Oral Answers to Questions

Debate between Jim Shannon and Alistair Burt

Tuesday 5th July 2016 Commons Chamber

[Alistair Burt]

I am sorry to hear about the difficulties of my hon. Friend’s constituents. There is a provision within the regulations to enable patients who have serious difficulty in getting to a pharmacy because of the distance involved or the lack of transport to receive dispensing services from a doctor. Doctors should certainly not be blocking the addition of local pharmacies. If my hon. Friend writes to me, I can look into the matter in greater detail.

[Jim Shannon (Strangford) (DUP)]

Taking into account the immeasurable value that community pharmacies provide for some of the most vulnerable people in sections of our society, does the Minister agree that, when it comes to Government budgets, these dispensing services should be included in any ring-fencing that goes on around front-line services?

[Alistair Burt]

The hon. Gentleman’s support for these services is well known and what he says is right. The regulations do protect the more vulnerable, but when I next look at them, I will make sure that they fulfil his requirements.

Child Dental Health

Debate between Jim Shannon and Alistair Burt

Wednesday 3rd February 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

It is a great pleasure to respond to my hon. Friend the Member for Mole Valley (Sir Paul Beresford) and his excellent speech. The House has been fortunate to benefit from his professional knowledge on a number of occasions. As a new Minister coming into office some nine months ago, I had an early meeting with him, from which I benefited hugely and continue to benefit. I am grateful for the way in which he put his case and for the heads-up in respect of what I might do and the speech that I might make to the British Dental Association in due course.

I am grateful that the usual suspects have been here to listen because of their interest in these matters, namely the hon. Members for Strangford (Jim Shannon) and for Nottingham North (Mr Allen). I thank my hon. Friend the Member for Battersea (Jane Ellison), who is the public health Minister, for being here, together with the Whip and the Parliamentary Private Secretary. I also saw the hon. Member for Dewsbury (Paula Sherriff), who has been to see me to talk about dental matters and who clearly cares very much about these issues.

I congratulate my hon. Friend the Member for Mole Valley on securing this very important debate about children’s dental health. Poor oral health in children and young people can affect their ability to sleep, eat, speak, play and socialise with other children. Other impacts include pain, infections, poor diet and impaired nutrition and growth. When children are not healthy, it affects their ability to learn, thrive and develop. To benefit fully from education, children need to enter school ready to learn and to be healthy, and they must be prepared emotionally, behaviourally and socially. Poor oral health may also result in children being absent from school to seek treatment or because they are in pain. Parents may also have to take time off work to take their children to the dentist. This is not simply a health issue; it impacts on children’s development and the economy.

It is a fact that the two main dental diseases, dental decay and gum disease, can be almost eliminated by the combination of good diet and correct tooth brushing, backed up by regular examination by a dentist. Despite that, as my hon. Friend has set out, their prevalence rates in England are still too high. Dental epidemiological surveys have been carried out for the past 30 years in England and give a helpful picture of the prevalence and trends in oral health. Public Health England is due to report on the most recent five-year-olds survey in the late spring.

There is a mixture of news, as the House might expect. The good news is that the data we have at present show that oral health in five-year-olds is better than it has ever been, with 72% of five-year-old children in England decay free. Between 2008 and 2012, the number of five-year-old children who showed signs of decay fell by approximately 10%. The mean number of decayed, missing or filled teeth was less than one, at 0.94. Indeed, the data suggest that, notwithstanding the All Blacks’ rugby success and their bone-crushing efforts on the field, oral health in children is currently better in England than in New Zealand. New Zealand’s data for children aged five in 2013 showed that the proportion who were disease free was 57.5% and that the mean number of decayed, missing or filled teeth was 1.88.

[Jim Shannon]

We have had a marked reduction in dental decay in children since the year 2000, as I said earlier in an intervention. With respect, Minister, I would say that we are doing some good work in Northern Ireland. The Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) knows that I always say, “Let’s exchange ideas and information.” We are doing good work in Northern Ireland and we want to tell Ministers about it.

[Alistair Burt]

This is possibly the fourth or fifth invitation that I have received from my hon. Friend to come to see different things in Northern Ireland, and he is right about every one. He finds in me a willing ear, and we will make a visit because there are several different things to see. Where devolved Administrations and the Department can learn from each other, that matters, and I will certainly take up my hon. Friend’s offer.

In older children there are challenges when comparing different countries, because of how the surveys are carried out. The available data still show that we have among the lowest rates of dental decay in Europe, but despite that solid progress we must do more. There is disparity of experience between the majority of children who suffer little or no tooth decay, and the minority who suffer decay that is sometimes considerable and can start in early life. In this House, we know the children who I am talking about—it is a depressingly familiar case. We can picture those children as we speak, as my hon. Friend the Member for Mole Valley described in the sometimes horrific parts of what he told the House. The fact that we know that such decay affects children in particular circumstances makes us weep.

