Children: Oral Health

Baroness Janke Excerpts

Tuesday 12th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is exactly right, in that improving children’s oral health is a wider picture: it is about not just access to dentistry but a preventive approach, which is a core government priority. This is exactly why we introduced the children’s obesity plan, one aspect of which is a consultation on advertising. Proposals on that will be brought forward shortly.

[Baroness Janke (LD)]

My Lords, what is the Government’s assessment of the number of children receiving dental care from Dentaid, a peripatetic charity that provides emergency care in third-world countries? Does she consider this an acceptable way of safeguarding children’s oral health, and what will she do about children’s lack of access to NHS dentists in many parts of the country?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. I shall have to write to her about access via Dentaid, which I was not aware of; it is a very important point. We are committed to driving down inequality of access and are pleased that the number of young people accessing dentists has increased. One of the key measures in reducing inequality is the Starting Well Core programme, which has targeted areas of highest need, and its performance is encouraging. However, she is absolutely right: we must drive out inequality of access to children’s dentistry and the Government are committed to doing that.

Brexit: Reciprocal Healthcare (European Union Committee Report)

Baroness Janke Excerpts

Tuesday 3rd July 2018 Lords Chamber

[Baroness Janke (LD)]

My Lords, it is a privilege to speak to this report. I pay tribute to the noble Lord, Lord Jay, and to his diplomatic skills in putting such a positive face on yet another report on Brexit, which again faces us with very worrying findings. I also thank the committee members and staff for their contributions; the staff provided us with very high-quality support.

In the words of one of our witnesses, Raj Jethwa, director of policy at the BMA,

“the best situation is one in which you are able to replicate or mirror as closely as possible the current reciprocal arrangements”.

So for many people it is a something of a “mad riddle”—to quote another recent discussion of Brexit—to understand quite how so much time, money and effort are being devoted to achieving something as close as possible to what we have already. Worse still, having taken part in this inquiry, I realise that lots of people simply have no idea of the risks ahead in healthcare post Brexit.

I add my thanks to the Minister, who has clearly attempted to reassure us and has put quite a lot of time into doing so. As such, I do not doubt his motives in any way; I am sure he wants to achieve the best possible solution. The report, however, provides us with a clear picture of the enormous benefits that have accrued to us as members of the EU.

There are the four routes to healthcare in the EU. First, the European health insurance card allows freedom of movement and access to healthcare wherever we might be. For holidaymakers and workers alike, there is no problem in accessing care or medicine. Secondly, the S1 scheme for people who live in the EU provides a simple, easy, accessible system. I am old enough to have lived in Europe before the EU. The system that existed before was so complicated and difficult that many people came home to the UK to get treatment where they could, rather than try to access it in Europe. Thirdly, there is the S2 scheme, which entitles British people to be referred to a specialist provider for treatment. Fourthly, the parent’s right directive gives British people the right to access high-quality treatment in the EU, particularly that which is unavailable in their own country, and to have the cost reimbursed. We often find that cheaper treatment for UK residents can be found in the EU than in the NHS. The average cost per pensioner has recently been calculated at €4.173 in Spain, as against £4.396 under the NHS, so there is even a savings benefit.

The noble Lord, Lord Ribeiro, spoke about Northern Ireland. I, too, was particularly moved to hear of the improvements and not just the peace dividend but the health dividend that has resulted from cross-border working, close co-provision and co-planning and, on an island as sparsely populated as Ireland, the absolute need to access high-quality healthcare, which had not been available before. The noble Lord also talked about children waiting four years for ear, nose and throat treatment, with all the ensuing difficulties that that entailed for their development. So there are enormous benefits.

I welcome the joint report, which tells us that the Government want the common travel area to continue, and the assurances that there will be no hard border. However, this gives rise to quite a few questions. I am sure that many people I know are unaware that the EHIC system is even at risk, but if it does not exist after March, can the Minister tell us about some of the issues that people will face over insurance? In the report, the insurance industry tells us that it is not completely prepared for a major impact of this kind after Brexit. How can families deal with this? What will the cost be for pensioners and people with long-standing illnesses? How will they be able to afford insurance and how much more will their holiday cost?

If we are to keep the common travel area—I understand that, as people say, nothing is agreed until everything is agreed—how will it happen? How exactly will this work with the red line of no freedom of movement and with the Government saying, as the Minister said yesterday, that there will be no barrier between Ireland and the EU? People need confidence; they need to understand what is going to happen and they need to make their own plans.

We heard Simon Stevens on “The Andrew Marr Show” on Sunday saying that the NHS is now planning contingencies for a no-deal scenario. This was one of the things we were assured: that there will not be a no-deal scenario. However, when we hear that the NHS is planning for this, it must raise all sorts of worries. The Government need to come clean with people, let them know what the risks are and let them understand what we are facing. All these things take time to resolve. They cannot be changed overnight or a magic wand easily waved so that everything will be as it was before. People need to know this. There is a huge lack of trust as these effects seem to come out slowly and have to be dragged out, whereas if people were able to understand that there were these risks, they could make their own plans for them. As the clock ticks, we can see that there is an urgent need for the Government to lead and reveal their plans; to make clear the extent of the shortfall in healthcare; and to let members of the public know what they can expect in terms of healthcare after March and after Brexit.

