Dentistry: Access for Cancer Patients

Andrew Western Excerpts

Wednesday 17th April 2024 Westminster Hall

[Andrew Western (Stretford and Urmston) (Lab)]

I beg to move,

That this House has considered access to dentistry for cancer patients.

As always, it is a pleasure to serve under your chairmanship, Mr Dowd. I want to start this debate, which I am delighted to have secured, by paying tribute to my constituent Michele Solak-Edwards, who is here to listen to the proceedings. Her phenomenal campaigning on these issues is the reason that we are all here.

Back in 2016, after a routine health assessment, Michele found out that she had triple negative breast cancer—a devastating diagnosis, followed by nine months of gruelling chemotherapy. Among the many, many challenges that Michele faced in that time was a deterioration in her dental health. That is a common yet rarely discussed side effect of chemotherapy and radiotherapy.

Unlike other physical side effects of cancer treatment, which may be medicated with the free prescriptions that cancer patients are entitled to, any side effects requiring dental treatment must be paid for. As we all know, the costs of dental treatment, even if someone is lucky enough to be registered with an NHS dentist, can be overwhelming. For Michele, the significant costs of her dental treatment had to be paid for at a time when, like many other cancer patients, she was unable to work because of her condition.

When Michele was going through one of the most difficult experiences a person can face, she found that accessing affordable dentistry was yet another obstacle for her and others in her position to overcome. So like all great campaigners, she took action to make a difference. She set up an online petition calling for better access to dentistry for cancer patients and for dental care to be free for cancer patients for five years from diagnosis, or until the end of life, if the diagnosis is terminal. This is crucial, given that dental issues do not always become apparent straight away at the outset of cancer treatment, and the issues caused can take a number of years, in some cases, to present themselves.

Within weeks, Michele had more than 130,000 signatures on the petition, with support from dentists, surgeons and oncologists. The petition now has the backing of almost 200,000 people, many of whom are cancer survivors. It is a privilege to be able to highlight its importance to the Minister today. Why is it important? Primarily, because there is an indisputable link between cancer and dental health issues. As the National Cancer Institute said, chemotherapy and radiotherapy can cause dental side effects, with both therapies altering the balance of bacteria in the mouth, leading to ulcers, tooth decay and potentially serious infection.

The link between cancer and dental health does not end there, because existing dental problems can worsen during cancer treatment, which can then impact the effectiveness of treatment or lead to it being delayed. That is why it is widely recommended, including by the British Dental Association, that a dental health assessment should take place after a cancer diagnosis and before the start of treatment.

While the link between cancer and dental health is clear, the pathway from a cancer diagnosis to dental health treatment is often blocked. The biggest issue is the crisis in accessing affordable dentistry. This challenge is not unique to cancer patients, with one in four of Britain’s adult population unable to see an NHS dentist in 2022. In my and Michele’s local authority area of Trafford, only 4% of dental practices are accepting new adult patients on the NHS, and that is by no means a low number, based on current availability. What this means for most people is the choice of going private or going without. When the costs of private dentistry are so high, that is not really a choice at all for many, especially for those on lower incomes.

Even if someone is lucky enough to access NHS treatment, costs can still be sky high, with the price of dental charges increasing by 45% over the past decade. I am not attempting to be party political, but I am suggesting that there is a link between being a cancer patient and being on a lower income because, as I mentioned, many do need to give up work. Macmillan Cancer Support estimates that a cancer diagnosis leads to a person being around £570 a month worse off, with 33% of patients having to give up work because of their condition. Cancer patients are more likely to be priced out of the dental treatment they need, and in cases where dental treatment is required before cancer treatment can begin or continue, that can have potentially life-changing consequences. Every day lost risks lives.

Let us look at some specific examples, such as the case of one of Michele’s campaign supporters, Kelly. Kelly is waiting to start bisphosphonate treatment, which is needed to strengthen bones that are at risk of breaking due to cancer. To start that vital treatment, she must undergo important dental work, which is proving impossible as she cannot see a dentist. The fact that a person’s cancer treatment can be delayed, impacting their life quality or even survival chances because they cannot access dental care is clearly unacceptable.

I know that the Minister understands the crisis in accessing dentistry and I am aware of the Government’s recently published dental recovery plan, which aims to address that. However, the British Dental Association has said that the plan fails to embrace the fundamental reform that patients and dentists so desperately need, with no new money provided and inadequate measures to tackle the workforce retention crisis. If we are ever to achieve the goals of Michele’s campaign, we must get that right, because the speedy provision of dental care for cancer patients would be significantly undermined if, in practice, many cancer patients were still unable to see an NHS dentist due to an unaddressed workforce crisis.

While addressing the crisis in NHS dentistry and the affordability of dental care is not something that can be achieved overnight, there are more immediate things that could be done to improve the pathway from cancer diagnosis to dental treatment. Currently, there is no guarantee that cancer patients will be informed by their doctor that they should seek a dental check-up before undergoing cancer treatment. That is despite guidance from the NHS Specialist Pharmacy Service, the Royal College of Surgeons, the BDA and the British Society of Special Care Dentistry stating the importance of patients being dentally fit before starting cancer treatment.

