NHS Dentistry: Recovery and Reform

Debbie Abrahams Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

The criteria that will apply to the areas covered by vans are clearly set on dental need and other factors such as distance from an NHS dental practice. We have been able to identify areas of particular need, where we want to get that help as quickly as we can through the dental van initiative and the other ways detailed in the plan.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Last year, about half of my constituents were able to access dental services—well below pre-pandemic levels. Under the plans, what proportion of my constituents can now hope to access NHS dental services within the next six months?

[Victoria Atkins]

The dental recovery plan sets out immediate-term, medium-term and long-term plans. In the immediate term, we have the new patient premium that will be live from next month, the increase in UDA value to £28 and the golden hellos that I have described to under-served parts of the country. There is a batch of measures throughout the plan to address the concerns from colleagues across the House.

New Dementia Treatments

Debbie Abrahams Excerpts

Thursday 11th January 2024 Westminster Hall

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is a pleasure to serve under your chairship this afternoon, Mr Sharma. I congratulate the right hon. Member for Ashford (Damian Green) on securing this very important debate and on his excellent speech. I learned a few things from that speech, and I had thought I was quite well informed on the developments in dementia research.

As some people may know, my mum, Angela, was diagnosed with Alzheimer’s disease when she was 64. I, along with my stepfather and brother, cared for her until she died in 2012. It was that experience that drove me, first of all, to be the first MP to become a Dementia Friends champion. As the right hon. Member knows, I was subsequently elected as co-chair of the all-party parliamentary group on dementia.

When we talk about dementia, we are using a collective term that covers the common symptoms associated with a range of brain diseases. The most common of them is Alzheimer’s disease, but there are dozens of others. My mother-in-law was diagnosed with vascular dementia in her 80s, and there is also dementia with Lewy bodies, frontotemporal dementia and, as I say, dozens of other conditions. Each of those diseases has a different pathology and, as a consequence, the specific therapies that we are talking about today will not necessarily be appropriate for them; they will need to develop their own specific therapies.

I absolutely agree with the right hon. Member for Ashford that this is a time of hope, because we are making groundbreaking discoveries and there have been developments in the therapies. I also totally concur with him about the importance of prevention. We know that what is good for our heart is good for our head as well. The previous debate that you were chairing, Mr Sharma, was about smoking and tobacco use; we know that has a significant impact on dementia prevalence.

I will reiterate some of the points that the right hon. Gentleman made about dementia. First, on prevalence, there are 900,000 people living with dementia in the UK, and that is likely to increase. I will pick him up on his point that life expectancy is increasing. It is not increasing; it is flatlining and has been since 2017. In areas such as mine, it is actually going down. The prevalence of dementia is reflected in that trend. I point people to the excellent work of Professor Sir Michael Marmot, who this week published his update that the picture is not changing, unfortunately.

People with dementia account for more than 70% of those in residential care homes over the age of 65, and 60% of those receiving home care. As we will have seen from today’s NHS performance data, it is estimated that a quarter of NHS beds are occupied by people with dementia, who remain in hospital on average twice as long as people who do not live with the condition. Again, I agree with the right hon. Gentleman that, unfortunately, that reflects the crisis we have in social care. We just cannot discharge people from hospital knowing that they are not going to have the support that they need, whether that is in the community or in specialist residential care beds. In addition to his point about NICE, we also need to be serious about the future of social care reforms, particularly the reforms recommended back in 2015 by Andrew Dilnot.

Most importantly, we need to recognise that dementia is now the UK’s biggest killer. It has overtaken heart disease and cancer as the biggest killer in the country. We also need to understand that dementia is not a natural and automatic part of ageing. Although, yes, because we are an ageing society, there will be an increase in the prevalence of dementia, it does not mean that we automatically get it as we get older. It is clear that dementia is the most significant health and social care challenge of our time.

I was disappointed that dementia has not had the political priority that it deserves. I was disappointed that the Government decided to absorb dementia into the major conditions strategy, and not give it the focus and attention that it deserves for all the reasons that the right hon. Gentleman has given. Unfortunately, that reflects a number of things, not least what is wrong with our political system and the short termism driven by where we are in the political cycle.

