The Secretary of State for Health and Social Care (Sajid Javid)
That is rubbish!
Wes Streeting
It is rubbish, but it is his record.
Why is it that so many people are accessing NHS services because of a failure to invest in social care, where staff can be recruited and deployed a lot faster? On the dentistry contract, the last Labour Government acknowledged that the 2006 contract was not good enough, which is why we put the reform of that contract in our 2010 manifesto. The difference is that we will not wait 12 years to deliver the promise after the election of the next Labour Government. Those are just some of the practical steps that we would take immediately and that the Government could take immediately.
Let me tell the House about some of the fundamental issues we would fix. First, mental health services in this country are in such a state that GPs are seeing more and more of their own cases present with mental ill-health. A Labour Government would recognise that there has been a surge in mental ill-health following the pandemic and we would not leave it to overwhelmed GPs to see them. That is why we have committed to recruiting 8,500 new mental health professionals, including specialist support in every school and mental health hubs in every community. We would pay for that by ending the charitable status of private schools and closing the tax loopholes enjoyed by private equity fund managers—and do not tell me the Health Secretary does not know where they are; he was using them before he became a Member of Parliament.
That policy—[Interruption.] Conservative Members are funny. They ask for our policies but they do not like it when we provide the answers, because we have them and they do not. That policy, which would put mental health hubs in every community and support in every school and speed up access to treatment for everyone in our country, would help to reduce pressure on GPs and to deliver better mental health treatment in every community and faster access to a GP for everyone else who needs to see them. It also tells you something about the choices we would make and the priorities we would have as a Labour Government: better public services enjoyed by the many, paid for by closing tax perks for the few.
I know that there is lots of cynicism about politics. We have a Prime Minister who wants people to believe that we are all the same, that things cannot change and that his shambles of a Government are the best that Britain can do. All I would say to the people of Britain is this: judge them on their record and judge Labour on ours. They have been in power now for 12 years. They delivered the highest NHS waiting lists in history, before the pandemic. They delivered record staffing shortages in the NHS with 100,000 vacancies, before the pandemic. They delivered cancer care that worsened in every year since they came to office, before the pandemic. Now they tell us that patients will be paying more and waiting longer.
The last Labour Government were in power for 13 years, and we delivered the highest patient satisfaction in the history of the NHS, the lowest waiting times on record and more doctors, nurses and new hospitals. There were no threats of strikes in the NHS when we were in government because staff could see the difference we were making and so could the patients. We did not get everything right—nobody is perfect—but Labour’s record on the NHS is one that this Government could not even begin to touch. The longer we give the Conservatives in power, the longer patients will wait. Well, people are sick, and they are tired of waiting. This Government’s time is up.
The Secretary of State for Health and Social Care (Sajid Javid)
I welcome this chance to come to the House to discuss primary care and dentistry, but I have to say that the audition by the hon. Member for Ilford North (Wes Streeting) did not go very well. I hope that he can see the irony—some might even say the hypocrisy—of his sudden interest in access to public services, today of all days. It is thanks to the strikes that he has been so vocal in supporting the fact that people right across the country cannot make their appointments, that GPs and dentists cannot get to work and that patients do not have access to the treatments they desperately need.
Several hon. Members rose—
Sajid Javid
I will take some interventions in a moment.
The hon. Gentleman has had every opportunity to do the right thing, to put patients first and to condemn these unjustified and reckless transport strikes, yet at every turn he has chosen to back his union paymasters.
Catherine West
The Secretary of State speaks about opportunities. In this House, we had a number of opportunities to get workforce reform, workforce numbers and a plan for our health service into the Health and Care Act 2022. Why did he miss those opportunities?
Sajid Javid
We are seeing record investment in the workforce, and we are seeing record increases. For the first time ever, the NHS is also coming up with a 15-year long-term workforce strategy, which I hope the hon. Lady welcomes.
The Government have always been on the side of patients and the people who care for them. I pay tribute to everyone working in primary care and dentistry for the difference they make day in, day out to their patients’ lives. I know that the pandemic has brought some unimaginable pressures, and equally I know that many of those pressures have not gone away now we are living with covid.
The hon. Member for Ilford North talks as though he does not know where the pressures have come from—as though he has had his head under a rock for two years. The NHS has said it believes that between 11 million and 13 million people stayed away from the NHS, including their GPs and dentists. Rightly, many of those people are now coming forward for the treatment they need—and I want them to come forward.
John Redwood
When the Secretary of State does the much-needed manpower review, will he ensure that a fast-growing area such as Wokingham with lots of new houses gets proper provision for that growth? Will the manpower plan also address how we recruit the doctors we have authority to get?
Sajid Javid
I absolutely agree with my right hon. Friend’s important point. In fact, I met my hon. Friend the Member for South West Bedfordshire (Andrew Selous) about that last week, and I agree with them both.
Hilary Benn (Leeds Central) (Lab)
Last month, a constituent contacted me who had developed severe dental pain. He phoned 40 dentists and not one of them could take him on as an NHS patient. It got so bad that he phoned 111 but was told that he was not eligible to see an emergency dentist. What advice would the Secretary of State give to someone in those circumstances? Many other hon. Members on both sides of the House will be able to tell similar stories. In the end, my constituent had to pay to go private, but that should not have happened. Why are our constituents being placed in that position?