Michele’s campaign therefore calls on the NHS to provide information to all newly diagnosed cancer patients, telling them of the need to seek dental assistance prior to their cancer treatments commencing. That does happen in many places, but we want to see it enshrined in law. That information could be provided by GPs and would include a list of dental practices in each area that could treat the cancer patient on the NHS.

I would also like to share the experience of Hayley from Reading. Hayley is another supporter of Michele’s campaign, and her stories sum up the issues that I have tried to raise today. When she was 21, Hayley had chemotherapy and radiotherapy for non-Hodgkin lymphoma. The radiotherapy caused severe dental issues. Now aged 44, Hayley has breast cancer and has had to remortgage her house to spend £11,000 on removing the remaining six teeth in her lower jaw and replacing them with implants. At no stage has Hayley been able to access NHS dentistry. Experiences such as that are why this campaign is so important. No one wants a situation where cancer patients are losing out on the healthcare they need because they cannot afford or access it.

We must act on this underappreciated crisis. I therefore encourage the Minister to address in her response the asks of Michele’s campaign, including not only the long-term aim of free dental care for cancer patients, but, in the short to medium term, the possibility of prioritising cancer patients for NHS dentistry and ensuring that there is clear guidance on the need for cancer patients to receive dental care provided at the first point of contact with their GP or cancer team. I am particularly interested to know what consideration the Minister could give to joining cancer and dentistry services together for cancer patients, offering out-patient appointments for sufferers in hospital alongside their other treatment. That would seem a practical way of ensuring that people can access the care that they need.

I also invite the Minister to meet Michele and myself—as the shadow Minister, my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), kindly did earlier today, and I know Michele was appreciative of that—so that we could discuss these issues in greater detail. She will appreciate that I have not been able to cover all aspects of this important issue. Likewise, I accept that there is an escalator of asks here, some with financial implications. Michele has a mine of further information on the subject, and I know that she would be keen to talk the Minister through some of her ideas for funding these changes.

Ultimately, we must all work together on improving access to dentistry for cancer patients. As I said, I do not consider this to be party political, but it is something that we must get right. It is the least we can do for people who are already facing one of life’s toughest challenges.

--- Later in debate ---

[Andrew Western]

I thank everybody who has contributed to the debate. We have a considerable amount of expertise in the room—in particular, my hon. Friend the Member for Bolton South East (Yasmin Qureshi) is the chair of the all-party parliamentary group and my hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton) is a former nurse and national lead for the Local Government Association on all things relating to health.

I am grateful to colleagues who have contributed to the debate in various ways and focused more generally on the considerable issues facing those seeking to access dentistry. I want to drill down more specifically on the issue of access for cancer patients, and I appreciate the Minister’s offer of a meeting, which will hopefully move us forward. I also welcome her commitment to looking at how we can deal with the information side of this. However, with respect—she would expect me to say this—that is perhaps the easiest of the issues to tackle. I gently say to her that at no point did I ask for all patients to have free dental treatment, but just for cancer patients to have dental treatment because their experience has not come about as a result of not looking after their teeth, but as a direct result of other treatments. [Interruption.]

I am cognisant of the Chair’s clearing of his throat, and I will raise some of the other issues that I was hoping to discuss today in the meeting with the Minister. As I say, I am grateful to her and the shadow Minister for meeting me and Michele earlier, and to everyone who has contributed.

Question put and agreed to.

Resolved,

That this House has considered access to dentistry for cancer patients.

NHS Dentistry

Andrew Western Excerpts

Tuesday 9th January 2024 Commons Chamber

[Andrew Western (Stretford and Urmston) (Lab)]

After 14 long years of Conservative Government, our country is going backwards. Nothing demonstrates that better than the dire condition of NHS dentistry. What kind of country has this Government allowed us to become when people are forced to pull out their own teeth with pliers, because locating a dentist taking new patients is almost impossible? Talk about going backwards: the Conservatives are dragging us back to Victorian times.

The lack of access to NHS dentistry is one of the most common issues raised with me by constituents in Stretford and Urmston. The most recent data available shows that only 4% of dental practices in my local authority area of Trafford are accepting new adult patients on the NHS. Moreover, the current NHS “find a dentist” website is badly out of date. Despite claims to the contrary, a search using a postcode from Old Trafford in my constituency reveals that none of the top five results is accepting new patients. My constituents tell me they waste time they do not have calling around surgeries because of the results they have been given, only to be disappointed.

For the lucky few who can find a dentist, the wait times for treatment are simply unacceptable. As of September last year, there were almost 2,000 patients waiting for oral surgery in my local authority area of Trafford, with the majority waiting far longer than the NHS 18-week target for treatment. Behind these numbers are people enduring months of pain, distress and misery. In many cases, their ability to work or learn is affected. They cannot sleep. They cannot enjoy the basics of life, like food and drink, and do not feel confident enough to go out with friends and family socially. That is the impact. That is the devastation that this crisis is causing up and down the country.

