NHS Dentistry: Bristol and the South-west

Darren Jones Excerpts

Monday 24th January 2022 Commons Chamber

[Darren Jones (Bristol North West) (Lab)]

I am grateful to have secured this evening’s Adjournment debate on access to NHS dentistry in Bristol and the south-west. Over the past few months, many of my constituents have told me how difficult it has become to find and access an NHS dentist in and around my constituency of Bristol North West. Their accounts have been wide-ranging, from having their NHS treatment left in limbo following the closure of a local practice to having to look as far as Gloucester to try and register as a new patient with an NHS provider.

In particular, last year an NHS dental surgery in Southmead in my constituency unexpectedly closed to patients. Many of my constituents were left without an NHS dentist, often mid-treatment. One constituent explained that they had paid for NHS treatment prior to the closure of the dental surgery but had been unable to secure another appointment with a local dentist. Their dental work remains incomplete. Another constituent described contacting nine dental practices across Bristol to try and resume their treatment as soon as possible, only to be told that none was accepting NHS patients.

[Karin Smyth (Bristol South) (Lab)]

I am grateful to my hon. Friend for securing this important debate; I have similar stories from my constituents. Does he agree that we also need to think about pregnant women, for example, who have free access to care but are also being denied access to dentistry at a really important point of their life?

[Darren Jones]

I absolutely agree, and I thank my hon. Friend for her contributions, not least as a leading voice on healthcare policy, knowing that prevention is more important than cure.

A third constituent of mine rang over 25 practices across the south-west, but was unable to secure an appointment as an NHS patient—something that has affected patients who were pregnant as well as everyone else. Southmead in particular is now left without any NHS dentists at all.

[Wera Hobhouse (Bath) (LD)]

The number of child patients nearly halved in 2021 compared with 2019, with a 42% decrease in the south-west, including my constituency and his. Is the hon. Member as concerned as I am that the most worrying part of these statistics concerns the loss of access to dental treatment for children?

[Darren Jones]

I do share that concern, because we know that children in particular are seeing the dentist on a fewer and fewer occasions, and I understand that the tooth extraction rate for children is increasing significantly because of a lack of prevention.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Some 3,925 teeth were removed from Plymouth children under anaesthesia in 2019-20. The figure was lower last year because of the pandemic, but does my hon. Friend agree that we will not solve this crisis until children get to keep the teeth in their mouths through better oral health, and that we will not get that until the dental crisis is properly addressed by Government?

[Darren Jones]

I thank my hon. Friend for his intervention; as ever, he is a strong advocate for his constituents. He identifies that children are ending up having teeth extracted in emergency situations instead of seeing the dentist in the first place.

While the three cases that I have referred to have stemmed from the closure of the same dental practice in Southmead in my constituency, their stories serve to highlight the difficulties faced by those across Bristol and the south-west in accessing NHS treatment.

[Luke Hall (Thornbury and Yate) (Con)]

The hon. Gentleman highlights Southmead; may I highlight another important case for the record? The closure of the Frampton dental practice has left many of my constituents unable to secure any type of dental support at all. He is therefore quite right to say this is an issue right across the region and to bring it to the Minister’s attention, so may I offer him my full support in this debate? Although we are grateful for the NHS’s medium-term response, there are lots of people seeking treatment now who cannot access it. I therefore offer him my support and call on the Minister to meet me to discuss the issue in further detail.

[Darren Jones]

I thank the hon. Member, because it sounds as if his constituents are suffering the same problem as mine. Many have rung eight, nine or 10 NHS service providers, to be told that they could be accepted only as a private fee-paying patient. Going private is simply not an option that many of my constituents can afford. Some have been left with no other choice and others have just not been able to see a dentist at all. Outside of emergency cases, it seems that dentistry in our country has become merely a private healthcare service, with all the unacceptable inequalities that that presents.

[Mr Ben Bradshaw (Exeter) (Lab)]

In many cases even emergency appointments are simply not available, given the number of people asking for them. The waiting time to get an NHS dentist in Exeter is currently two years. We have thousands and thousands of people in Devon as a whole with no access to an NHS dentist. They cannot afford to go private and they cannot get access, in pain, to emergency treatment. It is an absolute disgrace, and for the last eight years this Government have done nothing about it.

[Darren Jones]

I agree, and I thank my right hon. Friend for raising the case in Exeter, which seems similar to the many other cases we are hearing about this evening.

When I surveyed my constituents, 79% of those who responded said that they did not feel that they could access a timely dental care appointment when they needed it, while 60% had not had any form of dental treatment during the past year. Twenty five per cent. detailed that they had contacted 11 or more dental practices to try to register for NHS treatment but were unable to do so.

Information compiled by the Association of Dental Groups puts those conclusions in context. The ADG highlights that 43% of patients across Bristol alone were unable to book an appointment when they wanted to do so. That figure increases to over 50% of patients when considering the south-west altogether.

In its 2021 “Great British Oral Health Report”, mydentist found that those in the south-west who have had a dental appointment in the last year lived, on average, over 5 miles away from their closest surgery. More concerningly, those who had not had a dental appointment in the last 12 months were twice as likely than the national average to live over 30 miles away from their closest surgery. That seems to suggest that there is a correlation between someone’s proximity to an NHS dentist and the amount of time that has elapsed since their last appointment, adding geographical inequality to income inequality in the often privatised dental care system—no doubt a levelling-up priority for the Government.