Sajid Javid
I am sorry to hear about the right hon. Gentleman’s constituent. If he will allow me, in a moment, I will come on to the pressures that dentistry is facing and, most importantly, what we are doing about them.
Those pressures have come about for two reasons. First, there was a fear of infection, which was understandable in a context where 10 minutes in a dentist’s chair during the pandemic could have meant 10 days in self-isolation or, perhaps, worse. Dental practices were almost uniquely at risk of spreading covid, so their activity was rightly severely constrained across the world—not just here in England and across the UK—by the infection prevention rules that were necessary at the time. Despite all the innovations in dentistry over the last few years, dental surgeries do not have a Zoom option.
Secondly, the British people stayed away because of their innate sense of responsibility during the pandemic. As all hon. Members saw in their constituencies, people understood our critical national mission. Our GPs were doing their duty vaccinating people in care homes and in thousands of vaccination centres up and down the country, protecting the most vulnerable and working hard to keep us all healthy and safe.
When omicron struck—we all remember that period, which was not that long ago—I stood before this House and asked GPs to stop all non-emergency work once again. I did not take that decision lightly, but we were faced with a stark choice of having more lockdowns or accelerating our vaccine programme. We chose to accelerate, with help from all corners of the NHS and with the backing, at that time, of the hon. Member for Ilford North. I remember him standing at the Dispatch Box pledging his full support for that effort and rightly stating that the Government were acting
“in the best interests of our NHS, our public health, and our nation.”—[Official Report, 13 December 2021; Vol. 705, c. 795.]
He recognised that it was the right thing to do then; he has now conveniently changed his mind. I wonder why.
Mike Amesbury (Weaver Vale) (Lab)
But people like Mark in my constituency cannot find an NHS dentist. This is not about covid; it was happening before covid. The investment just is not there. He is in pain; he is in agony. The Secretary of State needs to step up, step in and get things right.
Sajid Javid
We are putting record amounts of investment into the NHS, including more funding into dentistry—I am about to come on to that right now—which will help with those pressures.
Clive Efford
Covid is just a pathetic excuse, because even if it was the sole reason, the Secretary of State should have been planning for when we came out of it, but nothing he has said explains why we had record numbers of patients on waiting lists even before covid started.
Sajid Javid
I think that many people working across the NHS will be listening to the hon. Gentleman and realising that he has no idea about the pressures that covid has created for everyone working there, especially those on the frontline.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
Excuse me for raising this issue, but I want to draw attention to the fact that there has been news released that the Secretary of State’s Government have declined to introduce mandatory reporting of complications resulting from mesh. In the context of problems with waiting lists, and wider issues, if we do not introduce a mandatory reporting scheme to identify problems with a medical product, more people will end up requiring medical intervention and medical treatment, so I urge the Government to look again at their declining to introduce mandatory reporting.
Sajid Javid
The hon. Lady raises an important issue. That is why the Government commissioned an independent report. We have responded to that report. We are still listening to what hon. Members such as herself and others are saying on this important issue, and then we will do a follow-up of the report within a year, so that will be later this year. I know that she will take an interest in that.
Paul Bristow (Peterborough) (Con)
Does my right hon. Friend agree that a lot of the issues with primary care services are about leadership? In my constituency, we have the brilliant Thistlemoor surgery with Dr Neil Modha and Dr Azhar Chaudhry, who serve 29,500 patients, 80% of whom do not have English as a first language. Same-day, face-to-face GP appointments are the norm in that practice. In contrast, a Thorney surgery has just temporarily closed a surgery in my constituency due to a lack of admin staff, which is not the fault of the admin staff themselves. Will he back my campaign to make sure that that GP surgery is open again serving local people as soon as possible?
Sajid Javid
My hon. Friend is campaigning passionately for primary care services in his constituency, and he points to some fantastic practices. I congratulate all the people involved in delivering that and support him in his work with his local commissioners to make sure that they are getting even better local primary care.
Dr Andrew Murrison (South West Wiltshire) (Con)
Does my right hon. Friend recognise that the crisis in NHS dentistry, which affects my constituency as it does his, well predates the pandemic, and indeed goes back to at least 2006 when the then Labour Government changed the way in which dentists are paid? Will he undertake to look at the units of dental activity system, which disincentivises dentists from providing dental work particularly in the most disadvantaged communities?
Sajid Javid
My right hon. Friend is absolutely right in his analysis, and I can give that undertaking. I will say a bit more about that in a moment.
If the hon. Member for Ilford North wants to talk about funding for the NHS, I am happy to oblige. Under the last NHS long-term plan, before the pandemic, we made a historic commitment of an extra £34 billion a year. Because of the pandemic, we then necessarily put in £92 billion of extra funding. At the last spending review, we increased funding still further so that the NHS budget will reach £162.6 billion by 2024-25, supported in part by the new health and social care levy.
We have made sure the NHS has the right level of resourcing to face the future with confidence, but we must also be alive to the consequences. The British people expect every pound spent to be spent well, and they expect us to be honest with them that every extra pound the hon. Gentleman calls for will be a pound less spent on education, infrastructure, housing and perhaps defence. I believe in a fair deal for the British people, and especially for our young people. We will be making plenty of changes alongside this funding.