Although no one doubts the challenges that the pandemic has caused NHS dentistry, the truth is that a lack of funding and a failure to reform in the preceding decade left NHS dentistry uniquely exposed to the impact of the virus. Between 2010-11 and 2021-22, total funding for dental services in England fell by 8%, leaving budgets that have been unable to keep up with inflation or population growth. Although today many Conservative Members have been quick to complain about the dental contract, their party has been somewhat slower to do anything about it, taking 12 years to make what have widely been acknowledged as minor tweaks—tweaks that were criticised at the time by the BDA, which said that their implementation would make “little meaningful difference”.

The Prime Minister pledged to restore NHS dentistry during his leadership campaign, but, over a year later, we know that a pledge from this Prime Minister is the kiss of death for whatever service he is highlighting. Lo and behold, his dental recovery plan, which was promised last April, is still nowhere to be seen. In contrast, Labour has a plan and it will not take us 14 years to deliver it. We will take immediate action to provide: 700,000 more urgent appointments; new incentives for new dentists to work in areas with the greatest need; supervised toothbrushing in schools for three to five-year-olds; and reform of the dental contract to rebuild the service in the long run. That is the type of ambition needed to address the scale of this enormous crisis, and it is an ambition that will have the funding it needs to become reality.

Politics is about choices. We on the Labour Benches choose NHS dentistry, ending the misery, the wait and the pain for so many, over tax breaks for the super-rich. There should be no contest. I urge all Members, including those on the Conservative Benches, to support the substantive motion.

Cost of Living: Healthy Start Scheme

Andrew Western Excerpts

Tuesday 23rd May 2023 Westminster Hall

[Andrew Western (Stretford and Urmston) (Lab)]

I beg to move,

That this House has considered the Healthy Start scheme and increases in the cost of living.

It is a pleasure to serve under your chairship, Mr Twigg. I am pleased I have been successful in securing a debate on this issue at such a timely and critical moment.

Hon. Members will be aware of the shocking revelations from Sky News last week that parents are being forced to steal baby formula to feed their infant children. Other parents revealed that they are watering down formula or mixing it with other ingredients, such as flour, in a desperate attempt to make it last longer. One parent in that situation, who was quoted in Sky’s report, talked about his baby’s “hungry scream” and how he has heard it so often that he knows it now.

It has also been reported that an unregulated black market has sprung up with second-hand baby formula, which is often less safe than formula found in supermarkets, being sold online at a cheaper price, to which parents are now turning in their panic. The British Pregnancy Advisory Service has warned that parents being forced to make such decisions is putting the UK on the brink of a public health crisis.

Let me be clear from the start: the fact that parents are in such a situation in 21st century Britain is utterly shameful. Although I do not want the debate to turn into a political slanging match, last week’s reporting from Sky should make the Government reflect on their record on the cost of living crisis. Not just baby formula is proving out of reach for struggling young families. Food banks are reporting steep increases in the number of parents with infant children coming to them for support. When asked what his Government were doing in the face of this cost of living catastrophe, the Prime Minister said:

“We have particular support for young families, something called Healthy Start vouchers, which provide money to young families”

to help

“with the costs of fresh food.”

I am sorry to say that the Prime Minister is living in a different world if he thinks the current rate of Healthy Start, which has been frozen by Conservative Governments in each of the past two years, is sufficient for struggling families who are living through the worst cost of living crisis on record. That is the reason I have secured the debate today. Healthy Start is simply not living up to its stated purpose. It does not cover the cost of healthy food, it does not cover the cost of baby formula and it is no longer acting as the nutritional safety net for families that it was originally intended to be.

Although many much-needed reforms could be made to Healthy Start to make it more effective, including auto-enrolment, on which my hon. Friend the Member for South Shields (Mrs Lewell-Buck) is doing great work, fundamentally, as is so often the case, this is a question of money. The money being provided by Healthy Start is simply not enough for struggling parents. The solution must, therefore, be to uplift the value of Healthy Start so that payments reflect inflation and so that children, regardless of background, are given the best possible nutritional start in life. That is what I am calling for today.

To set out the context: Healthy Start was introduced by the previous Labour Government in 2006. It provides payments to people who qualify to help buy milk, baby formula, fresh fruit and vegetables, and pulses. Eligible families receive £4.25 a week from the 10th week of pregnancy, then £8.50 a week while the baby is from nought to one year old and £4.25 per week thereafter, until the child is four. As of April 2023, there were 336,468 beneficiaries of Healthy Start payments, although my understanding is that there is a lack of transparency on the number of Healthy Start recipients as data is published only on the number of beneficiaries, as opposed to the number of actual children the claims relate to. I would be grateful if the Minister could set out why that data is not published, and commit to sharing that information as soon as possible, given the seriousness of the issue.

Healthy Start payments have been uplifted only once under the Conservative Government—once in 13 years. That was in April 2021 and was in response to a recommendation from the National Food Strategy. That date is important because, since the last increase, inflation has torn into the budgets of the poorest families hardest. The cumulative change in UK consumer prices from April 2021 to March 2023 was 17%. Looked at in isolation, food inflation was much higher than that and was running at 17.2% in the last year alone.