Despite the serious challenges, this is an incredibly exciting time for dementia research. I advise people to look at the all-party parliamentary group’s report on dementia research, which we conducted a couple of years ago. It went right through all the developments, from prevention and looking at biomarkers all the way through to the quality of care and the evidence base around that. There is a lot to be excited about.

In the past 18 months, we have seen the announcement of two effective disease-modifying treatments for early-stage Alzheimer’s that have been proven to slow the progress of the disease by 20% to 40%. That is really significant, and I share everybody’s excitement about it. Lecanemab and donanemab target and remove a protein called amyloid, which is what builds up in our brain and is harmful to it. It basically stops neurones communicating —not just with each other in the brain, but with all different parts of the body as well. They are really important drugs that will reduce the build-up, or clogging-up, of the neurones. As an aside, when I was undertaking personal care for my mum as she got to the late stages of her life—lifting her, lifting her head, and so on—I could feel the change in the shape of her head, because her brain was shrinking; it was just imploding on itself. I hope that gives a sense of what is happening in somebody with Alzheimer’s and of the ravages of the disease.

To have two new disease-modifying drugs for Alzheimer’s disease in the space of a year is a turning point in the fight against the disease and could mean the beginning of the end of this devastating condition. Science is proving that it is possible to slow down the progression of the condition, and lecanemab and donanemab are the first of what we hope will be many more effective treatments. Hopefully, one day, Alzheimer’s disease could be considered a long-term but manageable condition alongside diabetes and asthma.

Lecanemab has already been approved as a safe drug by the Food and Drug Administration in the United States. As we have heard, we expect the Medicines and Healthcare products Regulatory Agency to make a decision very soon. Then, of course, there is the clinical guidance associated with the implementation and use of these drugs, which is undertaken by NICE. I have to say that I had not picked up that, as the right hon. Member for Ashford said, it would look only at the impact on social care. I hope the Minister will respond that she will be writing to NICE to say that is just not acceptable. As co-chair of the APPG on dementia, I am quite happy to write a letter along those lines as well, together with the chair of the APPG on adult social care, the right hon. Member for Ashford. It just cannot happen. I urge the MHRA and NICE not to procrastinate, and to try to get this sorted as soon as possible without compromising the validity of their assessments.

However, very worryingly, even if these drugs were given clinical approval tomorrow, we would unfortunately not be in a position to make use of them. That is the state of our health system at the moment. For lecanemab and donanemab to be effective, they require an early diagnosis of dementia and a specific sub-type diagnosis of Alzheimer’s disease. In England alone, a third of people with dementia do not have a diagnosis, and many only have a non-specific diagnosis of dementia. Currently, none of those individuals would be able to access these novel therapies.

A few months ago, the APPG on dementia produced a report on diagnosis rates and the inequalities in the diagnosis rates. I heard of a diagnosis rate lower than the rate of 50% in Hereford mentioned by the right hon. Member for Ashford: a rate of 40% in Devon. The top marks go to Stoke. For whatever reason, Stoke seems to be doing very well, with a diagnosis rate of over 80%. Oldham, at 78%, has got a little bit of catching up to do to Stoke, but we are quite pleased with the direction of travel. We have not recovered to the pre-pandemic diagnosis rates. We all need to recognise what we can do about that.

I urge the Government to look at the following three areas as a matter of urgency. First, not enough people are being diagnosed at an early stage of disease progression. Many memory services are struggling to meet current demand, let alone the expected increase if disease-modifying treatments do become available. Secondly, there is a lack of sub-type diagnosis. As I mentioned at the start, there are more than 100 different diseases that cause dementia. Too often people receive a general diagnosis of dementia without a sub-type. Without that, it is impossible to determine an individual’s suitability for the new drugs.

Thirdly, there is insufficient access to positron emission tomography scanners and cerebrospinal fluid testing—the lumbar puncture testing that the right hon. Member for Ashford mentioned. As I mentioned, a specific diagnosis is required and the PET scanner and CSF test are the only tests that can give evidence of the presence of amyloid in the brain, but access to those tests is woefully restricted due to lack of equipment. I had not picked up on the cost-effectiveness, so I thank the right hon. Member for raising that.

Workforce and diagnostic barriers can be overcome with clear and decisive action from Government. I want to see at pace an expansion of diagnostic capacity so that everyone with suspected Alzheimer’s disease can access a test to confirm eligibility for treatment at an early stage in their disease progression. We must address the current inequalities in diagnosis across the country.

