Access to NHS Dentists

Caroline Johnson Excerpts

Tuesday 12th September 2017 Commons Chamber

[Judith Cummins]

I absolutely do.

Dental practices in working-class areas, facing spiralling overheads and a decline in their income, are struggling to stay afloat. In better-off areas, dental practices have been able to cushion themselves through extra revenue from privately paying patients. That extra income makes a difference. In working-class areas, the realities of life are hugely different. After many families have paid their rent or mortgage, covered day-to-day essentials and put food on the table, a visit to the dentist has now become one of life’s luxuries.

Research by the BDA supports that idea. Figures reveal that four in 10 patients have delayed a dental check-up because of fears about the high cost of treatment. That is understandable when we realise that the patient charge for treatment in the highest band—such as crowns or bridges—is £244.30. Working-class people, such as those in Bradford, are being hit the hardest. They have been abandoned by the Government, and they suffer failing oral health and chronic pain day in, day out. Worst of all, they are powerless to do anything about it because they find it difficult to access an NHS dentist. There is a clear human cost of poor dental health, which affects every part of a person’s day-to-day life.

The BBC spoke to a Mr Oldroyd during their investigations. Mr Oldroyd, a middle-aged man, has been trying to find an NHS dentist for four long years, during which he had suffered from chronic pain caused by his terrible tooth decay. He told reporters:

“The state of my teeth has made me depressed and I’ve literally begged to be taken on by an NHS dentist, but every time I’ve been turned away.”

Mr Oldroyd told reporters that his pain became so unbearable that, in the end, he resorted to self-extraction. He pulled out his own teeth. This is simply unthinkable. Mr Oldroyd believes that his poor dental health has contributed to him being out of work. As he puts it:

“The tops of my teeth are gone. I’m on benefits and trying to get a job, and when someone sees my teeth they just think I’m another waster.”

This crisis has been a long time in the coming. It has not crept up on the Government; it has been visible and in plain sight. The Government were put on notice when they came to power in 2010. There have been repeated warnings from dental professionals working in the sector, from within Parliament, and from the British Dental Association. All have warned that inaction is not an option, but sadly that is what we have seen.

It was not long ago that I, and many other Members, spent the afternoon right here in the Chamber in a Back-Bench business debate about health inequalities. During my remarks I set out a number of simple, uncontroversial steps that promised to improve access to NHS dentistry. First among those steps was to expedite reform of the NHS dental contract. Time and again when challenged about the reform of this contract, the Government have done little more than lay the blame at the door of the previous Labour Government. With respect, if that excuse was ever persuasive, it is now threadbare following seven years of a Conservative Government, two Conservative Prime Ministers and three general elections.

Reform of the contract is critical, as it promises to spend taxpayers’ money more effectively. The current dysfunctional contract sets quotas on patient numbers, fails to incentivise preventive work, including effective public information campaigns, and implicitly places an ever-growing reliance on dental practices to pursue private charging as a means of staying afloat. This Government are forcing dentists to make a terrible decision: either to stop providing NHS services altogether and go private, disregarding those who have less ability to pay, or to provide overstretched NHS dental treatment to their patients—or a combination of the both. That is a toxic choice for the dental profession.

Since first being elected in 2015, I have campaigned for more funding for Bradford. The city has among the worst oral health outcomes in the country, despite the hard work of local public health officials. We have received additional funding, to the credit of the previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), but frustratingly this was only temporary. Despite my efforts, the Government still have not announced whether any permanent funding will be put in place. That is simply unacceptable. Official figures reveal that a five-year-old in Bradford is four and a half times more likely to suffer from tooth decay than a child in the Health Secretary’s constituency of South West Surrey. According to figures, a third of children in Bradford have not seen a dentist for more than two years. Children should be given a check-up every six months.

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

Will the hon. Lady give way?

[Judith Cummins]

I am really sorry; I cannot give way because of the time.

One of the most shocking figures reveals that the number of children admitted to hospital for tooth extractions has risen by a quarter over the past four years. Some may think that tooth extraction is simply a part of growing up—a rite of passage for children. Some may recount their own personal memories of visiting the dentist. If anyone still holds that sentimental view, they should pause for a moment and rethink. The tooth extractions I am speaking of, which have gone up by a quarter in the last four years, mostly involve a general anaesthetic. A recent freedom of information request to Bradford hospitals sets out the scale of the crisis. In the short period from April to December 2016, 190 children were admitted to hospital to undergo a tooth extraction under general anaesthetic. What was also shocking about this request was the hospital’s admission that those figures were not available prior to April 2016. The hospital did not consider that the procedure warranted reporting.