This is a growing problem, with increasing numbers of NHS dentists closing and a shortage of dentists available to do the work. For those familiar with the south-west’s regional news, Thursday’s BBC “Spotlight” reported that the number of NHS dentists practising across the south-west had fallen by more than 200 between 2017 and 2021. Across the country, 45% of patients have been forced to pay for private care due to the closure of a local NHS dentist.

The good news is that there are several actions that the Minister can take to address these issues. First, the Government should consider measures to reverse the decline in the number of dentists offering NHS services. Research from mydentist shows that nearly 1,000 dentists ceased providing NHS treatment in 2020-21, and in response to a survey, 47% of the British Dental Association’s membership said that they were considering reducing the provision of NHS dentistry due to the pressures being faced. I understand that the Government have announced a south-west dental reform programme. I would be grateful if the Minister could provide some detail as to how it could be deployed to increase dentistry numbers.

Secondly, the Government should look again at how they recognise international dentistry qualifications. The overseas registration examination has only 500 places available annually in the UK. The ADG has recommended that part of the examination could be taken in the candidate’s home country as a way of reducing some of the pressures, and that the overall number of places available should be increased. Furthermore, both the ADG and mydentist have recommended that the Government take swift action to reduce the impact that Brexit will have on those who have received their training in the European Union but whose qualifications are not recognised in the UK, and therefore on the number of dentistry providers in the UK. At present, the Government have agreed to recognise dentistry qualifications achieved in the EU until the end of the year, but given that 22% of dentistry care and treatment is provided by dentists from the European economic area, it is vital that certainty about the future is provided to those dentists and their patients as soon as possible. It is ridiculous that Ministers would prevent EU dentists from being able to work in the UK. I would be grateful if the Minister could update the House on that particular issue.

Finally, and most importantly, the Government need to bring forward long overdue reforms to the NHS dental contract, which was established in 2006. Local dentists in Bristol North West have contacted me to highlight their frustration with the current contract, which prevents them from seeing NHS patients when they need to be seen. They have explained that they have been expected to meet higher patient targets due to local closures, despite the need for covid-19 safety measures and without the full payment usually required to see those extra patients. Those pressures are in addition to the backlog from the pandemic, with more than 350,000 dental appointments lost in Bristol alone between April 2020 and November 2021. Reforming the NHS dental contract is vital to solving the underlying issues with access to NHS dentistry, and I would welcome an update from the Minister on the status of that work.

In the round, NHS dentistry is broken and the problems are getting worse. The system works only for those with dental emergencies—and that is if they are lucky—while everyone else is left largely to pay private fees in a private dental system that costs significant sums of money. The closure of so many NHS dentists is adding geographical inequalities to the income inequalities created by the private sector-led dentistry system, and the shortage of dentists in the country is being exacerbated by a failure to recognise European Union dentists and an unwillingness to make it easier to welcome dentists from other countries around the world.

From my experience with Ministers and officials, I get the sense that dentistry in this country is now nothing more than an afterthought, placed in the “too difficult for Government action” box.

[Kerry McCarthy (Bristol East) (Lab)]

I do not know whether my hon. Friend has written to Ministers about this. I have written to Ministers on behalf of constituents who are in pain and need emergency surgery, but cannot come up with thousands of pounds to pay for it. It is so frustrating when the response we get is a link to a site where they can check where their nearest NHS dentist is, or similarly useless bits of information. Does he share my concern that the Government are totally complacent about the crisis we face?

[Darren Jones]

I thank my hon. Friend for her contribution and I agree entirely. I know from my own experience of trying to get access to ministerial time following the closure of an NHS dental practice in Southmead that it took ages to get a response. I then had time with officials, who tried to be helpful but could not resolve the problem, and we had local briefings in Bristol where, I am afraid, the presentations and information were completely inadequate. That confirms my point that dentistry seems to be an afterthought, not a priority, for this Government.

[Luke Pollard]

I am grateful to my hon. Friend for giving way again. Could he add one extra ask of Ministers—to keep the dentists we train in the west country in the west country? The last Labour Government opened a dental school in Plymouth that trains enormous numbers of high-quality dentists, but then they have to spend time in practice and they go into a national shuffle. If there was a regional shuffle to keep those dentists in the south-west, it is more likely that they would stay in the west country, providing additional services, rather than being spread across the country. Does he agree that would be a good idea?

[Darren Jones]

That sounds very sensible, and no doubt it would be a great levelling-up opportunity for the Government to ensure that dentists trained and qualified in the south-west stay there. I do not want to put particular pressure on this Minister, because this has been a long-running failure over many years.

[Sir Paul Beresford (Mole Valley) (Con)]

I have an interest here, clearly, but why should dentists, or any profession, be forced to stay and practise in the area they trained? No other profession has that. It would be a very unfair liability and tie on the dentists.

[Darren Jones]

I am not sure that was the suggestion from my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard); it was merely an opportunity for those who train in the south-west and who wish to stay there to do so, and I would support that.

