Health and Social Care
Victoria Atkins Excerpts(1 month, 3 weeks ago)
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Victoria Atkins
The hon. Gentleman articulates the case against Labour-run Wales with great power. There is £200 million on top of the £3 billion that we already spend on NHS dentistry in England.
[Official Report, 7 February 2024, Vol. 745, c. 264.]
Victoria Atkins
We have finite resources. As I have said, this is additional money. I have prioritised dentistry across the board, but this is £200 million of additional money—in addition to the £3 billion that we spend in England.
[Official Report, 7 February 2024, Vol. 745, c. 266.]
Letter of correction from the Secretary of State for Health and Social Care:
Errors have been identified in the responses I gave to the hon. Members for Carmarthen East and Dinefwr (Jonathan Edwards) and for Arfon (Hywel Williams). The correct responses should have been:
Victoria Atkins
The hon. Gentleman articulates the case against Labour-run Wales with great power. There is £200 million as part of the £3 billion that we will spend on NHS dentistry in England.
Victoria Atkins
We have finite resources. I have prioritised dentistry across the board. This is £200 million as part of the £3 billion, that we will spend in England.
Oral Answers to Questions
Victoria Atkins Excerpts(2 months, 1 week ago)
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Dr Alan Whitehead (Southampton, Test) (Lab)
The Secretary of State for Health and Social Care (Victoria Atkins)
The Government’s 2021 fuel poverty strategy recognised that warm homes can help to reduce health inequalities and pressure on the NHS. That is a key reason why we are delivering a package of cost support worth £3,700 per household on average from 2022 to 2025 and investing heavily in fuel efficiency.
Dr Whitehead
The recent Institute of Health Equity Marmot report highlighted the negative effects of living in cold and uninsulated homes, including respiratory and circulatory diseases and hampered lung and brain development in children. Last year, the Energy Systems Catapult and a number of NHS providers ran a trial of warm homes prescriptions, with NHS practitioners identifying vulnerable patients and supporting them with their energy needs. I think that the Secretary of State has accepted the link between cold homes and health outcomes. If that is the case, are the Government considering expanding this approach, or looking for alternative ways in which the health system and fuel poverty prevention can go hand in hand?
Victoria Atkins
The hon. Gentleman is right to say that a number of local warm homes prescription schemes have offered additional support to help people with health vulnerabilities to stay warm and well. Such schemes are excellent examples of local collaboration between the NHS, local government and other partners—tailored, of course, to the local needs of their areas—and I would be interested to see whether other parts of the NHS choose to take up these sorts of ideas in the future.
Mary Robinson (Cheadle) (Con)
Greg Smith (Buckingham) (Con)
The Secretary of State for Health and Social Care (Victoria Atkins)
We have met our manifesto commitment to deliver a record extra 50 million GP appointments annually. Our primary care recovery plan addresses increased GP access and expands community pharmacy services nationwide with Pharmacy First. Our NHS dentist reform plan also allocates resources for 2.5 million appointments, targeting rural and coastal communities.
Julie Marson
I thank the Secretary of State for her response, and I thank the Minister for Health and Secondary Care, my right hon. Friend the Member for Pendle (Andrew Stephenson), for visiting the community diagnostic centre and minor injuries unit at the Herts and Essex Hospital yesterday and all the fantastic staff there.
Frontier Estates committed to building a GP surgery as part of the wider Stortford Fields development. However, citing inflated build costs, it now questions the viability of the plans despite months of negotiations and efforts by the local NHS to find a solution. Will my right hon. Friend work with colleagues in the Department for Levelling Up, Housing and Communities, with whom I have already met on this issue, to ensure that Frontier really engages with the process and builds the surgery it promised my constituents?
Victoria Atkins
I congratulate my hon. Friend on the enormous amount of work she has done in her constituency to secure that community diagnostic centre. We have rolled out some 160 or so of those centres across England —we want to do more—and they are supplying some 6 million tests and scans for patients across England.
On the important issue that my hon. Friend raised, my officials and Levelling Up officials are already considering how primary care infrastructure can be better supported in the planning process to ease the pressure on primary care estates, particularly in areas of housing growth. I know that she will continue to be as conscientious in her campaigning on that as she is on other matters.
Greg Smith
Rural communities need local, easily accessible primary care. Since Long Crendon surgery closed during the pandemic, patients in that village and surrounding villages have been displaced, mainly to Brill and Thame, for GP appointments. For the vulnerable and those without private cars, the absence of regular bus services can mean an unaffordable £25 at least in taxis to see a GP. I have raised many times an innovative approach to building a new health centre in Long Crendon by the parish council, which has the land and the agreement by the ICB for the rent to put Unity Health in there—we just need the money to build it. Will my right hon. Friend break down every barrier to help us get that health centre built in Long Crendon?
Victoria Atkins
Again, I very much admire the effort and determination that my hon. Friend is showing to stand up for his constituents. He will know that sadly I am constrained from commenting on individual cases, but what I do know is that the innovation he is showing alongside his parish council—and, indeed, I would hope, his local integrated care board—is the approach we want to adopt across our rural and coastal communities to ensure that they, too, have the access to primary care that we all expect.
Valerie Vaz (Walsall South) (Lab)
Equal access to primary care is so important, but the use of physician associates is downright dangerous. Does the Secretary of State agree that patients have the right to see a qualified GP and not be fobbed off with a two-tier primary care system?
Victoria Atkins
I understand the concerns—we have seen them in the media—but, please, we in this House have a responsibility to our constituents and to professionals working in healthcare, including our clinicians and physician associates. In fact, physician associates have been working in the NHS for some two decades. They are there to work with doctors to assist them, freeing up doctors’ time to focus on the tasks that only they are qualified to do. We have been very careful to listen to the concerns raised, which is why we recently announced intentions to regulate them. But, please, we must all take that responsibility for ensuring that we are not spreading concern. Actually, these roles can have a very positive effect on healthcare system.
Alistair Strathern (Mid Bedfordshire) (Lab)
My constituents are fed up with battling to see a GP. I have been working hard across party lines with local councillors and the ICB, but I was surprised to hear from the Prime Minister in response to a question last week that only £2 million was allocated to my ICB for primary care, and that it should raid its hospital refurbishment budget instead. Could the Secretary of State advise me which part of the much needed hospital investment should be overlooked to compensate for the failure to invest in primary care locally?
Victoria Atkins
Again, it is for integrated care boards to assess the needs of their area. If there are concerns about access to primary care, we are keen to give them the autonomy to make decisions about how they spend their budget. We have set expectations of integrated care boards in a couple of respects—in particular, we expect them to use the money that we have provided for dental care and we have set clear expectations that integrated care boards will introduce at least one women’s health hub in their area this year.
Steve Brine (Winchester) (Con)
While we are talking about the recovery of primary care and the Secretary of State is at the Dispatch Box, the recovering access plan released last May talked about high-quality online consultation, text messaging services and online booking tools. They were due in July, but that became August and then December, and I understand that it has now been delayed indefinitely due to a claim made against NHS England in what is a £300 million project. That delay is hitting access to primary care. Will the Secretary of State update the House?
Victoria Atkins
We are determined to bring not just primary care but the whole NHS up to speed with technology. We are firm advocates of the idea that technology can help free clinicians’ time and ensure that they are spending time looking at their patients rather than at computer screens. In primary care, we are working to ensure the digital telephony services that have played such a critical role in providing those 50 million additional appointments, as I described. I will take away my hon. Friend’s points, and look into them carefully.
Daisy Cooper (St Albans) (LD)
I have been corresponding with the Primary Care Minister, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), and her predecessors about urgently needing to protect general practice locations in city centres from outdated Treasury rules that potentially force them to move to ring-road locations. The Minister’s latest reply suggested that the ICB could use capital funding to pay for new premises, but my ICB claims that that is against the rules. Would she and her officials please urgently meet me and my local ICB to bottom out what the rules are and urgently protect our city centre GP locations?
Victoria Atkins
I will ask the relevant Minister to write to the hon. Lady.
Wes Streeting (Ilford North) (Lab)
The simple fact is that the Conservatives have been in power for 14 years, and general practice has never been in a worse state. Despite slogging their guts out, GPs are struggling because this Government have cut 2,000 GPs since 2015, making it even harder for patients to get an appointment. Given that, why has the Government decided that the NHS needs what the Institute for Fiscal Studies has described as the biggest funding cut since the 1970s?
Victoria Atkins
It has been a very long time since Labour were in government, but even the hon. Gentleman knows that Ministers will never comment on fiscal events the day before they occur. Let me introduce some facts into his analysis. We have now delivered on our manifesto commitment for 50 million more general practice appointments per year, with 363.8 million booked in the last 12 months. That compares with 312 million deliveredin the 12 months to December 2019. [Interruption.] If the hon. Gentleman stopped shouting, perhaps he would be able to hear me. About 62,000 more appointments were delivered per working day last December, excluding covid vaccinations. We have our primary care recovery plan, and it is working. Of course there is more to do, but even the hon. Gentleman would not be so churlish as to deny those extra 50 million appointments.
Paul Girvan (South Antrim) (DUP)
Ms Lyn Brown (West Ham) (Lab)
The Secretary of State for Health and Social Care (Victoria Atkins)
Women’s health is one of my top priorities. As we approach International Women’s Day, we have already improved access to contraception and the treatment of urinary tract infections through Pharmacy First, announced £50 million of funding for research on maternity disparities and other health conditions affecting women, and set the expectation that each integrated care board area will have at least one women’s health hub operating this year.
Ms Brown
For more than a decade I have been raising the appalling, often agonising treatment of many women who need hysteroscopies in the NHS. They are being left with unnecessary trauma and are reluctant to engage further with doctors, which is quite simply life-threatening. However, the medical establishment continues to resist change and the Government shirk their leadership role. Earlier this year the Secretary of State set out her priorities for the women’s health strategy, and access to pain-free hysteroscopy was not included. Why?
Victoria Atkins
I thank the hon. Lady for her work in this regard, and I absolutely acknowledge the issues that women are experiencing with this highly invasive procedure at what is often an extremely distressing time in their lives. We are waiting for the Royal College of Obstetricians and Gynaecologists to update its guidelines on best practice in hysteroscopies. Following consultation last year that is under peer review, and is due to published soon. However, as the hon. Lady knows, I am clear that it should not be the responsibility of women in those very distressing circumstances to ask for pain relief. Clinicians must assume that a woman wants it, and discuss that with her before the procedure.
Theo Clarke (Stafford) (Con)
I welcome the Government’s recent refresh of the women’s health strategy and the addition to it of birth trauma. However, I am currently chairing a national inquiry into birth trauma, and we are hearing from mothers throughout the United Kingdom about some of the severe mental health conditions that they are facing, including postpartum psychosis. I have been particularly concerned to hear about the risk of suicide among new mothers. What action are the Government taking to address this?
Victoria Atkins
Let me put on record my admiration for my hon. Friend’s action in sharing her own experiences in order to improve healthcare for women across the country. She will know of yesterday’s important announcement about suicide prevention, elements of which addressed exactly the concerns that she has rightly raised. Thanks to her hard work, we have also announced that within eight weeks or so of giving birth mums will be asked by GPs whether they are okay, and we hope very much that that will open up the conversation with women who may be struggling.