--- Later in debate ---

[Steve Brine]

I absolutely agree with the hon. Lady, and if she will bear with me, I will come on to that point.

[Dr Caroline Johnson]

As a doctor, I have seen the distressing circumstances in which children as young as two come in for teeth extractions. Children sometimes have all the milk teeth in their mouth extracted. Does my hon. Friend agree that there is more to preventing caries and such extractions than just dental treatment and having more dentists? The answer, particularly for the very youngest children, lies in extra education about oral care, as well as good diet and not drinking fizzy drinks and the like.

[Steve Brine]

Yes, there should be a package, and I will come on to mention one or two of those points. This is as much about self-care as it is about interaction with the dental profession.

To conclude the point I was making, at a regional level in the period to 30 June, the north of England saw the highest percentage of patients seen—56.8% of adults and 63% of children. Although these access numbers are encouraging, I know that the hon. Member for Bradford South will not be sitting there thinking, “That’s all okay, then.” I know that more needs to be done to reduce the remaining inequalities in access, including in areas such as Bradford South, which she represents, and NHS England is committed to improving the commissioning of primary care dentistry within the overall vision of the five year forward view.

There are a number of national and local initiatives in place or being developed that aim to increase access to NHS dentistry. Nationally, the Government remain committed to introducing the new NHS dental contract, which the hon. Lady rightly referred to often in her speech. It is absolutely crucial to improve the oral health of the population and increase access to NHS dentistry.

A new way of delivering care and paying dentists is being trialled in 75 high street dental practices. At the heart of the new approach is a prevention-focused clinical pathway. It includes offering patients oral health assessments and advice on diet and good oral hygiene, with follow-up appointments where necessary to provide preventive measures, such as fluoride varnish, that can help the prevention agenda. Importantly, and this is of most relevance in this debate, the new approach also aims to increase patient access by paying dentists for the number of patients cared for—let me restate that: cared for—not just for treatment delivered, as per the current NHS dental contract. Subject to the successful evaluation of the prototypes, decisions will be taken on wider adoption. The prototypes are being evaluated against a number of success criteria, but let me be clear that they will have to prove that they can increase dental access before we consider rolling them out as a new dental contract.

I appreciate that this is taking a long time. It is as frustrating for me as it is for right hon. and hon. Members and for the profession, but Members will understand that rolling out a new dental contract is complicated and complex. We have to make sure that it is right and that what we put in place is better than what was there before.

Contaminated Blood

Caroline Johnson Excerpts

Tuesday 11th July 2017 Commons Chamber

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

I wish to start by echoing what has been said by so many in paying tribute to the victims of this tragedy, their families and those many hon. Members who have campaigned tirelessly for such a long time to ensure that this public inquiry takes place. I also pay tribute to our Prime Minister who, after so many people have not, has listened to these concerns and has organised this full public inquiry.

As a doctor, I prescribe blood products—and that will be continuing every day—often for people who are not in the position to make decisions for themselves. I prescribe blood for babies who have been born very prematurely and for children who have cancer—people who are not in the position to make these decisions, just like the youngsters with haemophilia and other constituents who have been mentioned.

This is an issue of trust. It is important that when people go into hospital and receive treatment they are able to trust that the risk-benefit decision that is made with them or, if they are very small or very unwell, on their behalf, is made on the basis of all the known facts and all the available information. With the contaminated blood scandal, it appears that that was not the case. Despite the fact that people knew that HIV, hepatitis and hepatitis B were transmissible through blood products, that information was not made available to the people receiving such products. The bloods were not being properly screened, and even when, as I understand it, bloods were being screened elsewhere, these products were being used on people in the UK.

[Ms Esther McVey (Tatton) (Con)]

Trust is the key word—trust and faith, if people have that, in the inquiry. Every story is different. My constituent Barry Flynn is a twin. His twin is not here, but on his behalf he wants to be able to trust the inquiry. He wants the victims to be heard and to decide the remit, and he wants their evidence to be taken. Does my hon. Friend agree that that is the way to get trust?

[Dr Johnson]

Absolutely; the victims and their families have the right and deserve to know what happened. They deserve answers to their questions. They need to know when people knew that these blood products could be causing harm and, if those people did know, why the products were still given.

The House should be under no illusions—I am sure it will not be, after listening to many eloquent Members describe their constituents’ cases—about the suffering people have been through, losing their family members. There is a stigma that still exists today around many of these medical conditions, particularly HIV. Other people, such as victims’ wives and children, have been put at risk, and many others still suffer today from poor health.

