Under-age Vaping

Rachael Maskell Excerpts

Wednesday 12th July 2023 Commons Chamber

[Neil O’Brien]

On driving up support for people to Swap to Stop, we are following the recommendations. On the things that we have been discussing in this debate, a whole set of other questions have been raised, on which our call for evidence explicitly invited evidence, because we want to have an evidence-based policy.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am grateful to the Minister for giving way, because I want to turn to the evidence. We know that, when we had plain packaging and removed advertising around cigarette sales, we saw a significant decrease in the use of those products, particularly among young people. We also have other evidence: Israel introduced plain packaging in 2020 and Finland in 2022. There is plenty of evidence out there on the implications of plain packaging, so why will the Minister not use that evidence and implement things?

[Neil O’Brien]

We are garnering evidence on every different aspect of this policy question. In my remarks today, I have tried to illustrate some of the questions that we are thinking about at the moment, which I am sure we will hear more of during the debate. I was simply trying to make the point that we need definitions of things and we need evidence before we take action.

In conclusion, we are committed to doing all we can to stop children from vaping—that is a personal priority of mine. We are also committed to stopping youth smoking. In order to meet our smoke-free 2030 ambition, we are committed to doing all we can to stop people from starting to smoke in the first place, and to give people the support that they need to quit and save their lives.

--- Later in debate ---

[Rachael Maskell (York Central) (Lab/Co-op)]

Twenty-nine years ago I handed in my dissertation for my degree. It was focused on tobacco advertising, and the very arguments being made today by the industry were being made back then as to why it was so important that advertising should not be prohibited further. That is why today’s debate should be as much about the business model, driven by the industry, as about the harm from these products to children and young people. I congratulate my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) on bringing this motion before the House, because the timing is so important. Some 30% of children and young people across Yorkshire have already tried vaping and we know, as we move into that summer period, that more and more children will be socialising outside of school time, and those risks will go up, as will the number of adults we see vaping.

I was honoured to sit on the Health and Social Care Committee as we took evidence from the industry, health professionals and an articulate headteacher talking about their experiences. What I have to say back is that over the past 29 years, we have seen an industry that has become far cannier in how it advertises and markets its products than it was in yesteryear. The situation calls on the Government to step up and be far cannier in being able to expediently put in place the full range of measures that we know will have an impact on the number of young people taking up vaping.

We welcome the reduction in the number of children smoking cigarettes, and we have seen that important shift over the decades. We know the measures that have levered that in—increasing the cost has certainly had an effect, and making smoking less accessible and less attractive has had an impact—but what also needs to be learned is that the very mechanisms put in place around cigarettes need to be applied immediately to vaping, too.

If we look at some of the measures introduced over the past 20 years, we have seen the billboards taken down along with newspaper and magazine advertising, the removal of tobacco from promotions, its removal from sport, its access taken away in shops, the shutters put down, vending machines taken away and these products being put out of use. There were also important public health measures to move away from indoor smoking and, as my hon. Friend the Member for Stockton North (Alex Cunningham) has just said, smoking in cars where there are children. We also had that important intervention on plain packaging, which we know Israel and Finland have already introduced for e-cigarettes. There is therefore no reason for a delay here.

The industry is using every reason it can consider as to why it needs to continue using advertising. I cross-examined the industry at the Select Committee. To summarise some of the exchange, we were discussing why Blackburn Rovers had those products on the shirts of the heroes of that town. The industry was saying, “It’s really important that we distract people from tobacco products on to our products, because that is our public health measure.” I challenged back and said, “Why don’t you have public health messaging on those shirts instead?” Of course, they argued that that would not work, because they wanted to draw in the next generation of people to use their products. That is what the industry has always been about: it is about generating profit for its shareholders. When it did that with tobacco-based products, ultimately its customers died. That was not the best business model it could induce. With vaping, the industry wants to make sure it has a continuous stream of addicts, and we need to understand that business model to introduce the public health measures needed around harm reduction.