Ministers’ long-running failure to tackle this issue is resulting in hundreds of thousands of people across the country, not least many thousands of children, being unable to access NHS dentistry until it becomes an emergency and a hospitalised problem. That is unacceptable; it no doubt costs the Government more to treat problems instead of trying to prevent them, and I call on them to put in the work to fix this problem now. I look forward to hearing the Minister’s responses to my questions.

--- Later in debate ---

[Maria Caulfield]

I will come to that in a moment, but let me first conclude on the impact of covid on dental services. The hon. Member for Bristol North West may be reassured to hear that the proportion of adults and children accessing dentists in Bristol, North Somerset and South Gloucestershire remains higher than the average for access to dentistry in England. It is probably no consolation to his constituents, but access is slightly higher.

[Darren Jones]

Is the average acceptable or below where the Minister would like it to be?

[Maria Caulfield]

I have been clear that covid means we are not yet operating at 100% of normal activity. We need to get back to pre-covid levels, when the majority of patients were able to access a dental appointment and around 28 million people saw an NHS dentist every 24 months. That is where we need to get back to but we will struggle, because of infection-control measures due to covid, to get there until we are at 100% of activity.

I reassure the hon. Gentleman that NHS England is supporting local commissioners. There was an intervention about helping to get more service provision; provision is commissioned at a local level, not by the national Government. National Governments provide the funding and then local commissioners commission the services. It is important that Members talk to their local commissioners to understand what services are being commissioned. NHS England provides flexible commissioning toolkits to local commissioners to help to focus the available capacity.

[Darren Jones]

Does the Minister recognise that local commissioners can only commission dental services if the NHS dentists exist and are willing to provide NHS dental services? The core of my debate this evening is not about the impact of the covid pandemic, which we all recognise; it is about the underlying issues of the dental contract and the shortage of dentists. Does she recognise that?

[Maria Caulfield]

I will come on to the contract, which was developed in 2006 under the last Labour Government, and highlight the impact it is still having on dentistry—

--- Later in debate ---

[Maria Caulfield]

No, I will not give way. The right hon. Gentleman is obviously not interested in my response.

In Bristol, North Somerset and South Gloucestershire, a dental helpline has been set up to help patients to find an NHS dentist for routine care and to arrange urgent treatment. In addition, we have written to dental practices asking them to update their online information on the nhs.uk website. It is really important that this is available so that patients can find out which dentists are taking on NHS patients and which are not. It is crucial that that is kept up to date because it does change on a significant timescale.

Dentists are also being asked to maintain a short-notice cancellation list so that they can proactively contact patients who are on their waiting list if a patient cancellation occurs. All these measures help with the underlying problem of gaining access to NHS dentists. Later this week, there will be an announcement on some extra funding so that local commissioners will be able to commission services, because in some areas there would be more capacity if extra funding were available. Colleagues across the House will see the details of that in the coming days. My hon. Friend the Member for Thornbury and Yate (Luke Hall) intervened on a similar point. I am happy to meet him to discuss the issue around Frampton Cotterell, as I am happy to meet all Members if they want to raise specific local issues around dentist availability in their constituencies.

To get to the crux of the long-term issues, we hope to get to 100% capacity at some point post the pandemic. However, as mentioned by many colleagues, there is an issue with the dental contract, which has perverse disincentives within the UDA—units of dental activity—system, which dentists struggle with because they are paid similar rates when they are taking out one tooth or doing one filling as compared with doing extensive dental work. This is a disincentive to dentists to take on NHS patients, or sometimes to hand back NHS contracts.

Work has already commenced on dental contract reform. The Department and NHS England are working with key stakeholders, including the British Dental Association, to look at alternative ways of commissioning services, because only when we address the fundamental of the contract that dentists are working on will we get to the crux of the matter of the poor uptake of dental contracts and the reluctance of dentists to take on NHS work. Our aim in contract reform is to improve patient access, reduce health inequalities and make the NHS a more attractive place to work for dentists, making them feel more valued and helping to recruit and, more vitally, retain the experienced dentists who do so much to protect and promote oral health in this country. I am sure that the hon. Member for Bristol North West will welcome that. We are making some building blocks in terms of work that is already happening.

A number of Members touched on the issue of recruitment and retention of dentists. Only in September last year, Health Education England published its “Advancing Dental Care” review report on a four-year programme of work to recruit, retain and train not just dentists but dental teams. We have identified more effective ways of utilising the skills mix in the dental workforce. We are widening access and participation to training, we are allowing more flexible entry routes, including for overseas dentists, and we are developing training places for dental professionals, not just dentists; we want to upskill dental technicians and dental associates by providing them with more skills so they can provide a greater range of services. We are also looking at providing training in areas where we have dental deserts—where we do not have dental provision that local commissioners can commission. Importantly, we know from GP trainees that those who train in an area are more likely to stay in the area. We want to facilitate that. Health Education England is doing a huge amount of work to make that happen.

[Darren Jones]

I thank the Minister for her answers. One specific question I asked was about the recognition of EU qualifications and the 22% of dentists in the UK who originate from the EU. Can she answer that specific question please?

