Medical Training (Prioritisation) Bill

Alex McIntyre Excerpts

2nd reading
Tuesday 27th January 2026 Commons Chamber

[Wes Streeting]

That is a fair question from the Chair of the Health and Social Care Committee. We are taking longer than I would have liked with the workforce plan. I hope it reassures the hon. Member and the House that we have taken more time because that is what the royal colleges, trade unions, and clinical and NHS leaders asked us to do. Their strong urging was to get it right, rather than rush according to a political timetable, which I thought was a fair challenge. It will be published this spring.

[Alex McIntyre (Gloucester) (Lab)]

I welcome this legislation. Does the Secretary of State agree with me that the fact that the Government have listened to the concerns of resident doctors about training places, and have acted at pace to bring forward the legislation, shows that we as a Government are committed to fixing the problems left behind by the Conservative Government? Does he agree that the BMA should consider that when thinking about going forward with any potential further action?

[Wes Streeting]

I agree with my hon. Friend. For context, I say to members of the BMA and resident doctors that to bring forward legislation in this way and at this pace is not easy. We have a packed legislative programme. The clock is ticking on getting everything through that we want to get through in the time that we have available, and I am grateful to the business managers in both Houses for facilitating the Bill. Cross-party support is going to be important, particularly in the other place, where we have lots of expertise to draw on, including from Cross-Bench peers.

We have introduced the legislation because fundamentally we agree with the case that the BMA and resident doctors have been making. In our discussions with BMA representatives, immediately prior to the last round of industrial action and since, it has been very clear that when it comes to jobs, we are not that far apart. We recognise the problems and we are working together to address the solution. On pay, there remains a gap between the expectations of the BMA and what the Government can afford. All I ask of resident doctors and their BMA representatives is some understanding and a bit of give and take about the range of pressures on the Government and the national health service, many of which require funding, which is why there are choices and trade-offs.

I hope that the BMA representatives know and have noticed that, regardless of the fact that we remain in dispute on these issues and have had a number of rounds of industrial action, I have not slammed the door in their faces and stopped talking—we have continued with good-natured and constructive talks—and I have not thrown my toys out of the pram either, and said “Right, we will not proceed with this Bill.” We have continued to work to enact solutions that we think are good for resident doctors, and therefore good for patients and good for the NHS. I hope that this will be the spirit in which we can work together.

The goal is to be in a place, particularly with the BMA and resident doctors although this applies to other groups in the workforce too, where we can work together and make progress outside disputes, so that we can gather around tables as partners, rather than as opponents. That will take some gear shifting from where we have been to where we want to be, but I know that both the Government and the BMA have entered the new year in that spirit, so we will continue to make progress.

Having stressed the urgency of the legislation, I want to address the commencement clause included in the Bill, which has already been raised. First and foremost, it is there as a failsafe. We are running to an extremely tight deadline. I do not want to be in a position where a law is enacted and we are unable to implement it in a timely and orderly fashion. Secondly, there is a material consideration about whether it is even possible to proceed if strikes are ongoing, because of the pressure that they put on resources and the disruption that is caused operationally, particularly among the people I require to help me deliver the measures in the Bill. Of course, I am keeping my options open. We are in a good place with the BMA, and we have entered the latest round of talks in good spirit, but we do not yet have an agreement on their disputes and we are waiting for the outcome of their ballot, so I am not going to do anything now that unnecessarily makes it harder to end the strikes.

The Opposition amendment to remove the commencement clause is designed to make industrial action more likely, not less likely. It tries to bind my hands and make this job even more difficult. It looks like political gameplaying, at a time when we are trying to save the NHS, and it looks like party interest before national interest. I hope that the Conservatives will consider whether their amendment is really necessary.

British taxpayers spend £4 billion training medics every year. We treat them poorly, place obstacles in their way and make them fearful for their futures. We are forcing young people, who should be the future of our NHS, to work abroad, in the private sector or to quit the profession entirely. It is time that we protect our investment and our home-grown talent. This Bill will ensure a sustainable workforce, cut our reliance on foreign labour, halve competition for places and give home-grown talent a path to become the next generation of NHS doctors. I commend this Bill to the House.

--- Later in debate ---

[Stuart Andrew (Daventry) (Con)]

Let me start by saying at the outset that—

[Alex McIntyre]

You are not defecting?

[Stuart Andrew]

No, I am most definitely not defecting.

In the spirit of being constructive, I will start by saying that the Opposition support the principle behind the Bill. Doctors trained in Britain and funded by the taxpayer should have a fair, clear and consistent route to progress in our NHS. Britain trains some of the best doctors in the world, yet too many are leaving—not because they want to, but because they cannot access the training places they need. That wastes talent, damages morale, and ultimately affects patient care. However, support in principle is not a blank cheque; the Bill must work in practice, not just look good in a headline. We should also be honest about why we are here. Much of what is in the Bill has been promised by the Government since their election in plans, reviews and ministerial statements, and the fact that it is only being brought forward now suggests that this is catching up, not leading.