Jonathan Edwards
One of the major problems we face in Wales and across the UK is the need to replace retiring GPs and dentists. There has been a welcome increase in the number of international medical graduates training in Wales, but the British Medical Association informs me that very few GP practices and dental practices in Wales are registered as skilled worker visa sponsors. Will the Secretary of State raise this with the Home Office to see what can be done to help GPs and primary care practitioners retain those international graduates to work in Wales and across the UK, if they so decide?
Sajid Javid
We are working with our colleagues in the Home Office on this and other skills and healthcare issues, so I can give the hon. Gentleman that assurance. He talks about the major problem he is facing in Wales, and that major problem is a Labour Government. I hope he agrees—[Interruption.] He is nodding.
Look at the performance of Labour in Wales, whether on health or education: the median waiting time for outpatients in Wales is almost double the median waiting time in England. People in Wales are waiting more than three years, whereas the longest wait in England is more than two years. Thanks to the covid recovery plan we set out in this House a few months ago, the number waiting more than two years has been slashed by more than two thirds in just four months, and it will be almost zero next month.
Thousands of people in Wales are waiting two or three years. In fact, one in four patients in Labour-run Wales are waiting longer than a year. In England it is one in 20, which is far too high and will be lowered, but in Wales it is one in four. It is not surprising the hon. Member for Ilford North had nothing to say about his colleagues in power in Wales.
Sajid Javid
I would like to hear what the hon. Lady thinks of the Labour Government in Wales and their abysmal performance when it comes to healthcare.
Kate Hollern
There is much better performance from the Welsh Government than from the UK Government. The Prime Minister promised 6,000 more GPs, which has not happened.
I wrote to the Secretary of State about Blackburn having only 33 GPs per 100,000 people, whereas the south-west has 73. I wrote to him about a young man whose cancer was misdiagnosed, but I have not had a response. I would say Wales is doing much better than the Secretary of State.
Sajid Javid
That is a very strange comment about the hon. Lady’s colleagues in Wales. Either she does not know or she is deliberately saying something she does not quite believe. Perhaps I can make her aware of the facts in Wales, where the number of people waiting more than two years for treatment currently stands at more than 70,000. That is more than three times the figure in England. That is more than three times the figure in England. It is at 70,000, and the hon. Lady seems to be very comfortable with that. I am surprised—it tells us all we need to know about Labour’s ambitions for government if she thinks that is acceptable.
Sajid Javid
Maybe the hon. Member for Rotherham (Sarah Champion) can tell us whether she agrees with her hon. Friend the hon. Member for Blackburn (Kate Hollern) on Wales.
Sarah Champion
The Secretary of State knows we are having a debate about the whole UK, but I am asking him specifically about England and his responsibility. Can he answer the original question from my hon. Friend the Member for Blackburn (Kate Hollern), which was about the Prime Minister’s 2019 commitment to 6,000 extra GPs? We know there are 1,000 newly qualified foreign GPs who are about to be deported by his Government, plus students who are unable to complete their studies because this Government are not providing them with the money for the final years. Under the management of the Secretary of State’s Government in the last decade, we have lost 4,500 GPs. Can he talk about what he plans to do to replace them?
Sajid Javid
I am happy to talk about that. Because of the record funding this Government have put in, both pre and post pandemic, we are seeing record increases in the workforce across the NHS. When it comes to GPs, since March 2019 we have seen an increase of some 2,389. On top of that, we have seen a further increase of more than 18,000 full-time equivalent staff working in other important primary care roles. That is in England—I am talking about England numbers.
Of course, we are working hard towards the targets we have set. We are also seeing more GPs in training in our medical schools than ever before, with more medical schools operating than ever before. I hope the hon. Lady will welcome that result and that investment.
Steve Brine (Winchester) (Con)
We are talking about GP and dentistry services today, but the wider primary care family includes community pharmacy and ophthalmology, the vast majority of which are not NHS providers but operate under contract providing NHS services. In my excellent right hon. Friend’s second year in the Health Secretary job, will there be a ruthless focus on the wider primary care landscape? When it comes to prevention, surely those people must be the front door of the NHS to ensure that the system is sustainable in the long term.
Sajid Javid
Yes, absolutely. I know my hon. Friend speaks with great experience in this area. I am just about to come on to some of the changes we will be making to primary care, which I am sure he will welcome.
Andrew Selous
When the Secretary of State goes back to the Department, will he have a quick look at how it is that, in Leeds, north-east Lincolnshire, Fylde and Wyre and Stockport in the past six-and-a-half years, we have increased the number of GPs by between 18% and 22%? I am curious to know whether there are any lessons we can draw from those areas for the rest of the country. Will he ask his officials to look into that to see whether there are useful points for us?
Sajid Javid
I will, and I will get back to my hon. Friend on that issue with more detail. I hope he welcomes the investment we are seeing and the record numbers of doctors and GPs in training.