Alison Thewliss (Glasgow Central) (SNP)
Amma Birth Companions has just been recognised in the 2024 GSK IMPACT awards. The charity is doing really important work to support vulnerable asylum seekers and refugees who would otherwise face giving birth alone. Will the Secretary of State meet the charity to discuss its work and research, given the disparities that continue for this group of women?
Victoria Atkins
The hon. Lady describes a very interesting piece of work. I will ask my ministerial colleague to meet the charity, as we want to support women. Indeed, part of our work across the women’s health strategy is ensuring that maternity services are not just safe, but trusted by mums-to-be.
Sir Michael Ellis (Northampton North) (Con)
With regard to healthcare for women, a gynaecologist who claimed that Hammersmith would be better if it were “Jew free” has been ruled as not racist, but merely
“comfortable with using discriminatory language”,
according to the Medical Practitioners Tribunal Service. He was merely suspended for three months and is due to start seeing patients again in a few weeks. I am concerned that this doctor may be a danger to Jewish patients. I am also concerned that the tribunal is defective and its decision is grossly unreasonable. Will the Secretary of State instruct Government lawyers to begin judicial review proceedings against the tribunal?
Victoria Atkins
I sincerely thank my right hon. and learned Friend for raising this issue. As the Prime Minister set out on the steps of Downing Street last week, there are people whose ideology and dogma are in direct conflict with our country’s shared values. Just as we will not stand for that across the country, nor will I stand for it in our NHS. I have already written to NHS England and regulators, setting out their responsibilities and our expectations of them, and I can assure my right hon. and learned Friend that I will be looking into this issue with great urgency and great care.
John Penrose (Weston-super-Mare) (Con)
The Secretary of State for Health and Social Care (Victoria Atkins)
I am committed to making our NHS faster, simpler and fairer for all, including families, which is why the Government have recently introduced baby loss certificates. Nothing can diminish the pain of losing a baby, but we hope that this formal recognition of a life lost can help families to live alongside their grief. Indeed, since we announced the launch some two weeks ago, more than 37,000 certificates have been requested by parents.
That same commitment to families is why we are rolling out Martha’s rule across England, giving patients and their families the automatic right to a rapid review of their case—24 hours a day, seven days a week. Families and carers know when something is not right or their loved one’s condition is deteriorating. Martha’s rule not only recognises this powerful instinct, but allows anyone concerned to act on it and to make sure that the NHS listens.
With your permission, Mr Speaker, for which I am very grateful, I would like to alert the House to a written ministerial statement and a detailed letter from NHS England that has been laid this morning. It addresses a historical issue whereby women who received radiotherapy above the waist to treat Hodgkin lymphoma, and who were therefore at a higher risk of breast cancer, were not given annual checks. Yesterday, the NHS wrote to the 1,487 women affected in order to inform them. We expect all women to be offered a scan within the next three months, and NHS England has established a helpline and briefed GPs and relevant charities. The vast majority of this group of women will already have been receiving screening on a three-yearly basis, but NHS England wants to ensure that they receive annual tests, in line with the clinical guidance.
I wanted to alert hon. Members to that because, with the letters having been sent out yesterday, it is perfectly possible—indeed, probable—that they will start to receive queries from their constituents. I will of course keep the House updated. I emphasise, however, that what I have given is a summary, and I would encourage hon. Members to look at the very detailed letter from NHS England in order to reassure their constituents that we are scooping up everybody we can to look after them at this very troubling time.
John Penrose
Like many people here, I was delighted by last month’s NHS dentistry recovery plan. How many new NHS dental appointments does the Secretary of State expect to be available in my constituency of Weston-super-Mare, and by when?
Victoria Atkins
I thank my hon. Friend for supporting our dental recovery plan. Indeed, he is one of many colleagues who campaigned hard for it. I am pleased to inform him that dental activity, as measured by courses of treatment, has increased by 15% on the previous year in his local integrated care board area, and our plan will support further increases to dental access through some 2.5 million additional appointments across the country, including in his constituency. The first measure, namely new patient premiums, went live on Friday, and we hope to have the results very soon.
Wes Streeting (Ilford North) (Lab)
With a general election in the air, I welcome what the Secretary of State has said about baby loss certificates and Martha’s rule—there is genuine cross-party agreement on this. I also thank her for advance notice of today’s important written ministerial statement.
However, with a general election in the air and given the Secretary of State’s principled, vocal and consistent opposition to funding the NHS by abolishing the non-dom tax status, on a scale of one to 10—one being utterly shameless and 10 being highly embarrassed—how red-faced will she be when the Chancellor adopts Labour’s policy tomorrow?
Victoria Atkins
One of the joys of being at the Government Dispatch Box is that not only do we have to deal with very serious matters, such as I have just set out, but we get to have a knockabout on the Labour party’s electioneering. The hon. Gentleman will know the Conservatives’ proud record on funding our NHS since 2010. I invite him to wait for tomorrow’s Budget to see what more this Conservative Government are doing to support our constituents, and to help our economy grow for a bright future.
Wes Streeting
The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), has said that the policy will be
“as much use as an ashtray on a motorbike.”—[Official Report, 28 February 2023; Vol. 728, c. 710.]
As she speeds down the A23 back to Lewes, to defend her constituency against the Liberal Democrats, how on earth will she feel with all those embers of the Conservatives’ 14-year record blowing in her face?
Is it not now clear that, with the Government having adopted Labour’s workforce plan, Labour’s dentistry recruitment plan and now Labour’s NHS funding plan, when it comes to a record to be proud of, and when it comes to finding the answers, only Labour can deliver an NHS that is fit for the future?
Victoria Atkins
The Leader of the Opposition is a former barrister, and barristers like to rely on evidence, so let me give some evidence on what the Labour-run NHS in Wales looks like. People are almost twice as likely to be waiting for treatment under the Labour-run Welsh NHS—21.3% of people in Wales are waiting for hospital treatment after a consultant referral, compared with 12.8% in England. Patients in Labour-run Wales are, on average, waiting five weeks longer for NHS treatment than patients in England, and the number of patients in Wales who are escaping to seek treatment in England has increased by 40% in two years. But don’t worry, folks, according to the Leader of the Opposition this is the blueprint—
Mr Speaker
Order. I remind everyone that these are topical questions. It is about the many Members I need to get in, rather than the ping-pong over the Dispatch Box. Let us move on to Andrew Jones as a good example.
Victoria Atkins
Again, I thank the hon. Lady for sharing her experience, and of course we are doing all we can. I know that the SNP Scottish Government share our determination to ensure that cancer treatment continues to improve. England is diagnosing earlier and treating more. We have seen cancer survival rates improve by almost 10 percentage points since 2005, but we also know that four in 10 cancers could be prevented, which is exactly why we are bringing forward the smoke-free generation work. Of course, if the Scottish Government would like us to help with some of their waiting lists, we genuinely stand ready to do so.
Andrew Selous (South West Bedfordshire) (Con)
George Freeman (Mid Norfolk) (Con)
Rural Norfolk is experiencing a dental crisis and a generation of children are in danger of going without dental care. I welcome the dental recovery plan, but I notice that it will be four or five years before we get more dentists. Last week, NHS Norfolk and Waveney integrated care board announced a £17 million underspend on dentistry. Will the Minister agree to meet with me and the ICB to work out how we get more money out now to help dentistry in Norfolk today?
Victoria Atkins
One of the many ways we have tackled access to dental care is to ensure that those dentists who have a contract to conduct NHS work are using them to the top of their licence. We are encouraging dentists to do that through the new patient premium and a higher rate paid for units of dental activity. There is so much more to the plan. Labour keeps trying to claim credit for our plan, but the truth is that our plan promises 2.5 million appointments while its plan promises a miserly 700,000.
Rachel Hopkins (Luton South) (Lab)
It is imperative that we tackle the scourge of mental ill health in children and young people. Labour will ensure access to mental health support in every school and establish an open-access mental health hub in every community, paid for by charging VAT on private school fees. Why will the Government not adopt that plan?
Florence Eshalomi (Vauxhall) (Lab/Co-op)
The Secretary of State will know that NHS England is expected to announce the decision about the primary children’s centre for cancer treatment in south London and south-east London. Evelina London Children’s Hospital in my constituency is one of the only specialist centres in south London. Does she agree that the final decision should be made as soon as possible in order to benefit staff, patients and families? Will she join me in visiting Evelina London?
Victoria Atkins
I thank the hon. Lady for her question. In fairness, colleagues from across the House have been raising this issue with me because it affects a large population of London and the surrounding areas. I must leave it to NHS England to finish its consultation process, but I would be very happy to visit not just the Evelina but our other wonderful hospitals that look after children.
Maggie Throup (Erewash) (Con)
Given the expansion of health services through Pharmacy First, what action is my right hon. Friend the Minister taking to ensure that communities such as Sandiacre in my constituency, whose branch of Boots is due to close at the end of the month, are not left without access to such vital services?
Mr Gregory Campbell (East Londonderry) (DUP)
On access to primary care provision, will the Secretary of State assure the House that she will liaise with Health Ministers in the devolved Departments to ensure that rural communities do not lose out because of their isolated locations?
Victoria Atkins
I am very happy to give that assurance. I was delighted to meet Minister Swann yesterday to discuss his plans for Northern Ireland healthcare, including access to primary care.
Will Quince (Colchester) (Con)
No doctor wants to be on strike, so I welcome the new deal with the consultant unions. It shows that by being reasonable, pragmatic and acting in good faith, unions can deliver for their members. Does my right hon. Friend agree?
Victoria Atkins
My hon. Friend knows only too well the importance of industrial action and the impact it can have on patients and on the NHS as a whole. I am pleased that the BMA has announced today, following the previous settlement that was narrowly rejected in its ballot, that it has been able to get back around the table with my officials and me. We have been able to find a fair and reasonable settlement that the BMA will advocate for and recommend to its members. We hope that that shows those who are choosing to strike that constructive negotiations, and trying to sort out some of the concerns that we know clinicians have, can be dealt with in a reasonable manner, which is of benefit not just to staff, but to patients.
Sir Chris Bryant (Rhondda) (Lab)
How many people were treated for acquired brain injury last year?
NHS Workforce: Revised Offer to Unions
Victoria Atkins Excerpts(2 months, 1 week ago)
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The Secretary of State for Health and Social Care (Victoria Atkins)
After re-entering negotiations with the British Medical Association (BMA) and Hospital Consultants and Specialists Association (HCSA) committees last month, during which the consultants did not take up industrial action, I am pleased to inform the House that I have made a revised formal offer to both unions, which includes a package of reforms to be applied from 1 March 2024. Both unions will recommend this revised offer to their members.
If accepted by their members, this would end the prospect of damaging strike action, benefit patients and deliver for consultants by delivering much-needed reform.
All sides returned to the negotiating table in good faith and in recognition of the narrow margin by which the initial offer was rejected. I would like to thank the unions for their co-operation and willingness to come to a swift resolution.
This demonstrates that approaching negotiations constructively and with reasonable expectations can lead to a good outcome for patients, consultants and the taxpayer.
The principles and aims of the updated offer remain the same. The Government’s position is that the headline pay uplift for 2023-24 was settled through the pay review body process. This updated offer adds further clarity and specificity, as well as addressing concerns that consultants have raised. The Government’s position remained that the headline pay uplift for 2023-24 was settled through the pay review body process.
This is a reform offer. The core contract for consultants has not been updated for 20 years and this offer will deliver reform to reflect modern ways of working, such as enhanced shared parental leave, in line with other NHS staff. It invests in modernising the consultants’ pay structure—reducing the number of pay points and the time it takes to reach the top of the pay scale.