If we look at the figures, we see that a YouGov survey showed that of the 3.6 million adults who are vaping, 2 million are ex-smokers who have now returned to using a nicotine-based product, 1.4 million are current smokers and 200,000 have never smoked and are vaping. Another survey showed that of the people who were vaping, only 47% were also smokers, and 53% were not. We can deduce from that that the reach of these measures and the availability of vaping products means they are being used far beyond the purposes that Public Health England intended and that Javed Khan put in his report to reduce people’s use of tobacco-based products. As a result, we are seeing more people drawn into an addictive habit, addicted to nicotine and able to use it more regularly and with far more availability. They are therefore taking on higher quantities of this drug, and we are seeing the consequences of that.

The call for taking all the same measures currently in place for cigarettes is therefore vital. ASH and others recommend putting an excise tax of £5 on the product, and we will need to adjust the cost of cigarettes in line with that to ensure that they remain less attractive. We need to ensure that we have investment in the trading standards workforce to address the illicit trade we see in counterfeit products, with the dangers they cause. On branding, it is very clear that plain packaging is required. We must remove the cartoons, the sweet names, the colours and the flavours that are currently being propagated. We must also ensure that promotion is not possible in any sphere. Ultimately, we need to ensure that these products are used only for harm reduction and take that really important whole approach to public health as opposed to looking at one product or another.

We have got to question why young people are taking up the use of nicotine. Yes, there is peer pressure—of course, we understand that, and that is really important. We heard about how children discuss the different flavours and try them out, using the product more and more as a result. Yes, there is the power of advertising—why else would companies advertise but to attract custom? But why is it that young people need a dependency on a drug? We need to get to the heart of that question through a wider public health approach. I am very disappointed that the Government have pulled away from some of their public health strategies, including the health disparities White Paper and bringing forward a more holistic approach to public health. Ultimately, we have got to protect young people from becoming the addicts of the future. That is the role of this Parliament

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister.

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[Maria Caulfield]

As I just said and as the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) said earlier in the debate, the consultation closed only recently. Officials are going through the evidence and will come forward with the results in the autumn and take them forward.

[Rachael Maskell]

I raised the issue of addiction; although the Minister has said that vaping products are safer, does she agree that if they are drawing more children into addiction, they are clearly not safe in that field?

[Maria Caulfield]

We have to consider the evidence and that is not necessarily what the evidence says. NHS England is reviewing the number of admissions and incidents that it feels are caused by vaping, so we are gathering the evidence on that. We need to take an evidence-based approach and currently there is not the evidence that there is necessarily an addiction problem. But we do need to keep building the evidence base.

As we have set out today, we are committed to taking strong and assertive action to tackle youth vaping, and we are willing to go further as part of our evidence-based approach. We have to work with all parties and across Government. This is not just a health issue: it is an issue for the Department for Education, for the Department for Culture, Media and Sport in terms of advertising, and for DEFRA in respect of how single-use vapes are disposed of.

We are committed to effectively tackling the issue and driving down youth vaping rates, while making sure that vapes are available to smokers as an effective aid to quitting smoking. We are committed to doing all we can to prevent children from starting vaping and we are actively working on ways that we can go further. We will go further in not only protecting children but driving down smoking rates, so that we make a future where people are not damaged by smoking. To meet our smokefree 2030 ambition, we will do all we can to prevent people from starting smoking in the first place and to give people the support that they need to quit.

Question put and agreed to.

Resolved,

That this House is concerned that children are being inappropriately exposed to e-cigarette promotions and that under-age vaping has increased by 50% in just the last three years; condemns the Government for its failure to act to protect children by voting against the addition of measures to prohibit branding which is appealing to children on e-cigarette packaging during the passage of the Health and Care Act 2022 and for failing to bring forward the tobacco control plan that it promised by the end of 2021; and therefore calls on the Government to ban vapes from being branded and advertised to appeal to children and to work with local councils and the NHS to help ensure that e-cigarettes are being used as an aid to stop smoking, rather than as a new form of smoking.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 11th July 2023 Commons Chamber

[Steve Barclay]

There are a number of measures in the primary care recovery plan, from how we better use the skills mix within pharmacies to how we deregulate some of the tasks that take up pharmacists’ time, such as the requirement for a pharmacist to be present after drugs have already been prepared or to clip out tablets because they do not match the number prescribed by a GP. There are a number of areas in which we can better use the skills mix, and there are areas where we can take load off pharmacists. We are also funding additional services through Pharmacy First to support the pharmacy model.