The first test is delivery. We cannot solve a shortage by changing the queue. Unless the Government deliver the 4,000 new specialist training places that they have promised, including the 1,000 places that are needed early, the Bill will not fix the bottlenecks; it will simply shift frustration from one group of doctors to another. That is why we are proposing constructive amendments to the Bill that we believe are workable and fair.

The next test is clarity. The real impact of this Bill will be determined by the rules that sit beneath it—who qualifies, how experience is assessed, and how decisions can be challenged. We welcome the focus on foundation training; prioritising UK and Irish graduates for foundation training is sensible, as it strengthens the pipeline and improves workforce planning. However, it will only work if there are enough placements and the system is transparent. That is why amendment 8 would clarify that a UK foundation programme must mean a programme in which the majority of training takes place in the United Kingdom. That is a necessary safeguard against loopholes.

Amendment 9 would ensure that from 2027, British citizens on UK foundation programmes are prioritised in a meaningful way. Prioritisation must apply not only at the final offer stage, but at interview, which is where selection decisions are often made. The amendment addresses many of the points that Labour Members have been raising, so I encourage them to support amendment 9 when we divide on it.

We are also concerned about doctors serving overseas with the armed forces. I was pleased to hear the Secretary of State talk about them, since they certainly should not be penalised because part of their training takes place abroad on service. As such, amendment 10 would expand the definition of a UK medical graduate to include those undertaking placements as part of an armed forces posting outside of the British Isles. I hope the Secretary of State will consider accepting that amendment to give reassurance to our armed forces, which I know is something he cares about. These are practical changes that would improve fairness and operability, and we hope the Government will adopt them.

We also support new clause 2, tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), which would make clear that once priority groups are established, training places should be allocated on merit. That allocation should be based on academic achievement and clinical performance, rather than a lottery or a computer-generated ranking divorced from real performance. Again, I hope the Government will seriously consider the new clause. When the Minister for Secondary Care sums up, will she put on record that merit will remain central to selection?

Another issue that cannot be ignored is the impact on medical schools, especially those that rely on international students. New clause 3 would require an annual report to Parliament on the number of international students at UK medical schools and the financial consequences flowing from the Bill’s provisions. International students pay higher fees and help sustain our universities. If those numbers fall, what funding model would replace them? When she sums up, will the Minister for Secondary Care outline what assessment has been made of the impact on medical school finances? How many international places do the Government expect to fund in future, and on what basis?

The Bill cannot stand in isolation. Workforce planning depends on more than allocating training posts; it requires enough trainers and clinical supervisors, viable rotas that support learning and facilities that make training possible. The revised NHS workforce plan must set out how those needs will be met, and how the extra training places will be staffed and supported. With NHS England set to be abolished in April 2027, we need to hear from the Government who will lead workforce planning and accountability thereafter.

Our approach is straightforward. We will support measures that are fair and practical, that strengthen patient care and that respect staff. We will press the Government where we feel that proposals are rushed, underfunded or left vague. Backing doctors means giving them a route to progress and ensuring that the system is properly planned and properly resourced. I repeat that, in principle, we support the Bill. We want doctors trained in Britain to build their careers in the national health service.

That brings me to enactment. As we have heard, the Government propose that the Bill should take effect when the Secretary of State decides, rather than on the date of Royal Assent. When he said that he wanted to introduce this Bill, and that it would be urgent, I said that we encourage that and support it. However, if this Bill is truly urgent, and if Ministers want it to affect this recruitment round, why would they not commence it immediately? The Secretary of State should not be playing politics with people’s jobs. It is not right for doctors, including those not involved in industrial action, to be treated as bargaining chips, and it is not right for Parliament to be treated in this way to give him the tools that he needs because he did the first set of negotiations so badly. Will the Government support amendment 1, so that the Bill takes effect on Royal Assent? Will they commit to enacting the Bill as quickly as possible?

When does the Secretary of State intend to commence the Bill? If the Minister for Secondary Care cannot give the House a date today, what makes the Bill so urgent that it needs to be pushed through Parliament in a single day? Will the Government proceed with this legislation, even if no agreement is reached with the BMA? If industrial action is paused, will the Government still honour their commitment to prioritise UK medical graduates?

Many doctors took industrial action because they felt that their career progression was blocked. This Bill could play a part in rebuilding that trust, but that will only happen if Ministers deliver, publish the detail and follow through. They must be straight with the House. If this Bill is urgent, it should commence on Royal Assent. If implementation takes time, the Government should publish a timetable and the steps required to deliver it. To do anything else, frankly, would be discourteous to Parliament.

Oral Answers to Questions

Alex McIntyre Excerpts

Tuesday 13th January 2026 Commons Chamber

[Wes Streeting]

I certainly join the hon. Member in his final message and commend him for his declaration, because the more we can break taboo and stigma around these issues and get people talking more openly about the telltale signs of risk, the better protected we will all be. As he will know, we are looking very carefully at the recommendations around screening. I will be convening a group of experts with the chief medical officer to probe some of the recommendations, and I will keep the House informed.