Richard Fuller
I know my right hon. Friend is coming on with some more ideas, but from talking to GPs across my constituency, one of the issues I have found is that, as we have diversified primary care staff beyond GPs to paramedics and others, the role of what might be called receptionists and telephonists has moved far more into triage. It is now a more complicated role. Is he attracted to the idea in the Policy Exchange document of creating an NHS gateway to provide more medically qualified staff at that first point of entry to GPs, but on a nationalised basis, available via internet, telephony and the cloud?
Sajid Javid
Yes, I am. I have seen the report my hon. Friend refers to and have discussed aspects of it with its authors, so the short answer is yes.
Sajid Javid
I will later.
In terms of the changes we are making, let me first turn to primary care. The hon. Member for Ilford North, in his motion today, is calling on me to
“urgently bring forward a plan to fix the crisis in primary care”,
as he puts it. That is his motion. He is probably too busy supporting the strikers to have read my speech to the NHS Confederation last week. Had he bothered to listen to or read what I said in that speech, or the similar words from Amanda Pritchard, the chief executive officer of NHS England, he would have heard me acknowledge that our current model of primary care simply is not working. I have made no secret of that, or of my desire for change.
We are now working on a plan for change and, based on today’s motion, I will be glad to count on the hon. Gentleman’s support when we bring those plans forward, because what he has asked for, we are already doing. Our plans, for example, include a much bigger expansion in what our fantastic pharmacists can do. In fact, on the very day that I made that speech in Liverpool, we also announced a new pilot scheme to allow people with signs of cancer to be assessed and referred by pharmacists. That is yet another example of how we are working hard to enhance the role of our brilliant pharmacists and thereby freeing GPs to spend more time with their patients.
Imran Hussain
Thus far, if I have got this right, the Secretary of State has told us that there have been record levels of investment across our NHS services, including GPs and hospitals, and that any minor concerns that have arisen are because of the covid years. Does he think that the British public have been asleep for the last 12 years? Does he think that the British public will buy this? The stark reality on our streets—the Secretary of State may want to go and have a look—is as dire as it has ever been.
Sajid Javid
As I said—I am glad that the hon. Gentleman was listening—there have been record levels of funding in the NHS, and, as we set out in our spending plans, that will continue. But that is no thanks to the hon. Member for Ilford North and his colleagues, who all voted against that record funding. They wanted to deny those resources to their constituents. He should reflect on the impact of that had their wish gone through the House.
On the changes that we are making, we are going further, from improving telephone services to letting others such as nurses and pharmacists complete fit notes. Appointment numbers are already exceeding pre-pandemic levels—for example, in April, GPs and their teams were delivering 1.26 million appointments per working day. That is a phenomenal achievement, which the hon. Gentleman should be commending, not castigating.
The hon. Gentleman raised Wakefield and primary care. He was using dodgy numbers, so he was corrected by my hon. Friend the Member for South West Bedfordshire. He also gave out further dodgy information by somehow claiming that the King Street walk-in centre was under threat. I do not know if you have seen this in the by-elections, Mr Deputy Speaker, but the Labour party has a history of just making things up and creating fake news to scare local people. That is the respect that they show for local people. The walk-in centre has never been under threat. The local clinical commissioning group has confirmed that it has never been under threat. If he had any decency, he would stand up and withdraw his remarks. I give him that chance.
Wes Streeting
I would have thought that the Secretary of State would have learned by now that it is silly to give way to me when he makes these facile points. It is absolutely the case that the walk-in centre’s future was in jeopardy. It is absolutely the case that Simon Lightwood campaigned to save it. If that is what Simon Lightwood can achieve as a candidate, imagine what he will do as Wakefield’s next Labour MP.
Sajid Javid
The hon. Gentleman is now using the past tense. A moment ago, he claimed that it was under threat. He clearly has no issues with giving false information in this House. The truth is that, if Wakefield wants a better future, as everyone in Wakefield deserves, only one by-election candidate can provide that, and that is Nadeem Ahmed.
We intend to go much further to build a truly 21st-century offer in primary care. That includes Dr Claire Fuller’s independent review, which I found to be extremely valuable, and the changes that will stem from that as well as the many others that we will bring forward shortly. We will work with the population and the profession alike. The hon. Gentleman was right to focus on the importance of the profession, but he did forget to mention, as I referred to earlier, that since March 2019 we have more than 2,380 additional GPs in primary care, record numbers of doctors in training and more than 18,000 additional primary care professionals.
Let me turn briefly to the important steps we are taking in dentistry. Urgent care has been back at pre-pandemic levels since December 2020, and the 700 centres for urgent care that we set up to provide treatment for patients during this difficult period have helped thousands of patients across the country. At the start of this year we put an additional £50 million into NHS dental services, which boosted dental capacity by creating 350,000 extra appointments. Dentists are currently required to deliver 95% of pre-covid activity, and we are planning to return to 100% shortly. I commend all the dentists who are already achieving that.
Paul Blomfield (Sheffield Central) (Lab)
The Secretary of State referred to an additional £50 million. As he knows, the way in which that was framed made it difficult for dentists to draw down the money. Will he tell the House how much of it has been drawn down and used?
Sajid Javid
I do not have the exact figures to hand, but I know that millions of pounds were drawn down and used to deliver tens of thousands of appointments across the country. That made a huge difference to a great many people.
