Oral Answers to Questions

Clive Efford Excerpts

Tuesday 6th December 2022 Commons Chamber

[The Minister of State, Department of Health and Social Care (Helen Whately)]

My hon. Friend makes an important point. The NHS is strongly encouraging local vaccination teams to vaccinate staff, as well as residents when they visit care homes. That should be normal practice. I am happy to look into it, if that is not happening in her area. I take this opportunity to encourage any health or social care worker who has not had their covid or flu jab this winter to please go ahead and get one.

[Clive Efford (Eltham) (Lab)]

T5. Parents are becoming increasingly worried about the current prevalence of strep A. It is a time of year when parents are going to have children with high temperatures and sore throats, so concern is likely to be very high. There are also concerns about the availability of antibiotics. Does the Secretary of State believe that this is a moment where the Government need to make a statement and show clear leadership to calm people down and reassure them about the situation?

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

We held a cross-party briefing last night on strep A. We want to reassure parents, and if their children have symptoms and they are concerned, please seek help. GPs are ready and A&E departments are ready, and we have directors of public health proactively going into schools where there are cases. There is no shortage of antibiotics—we want to reassure people on that—and we are keeping an eye on that on a daily basis.

Covid-19: PPE Procurement

Clive Efford Excerpts

Thursday 24th November 2022 Commons Chamber

[Clive Efford (Eltham) (Lab)]

I heard what the Minister said earlier about the process and how meticulously it was followed for every company that applied for contracts during covid. What is it about the individuals or companies that had associations with the Conservative party or Ministers that made them so adept at getting through the process?

[Neil O'Brien]

As I said, 90% of them did not get a contract, so it was not that they were being given some sort of guarantee of a contract. That scheme was a way of managing the contacts that were happening with Ministers. They were being directly contacted by MPs from across the House and all sides of it. There had to be a way of understanding what was happening with each of those bids, because otherwise it would have been completely overwhelmed. To reiterate: all the bids went through exactly the same process—not done by Ministers, but by civil servants—of checking the quality, the price and whether they could realistically deliver. There was no difference in the process that they went through.

Oral Answers to Questions

Clive Efford Excerpts

Tuesday 1st November 2022 Commons Chamber

[Clive Efford (Eltham) (Lab)]

11. What progress his Department has made on recruiting 6,000 more GPs by 2024.

[The Secretary of State for Health and Social Care (Steve Barclay)]

We are making progress on increasing numbers. The number of doctors in general practice has increased over the past three years, from 34,729 in September 2019 to more than 37,000 in September this year.

[Clive Efford]

I am grateful for that answer. I recently met representatives of the local GP network in my constituency who described to me their difficulties in employing GPs. What can the Secretary of State do to ensure that people choose to go into general practice and to make the job much more attractive, so that he hits his target of recruiting 6,000 more GPs, which he is woefully way off doing?

[Steve Barclay]

I touched on that exact point in an earlier answer. There are parts of the country where it is more difficult to recruit GPs; that is why we have a targeted fund to attract people into those areas, with grants of up to £20,000. Alongside the appointment of GPs, we are also looking at using the wider primary care skills workforce, so that people can get to the appointment that they need.

East Kent Maternity Services: Independent Investigation

Clive Efford Excerpts

Thursday 20th October 2022 Commons Chamber

[Dr Johnson]

I know that my right hon. Friend shares the House’s desire to ensure that such events do not reoccur, and that his constituents are safe. He asked about failures over time. In fact, there were signs as early as 2010 that problems were being raised with the trust. The failure was not so much to find those problems, but that they were not properly dealt with when they were found. Yesterday, I received assurances from the regional director of NHS England, as I described a few moments ago, and I will meet her regularly to receive updates to ensure that the process is not just put in place but followed through.

[Clive Efford (Eltham) (Lab)]

The stories of the families are harrowing to read. I hear what the Minister says: that staff shortages cannot be used to excuse the poor practice that has taken place. None the less, it is disturbing that NHS England has abandoned its safety targets under the midwifery continuity of care model. When more midwives are leaving the profession than coming into it, as a matter of urgency to avoid such occurrences in other places, what are the Government going to do to turn around that loss of midwives?