[Alex McIntyre (Gloucester) (Lab)]

Last Friday, I went on a visit to my fantastic local GP service, Hadwen Health. The team there are already using technology and AI to make sure patients get the right care that they need, but they told me that there is currently no technological solution that allows patients to both be triaged and directed to their hard-working family doctor when booking online. What steps is the Department taking to support the roll-out of technology in GP surgeries like Hadwen Health in Gloucester?

[Stephen Kinnock]

I am a little bit surprised; I think that that technology does exist. I have visited a couple of GP practices where the online booking system gives the patient the option to specify the doctor that she or he would like to see. I would be happy to connect my hon. Friend with relevant officials in the Department, so that they can connect with the GP surgery to resolve that issue.

NHS: Winter Preparedness

Alex McIntyre Excerpts

Monday 15th December 2025 Commons Chamber

[Wes Streeting]

We are doing much of what the Liberal Democrat spokesperson asks; the hon. Lady is absolutely right that we need to focus on delayed discharge and demand management, and the system is doing all of those things. It is challenging in the NHS. The House will know of our determination to end corridor care. We have certainly ended the nomenclature of “temporary escalation spaces”, which makes corridor care sound like it is both normal and acceptable in the NHS, neither of which is true. I will stop short of asking the Prime Minister to chair Cobra meetings. That would not be the right mechanism or response, but of course he and I meet regularly to discuss winter pressures, and I will keep him apprised of the situation.

[Alex McIntyre (Gloucester) (Lab)]

I thank the Secretary of State for his statement. Gloucester residents are rightly worried about the rising flu levels. I was struck down a few weeks ago and can attest to how tough the current strain is. Does he agree that in this context it is reckless of the BMA to be taking its members out on strike, and will he call for resident doctors in Gloucester to go to work next week to keep their patients safe?

[Wes Streeting]

It is one thing for the BMA to have rejected the offer we made; it is quite something else to have done that following a 28.9% pay rise—but we are where we are. The thing that I find utterly inexplicable and indefensible about the BMA’s position is that we offered it the chance to extend its strike mandate to the beginning of February, in order that strikes could be delayed into January, to give the NHS a clear run at an extremely difficult and challenging winter and the most challenging time of the year for the NHS. The only reason the BMA is choosing this week to strike is that it knows it will inflict maximum damage on the NHS, but in doing so it risks avoidable harm to patients. That is unconscionable, indefensible and unnecessary, and I ask ordinary members of the BMA, whatever their views on the offer or this Government, to bear that in mind when deciding whether or not to leave their patients this week.

Resident Doctors: Industrial Action

Alex McIntyre Excerpts

Wednesday 10th December 2025 Commons Chamber

[Wes Streeting]

I thank the Liberal Democrat spokesperson for his support, as well as for the constructive challenge. He is absolutely right to describe the challenge that we inherited, and we are seeking to deal with it. We have taken a number of steps along the way. For example, we promised to recruit an additional 1,000 GPs to the frontline in our first year. We expanded the additional roles reimbursement scheme in order to do that, and we were actually able to recruit an extra 2,500. The international medical graduate dimension of the deal means that the extra speciality training places go even further.

Although I would never pretend that the steps we have taken in our first 18 months in office have solved everything all at once—there is no shortage of things to solve—I say to those BMA members considering how to cast their vote that we have delivered a 28.9% pay rise, have taken action on international medical graduates through urgent legislation, and have expanded speciality training places. This is real progress. It is meaningful change in people’s pockets and to their lives, working conditions, career progression and prospects. 

The BMA should please not let the perfect be the enemy of the good. We have a lot of fires to put out on a lot of fronts as a Government, and that does take time. We are committed—and I am personally committed—to working constructively with the BMA on things like workforce planning to address those issues, if it is willing to work with us. That is all I ask. It is all I ask from any part of the NHS workforce. It should work with us constructively, understand our constraints, work through the challenges with us, and we will all get to a better place and create a rising tide in the NHS that lifts all ships.

[Alex McIntyre (Gloucester) (Lab)]

I thank the Secretary of State for his statement. My residents in Gloucester are rightly worried about strike action in the run-up to Christmas, and the impact that it will have on waiting lists in my patch in Gloucester. I am not surprised that there is no one here from the Reform party to hear about the challenges that our NHS is facing, and I am really shocked that there is nobody from the Green party, but there we go. Can the Secretary of State confirm that there will be resident doctors sitting at home in Gloucester tonight who will want to vote for this deal, who will not want to go on strike next week, and who want to get the NHS back on its feet? The BMA should do the right thing, and call off the strikes next week. It should listen to its members, and let us together get on with the work of repairing our NHS and the damage the Conservative party did.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. I was about to say that it is always a disappointment when Reform and Green Members do not appear in the Chamber, but I would not want to be accused of misleading the House. I am sure they had a better offer, and there is a Christmas party up the road.

In all seriousness, my hon. Friend is absolutely right. The tragedy of the past couple of rounds of industrial action is that each round costs about a quarter of a billion pounds. Each round, despite the best efforts of NHS leaders and frontline staff, does cause disruption, and we all lose when that happens. One of the things that is really hard for staff is that they are also confronted in a very real way with the impact of the state of the NHS on their patients. They are not in it for themselves, but because they believe in public service and want to improve the health of our nation. We are so much better able to achieve our shared goals if we work together, and we can grasp that opportunity if doctors vote for this deal, we draw a line under this dispute, and we try to reset the relationship between me and this Government on one hand, and the BMA’s leadership on the other.