Greg Clark (Tunbridge Wells) (Con)
The urgent care centres are an important innovation, but it is also important for them to be accessible throughout the country. There are seven in Kent, but the one nearest to my constituents is 33 miles away. Could my right hon. Friend intervene with the NHS in the south-east to bring about a more even distribution?
Sajid Javid
My right hon. Friend’s point is important and well made, and I will look at the issue closely and get back to him, if I may.
As we have already heard today—but it is such an important point—the challenge for NHS dentistry predated the pandemic. It is not just about the number of dentists in England, but about the completely outdated contracts under which they are working, which were signed under a Labour Government. [Interruption.] Labour Members do not like it, but it is true. These contracts mean that we are operating almost with one hand tied behind our backs. They do not incentivise prevention, they hold back innovation, and they mean that hard-working families cannot get the dental services that they deserve. However, we will now be changing that; our work with the sector, along with the work of Health Education England on recruitment and retention, will be vital for the future.
Sajid Javid
I will in a moment.
If there is one thing that unites all our work on primary care and dentistry, it is this. We are shifting to a new mode of operating—one that is about helping the whole population to stay healthy, not just about treating those who ask for help. We need to get to a place where we are healthier for longer, because freedom is hollow without our health.
Our new Health and Social Care Act 2022 is an important step in that ambition. Statutory integrated care systems will be responsible for the funding to support the health of their respective areas—not just treating people, but helping people to stay healthy in the first place. The Act also allows us to make safe and effective public health interventions such as water fluoridation, and we will set out further plans for that shortly.
Prevention, personalisation, people and performance: those will be our watchwords for modernising NHS services. They will sit at the heart of everything to come, from the health disparities White Paper to the update of the NHS long-term plan. While the Opposition continue to go off the rails, we remain firmly on track, laying down our plans to deliver a truly 21st-century offer for the profession and, most of all, for patients.
Several hon. Members rose—
Paul Blomfield
I thank my hon. Friend for that intervention, and she is absolutely right about how that highlights the crisis we are facing in NHS dentistry. That exists right across England, and it was interesting to hear comments from other nations, because significantly less is spent on dentistry in England than in Wales, Scotland or Northern Ireland. The Secretary of State blames everything on the contract, but the cuts to dentistry have been deeper than in the rest of the NHS, with spending a quarter less than it was in 2010, and I am not surprised that he made no mention of that.
Last Wednesday, I met our local dental committee to discuss the problem—dentists who are committed to their profession and to NHS provision, and who want a solution—and following our discussion, they commissioned a survey of waiting lists across the city. Some 37 practices responded, which is about half of the city’s providers, but only one practice could offer a waiting time shorter than a year. For 29% it was up to two years and for 32% more than two years. The most significant number was that 35% of practices were unable to add any patients to their waiting lists.
Across England, the number of dentists providing NHS services fell from 24,700 in 2019-20 to 21,500 now, which is a fall of 15% in just two years—
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
indicated dissent.
Paul Blomfield
I see the Minister shaking her head.
However, there is provision for those who can pay. Healthwatch reported last year:
“Whilst some people were asked to wait an unreasonable time of up to three years for an NHS appointment, those able to afford private care could get an appointment within a week.”
That is adding to health inequalities, and it is not because dentists are reluctant to take on NHS patients, but because the system discourages them from doing so. We have patients wanting NHS dentistry and dentists wanting to provide it.
It is true that there are flaws in the 2006 contract. It is based on units of dental activity using figures from the two years prior to its imposition, which are now massively outdated. It contains huge discrepancies in remuneration rates between practices doing the same work. There are penalties through clawback for underperformance for reasons beyond the control of practices, but no reward for overperformance. I see the Minister smirking, but she has been delivering this contract, and the Government have been operating within it for 12 years. There are limits on how much NHS treatment a practice can provide. That is because of quotas and the way that providers are contractually obliged to spread their NHS work. Dentists have a disincentive to take on new patients, who are more likely to have greater treatment needs, because the fee-per-item system was replaced with a system in which the same is paid for one filling as for 20.
Paul Blomfield
As the Minister is nodding, let us review the position as regards the contract. Back in 2008, the Select Committee on Health declared the system not fit for purpose. The then Health Secretary, Alan Johnson, responded by ordering a review of the system. In 2009, the Steele inquiry reported, and in 2010, we committed to reforming the contracts, but 12 years on, nothing has happened.
Ministers also blame covid. Clearly, it has had an impact; there was a backlog of 3.5 million courses of dental treatment after lockdown, and patients are inevitably presenting with bigger problems and increased need, which means longer appointments and extra work, for which dentists get no remuneration. The Ministers sitting on the Front Bench have presided over this flawed system. In quarter 4 of 2021-22, 57% of practices faced financial penalties for being unable to meet the targets that those Ministers effectively imposed; the problem is due to the additional infection prevention control requirements and the lack of adjustment to the remuneration system.
We have reached a tipping point for NHS dentistry. Unless the Government act, the number of complaints that all Members of Parliament are getting will only grow. More practices will move to a private model, which will add to the difficulties, because the system does not work for them.
Daisy Cooper (St Albans) (LD)
The Conservatives have been running our health and social care system into the ground for years. Covid has made an already bad situation worse, but it was already bad, and my constituents—patients and healthcare professionals—can really feel it. A constituent who is a professional chauffeur needs to provide regular medical assessment certificates to keep his job, but his GP is not doing them right now, so my team have had to work hard to make sure that his employer will not sack him.