New data from First Steps Nutrition Trust shows that the cost of the cheapest brand of formula milk has risen by 45% in the past two years. Other brands have risen by between 17% and 31% in the same period. Currently, Healthy Start payments do not cover the full cost of any baby formula on the market in the UK. What might have been affordable when the last increase was announced is now out of reach for many of those in most need.

The Government talk about halving inflation, but I am sure that even the Minister would agree with me that that cannot be achieved overnight. In the meantime, families have to make ends meet, but at the moment they simply cannot. Increasing Healthy Start payments to reflect the 17% rise in costs that families have endured in the last two years would make a real difference. That is being called for by the national charities working in this area, as well as my local Labour-run Trafford Council, which I must credit with first raising this matter with me and highlighting the impact that freezing the allowance is having on families in my constituency and across Trafford.

I understand that money is tight, and 17% might sound like a big increase, but we are talking in real terms about less than £1 per child per week for those on the lower rate of Healthy Start, which is the vast majority of recipients. If the £4.25 voucher were uprated to reflect inflation, it would rise to around £4.97—72p more than current levels. For context, the Best Start Foods scheme in Scotland is currently £4.95 per child aged between one and three years old, so the uplift would effectively bring parity. I do not believe that in 21st century Britain, which, despite all our many issues, remains one of the wealthiest countries in the world, a 72p increase to help the poorest children is beyond us. Not only is there a strong moral case for it; there is also a compelling economic case. We know the impact that child poverty and the poor nutrition that comes with it have on a child’s health and wellbeing, with a knock-on effect on their future life chances.

Loughborough University has estimated that the costs of child poverty on future lost earnings retained by individuals were £11.6 billion in 2021. Not only is that terrible for the individual, but it represents billions in lost tax revenue for the Treasury. That is before we get to the fact that people on the lowest incomes are more than twice as likely to say that they have poor health than people on the highest incomes, meaning that they are more likely to be reliant on an NHS that is now at breaking point.

I am pleased that yesterday the Labour party put prevention at the heart of our mission for the national health service. I am sure that when the shadow Minister, my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), responds—[Interruption.] He says “Hear, hear” from a sedentary position, but he might not when I finish. I hope that he will agree on the importance of tackling health inequalities and on why it is such an important issue. An improved Healthy Start scheme can be a part of the journey, given we know that it is effective in improving childhood nutrition and leads to greater consumption of healthy foods.

I will not pretend that increasing the value of Healthy Start is a silver bullet. The increases that I am calling for are modest, but they must form part of a much wider national effort to tackle child poverty, which has now reached such a level that more than 4,000 children in my constituency of Stretford and Urmston are growing up under the yoke of poverty. Labour has a record to be proud of here: the last Labour Government lifted more than a million children out of poverty, largely through fairly redistributing the proceeds of sustained economic growth, which this Government is failing to achieve. Alongside that, they prioritised tackling child poverty and implementing the measures in the Child Poverty Act 2010. Those measures were scrapped by this Government several years ago, leaving us in the mire we now find ourselves in.

The debate is about calling on the Government to take action now. They are the ones with the power to make a difference. A modest increase to Healthy Start could have a significant impact on the poorest families. When considering the issue, I urge the Minister to think of last week’s reports, the indignity that poverty brings and the stigma, shame and anxiety felt by families who are forced to steal or risk their child’s health. Think of what it must be like to feel helpless, hearing again your child’s hungry scream, which many parents now know so well. With all that in mind, if the Minister does not support uplifting the value of Healthy Start in the face of such powerful testimony, I ask him, why not?

--- Later in debate ---

[Andrew Western]

I thank everybody who has taken the time to participate in the debate. This matter is incredibly important to me, my constituents and so many people up and down the country in the midst of this cost of living crisis.

I will comment on some contributions from hon. Members, beginning with the hon. Member for Strangford (Jim Shannon). I am very grateful for his support for uprating the Healthy Start allowance. He is right to highlight the scheme’s importance to the people of Northern Ireland; it is also important to people across the whole UK, as he rightly said. He was also right to mention free school meals, because that is a major problem with the scheme as it stands. The Healthy Start allowance finishes on a child’s fourth birthday, after which the children of some of the very poorest families do not receive that support. We are talking about children and the food they eat, rather than about the families. At a crucial time in any child’s development, those children do not receive that support until they are at school and in receipt of free school meals. I thank him for making that point.

I also agree with the hon. Gentleman’s point about the potential extension of eligibility. I very deliberately sought to put forward a reasonable ask of Government today. Based on the Minister’s response, I need not have bothered to do so; I could have asked for all the issues with the scheme to be addressed. I made a minimal request in the hope that there might be a positive offer in response. The extension of the eligibility criteria would be particularly welcome not just to those with children over the age of four, but to everybody in receipt of universal credit. The current level of eligibility is set at any family earning up to £408 a week from employment, which is not a significant sum when there are little mouths to feed.