I very much welcome the announcement of the public inquiry, which I hope will get to the bottom of all the issues. I hope that the victims receive the compensation they deserve.

Adult Social Care Funding

Caroline Johnson Excerpts

Thursday 6th July 2017 Commons Chamber

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

Improvements in medicine have enabled people to live longer, but we also want them to live more healthily. We know that investment in reducing loneliness, in improving activity and in treating conditions such as macular degeneration, which causes blindness, will help to reduce the need for social care. What is the Minister doing in this regard?

[Steve Brine]

Although I am not specifically the Minister with responsibility for care, I am the public health Minister and the primary care Minister. We have brought those two subjects together because we want to see a healthy population across the board. I am pleased that my hon. Friend has mentioned the Commission on Loneliness. It was probably set up before she entered this House; it was started by the late Member Jo Cox, who did some really good work that is rightly being taken forward in this Parliament.

NHS Shared Business Services

Caroline Johnson Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

I gently remind the hon. Gentleman that the last Government who had an active policy of increasing private sector market share in the NHS were the last Labour Government. This Government legislated to stop the Government nationally prioritising the private sector and made that a decision for individual doctors at a local level.

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

As a doctor, I understand the importance of ensuring that results and letters are reviewed in a timely manner. There will always be opportunity for error in any system relying on bits of paper being sent around. Hospitals such as Peterborough City hospital, where I have worked, provide results electronically, which is quicker, as well as having a back-up paper form, which provides for patient safety. Will the Secretary of State reassure us that good practice such as this is being rolled out elsewhere?

[Mr Hunt]

Absolutely. My hon. Friend is right to point out that we are in a different world from the world of 2011. The future is to transport patient records securely over electronic systems. It is much quicker and there is much less room for error, but we do need the back-up systems that she mentioned.

O’Neill Review

Caroline Johnson Excerpts

Tuesday 7th March 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Streeter. First, I thank my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for bringing this crucial issue forward for discussion. Keeping it in the spotlight is vital, to ensure that there is sufficient political will to carry forth the recommendations in the O’Neill report on antimicrobial resistance.

Having worked in the NHS as a consultant paediatrician, and having treated many patients with antibiotics, I have seen at first hand the work the NHS is doing to ensure that they are prescribed responsibly. I have also used the CRP test, which my hon. Friend the Member for Erewash (Maggie Throup) mentioned, many times. However, I would caution that the result of that test is only a small part of a much larger clinical picture, and we should be mindful that a normal result does not exclude serious infection.

Over the years of my clinical practice, many measures have come into force to ensure that the right antibiotic, appropriate for the infection and the patient, is used. One of those is limiting access to the newest antibiotics, and using them only in specific circumstances after discussions with the hospital’s consultant microbiologist. The measures have resulted in a more responsible use of antibiotics within the health service. However, as the O’Neill review identified, such stringent measures do not exist within veterinary medicine, and the use of antibiotics in farming accounts for about 40% of the UK’s consumption of antibiotics.

As a Member for a rural constituency and the wife of a farmer, I believe that minimising the growth of antimicrobial resistance through our agricultural practices is of great importance and must be tackled with the same vigour with which we have addressed the use of antibiotics in human medicine. The O’Neill review made a number of recommendations, including the responsible use of antibiotics in animals, restricting the use of antibiotics that are critical to human medicine, and disease prevention. An effective antibiotic monitoring system can have a huge impact on reducing the use of antibiotics, as shown by the implementation of such a system in the British meat poultry sector, which resulted in a 44% reduction from 2012 to 2015. Restricting the use in agriculture of antibiotics that are of the most critical importance to human medicine is vital to ensure their continued effectiveness. The Department of Health requires continued support to bolster the regulatory oversight of veterinary antibiotics, to ensure that they are used responsibly and to keep back the priority antibiotics.

Finally, we must support our farmers in methods to prevent disease by emphasising improvement in overall biosecurity and herd health, including through vaccination. It is important that we do our part to deal with antibiotic resistance, but we also need to recognise, as my right hon. Friend the Member for Tatton (Mr Osborne) said, that this issue can only really be solved with international co-operation and a push for awareness of the problem, not only at home but within the international community, to help develop the regulatory framework. Much talk is made of a cliff edge where drug-resistant bacteria will be able to defeat the entire arsenal of antibiotics, but we have already reached that cliff edge.