Resident Doctors: Industrial Action

Alex McIntyre Excerpts

Thursday 10th July 2025 Commons Chamber

[Wes Streeting]

I think the shadow Secretary of State’s memory is letting him down. Let me just remind him that before the general election, and after months of refusing to meet the BMA, the Conservatives finally entered negotiations, but not before strikes were left to run and run—at a cost of £1.7 billion to the taxpayer—and 1.5 million operations, appointments and procedures were cancelled. They also offered the BMA junior doctors a pay rise, which was only about 4% of the pay rise that we eventually agreed. Imagine what would have happened if the Conservatives had pulled their finger out and got the doctors around the table sooner, and had not been quite so intransigent.

The shadow Secretary of State is right to say that I criticised my predecessors for their unwillingness to negotiate. The difference between me and them is that I have acted. Resident doctors have had a 28.9% pay increase thanks to the decisions that I have taken as Secretary of State, with the support of the entire Government. They have a Secretary of State who does not slam the door in their face, but who is open to working with them to improve their conditions.

The responsibility for these strikes lies squarely with those running the BMA’s resident doctors committee. Despite failing to get a majority of their members to vote for strike action for the first time in their campaign, they are still proposing to lead their members out on a five-day strike. They even made the announcement on the day that I had already written to them to suggest that we meet to avert unnecessary strike action.

The shadow Secretary of State is right to talk about the jeopardy facing the future. Because we produced our 10-year plan in partnership with patients, the public and NHS staff, there is not only much in it that resident doctors should welcome, but much that they suggested. Our 10-year workforce plan will set out training, education and retention of the workforce, and we will work closely with resident doctors on standards. They should start to experience an improvement in their working conditions on everything from the availability of nutritious food and drink to reducing violence against staff and tackling discrimination. We have already committed to prioritise UK graduates for training, and we have started a conversation on contractual reform with trade unions across the board. We are determined to recruit more people locally and to tackle social disadvantage, access to medicine and all the issues that are at the forefront of the minds of resident doctors, such as placements, rotations and future career progression, including specialty bottlenecks. I absolutely want to work with them.

These are not conditions for strikes. These are conditions to work in partnership with the Government, just as other NHS unions and so many other trade unions across the public sector do. I say to resident doctors once more that sitting in front of me is the ghost of Christmas past. Reform—its Members are not in their place today—is the ghost of Christmas future. Perhaps BMA members might consider that they are lucky to have the ghost of Christmas present in front of them.

[Alex McIntyre (Gloucester) (Lab)]

I am glad the Secretary of State has reminded Conservative Members that they have rather short-term memories. When I took my place in this House last year, thousands of my residents in Gloucester were on NHS waiting lists—many of them for longer than 18 months. Since this Labour Government took power last year, the number has come down by 92%, in part thanks to the hard work of resident doctors in my constituency. Does the Secretary of State agree that strike action by the BMA will put that recovery at risk? Will he invite its members to meet my residents who are still on the waiting lists left behind by the Conservative party, so that they can explain why the 28.9% pay rise, which many of my constituents will not receive this year, is not enough?

[Wes Streeting]

I completely agree with my hon. Friend. I urge BMA members to consider not just the significant progress that they have already made by working with a Labour Government, but the wider context in which we are operating. It is not just resident doctors who have seen their pay eroded over more than a decade of Conservative Government; it is the entire public sector. It is not just resident doctors who are working in crumbling buildings with out-of-date equipment and technology; it is the same in our schools, our hospitals, our prisons and the entire public sector estate.

This Government are facing enormous challenges across our economy, and we cannot sort out every issue that we inherited overnight, or even in one year—it is going to take time. BMA members should be proud of the progress that we have made together, and reassured that we want to make further progress with them, but there has to be some give and take here, and there has to be some reasonableness. Given the potential consequences of their action for patients, for their fellow staff and for the future of the NHS, the strike action is unreasonable, unnecessary and deeply unfair.

NHS 10-Year Plan

Alex McIntyre Excerpts

Thursday 3rd July 2025 Commons Chamber

[Wes Streeting]

I am always willing to search the world for ways to spend taxpayers’ money more effectively, and the right hon. Gentleman makes some good arguments on making sure that we get a good deal on medicines pricing, and on using the real procurement power of the single payer model—but therein lies the answer to the other part of his challenge. It is the single payer model, created in 1948, that makes the NHS ideally placed to get much better value in procurement, and to harness and lead the revolution in AI, machine learning, genomics and big data, in a way that many insurance-based systems struggle with. I assure him that if there were a better way of funding the NHS, I would have the political courage to make the argument, but we looked at other systems of funding and concluded that that is really not the problem. It is not the model of funding; it is the model of care, and that is what we are going to sort out.