[Maria Caulfield]

Absolutely. We want to encourage everyone who wants to come and work in the United Kingdom to be able to do so, and we are working with the General Dental Council to make sure that happens. Currently a period of continued automatic recognition is in place for dentists with EEA and Swiss qualifications wishing to work in the UK and we want that to continue. Those with qualifications which were previously automatically recognised will continue to be recognised in the UK. I have heard from dentists from abroad who want their qualifications to be recognised here and we will work hard as part of the contract reform to make sure that that process is easier than at present.

On preventive work, my hon. Friend the Member for Mole Valley was absolutely right to point out that, as well as dealing with dental issues, oral health is crucial, and the Health and Care Bill is introducing proposals that will transfer the power to bring forward the new water fluoridation schemes, which will transform the oral health of many in the most deprived parts of our country, and could reduce the level of decay among five-year-olds by up to 28%. Simple measures such as that will make a big difference.

Although tonight I am unable to present colleagues with a quick-fix solution, I want to assure them that we are dealing with the issues covid has brought to us and we will be announcing further funding in this financial year to help to deal with some of that backlog, but there are issues with the current dental contract that unless addressed will continue some of the problems Members have raised this evening.

[Darren Jones]

I thank the Minister for giving way one last time. Might I gently suggest that the advice the Minister has this evening given my constituents in Southmead and across Bristol and the south-west who cannot get access to an NHS dentist is to call 111—they have tried that; it has not worked—to try to find a local NHS dentist, which they have tried too, and has not worked, and to wait for reform of the NHS dental contract, which has been in place since 2006 and this Government have been in office since 2010? They have been waiting for many years for that and I am not sure they are going to see it any time soon. I have constituents who are in pain waiting for dental care, and children who are not being seen. What are the immediate interventions the Minister can make? She has not offered any this evening.

[Maria Caulfield]

I would strongly disagree with the hon. Gentleman. He wants to work in a constructive way to deal with the issues facing his constituents, and he has already said that he wanted to meet the Minister, but he has never made an approach to meet me ever—

[Darren Jones]

Will the Minister give way?

[Maria Caulfield]

I will not give way any further; I think the hon. Gentleman has made his points fairly clear. I have said to him that we are issuing a range of help. I have said there will be announcements later this week about funding in this financial year to help patients to be able to access dentists. I have also said that we are—

[Darren Jones]

On a point of order, Madam Deputy Speaker.

[Madam Deputy Speaker (Dame Eleanor Laing)]

A point of order at the end of an Adjournment debate?

[Darren Jones]

It is for clarification and for guidance, which I think is a point of order, if I may, Madam Deputy Speaker? My question to you is: the Minister suggested I had not been in touch with her to arrange an appointment, but it was the previous Minister. I wanted to ask if I was able to clarify that on the record.

[Madam Deputy Speaker]

That is not a point of order for the Chair, but I understand why the hon. Gentleman wanted to clarify that. [Interruption.] Order. We will not have any more shouting from people who are sitting down.

Coronavirus

Darren Jones Excerpts

Wednesday 11th March 2020 Commons Chamber

[Matt Hancock]

This is a really important point that I met the NHS to discuss specifically today. It is critical that we ensure that discharges are as fast as possible. That is important in normal times, but when large proportions of those in hospital could, with the right support, leave hospital and be in a setting that works for them in social care, we have to make sure that that happens. The extra funding will help with that, but it is not all about funding; a lot of it is about co-ordination, and people are working at their level best to try to make that happen.

[Darren Jones (Bristol North West) (Lab)]

Some parents are unsure whether to send their children to school when somebody in the family household is self-quarantined. Will the Secretary of State confirm what guidance has been given to schools to deal with what would normally be classed as unauthorised absences? Perhaps he will be able to alleviate some of the concerns from headteachers and indicate that Ofsted will take a lenient view of absence figures in later inspections.

[Matt Hancock]

Yes, Ofsted absolutely will take a lenient view of the impact of coronavirus on what happens in schools. When it comes to the broader point about what households should do when one person tests positive, that is of course something we are considering very closely. At the moment, the number of cases is at a level such that we can give individual advice to each household. It is likely that that will not be possible throughout this situation, so we will make sure that there is formal public guidance for everybody, so that everybody knows what to do.

Adult Community Services

Darren Jones Excerpts

Wednesday 26th June 2019 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

I beg to move,

That this House has considered re-procurement of adult community services by Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group.

It is a pleasure to serve under your chairmanship, Mr Gapes. I am pleased that this important subject has been selected for debate. Although they cannot be present, my hon. Friends the Members for Bristol West (Thangam Debbonaire), for Bristol East (Kerry McCarthy) and for Bristol North West (Darren Jones) fully support my comments. This is an important issue for the people of Bristol South, and it is a local example of the debate on the legacy of the Health and Social Care Act 2012 and of the invidious position that local managers are being put in to understand the procurement rules.

Hon. Members know that I speak frequently about accountability and the opaque way in which many parts of the NHS operate. We seem to have lost sight of the fact that, however individual bodies are constituted, our health services are public services that are paid for by taxpayers—our constituents. I have also repeatedly said that if we keep asking people to pay more for our health services, they must have a greater say in the way that those services are run, particularly when they are being changed.