Dental Care

Baroness Janke Excerpts

Thursday 1st February 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness might send me her book so I can get her ideas on reaching adults with learning difficulties. Most adults with significant learning difficulties are likely to be on a range of benefits. That means that their dental care is free, if not for all, I suspect, then for some. She is absolutely right to point to sugar. We now have the sugar levy, which has had a really big impact. About 50% of drinks that would have been affected have been reformulated to either reduce or remove the application of that levy. That is a really good impact. On her point on advertising, we have very tough advertising rules in this country, including the banning of advertising of sweet drinks, sugary products and so on in children’s media. That is one of the reasons why we are seeing some hopeful signs on, for example, the number of extractions falling in primary care year on year.

[Baroness Janke (LD)]

My Lords, is the Minister aware that 41.5% of children have not visited the dentists for the year up to September 2017 and that many of these children are in the poorest communities of the country, many of which, as the noble Baroness, Lady Kennedy, said, are now dependent on charity for dental care? What action will he take to ensure that all children have proper access to NHS dentistry, wherever they live throughout the country?

[Lord O'Shaughnessy]

The noble Baroness is right. About 59% of children have seen a dentist in the last two years, but of course that leaves 41% who have not. I have to say that that is an improving picture. On her two particular issues, there is NHS England’s Starting Well programme, which is targeted on 13 local authorities that have the worst oral health outcomes for children. The range is really quite dramatic from one area to the next. It has also developed a core offer to help every local authority commission better dental health for children.

NHS: Community Pharmacies

Baroness Janke Excerpts

Tuesday 6th December 2016 Lords Chamber

[Lord Prior of Brampton]

This party does believe in competition. But it also believes that the NHS’s supporting community pharmacies to a very large extent when 40% of them are in clusters of three or more within 10 minutes’ walk from each other, and paying an establishment fee to each of those pharmacies, is probably not a very good allocation of resources.

[Baroness Janke (LD)]

My Lords, have the Government yet published the cost-based evidence for the cuts to the community pharmacies budget, and what safeguards will they put in place to ensure that the most needy communities are not hit hardest by the cuts to the pharmacies budget?

[Lord Prior of Brampton]

The pharmacy access scheme is being set up to deliver exactly what the noble Baroness is asking for—that rural pharmacies and those in very deprived areas will receive greater payments than others. I am not quite sure what report she is referring to. I will have to look at her question afterwards and write to her.

Children: Oral Health

Baroness Janke Excerpts

Monday 31st October 2016 Lords Chamber

[Lord Prior of Brampton]

My noble friend has slightly confused me, I am afraid. There is no question that fluoride has an impact on oral health. I am not aware of any evidence to suggest that it has other, detrimental impacts on children’s or other people’s health. We have huge inequalities throughout the United Kingdom, most of which are as a result of social deprivation, poor housing, high unemployment and the like. Those are the fundamental drivers of health inequalities, rather than health systems per se.

[Baroness Janke (LD)]

My Lords, given the harm caused by high levels of sugar added to some processed foods, does the Minister agree that the present restraints on the food industry are woefully inadequate? Does he further agree that much tougher measures need to be taken if the Government are to meet their own public health objectives on oral health, diabetes and obesity?

[Lord Prior of Brampton]

My Lords, the introduction of the sugar levy is evidence that the Government take this matter extremely seriously and believe that it cannot be left solely to industry to reduce sugar levels. The Treasury is due to report on the extent of the sugar levy on 6 December. As part of the obesity strategy, targets are being set for nine key categories of food eaten predominantly by children. The results of reduction over time will be made transparent and open. A combination of those measures should have an impact.

Smoking-Related Diseases

Baroness Janke Excerpts

Wednesday 14th September 2016 Lords Chamber

[Baroness Janke (LD)]

My Lords, I rise to draw attention to Public Health and its contribution to the success of cutting smoking. I speak as someone who comes from Bristol, where the legacy of the tobacco industry has left generations suffering following the free cigarettes that were provided to workers as a matter of course. As has already been said, the estates in south Bristol, which were built to provide workers for the tobacco industry, are still among the most deprived in the country. Life expectancy there and in other parts of the city differs by 10 years and sometimes more. It is not just about death. It is about the quality of life for very many people in those communities.

When I was leader of the city council, I took a very active part in the Smoke Free Bristol campaign. The campaign was very successful because it captured the imagination of local people. The owners of clubs, bars and pubs were not all as enthusiastic, but very many of them could see the arguments, and we supported them and worked with them to bring the campaign in.

Equally, in the Public Health self-help groups, the fact that local people were trained to support each other —the health trainers and assistants were all local people —led to a much greater awareness of health within these communities. There was a wide range of projects, tackling not just smoking but such things as obesity, alcohol, depression and diabetes. I was very impressed with the progress that was made. However, the Public Health budget is being cut by 9.6% from 2015-16 to 2020. That is on top of the dramatic local authority cuts.

I would like the Minister to consider making this a priority. The emphasis on health that we have through Public Health, rather than on illness, has had a huge impact in these poorer communities. Public Health has enabled people-led schemes rather than professional-led schemes. I agree with others who have said that sustained investment and funding is absolutely vital if we are to do the things that are needed in these communities and to help people take responsibility for their own health.

Health Funding

Baroness Janke Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

The decisions about which services to reduce must lie with local authorities.

[Baroness Janke (LD)]

My Lords, does the Minister realise that many of the contracts for public health are already let in the medium term? Is the proposed cut on uncommitted funding, or are the Government proposing to give some help to local authorities who have no way of ending those contracts?

[Lord Prior of Brampton]

The noble Baroness raises a good question. This will be a crucial part of our consultation, which will take place very soon.