I very much associate myself with the comments from the hon. Member for Strangford about the complexity of the application process. I hear what the Minister said about the move online and the digitisation of the scheme, but there have been significant problems, not least with the availability of reporting and data as a result of the shift to digitisation. The hon. Member for Strangford made a point about his dear friend who spends so much time advising on benefits that it is a full-time job. He is absolutely right: it would need to be, because the scheme is so complex that many families are simply not taking it up. The shadow Minister, my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), pointed out that we are missing the Government’s target, and I will return to that serious issue momentarily.

I turn to the comments of the hon. Member for Glasgow Central (Alison Thewliss), whose expertise in this matter—not least that garnered as chair of the all-party group on infant feeding and inequalities—is second to none. I stress that I am not here speaking specifically about baby formula. She says that that is not a new issue, and I absolutely appreciate that. However, on this issue, we have an acute and current problem that is relatively new across the piece, because Healthy Start is used for things other than baby formula, including milk, pulses, fruit and vegetables, and so on. I know she understands that, but I am trying to continue making the case for why this is important in and of itself. There is a broader remit up to the age of four, and it is incredibly important to note that, but I endorse everything that she says about milk formula, and the challenges for the lowest-income families as a result of the current system and the current pricing regime.

The hon. Lady’s comments about the value of the voucher, in terms of the loss of milk, are really pertinent. For the value of the voucher to be down by the cost of more than two pints of milk over a relatively short period shows the impact on families. I am incredibly fortunate to do this job. I do not know what it is like to have to sit there and work out, “Can I buy an additional pint or two of milk this week?” For families in that situation, it must be absolutely devastating when they have a hungry child crying for food as they make that calculation.

I also associate myself with the hon. Lady’s comments about individuals with no recourse to public funds. That is really important, and I firmly agree that that should not be a barrier to receiving the Healthy Start allowance. In particular, the Government have moved on that specifically in relation to free school meals. When one considers a child’s journey through the early years and on to education, I can see no difference that would excuse these two alternating and contradictory positions. If nothing else, I hope that the Minister will take that away and endeavour to look at it.

The shadow Minister, my hon. Friend the Member for Denton and Reddish, made some really important points about uptake, building on the comments of the hon. Member for Strangford. We have up to 200,000 beneficiaries of the allowance not currently taking it up. We have a Government target of 75% against a national average of 64%, so that is a significant failing. Having said that I would restrict my requests to one particular area, I place on record that I support the Food Foundation’s request for a £5 million investment campaign spent on promoting the scheme to drive up the uptake.

My hon. Friend’s broader list of points, in setting out Labour’s agenda, shows the breadth and scale of change that is needed to genuinely tackle the cost of living crisis. I said in my opening speech that this change alone would not be a silver bullet. It is one of myriad interventions that are needed, given the scale of the crisis that young families and people up and down the country face, whether they have young children or not. That sort of visionary and transformational agenda will be required to tackle child poverty. I know that my hon. Friend will agree that the last Labour Government did that, and I hope that the day when we can do so again comes very soon.

To turn to the Minister’s contribution, it has probably come across that I am relatively disappointed by the response. He refused to say, and presumably has not even looked at, what the cost of this intervention would be. He mentioned that the data—which I pointed out was troublesome—made this complicated. I am happy to give way if he wants to provide clarification on this point. There is an awful lot of talk about “beneficiaries”—he used that term—but that does not make it clear to me whether we are talking about one parent in a family, two parents in a family, one family, one child or two children in the same family. It is not clear, so I have had to make these calculations based on 336,000 current recipients of Healthy Start, assuming that around 30% of those fall into the category of children between nought and one. An inflation-level uplift of 72p a week for those on the lower rate and therefore £1.44 for those on the higher rate would add up to a whopping £16.3 million. That is nothing when one considers the grotesque scale of waste that the Government incur through failing to intervene early enough in children’s lives, before they face deeper problems further down the line. That is nothing against what I set out in my opening speech in relation to the lost revenue to the Treasury when one considers the lost potential over the course of a lifetime.

These are tiny sums in reality, but they would make an enormous difference to people on the lowest salaries and incomes. When the Minister lists the litany of interventions from the Government and says, for instance, that the living wage has been increased to £10.42, it is important to recognise that that can be a problem for previous recipients of Healthy Start, because not uprating the Healthy Start allowance means that some people may roll off it and be worse off. There is no taper and no support for those just over the limit. Forgive me, I had not considered this in advance, or I would have made this point in my opening speech: I think I am correct in saying that the decision not to uprate Healthy Start will lead to fewer people being eligible. That is shameful, given the crisis that we face in this country, and given that we have families stealing to feed their babies. It terrifies me that the Minister hides behind an increase in the national living wage, when that leaves people potentially worse off in this instance.

We have to be honest: this invest-to-save measure would have been particularly cheap for the Government to enact. The greatest impact that we can have on anybody’s development is in those first few years. That is why we have policies such as Sure Start and why we have the Government’s albeit limited family hubs policy. No child can reach their potential if they grow up without the food and nutrition that we all need, particularly in our youngest years.