Some of my constituents have managed to see their GPs. One has had a referral for chronic back pain, another for a diagnosis of breast cancer that needs treatment, but having had those appointments they then discovered weeks later that the referral letters were never sent. Another constituent who had a contraceptive implant has had some very severe side effects and wants to have it removed, but she cannot get an appointment. A constituent who contacted her GP to say that she was having suicidal thoughts was asked to fill out a form.
I was so concerned about these reports that I have been to visit our GP surgeries in St Albans. From the other end of the spectrum, it is incredibly shocking. The very second the phone lines open in a GP surgery, there are flashing lights on its big screen. At one minute past the time that its phone lines open, there are hundreds and hundreds of calls on the electronic board. Many of those phone calls are from very distressed callers who are in pain and very concerned. Many of the people at the counter—the receptionists at the other end of the phone—are receiving verbal abuse, and we know that GPs are receiving abuse in their surgery rooms behind closed doors as well. The BMJ suggests that violent incidents in GP surgeries have doubled in the last five years.
One of the GP surgeries in my constituency has now employed somebody on a full- time basis to do one job: to chase the local hospitals to send the letters so that the GPs can get the results that their patients need. We have heard Members across the House talk this afternoon about how fantastic it would be if we could use big data and if our constituents could become expert patients and use all the information collected on their phone, but frankly, at the moment, we are starting from a basis where we cannot even get a letter from a hospital to a GP surgery. It feels as though the entire system is creaking at the seams, and that is even before we get to the postcode lottery of the number of patients each GP has, or the length of appointments.
Members across the House have talked about the planning system and the fact that lots of new homes are often built in areas without the infrastructure to go with them. I wholeheartedly sympathise with the calls for new homes, but it seems crazy in the circumstances that clinical commissioning groups are not even statutory consultees for planning applications, for local plans or even for permitted development. It should be a priority for this Government to change that and make sure that CCGs have the right resources to respond to planning proposals.
Then we have the problems with dentists. Like many other Members use, I have constituents who have raised these problems. I have mothers with MAT-B certificates who cannot get dental treatment. I have parents whose children are developing gum disease, but they cannot get an appointment with their dentist. I have couples who have moved to St Albans and, because they have moved, cannot get an appointment with the dentist. The list goes on and on.
I have challenged the Minister before about the Government’s announcement earlier this year that they were going to give £50 million to dentists to create some emergency catch-up appointments. When the Secretary of State was challenged on this earlier this afternoon, he said that that £50 million had resulted in tens of thousands of new appointments. That was news to me. Earlier this year, I submitted a number of written parliamentary questions. I asked the Government how many dental practices had achieved the quarter 3 targets to make them eligible for this £50 million. The answer was that the Government did not hold that information centrally. I asked the Government how many expressions of interest had been received by the deadline of 3 January. The answer was that the Government did not hold that information centrally. I then asked the Government how many of those who had offered to carry out this urgent dental practice had been accepted. Again, the Government said that they did not hold that information centrally. So what has happened to that £50 million? How much of it has been drawn down?
Maria Caulfield
The hon. Lady will know, because she raised this in oral questions, that dentists return that data in quarters. We will have that data from the dental community by the end of June, and we will then be able to answer her questions. She knows that; she is making a political point here.
Daisy Cooper
I am genuinely incredibly grateful for that answer, because when I challenged the Minister on this last week I did not receive that answer. I am grateful to receive that response. I submitted a letter to the Minister—I think it was in April—and attempted to come to some drop-in events that were cancelled, so I am pleased to hear that that data will be provided by the end of June. However, my constituents in St Albans have seen absolutely zero appointments created from that money. Every dental practice has said that because of the way the funds have been set up, it has been impossible for them to apply for them. A number of other Members have raised that point.
The truth is that the Government have failed to recruit the GPs that we need. We have a retirement time bomb among our general practitioners, and we know that dentists are leaving NHS work as well. We need to see a serious plan from the Government so that everybody who needs to see a GP or a dentist can actually see one.
Imran Hussain
I absolutely agree with my hon. Friend, who makes the point that I was coming on to raise. Her Luton constituency is not dissimilar to mine. With a single GP having 2,800 patients, it is obvious why those patients are not getting to see their GP. I could spend a long time in this Chamber going through constituency cases that I have recently dealt with. Indeed, I have done that in the past and those cases are on the record. Let me cite just one case today. An elderly lady in her 90s had to go to hospital and was then told to go to see her GP. Her son tried day after day to make a simple GP appointment for her. She had multiple health needs. My office had to intervene and even we were unable to secure a GP appointment for her. People are having to go through this ping-pong of not getting a GP appointment and then going to A&E as they have nowhere else to turn.
I am grateful because I did ask the Health Secretary about Bradford and urgent treatment centres, and he did favourably say that he would arrange a meeting with the Minister for Health, the hon. Member for Charnwood (Edward Argar), who joins us now, at precisely the right time. I look forward to that meeting because that is a way through and I am grateful for that offer. But the reality remains that the Government’s promise—or the points the Secretary of State made earlier today—is not apparent on the streets. People continue to suffer, they cannot get GP appointments and they have nowhere else to turn. That point has been made eloquently by a number of Members.