As we originally proposed, this would make it faster for consultants to progress and help mitigate the gender pay gap, which was expressly highlighted in the independent review into gender pay gaps in medicine in England. Under the revised offer, the Government have agreed to include an uplift for consultants with four to seven years of experience, in direct response to members’ concerns.
To enable these reforms, unions have agreed to end local clinical excellence awards going forward—an employer level bonus scheme that has been seen to contribute to pay inequalities.
The updated offer reaffirms our intention to introduce pay progression arrangements, which link pay progression and evidence of skills, competencies and experience, and further clarifies how this will work in practice.
In addition, the Government will enact changes to the operation of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) to address matters raised by the BMA and HCSA. This offer sets out the detail of work to improve the process for the appointment of members to the DDRB, and revises the panel’s terms of reference.
The Government have listened carefully to the concerns of consultants and their representatives, particularly around retention, motivation and morale. This revised offer has been carefully balanced to meet those concerns while also ensuring value for the taxpayer. This offer, should it be accepted, will improve the working lives of consultants while ending the prospect of damaging strike action, which has had a detrimental impact on patients and the NHS.
The BMA and HCSA will recommend this offer to their members in a vote in the coming weeks. No further industrial action will be called while this happens.
[HCWS311]
Martha's Rule
Victoria Atkins Excerpts(2 months, 3 weeks ago)
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The Secretary of State for Health and Social Care (Victoria Atkins)
I would like to update the House on the Government’s commitment to implement Martha’s rule in England. Today we are announcing plans to implement Martha’s rule in at least 100 acute or specialist NHS sites in England by March 2025. Martha’s rule is an initiative that gives patients and their families who are concerned about deterioration in their physiological condition the right to initiate a rapid review of their case 24 hours a day from someone outside of their immediate care team.
Calls for Martha’s rule came following the tragic death of 13-year-old Martha Mills, who, after being admitted to hospital following an accident, contracted sepsis and deteriorated quickly.
Sadly, the signs of sepsis were not acted upon by doctors quickly enough, despite Martha’s family raising concerns with clinicians. Coroners found that Martha would probably have survived if doctors had identified the warning signs and transferred her to intensive care earlier.
I would like to pay tribute to Martha’s parents, Merope and Paul, who have worked tirelessly to raise awareness of what happened to Martha and to highlight the critical role that families play in recognising the signs of deterioration in their loved ones.
In September, the then Secretary of State for Health and Social Care, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), asked the Patient Safety Commissioner, Dr Henrietta Hughes, to rapidly lead work on how Martha’s rule could be implemented in England. I am grateful to Dr Hughes for her extensive engagement with system leaders and stakeholders, and for her recommendations on what Martha’s rule should look like.
While some NHS trusts already offer rapid review processes similar to Martha’s rule—called Call 4 Concern—others do not have an equivalent mechanism in place. In recognition of these variations in readiness, we are initiating a phased approach to implementing Martha’s rule.
The first phase will see Martha’s rule rolled out to at least 100 acute or specialist provider sites in England in 2024-25, supported by up to £10 million. NHS England will lead the process of identifying which acute provider sites will participate in this first phase and supporting the development of their local processes. Alongside this, drawing from the local learning from new and existing schemes, NHS England will develop proposals for national roll-out in the next spending review period.
This approach will enable significant progress to deliver Martha’s rule next year and to evaluate the additional resources needed for national roll-out.
I also look forward to working with the Patient Safety Commissioner, whom I have asked to chair a stakeholder oversight group jointly with NHS England and the DHSC. This group will build on the extensive engagement that has taken place over the last year, and will bring together patients, clinicians and external experts to provide ongoing advice to NHS England on the delivery of Martha’s rule.
[HCWS273]
NHS Dentistry: Recovery and Reform
Victoria Atkins Excerpts(3 months, 1 week ago)
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The Secretary of State for Health and Social Care (Victoria Atkins)
With your permission, Mr Speaker, I would like to make a statement on our plan to recover and reform NHS dentistry. First, though, on behalf of the entire House and my Department, I send our very best wishes to His Majesty the King. His decision to share his diagnosis will be welcomed by anyone whose life has been touched by cancer, and I know that we are all very much looking forward to seeing him make a speedy recovery and resume his public duties.
Thanks to a once-in-a-generation pandemic, 7 million patients across England did not come forward for appointments with NHS dentists between 2020 and 2022. Since then, we have taken decisive action to recover services: we have made reforms to the dental contract, so that practices are paid more fairly for caring for NHS patients with more complex needs; and we have made sure that dentists update the NHS website regularly so that the public know that they are taking on new patients. That has delivered results, with more than 1 million more people seeing an NHS dentist last year than in the year before. However, we know that too many, particularly those living in rural or coastal communities, are still struggling to find appointments. This recovery plan will put that right by making NHS dental care faster, simpler, and fairer for patients and staff. It is built on three key pillars, which I will address in turn.
First, we will help anyone who needs to see an NHS dentist to do so, wherever they live and whatever their background. To do this, we must incentivise dentists across the country to care for more NHS patients. That is why I am delighted to tell the House that for the coming year, we are offering dentists two new payments on top of their usual payments for care—£15 for every check-up they perform on NHS patients who have not been seen over the past two years, and £50 for every new NHS patient they treat who has not been seen over the same period—because we know that patients who do not have a relationship with a dentist find it harder to get care. That is not a long-term ambition: our new patient premium will be available from next month.
We are also increasing the minimum payment that dentists receive for delivering NHS treatments, which will support practices with the lowest unit of dental activity rates to provide more NHS care. However, we know that in many of our rural, remote and isolated communities, dentists themselves are in short supply. That is why starting this year, up to 240 dentists will receive golden hello payments worth up to £20,000 when they commit themselves to working in one of those areas for at least three years. These dentists will give patients the care they need faster, make dental provision fairer and tackle health inequalities.
We are also delivering dentistry to our most remote regions without delay. This year, we will deploy dental vans to more isolated, rural and coastal areas. Staffed by NHS dentists, they will offer check-ups and simple treatments such as fillings. This model has been a tried and tested success across many regions. For example, last year in Cornwall, a mobile van visited five harbours, treating more than 100 fishermen and their families. We will be rolling out up to 15 vans across Devon, Gloucestershire, Somerset, Norfolk, Suffolk, Lincolnshire, Cambridgeshire, Dorset, Cornwall, North Yorkshire and Northamptonshire. This move has been welcomed by Healthwatch, the Nuffield Trust and the College of General Dentistry. We will let patients know when vans will be in their area, so they can get the care they need faster.
These reforms will empower NHS dentists to treat more than 1 million people and deliver 2.5 million more appointments. As the chief executive of National Voices, a group of major health and care charities, said:
“This extra money…should help thousands of people who have been unable to see a dentist in the last two years to get the care they need.”
These reforms are just the beginning. This recovery plan will also drive forward reforms to make NHS dentistry sustainable for our children and our grandchildren.
That brings me to the second pillar: growing and upskilling our workforce for the long term. Our long-term workforce plan, the first in NHS history, gives us strong foundations on which to build. By 2031, training places for dentists will increase by 40%—forty per cent—and places for dental hygienists and therapists, who can perform simple tasks such as fillings, will also rise by 40%. More dentists and more dental therapists will mean more care for NHS patients.
I am delighted to tell the House today that we are going further in three key ways. First, we will consult on a tie-in to NHS work for dentistry graduates, because right now too many are choosing to deliver private work over valuable NHS care. More than 35,000 dentists in England are registered with the General Dental Council, but last year almost a third worked exclusively in the private sector. Training these dentists is a significant investment for taxpayers, and they rightly expect it to result in the strongest possible NHS care. That is why, this spring, we will launch a consultation on a tie-in for graduate dentists and how this could deliver more NHS care and better value for taxpayers.
Secondly, we will take full advantage of our dental professionals’ skills. Today, even though they have the right training, without written direction from a dentist dental therapists cannot do things such as administer antibiotics. This year, we will change this, making life simpler for dentists and making care faster for patients. As the president of the College of General Dentistry has said, the
“use of the full range of skills of all team members will enable the delivery of more care and make NHS dentistry more attractive to dental professionals.”
Thirdly, we will recruit more international dentists to the NHS. We have a plan to do this by working with the General Dental Council to get more international dentists taking exams and to get them on to the register sooner, and to explore the creation of a new provisional registration status so that, under the supervision of a dentist who is already on the register, highly skilled international dentists can start treating patients sooner, rather than working as hygienists while they are waiting to join the register.
I turn now to our plan’s third pillar, which is prioritising prevention and giving children a healthy smile for life. This begins by supporting parents to give their children the best possible start. That is why family hubs up and down the country will offer parents-to-be expert advice on looking after their baby’s teeth and gums. As those babies grow up, we will support parents and nurseries in making sure that before every child starts primary school, brushing their teeth is part of their routine.
The evidence is clear: the earlier good habits are built, the longer they will last. Seeing a dentist regularly is vital for children’s health, but since the pandemic, too many have been unable to do that. That is why this year we are taking care directly to children. We will deploy mobile dental teams to schools in areas with a shortage of NHS dentists. They will apply a preventive fluoride varnish to more than 165,000 reception-age children’s teeth, strengthening them early and preventing decay. Our Smile for Life programme has already been endorsed by the College of General Dentistry.
Six million people in England already benefit from water fluoridation. In order to go further in protecting children’s teeth, we will consult on strengthening more of our country’s water with fluoride. Again, the evidence is clear: in some of the most deprived parts of England, enhancing fluoride levels could reduce by up to 56% the number of teeth that are extracted because of decay. That is why, through the Health and Care Act 2022, we have made it simpler to add fluoride to more of our water supply. As a first step, this year we will launch a consultation on expanding water fluoridation across the north-east—an expansion that would give 1.6 million more people access to water that strengthens their teeth, preventing tooth decay and tackling inequality.
This is our Government’s plan to recover and reform dental care: dental training places up by 40%; 2.5 million more appointments; dental vans treating more patients; more dentists in remote areas; more dentists taking on NHS patients; better support for families and better care for children; patient access up and inequity coming down. It will make life simpler for staff, and treatment faster and fairer for patients and staff. We have taken the difficult decisions, and we have now delivered a long-term plan to make dental care faster, simpler, and fairer for people across the country. We are going to get on with the job and put our plan into action, and I commend this statement to the House.
Wes Streeting
Don’t worry, Mr Speaker: I will come back to the Parliamentary Private Secretary shortly. Tooth decay is the No.1 reason for children aged six to 10 being admitted to hospital. Unbelievably, there have been reports of Ukrainian refugees booking dentist appointments back home and returning for treatment, because it is easier to fly to a war-torn country than it is to see an NHS dentist in England. Well, at least one Government policy is getting flights off the ground—and it is certainly not the Government’s Rwanda scheme failure.
Let us look at the human consequences of this Conservative tragedy. Labour’s candidate in Great Yarmouth, Keir Cozens, told me about Jeanette, a young woman in her 30s who has struggled with gum and mouth problems all her life. She used to be able to get treatment; now she cannot find an NHS dentist in all of Norfolk to take her. She cannot afford to go private. It hurts to smile, it hurts to laugh, and the pain is so great that Jeanette does not go out anymore. Just this week, she resorted to trying to remove her tooth herself. That is not right for anyone of any age, but Jeanette should be in the prime of her life. Will the Secretary of State apologise to Jeanette and the millions like her for what the Conservatives have done to NHS dentistry?