There are many issues. As I said, I began in a rather restrained way, but we received such a disappointing response from the Minister. He did not even consider this proposal and pointed to broader lists, seemingly not having looked at what the negligible costs would be, so I will briefly set those issues out. I would have liked to say more about auto-enrolment and take-up; expansion of the scheme to all children under free school meals age; and widening the eligibility criteria to all families on universal credit and those with no recourse to public funds, who can now get free school meals.

Fundamentally, however, I came here with a reasonable ask today, at a time when we know that families are so desperate that they are stealing to feed their children and are listening to hungry cries because of the empty bellies of the very youngest people in our society. We are talking necessarily about the most vulnerable young people in our society, in families on the lowest incomes. This proposal would have cost next to nothing, but I fear that the price for those individuals will be grave indeed. I am grateful to everybody who has participated today, but I have to say, I remain deeply disappointed by the Minister’s response.

Question put and agreed to.

Resolved,

That this House has considered the Healthy Start scheme and increases in the cost of living.

NHS Workforce Expansion

Andrew Western Excerpts

Tuesday 28th February 2023 Commons Chamber

[Aaron Bell]

I thank the hon. Gentleman for his point; I am sure the Minister has heard it. I will not say any more about that specific case, because I do not know his constituency that well—although I did work in Harrow once upon a time.

We had 120,000 more GP appointments every day in January ’23 compared with January ’22, and we are delivering the biggest ever catch-up—it is a necessary catch-up—over the next three years, with an extra £45.6 billion in funding to help us recover from covid. That will mean 9 million more scans, 9 million more checks and 9 million more procedures for the people who need them.

We know what Labour would do. It claims to have a plan funded through non-dom status, but I doubt that would raise the money, not only for the reasons I gave in the Opposition day debate at the end of January, but because it has already committed that money to breakfast clubs and various other things. There is a never-ending magic money tree that pays for all Labour’s commitments —[Interruption.] I know that the shadow Health Secretary and others have made many unfunded spending commitments. Labour’s answer is always more money, and the answer to how that will be funded is always a non-dom tax, which would not even raise the money Labour claims, as Ed Balls said, as Alastair Darling said, and as Gordon Brown found out for himself.

[Andrew Western (Stretford and Urmston) (Lab)]

Will the hon. Gentleman give way?

[Aaron Bell]

No, I have already spoken for 11 minutes, so I must get to the end—I have heard your strictures, Mr Deputy Speaker.

The NHS in Labour-run Wales has a shocking record of failure. As I said earlier, the health board in north Wales is once again under special measures. Since 2009, the Welsh Labour Government have consistently failed to meet the 95% four-hour target. England and Scotland, as the hon. Member for Central Ayrshire said, do a lot better on that measure. Patients in Wales are twice as likely to wait for hospital treatment, with 21.3% waiting after a referral by a consultant compared with only 12.8% in England. Perhaps the shadow Minister will explain, when summing up, whether he approves of Labour’s record in running the NHS in Wales or condemns it, as we do.

We also know about Labour’s record in government here in Westminster. As I said earlier, the elective surgery figure is a fact. Instead, we are investing record sums in our NHS. We are investing in its buildings and equipment but most of all in its staff. Having delivered for this country throughout covid, having vaccinated us and got us out of lockdown—which I recall the shadow Health Secretary opposing before Christmas 2021—and back to work, we are now helping the NHS to recover. I am proud to support this Government.

--- Later in debate ---

[Andrew Western (Stretford and Urmston) (Lab)]

I rise to support the motion before the House today. Our NHS is in crisis. It is a multifaceted crisis, but at its source it is a workforce crisis caused by years of Tory neglect. Colleagues have ably set out the scale of the issues facing the health service: a shortage of 9,000 doctors and 47,000 nurses; crises in midwifery, dentistry, general practice and mental health services; and more than 7 million people waiting months for NHS treatment, with 400,000 waiting over a year. The waiting times are the worst since records began. The system is on the brink of collapse, and the Government know it. The draft NHS workforce plan calls for a doubling of medical training places, yet the Government cut the number of medical training places this summer, in the teeth of the worst workforce crisis in the history of our NHS.

I am grateful to all our NHS workers. This situation has arisen through no fault of theirs, but it is a huge issue none the less. It is a huge issue in Stretford and Urmston, where the national shortage of GPs is seen in microcosm at one local medical centre, with some 16% of patients waiting more than 28 days for an appointment. That is outrageous, but the scary thing is that it is not unique. It is far from an outlier nationally. It is simply not good enough. The Government tell us not to worry, and that they will guarantee an appointment within two weeks—never mind the fact that under the last Labour Government the wait was two days or the fact that this Government have no plan to achieve it.

We have heard various excuses from the Government. No doubt we will hear more about covid, the weather or striking workers—anything but the Government—but waiting lists rose consistently between 2012 and 2019. The 18-week treatment target has not been met since 2016. Cancer patients have been waiting longer for treatment every year since 2010. Performance on the two-week cancer referral waiting time target has fallen to record lows. Performance declined between 2013 and 2018, and it has fallen further since the pandemic, but the problems are deeper seated than that.

