we are training up enough dentists and providing them with incentives to move away from where they are studying to areas with greater demand. Bupa has also advocated for putting dental practitioners on the shortage occupation list in order to increase overseas recruitment and fill shortages, then upskilling those practitioners via short courses to meet UK standards. Could the Minister please comment on the actions being taken to increase the number of dentists from overseas?

    I am very concerned that NHS England has proposed closing the intermediate minor oral surgery service in Loughborough, meaning that local residents will have to go as far as Leicester for treatment. That city is some considerable way away, and there has been a recent cut in bus services, the No. 2 bus service in particular. Loughborough is effectively Leicestershire’s county town, so there is more than enough demand there for that service. Closing the centre will only increase pressures on the Leicester centre, extending waiting times and further impacting on patient care. That centralisation of services does not meet the needs of the patient, and I ask that the Minister look with some urgency at local services’ availability throughout the country, especially throughout Leicestershire.

    Having listened to the whole of today’s debate, it has been very interesting: there are a small number of points that need to be addressed, which have been made by Members from all across the Chamber and all over the country. I do not think this is an insurmountable problem to solve, and I feel sure that the Minister will be able to address it.

  • Selaine Saxby – 2022 Speech on NHS Dentistry

    Selaine Saxby – 2022 Speech on NHS Dentistry

    The speech made by Selaine Saxby, the Conservative MP for North Devon, in the House of Commons on 20 October 2022.

    Like other colleagues, I have spoken out many times in this House about dentists, including in the debate earlier this year. Indeed, the very first letter that I wrote as an MP back in 2019 was about the dental contract, which was brought to my attention by one of the dental practices in Barnstaple. I cannot stress the severity of the dental desert that is now Devon, with not a single NHS practice accepting new patients. Not a week goes by without correspondence from a constituent in distress. As William Shakespeare himself said in “Much Ado About Nothing”:

    “For there was never yet a philosopher that could endure the toothache patiently.”

    And nor should they. It really is time that something is done. I thank the current Health and Social Care Secretary for recognising dentistry within the ABCD and that there is a problem. I thank, too, the current Minister’s predecessor for at least taking some steps towards redressing the issue of the contract, which is clearly the undermining problem. However, that is a long-term solution. The steps outlined there and the training of more dentists are not going to address the current situation.

    Only last weekend, a friend, who was already registered at a dentist, told me that they had actually managed to get a dental appointment. When they got there, they were told that they needed to see the dental hygienist. They went to book an appointment and were told that there was a six-month wait to see the hygienist, who then told them that they needed to have a second appointment to do the other half of their mouth. They went to book, only to be given another six-month wait before they could see the hygienist, so it took a full year. As they said, it is a bit like cleaning the Forth bridge. This is not how our constituents’ teeth should be treated.

    My concern extends to my younger constituents. The No.1 reason youngsters under 18 are admitted to hospital in my patch is linked to their teeth. At a time when our hospitals are under such duress anyway, could we not do something to help to ensure that people are able to see a dentist?

    My frustration is extended by the fact that I have now managed to secure and find two separate methods for getting dentists into North Devon. Although I do not mind doing this for my constituents—indeed I welcome doing anything I can to help my constituents—I do not quite understand why it is coming down to us as individual MPs to deliver the dentistry that our constituents so desperately need.

    Less than 13% of the covid catch-up funding in Devon was spent because there is no one to deliver the treatment. My NHS dentists who train up new dentists at the nearest dental schools advise that these youngsters do not wish to remain in NHS dentistry. We need to address that. Those who train to become dentists under the public purse should have to serve as NHS dentists for a certain period, but they wish to go on to do cosmetic dentistry, which pays much better. The good people of North Devon in the main are not looking for cosmetic dentistry. We are much more interested in fillings and dentures and in ensuring that our young people go on to have good-quality teeth when they get past the age of 10. I urge the Minister to push forward some of these changes, and I hope the new team remain in place long enough to do so.

    We need dentists on buses or similar to get to remote rural communities and into schools, to enable every child to have the dental check-up they deserve and to provide emergency access for those people who have failed to secure a dental appointment—not because they have not tried or because of covid, but simply because there is not a dentist available to see them and many people cannot afford to pay for the treatment that they now need after waiting so long.

    Sir John Hayes

    My sons, who are now 21 and 18, have access to NHS dentistry, as I have, at the excellent Fen House dental practice in Spalding, but many of my constituents’ children do not, as my hon. Friend says. She talks about dental deserts in rural areas, and Lincolnshire is among the worst of those, with 38 dentists per 100,000 population. She is right both about young people and about the particular problems of rural areas. The Minister, for whom I have high regard, needs to give us very firm answers to those questions and a clear plan for what the Government intend to do about them. There is a plethora of private dentists, but too few NHS dentists.