Ambulance Pressures

Clive Efford Excerpts

Monday 18th July 2022 Commons Chamber

[Steve Barclay]

I do not know the specific circumstances of the case my hon. Friend highlights, but in general good consultation and engagement with stakeholders will of course lead to better and more informed decision making. Where decisions have been taken and the outcomes proceed in a sub-optimal way, I know from my knowledge of my hon. Friend that he will make such a case in the strongest terms.

[Clive Efford (Eltham) (Lab)]

It is worth remembering that the 2010 to 2015 Conservative Government took £6 billion out of social care, so it is no wonder that we are facing a logjam. Since 2015, not once have the Government hit their four-hour target at A&E, and it is down to less than 72% on average right now. This logjam is created by the Conservative Government’s mismanagement of our national health service, so what is the Secretary of State going to do to get back to the four-hour target for A&E?

[Steve Barclay]

This Government are investing in our NHS. That is why the resource departmental expenditure limit, which in 2010 was £99 billion, went up last year to £150 billion. It is why we are investing more than £10 billion in capital this year alone. It is why the NHS will get an uplift of about £38 billion over the five years from 2019-20 to 2024-25, and it is why this Government have invested in our 40 hospitals programme as part of a £22 billion commitment.

Access to GP Services and NHS Dentistry

Clive Efford Excerpts

Tuesday 21st June 2022 Commons Chamber

[Wes Streeting]

Thank you, Mr Speaker.

I was about to quote the great political philosopher, Jonn Elledge, who, in response to what the Secretary of State said, commented on Twitter that we are

“all as ants before the might of the all powerful shadow health secretary”.

When is the Health Secretary going to wake up to the fact that he is in government, he has responsibilities, he is discharging the greatest crisis in the history of the NHS and he is doing nothing about it? Instead of lecturing the Opposition, when is he going to show some leadership and get on with governing?

[Clive Efford (Eltham) (Lab)]

The “Panorama” programme also exposed the fact that GP practices are being hoovered up by the private sector. Operose Health now owns 70 practices, with more than 600,000 patients. That exposes the fact that there is now a value to GP patients lists and that they are being sold on. They are collected by GPs, free of charge and then, as they are amassed in great number, they are sold to the private sector. Is my hon. Friend, like me, concerned about that practice?

[Wes Streeting]

I wholeheartedly agree with the point my hon. Friend makes. It is simply not good enough for the Minister to keep on talking about what the last Labour Government did. If she does not agree with the situation described by my hon. Friend, which is happening on her watch, why does she not legislate? If she is incapable of governing, she should make way for people who can govern.

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[Sajid Javid]

We are putting record amounts of investment into the NHS, including more funding into dentistry—I am about to come on to that right now—which will help with those pressures.

[Clive Efford]

Covid is just a pathetic excuse, because even if it was the sole reason, the Secretary of State should have been planning for when we came out of it, but nothing he has said explains why we had record numbers of patients on waiting lists even before covid started.

[Sajid Javid]

I think that many people working across the NHS will be listening to the hon. Gentleman and realising that he has no idea about the pressures that covid has created for everyone working there, especially those on the frontline.

Health and Social Care Leadership Review

Clive Efford Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

This is a very important issue for my hon. Friend. I would be happy to meet him to discuss it further.

[Clive Efford (Eltham) (Lab)]

NHS staff are exhausted and demoralised, and now we are asking them to deal with the growing waiting lists. We still have a huge vacancy problem within our NHS. Where is the plan to deal with that issue? If we are to improve our NHS going forward and have anything there for these managers to manage, we need to deal with that problem within the workforce.

[Sajid Javid]

That is exactly why I have commissioned a 15-year workforce strategy from the NHS.

Breastfeeding: Government Support

Clive Efford Excerpts

Tuesday 8th March 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward this debate. She has certainly been a champion on this issue—that word is used often in this House, but it is applicable to her. Following on from my work with her in the all-party parliamentary group on infant feeding and inequalities, I met a lady called Claire Flynn—a Breastival board member from Belfast—who I think the hon. Lady knows. She said that breastfeeding strategies and plans vary across Scotland, Wales, England and Northern Ireland. Does the hon. Lady agree that there is a real need to reinstate the infant feeding survey? We understand that work on that is under way at Public Health England. Northern Ireland must be included and funding must be made available to enable that. Through the hon. Lady, I ask the Minister to consider a UK-wide approach.