I will raise a specific issue from my constituency and broaden the debate somewhat by talking about access to orthodontics. The family of a constituent have been in touch with me. This teenage girl waited almost two years for a referral, only to be told when finally referred that the waiting list for treatment is two to four years. She is almost 15. The near-constant pain at the back of her jaw causes headaches, and her overcrowded teeth are also affecting her mentally and socially at a difficult age. When her parents explain the situation, they are told to give her painkillers to manage the problem—painkillers for up to four years. The waiting list could take her past the age of 18, meaning she may not be able to access services at the end of her wait. This is a broken system and we need to take action now. Only Labour has a plan to take the action needed.

Ultimately, politics is about choices. I know what side Labour is on, and it is clear today what side the Conservatives are on. Labour chooses to scrap non-dom status, while the Conservatives protect the super-rich instead of providing an NHS workforce fit for the future. The Conservatives had a chance today to break from the long-standing truth, proven time and again, that the longer the Conservatives are in power, the longer NHS patients will wait for the treatment they so desperately need. It saddens me, and it will sadden my constituents, that they seem unwilling to do anything about that today.

Cystic Fibrosis: Living Costs

Andrew Western Excerpts

Thursday 2nd February 2023 Westminster Hall

[Jim Shannon]

It is almost like the hon. Lady read my next point. That is one of the focuses of my request. It is my next sentence, would you believe?

We must remove unnecessary PIP reassessments for people with long-term conditions such as CF. There has to be an understanding of what CF is and how it affects people. There has to be an understanding that their lives are not like anybody else’s lives. I said earlier that the median lifespan for people with CF in the last year was 38 years. It is sad to say this, but it is a life-limiting condition.

There is a requirement for claimants to report any change in health to the Department for Work and Pensions—wow! It would be great if every person with cystic fibrosis could say, “I tell you what, I’m better today. I won’t need those 70 pills and the medication for the next wee while.” That does not happen. It would be a miracle. I believe in miracles—you know I do, Ms Harris—but they do not happen every day. The fact is that people sometimes have a sickness or a disability—this is one of them—that means they need help. I have always been a great believer that society is marked by how it helps those who need help, and that is what we need to do.

These people have a progressive lifelong condition and their health is unlikely to improve, but there is the threat of constant reassessment—my goodness, reassessment again. We know the condition is life-changing and life-limiting, and that they probably need a transplant. The hon. Member for Bristol East (Kerry McCarthy) is always here in these debates. I welcome her to her place—not that it is my job to welcome people to Westminster Hall, but I like to see her because I know she makes very helpful contributions. The reassessments provoke anxiety and are costly and unnecessary. Streamlining the assessment system would mean that those with progressive, long-term conditions such as CF do not have to undertake reassessments. That would not only remove the anxiety but provide cost savings to the DWP. We do not need to do those reassessments because it is a life-limiting disease.

I feel very frustrated—I am sure others do too—when people with life-limiting diseases have to go through reassessments for employment and support allowance, PIP or DLA. It is absolutely unbelievable that that should happen.

[Andrew Western (Stretford and Urmston) (Lab)]

The hon. Gentleman is making an excellent point about the reassessment process. Does he agree that many people with cystic fibrosis are unfortunately unable to access PIP because it is treated as an illness, rather than a disability? The assessment process assesses what people may theoretically be able to do, rather than what they can do in practice on a daily basis.

[Jim Shannon]

The hon. Gentleman has summed it up in that one sentence. I said when he made his maiden speech last week that his contributions will add much to this House. That is one of them, and I thank him for it. I wholeheartedly support him.

I again ask the Minister—she knows these requests, because I have made her Department aware of them—to remove VAT on energy bills. That is important for people with CF because, at a time when energy bills are already astronomical, the median energy bill for an adult with CF is £26 higher every month than for typical households. For parents of children with CF, the figure rises to £36, because they do more and keep more heat in the house for their children. Adults can sometimes bear with it a wee bit, but there is still a cost factor.

--- Later in debate ---

[Andrew Western (Stretford and Urmston) (Lab)]

It is a pleasure to serve under your chairship, Ms Harris, and I congratulate the hon. Member for Strangford (Jim Shannon) on securing what is an incredibly important debate, in which I will speak on behalf of my constituent Penny Mitchell and her family. Penny’s daughter, Eva, is 15, and cystic fibrosis affects all her organs. As we know, CF is a degenerative, life-shortening disease. I will not go through the symptoms, as colleagues are already aware of them—the hon. Member for Strangford set many of them out—but I will focus on some of the challenges that Penny has taken the time to tell me about, and I will share just some of her correspondence with me.

For Penny and Eva, the problem with the current system of support is that CF is seen as an illness, not a disability. CF adults are not eligible for free prescriptions, because that list was last reviewed in 1968, and at that point—as the hon. Member for Strangford highlighted—those with CF were not expected to live to adulthood. The need for a review is clear: when we consider that Eva was born with CF and is currently taking around seven different medications a day, we can see what an injustice that is.