[Alex McIntyre (Gloucester) (Lab)]

When I knock on doors in my Gloucester constituency, I hear time and again about the importance of tackling the 8 am scramble for a GP appointment, and the difficulty many of my constituents faced under the Conservative Government getting the care they needed. Will my right hon. Friend explain how Labour’s 10-year plan for health will deliver on the Government’s mission to get treatment out of hospitals and into the community, so that every one of my constituents can get the care they need in the community in which they live?

[Wes Streeting]

I am grateful to my hon. Friend for his question; he is such a strong voice for the people of Gloucester. We are already delivering improvements in general practice, with 1,900 more GPs employed on the frontline, £900 million more for general practice, and the first contract agreed with GPs for quite some years. We are working in genuine partnership with GPs, who will be at the centre of the neighbourhood health service and of neighbourhood health centres. I am determined to ensure that we do things with our friends in general practice, not to them. Where things are working, I have no interest in going in like a bull in a china shop and imposing top-down change unnecessarily; we learned that lesson from Lord Lansley. I am confident that we have a plan that GPs will relish and embrace, and that they will feel reassured that the future of general practice is bright. After years of campaigning for a Government to rebuild general practice, they finally have a Government who are on their side.

Spending Review: Health and Social Care

Alex McIntyre Excerpts

Thursday 12th June 2025 Commons Chamber

[Karin Smyth]

I am entirely unclear, after that run-through of a number of different issues, whether the Conservatives welcome the extra investment in the NHS or oppose it. We know they oppose the means of funding it, but after that, I have no idea. At some point, they have to make up their mind whether they support that extra investment or not. As I said in my statement, if they do not, what out of the list of the improvements that we have already made would they not do?

As Lord Darzi made clear, under the Conservatives’ watch for 14 years the NHS was broken. Staff were left with out-of-date equipment and unable to do the job they needed to do. We agreed with Lord Darzi’s diagnosis, but Conservative Members have still not said whether they agree with it, or apologised for the state they left the system in. I do not know whether the right hon. Member for Melton and Syston (Edward Argar) has not been able to read the elective reform plan or the urgent emergency care plan that we published recently. It is up to him to read those plans properly and try to understand what is happening.

The right hon. Gentleman has started to do my job for me again, because he cites various think-tanks and people who have said that this cannot be done. Well, I can tell him that we were told, for example, that waiting lists would not drop in April because of seasonality, but we have shown—by keeping a relentless focus on the system, working closely with leaders on the frontline and being clear with officials in the Department—that it can be done. That is what we heard this morning.

We are taking a relentless approach to spending, line by line, throughout the NHS and the Department of Health and Social Care. We have rolled up our sleeves and we will not accept putting more and more taxpayers’ money into a leaky system, which is what happened under the right hon. Gentleman’s Government. If he had read the patient satisfaction survey, he would know that taxpayers across the country, in all our constituencies, love the NHS. They understand that the Tory party broke it and that it will take long time to fix. They also know that they are paying more taxes for it and getting a worse service, and they expect us to do much better. That is what we have already shown we are doing, and what we will continue to do.

I have outlined the capital that is going into the new hospital programme, which we are committed to, and we have already seen increases in diagnostic capability and surgical hubs throughout our constituencies. We will continue to do more of that. I agree with the right hon. Gentleman that it is critical to ensure that social care is supported alongside the NHS. That is why £4 billion is going into social care through our colleagues in the Ministry of Housing, Communities and Local Government, and as he knows, Louise Casey will publish her interim report next year.

We are clear that fiscal responsibility does not stop at the Treasury or down in Victoria Street with the Department of Health and Social Care. It is important that everybody in the NHS is aware that we are determined to fix the NHS and put it back on a sustained footing. There is record investment; that is our commitment to people, and I know from the people I worked with in the health service over many years that they are determined to make it better. Morale sank to an all-time low under the Conservative party, but we are raising that morale, and we will continue to work with the system to make sure that it is fit for the future.

[Alex McIntyre (Gloucester) (Lab)]

I welcome my hon. Friend’s statement about the record funding going into our NHS. We are already seeing the benefit in my constituency, with millions of pounds going into investment in our hospital; that is so desperately needed to get waiting lists down. People were left behind by the Conservative party, and I note that there is still no apology to any of my residents who were left in pain and agony for years and years under their watch—not one word of an apology.

One of the big challenges facing my constituents is accessing an NHS dentist—my hon. Friend knows about that from the time she came to visit me during my campaign. I am campaigning to get new dentists for my constituents in Gloucester, so will she help me to get a meeting with the relevant Minister to ensure that some of this record funding comes to Gloucester to get an NHS dentist for all my constituents?

[Karin Smyth]

As my hon. Friend said, this is a health area that I know well, and he has been the most amazing campaigner for Gloucester and the health service there since he became the Member of Parliament. He is absolutely right: dentistry is a key worry. It is one of the key areas that the Conservative party neglected for 14 years. That is why it was a manifesto commitment, and why I was able to outline today that meeting the target of 700,000 is front and centre, and part of the plan as we go forward. I know that the Minister for Care, who is responsible for dentistry, is keen to meet many hon. Members, and I will make sure he has heard that request.