Public Health England’s 2013 dental survey of three-year-olds found that of the children in England whose parents gave consent for their participation in the survey, 12% had already experienced dental decay. On average, those children had three teeth that were decayed, missing or filled. Their primary, or baby, teeth will only have just developed at that age, so it is highly distressing for the child, parents, and dental teams who need to treat them. Dental decay is the top cause of childhood admissions to hospitals in seven to nine-year-olds. In 2013-14, the total number of children admitted to hospital for extraction of decayed teeth in England was 63,196. Of those, 10,001 were nought to four-year-olds, and so would start school with missing teeth.

From April 2016, a new oral health indicator will be published in the NHS outcome framework based on the extraction of teeth in hospital in children aged 10 and under. That indicator will allow us to monitor the level of extractions, with the aim of reducing the number of children who need to be referred for extractions in the medium term. Extractions are a symptom of poor oral health, and the key is to tackle the cause of that. Today I commit that my officials will work with NHS England, Public Health England and local authorities to identify ways to reach those children most in need, and to ensure that they are able and encouraged to access high-quality preventive advice and treatment.

The good news is that the transfer of public health responsibilities to local authorities provides new opportunities for the improvement of children’s oral health. Local authorities are now statutorily obliged to provide or commission oral health promotion programmes to improve the health of the local population, to an extent that they consider appropriate in their areas. In order to support local authorities in exercising those responsibilities, Public Health England published “Local Authorities improving oral health: commissioning better oral health for children” in 2014. That document gives local authorities the latest evidence on what works to improve children’s oral health.

The commitment of the hon. Member for Nottingham North to early intervention and the improvement of children’s chances is noteworthy and well recognised in this House and beyond, and of course he can come to see me. I would be happy to discuss with him what he wants to promote in Nottingham, which sounds just the sort of initiative we need.

Public Health England is also addressing oral health in children as a priority as part of its “Best Start in Life” programme. That includes working with and learning from others, such as the “Childsmile” initiative in Scotland, to which my hon. Friend the Member for Mole Valley referred. It is important that health visitors—I know that the Public Health Minister takes a particular interest in their work—midwives, and the wider early years workforce have access to evidence-based oral health improvement training to enable them to support families to improve oral health.

Public Health England and the Royal College of Surgeons Faculty of Dental Practice are working with the Royal College of Paediatrics and Child Health to review the dental content of the red book—the personal child health record—to provide the most up-to-date evidence-based advice and support for parents and carers. The National Institute for Health and Care Excellence has also produced recent oral health guidance that makes recommendations on undertaking oral health needs assessments, developing a local strategy on oral health, and delivering community-based interventions and activities for all age groups, including children. Community initiatives to improve oral health include supervised fluoride tooth-brushing schemes, fluoride varnish schemes and water fluoridation.

I agree with my hon. Friend that water fluoridation is an effective way of reducing dental decay. However, as the House knows, the matter is not in my hands. Decisions on water fluoridation are best taken locally and local authorities now have responsibility for making proposals regarding any new fluoridation schemes. I am personally in favour. I think I am the only Member in the Chamber who remembers Ivan Lawrence and the spectacular debates we had on fluoridation in the 1980s. He made one of the longest speeches ever. Fluoridation was bitterly and hard-fought-for and I do not think there is any prospect of pushing the matter through the House at present. I am perfectly convinced by the science and that is my personal view, but this is a matter that must be taken on locally.

Diet is also key to improving children’s teeth and Public Health England published “Sugar reduction: the evidence for action” in October 2015. Studies indicate that higher consumption of sugar and sugar-containing foods and drinks is associated with a greater risk of dental caries in children—no surprise there. Evidence from the report showed that a number of levers could be successful, although I agree with my hon. Friend that it is unlikely that a single action alone would be effective in reducing sugar intake.

The evidence suggests that a broad, structured approach involving restrictions on price promotions and marketing, product reformulation, portion size reduction and price increases on unhealthy products, implemented in parallel, is likely to have the biggest impact. Positive changes to the food environment, such as the public sector procuring, providing and selling healthier foods, as well as information and education, are also needed to help to support people in making healthier choices.

Dentists have a key role to play. “Delivering Better Oral Health” is an evidence-based guide to prevention in dental practice. It provides clear advice for dental teams on preventive care and interventions that could be delivered in dental practice and school settings. Regular fluoride varnish is now advised by Public Health England for all children at risk of tooth decay.

For instance, the evidence shows that twice yearly application of fluoride varnish to children’s teeth—more often for children at risk—can have a positive impact on reducing dental decay. In 2014-15, for children, courses of treatment that included a fluoride varnish increased by 24.6% on the previous year to 3.4 million. Fluoride varnishes now equate to 30.9% of all child treatments, compared with 25.2% last year. This is encouraging progress.