[Clive Efford (in the Chair)]

Order. For those who missed the start of the debate, and so that people do not miss out on their time—we are tight for time—let me just say that we had planned to give Alison four to five minutes, and she has that now. Then the SNP spokesperson will have three to four minutes, Back Benchers two to three minutes and the Minister 10 minutes. I thought it would be worth intervening with that so that Members could work out the timing of their speeches.

[Kirsty Blackman (Aberdeen North) (SNP)]

On a point of order, Mr Efford. I am happy to squeeze my speech if my hon. Friend would like to extend hers.

[Clive Efford (in the Chair)]

Okay.

[Alison Thewliss]

Thank you, Mr Efford. I had a conversation with some of the senior Clerks, and I had thought I would be allowed to slightly extend my time if we could get back quickly from the Chamber after the statement.

I agree with the hon. Gentleman’s comments about Breastival; it is a wonderful event in Northern Ireland and I have been able to participate in it. I agree very much that we need to have consistency and the infant feeding survey.

The World Health Organisation and UNICEF published a report last month entitled, “How the marketing of formula milk influences our decisions on infant feeding”, which found that this $55 billion industry is still doing all it can to target families and to influence their feeding choices,

“undermining women’s confidence and cynically exploiting parents’ instinct to do the best for their children”.

Their data estimates that scaling up breastfeeding globally could prevent the deaths of 800,000 children under five and 20,000 breast cancer deaths among women every single year, which is quite astonishing.

Exposure to formula milk marketing reaches 84% of all women surveyed in the UK. We all know that this advertising works—that is exactly why companies invest so much money, time and effort in it. It influences which brands we choose and how much we spend. The report states that the evidence is strong that formula milk marketing —not the product itself—disrupts informed decision making and undermines breastfeeding and child health. Those who responded to the survey for this debate agreed. Deborah said:

“The aggressive advertising of infant milks and bottles undermines the giving of human milk at every step. It feeds us doubt of our own bodies.”

Stacey said:

“Advertising infant formula basically makes out that breastfeeding should be done for 6 months maximum, then baby should be on ‘proper’ milk. It is completely untrue and it needs to be better regulated as people just assume a baby will be bottle fed formula and advertising does an excellent job of solidifying this belief.”

Much of the marketing in the UK is done through traditional means such as television, but there is also a lot going on in social media, through companies’ advertising and influencers, and through online baby clubs run by formula companies, which are a tool to recruit and to market to families, and are a lot harder to monitor. What discussions has the Minister had with her colleagues at the Department for Digital, Culture, Media and Sport about whether such marketing should be brought into the scope of the Online Safety Bill? After all, this is about the health and wellbeing of parents and the best start for our youngest citizens.

Alongside investing in comprehensive service provision, the Government should do their bit to advertise breastfeeding. There was a brilliant campaign by the Public Health Agency in Northern Ireland called “Not Sorry Mums”. I encourage the Minister to watch it and to see what more her Department can do to protect, promote and support breastfeeding through the means at her disposal. After all, if there can be giant billboards promoting levelling up, there is no reason why there cannot be breastfeeding ones on exactly the same scale. The new mural in Greenock by graffiti artist Smug depicts beautifully a breastfeeding mermaid across a whole gable end. Some have argued that normalising breastfeeding ought to use real women rather than fantastical mermaids, but it is beautiful and we should have a lot more of that.

I repeat that it is crucial to have the service provision there, not just the advertising or the advice; otherwise, we are setting women up to fail. Emma, who responded, said,

“there is a lot of information promoting breastfeeding through the NHS but then very little actual support to help facilitate it. This mixed messaging then causes women to feel like a failure if they are not successful meeting in their breastfeeding goals.”