[Rachael Maskell (York Central) (Lab/Co-op)]

The number of deaths increased by 13.5% in December 2022, particularly around influenza and pneumonia—up by 26.2%—so York’s public health team want to know what the Government are going to do about winter planning and when.

[Steve Barclay]

We set out comprehensive plans for winter preparation in the urgent and emergency recovery plan. Similar to what I said a moment ago, this includes making much better use of community schemes, particularly those targeted at the frail elderly, and making better use of technology through schemes such as virtual wards. It has also put additional bed capacity into hospitals, with more than £1 billion of funding for 5,000 more permanent beds to help alleviate the pressure on bed occupancy and get flow through hospitals, which is so important to addressing the pressure on ambulances.

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

Rachael Maskell Excerpts

Tuesday 11th July 2023 General Committees

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Ms Harris. I, too, welcome the draft regulations and wish to highlight the inequality that has arisen between Northern Ireland and England. I have to say that the sluggish response from the Government, knowing the harm that tobacco causes, is quite astounding. I very much hope that we will shortly see regulation on heated tobacco products here in England.

I want to home in on the harm that is being done by putting flavourings into tobacco products. The Health and Social Care Committee recently took evidence not only from health experts, but from the industry. It became incredibly evident to us that this is yet another marketing ploy by the tobacco industry to sell its harmful and life-threatening products. We heard evidence from the head of a school, who said that the topic of conversation for young people in the playground was about the different flavours that they were trying. That is clearly where legislation like this will protect young people. For instance, we were told about different flavours of vape, such as gummy bear, slushy, unicorn milk and unicorn frappé. The introduction of those flavours is clearly not aimed at an adult audience. We are talking about vanilla and other flavours in heated tobacco products, but it will not be long before we see them being extended to products that are attractive to children, to get them to take up smoking.

What through in our inquiry, which applies to the draft regulations, is that the industry is driven to recruit a new generation of addicts, whether they are addicted to tobacco products or to nicotine products, to drive up their profits from another generation, having killed off the last. It is therefore absolutely essential that we get the draft regulations on the statute book not just in Northern Ireland but across England and the rest of the UK. It is evident what the industry is about, and I urge the Minister to go far further and far more quickly, so that we stop producing another generation of addicts to these products and ensure that we safeguard people from the real public health concerns that we all have.

NHS Long-term Workforce Plan

Rachael Maskell Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

Characteristically, my hon. Friend the Chair of the Health and Social Care Committee makes an extremely pertinent point about the role of the ICSs. As we move to place-based commissioning and look to integrate more, the interplay between the workforces in the NHS and in social care will be a key area where the ICSs will be extremely important.

The ICSs will have a particular role in the apprenticeship and vocational training, which are key retention tools in those parts of the country where it is hard to recruit, as well as in offering more flexibility to staff. When I talk to NHS staff, they often talk about having different needs at different stages of their career—whether for childcare commitments, which relate to the measures the Chancellor set out in the Budget, caring for an elderly relative, or wanting to retire and work in more flexible ways—and the ICSs have a key role to play in that. I welcome my hon. Friend’s comment that this is a serious and complex piece of work, and that it was right that we took our time to get it correct.

[Rachael Maskell (York Central) (Lab/Co-op)]

Despite the significant desert of dentists, I note from the plan that we will not see an increase in dental training places next year, the year after or the year after that, meaning that we will not see more dentists for nearly another decade. We have a crisis now, so what is the Secretary of State going to do about it?

[Steve Barclay]

We are already seeing a fifth more work than last year, due to the flexibilities that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) announced, including the ability for dentists to take on more work within their commission and the changes to the units of dental activity pricing to better reflect more complex work. Of course, we have 6.5% more dentists than in 2010, but we also recognise that within the £3 billion budget, we want to go further. That is why we are looking at proposals to go further than the measures announced, but progress is being made, with a fifth more activity than last year.

Mental Health In-patient Services: Improving Safety

Rachael Maskell Excerpts

Wednesday 28th June 2023 Commons Chamber

[Steve Barclay]

In my discussions with my right hon. Friend and colleagues, I found the compassion that they showed and the way they championed the family voice compelling. I absolutely agree that it is important that families take confidence from the decision to move the inquiry on to a statutory footing and come forward with their evidence. I know that she plays an active part in that. Of course, we want families to be part of the discussion on the terms of reference. I know that, with her significant experience, my right hon. Friend is keen to be part of that too, and we are keen to engage with her on it.