We need a transformational change to the diagnostic workforce to ensure sufficient workforce capacity with the necessary skills and expertise to administer the required specialist tests and make diagnoses. Meaningful involvement of the people living with Alzheimer’s disease and their carers must be central to plans for system preparedness, with continuous consultation from the outset and ongoing oversight through an established group.

I am sure we would all agree that we are at a pivotal moment for dementia in this country. Lecanemab, donanemab and the treatments that might follow have the potential to improve the lives of hundreds of thousands of people, but we need to act now to ensure we are ready to deliver them as soon as they become available. We have come such a long way in the past 20 years, with incredible advances in scientific research that has culminated in the discovery of those novel drugs. Such effort cannot be wasted by Government inactivity and failure to respond.

Simply put, scientists are doing their job to give us new treatments, but now it is up to the Government to do theirs and ensure the system is ready to deliver therapies to the people who need them. It is time to make dementia a priority and we should make a start.

I thank the Alzheimer’s Society for its support with the APPG.

--- Later in debate ---

[Debbie Abrahams]

I am reassured to some extent by what the Minister says, and I am grateful for her tone and her positive approach. Given the inequality—let us call it what it is—in current diagnosis, and these are non-specific dementia diagnosis rates, have she and her Department conducted any analysis of the gaps in more specific PET and CSF testing? Can she publish that data or write to us with it? That would reassure us, because rather than just hoping something will happen, we could identify it: “Yes, in Greater Manchester we are at 90% of the level we need for all these tests,” and similarly in Kent and so on. If she could do that, it would be very helpful.

[Helen Whately]

I fully appreciate the hon. Member’s question, and I can assure her that I do look at the variation in diagnosis rates between different areas, as she rightly pointed out in her speech. I would be happy to write to her with further detail on the specific question of more sophisticated diagnosis techniques and our readiness for new treatments and for carrying out earlier and more sophisticated diagnoses.

I assure hon. Members of the Government’s ambition for the UK to be a world leader in dementia research, diagnosis and treatment; I would also like us to lead the world in the prevention of dementia. That is why the Government are investing in research. We are getting ready to make new treatments available and building on what we are already doing in prevention with our major conditions strategy. Given the scale and impact of dementia on our society, successful prevention and treatment are not just a nice-to-have, but an imperative for individuals, for their families, friends and loved ones, and for our society.

NHS Dentistry

Debbie Abrahams Excerpts

Tuesday 9th January 2024 Commons Chamber

[Victoria Atkins]

Again, cutting through the froth, the hon. Gentleman called this debate and has not set out his plan. He knows full well that this is an Opposition day debate and I am responding to Labour’s motion by moving an amendment. He has no plan on dentistry. When I asked him to clarify whether he will follow the capitated system in Wales, he declined to answer. I assume that is because he knows we tested a prototype system based on the Welsh capitation approach here in England, and the results were clear. It worsened access and widened oral health inequalities.

The hon. Gentleman quoted the Nuffield Trust, placing great emphasis on it, in his opening speech. As he agrees so much with the Nuffield Trust’s report, does he also agree with its former chief executive who said that his ideas on general practice represent

“an out of date view”

and “will cost a fortune”?

It is becoming increasingly clear that the Labour party’s approach to our NHS is empty words about reform followed by the phrase “funded by non-doms.” We are very lucky in this country—on this side of the House we consider ourselves blessed—to have incredible dentists working across the NHS.

Here are some facts for Opposition Members. There are now 1,352 more dentists working in the NHS than 14 years ago, thanks to the stewardship of this Conservative Government. I thank them and their colleagues for everything they do, and we are backing them to build a brighter future for NHS dentistry by taking concrete steps to improve recruitment and retention. That is why our long-term workforce plan, the first in NHS history, will expand dentistry training places by 40%, providing more than 1,100 places by 2031, which will be the highest level on record under any Government.

Over the same period, this Government’s plan will also increase training places for dental therapists and hygiene professionals to more than 500. The importance of the long-term workforce plan to dentistry’s future was recognised across the sector, and Professor Kirsty Hill, who chairs the Dental Schools Council, backed our plan:

“Expansion is a significant and positive development, and we commend the government for recognising the importance of increasing dental hygiene and dental therapist positions. These roles play a vital role in enhancing capacity and improving care.”