Access to NHS Dentistry

Alex McIntyre Excerpts

Thursday 22nd May 2025 Commons Chamber

[Alex McIntyre (Gloucester) (Lab)]

I thank my hon. Friend the Member for Great Grimsby and Cleethorpes (Melanie Onn) for securing this important debate. I also thank the dentists, hygienists, dental nurses and practice staff in my constituency who do so much to look after my constituents.

The reality is that the dentistry system we inherited from the previous Government is broken, and we need to fix it. Time and again when I am knocking on doors in Gloucester, I hear that patients cannot get the dentist appointments they need, that we have people pulling their own teeth out at home, and that there are children with teeth rotting in their mouths.

We need more NHS dentists in Gloucester. This week, I have launched a campaign to get a new dental practice in Gloucester city to deliver for my constituents, and I wrote to my local ICB earlier this week about it. We need to see this new practice as soon as possible, so I would welcome a meeting with the relevant Minister to discuss my campaign to deliver a new dental practice for my constituents.

I recognise that my ICB and this Government have made fantastic progress on urgent dental care in Gloucestershire. We have another 11,000 urgent dental appointments in my constituency and the wider area, which is already delivering for my constituents who are most in need. But what we really need are regular check-up appointments so that people can be seen more regularly. I welcome reform of the dental contract and the consultation with local dentists, and I encourage all dentists and dental practices in my constituency to get involved with it so that we can deliver a better dentistry system than the one left behind a year ago by the Conservative party.

--- Later in debate ---

[Dr Danny Chambers (Winchester) (LD)]

I thank the hon. Member for Great Grimsby and Cleethorpes (Melanie Onn) for securing this really important debate. Before I was elected, I drove around Winchester, the Meon valley and the beautiful New Forest treating horses as a veterinary surgeon, and a key part of that role is providing regular dental treatment. Horses do not like going to the dentist any more than humans do, but they need to have their teeth brushed every six months—at least every year—or they get ulcers in their mouths and they can get infected tooth roots. When we have to remove a tooth with a root that is three inches long—especially on a hot day like today—we work up a sweat and it takes a long time, but it is really painful for the horse, even though we use painkillers and nerve blocks. Often, all of that would have been avoidable had they had regular dental treatment, and it costs the owner a lot more money. It is exactly the same with human medicine.

There is cross-party agreement, with no one disputing that prevention is better than cure, and when it comes to dental care in the NHS we are failing at even the most basic level of public health. I am not going to go through all the stats that hon. Members have repeated about the numbers of children needing general anaesthetics for dental care.

[Alex McIntyre]

Will the hon. Gentleman welcome the Government’s partnership with Colgate on tooth- brushing in schools so that we can tackle prevention with children and make sure they are not going into hospital with tooth decay because they are learning how to brush their teeth and doing so properly?

[Dr Chambers]

I absolutely welcome that fantastic initiative.

I visited two dental practices in Winchester, and both told me exactly the same thing: they want to do more NHS work, and they want to be there for their communities, but because of the current NHS dental contract they simply cannot make it financially viable. They are effectively subsidising their NHS patients with income from private work. The British Dental Association estimates that private dentistry in England cross-subsidises NHS care to the tune of £332 million a year, which is due to rise to £425 million if NHS practices are not offered any help with the tens of thousands in additional staff costs brought in by the increase in national insurance. With the NHS work they do perform, they do not have time for the education—the proactive, holistic healthcare— that they want to do. Instead, they have to get people through in a quick turnaround. I say this clearly: dentists are not the problem. They are doing their best within a contract that is outdated and damaging.

I also want to speak to something that is often overlooked in this conversation: oral health is not just about teeth. I know that my dentist colleagues, as in veterinary practice, routinely identify serious conditions such as oral cancers and squamous cell carcinomas during routine dental checks. Those cancers are often aggressive but spotted early, they can be treated. We also know that infections in the mouth can lead to things such as endocarditis, which is not a trivial condition, and there is good evidence that periodontitis can contribute to the onset of dementia. How many cancers are we missing? How many heart problems are we not avoiding by not having routine dental checks?

I will sum up now as I know that we are pushed for time. The Liberal Democrats will continue to fight tooth and nail for an NHS that includes dentistry. I managed to avoid making any jokes about equine dentistry, and Members will be glad to hear that straight from the horse’s mouth. We do not want NHS dentistry to be an afterthought; it has to be a core part of a truly universal, holistic health service. Everyone deserves access to routine dental care. Many Members have said that they live in areas that are dental deserts, where NHS dentists are rarer than hen’s teeth. It is clear that we have cross-party consensus. Let us get the dental contract reformed and let us make this Parliament the last one during which anyone has to extract their own teeth.

--- Later in debate ---

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate the hon. Member for Great Grimsby and Cleethorpes (Melanie Onn) on securing this debate. Dentistry is important. Dentists do not just deal with our teeth; they deal with our mouth and gums, they identify physical diseases that include cancer and they prevent sepsis. Last month, I visited The Dental Design Studio in Sleaford to celebrate its 20th anniversary of great dentistry and I met some fabulous, committed professionals. Somewhat unexpectedly, given the venue, I was asked to help judge a cake competition. Members and my dentist will be pleased to know that I brushed my teeth very well afterwards.