After 14 years of neglect, cuts and incompetence, the Government have today announced a policy of more appointments, recruiting dentists to the areas most in need and toothbrushing for children. It sounds awfully familiar. They are adopting much of Labour’s rescue plan for dentistry. Does that not show that the Conservatives are out of ideas of their own, and are looking to Labour to fix the mess they have made? I say: next time Conservative Ministers say that Labour does not have a plan, or that Labour’s plan is not credible, don’t believe a word of it.
There are some differences between our two parties’ approaches. Labour is pledging an extra 700,000 urgent and emergency appointments, which are additional to the appointments announced today. Can the Health Secretary confirm that the Government’s plan does not provide any additional emergency support? Labour proposed supervised early-years toothbrushing, and Conservative MPs accused it of being “nanny state”. Does the Health Secretary stand by that label, or does she now support children under five being supported in brushing their teeth?
The key difference is that we recognise that our plan is a rescue plan, and that to put NHS dentistry back on its feet, immediate reform of the dental contract is needed. Without that, the Government’s plan is doomed to fail. Do not just take my word for it; the British Dental Association has said that the plan will not stop the exodus of dentists from the NHS, will not provide a dentist for every patient who needs one, and will not put an end to this crisis.
I come to the Parliamentary Private Secretary, the hon. Member for North Norfolk (Duncan Baker), and the miserable script that the Whips are spreading out on the Table. If Labour’s contract is to blame, why have the Government not reformed it in 14 years, and why are they not reforming it now? In 2010, the Conservatives promised in their election manifesto to reform the dental contract. They are bringing back not just Lord Cameron, but his broken promises. People have been desperately trying to get dental care for years, but there was nothing from the Conservative party. Now that we are in an election year, the Conservatives are trying to kick the can down the road, and are scrambling for a plan. They only discover their heart when they fear in their heart for their political futures, and the consequences have been seen: queues around the block in Bristol.
Finally, the Secretary of State is promising reform after 2025 and after the next general election. Who is she trying to kid? After 2025, the Conservatives will be gone, and if they are not, NHS dentistry will be. How many more chances do they expect? How many more broken promises will there be? We had 2010, 2015, 2017 and 2019. Their time is up, and it is time for Labour to deliver the change that this country needs.
Victoria Atkins
I tried to help the hon. Gentleman by giving him an advance copy of my speech yesterday, yet that was his speech. This Government are focused on delivering for patients. Perhaps I can help him understand the difference between the Opposition’s proposals and the Government’s fully funded dental recovery plan. The Opposition’s ambitions reach only as far as 700,000 more appointments. Our plan will provide more than three times that number of appointments across the country—that is 2.5 million, to help him with his maths. We are offering golden hellos to 240 dentists who will work in hard-to-reach and under-served areas; their proposals cover only 200. They have no plan for training more dentists; we set out in the long-term workforce plan last year, and again in the dental recovery plan, that we will increase training places for dentists by 40% by 2031.
Then we have the centrepiece of the Opposition’s proposals: making teachers swap their textbooks for toothbrushes—an idea that is hated by teachers and that patronises parents. We believe that most parents do a great job of looking after their children. I know that the Labour party does not agree with that; the hon. Gentleman called our children short and fat on a media round. We believe that most parents do a great job, and that is why we support pregnant mums-to-be, and support parents in family hubs and nurseries. We will not wait until reception class, by which time children have already got their teeth.
I want to dwell on the experience of anybody living under Labour in Labour-run Wales. Health services in Wales are devolved, and the Leader of the Opposition has called Wales “the blueprint” for how the Opposition will run our health system. Welsh Labour has the highest proportion of NHS dental practices not accepting new adult patients, and the joint highest proportion of those not accepting new child patients. In Wales, 93% of NHS dental practices are not accepting new adult patients. That is a higher figure than for any other nation in the UK. Some 86% of practices there are not accepting new child patients, which is the joint highest figure with Northern Ireland. Our plan is fully funded, but how will Labour pay for its plan? By using the magical money tree. The list of policies funded by the non-dom policy is as long as my arm. In 2022, it promised to fund a workforce plan. Last September, it became breakfast club meals. By October, it morphed into 2 million appointments and scanning equipment. By Christmas, it was funding a dentistry plan. It is the same old Labour: it has no plan.
Sir Peter Bottomley (Worthing West) (Con)
The House enjoyed the words of the Opposition spokesman, the hon. Member for Ilford North (Wes Streeting), although I am not sure how many he wrote himself; some may have seemed rather familiar to anyone who read Matthew Parris this morning on going to Ukraine to have a filling fixed.
In West Sussex, in Worthing and Arun, we want the same situation found in parts of London, where dentists have a sign saying, “New NHS patients welcome”. Has the Secretary of State been working with the British Dental Association and the General Dental Council to bring forward registrations, to get incentives right, and to make sure that dentists are no longer told, “You can’t serve any more patients because you will go above your limits”? Can she confirm that we are taking limits off, so that dentists, especially the young ones, can do as much work as they can, and can help as many patients as possible, so that we can get back to the situation that we were in before Labour changed the rules about 20 years ago?
Victoria Atkins
We have focused this plan on introducing the new patient premium—a bonus for new patients. Having discussed this carefully with professionals, we think that is one way that we can incentivise people into NHS practice. Dentists can already work up to 104% of the contract. Many do that, but some sadly do not, so we are trying to encourage those dentists who already have NHS contracts to go the extra mile and use the full slot available to them.
Rachael Maskell (York Central) (Lab/Co-op)
The Health and Social Care Committee took months gathering evidence and putting together a recovery plan, which the Government should have adopted. Dentists wanted that plan put in place. Central to it was reform of the NHS dental contract. However, the Secretary of State has completely failed to even mention reform of that contract. As a result, dentistry in my constituency in York, where constituents are waiting seven years to see a dentist, will not have the recovery that she talks about. Why did she not adopt our plan?
Victoria Atkins
I hope the hon. Lady will, as usual, be the help that I expect her to be to her constituents in publicising this plan. We are getting graphics and information out to all Members of Parliament, so that they can help their constituents understand what will be available in their area, because each and every one of us wants the very best for our constituents. She will be interested in the new patient premium, which is encouraging dentists back into NHS practice, or into NHS practice for the first time, and in the increased price for units of dental activity. Reform of the dental contract is part of our agenda, but we realised that we needed to give immediate help to communities such as hers.
Steve Brine (Winchester) (Con)
I welcome the plan. Recovery and reform is right, and the Select Committee will study the plan carefully. The dental Minister, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), has already been invited to come before us, so that we can talk it through with her to see whether it reflects our aforementioned report on the subject. The golden hellos, the toothbrushing for pre-schoolers—as long as the workforce can handle it—and the mobile vans are good, but even a day longer of a contract focused on units of dental activity is a problem. Can the Secretary of State say how she plans to entice professionals into returning to NHS dentistry? So many have left, and that is key.
Victoria Atkins
Very much so, and that will be primarily through the patient premium, which will mean that from next month dentists will be able to turn their signs from “closed” to “open” for NHS patients. We wanted to use levers that could be deployed immediately in order to help our constituents.
Daisy Cooper (St Albans) (LD)
It is estimated that more than 12 million people are waiting for dental treatment, but the Government’s announcement says that it will help just 1 million. The Government’s underspend last year was £400 million, and it is expected to be the same this year, but only £200 million has been announced. This plan is a drop in the ocean. In St Albans, my dentists are desperate to provide NHS care, and my constituents are desperate to see a dentist. At the heart of the problem is the broken contract. Will the Government take up the Liberal Democrats’ plan to reform the contract and provide guaranteed access to an NHS dentist for everybody needing urgent and emergency care?
Victoria Atkins
I heartily recommend the recovery plan to the hon. Lady, because it offers 2.5 million more appointments and has a long-term ambition for the prevention of tooth decay in children. In addition, it has that long-turn vision about increasing training places for our dental professionals by 40% by 2031.
Sir Paul Beresford (Mole Valley) (Con)
As you are aware, Mr Speaker, I have a declared interest in this particular topic.
As my right hon. Friend the Secretary of State is aware, dentistry in England is a seller’s market. It is estimated that there are 5,000 dentist vacancies in England. When I came here in the early ’70s with my dental degree, like very many colleagues from Australia, New Zealand and so on, I presented at the General Dental Council, who said “welcome” and stamped my hand, and I went off and worked on the national health service the next day.
Now, and for decades, the General Dental Council has required graduates from world-class dental schools—every bit as good as the ones we have here—to wait, to pay and to sit what is called an overseas registration exam. Currently, the waiting list for the exam is 2,000 overseas dental graduates, many of whom are every bit as good as those we produce in this country. The GDC could change that overnight by accepting graduates automatically from known and trusted international schools. Will my right hon. Friend please have a small chat with the chairman of the General Dental Council?
Victoria Atkins
I thank my hon. Friend and recognise the enormous expertise he brings to the Chamber on this matter. He knows—he has genuinely talked to me about this on many occasions—the important role that the General Dental Council plays to ensure that we get international dentists registered as quickly as possible. I very much look forward to discussing that with the GDC so that we can get more international dentists on to our register and working in our practices.
Judith Cummins (Bradford South) (Lab)
I welcome much in the plan, which mirrors many of my ideas over the years, and indeed much in Labour’s plan. However, on access, the Government claim that the recovery plan will deliver care for up to 2.5 million people, but Government data shows that 12 million people in England have unmet dentistry needs, which leaves about 9.5 million people without an NHS dentist. That includes my constituent Beverley Kitson, who has osteoporosis and takes alendronic acid as treatment. The drug has damaged her teeth, and she now requires a check-up every three months after four of her teeth have decayed to such an extent that they need to be extracted. Beverley has been with the same dental practice for 50 years, but she has just been told that it is going fully private, leaving her without an NHS dentist. Will the Secretary of State guarantee Beverley that she will be able to access an NHS dentist under these plans?
Victoria Atkins
We have very much tried to ensure that dentists who already hold NHS contracts will keep them and keep working them. That is why we have fallen upon the new patient premium to make it more in their financial interests to take on new patients. I appreciate the hon. Lady’s point about retention, which, again, we are looking to address through the increase in the UDA. But we all acknowledge that dentists are independent contractors, so we must ask them—and particularly those who are new dental graduates—to do their bit and help our NHS out.
Maggie Throup (Erewash) (Con)
A number of NHS dentists across Erewash have recently retired, leaving a cohort of my constituents without access to NHS dentistry. Unfortunately, practices are finding it really difficult to recruit replacements for the retirees. How will the plan help speed up that recruitment so that my constituents are not without NHS dentistry for much longer?
Victoria Atkins
May I thank my hon. Friend for all the work she did in the Department and has done on this subject? We are taking a long-term view with training dentists. As I said, last year, through the long-term workforce plan, we set out an ambition to train up to 40% more dentists by 2031. As we also begin the consultation on a tie-in with those graduates, we are confident that we will see a greater supply of dentists to our NHS services.
Mrs Paulette Hamilton (Birmingham, Erdington) (Lab)
The £200 million pledged today is less than half last year’s record-breaking underspend. The plan says that any underspends will be ringfenced for dentistry. That was promised by a Minister last year, but it did not happen because integrated care boards were using that underspend. Why should the 73% of dentists in the west midlands who cannot and are not accepting any new patients believe it will be any different this year?