My right hon. Friend is right to highlight the evidence that has already been gathered through the excellent work of Dr Strathdee. I had a meeting with her yesterday to ensure that we capture that as part of the work that is moving forward. I hope—I reinforce my right hon. Friend’s point—that families will take confidence from today’s announcement and that those families who have not come forward to date will be able to do so. I know that in my right hon. Friend they will have a resolute champion supporting them to do so.

[Rachael Maskell (York Central) (Lab/Co-op)]

I, too, welcome the Secretary of State’s statement, but I am disappointed that he did not say more about the serious risks that we have raised in the House—not least about timely access to services and the significant risk that many of my constituents have faced out in the community—in respect of Tees, Esk and Wear Valleys NHS Foundation Trust, which serves York. I wonder whether he can expand on that, and on his proposals for taking things forward at the trust. I am meeting one of his Ministers next month, but I would like to hear his position on addressing the serious concerns that have been raised.

[Steve Barclay]

The hon. Lady raises a very valid point. There are real concerns about Tees. We considered that when considering the scope of the statutory inquiry. Given that significant work had been done in Essex, we decided to strike the balance by putting that on a statutory footing but enabling work to proceed at pace through HSIB on Tees and some other areas. The hon. Lady will know that the Care Quality Commission prosecuted the trust in May for a regulation 12 breach, and that significant work has already gone in; the report of the system-wide independent investigation was published last March. They are very serious issues on which I think there is concern across the House, and we stand ready to work with her and other elected representatives from that area as part of the wider work.

Lung Cancer Screening

Rachael Maskell Excerpts

Monday 26th June 2023 Commons Chamber

[Steve Barclay]

I know that my hon. Friend was a Health Minister at the time that James was raising these points, and that he takes a close personal interest in the issue. He is right about the importance of the point at which people come forward. I was having a discussion this morning about the fact that when most patients come forward for screening, they will not be diagnosed with cancer, but it is still an opportunity for smoking cessation services, for example, to work with them on reducing the risk that continued smoking poses. My hon. Friend is right about using the opportunity of screening to pick up other conditions and to work constructively to better empower patients on the prevention agenda.

[Rachael Maskell (York Central) (Lab/Co-op)]

Of course those most at risk must be fast-tracked into diagnostic services, but when we are 2,000 radiologists short, 4,000 radiographers short and 5,000 other health staff short in those diagnostic services, how can people get the diagnostic services they need? When will we have the workforce in place to service this policy?

[Steve Barclay]

Clearly, the earlier we detect cancer, the less pressure it puts on the workforce. There is much more work involved in the treatment of a later cancer than of an earlier cancer. That is why we are investing in our community diagnostic programme, with 108 community diagnostic centres already open and delivering 4 million additional tests and scans. As part of the wider £8 billion investment in our electives recovery, over £5 billion is going into that capital programme. Yes, the workforce plan is a key part of that, but so is getting the CT scanners and the other equipment in place. That is exactly what our community diagnostic programme is doing, and it is being furthered by our screening programme through announcements such as this.

Hospice Services: Support

Rachael Maskell Excerpts

Wednesday 14th June 2023 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve with you in the Chair, Ms Nokes, and I thank the hon. Member for Eastleigh (Paul Holmes) for securing this timely and important debate.

For children in York, hospice care is provided by Martin House, and for adults by St Leonard’s. I pay tribute to all the staff at both hospices for their services and their love, care, professionalism, sacrifice and dedication for their patients and the families they serve. Where would we be without them? I will never forget the doctor, who had experience right across the NHS, who told me that before she came to St Leonard’s she had never seen care like it. That is what people across this country experience as they pass from this world.

Hospices are special places, as we have heard at lot in this debate, but they are also important places whose funding we cannot just leave to the rattling of tins. That is why it is so important that we focus on their funding, which is the call from today’s debate that the Minister must hear loud and clear. It is not good enough just to say that ICBs have the money and it is their decision, because ultimately hospices need funding from the Government. Now that the Government have put it on the statute book, thanks to the Lords, they need to make sure that they put the money behind this service.