At least, after days and weeks of trying, people are able to get an appointment with a GP. Many Members have talking about issues with joining an NHS dentist. There is more chance of finding gold bricks on the street, or of finding the parallel universe that Government Ministers live in, than there is of getting on to the list of an NHS dentist. People simply cannot get NHS dentists, and we have heard accounts today of how they are being forced to carry out DIY operations at home, without anaesthetic or any medical care—I have come across such cases in my own constituency—because they have no other option. Frankly, as the fifth largest and richest economy in the world, it is shameful that people are having to resort to DIY treatment at home. Again, that is happening on this Government’s watch.
I have been in this place since 2015, and every time we have a debate about NHS dentists or GPs, Tory Members refer back to the Labour Government of 12 years ago. I remember that when I was growing up, under a Thatcher Government, GP practices were back-to-back houses on terraced rows without adequate facilities. The last Labour Government brought in record investment, gave us state-of-the-art health centres, and reduced health inequalities and child poverty. That was all under a Labour Government, but Tory Members cannot pretend that the Labour Government of 12 years ago are somehow responsible for the issues we face today. The Whips are not in their place, but I say to the Tory Whips, “Please do your Members justice and remove that line from the long-standing script you have for them”, because it is becoming embarrassing when Tory Members stand up and say, “12 years ago, there was a Labour Government, so it must be all their fault.” They can use that line for a year or two, but unfortunately, in nobody’s world can they use it for 12 years. Tory Members need to start understanding that.
Can we expect any more from this Government? This is a Government who believe people choose to be poor—they have said so in this very House and on TV. This is a Government who believe people should work extra hours and do more, and that those who are forced into poverty are not forced, but have chosen poverty. The reality is that this is a Government who could not care less about people in Bradford who continue to suffer. [Interruption.] The Minister chunters from the Front Bench; she will have time to address those points when she responds.
Maria Caulfield
I would be interested to hear the hon. Gentleman’s opinion on the position in Wales, which was set out in the Secretary of State’s opening remarks. Wales faces exactly the same pressures, and its waiting times are actually worse than England’s. What is the hon. Gentleman’s reason for why the Welsh Labour Government are in exactly the same position as this Government?
Imran Hussain
Again, the first defence is “Labour 12 years ago”; the second defence is “Labour in Wales”. The point about Labour in Wales has already been appropriately addressed, but the Minister’s job is to address those issues in England. Rather than address those issues, she thinks that saying “What about Labour in Wales?” somehow provides a cover, an umbrella, and a defence against the incompetence that exist across our health sector. That does not wash with the British public, because they have not been asleep for the past 12 years. They have noted the devastation that the Tory Government have caused in our communities, and the back-door privatisation and ideological agenda they have brought to our health service. I have said it before, and I will say it again: people will repay them with interest at the ballot box.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to close this debate after a wide range of speeches. First, I will put my hands up and acknowledge that there are challenges and difficulties in primary care and dentistry. We heard that from Members from Scotland, Northern Ireland and Wales, which shows that all the devolved areas of healthcare are facing exactly the same challenges.
I start by thanking all those in primary care and dentistry for going above and beyond, and not just during the covid pandemic but as we are coming out of it, whether that was dentists providing urgent treatment under difficult infection control measures, or GPs delivering millions of vaccinations while continuing to see patients. We are now seeing not only the routine number of patients we would usually see, but the two years’ worth of patients who stayed at home and protected the NHS, as we asked them to do.
Despite the Opposition’s protests, we are making progress and record numbers of patients are being seen—higher than ever before. We are seeing 1.3 million patients per working day in primary care. That is a 44% increase since last year, and 63% of those are seen face to face. As my hon. Friend the Member for Wantage (David Johnston) said, that is 2 million more face-to-face appointments than this time last year.
There are record numbers of GPs, despite what Opposition Members have said—nearly 36,000 full-time equivalents, which is 1,400 more than in March 2019. We are going further, with 4,000 more trainees taking up GP training this year, providing more GPs for the future. We have delivered 30 million extra GP appointments, as part of our manifesto commitment to deliver 50 million more GP appointments. As an indication of the scale of the record numbers of patients coming through the system, we are seeing 11,000 cancer referrals a day, which is a record high.
How are we supporting GPs? We had the £250 million winter access fund, which helped deliver a cloud-based telephony system that some practices took up, which is transforming how patients can get through to their practices. If practices did not take up that offer, NHS England is rolling out the system across the country, so I urge them to look into it because it delivers better capacity, allowing patients to get through to make their appointments. It bought extra hours to pay for staff to do more shifts and see more patients, and it paid for more physical space in practices.
We have delivered 13,000 of the additional 26,000 roles pledged in our manifesto—paramedics, practice nurses, primary care pharmacists, physios and OTs working in primary care. We are tackling the bureaucracy that GPs face, and laid a statutory instrument to address fit notes to allow professionals other than GPs to return people to work. We have developed the pharmacy consultation system, whereby 111 or GP receptionists can refer people directly to a pharmacy for first-line care. We are developing a renewed GP contract, opening up access at weekends and in the evening. We are expanding community pharmacy with our work on Pharmacy First to deal with minor ailments, blood pressure checks and discharge medicine services.