Victoria Atkins
The hon. Lady alights on an important fact that is sometimes lost in this debate: although an NHS dentist may have an NHS contract, they may not work the whole of that contract. Some NHS dentists very much do so; others work a fraction of it. We are trying to encourage dentists who do not use their full contract to do so, because that in itself will bring in more patients. We are confident that alongside the new patient premium, that will help constituents such as hers to get the treatment they need.
John Redwood (Wokingham) (Con)
Wokingham has a fast-growing population based on building a lot of new homes. So as the Secretary of State rolls out her new plans, will she also ensure that there are incentives to provide dental services on the NHS in areas where a population is moving in and needs them?
Victoria Atkins
My right hon. Friend raises an interesting point. Indeed, that is exactly the sort of discussion I am having with my right hon. Friend the Levelling Up Secretary, because I am really interested in having that connected and joined-up approach between planning and health. I think it could bring dividends for us all.
Barbara Keeley (Worsley and Eccles South) (Lab)
I do not believe that what the Secretary of State has described will deal with the complexity of dental problems out there. I have a constituent who was referred to the Manchester Dental Hospital for a possible abscess and was told that even an urgent referral would take a month. In fact, the dental hospital did not get back to her for five months after the referral; it offered her a telephone consultation. The amount of pain and infection meant that she had to seek private treatment at a cost of £4,000, but many cannot afford that, including the young man wheeled into Royal Bolton Hospital in great pain, leaking blood on the floor after trying to remove a painful tooth with pliers. What does the Health Secretary say to patients who have long-standing and complex dental problems and are paying the price by waiting in pain, paying for private treatment or trying to remove their own teeth?
Victoria Atkins
I take that constituency case very seriously. I am really keen to urge the hon. Lady that if a constituent contacts her in future with that level of discomfort and pain, she should advise that constituent to contact 111 and, if necessary, go to accident and emergency—[Interruption.] Labour Members are shaking their heads, but what she has just described is a serious situation. That constituent needs medical attention, and the NHS is there, ready and willing to help. That is the advice that she should be giving her constituents, and I hope that she takes it as seriously as I do. [Interruption.]
Madam Deputy Speaker (Dame Eleanor Laing)
Order. The Secretary of State was giving an answer to a question. We do not need all this shouting. People might not agree with the answer, but you have to listen to the answer.
Sir John Hayes (South Holland and The Deepings) (Con)
In congratulating my right hon. Friend—my personal friend—on this welcome, excellent statement, may I ask her to forgive the ferocity with which my right hon. Friend the Member for Gainsborough (Sir Edward Leigh) and I made the case for NHS dentistry when we met her recently? In that spirit, will she ensure that some of these new dentists come to rural Lincolnshire, where we desperately need good dental care? She has today irrigated the dental desert.
Victoria Atkins
I give my very sincere thanks to my right hon. Friend. The House can imagine the advocacy I have received from both him and my right hon. Friend the Member for Gainsborough (Sir Edward Leigh). On reaching rural and coastal areas, as a proud Lincolnshire MP myself I wanted to bring about a set of plans that will address those underserved areas. I am delighted that the plan meets with my right hon. Friend’s approval.
Sir George Howarth (Knowsley) (Lab)
The Secretary of State will be aware that the NHS dentistry crisis has been 14 years in the making. She will also be aware that it is impossible for anybody in Knowsley today to sign up with an NHS dentist. The measures the Secretary of State has described may, over time, help to meet the problem, but what advice would she give today to my constituents who cannot get an NHS dentist?
Victoria Atkins
The advice and guidance to dentists will be going out today, while the new patient premium that I have told the House about will come in from March—it is weeks away.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
I thank my right hon. Friend the Secretary of State for an excellent statement and an excellent plan. It is exactly what patients in Suffolk have been waiting to hear—the rural payment, the bonus there and the mobile service. I am conscious that many dentists have chosen not to have more patients, and they might blame the contract—this, that or the other. That is why I welcome her plan about potentially tying in graduates to the NHS. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) has already referred to the General Dental Council, which, in my view, has not taken full advantage of the regulations that came into force last March. Will the Secretary of State also look at the NHS’s own rules that further restrict the rapid supply of dentists into the NHS for our constituents?
Victoria Atkins
I thank my right hon. Friend for all the work she did on dentistry in the Department. I am conscious that many people have contributed to this plan; I am grateful to her and others. Again, I hear the observations on the General Dental Council, and will ensure that the GDC hears them as well. That is a fair challenge to the NHS. Colleagues will see that the plan is co-signed by NHS England, which shares our ambition to deliver those 2.5 million more appointments and set up the future of NHS dentistry for our country.
Christine Jardine (Edinburgh West) (LD)
Today’s statement by the Health Secretary will have been listened to with great interest by my constituents in Edinburgh West, who share a lot of the same concerns, face the same difficulty getting NHS dental treatment and will be looking for the same sort of solution as constituents in England. Could the Secretary of State clarify for me, and for all those who come to me, whether there will be Barnett consequentials? If there are, will she impress upon the Scottish Government the need to ringfence the money and actually invest it in dental services? If not, would she be willing to share with the Scottish Government how she is approaching the problem in the hope that they might actually respond and do something?
Victoria Atkins
I hear the frustration in the hon. Lady’s question. This is a devolved area—as it is in Wales—and is therefore a matter for the Scottish National party. I assume the hon. Lady will continue her usual advocacy on behalf of her constituents to ensure that the SNP looks at what is happening in England and tries to do better for Scotland.
Neil O’Brien (Harborough) (Con)
I really welcome this plan; I welcome the extra £200 million, the new patient bonus, the measures to get dentists into areas that do not have them and the minimum UDA. These are all good things that will help people in Harborough, Oadby and Wigston to get a dentist. Can I ask the Secretary of State to press on with two things? The first is the move to a proper national funding formula. Dentistry is the only part of the NHS without a funding formula, which disadvantages shire and coastal areas with older populations. The second is the next round of contract reform—the move to band 2b is working, and dentists are using it, but there are patients with complex cases for whom a capitation-like payment would be much better, as the British Dental Association pointed out. I encourage the Secretary of State to start working on that difficult group so that we can get extra help for them too.
Victoria Atkins
I must thank my hon. Friend for all his work. I know how much how much effort and commitment he has put into these plans, and it shows the genuine—[Interruption.] Sorry; the hon. Member for Ilford North (Wes Streeting) is being a little ungracious. My hon. Friend the Member for Harborough (Neil O’Brien) has been part of the united work across Government to deliver these plans. I very much take on board his recommendations and encouragement. As I say, we see this plan as delivering 2.5 million more appointments for our constituents, but of course we want to look to the long term as well.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Is the Secretary of State aware that Rip Van Winkle fell asleep for 20 years? This Conservative Government have been asleep for even longer than that, as far as dentistry is concerned. Will the Secretary of State now wake up and talk to real working dentists, such as Phil Lucitt—one of my excellent NHS dentists in Huddersfield, who is in the Gallery with his wife today—and get something done about this crisis? It is a crisis in Huddersfield, as in every town in this country, such as Bristol, as we heard yesterday. People are in pain, people are suffering, and for 14 years her Government have done little about it.
Victoria Atkins
I must admit that I did not know quite where that question was going, but I think the hon. Gentleman is urging me to speak to dentists. I am delighted to reassure him that my ministerial officials and I do of course speak to dentists. In fact, only today I was at a practice in the heart of Westminster, speaking to a dental manager who welcomes this plan. I will veer away and resist the temptation to comment on Rip Van Winkle.
Peter Gibson (Darlington) (Con)
I welcome this dental recovery plan, which will help to deliver dentistry in Darlington. Can my right hon. Friend the Secretary of State provide me with advice on what more I can do to get my integrated care board to get on with the commissioning at Firthmoor community centre, which lost its dentistry practice 10 months ago? In looking to expand the number of dental training places, I urge the Secretary of State to look at Teesside University, which has ambitions to build on its existing dental technology provision and train the Tees Valley dentists of tomorrow.
Victoria Atkins
Thanks to the work of my hon. Friend and others, Tees Valley is a powerhouse of growth industries, as exemplified by the Chancellor in his Budget and autumn statements recently. I will take away my hon. Friend’s words of advice about his university. On the point about encouraging ICBs to take part in this work, as this plan is a joint document with NHS England, the expectation will be on ICBs to deliver the plan, because they exist to look after our constituents. This plan is one of the ways we will be able to secure that help.
Mohammad Yasin (Bedford) (Lab)
In Bedford and Kempston, like many areas in the country, we have a dental crisis. I have raised the matter of dentistry previously, including in a Westminster Hall debate. There can be no question but that under this Conservative Government there is a dentistry crisis and the people of this country have been failed. Why does the Health Secretary refuse to admit that 14 years of neglect and underspending have led us to this?
Victoria Atkins
Says the script. I assume the hon. Gentleman will welcome the 2.5 million more appointments that this dental recovery plan will deliver for all our country.
Mrs Heather Wheeler (South Derbyshire) (Con)
I thank my right hon. Friend the Secretary of State for this brilliant statement, and thank all the team for their huge amount of hard work. Today is dentist day—yesterday was dentist day for me, as I had an appointment with the Minister and an appointment with a real dentist from South Derbyshire. This news is absolutely superb. Will the Secretary of State get dentists to move to South Derbyshire, and ensure more free NHS dentistry there?
Victoria Atkins
I have no doubt that with my hon. Friend’s characteristic joy and as an irresistible force of nature, she herself will be an advert for dentists to come to work in her constituency.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
A constituent recently told me that when she tried to register members of her family with an NHS dentist, she was told that there was an eight-year wait. We know that workforce is a really big issue. On that basis, will the Secretary of State meet me and a cross-party group of Members of Parliament to talk about how we could develop a dental school at the site of the excellent Hull York Medical School to grow our own dentists for the future?
Victoria Atkins
The right hon. Lady will know that part of the focus of the long-term workforce plan is to train people where they are most needed. I will happily arrange for her to meet the relevant Minister. On registration, the current system is not like a GP practice where, once a family is registered, they can only go to that GP. The whole reason that we have been encouraging dentists to update their details on the NHS website is so that people can move around to visit different dentists to get the treatment they need. Today’s plan will help turbocharge those efforts.
Peter Aldous (Waveney) (Con)
I welcome this recovery plan, which provides the foundation for putting NHS dentistry on a sustainable long-term footing. I urge my right hon. Friend to continue her negotiations to replace the existing NHS dentistry contract as soon as possible, and to provide funding to the Norfolk and Waveney integrated care board so that the University of Suffolk can open a new treatment and training facility in our area, to replicate the innovative service that is about to open in Ipswich.
Victoria Atkins
I understand my hon. Friend’s point, and I commend him for his work to ensure that his constituents receive the care and help that they deserve. On training, I hope he has drawn out from the plan the emphasis that we are putting on long-term ambitions. We understand that we need to train more dentists and get internationally trained dentists registered in our system. We recognise the critical role that dental hygienists and therapists can play as well.
Clive Efford (Eltham) (Lab)
If the Tories cared about the NHS, we would not have 7.6 million people on the NHS waiting list and dentistry in crisis. The answer that the Secretary of State gave to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) demonstrates why we are in this situation. It is not about people turning up at A&E; the inability to access NHS dentistry services leads to people being in a crisis situation and needing emergency care. After 14 years of the Tory Government, why do we need a recovery plan for dentistry?