Let me talk about St Leonard’s, which this year faces a £1 million deficit. It has not received the increase in funding to cope with the pressures of inflation. It received just £340,000 from the better care fund, which is the same amount as in 2016. There has been no increase, despite the fact that there has been an increase in the number of patients, moving from 200 back then, with the hospice-at-home service, to 700 patients a year now. St Leonard’s provides excellent care in the home, allowing people to choose where they die and the support they receive when they die.

The hospice faces fuel costs that are up by 180% for that hospice-at-home service. Of course, the in-patient service has seen energy costs rising, alongside the rising cost of food and so many other things. Indeed, staffing costs have also increased and are up by 31% over the last three years. We cannot just keep rattling tins when the cost of living crisis is impacting on everyone; we need to find a secure, assured and long-term funding solution for the services we are talking about.

Less than 30% of St Leonard’s funding comes from statutory sources. That situation cries out to this Government: “Surely, ensuring that people have a good death is worth finding the money for.” That is why I call on the Minister to think about what this means not just for NHS budgets but for families, carers and all the people who depend on hospice services. We need to move urgently to find that security, just as people find that security at the end of life.

--- Later in debate ---

[Helen Whately]

I commit to continuing to dig into getting visibility on the extent to which extra funding is going through to hospices. Of course, there is a balance to be struck when giving integrated care boards the freedom to do what we want them to do, which is to understand fully the needs for care in their populations, and make good decisions about how they fund care for their populations. None of us believes that a Minister in Westminster has the answers about what should happen and exactly how funding should be distributed in every single one of our communities. I will continue to get that visibility, because it is important that we know the extent to which our hospices are getting support for the extra financial pressures that we have been discussing.

[Rachael Maskell]

Will the Minister give way?

[Helen Whately]

I will make a bit of progress, because I am conscious that the clock is ticking.

Integrated care boards are responsible for ensuring the provision of the end of life and palliative care that is needed in our communities across England. In addition to the funding, I am working with NHS England to ensure greater visibility relating to what that means in practice and what is being commissioned.

The shadow Minister’s point about inequality of access was very important. We know that there is inequality of access to palliative and end of life care. Some communities are much better served than others, in part due to the fantastic legacy of our hospices: where there is a really good hospice, there is often much better access to end of life and palliative care around it. We want to improve equality and reduce some of the disparities in access to end of life care. As part of that, people should be able to do what most people want—to die at home with the right support in place.

I want to talk about the funding for children’s hospices, which several hon. Members brought up. Recognising the importance of palliative and end of life care for children and young people, NHS England provided £25 million specifically for that, via the children’s hospice grant during this financial year. I have, of course, heard the calls for that grant to be continued, and for greater continuity and visibility of funding further out. I cannot say more on that today, but I can assure hon. Members that I have been speaking to NHS England about that funding beyond this year. I do expect further new to be communicated about that shortly, appreciating the level of concern among hon. Members and children’s hospices in their communities.

[Rachael Maskell]

I am grateful to the Minister for giving way. The Health and Care Act 2022 put a responsibility to fund palliative care on the statute books. Will the Minister set out what has changed, to enable that funding to come forward? We know there are people in our communities who are not receiving that care, although they need to now under the law. The funding needs to be in place for them to receive the care that they need at the end of life.

[Helen Whately]

That alludes to exactly the point I made a moment ago. As flagged in that 2022 Act, ICBs have responsibility for commissioning that care, using the budgets they receive through NHS England. I am working to ensure the visibility of the commissioning, to be assured that that is taking place, so that we can be assured about the availability of end of life and palliative care for our communities.

I want to make a final point as I close; I am looking at the clock ticking. Against the backdrop of financial concerns, which I of course recognise and which we are discussing, is the strength of hospices in their communities, and the importance, as mentioned by hon. Friends, that they are not solely financially dependent on the state and the NHS for funding. They receive some NHS funding, but it is important that hospices are successful in fundraising and gaining support from our communities. That is one of the strengths of their model, and I want to continue to support that.

I pay tribute to all the volunteers and those involved in fundraising, including many hon. Members this morning who mentioned the fundraising efforts that they are personally making for hospices in their communities. I wish very good luck to my hon. Friend the Member for Eastleigh for his forthcoming skydive. All credit to him for having the courage to jump out of an aeroplane. I sincerely hope that he is successful.