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I find it absolutely extraordinary that the Health Secretary lectured the shadow Health Secretary on calling a debate to hold this Government to account. Twelve million people are not able to access dental care, including thousands in my Oldham constituency.

[James Wild]

What’s your plan?

[Debbie Abrahams]

You are the Government, unless you want to call a general election.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The hon. Lady knows that she must not refer directly to other Members.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 5th December 2023 Commons Chamber

[Priti Patel (Witham) (Con)]

7. What funding her Department is providing to help tackle health inequalities in Essex.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

9. What steps she is taking to help reduce health inequalities.

[The Secretary of State for Health and Social Care (Victoria Atkins)]

I am pleased to reiterate to my right hon. Friend the Member for Witham (Priti Patel) that Essex is receiving funding from the National Institute for Health and Care Research, which is funded by the Department of Health and Social Care, to promote research into health inequalities and support better health outcomes for her constituents and all residents in Essex.

[Victoria Atkins]

I thank my right hon. Friend very much for her kind words. She will remember how much I enjoyed sitting on the Front Bench alongside her when we were in the Home Office. In terms of her work in Essex, she is a formidable campaigner and she will know that the decision on such a healthcare centre lies with her integrated care board, to which the Government have given some £183 million of capital funding between 2022 and 2025. I am sure she will make a compelling case to the ICB for such a centre in her constituency. Interestingly, the Mid and South Essex integrated care board is one of seven sites receiving additional support and funding from NHS England to address health inequalities, and I know she will pay close attention to how that is spent.

[Debbie Abrahams]

There were multiple warnings from experts such as Professor Sir Michael Marmot of the widening health inequalities that started in 2015. Covid just exposed and amplified those inequalities, so that in the north there were 17% more deaths, or more than 2,500 avoidable deaths. While I welcome the new Health Secretary to her post and I welcome her announcement this morning, what else is she going to do to address in particular the socioeconomic inequalities that drive those health inequalities?

[Victoria Atkins]

I thank the hon. Lady for her welcome. Having grown up in Lancashire myself, I very much understand why she is speaking up on behalf of her constituents. There are many different ways that we deal with this, but let me use a couple of headline points. First, we are increasing the public health grant to local authorities, providing more than £3.5 billion this year, so per capita public health grant allocations for the most deprived local authorities are nearly two and a half times greater than for the least deprived.

There is also interesting work going on with family hubs. Indeed, the Under-Secretary of State for Health and Social Care, my right hon. Friend for South Northamptonshire (Dame Andrea Leadsom), who has responsibility for start for life, is leading on that. The family hubs and start for life programme will deliver a step change in outcomes for babies, children and parents in 75 local authorities in England with high deprivation. We believe strongly that if we can give the best start in life to our babies and children, it will bode extremely well for their future years.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 11th July 2023 Commons Chamber

[Neil O’Brien]

I know how intensely my hon. Friend is campaigning on this issue. The amount of NHS dentistry being delivered has gone up by a fifth over the last year, partly as a result of the reforms we are already rolling out. He will have seen in the workforce plan that we are going to increase training places for dentists by 40% so that we have the NHS dentists we need. However, that is not all we will do, and our forthcoming dental plan will take further steps.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

We have known for a while that our life expectancy is shorter than it was in 2010. However, we are now seeing impacts on children in the UK, who are about 7 cm shorter at five compared, for example, with the children of our neighbours in Holland. What is the Secretary of State doing on this issue, and will he support the all-party parliamentary group on health in all policies in assessing the impacts on health and health inequalities?

[Neil O’Brien]

Of course we are taking action to improve public health, and that includes children’s nutrition. That is why we are spending £150 million on healthy food schemes, such as the school fruit and vegetable scheme, the nursery milk scheme and Healthy Start. It is also why we are investing £330 million a year in school sport and the PE premium and a further £300 million through the youth investment fund. We will continue to take action on this key issue.

Draft Tobacco and Related Products (Amendment) (Northern Ireland) Regulations 2023

Debbie Abrahams Excerpts

Tuesday 11th July 2023 General Committees

[Neil O'Brien]

We have driven down smoking rates in England to a record low—from about 40% in the 1970s to about 20% in 2010 and down to a record low of 13% today. We have done that partly by doubling excise duties and partly by introducing a minimum excise on the cheapest cigarettes.