Donor milk has a crucial role to play in supporting babies in neonatal units. I am proud that Scotland has had a national milk bank based in Glasgow for some years now, but the picture is a bit patchier in other parts of the UK. Professor Amy Brown and Dr Natalie Shenker have been researching the impact that milk banks can have on the mental health of women and their families, in offering both reassurance and support for mums until their own milk comes through. I urge the Minister to engage with that research and see what more can be done to develop and support milk banking.

The provision of tongue-tie treatment is also patchy, but it can make all the difference to parents. Siân contacted me to share her experience, the distress she went through and her heartfelt thanks to her fairy godmother Lisa, a specialist breastfeeding support worker who listened to her and got her the support she so desperately needed. Everyone should have access to a Lisa.

I would add that it is also important to recognise the other disparities and inequalities that exist. Those living in deprived communities are less likely to breastfeed—although there is some evidence in Scotland of the difference we are making on that. Those who are new to the UK also encounter barriers coming into a bottle-feeding culture and feel pressured to adopt that culture rather than continuing to breastfeed, as their families would have done before. There are also barriers for those who are HIV-positive, who can receive very variable advice, and barriers put in the way of LGBT couples. Laura-Rose Thorogood of The LGBT Mummies Tribe contacted me to highlight the lack of support that she and others like her had experienced. I hope the Minister will meet that group, too, to discuss support further.

I could speak about this for much longer, as I am sure you are aware, Mr Efford. I could give numerous examples and testimony to illustrate what more needs to be done. I would like the Minister to agree to look seriously at the funding of all services and at the full implementation of the international code of marketing breastmilk substitutes, as the World Health Organisation and UNICEF have called for. She has the power to make this change to protect, promote and support breastfeeding now and in the future.

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[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Efford.

I thank the hon. Member for Glasgow Central (Alison Thewliss) for securing this important debate, which warrants more time and discussion. I agree that, as we participate in this debate, we are thinking about those women in Ukraine who are either giving birth or are about to give birth in the most extraordinary of circumstances and about the difficulty they face in feeding their children. For those of us who have given birth in normal circumstances, that is a truly horrific thought.

We know that the first few months of a child’s life are crucial for their later development and that parents need support in their choices for their children. I welcome the Minister’s commitment to additional funding for breastfeeding support, but it is clear that the cuts, particularly to Sure Start, were a really bad false economy, with centres having closed, parents lacking support and advice, and children being let down. I was proud to be a governor of a Sure Start early years centre and I know how valuable such centres were.

We have heard that women’s isolation during the pandemic was exacerbated because more services were cut. It was horrific to hear the evidence given by my hon. Friend the Member for Putney (Fleur Anderson) that it was only when she rang up that she found out that the centre she mentioned had closed. We already know that there is a shortage of such venues and that we need more of them.

Disadvantaged mothers are more likely to have babies of low birth weight, and low birth weight is associated with raised blood pressure and coronary heart disease, as well as reduced educational attainment, qualifications and employment. Sure Start centres help to level up and supporting them would be a really easy, quick win for the Government to support women in optimal infant nutrition, particularly breastfeeding.

We know how much breastfeeding increases children’s chance of a better life. According to analysis from the millennium cohort study, by the age of five breastfed children were already one to six months ahead of those children who were never breastfed.

I was fortunate to have three healthy children. I fed them all myself, with variable results; it was difficult with some of them and not with others—I will not say who, because they might at some point watch this debate, and you can never have favourites. When breastfeeding works, it works well, and when it does not work, it is extraordinarily difficult and stressful.

We also know that those households in the lowest socioeconomic groups have significantly worse health outcomes. We know that women in those households need support and that such support yields results in later life. This is an important debate, particularly on International Women’s Day, and I hope that we can have some positive news from the Minister to support women across the country.

[Clive Efford (in the Chair)]

As the Minister knows, we will be suspending the sitting at 4.55 pm, but if she can make a start now perhaps I can give the mover of the motion longer for summing up at the end.

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[Maria Caulfield]

I do not have that information, but I was interested to hear about the experience in Putney. I will take that away because I spoke to midwives who were redirected during covid, but I am not aware of which services have and have not restarted. I am keen to look at that, so I will follow that up. I am happy to conclude, Mr Efford, if that would be helpful.