I have spoken before of my concern about the attitude of my local clinical commissioning group in Bristol, North Somerset and South Gloucestershire to the openness and transparency of its work, especially on the reprocurement of adult community services. The lengths to which the CCG, supported by NHS Improvement, has gone to hide, cover up and obfuscate are nothing short of a scandal. Most infuriatingly, the whole protracted cloak-and-dagger exercise has been entirely unnecessary, because a far less onerous and costly approach could have been used instead. The reprocurement is the wrong approach at the wrong time to developing community services, and runs counter to the direction of travel being set, in theory, by the new NHS 10-year plan.

Before I review the shortcomings of the reprocurement in greater detail, I will remind hon. Members why it matters. Away from the jargon, acronyms, terse letters and confidentiality agreements, thousands of people across Bristol, North Somerset and South Gloucestershire simply want to know what is happening to their local health services.

My constituent Clive got in touch just over a year ago to tell me about the great work being done at the Healthy Together leg clinic at the Withywood Centre, which provides intervention and treatment for the leg ulcers of patients in south Bristol. It is exactly the sort of joined-up, innovative and integrated community provision that Ministers tell us they want to see—a true partnership between Bristol Community Health, local GP practices and Age UK in Bristol, which come together across different sites to deliver gold-standard patient care that promotes faster and longer-lasting wound healing. The clinic also provides a social setting where patients feel more supported and are encouraged to feel more in control of their condition. There is time for people to care.

The service has transformed countless lives in my constituency and has been nominated for a national award. As I saw first hand when I visited the clinic earlier this month, it is an exemplar of the sort of collaborative provision that the new adult community services contract could and should expand on. Such collaboration takes years to yield results and very much responds to the local needs of the particular community.

The people who are providing the service, however, do not know for how long they will be able to continue, because the CCG will not tell them. The patients do not know for how long they will be able to access that life-changing service, because the CCG will not tell them. As the local MP, I cannot lobby, engage or reassure people, despite asking repeatedly for a peek behind the self-imposed reprocurement iron curtain, because—hon. Members will have guessed it—the CCG will not tell me.

Interestingly, another consequence of the process, which I do not have time to really go into, is the destabilising impact on the voluntary sector. Age UK will have to wait, cap in hand, to see which successful bidder secures the primary contract and how it then decides to sub-contract the provision. The same goes for all voluntary organisations involved in this sort of service provision. It would be bad enough if the Healthy Together clinic were a one-off —the only service caught up in a closed-shop procurement mess—but it is not. In truth, every adult community service is in the same position, which is simply not good enough.

Despite a year of making speeches in this place, asking questions of Ministers, doing time-consuming research and making countless phone calls to offices, neither the CCG locally nor NHS Improvement nationally will engage with me beyond continually asserting that they had no choice but to go down this route. That is a prime example of what the Health and Social Care Committee referred to in its recent report, which said that the

“problems stem not only from the procurement rules themselves, but also from people’s interpretation of these rules and their difficulty in understanding what is permissible within the rules.”

In place of answers, I am forced to restate the litany of my constituents’ questions and concerns that have essentially gone unanswered. First, there is a fundamental lack of clarity surrounding the reprocurement and an abject failure to link it to any broader NHS strategies. I am not the only one who is concerned about the process. I have been spoken to privately by many consultants, nurses, and other staff throughout the healthcare system; I am grateful to them for contacting me.

At no point has the CCG properly defined a needs assessment in the request for proposals. Moreover, at no point has it made the business case for change—the most basic starting point for any such process. Staggeringly, there is no service baseline, so we do not know what services exist. By extension, there are no defined outcomes, so bidders are being asked to make proposals. That is not what commissioning is meant to be about.

Although Ministers continue to trumpet the importance of the sustainability and transformation plans, there is no sense of alignment with those plans, the NHS long-term plan or the emerging integrated care systems. Similarly absent is any indication of integration with local councils on social care or public health, which we all acknowledge are the key issues facing our constituents.

Secondly, there are concerns about the chosen procurement process, because any number of much less onerous and costly approaches were possible. As ever, however, accurately assessing the process is near impossible because of the vice-like secrecy that the CCG has used throughout. What is certain is that we do not know how much it is costing the CCG or the bidders, which include the current not-for-profit community service providers. That means that we do not know how much it is costing us, the taxpayers.

I worked in the national health service for many years, and I have some experience of procurement in the organisation, but I have struggled to understand properly the process through which the procurement has been undertaken. To illustrate, the CCG’s description of the chosen process, in its own words from its own document—bear with me, Mr Gapes, because I did not write it—says:

“The procurement is being undertaken using a process developed by the CCG which has similarities to a competitive process with negotiation. For the avoidance of doubt, the CCG is not running the process strictly in accordance with any specific procedure set out in the Regulations so reserves the right to depart from that form of procedure at any point. This Request for Proposals sets out the procurement process the CCG plans to use for this particular Contract. The inclusion of particular stages, the use of terminology and any other indication shall not be taken to mean that the CCG intends to hold itself bound by the full scope of the Regulations.”

What does that mean? I think it means that the process is as clear as mud, carried out behind a wall of secrecy, but with a disclaimer that enables the CCG to do what it wants without our knowledge. Although we cannot access the process details, what we know does not bode well.