We continue to move forward in our efforts to cut smoking. I recently set out plans to give all women who smoke during pregnancy new incentives to quit smoking, and plans to give 1 million smokers help to “swap to stop” with free vaping kits. The Government are taking determined action to drive down rates of smoking, and we will keep all measures about comparability between Northern Ireland and the rest of the UK under review.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

The Minister has not responded to the point made by my hon. Friend the Member for York Central.

[Neil O'Brien]

Which point?

[Debbie Abrahams]

The point about the inequalities that there will be between Northern Ireland and the rest of the UK, and whether there has been an assessment of them. I gently remind the Minister that it was a Labour Government that introduced smoke-free zones and ensured that people were protected from second-hand smoking. The Government need to recognise that.

[Neil O'Brien]

We keep all those things under review. Flavourings in heated tobacco are a relatively niche issue, but of course we will look at the regulation of those things. The mainstay of our policy is raising tax on cigarettes, which has driven down smoking rates, and using vapes, but not heated tobacco, as a potential substitute to get people off smoking.

I commend the draft regulations to the Committee.

Question put and agreed to.

NHS Long-term Workforce Plan

Debbie Abrahams Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

The hon. Lady raises a fair point. It also applies to the issue of stroke. The elderly population has increased in many coastal and rural communities. That has created significant pressure: for legacy reasons, services are often in other parts of the country. We have five new medical schools in place, and we have looked at those parts of the country where it is often hard to recruit. Part of the expansion will be to look further at what services are needed in different areas. The hon. Lady’s point also speaks to that raised by the Chair of the Health and Social Care Committee. By giving greater autonomy to place-based commissioning through the integrated care systems, we will enable people at a more local level to design the services and the workforce that they need, and that includes the flexibilities required to retain local staff.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I welcome the workforce plan. Given that it has taken 13 years, one tends to wonder why it has taken so long, but then of course we remember that there is a general election on the horizon.

Page 121 sets out a labour productivity rate of 1.5% to 2% per year. That has never been achieved by the NHS or any other comparable health system, so what assumptions is the Health and Social Care Secretary making in relation to achieving that?

[Steve Barclay]

First, this is a plan developed by colleagues in NHS England, so these are assumptions that have been agreed by those who lead within the NHS. It is about ensuring that people operate at the top of their licence. It is about having new and expanded roles, such as advanced practitioners and associate roles, that allow people to progress in their careers and, in doing so, freeing up capacity for senior clinicians, who often spend time doing things that do not need to be done by people in those roles.

Of course, there are also rapid changes in technology. We often talk about the developments in artificial intelligence, and I have touched on developments in the life sciences industry. I have also mentioned advances in screening and genomics. All those developments will in turn help us to prevent health conditions, and treating those conditions early will be not only better for the patient, but better value for money for the taxpayer.

Mental Health Treatment and Support

Debbie Abrahams Excerpts

Wednesday 7th June 2023 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

As we have heard from colleagues from all parts of the Chamber, we are in a mental health crisis. Unfortunately, it is becoming increasingly endemic. I pay tribute to the work of our offices, including my own team, who regularly deal with critical cases of mental ill health, including suicide calls, for which we have had to put on special training. That was happening before the pandemic too, and we need to recognise that.

Recent figures show that seven out of 10 secondary school children are expressing mental health distress. That should worry us. It has already been mentioned, but we know that there are risk factors and risk conditions that can contribute to the onset of a mental health problem. I will speak about the importance of early intervention a little later.

Oldham has the 37th highest prevalence of mental health disorders in the country. That puts it in the highest 20% in the UK; for reference, the Prime Minister’s constituency is in the lowest 6%. On the other side of the coin to this higher prevalence is our reduced funding. Research from the Children’s Commissioner found that child and adolescent mental health services in Oldham received over £100 less in spending per child from the Government than those on the Isle of Wight. Similarly, in 2019 The Guardian reported that London had nearly double the number of psychiatrists in the north of England. As I have mentioned, it is true that things have got worse since the pandemic, but that is not just a consequence of the pandemic.