There are many measures that can and should be taken in order to reduce the prevalence of decay in children, but we recognise it is unlikely that we will be able to eradicate entirely the causes or the effects of poor oral health in children. This means that the continued provision of high quality NHS primary dental services will continue to be an important part of ensuring that every child in England enjoys as high a standard of oral health as possible. NHS England has a duty to commission services to improve the health of the population and reduce inequalities—this is surely an issue of inequality—and also a statutory duty to commission primary dental services to meet local need. NHS England is committed to improving commissioning of primary care dentistry within the overall vision of the “Five Year Forward View”.

Oral Answers to Questions

Debate between Jim Shannon and Alistair Burt

Tuesday 5th January 2016 Commons Chamber

[Alistair Burt]

Herbal products are slightly beyond my normal portfolio remit, but anything that assists in social care and makes people feel better and can add to their vitality and wellbeing is to be welcomed. I am sure in many local areas they are taken extremely seriously.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his response. Integration and improving care outside of hospitals is just one way we can revolutionise the health service. Will he outline any links his Department is exploring between reducing pressure on A&Es and using care provision outside of hospitals to facilitate reducing that pressure?

[Alistair Burt]

Absolutely, and a number of the pilots and pioneer programmes are doing just that. Early results from the living well programme in Penwith in Cornwall show a 49% reduction in non-elective admissions to hospital and a 36% reduction in emergency admissions to hospital. So the hon. Gentleman is right: better social care and better integration may have, and should have, an impact on hospital admissions and make sure people are receiving the most appropriate care in the most appropriate place.

Oral Answers to Questions

Debate between Jim Shannon and Alistair Burt

Tuesday 17th November 2015 Commons Chamber

[Alistair Burt]

I fairly regularly meet families and others who have had young people and older people in the system and where there is a difference of opinion about what might be done. Some of the stories are very distressing. Families will sometimes feel that people have not listened to them. There can be quite difficult clashes of opinion on occasion. Of course, any case that my hon. Friend wants to bring me I would be happy to see, but this is a perpetual issue. The important thing is always to listen to those who are closest to a problem. That is likely to be the best way forward. Even if there is a difference of opinion, if people feel that they have been listened to, there is a proper opportunity to explore what can be done.

[Jim Shannon (Strangford) (DUP)]

The autism numbers in Northern Ireland are growing. I understand that it is a devolved matter, but it is clear to me that three Departments have a responsibility: Health, No. 1; Education, No. 2; and Employment, No. 3. We need to ensure that the health of autistic children is looked after and that they have an education that prepares them for employment. Does the Minister have a strategy that takes all three Departments on board, and if so, is it shared among all the regions of the United Kingdom of Great Britain and Northern Ireland?

[Alistair Burt]

Yes. I could not have put it better myself. We have an autism programme board, on which sit representatives of the families of those with autism, which provides an opportunity to look overall at the Government strategy. The hon. Gentleman is right to say that it contains many different elements. For example, in relation to work, we have set out a challenge to halve the disability employment gap, because more people with disabilities want to take the chance of working. That must be done in the right way; we are working closely with the Department for Work and Pensions in relation to that, but things such as the autism programme board give a chance for families to be involved right across the areas where they might expect help and assistance.

Mental Health (Armed Forces Veterans)

Debate between Jim Shannon and Alistair Burt

Wednesday 14th October 2015 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

It is standard to congratulate the hon. Member who has secured the debate, but I really do congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). This has been a very interesting 18 minutes, and my only criticism is that we should have had at least an hour and a half, or maybe three hours somewhere else, but I suspect that might happen. I also congratulate the hon. Lady on raising this subject at Prime Minister’s questions today. If she permits, may I thank her for her service to the NHS and those in difficulties and thank her husband for his service to the country?

I am delighted to be joined by the Under-Secretary of State for Defence, my hon. and gallant Friend the Member for Milton Keynes North (Mark Lancaster), who has also seen active service and we have just heard from my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer). I say to them that there are times when their Minister feels very humble in that their collective experiences outrank mine very considerably. So I will do my best to respond to the debate. Because of the length of the initial speeches, I have slightly less time in which to do that, but that is all right because I want to make some changes to what I was going to say.

I should like to set out what the Government are doing. In doing that, I do not intend to suggest that what has come forward up to now is not valid, relevant, important or challenging to the Government. It would, however, be fair of me to put on record what is going on, although it is palpably not enough. If the hon. Member for East Kilbride, Strathaven and Lesmahagow, with her experience, needs more and if my hon. Friend the Member for Plymouth, Moor View, with his experience, needs more, then it is clear that whatever we are doing—good though it is, and better than it was—is not yet meeting the demands and the needs. It is also clear from the comments of other Members tonight that it is not yet meeting the demands of the House. My hon. and gallant Friend from the Ministry of Defence and I have listened carefully and there will be more to be said.