Victoria Atkins
The hon. Gentleman was obviously asleep at the beginning of my statement, because I set out what I hope is a fact agreed across the House about the pandemic—the real problem. People who had a relationship with a dentist before the pandemic do not face quite the same pressures as people who may have moved home or whose dentist may have moved practice. That is the cohort of people who we are trying to help. It really would help if Labour Members focused their arguments a little more on the facts, rather than on the scripts that their Whips have given out.
Andrew Lewer (Northampton South) (Con)
I very much welcome this statement and the meetings I have had with my neighbour, the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). The Secretary of State said that Northamptonshire will be included in a dental van roll-out, which is welcome, but the rest of the statement had a very rural focus. She will recall that my Prime Minister’s question focused on shortage in Duston. Is it at least a possibility that vans will go to suburban areas as well as rural ones?
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.
Paul Bristow (Peterborough) (Con)
I have a plan to open a brand-new NHS dentistry practice in Peterborough. New financial incentives, increased UDA rates and recruitment of overseas dentists to Peterborough are all part of that plan. Will my right hon. Friend meet me and those who want to open new NHS dental clinics in Peterborough, so that we can take advantage of every part of her excellent plan?
Victoria Atkins
I commend my hon. Friend for his excellent work as a constituency MP. It is exactly that sort of drive and ambition that will deliver results for his constituents. I would be delighted to meet him to discuss his plans, and I am pleased that our national dental recovery plan will fit well with his own local delivery plan.
Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)
I regret to inform the House that the situation in west Wales is quite catastrophic, and recent reforms by the Welsh Government have probably made matters far worse. However, my constituents and I would like to know how much of what the Secretary of State has announced today is new money, resulting in Barnett consequentials for the Welsh Government.
Victoria Atkins
The hon. Gentleman articulates the case against Labour-run Wales with great power. There is £200 million on top of the £3 billion that we already spend on NHS dentistry in England
Siobhan Baillie (Stroud) (Con)
I have raised dentistry a lot, because Stroud constituents and dentists have been really worried, so I welcome the Government’s plans with NHS England. I give credit to Gloucestershire ICB, which recognised the complexity of this issue. Post pandemic, it set about raising provision and we have decent take-up so far. My plea to the Secretary of State and to the Under-Secretary of State for Health and Social Care, my right hon. Friend Member for South Northamptonshire (Dame Andrea Leadsom) is to continue their relentless focus on prioritising children’s appointments, and not to let parents off the hook, because we can all do better even if it is hard to get a toothbrush in a three-year-old’s gob every night. Will the Secretary of State say more about how ICBs will be supported to deliver the plans and integrate the work that they are already doing? The local areas that are prioritising this are making a difference.
Victoria Atkins
My hon. Friend was probably summing up this morning’s toothbrushing ahead of the school run for many mums and dads up and down the country. That is the point—we want to work with parents. We do not want to patronise them. The overwhelming majority of parents do a great job looking after their kids’ teeth. Our plans are to support those who are struggling. The expectation on ICBs is clear. The plan is a document between NHSE and us. We want to deliver this plan at local level. Expectations will be set on ICBs to make sure that they fulfil the potential of this great plan.
Justin Madders (Ellesmere Port and Neston) (Lab)
I welcome this long overdue focus on dental access. I am particularly interested in the 240 golden hellos that will be available. Clearly, they will be inadequate to deal with the scale of the challenge. I am also concerned that the focus of the statement seems to be on putting those golden hellos in rural areas. Visibility and transparency are needed about where they are allocated, because places such as Ellesmere Port have exactly the same issues as other areas in the country. We get phone calls every week from constituents asking where they can see an NHS dentist. We are not able to send them anywhere at the moment. Is the Secretary of State able to guarantee that in future we will be able to send them somewhere?
Victoria Atkins
I hope the hon. Gentleman will publicise the new patient premium, because that is one of the levers through which we will unlock places for new patients. I remember that he has taken an interest in this issue. I very much understand the point about location. We have set strict criteria for how dental vans will be deployed, but the new patient premium is across the country. We want as many people as possible to see NHS dentists and fill those 2.5 million more appointments.
Martin Vickers (Cleethorpes) (Con)
I particularly welcome the initiative to improve services in coastal and rural areas. The Health Secretary and I are constituency neighbours, and she will know the complexities of delivering local services in what we know as greater Lincolnshire, because her constituency is in the east midlands and mine is in Yorkshire and the Humber. Can she guarantee that the whole of greater Lincolnshire, from the south of the county up to Barton-upon-Humber, will receive the benefits of the new proposals?
Victoria Atkins
I am delighted to inform my hon. Friend and neighbour that the new patient premium applies across England, and of course people can move to the dental practice that can offer them the services they need, so I trust that his constituents will be as happy as mine.
Hywel Williams (Arfon) (PC)
Is the £200 million additional, in the sense of being diverted from other parts of the NHS in England, or is it new money from the Treasury that would attract the Barnett consequentials for Wales, Scotland and Northern Ireland? Which is it?
Victoria Atkins
We have finite resources. As I have said, this is additional money. I have prioritised dentistry across the board, but this is £200 million of additional money—in addition to the £3 billion that we spend in England.
Sir Jeremy Wright (Kenilworth and Southam) (Con)
I welcome what my right hon. Friend has said, and I understand why some of the new resources that she has announced are directed at particular types of intervention and particular groups of patients, but does she agree that one of the downsides of such an approach, at least potentially, is the extra administration that will obstruct dentists in the effective delivery of that resource? Will she therefore ensure that the funds are easily accessible, and that there is no such extra administration that would make that more difficult? Does she accept that longevity and consistency of funding matters, because it enables dentists to plan properly for their patients?
Victoria Atkins
My ethos is to make our NHS and social care system faster, simpler and fairer, and not just for patients but for practitioners. We do not want bureaucracy to get in the way of the delivery of these services, and I am impatiently keen to get them up and running in Members’ constituencies, so we will ensure that we make it is easy as possible for dental practices to use them.
Alistair Strathern (Mid Bedfordshire) (Lab)
I am sure that fellow former teachers who are here today will have memories of the disappointment they felt when, after repeated delays and excuses, a student finally handed in some work, only for it to turn out to be not just a copy of someone else’s work, but a pretty poor one at that. After so much delay and uncertainty, dentistry is at breaking point, so any progress, however late, has to be welcomed. But every local professional network I have met has stressed the need for fundamental reform of the dental contract so that things can get done. Given that this Tory Government have been in place for 14 years, why will the Minister not commit herself to finally reforming the contract and providing the boost to dentistry that my constituents so desperately want to see?
Victoria Atkins
I think it is very courageous of any Labour Member of Parliament to talk about education, because we know just how dire the education results are in Labour-run Wales. Yes, I have committed to reform of the dental contract, and we will deliver these services immediately because we want to deliver results for the hon. Gentleman’s constituents as well as ours.
Selaine Saxby (North Devon) (Con)
I thank my right hon. Friend for securing this vital plan, and I also thank her team for their ongoing engagement in what has been a difficult issue in my constituency since long before the pandemic. I cannot wait to see a dental van in South Molton and Ilfracombe, and to welcome new dentists to Barnstaple, Braunton and beyond. However, I recognise that this will take time. We have recruitment challenges despite our staggeringly beautiful surf beaches, which extend far beyond my right hon. Friend’s Department. Given her success in securing today’s announcement, might she be able to help me to promote these new dentistry opportunities to attract those who may not have previously considered spectacular, if remote, North Devon to be their future?
Victoria Atkins
My hon. Friend is exactly right. She is a wonderful constituency Member who speaks up for her constituents, and I can assure them that she has been talking to me since the moment I was appointed. As for advertising the new services, this is an opportunity for Members across the House—and I do hope that Opposition Members will be gracious—to ensure that their constituents are aware of them. We all want the best for our constituents, and the more we encourage local dentists to take up the new patient premiums and units of dental activity as well as the golden hellos, the sooner we will all see benefits in our constituencies.
Imran Hussain (Bradford East) (Lab)
For nearly a decade, I have stood in this Chamber and told numerous Ministers that there is more chance of finding gold bricks on the streets of Bradford than there is of getting an NHS dentist when you need one. For 14 years, Ministers have made a political choice to ignore our calls, but now, in a general election year, the Government suddenly want to take part of Labour’s plan and present it as their own—frankly, it is shameless. Will the Minister at least accept that unless there is proper reform, our NHS dentistry will remain rotten to the core?
Victoria Atkins
Again, we have heard a very loud performance from the hon. Gentleman—a typically loud performance. If only it had been as factual as it was loud. I have already set out, in response to the hon. Member for Ilford North (Wes Streeting), the difference between Labour’s plan and our fully funded plan to secure immediate and long-term changes. After 14 years of opposition, is this it?
James Sunderland (Bracknell) (Con)
As the Health Secretary will recall, we met recently to discuss dentistry in Bracknell, so I really welcome the plan that she has announced today. Will she please confirm, for the sake of absolute clarity, that a cornerstone of the recovery plan will be quicker and easier access to NHS dentists, and also that they will be properly incentivised to absorb all the patients who need support?
Victoria Atkins
Indeed, and it was a pleasure to meet my hon. Friend to discuss the issues facing his constituents. I hope he recognises that we will have those aims very much in mind in the delivery of the recovery plan. We will begin to see the roll-out of those 2.5 million more appointments in the coming weeks as the new patient premium takes hold.
Richard Burgon (Leeds East) (Lab)
Last month, Healthwatch Leeds submitted evidence to the Health and Social Care Committee—testimonies from people at the sharp end of the NHS crisis. One said:
“I am really struggling to find an NHS dentist that is accepting new patients at the moment. I am an apprentice and get paid minimum wage and cannot afford a private dentist.”
Others spoke of the way in which, according to Healthwatch Leeds,
“having no access to treatment is impacting on their general well-being and mental health.”
One of them said:
“ I just don’t know what to do, who to turn to, how to get help. I just want to be able to smile again”.
Is it not the case that this Government’s plan is too little too late, and that the queues snaking around dentists’ surgeries are testimony to the failure of 14 years of Conservative government and a deliberate undermining of our valuable public services?
Victoria Atkins
The hon. Gentleman has quoted Healthwatch. I presume that he will also be gracious enough to acknowledge that the move to introduce 15 dental vans has, in fact, been welcomed by Healthwatch.
Bob Seely (Isle of Wight) (Con)
We need more NHS dentistry on the Isle of Wight. I welcome this recovery plan, but can the Secretary of State tell me by when my constituents will see its benefits?
Victoria Atkins
By 1 March, because that is when the new patient premium comes into force. Other aspects will take a little longer, but we are clear about the immediate benefits, and we want to get those out to people as quickly as possible.
Richard Foord (Tiverton and Honiton) (LD)
In Devon and Cornwall last year, 57% of dental surgeries had at least one vacancy. Before 2016, more than 500 dentists registered in the UK had trained in European countries, and they made up a quarter of the workforce. Will the Secretary of State heed the call from the Association of Dental Groups for it to be made easier for qualified European dentists to practise here in the UK?
Victoria Atkins
That is exactly what we are doing, and not just in relation to other European nations but in relation to other countries around the world. We want the General Dental Council to ensure that qualified dentists from overseas are recognised and supported, and get on to our registers as quickly as possible.