I want to focus on what needs to happen, because we need a serious plan, and I am not from the Minister’s speech that the Government recognise that. The Opposition want to recruit thousands of new mental health professionals, which will go some way to addressing the lack of parity of esteem between mental and physical health services. That needs to be reflected in the Government’s NHS workforce plan. We have waited ages for the Government to produce that and it makes the partygate report look quite prompt. As the Government sit on their hands and fail to produce a plan, the crisis continues to get worse. That is why we will commit to the biggest expansion of the NHS workforce in history. We must also look at the metrics we use. For example, we would guarantee treatment within a month. That would make such a big difference to all those people stuck on what feel like endless waiting lists in Oldham, Saddleworth and across the country.

Finally, I am pleased to see our party committing to a paradigm shift from the medical to the social model of health, focusing on prevention in communities as well as treatment. The Leader of the Opposition has committed himself to that in Labour’s health mission, and we have also pledged that there will be a mental health hub in every community. We will go further than that: our commitment to addressing the rampant health inequalities across our country includes tackling the inequity in mental health. As we develop national policy from education to transport and finance, we will consider the impacts on health and health inequalities, including mental health. This is the difference a Labour Government will make. The next Labour Government have a plan that is both radical and credible, and for my constituency and for our country, it is long overdue.

[Mr David Davis (Haltemprice and Howden) (Con)]

On a point of order, Madam Deputy Speaker. You will be well aware, because you have chaired many of the debates, that there has been a campaign in this House for over a year to stop SLAPPs—strategic lawsuits against public participation—which are used by very rich men to oppress free speech in this country. Just in the last hour or so, the High Court has ruled one of those SLAPPs cases out of order: the case of Mr Mohamed Amersi against the ex-Member of this House Charlotte Leslie has been struck down. In my view, that is a great victory for free speech. Because it is so important, I give notice that I will be raising the matter on the Adjournment.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 6th June 2023 Commons Chamber

[Neil O’Brien]

My hon. Friend is quite right that we absolutely need to go further. That is why, through the primary care recovery plan, we are taking some of the pressure off general practice, investing £645 million in the new Pharmacy First service, which will free up about 10 million GP appointments a year. That is why we are investing about £60,000 per practice in new IT and modern online systems. None the less, he is totally right: we need those doctors in general practice. We have about 2,000 more now than we did in 2019, but we will go further. We have already increased GP training and we are looking at building on that further.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Can the Minister clarify when Oldham will receive its share of the 6,000 additional GPs that were promised in the Conservative 2019 general election manifesto? Today we are running with fewer GPs, and that is not helpful to anyone.

[Neil O’Brien]

I have already noted that we have increased the number of doctors in general practice by nearly 2,000 since 2019 alone. The number of direct patient-facing staff in general practice is 50% higher in total than in 2019, and that is up right across the country. However, of course we will go further and grow the number of clinicians in general practice, building on what we have already done.

Recovering Access to Primary Care

Debbie Abrahams Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

My hon. Friend has a great deal of experience, and he is right to focus on the amount of clinical time often spent on non-clinical issues. Sending reminders through the NHS app will reduce non-attendance. We are also looking at the key interface between secondary care and primary care, as well as considering which appointments can be done elsewhere, such as through pharmacies and the additional roles. The online booking system can better triage people to the right place, and there will be some self-referral in order to take pressure off GPs—not for things that carry a clinical risk, such as internal bleeding, as the Opposition suggest; but for things like hearing aids. If a person has taken a hearing test, they will not need to clear an appointment for a hearing aid through their GP.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I reinforce what colleagues have said. This is a step in the right direction, but it fails to grapple with the grave situation in which there has been a threefold increase in waiting lists since 2010, including a twofold increase since 2019, before the pandemic. In Oldham we have fewer GPs and more patients with increased acuity, so when will we get our fair share of the promised 6,000 GPs?

[Steve Barclay]

I have recognised throughout that demand has increased. Primary care is treating 10% more patients than before the pandemic, with around 1 million appointments a day. There is more demand, not just because of the pandemic but, as I said in my opening remarks, because we have a third more people over the age of 70, and they are five times more likely than younger people to go to their GP. That demographic change, the impact of the pandemic and a change in public expectations of advances in medicine are all creating additional pressure, which is why it is right that we use the full range of additional roles and that we invest in technology, in addition to the 2,000 more doctors in general practice.