Access to NHS dentistry has been a problem for a very long time. When I moved house in 2001, there was no NHS dentist available and I travelled two hours to Redcar to see the wonderful dentist Mr Dixon for many years until he retired. After that, there was no dentist at all. Are we therefore short of dentists? No, we are not. The Conservative Government increased the number of new trainee places and the number of new dentists, and although the population increased, there are still more per capita than in 2010. As the Minister for Care has said,

“The issue is not the number of dentists…but the paucity of dentists who are doing NHS work.”—[Official Report, 25 March 2025; Vol. 764, c. 766.]

I encourage the Minister for Secondary Care to consider more dental places, because we see that one in 15 of the youngsters who want to become a dentist is turned away and, as such, they go overseas to train or train to do something else. Will she commit to a dental school not just in Norwich, but in other underserved areas, such as Lincoln?

The main problem, as many have identified, is the 2006 contract with the UDA bands for procedures, and there are several issues with that. First, the amounts vary between practices based on historical volume data; secondly, there is a disincentive to treat new or high-need patients; and thirdly, the UDA simply do not cover all the costs. The Conservatives improved that a little bit, ironing out some of the bizarre UDA contract terms and setting a new, higher floor for minimum UDAs. Yet there is much more to do, as we have heard today, to reform it completely. How are the Government getting on with that? Will the Minister give us an update, please? As the Public Accounts Committee notes,

“NHSE and DHSC do not yet know what that reform might look like or to what timescales it can be delivered”,

beyond a vague assertion that some reform is imminent.

[Alex McIntyre]

Will the hon. Lady give way on that point?

[Dr Johnson]

I will not because there is not much time at all.

I met Eddie Crouch from the BDA recently, who talked about the national insurance costs. Before today’s announced pay rise, dental practices were facing a 9.5% increase in staff costs, again pushing more of them further to private practice. Will the Minister ask the Chancellor to exempt NHS dentists from the national insurance contribution rise? There has also been discussion about compelling dentists to do a proportion of their work in the NHS, either by compelling dentists who are newly trained or by incentivising with the use of student loan repayments. Have the Government considered that?

We have many overseas trained dentists—some are British students who were trained overseas, some are foreign nationals—but the overseas registration exam has 2,000 people on its waiting list. Somewhat bizarrely, those who pass can work in the private sector, but not in the NHS without supervision. That seems somewhat incoherent. Does the Government have confidence in the exam or not? It is illogical to allow a person to practise as a private dentist but not in the NHS. It is also a clear disincentive to NHS practice. What good discussions have the Government had with the General Dental Council about this issue?

My right hon. Friend the Member for Herne Bay and Sandwich (Sir Roger Gale) has repeatedly raised the issue of Ukrainian dentists. There are 200 Ukrainians dentists in the UK. Why not assess them and allow them to work? It is better for them and for us.

Dentists form part of a wider team of hygienists, nurses, technicians and therapists. What are the Government doing to help people in each of those roles practise at the top of their skill range to provide greater dental care? What are the Government doing to support rural areas since they cancelled the mobile dental vans? What are they doing to ensure they deliver the 700,000 promised appointments a year, since they have delivered hardly any of them so far?

Department of Health and Social Care

Alex McIntyre Excerpts

Wednesday 5th March 2025 Commons Chamber

[Alex McIntyre (Gloucester) (Lab)]

In my last career, prior to entering this House, I was incredibly proud to represent our NHS and other healthcare providers, and I will continue to fight for our NHS now that I sit here as an MP. I saw at first hand the impact that Tory mismanagement had on our NHS, which breached one of the fundamental principles of medical ethics: “first, do no harm”.

I saw that at first hand this week in my constituency when I visited Gloucestershire Royal hospital. I also met with Gloucestershire ICB this morning, and earlier this year I visited the surgery in Tuffley. The challenges that they face will not surprise anyone in this House, as they were set out in stark terms in the Darzi report, and they are replicated across the country in many constituencies—maintenance backlogs, lengthy ambulance waiting times, recruitment challenges and an ageing and sicker population. What struck me most about my visits this week was the resilience of our NHS staff, who are committed to people in our county and in my city of Gloucester.

What a difference a Labour Government are making with more investment in our NHS. Waiting lists locally are already coming down, and patients are now able to access emergency dental treatment, rather than pulling their teeth out at home. We have more midwives and dentists and a new GP contract that will help to bring back the family doctor. That is what we can do in eight months—imagine the impact that we could have if we had 14 years, as the Conservative party did.

From a personal perspective, I have seen how important that work is. I used to joke on the doorstep that I should be a poster boy for why prevention is better than cure—it will not surprise Members that I may have a few extra pounds that I could afford to lose. Sadly, the prevention piece came too late for me; I was diagnosed with type 2 diabetes earlier this year. The treatment I have received since then has been phenomenal. I am now on the path to remission programme—available in Gloucestershire, but not across the country—which has already brought my blood sugar levels down and helped me to lose 3½ stone. [Hon. Members: “Hear, hear!”] Thank you very much. It will help countless others across Gloucestershire and across the country. As we move to prevention work, it is so important that we also look at public health measures around diabetes; I echo the comments made by the hon. Member for South Northamptonshire (Sarah Bool).