[Clive Efford (in the Chair)]

The message we are receiving is that the Chamber has been suspended. I was going to suspend the sitting at 4.57 pm, but if the Minister has finished, we can suspend now and come back after.

[Maria Caulfield]

I will just conclude by thanking everyone. There remains a huge amount to be done. I very much take on board the points that have been raised in the debate, and I will follow up with colleagues because we need to put breastfeeding higher up the agenda.

[Clive Efford (in the Chair)]

I am suspending the sitting for 15 minutes, but we will start as soon as people are back in their places.

Government Contracts: Randox Laboratories

Clive Efford Excerpts

Thursday 10th February 2022 Commons Chamber

[Maggie Throup]

That is really for the Treasury to look at, but I come back again to the fact that Randox was an established company in diagnostic testing and that at the time we looked at which businesses could deliver our testing requirements. I am delighted that since then we have built up our own additional testing structure; in fact, later today I will be visiting the Rosalind Franklin Laboratory in Leamington Spa to see the amazing testing work that we have set up there under the UK Health Security Agency.

[Clive Efford (Eltham) (Lab)]

There were four meetings between Health Ministers and Randox that were not registered. Does the Minister accept that, if she had taken part in unregistered meetings of that kind, she would have breached the ministerial code?

[Maggie Throup]

I register all my meetings, as I should do.

Access to NHS Dentistry

Clive Efford Excerpts

Thursday 10th February 2022 Westminster Hall

[Clive Efford (in the Chair)]

Before we begin, I remind Members to observe social distancing and to wear masks. There is clearly a lot of interest in the debate. We will work out roughly how long people have to speak, but I do not intend to impose a strict time limit, unless people abuse the timings. We will give you an indication of how long to speak for, and if you could roughly stick to it that would be really helpful. I call Peter Aldous to move the motion.

[Peter Aldous (Waveney) (Con)]

I beg to move,

That this House has considered access to NHS dentistry.

It is a pleasure to serve under your chairmanship, Mr Efford. I thank the Backbench Business Committee for granting this debate. I am grateful to the hon. Member for Bradford South (Judith Cummins) for her work in helping to secure it.

NHS dentistry has been the No. 1 issue in my inbox for the past nine to 10 months. This is a national crisis, though the problem in my constituency—in Lowestoft and Waveney—is acute. Dentists have retired, which has led to resources and dental capacity being taken away from the area, notwithstanding the increased need and demand following the pandemic. Many of the remaining practices are experiencing difficulties in recruiting and retaining dentists, and the situation has been exacerbated by a lack of funding, with net Government spending on general dental practice being reduced by a third over the past decade. That said, the overall situation locally has improved since I first raised concerns in an Adjournment debate on 25 May last year, and I will outline the improvements later. They are welcome, but I am concerned that they might be a short-term sticking plaster and might not provide a long-term solution.

As we emerge from covid, the situation both locally and nationally has reached crisis point. Locally, that is due to covid, as well as retirements in two NHS dental practices in Lowestoft and the closure of the mydentist practice in Leiston, in the constituency of my right hon. Friend the Member for Suffolk Coastal (Dr Coffey). That practice closed due to the difficulty of recruiting dentists to work in the NHS in the area—a theme that is repeated across the country.

Access to NHS dentistry is a problem that has been brewing for a long time. The situation can be likened to a house built on shallow and poor foundations. The earthquake of covid has led to that house falling down. There are now parts of the country—particularly in, though not confined to, rural and coastal areas—that are dental deserts.

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[Clive Efford (in the Chair)]

Order. Before the hon. Gentleman responds, I should just point out that a number of Members who have their names down to speak are intervening. To respect others who want to speak, could you please refrain.

[Peter Aldous]

I am grateful because, with those four interventions, we have re-emphasised the importance of fluoridation.

There is a need for greater accountability, and the Health and Care Bill can provide the framework within which that can be secured. It is welcome that the commissioning of dentistry is set to move to integrated care systems. That can make for a more transparent system, but there is a risk that dentistry and its impact on overall health could be overlooked in the integrated care proposals. It is important that dentists are properly represented on integrated care system boards.