We are also tackling the infrastructure problem through the Levelling-up and Regeneration Bill whereby health and local government will work hand in hand to tackle the issues my hon. Friend the Member for North East Bedfordshire (Richard Fuller) raised. We are also delivering—
Maria Caulfield
No, I will not.
We are also delivering zero tolerance to abuse through the Police, Crime, Sentencing and Courts Act 2022. Labour talk the talk, but it was those of us on the Government Benches who voted to double the maximum sentence for those who abuse our emergency care workers. Labour actually voted against giving the Bill a Third Reading. That tells us all we need to know.
With the time I have left—
Maria Caulfield
I am not frit, but I am conscious that another debate follows this one. I did not want to play politics, but if Opposition Members want to, I will give them politics.
The Labour party is against everything and for nothing. We have not had one suggestion from Labour or the Lib Dems. They are full of complaints without a single solution. We know that the shadow Secretary of State was busy over the weekend deleting his past misdemeanours, but he cannot delete Labour’s misdemeanours with the NHS. As Davina McCall would say, let’s have a look at their best bits. There are the PFI contracts that they mysteriously introduced—£1.4 billion a year is still going to private investors because of the deals made under a Labour Government. Full Fact confirmed that £57 billion will be spent in total on those PFI deals.
Moving on to the 2004 GP contract negotiations, evening and weekend cover was taken away, handed to primary care trusts and given to private companies. Changes to the law in 2007, voted for by Labour Members, allowed bigger businesses to buy up GP practices, resulting in the evidence we saw on “Panorama” last week. The top hit is the 2006 Labour dental contract—
Maria Caulfield
The hon. Gentleman may say, “Here we go,” but Opposition Members acknowledged this afternoon that the Labour contract was causing the problems. We are getting on with dealing with that.
My hon. Friend the Member for Waveney (Peter Aldous) asked what progress is being made. We put the negotiations to the BDA on 24 March and made a final offer—[Interruption.] They don’t want to listen, Madam Deputy Speaker; they don’t care. We put the final offer to the BDA on 20 May, and we are waiting to hear back. We are reforming the dental contract, which perversely disincentivises dentists to take on NHS work.
To correct the hon. Member for Portsmouth South (Stephen Morgan), he did not host that dental summit; it was my right hon. Friend the Member for Portsmouth North (Penny Mordaunt), who invited me. The summit came up with a solution, and I am meeting her team so that we can work on that and take it forward.
In addition to the dental contract, we are reforming how we take on dentists from overseas. We consulted the GDC, which recently ran a consultation, and we will be laying legislation to give it powers to allow dentists to come here more easily—[Interruption.]
Madam Deputy Speaker
Order. I can hear what Members are saying, and it is just not right. It is simply rude when we are supposed to be listening to the Minister.
Madam Deputy Speaker
Order. You are not saying anything while you are sitting down—nothing! I call the Minister.
Maria Caulfield
Thank you, Madam Deputy Speaker. Labour Members do not want to hear about the work that the Government have been doing. They are just too busy criticising.
My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) also mentioned the work that we are doing on centres for dental development. We are already working in places such as Cornwall to start training more dentists in those areas. In Norfolk and Norwich, we have met representatives from the university. The meeting was led by local MPs who brought people together to set up centres. We have also been working in Lincolnshire as well.
We are empowering the dental workforce by changing and upskilling dental technicians, dental nurses, and dental assistants to be able to take on more work. We are also tackling the issue of clawback.
You would think, Madam Deputy Speaker, that this is just an issue in England. If we look at Labour-run Wales, we find that the Community Health Councils have acknowledged that Wales is also facing a crisis of access to GPs, and that patients are waiting more than an hour to get through on the phone only to find that there are no appointments left.
The number of dental practices in Wales has fallen—from 1,500 in 2019 to 1,389 last year. In the past year alone in Wales, there was a 71% drop in courses of dental treatment. Why is that happening under a Labour Government? [Interruption.] I have given the answer. Opposition Members are too busy talking, Madam Deputy Speaker. They do not want to hear the answers.
Opposition parties need to be honest with the public. Whether we are talking about Scotland, Wales or Northern Ireland, we are all facing the same challenges. [Interruption.] No! There is a Labour-run Government in Wales and an SNP Government in Scotland. [Interruption.] The Opposition continue to play politics, but we are getting on with the business of reforming and making those changes. They have no solutions, no answers and no ideas. It is this Government who are delivering the changes. We are being honest with the British public that we will face challenges, but we are making the changes to improve access to both dental and primary care services.
Question put and agreed to.
Resolved,
That this House notes that primary care is in crisis, with people across the country struggling to access GP services and dental treatment; believes that everyone should be able to get an appointment to see a doctor when they need to and has the right to receive dental treatment when they need it; is concerned by the Government’s failure to remain on track to deliver 6,000 additional GPs by 2024-25; and therefore calls on the Secretary of State for Health and Social Care to urgently bring forward a plan to fix the crisis in primary care, meet the Government’s GP target and ensure everyone who needs an NHS dentist can access one.