I also thank all the staff who looked after my little boy last year when he was really sick. We need to ensure that when we look at investment in our NHS, we prioritise maternity services and services for the youngest in our society to ensure they get the healthcare they need.

We have talked about British values a lot in this place over the last few months. When people ask me what makes me proud to be British, I point them to our NHS—a system without comparison in the world that means that everyone can access healthcare, regardless of their wealth. I know that Reform Members are not in their places today, but they say that all options are on the table. I would like the Minister to make it clear in her remarks that standing against our NHS and its principles—being there for everyone, regardless of their wealth—is the opposite of being patriotic and that their options are not on the table.

I welcome the record investment in our NHS and the shift from analogue to digital and from cure to prevention. I would also welcome the Minister’s comments on how we can ensure that we deliver on the people’s priorities in Gloucester.

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

--- Later in debate ---

[Dr Johnson]

I will give way in a moment; let us first look further at those tax rises. It is clear that the Chancellor had not properly considered the effects of the NICs rise on the wider healthcare system. For example, the Government have exempted the NHS from that tax rise, but that exemption does not cover general practice, hospices, charities, many social care providers—including many care homes—air ambulance charities, dental clinics, opticians, private healthcare providers, agency staff, local pharmacies and other suppliers and contractors, to name but a few.

[Alex McIntyre]

I am sure that the shadow Minister is about to come on to this in her speech, but given that she has just criticised this Government for lacking a plan —a plan that is about to come forward to the House later this year—surely she will now put forward her plan for how much extra the Conservatives propose to put forward for the NHS and how they would pay for it, and explain why they did not do that for the past 14 years.

[Dr Johnson]

If the hon. Gentleman looks back at the figures, he will see that there has been a substantial real-terms increase in NHS funding over the past 14 years. That cannot be said for this year, potentially, which is why I am asking the question.

Type 1 Diabetes and Disordered Eating Services

Alex McIntyre Excerpts

Wednesday 5th March 2025 Commons Chamber

[Josh Newbury]

I completely agree with the hon. Lady, and I thank her for the lived experience that she brings to this House, and for how candid she has been in sharing her experiences. I could not agree with her more.

Many people are falling through the cracks of a system that often fails to recognise the unique needs of people who live with both type 1 diabetes and disordered eating. While disordered eating in those with type 1 diabetes is sometimes referred to as “niche” or “rare”, it is becoming increasingly clear that it is simply under-recognised, and it is often missed. Evidence suggests that up to 40% of women and girls, and up to 15% of men and boys with type 1 diabetes experience some form of disordered eating. That is a quarter of the 400,000 people in the UK with type 1 diabetes.

[Alex McIntyre (Gloucester) (Lab)]

My hon. Friend makes the important point that this issue affects so many people. I have direct experience with a family member who had type 1 diabetes and what, back then, was referred to as diabulimia. They could not get support because the medical profession did not accept that it was a condition. Does my hon. Friend agree that part of tackling this issue is recognising its impact on families across the country, as that is the first step to ensuring that people get the support they need?

[Josh Newbury]

I agree with my hon. Friend. We need far better awareness of this condition, and better support for people affected and their families—I will come on to that a little later in my remarks.

As my hon. Friend said, a key issue we still face is the absence of internationally recognised criteria for T1DE, which hampers accurate diagnosis and classification, as well as collaboration and research. Within our NHS, pockets of fantastic practice have existed for a long time, but overall the current system often does not take account of the unique challenges faced by people with T1DE. Eating disorder specialists might lack the necessary understanding of diabetes management, while diabetes care teams may not be fully equipped to deal with the psychological aspects of eating disorders. The gap in knowledge and siloing of services means that people with T1DE sometimes come up against exclusion criteria and will end up disengaging from services at a critical point in their condition.

The need for joined-up, bespoke services is where the five NHS England T1DE pilot sites come in. Those trailblazing projects are combining diabetes and eating disorder support into one service, helping people to recover faster from T1DE and reducing repeated hospital admissions. That is where my interest in T1DE comes in, because in a past life I worked in the communications team at the Coventry and Warwickshire partnership NHS trust. When it was selected as one of the second wave of pilot sites, I had the privilege of working on preparations for the launch of the new service. Although I sadly moved on before the service was launched, that was a highlight of my years working for our NHS. What I learned about T1DE in those few months has stayed with me, as has the expertise and dedication of Dr Tony Winston and his team at the Aspen centre in Warwick, which is to be commended.

I pay tribute to CWPT and all the pilot sites for the pioneering work they have done to develop these services from the ground up, co-designing them with patients who at last are being heard and treated. Diabetes UK told me that it supported NHS England in the development of those pilots, and it is calling for long-term funding to ensure that best practice is shared and, most importantly, that support is offered by those services on a sustainable footing.