    Selaine Saxby

    My right hon. Friend’s comments are wise, as always.

    On international dentists, during the first lockdown, I had an Indian dentist come and meet me privately, and I forwarded that information back to the Department; apparently, there are many, many Indian dentists who would be delighted to come. We would welcome them to North Devon with open arms—indeed, we would welcome dentists from anywhere into North Devon, such is the need. I urge the Minister to look at what else can be done to speed up access for those people who are well trained internationally to come over and look at our teeth.

    I will finish by reminding hon. Members how important our teeth are. I ask the Minister to do anything that can be done to help both our youngsters and those people who have struggled to see a dentist, so that we can again say that the dentist will see us now.

  • Peter Dowd – 2022 Speech on NHS Dentistry

    Peter Dowd – 2022 Speech on NHS Dentistry

    The speech made by Peter Dowd, the Labour MP for Bootle, in the House of Commons on 20 October 2022.

    Where are we to begin with this? We have been here before, time after time. I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for bringing us this debate. We have discussed this many times and we had a debate in Westminster Hall in the summer, but nothing has really moved on. Nothing at all seems to have changed.

    I want to read out part of a letter I received from a constituent, and this is typical of the problem we are facing. I have received even worse horror stories, to the extent that one local dentist told me that they may close in the next few weeks. That is typical and symptomatic of this bigger problem. My constituent said:

    “I wanted to take the time to get in touch with you over my experience of getting on the books for an NHS dentist. I have had no luck and have had to have private dental visits. I have luckily not had to have any treatment as I would not be able to afford it. I have reached out to a few dental practices in the area…to be told that they are only taking on children on the NHS.”

    That is typical of the experience of everyone in this Chamber. I exhort Conservative Members to stop dealing with this in the abstract, as though it is only affecting individual Members of Parliament; it is a collective issue, and it needs a thorough review and a thorough push by the Government. It is not in the abstract. The hon. Member for Salisbury (John Glen) referred to covid. I completely accept that covid had an impact on the provision of dental services—it hothoused an already challenging situation—but dental services in all our constituencies were under huge pressure before covid. Let us not pretend that covid was the be all and end all of the dental health problem.

    Sir John Hayes (South Holland and The Deepings) (Con)

    I agree with the hon. Gentleman that there are systemic problems, part of which goes back to the contracts agreed with dentists donkey’s years ago, under the Labour Government—the same applies in respect of GPs. That genesis of the problem was there, but we then face the problem of training too few dentists, which I think we do, and the problems in particular parts of the country, including, Lincolnshire, which is among the worst affected. My constituents cannot get an NHS dentist and they need to have one. That particularly applies to young people and children. He is absolutely right on this.

    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.

    Rachael Maskell (York Central) (Lab/Co-op)

    I apologise that I was not able to be here for the whole debate; I have been in a Bill Committee. In York, people have to wait six years to see a dentist. Of course that is completely unacceptable, but my real concern is that, with the transition of dental services into integrated care systems, ICSs will not have the powers—the levers—to make the difference on training, funding and the contract and, ultimately, dentistry will be pushed into a tug of war between ICSs and the Government.

    Peter Dowd

    I am glad that my hon. Friend raised that matter because it is something that I was going to raise. The health service, because of the reorganisation, is in an element of flux. It is feeling under a bit of pressure. Potentially, people are having to reapply for jobs in the broader sense in the NHS because of the reorganisation. That is a fact. I am not sure whether we should be having a reorganisation of the NHS in the post-covid environment, but that is a different argument for a different day. The broader dissonance in the system now multiplies the problems that we are having in dental practices, because they are getting pushed further away, which is why practices need representation on these boards. I am glad that my hon. Friend highlighted that point.

    As I said in the debate before the summer, we do not want any more excuses from the Government. We do not want any more prevarication, any more procrastination, any more pretext or any more self-exoneration. I hope the Government and the Minister, whom I welcome to his place, really get the sense of the frustration and, in certain situations, anger in the Chamber today. They really must pull their finger out—if not people’s teeth.

  • John Glen – 2022 Speech on NHS Dentistry

    John Glen – 2022 Speech on NHS Dentistry

    The speech made by John Glen, the Conservative MP for Salisbury, in the House of Commons on 20 October 2022.

    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.