There are myriad loose ends and errors throughout the process. Taken together, they form a significant body of concerning issues. Of course, I would never have known about them—most people do not—if I had not scoured 300 pages of detail and 100 clarification questions asked by bidders. In fairness, I doubt the CCG was expecting anybody outside the process, including the local MP, to do so, but I read them all because I like detail and I think it is important to know what is going on. A lot of the gaps and oversights concerned me.

There seem to have been incorrect working assessments about bed numbers at South Bristol Community Hospital; gaps relating to workforce numbers and staff who have been TUPE-ed; and a number of misunderstandings and examples of where the CCG lacked knowledge about current contracts, rental payments and void space. There is also missing information about assets, and the bidders were apparently expected to carry out the due diligence. That not only places a huge burden on providers, but runs the risk that the entire process will collapse if it is not carried out correctly, as has happened elsewhere. It is worth highlighting that the National Audit Office investigation into the collapse of the UnitingCare Partnership contract in Cambridgeshire and Peterborough found that bidders

“faced significant difficulties in pricing their bids accurately due to limitations in the available data”.

The evidence I have seen in the documentation suggests that that is now happening.

We should all be very worried about that, because failed procurements in Staffordshire for cancer services and end-of-life care, and in Cambridge and Peterborough, had similar procurement processes to the one chosen by Bristol, North Somerset and South Gloucestershire CCG. In each case, there was a secretive process, a complex procurement methodology and a failure to engage. Together, they cost taxpayers millions, and they all failed. Instead of learning lessons, NHS Improvement and the CCG seem intent on repeating the mistakes.

[Darren Jones (Bristol North West) (Lab)]

I congratulate my hon. Friend on securing this important debate. Does she agree that the complexity of the procurement process and the difficulty that she—an expert in this area—is experiencing means that patients who rely on these services and workers in not-for-profit organisations, who deserve to know what the process means and what the outcomes will be for them, find it impossible to take part as important stakeholders?

[Karin Smyth]

Absolutely—I completely agree. That is why I will continue to speak up on behalf of my constituents; I know I have my hon. Friend’s support.

Predictably, I would like to finish where I began, on the issue of secrecy and a lack of transparency. As I have highlighted, this absurd behind-closed-doors approach has bedevilled the reprocurement from the off. If this is such a great change to community services, why are we not trumpeting it? Reprocurement was first referred to in governing body papers in May 2018, but other than that there has been virtually nothing. There was no official announcement, no media blitz, no news stories or television news clips, no leaflets in local GP surgeries or South Bristol Community Hospital to enable local people to have their say on the plans—nothing. Although there has been talk of consultation, it seems that only 20 people from south Bristol took part. In fairness, there were some nods to engagement, and surveys were completed by 196 people. There was an engagement planning workshop with patients, carers and the voluntary sector, but because it is a contracting process, they were asked to sign a confidentiality agreement.

There is no evidence that even that limited feedback has been listened to or acted on. The workshop was merely an illustration to bidders of what stakeholders might want to identify when community services are planned and delivered. Tellingly, in documents from January, the CCG stipulated:

“Formal public consultation is not required as part of the procurement as no ‘significant variation’ to services is planned at this stage”.

Why is it being done if there is no significant variation to services?

All the documentation—approximately 300 pages in total—is hidden behind a portal, including more confidentiality agreements. The whole process appears so desperate to avoid the merest hint of engagement that it screams, “We’ve got something to hide!” It is utterly self-defeating, and serves no one well—not patients, bidders, the CCG or the community at large.

The CCG says that it is seeking a consistent service across all three areas and both acute trusts. Two of the CCGs and one of the trusts have been in deficit for years, and at various times in the past few years they have been on NHS Improvement’s naughty step. The deficits are now being shared across the whole community. The jam is being spread more thinly and differently from how it was spread before. The process is being embarked on to help spread the already struggling and inadequate level of service more thinly. Those service providers are spending money that should be spent on services on a process that I believe will inevitably reduce community services in Bristol.

I have great respect for the Minister, but I have no confidence that the Government will be able to make any difference to the local position. I hope that she takes note of the variability in how the rules are interpreted locally, as the Health and Social Care Committee noted in its response to the legislative proposals for the NHS long-term plan. Other commentators are saying the same. I hope the Minister will reflect on this local example. Will she explain directly or through her officials why, when I wrote to the Secretary of State about this originally, I got a reply from NHS Improvement? NHS Improvement is the provider regulator; this is a commissioning issue.

I believe that the Government should rapidly respond to the proposals to remove the requirement for competition under the section 75 regulations. There is no reason to wait; they need to get on with it. This saga shows that the lack of investment in NHS services remains a problem. Why not just build capacity rather than go through these expensive tendering processes with providers outside the NHS? I actually support the place-based approach to service provision in the NHS plan, but I object to the fact that this reprocurement goes counter to that plan.

At the very least, on behalf of local people, I would like the Minister to support my calls to see the proposals before contracts are signed for the next 10 years. We need a local plan and collaboration with the local authority that meets our health and social needs. I want a guarantee that people in south Bristol will not be worse off. Currently, no one can give me that.