However, Penny’s biggest concern is that when Eva turns 16 in June, she will no longer be eligible for disability living allowance for Eva, who will have to claim PIP. As I highlighted in my intervention earlier, that can be a challenging process for those with CF, because PIP is assessed on difficulties doing daily tasks and on mobility and does not necessarily reflect the struggles of people with illnesses such as Eva’s. In many ways, she is quite unlikely to be eligible for PIP, even though the things for which Penny was given DLA still need doing and funding. Penny is scared that, without financial support as an adult, Eva will simply decide she is unable to do those things—things like attending hospital, buying the extra food she needs or keeping herself warm and clean. The risks to her health are obvious.

Eva is currently in school year 11. Because she is constantly fatigued and trying to battle chest infections, and also suffers from anxieties related to living with a medical condition that will shorten her life, she has only been able to physically attend school for 50% of this school year and the previous year. That has an impact on her ability to get good qualifications and secure a good, well-paid job in future.

[Kerry McCarthy]

My hon. Friend mentioned anxiety. As many people will know, I have a niece with CF, who has just turned 18. She is very much at the healthy end of the spectrum, which is good, but there comes a point, particularly with access to social media, when young people start to learn that they have a life-limiting condition. They learn far more about it than they perhaps would have done in the days when they would have relied on their parents to tell them about it and at a time when their parents thought they could handle it. Supporting them from a mental health point of view while they are going through that is really important too.

[Andrew Western]

My hon. Friend makes a really important point. We have talked about some of the associated conditions that can come with CF, such as diabetes, but the mental health implications for some sufferers are acute. I hope the Minister will take account of that in her response.

Penny is incredibly concerned—given how difficult it is for Eva to attend school and the support she needs from Penny to do that—about how difficult it will be for Eva to secure work. That is something they worry about a considerable amount; with the current cost of living, it is a huge concern, because without receiving funding to support her living costs, Eva will be left in a vulnerable position. She will be less likely to earn a decent living, as she may be able to work only part time and will not necessarily have the same qualifications as somebody who has been in school full time.

Eva’s illness is not properly recognised by the current criteria, which seem to assume that people need financial help only because they are unable to do certain physical daily tasks and lack mobility. In theory, Eva can do those things, but she does not usually feel well enough to do them and so relies heavily on help, but that does not necessarily come across in the current system. Why does current financial support not consider the impact of an illness on a person’s ability to get an education and gain decent employment, and recognise that providing support would enable them to maximise their potential and earn the best living that they can in the circumstances?

If young people such as Eva were routinely financially supported with PIP, it would take some pressure away from them so that they could focus on doing what they can manage to do, and it would help them to meet their costs of living. Penny faces the prospect that, in order for Eva to attend college, she will have to reduce her hours at work to be able to take her there. That would obviously have a significant impact on the family finances, but getting a bus early in the morning and back again after college may add to Eva’s fatigue, so Penny taking her there is the only way for the situation to be manageable and for Eva to avoid missing college too often.

[Margaret Ferrier]

The hon. Member is making a great speech. People with disabilities such as cystic fibrosis find it harder to maintain employment and, as he says, worry about keeping up with bills. It is estimated that only half of employers have occupational sick pay schemes. Does the hon. Member share my concern about the impact of the UK’s very limited statutory sick pay rate on vulnerable people who need to take time off work?

[Andrew Western]

I share the hon. Lady’s concern. She is absolutely right that this impacts significantly on people’s ability to function in the workplace. It also impacts on the mental health issues raised by my hon. Friend the Member for Bristol East (Kerry McCarthy), so it is an important issue, and the hon. Lady is right to raise it.

Let me return to Penny and Eva’s plight and the concerns that Penny has set out to me. Because Penny will no longer get DLA and Eva is unlikely to get PIP to help with costs, there appears to be little support for Eva, moving forward. I have had correspondence with Penny beyond what I have shared with colleagues here. Eva needs multiple prescriptions, which she will have to pay for as an adult. She has frequent hospital visits. These are familiar concerns, which we have heard about. Travelling to hospital incurs parking costs, but also petrol costs. Eva needs extra food to prevent her from being malnourished, as she cannot digest food properly; extra water to be clean, as she sweats excessive salt out; and, of course, extra heating—an issue that colleagues have mentioned—to keep her warm.

The cost of living is tough for us all, but it is having an especially acute impact on those with CF. Given that it is so hard for them to work full time and that the benefits system does not necessarily look after them in adulthood, this is a real crisis, so I hope action can be taken. I am pleased to associate myself with colleagues who have so far spoken in highlighting the many ways in which the Government could take action. A review of the now 55-year-old list of conditions for which there are free prescriptions is one such way. The hon. Member for Strangford highlighted an uprating of benefits. There could also be some practical support around VAT on energy bills. Other support could be offered to help people with the rising cost of food, and the hon. Member for Ashfield (Lee Anderson) mentioned the potential clash in managing diet when balancing the impacts of cystic fibrosis and diabetes, which can in itself add to food costs, although that may be offset by the free prescriptions.

There is a considerable amount going on here. As I said, I associate myself with the comments of my colleagues, and I hope the Minister will indicate in her response what action can be taken.