Julian Sturdy (York Outer) (Con)
Like many others, I very much welcome the recovery plan, and I thank the Secretary of State for meeting me earlier to discuss the issues that we face in York. However, may I press her on the subject of integrated care boards? Will she ensure that they are held to account? Will they face increased monitoring to ensure that they spend the allocated money on dentistry and on the target areas in the recovery plan, and will that money remain ringfenced?
Victoria Atkins
I well understand why my hon. Friend has asked that question, about a matter that other Members have also raised. We are exploring ways in which we can make the expenditure of the dentistry budget more transparent, because it is right for ICBs to reflect the needs of local residents and deliver the services that should be available under this dental recovery plan.
Tom Hunt (Ipswich) (Con)
I very much welcome these interventions, particularly as I raised a question just a few weeks ago in Prime Minister’s questions about the time period. I am particularly pleased about that. On international dentists, I completely agree with what many colleagues have said. I have a close friend whose husband is Mexican and fully qualified as a dentist. The period between him getting the right to be in the UK and becoming a dentist in the UK is two or three years—it is far too long and there is far too much bureaucracy. I appreciate the announcement on therapists. We have 24 new ones on the new course in Suffolk, but 400 applied so I think there is room for even more therapists to play a key role. Can we also make sure that the consultation period is rapid? This is a common-sense policy and I think we should just get on with it. Finally, will the Secretary of State visit Ipswich to see the new dental centre and hear the case we are making for a dental school? We are the obvious place in the east of England, now that we have a dental centre.
Victoria Atkins
My hon. Friend will appreciate that I get a lot of invitations, but I will do everything I can to meet him. His passion and ambition for his local area shine through, and not just in the question he asks today but in the question he asked the Prime Minister a few weeks ago. He is absolutely right: we need the General Dental Council to work with us—I think it will—to ensure that we can get more international dentists registered as quickly as possible, for the benefit of our constituents.
Andy Carter (Warrington South) (Con)
I welcome what the Secretary of State has said today. I also pay tribute to the ICB in Cheshire for the work that it has done to make additional appointments available in Warrington, where it has been incredibly difficult to access NHS dentistry despite there being many dentists on the high street, because so many have decided to move away from the NHS. Can she explain how the changes announced today will incentivise dentists to return to providing NHS services, so that constituents in Warrington South can get the NHS appointments they want?
Victoria Atkins
As I have said, dentists are independent contractors but we want to encourage them back into the NHS if they have left it, and we believe that the new patient premium and the work on the UDA are just two of the levers that we can deploy to achieve that. We also have a longer-term vision for our NHS, and through the long-term workforce plan we will be training 40% more dentists by 2031. That is real ambition and a plan for the long-term future of our country.
Anna Firth (Southend West) (Con)
I completely welcome this plan, and particularly my right hon. Friend’s focus on underserved areas and coastal communities. This is something I have raised before in the Chamber. Southend is a coastal city with over 180,000 residents but only three dentists currently accepting NHS patients, so we qualify on both counts. Please could she confirm for Southend and Leigh residents that we will also get either a van or better dental care, preferably within months, not years?
Victoria Atkins
I am delighted to tell my hon. Friend that those dental surgeries already operating under NHS contracts will have the benefit of new patient premiums and the increased rate of UDA. On the dental van, she will appreciate that we are having to apply strict criteria to this, but I am delighted to see how enthusiastic she is about this recovery plan.
Holly Mumby-Croft (Scunthorpe) (Con)
I thank my right hon. Friend for this really welcome plan. Can she give any advice to patients who are registered with an NHS dentist but have not been seen in the last two years? Should they contact the dentist if they want an appointment or should they wait to be contacted? For those who are not registered, where will they find a list of dentists that they can contact to register their interest in becoming a patient?
Victoria Atkins
I thank my hon. Friend and fellow greater Lincolnshire MP for her question. In terms of the mechanics of this being delivered, the new patient premiums will come into force and patients can already look at the NHS website to see which practices have places available in their area. They can go there; they do not need to have had an existing relationship with that dental practice. We will also be setting out for constituents and Members of Parliament how, once the new premium comes in, people can get in contact and get the appointments we all want them to get.
Ben Everitt (Milton Keynes North) (Con)
More dentists, more appointments, more incentives for NHS work and a focus on underserved areas—this is exactly what Milton Keynes needs. I would like to thank the Secretary of State and, in particular, her dental Minister and my constituency neighbour, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), for all the work they have done, and in particular for listening to me banging on about dentistry in Milton Keynes for so long. I seek just one more clarification, please. Will the mobile dentist vans be serving hard-to-reach rural areas, such as my beautiful market towns and villages in Milton Keynes North?
Victoria Atkins
I join my hon. Friend in his praise for our right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). As I say, we are having to apply strict criteria to the dental vans. We want to get them out as quickly as possible to the most underserved areas, but we do not want dental vans to be the limit of our ambitions. The idea behind them is very much to revitalise those parts of the country that do not have NHS dental practices within a reasonable distance, and we are convinced that dental vans are just one of the levers by which we will achieve that.
Matt Vickers (Stockton South) (Con)
As my right hon. Friend knows, I am extremely concerned about access to dentistry for residents in Stockton South, so I hugely welcome this unprecedented investment and the places it will create locally. Can she confirm that the Government are committed to tackling the situation as quickly as possible and also for the long-term, and that they will continue to consult on broader workforce and contract reform?
Victoria Atkins
I am delighted to confirm that. We have wanted to deal with the issues as quickly as we can, but also with an eye to the future. This is the way in which the Government set out our plans for the NHS and for our social care system. I am confident, for example, about the introduction of golden hellos for new dentists. We know that that works with GPs and we now want to try it with dentists to see whether we can get dentists into those areas that do not have the service they need at the moment.
James Wild (North West Norfolk) (Con)
According to the National Audit Office, North West Norfolk has one of the lowest numbers of dentists per population. Can my right hon. Friend confirm that my constituents will benefit from the £20,000 incentives and from the mobile dental vans? On training, will she look closely at the proposal from the University of East Anglia for a dental training school? That is the obvious place to have it in the east of England.
Victoria Atkins
My hon. Friend will not be surprised to learn that I have received rather a lot of lobbying about the location of future dental schools. He will see in the plan that we are very open to the idea of training people with a view to their remaining in those areas. This is where golden hellos come in, and they will most definitely apply in the hardest-to-reach and underserved areas. As I say, we are taking very careful criteria-driven decisions about where the dental vans will be supplied, but we understand the problem that Norfolk has.
Andrew Jones (Harrogate and Knaresborough) (Con)
I welcome the statement and also thank my right hon. Friend for meeting me recently to discuss dental care in Harrogate and Knaresborough, where we have recently seen two practices hand back their NHS contracts, causing significant patient concern. I was pleased to hear her comments earlier about the retention of dentists within the NHS. Does she agree that good oral health is a critical part of good overall health, that establishing best practice early in life is essential and that that involves the very earliest years and supporting parents?
Victoria Atkins
Very much so. The truth is that teeth appear long before reception class, and this is why we want to focus not just on babies and toddlers in early years settings but, importantly, on pregnant mums because their oral health while pregnant can have ramifications for their baby. The dental recovery plan is seeking to address this through a long-term sweep from the very beginning of life to adulthood, with 2.5 million more appointments and a long-term plan for NHS dentistry in our country.
Madam Deputy Speaker (Dame Eleanor Laing)
I thank the Secretary of State for answering for more than an hour. We will now proceed, but first I will take points of order.
Pharmacy First
Victoria Atkins Excerpts(3 months, 2 weeks ago)
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Dame Andrea Leadsom
Well, the very first appointment under Pharmacy First happened at 8.30 this morning.
Dame Andrea Leadsom
Oh, was it 8.31? I thank the Secretary of State. When will the services be available? I should think that many more are taking place already.
I am afraid that, while welcoming this, the hon. Lady is being a little pusillanimous with her praise. A lot of her suggestions, as she will know, are simply not true: already, well over 2,000 new GPs and tens of thousands of nurses are working in our NHS. Many thousands of additional practice staff are working in GP practices, and, as she will know, our brilliant GPs have made 50 million more appointments available each year ahead of the target in our manifesto. Good on them. They are doing an amazing job, and Pharmacy First will ease the ever-increasing burden on them.
The hon. Lady talks about technology. I am pleased to tell her that ensuring that the technology was in place was key in deciding when we could go live. There is a very short window in which some systems will have elements of manual intervention, but only for a few weeks. The whole system will be fully automated and will provide the ability to inquire into GP records and to swap advice, which is important for pharmacists to deliver the excellent service that they are already delivering.
Finally, the hon. Lady will know that community pharmacists have for some time now been delivering blood pressure checks, which in some cases are truly lifesaving. This is amazing patient access and patient convenience. The Labour party should, for once, simply praise it and be glad that the Government have stuck to our plan and got on with it.
CQC Review: Nottingham Healthcare NHS Foundation Trust
Victoria Atkins Excerpts(3 months, 2 weeks ago)
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The Secretary of State for Health and Social Care (Victoria Atkins)
I have requested that the Care Quality Commission (CQC) conduct a special review of mental health services in Nottinghamshire under section 48 of the Health and Social Care Act 2008.
Like many of my Parliamentary colleagues, I was appalled by the horrendous and tragic killings of Barnaby Webber, Grace O’Malley-Kumar and Ian Coates in Nottingham in June 2023. I would like to place on record my deepest sympathies and condolences to the families of Barnaby, Grace and Ian.
The CQC special review will focus on reviewing the care provided by Nottinghamshire Healthcare NHS Foundation Trust and identifying where things may have gone wrong. This will give the families much-needed answers and will help identify how to improve the standard of mental health care in Nottinghamshire.
Any concerns regarding patient safety, quality of care, or public safety will be reported by the CQC, who will consider carefully the available relevant evidence, including witness and other oral evidence made public during the criminal trial of Valdo Calocane.
It is essential we move quickly to get the answers we need. This is why I am asking the CQC to conclude their investigation by the end of March at the very latest.
This special review will proceed alongside the Trust’s own internal investigation and NHS England’s Independent Mental Health Homicide Review, which is standard practice in these cases. I expect all parties to share information to avoid duplication and make sure that we receive as full a picture as possible. The CQC review will focus on this case and on wider issues in mental health care provision in Nottinghamshire, including at Highbury Hospital and Rampton Hospital.
I would also like to take this opportunity to update the House on the next steps of the Health Services Safety Investigations Body (HSSIB) investigation into mental health inpatient settings, which my predecessor announced in June 2023, in response to a number of tragic incidents that had taken place across the country.
Since June, the HSSIB, and its predecessor, the Healthcare Safety Investigation Branch (HSIB), has undertaken significant preparatory work, including holding over 30 meetings as part of the process of determining the scope of the investigation, and have reviewed the research evidence on safety.
The terms of reference for the investigation have today been published on the HSSIB website at https://www.hssib.org.uk/patient-safety-investigations/. There will be four investigations, which will focus on the themes of:
Learning from inpatient mental health deaths, and near misses, to improve patient safety.
The provision of safe care during transition from children and young person to adult inpatient mental health services.
Impact of out of area placements on the safety of mental health patients.
Creating the conditions for staff to deliver safe and therapeutic care (the workforce, relationships, and environments).