Recovering Access to Primary Care

Rachael Maskell Excerpts

Tuesday 9th May 2023 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op)]

The impact of today’s announcement will be miniscule compared with the scale of the challenge facing primary care right now. In York, our GPs are innovative and ambitious—far more ambitious than the Secretary of State—and want to bring real change to the way pathways operate. In light of that, will additional money be available for innovation in primary care, so that GPs can meet the challenge and lead the change that is needed?

[Steve Barclay]

There is funding in other parts of the Department’s budget, not least for tech innovation and the work we are doing on artificial intelligence. There is further scope to use AI in demand management, for example to relieve pressure on GPs by looking at changes in the behaviour of frail or elderly patients and picking up changes early. The use of AI presents a significant opportunity. There are questions about how we can use data better; indeed, there are challenges for those across the House in how we can use data better to manage pressure within primary care. So there is funding elsewhere in the Department’s budget, in addition to what I have announced here.

Vaping: Under-18s

Rachael Maskell Excerpts

Tuesday 2nd May 2023 Westminster Hall

[Dr Hudson]

Again, this is about the differentiation between adult use of vaping products and young people’s use of vaping products.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am grateful to the hon. Member for making such an excellent speech. Does he agree that recruiting a new generation of addicts is the business model that the industry has forever driven, no matter whether the product kills or harms? The industry itself needs to be tackled on the issue.

[Dr Hudson]

I agree with the hon. Member. The industry needs to take a close look at itself, but it is also the case that a lot of the vapes that are ending up with children are coming through illicit means. We need to have a targeted approach to look at how best we can prevent our young people from accessing those products.

--- Later in debate ---

[Rachael Maskell]

Will the Minister also put in place services, similar to smoking programmes, to support people who are now addicted to vaping, to enable them to come off vaping?

[Neil O'Brien]

Absolutely, and I will touch on that in just one moment. Vapes—

Reforms to NHS Dentistry

Rachael Maskell Excerpts

Thursday 27th April 2023 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op)]

The ever-growing despair has left York and North Yorkshire a dental desert. Thousands of my constituents cannot even get on a waiting list. If they are lucky as they phone around, they may be put on a list, but they then have to wait a minimum of five years to see a dentist. Children are having their teeth pulled out, and adults are getting the pliers out. Although this Government have to own the last 13 years, I want to look forward, not back, because we have a crisis to solve.

Dentistry being left like this is a reminder of what things were like before the NHS was created, and before Labour stepped in and demanded equality of health for all. The model does not work; the system of payment does not work. We need radical reform—not tweaking of the system of units of dental activity. In my constituency, three dental practices have withdrawn from NHS contracts and, over the past four years, 126,130 UDAs have gone. We know that that crisis is deepening. In fact, by the coming June, Bupa NHS—an oxymoron in itself—will have seen a loss of 6,000 more NHS dental spaces. My community cannot get dental healthcare, and they are suffering and struggling because of that.

I, too, sit on the Health and Social Care Committee, and I listened carefully to the Minister, as well as to the chief dental officer, who I thank for her candour and for restoring my hope. She set out a programme of how it can be possible to deliver a future NHS dental service creatively through the integrated care boards, as did the chair of my local dental committee and the associate postgraduate dental dean for primary care dental foundation training in my constituency. They set out a vision which is practical, with purpose and can deliver. If I mesh that with my dental charter, which I have given to my ICB, starting with the ambition to have a children’s dental service within a year, we can start building back. The second year could aim to help older people and those in care homes, as well as those who live in the greatest deprivation. In years 3, 4 and 5, we could build back for the rest of the adult population so that people can get their timely oral health appointments.

However, we need co-operation from the Government, who have now become the servants, with the ICBs as masters. In particular, we need Government support to train more professionals. I too welcome the meeting with the Minister about the proposed York dental school, and I have met the University of York to prepare the way for that. It is important that we train more dentists, but it is also an opportunity to embed a centre of dental development in our city. The ambition is there and the vision has been created.