NHS 10-Year Plan

Darren Jones Excerpts

Tuesday 19th February 2019 Commons Chamber

[Jonathan Ashworth]

The hon. Gentleman makes an important point. There are elements of the long-term plan that we welcome, including the access targets for mental health. We also welcome the commitment to save 400,000 lives, although there is no detail in the plan about how those lives are going to be saved. We welcome the rolling out of early cancer diagnostic and testing centres—after all, it is a policy that I announced in the 2017 general election campaign. We welcome the roll-out of alcohol care teams in hospitals—a policy that I announced at the Labour party conference last year. We welcome the commitments on perinatal mental health—again, a policy that we announced previously. We welcome the commitment for preferential funding allocated to mental health services—another policy that the Labour Opposition previously announced—but we will need to study the details carefully, as the hon. Member for Oxford West and Abingdon (Layla Moran) said.

The points about mental health from the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) were well made, because currently three in four children with a diagnosable mental health condition do not get access to the support they need. Child and adolescent mental health services are turning away more than a quarter of the children referred to them for treatment by parents, GPs, teachers and others. That is quite disgraceful, so I hope the extra investment in mental health services reaches the frontline quickly, and I hope that in summing up the debate the Minister will give us more details about when we can expect to see progress on that front.

[Darren Jones (Bristol North West) (Lab)]

Does my hon. Friend agree that for hospitals such as Southmead Hospital in my constituency, which is one of the largest hospitals in Europe, frontline delivery requires a workforce that is able to meet the demand? Does he therefore agree with the comments from the King’s Fund, which says that the Government not only failed the test on the workforce but did not even turn up for the exam?

[Jonathan Ashworth]

My hon. Friend makes a good point, and I will come on to discuss the workforce in a few moments. First, let me pick up the point made by my hon. Friend the Member for Sheffield, Heeley (Louise Haigh).

There is recognition in the plan that widening health inequalities are becoming a more important issue, which we need to confront. There is much in the document about widening health inequalities. After years of austerity, with poverty rates increasing and child poverty at 4.1 million, we now see life expectancy in this country stalling for the first time in a hundred years, and actually going backward in the poorest parts of the country. Child mortality rates for children born into the most deprived of circumstances have increased. The truth is that poorer people get sick quicker and die earlier. For me, as a socialist and a Labour politician, that is shameful. We should be creating conditions in which people live longer, healthier, happier lives, which is why we need to end austerity across the board. The focus on health inequalities is therefore welcome, and that includes the stark recognition that inequalities are costing the NHS £4.8 billion a year in admissions—a remarkable figure.

Appropriate ME Treatment

Darren Jones Excerpts

Thursday 24th January 2019 Commons Chamber

[Darren Jones (Bristol North West) (Lab)]

Given the very short period available, I will not be able to do justice to Karen, Carolyn, Nathalie, Anna, Emma or many of my other constituents by telling their stories today. Like my hon. Friend the Member for Ealing North (Stephen Pound), I tell my constituents and all those watching, “The House has heard you and your stories, and understands your plight.” The will of the House will make that very clear to those on the Government Front Bench.

It is clear from the stories we have heard today what a devastating and complex disease this is. When I was a young undergraduate in human bioscience, studying immunology, I heard this referred to in the labs as “Multiple Excuses”, and that was not so long ago. There is clear evidence that much more work is needed on the biomedical and biological processes behind this complex and devastating disease.

I am a member of the Science and Technology Committee, and we have recently completed an inquiry into research integrity. We have some concerns about reporting and transparency, especially in clinical trials. This goes to the concerns of many ME sufferers about what research is being done and how it is being done. Further to our Select Committee inquiry, I hope that the Minister will say what he will do to provide transparency in prospective registration, to deal with positive bias in journals—researchers are incentivised to find positive answers, as opposed to proving negatives, which is sometimes just as important—and perhaps to change the culture of that environment.

Lastly, on the delivery of care, about which we have heard from many hon. Members, the research must be recognised in the NICE guidelines, which lead to the delivery of care for many sufferers—children and adults—and to some of these heartbreaking situations. In my final 10 seconds, I pay tribute to the hon. Member for Glasgow North West (Carol Monaghan), a colleague on the Science and Technology Committee. I was pleased to support her application for this debate, and I hope the Government will respond in the significant way that is needed.

Autism and Learning Disability Training: Healthcare Professionals

Darren Jones Excerpts

Monday 22nd October 2018 Westminster Hall

[Darren Jones (Bristol North West) (Lab)]

I rise as the Member of Parliament for Bristol North West, which contains Southmead Hospital: it was part of Oliver’s story, from which lessons need to be learned. Does the hon. Lady agree that the important point here is that we evidently have strong cross-party consensus; that we must now focus our efforts not just on debate and consultation but on achieving real change in the health service and our public services generally and right across our country; and that today’s debate gives us the impetus to do that?

[Wera Hobhouse]

I thank the hon. Gentleman for his intervention. I have said at another occasion today that the word “Parliament” comes from the French word “parler”, which means to talk, but we are also here to take action, so we must stop talking and take action. The issue of mandatory training is something that we can fix or determine here, and I very much hope that the Government will take that on board.