At Report stage of the Health and Care Bill, I tabled new clause 18, which called on the Secretary of State to publish an annual report on access to NHS dentistry, to collect data on the length of waiting times for primary dental care treatment and, if necessary, to take action. The Minister for Health declined to accept the new clause. I do not know whether a similar clause will be introduced in the other place. If it is, I would urge the Government to give it serious consideration. Such a reporting mechanism can drive sustainable and meaningful improvement in access to NHS dentistry.

Mr Efford, you will be delighted to learn that I am coming to a conclusion. Tackling access for NHS dentistry, which has been neglected for 15 years, is an opportunity that we must grasp in order to demonstrate the levelling up of healthcare right across the UK. We must put in place an NHS dentistry system that is fit for the 21st century, instead of reversing into the 19th century.

[Clive Efford (in the Chair)]

I am grateful to the hon. Member. It looks like we have six minutes each for Back-Bench speeches. If anyone can deliver their speech in less time, it would be very helpful.

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[James Wild (North West Norfolk) (Con)]

I congratulate the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) on securing this important debate. Our constituents in Norfolk and Waveney face similar challenges in getting access to NHS dentists.

This is a long-running problem, which my predecessor also pursued following the closure of a dentist in Snettisham. I raised this issue in my maiden speech and I have focused on it ever since due to the inadequate provision in west Norfolk. Of course, the restrictions put in place during covid have further reduced access, as others have said. The British Dental Association estimates that 40 million appointments were lost overall, but the situation before covid was poor.

The National Audit Office found that my constituency had the lowest number of dentists per head in the country. Moreover, Norfolk had the lowest level of dental activity delivered in the country, with only 65% of contracted NHS activity delivered compared with the national median figure of 96%. My right hon. Friend the Member for Basingstoke (Mrs Miller) also made that point. And, at 17.5%, Norfolk had the highest percentage of people who were unsuccessful in trying to get an NHS dental appointment.

Since being elected I have met the NHS East of England team regularly to press for better access to dentists, particularly following the closure of the mydentist practice in King’s Lynn. I am pleased that those discussions led to a procurement process, which, although delayed by covid, took place from summer last year, and that that procurement has been successful, with the NHS having just announced two new contracts for Smile Care Norfolk to increase access to dentists in King’s Lynn. I want to put on the record my thanks to the NHS East of England team for its efforts in successfully completing the procurement, which will mean that from 1 July my constituents will have better access.

As my hon. Friend the Member for Waveney said, it is disappointing that Fakenham and Thetford have not been successful in the procurement process. If my hon. Friend the Member for Broadland (Jerome Mayhew) catches your eye, Mr Efford, I am sure that he will speak about that.

Members have also touched on the supply of dentists. Office for Students figures show that there were 895 dental students in 2020, rising to 983 in 2020, compared with 810 in 2019. The 2022 intake, however, is just 809. Given the challenges in dentistry provision, we should be increasing that number, not reducing it. We should consider measures that enable those who are undertaking training to spend time in those areas where coverage is weakest. We should also be more direct and require those who have qualified to spend time in those areas as well.

I note that none of the 11 dental schools in England is in East Anglia. Given the low levels of dental coverage, I join the hon. Member for York Central (Rachael Maskell) in putting in a bid for one in East Anglia, Norfolk, King’s Lynn, to help address that gap.

Another issue that has been raised is that the contract dates from 2006. My hon Friend the Minister candidly referred to it last month as a “disastrous contract” with perverse incentives—or disincentives—for NHS dentists to take on NHS work. I am sure she will be able to update us on when new measures will be introduced to provide a greater focus on prevention and care for individual patients.

In conclusion, the new services coming to King’s Lynn are warmly welcome and will improve access. However, further reforms are needed, including to training and the contract, to ensure that people have the access to dentistry that they need and deserve.

[Clive Efford (in the Chair)]

You have all been very disciplined in keeping speeches brief, so I am grateful for that. We are well on time. I call Wera Hobhouse.

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[Giles Watling (Clacton) (Con)]

It is an honour to serve under your chairmanship, Mr Efford—[Interruption.] I will try to stand up without knocking the furniture over. I thank my hon. Friend the Member for Waveney (Peter Aldous) for bringing this important debate. It is impressive that so many have attended. I have been listening to your entreaties from the Chair, Mr Efford. Many points have been made about the expansion of housing, covid, fluoridation and the UDA system, so I will not repeat all that, you will be delighted to hear; I will cut my speech very short.