In addition, we need to ensure that we have good foundation training. I recognise what the hon. Member for Hartlepool (Jill Mortimer) said about having a training bond, because if we are spending £100,000 on dental training, we need to see a return on that investment. A foundation training programme that consolidates practice will upskill dentists in a more coherent way, with supervision and mentoring to ensure that they are the very best professionals. I have to challenge the GDC about its oversight of the dental profession particularly in primary care, and say “Up your game.”

On top of that, we need to ensure that our whole communities can have confidence in what is being created. Through prioritising our young people and ensuring that we take a preventive and proactive approach to dental healthcare, we will start to see other people taking on those competencies and drive that through a public health agenda.

Listening to the opportunities set out by our chief dental officer, the professional on the pitch, it is clear that the Government are not up to the job, and in some places they have been an active block. She has the ideas and the formula, and, my goodness, she has the drive and the energy. Just meeting her and hearing her set out that vision gave me hope that I can go back to my constituents in York and say that there are some people who can really deliver the national dental health service that we need for the future.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

I thank my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) for securing this important and timely debate as we work on our dental plan and the NHS workforce plan. We have had some excellent and useful contributions, and all the ideas that have been put forward are extremely timely.

The hon. Lady said it is time for real change, not patching, and I completely agree. The Chair of the Select Committee, my hon. Friend the Member for Winchester (Steve Brine), made too many important points to list, but he made an important point about the need for greater transparency on data and delivery, and I completely agree.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) listed some of the problems that are firing our ambition to fundamentally change the system. My hon. Friend the Member for Waveney made a series of important points, and I am grateful for his contribution not only today and in previous debates but outside the Chamber. He has many thoughtful observations to make about ringfencing, changing the UDA system, fluoridation and so on, and all those ideas are flowing into our work. The right hon. Member for Kingston upon Hull North (Dame Diana Johnson) was the first in this debate, but not the last, to emphasise the importance of where dentists do their training and foundation training to getting more dentists into under-served places, which we are looking at.

My hon. Friend the Member for Hartlepool (Jill Mortimer), like my hon. Friend the Member for Waveney, talked about the perverse effect of the contract bands. That was brought home to me by the conversation she engineered for me with some of her local dentists. I found that conversation incredibly useful. Their passion for NHS work and dentistry shone forth, and it brought home the central role of local commissioners in making the choices of the kind she raised in this debate.

The hon. Member for City of Durham (Mary Kelly Foy) talked about the importance of prevention, not just treatment, and we are thinking about that. My hon. Friend the Member for Broxtowe (Darren Henry) raised the important issues for Sacha and Joan, and I am happy to meet him and his local ICB to talk about how we can address those cases.

The hon. Member for Bootle (Peter Dowd) asked whether we have gone far enough. No, we have not, hence the need for a dental plan. My hon. Friend the Member for Milton Keynes North (Ben Everitt) emphasised the need for housing plans to take better account of the need for primary care facilities and dentists, which we have discussed outside the Chamber. Some places do it well, but that does not happen everywhere, including in his local authority.

The hon. Member for York Central (Rachael Maskell), as always, made interesting comments about prevention among young people, which we are certainly looking at. My hon. Friend the Member for Barrow and Furness (Simon Fell) was the first person to mention that the overseas registration exam is much too long-winded, and that it takes people much too long at the moment. The legislation to enable that to change came into force last month, and we now need the GDC to move quickly to address the backlog and those problems.

It is always a pleasure to hear the hon. Member for Strangford (Jim Shannon) speak in a debate to bring a UK-wide perspective, and he asked a straight question about how we are engaging with the profession. We are generating these ideas by talking directly to dentists. My right hon. Friend the Member for Tatton (Esther McVey) said that dentists had told her that the 2006 contract had never worked, and I have certainly heard that from many dentists.

I am happy to meet my hon. Friend the Member for Bolsover (Mark Fletcher) and his ICB to discuss the recommissioning of services. He raised the issue of Bupa, and I agree that having a three-way meeting would be useful. My hon. Friend the Member for Don Valley (Nick Fletcher) got to the nub of the issue when he talked about basic incentives.

When I visited my hon. Friend the Member for North Devon (Selaine Saxby), I was once again reminded of the particular challenges of coastal communities, and that is especially true in dentistry. We have talked about this before and are thinking about how to get dentists to go places that are historically under-served.