The Government are fully committed to continual improvement in the treatment of mental health conditions for veterans and the general public alike. We are rightly proud of the courage and dedication of our armed forces. For those who have been injured either physically or mentally, it is our duty to ensure that they continue to receive the very best possible care. As Members have already said, the vast majority of those leaving the armed forces do so fit and well, having benefited from their time in the forces. Members of the armed forces are not significantly more likely to develop mental health issues than those in other professions, but support and clinical care that are geared to the specific needs of veterans need to be available.

Armed forces and veterans mental health provision has vastly improved since the publication of the landmark report “Fighting fit” in 2010. The report was produced at the hands of my hon. Friend the Member for South West Wiltshire (Dr Murrison), who recommended that there should be 30 mental health professionals across England to provide services to veterans. With 10 veterans mental health teams in place across England, we now have significantly more than the 30 professionals recommended.

In deference to the position of the hon. Member for East Kilbride, Strathaven and Lesmahagow, let me now say a bit about Scotland’s provision. Scotland is proud of its commitment to improving mental health, including for veterans and their families. Visibility and awareness of mental health issues have substantially risen in the nation over the past decade. That echoes something that my hon. Friend the Member for Plymouth, Moor View said. There is greater awareness following long-standing campaigns against stigma. We have not gone as far as we need to go, but it is easier for people to talk now. For those with very difficult conditions, however, those are easy words, and it is still very difficult for them.

There is better public awareness of mental illness, suicide prevention and faster access to NHS services and other sources of help. Veterans and their families have unhindered access to all NHS services, enhanced by priority treatment where that applies. Evidence-based care and treatment are provided across community-based settings through support from primary care, with specialist or hospital in-patient services provided as appropriate.

In partnership with NHS Scotland and Combat Stress, the Scottish Government recently renewed funding for the provision of specialist mental health services at the Hollybush House Combat Stress facility in Ayr, for veterans resident in Scotland. The sum of £1.22 million a year over the three years to 2018 will fund a range of specialist clinical, rehabilitation, social and welfare support at the facility. Evidence-based treatment programmes include an intensive post-traumatic stress disorder programme; trans-diagnostic and stabilisation; and anger management programmes.

NHS Lothian secured £2.5 million of armed forces covenant LIBOR funding to support the commitment, and established Veterans First Point Scotland to work with local partnerships to explore how the strengths of the Lothian service could be delivered in other localities. Over the past year, work has been taken forward in 10 health board areas across Scotland to assist each local area to establish key partnerships, identify premises, plan requirements and recruit and select staff. This work continues, with the service in Tayside now open with others to follow.

I want to demonstrate that England, too, is recognising and trying to respond to the needs of veterans. Before I say a bit about that, may I thank the hon. Member for Strangford (Jim Shannon) for raising the issue in relation to the Republic? I do not know the answer, but I will find out. I recognise the point that he makes.

Underpinning all that I am saying is the demand for more research. There is some good research. The King’s Centre for Military Health Research has done some good work in identifying the categories of those who might be more at risk. Reservists and their particular issues came up, as did the other groups of veterans, particularly those who have been back for some time. There are ways of picking up those issues, and I will say a little more about that.

NHS England spends £1.8 million a year on mental health services for veterans including the 10 veterans’ mental health teams. Up to £18 million funding is in place to provide the Combat Stress six-week intensive post-traumatic stress disorder programme for veterans, with an additional £2 million of LIBOR funding being provided to Combat Stress to help veterans with alcohol problems, which is a key indicator of problems. Help for Heroes has received £2 million of LIBOR funding for its “hidden wounds” work, offering low-level improving access to psychological therapies services to veterans. Subject to the spending review, a further £8.4 million will be provided over the coming five years to help the most vulnerable veterans who have mental health problems.

[Jim Shannon]

The Minister mentioned LIBOR funding, and that is something that I have been pursuing through the Defence Committee and other ways. We have been seeking to have some of that LIBOR funding available for Northern Ireland to provide a rehabilitation centre for the many people who have served and who will continue to serve. None of that has been forthcoming to the Province so far. I understand that the Minister cannot give me an answer today, but perhaps he can look at the matter and come back to me.

[Alistair Burt]

My hon. and gallant Friend from the Ministry of Defence says that there is money available in a bidding programme and he will write to the hon. Gentleman and see what more can be done in relation to that.

I want to say two things as we run towards a conclusion. Many of the servicemen affected will of course be treated by the NHS in the course of ordinary medical treatment. The so-called talking therapies from the IAPT programme have been particularly successful. It is important to ensure that the particular needs of veterans are catered for in this programme. Work has been under way to ensure that that is done. The IAPT programme has been very successful. For the first time, we have standard waiting times and access targets. That will help veterans too.