The urgent need for better training on autism and learning disability and the complications of the condition could not be shown more starkly than by the failings in Oliver’s case. In February, the charity Mencap launched the “Treat me well” campaign, which is aimed at transforming how the NHS treats people with a learning disability in hospital. In particular, women with a learning disability suffer disproportionately from health inequalities. We have heard the statistics today; they die on average 29 years before women in the general population, and men with a learning disability die on average 23 years before those in the general male population. That cannot be overlooked. We have also heard these figures today, but that does not matter—it will do no harm to repeat them: a YouGov survey conducted in 2017 found that nearly one quarter of the health professionals surveyed had never attended any training on learning disability, and two thirds wanted to have more training, so what are we waiting for?

Any illness or disorder that is either misdiagnosed or diagnosed late leads to far greater problems down the line. Early intervention depends on early diagnosis, and early diagnosis on training of those who come into contact with the sufferers. We are calling today for better training of healthcare professionals, which is an obvious start, but why not go even further? Let us look at the settings to which young people are exposed from an early age—namely, nurseries and schools. Given that ASD is so widespread, nursery nurses and teachers should receive at least some basic training to recognise the early warning signs. Far too little is being done. In my constituency of Bath, we have an autism board, but it rarely meets and has not even set up a work plan yet. Clearly, none of this is good enough.

ASD and learning disabilities can be successfully treated to give sufferers a full life. The earlier we diagnose the problem, the better the outcome. Many people with ASD also suffer from mental health problems, often as a consequence of not being diagnosed early enough. Let us end this tragedy. I fully support the recommendations that have been made, and I hope that we have the cross-party consensus to really do something quickly.

NHS Pay

Darren Jones Excerpts

Wednesday 13th September 2017 Commons Chamber

[Helen Whately (Faversham and Mid Kent) (Con)]

It is a pleasure to speak in this debate. I will not try to compete with my right hon. Friend the Member for Broxtowe (Anna Soubry), but one reason why I am speaking today—and why I often speak on healthcare matters in this place—is that I, too, come from a family of doctors and nurses who work in the NHS. It was wanting to make the NHS better that first got me involved in politics, and I care very deeply about our national health service.

I welcome the Government’s decision to lift the pay cap, and to do it in a responsible way, but it has served a purpose. Back in 2010, the pay cap was necessary. Indeed, there was a pay cap in the Labour party’s 2010 manifesto as well. Labour also recognised that a level of pay restraint was necessary because of the financial situation in which the country found itself. Pay restraint was urgently needed, because wages are a significant driver of costs in the NHS and the wider public sector, and the public finances were running totally out of control. The pay cap was part of the restoration of financial discipline, of confidence in our economy and of growth, which we are now enjoying. Thanks to that growth, millions more people are now in work.

It is right to lift the pay cap now, but it must be done with caution because this country still has a sizeable deficit and increasing levels of debt. We are still paying off large amounts of debt interest. We therefore have to be responsible in the way we make commitments on public sector spending. I am very concerned about Labour’s plans for the pay increases that they would be willing to fund. They seem to involve an open promise and a potentially bottomless pit. Labour Members will not tell us how much the pay increases would be, but we know that the proposals in their manifesto would have cost between £6 billion and £9 billion extra. It was not clear where that money was to come from. Time and again, we heard that it would come from corporation tax, but we know that when we put up corporation tax we reduce the tax take, so that policy would not have funded the increases. I am concerned that Labour Members are making an irresponsible promise that they would not be able to deliver, were they in a position to try.

I welcome the more responsible approach taken by this Government. It will not involve a blanket pay rise; rather, it will draw on the guidance of the next pay review body for the health service and make pay rises where they are most necessary. In my constituency in the south-east, for example, I am aware that the high cost of living affects the people on the lowest pay in the public sector, and I hope that they will be recognised in the pay review. We should definitely draw on the expertise of that body when making proposals for public sector pay, rather than just trying to score debating points and get the right headlines.

In my experience of about a decade working in many parts of the NHS, including hospitals, and as an MP, I have spoken to people working in the NHS and found that pay is rarely, if ever, the No. 1 concern. The issues that come up much more frequently include having time to care—

[Darren Jones (Bristol North West) (Lab)]

I thank the hon. Lady for allowing me to intervene. She clearly wishes to champion nurses and their selfless desire to serve the public, but does she acknowledge that nurses in my constituency have to visit a food bank after a long shift at the hospital? Should not their selflessness in wanting to serve the public be recognised by their being paid what they deserve so that they can fund their families and their livelihoods?

[Helen Whately]

I genuinely believe that all members of the public sector should be paid a fair amount, and that is exactly what the pay review body will report on in its next report.

I was making the important point that pay has not been the No. 1 issue among nurses and other healthcare professionals when I have asked them what worries them most. Instead, they mentioned having time to care; being part of a stable team rather than having a high turnover of staff and lots of temporary staff; being listened to by the people they work with, particularly the senior people in the institution; and being valued. Being valued is not all to do with pay; it is much more to do with the way they are treated. In fact, I remember very well talking to one nurse whose line manager had not talked to her since the previous appraisal. To me, that is an extraordinary way of not valuing a member of staff; everyone should have regular conversations with their manager about how they are progressing.

Part of the problem in some NHS institutions is, therefore, in my view, not good enough management practices. If they were improved, we would have a much better environment for staff to work in, and I would very much like to see more attention paid to creating the right environment for healthcare workers, as well as ensuring that there is a fair and sensible pay settlement.