My hon. Friend the Member for Broadland (Jerome Mayhew) raised the same point, as well as a deep question about the historical allocation of funding in dentistry. We are certainly looking at that. I reassure him that we are also looking at the whole issue of centres for dental development, and the proposals emerging in his area are extremely interesting.

Last but not least, my hon. Friend the Member for Keighley (Robbie Moore) mentioned our new requirement for dentists to keep their records on the NHS website up to date. We are keen to drive that forward and to ensure that records are accurate for exactly the reasons that he mentioned.

Dentistry was hit much harder than most other health services because of its fundamental nature: dentists are looking down people’s throats and creating a lot of aerosols, so of course during the covid pandemic the sector was particularly hard hit. We allocated £1.7 billion of funding to carry NHS dentists through the pandemic, which enabled many to survive, but dentistry was clearly hard hit, and it is a hugely important part of the NHS, as many Members have said.

The package of changes that we brought in last July were an important first step—only a first step—in addressing the challenges facing the sector. We have started to reform the contract, with the first significant changes since 2006, to make NHS dentistry more attractive. We have created more UDA bands to better reflect the fair cost of work and to incentivise NHS work. We introduced for the first time a minimum UDA value to help sustain practices where values are lower, and to address unfair and unjustified inequalities in UDA rates, which are now based on quite historical data. We have enabled and allowed dentists to deliver 110% of their UDAs for the first time to encourage more activity and to allow those who want to deliver more NHS dentistry to do so. We have also made it a requirement for the first time for dentists to keep their availability up to date on the NHS website.

We have also made it easier—a number of hon. Members have made this point today—for dentists to come to the UK. The legislation came into force last month to enable the GDC to increase the capacity of the overseas registration exam. As of 1 April, people will no longer have to pay the charges that they used to pay. The Chair of the Select Committee stressed how important it was for the GDC to respond to those increased flexibilities and to work at pace to get through the backlog, and we are actively in discussions with it about how best to do that. Plans are advancing for centres for dental development, as a couple of different hon. Members have mentioned, not just in Suffolk or Norfolk, but further afield, such as in Cumbria. We are watching those plans closely and working with local partners to see what is possible.

Hon. Members raised the matter of prevention. We have already started the process of expanding fluoridation across the entirety of the north-east, which would—subject to consultation—encompass about 1.6 million more people. We will be launching that consultation this year in order to provide the benefits of fluoridation to a large new area for the first time since the 1960s.

All these changes are starting to have some positive effects. In the year to March, about a fifth more patients were seen compared to a year earlier. In total there are about 6.5% more dentists doing NHS work now than in 2010, and UDA delivery is going up from that huge hit it took in the covid pandemic, but of course we must go further; I am the first person to say that. I can see that some of the reforms are working. The proportion of dentists making the new band 2b claims is increasing and it is great to see that practices are prioritising those with higher needs. But this is absolutely just the start and I know that we must go further.

[Rachael Maskell]

Will the Minister set out with great clarity the data that is required, so that we do not just measure how many people are working in NHS dentistry, but we understand the number of sessions they are providing, and we marry that up with need and demand in order to understand what gap is there?

[Neil O’Brien]

The hon. Lady is right; in dentistry, not only do we have headcount measures showing that six and a bit per cent. more dentists are doing NHS work, but we can see the amount they are delivering and we can see those UDA rates starting to go back up again. Of course, we want them to go up further, and I am keen to start publishing more data so that there is greater transparency about what is being delivered where.

There are further changes we must make. We are trying to drive activity back up to at least pre-pandemic levels and to address the fundamental shortfalls that were there even before the pandemic. When I speak to dentists, they have a keen sense of whether the payments they are offered under the 2006 contract make work profitable or unprofitable. Often, for some of those bands, they feel that they are not being fairly remunerated for the cost of the work they are doing. We need to make sure that they do feel fairly remunerated so that they are more attracted to doing NHS work. We could go further in addressing some of those historical, and potentially now unjustified, variations in UDA rates. In particular, the move to ICBs and away from regional commissioning provides an opportunity for not just more transparency, but much more accountability. Instead of a remote regional body, hon. Members will be able to talk to their local ICB about what it is doing to drive up delivery. When we arm Members of this House with greater transparency and greater data, they will be able to have those conversations about what we are doing collectively to drive up the levels of delivery.