Of the most common issues in my mailbag that constituents write to me about, at the very top is dental care, and NHS dental care in particular. That this issue is widespread is evidenced by all the Members here. I will bring out a few points that I mentioned in the Adjournment debate the other day, because they are so shocking. Some 85% of dental practices are now closed to new NHS patients. Nearly half of patients are forced to get private treatment because of access problems, as reflected in my mailbag. This horrifies me: one child is admitted to hospital every 10 minutes for tooth extractions. Imagine the cost of that, let alone the trauma involved. That is why we have to be proactive, rather than reactive, and why I was pleased to hear fluoridation mentioned.

Some 1,000 clinicians have left the profession in the last year, with yet more significantly reducing their NHS hours, as we heard. That is utterly unacceptable. I welcome the levelling-up agenda, but I do not believe we are being levelled up in an entirely fair manner. Areas such as Clacton are often considered to be rich and well-heeled because we fall into the wider eastern region—Essex is lovely and leafy and is an economic powerhouse—but the coastal areas have pockets of deprivation. I am not proud of it, but my constituency has the most deprived ward anywhere in Britain. Something has to be done about that. If we really want to level up public services, we must consider areas such as Clacton when it comes to dental care. We need to make sure that levelling up follows the data, if we can get it, and not just the rhetoric, and gives coastal communities the help they need.

To my mind, there are two key areas we really need to hit. In an age of integrated care systems and devolving more and more power over primary and acute care to local leaders, I increasingly question the role of certain state monoliths such as NHS England and NHS Improvement. My constituents do not need more national mandarins, they need local, empowered leaders with proper devolved budgets. I reflect on the outstanding leadership of my former CCG and its accountable officer, Ed Garratt; I mentioned him the other day, but I have to again, because he is so good. He has provided a great service to us locally. Thanks to his and his team’s work, Clacton primary care is in a much better state. I want to give local systems the commissioning powers and budget so that we will level up in a local, focused and measurable manner. The PCTs had their day and local care leadership is now delivering. It is time for NHS England to be devolved in the same manner.

Let us move on to the workforce. Increasing the number of UK-trained dentists will help but will take at least six years to make the difference. Urgent action is now needed to increase places on the overseas registration exam, develop an adaptation programme and recognise qualifications from top dental schools around the world.

Our membership of the EU forced us to look away from people in areas such as our wider Commonwealth who are being trained in first-class dental care, and the Asian subcontinent. We could see more of those practitioners in areas such as Clacton, which would be the very Brexit dividend we were led to expect.

I am delighted that Clacton has been selected as a pilot area for new dental training courses, but clarity is needed on how existing budgets can be used to support and improve dental access in constituencies such as Clacton.

To conclude, Mr Efford—I am doing this very quickly—

[Clive Efford (in the Chair)]

Order. I do not want the people of Clacton to miss out on this debate. You have all been so disciplined that we can be a little bit flexible with the six-minute limit. Please do not cut your speech too short so that we miss out on any points.

[Giles Watling]

Mr Efford, with all due respect, I have deliberately gone to the shorter version of my speech. If the Minister wishes to visit the wonderful constituency of Clacton, with its 35 miles of glorious coastline, I would love to discuss dental services with her.

Levelling up is not just about expanding employment outside London. It must be about addressing inequalities wherever we find them, such as decreasing NHS dental care in coastal communities such as Clacton. We can do that by forcing cash and power out of NHS England, alongside using our Brexit freedom to open the nation to the dentists of the world we have so long spurned.

Finally, I put in a plea—a plea for sympathy. In a couple of weeks, I am having root canal treatment. Our dentists are excellent, but I hope it goes well—[Laughter.]

[Clive Efford (in the Chair)]

I know I am going to regret saying that we can be quite relaxed about the six-minute limit, but we can. If you run over by a little bit, it should not cause too many problems for people speaking later in the debate, but do not abuse that generosity. I call Tan Dhesi.