The investigations will identify risks to the safety of patients, and the HSSIB will seek to address those risks by making recommendations to facilitate the improvement of systems and practices in the provision of mental health care in England. This will include consideration of patient and staff safety with regard to allegations of sexual assault and rape. The investigations will conclude by the end of 2024.
Patient voice will be integral to the HSSIB’s investigation and report. They have been in touch with patients and families who have experienced poor care, as well as their parliamentary representatives, and are working with patient advocates and the charitable sector to arrange focus groups to support these investigations.
The HSSIB can also be contacted directly by any patient, carer or family member who wants to share their experiences of the mental healthcare they or their loved ones have received by emailing enquiries@ hssib.org.uk. I would strongly encourage all Members to highlight this opportunity to their constituents who may feel they would like to engage with this process and have their voices heard.
[HCWS226]
Oral Answers to Questions
Victoria Atkins Excerpts(3 months, 3 weeks ago)
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Sara Britcliffe (Hyndburn) (Con)
The Secretary of State for Health and Social Care (Victoria Atkins)
May I start by wishing the hon. Member for Ilford North (Wes Streeting) a speedy recovery?
We are taking a wide-ranging approach to alcohol harms. Some £27 million has been invested in specialist alcohol care teams in a quarter of hospitals with the highest need, and we have published the first ever UK-wide clinical guidelines on harmful drinking and alcohol dependence, as well as providing around £300 million in funding to 75 local authorities through the family hubs and Start for Life programme. Family hubs funded through that programme are encouraged to provide full wrap-around support for families, which may include alcohol support services.
Sara Britcliffe
To the Government’s credit, they are currently putting money into addiction services. However, at the same time, there is no national strategy for children of alcohol-dependent parents. That has not always been the case. Between 2017 and 2021, there were local and national helpline services funded through a national strategy. Will the Secretary of State meet me to discuss this matter, as the children in these awful situations are some of the most vulnerable in society?
Victoria Atkins
May I thank my hon. Friend for her care and also for sharing her experiences on this subject? Through the drugs strategy, we have committed an extra £532 million of funding over three years to improve alcohol and drug treatment services, with £15.7 million invested in Lancashire. Last year, we saw a further £2.8 million invested nationally in line with guidance for the extra drugs strategy funding, which allows local authorities to fund targeted services for parents in need of treatment and support for their children and families. I will, of course, be happy to meet my hon. Friend to discuss this further.
Mr Sheerman
I have turned over a new leaf, Mr Speaker.
May I urge the Secretary of State to take this issue very seriously, to direct much more social media at young people and to get into schools the message about the real damage that can be done to the entire life of a child if the mother is drinking alcohol during pregnancy?
Victoria Atkins
I thank the hon. Gentleman for bringing some insight into how we can best reach families. Of course, it is not just mums, but fathers or carers who can have a huge impact on our children. That is why the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), is investing so much energy and commitment in our family hubs. We believe that they can be the centre for families to make the very best start to a child’s life.
Sarah Green (Chesham and Amersham) (LD)
Simon Lightwood (Wakefield) (Lab/Co-op)
The Secretary of State for Health and Social Care (Victoria Atkins)
Our plan includes opening 5,000 more beds, increasing ambulance capacity, expanding innovative services such as virtual wards and bringing forward covid and flu vaccinations for the most vulnerable. Thanks to the hard work of staff, NHS performance this winter has improved on last year, despite the impact of industrial action.
Simon Lightwood
I am sure the caveat to that was the word “shortly”. I have had constituents contact me in desperation regarding delays at Pinderfields Hospital in my constituency. They tell me they have waited hours in emergency care this winter for routine blood tests—literally all day in some cases—even while in extremely poor health. The Tories’ patchwork reforms and sticking-plaster politics are not fooling anyone. Does the Secretary of State not think that those dangerously long waiting times are a damning indictment of 14 years of Conservative mismanagement? What does she say to my constituents who are suffering right now?
Victoria Atkins
I am sure that the hon. Gentleman is a fair man, and that, being so, he will point out to his constituents, when they call him with their issues, that ambulance response times for category 2 emergency incidents in his local area have in fact been over 30 minutes faster than last year. However, we accept of course that this is a two-year plan and will take time to meet our full ambitions. Interestingly, the latest figures show that we have provided £6.9 million from the community diagnostic centres fund for the development of a community diagnostic centre at Wakefield. Presumably he welcomes that Conservative innovation.
Steve Brine (Winchester) (Con)
The pressure on services is acute this winter, as it is every year. So far, we have heard very little mention in these 20 minutes of the biggest headache facing trusts, integrated care boards, patients and, of course, the Prime Minister’s pledge to cut the waiting lists further. Given that the British Medical Association ballot on consultants’ action closes today, and that the dispute among doctors in training continues, can the Secretary of State update the House on her message to those voting today, and on where we are in wider industrial disputes, which are a drag anchor on the NHS right now?
Victoria Atkins
My hon. Friend is right to point out that we are in the final few hours of the consultants’ ballot on the pay reform programme that we have offered the British Medical Association. I very much hope that consultants will feel able to support that programme, because it is about bringing together the frankly quite bureaucratic system that they have to deal with at the moment, so that they are assessed in a shorter time with less bother and paperwork, while respecting their need to train and keep up their education and supporting professional activities commitments. I hope that they will agree with us on that. As I have said to the junior doctors committee from this Dispatch Box, should they return with reasonable expectations, we will, of course, reopen negotiations.
Karin Smyth (Bristol South) (Lab)
The Secretary of State has said that preparation for winter started last January, but 54% of A&E departments were still rated inadequate or needing improvement in December, exacerbating the winter crisis. What will she do differently this year to ensure that we do not have another winter crisis in 2024-25?
Victoria Atkins
Again, the plan that we laid out last year is having a real impact at local level on the services being deployed through our accident and emergency services. We have seen discharge rates improving, for example. We appreciate that there can be local differences, but the importance that we put on maintaining that flow through hospitals is critical to ensuring that the waiting lists and waiting times that the hon. Lady describes are reduced. However, I gently remind the Labour party that it has been running the NHS in Wales for some time now, and it is a great shame that the good people of Wales—[Interruption.] The good people of Wales are waiting longer for their treatment—[Interruption.] They are almost twice as likely—
Mr Speaker
Order. I am a little bothered, because we have a long way to go on the Order Paper. I call the SNP spokesperson.
Amy Callaghan (East Dunbartonshire) (SNP)
We cannot discuss winter pressures in the NHS without acknowledging workforce shortages. The Secretary of State is having to contend with new immigration policies from her Cabinet colleagues that prevent dependants from coming to the UK, meaning that we are asking people to come and care for our loved ones while they leave behind theirs. I imagine that she is frustrated that that is now another barrier to recruiting staff to our health and care sectors. Has she expressed those frustrations to her Cabinet colleagues?
Victoria Atkins
I genuinely want to work with the Scottish Government, because I am troubled, to put it bluntly, that Scotland has some of the worst health outcomes in western Europe. It has the worst level of drug death rates in Europe, the highest alcohol death rates in 14 years, and there was a fall in life expectancy for three years in a row. We offered to allow Scottish patients to receive lifesaving operations in England, but sadly, that offer has been declined. I remain genuinely willing to work with the Scottish Government to help them with their health service.
Sarah Edwards (Tamworth) (Lab)
Kerry McCarthy (Bristol East) (Lab)
The Secretary of State for Health and Social Care (Victoria Atkins)
We are investing an additional £165 million a year to improve maternity and neonatal care, rising to £186 million a year from April. This will increase the number of midwifery posts and improve the quality of care that mothers and babies receive. As of October last year, there were 23,100 full-time equivalent midwives working in NHS trusts and other core organisations in England, which is more than 1,000 more than a year ago and 3,500 more than in 2010.
Kerry McCarthy
I thank the Secretary of State for that response. The Royal College of Midwives estimates that there is a shortage of around 2,500 full-time midwives working in the NHS. I know that at first hand from Cossham Hospital in my constituency, which has a wonderful birth centre, but it has been closed for most of the last few years, because it simply cannot get the midwives to staff it—they have to go elsewhere where more serious cases need to be dealt with. What is she doing specifically about the retention of midwives? I know that student numbers are, thankfully, coming up, but a lot of midwives are choosing to leave the profession because there is not enough flexibility in their work.
Victoria Atkins
I think we all agree that a career as a midwife is just one of the most rewarding and fulfilling careers that one can hope for. That is why we have placed such priority on retention in the long-term workforce plan that we launched last year. The national retention programme for midwifery and nursing has prioritised five actions to support staff retention, including menopause guidance, because we know that that can be an issue for midwives, and valuing them and their contribution is also a key objective of NHS England’s three-year plan for maternity services.
Vicky Ford (Chelmsford) (Con)
As well as recruitment and retention, training matters. Anglia Ruskin University has a campus in Chelmsford and is the provider of the largest number of health and social care degrees in the country, training midwives, nurses and, since the medical school opened, doctors. Will the Secretary of State back the campaign to expand the medical school in Chelmsford so that we can train even more local people to work in our local NHS?
Victoria Atkins
I thank my right hon. Friend for raising her local college, which does amazing work for the whole of the NHS as well as in her local area. I may have to retain a discreet silence over that particular application but I know that if any Member is sure to advocate effectively for their local area, it is my right hon. Friend.
Abena Oppong-Asare (Erith and Thamesmead) (Lab)
Recruiting and retraining more NHS staff is crucial if women are to get gynaecology, obstetric and maternity care. I would like to share the story of Sandy Simmons. She was told 11 months ago that she needed surgery for a uterine prolapse; today, after nearly a year of pain, she is still waiting. Labour candidates such as Keir Cozens in Great Yarmouth are speaking up for women like Sandy and the 905 women waiting more than a year for treatment in Norfolk and Norwich University Hospital. Will the Secretary of State apologise to these women—or, like the Prime Minister, will she just walk away?
Victoria Atkins
I was genuinely delighted to welcome the hon. Lady to the Government’s women’s health summit last week to announce the consolidation, and indeed the improvement, of the women’s health strategy that this Government have launched. We saw significant success last year with hormone replacement therapy improvements and she knows, because she attended the summit, that I have just announced a £50 million research fund looking at maternity disparities and also research into female-specific conditions. Any concern she has about operation times she should take up with the local trust and it will perhaps tell her what impact industrial action has had, sadly, on elective surgery.
Theresa Villiers (Chipping Barnet) (Con)
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)
The Secretary of State for Health and Social Care (Victoria Atkins)
We have made progress against our target to reduce learning disability and autism in-patient numbers in England by 50% since 2015. For people with a learning disability without an autism diagnosis, there has been a 58% net reduction; for people with a learning disability who are autistic, the net reduction is 35%.
Dr Cameron
I thank the Secretary of State for that comprehensive answer. As chair of the all-party parliamentary group for disability, I have been hearing from organisations such as Mencap that remain concerned that people with learning difficulties are disproportionately detained for five to 10 years and for over 10 years. Will she reassure those organisations that the “Building the right support” action plan will continue to progress the great work that is being done?
Victoria Atkins
I thank my hon. Friend for her interest and, of course, her many years working as a clinical psychologist. She brings that experience to the Chamber. National commissioning guidance to integrated care boards was published in November. It sets out that a mental health in-patient stay for a person with a learning disability
“should be for the minimum time possible, for assessment and/or treatment which can only be provided in hospital”.
In overseeing implementation of the action plan going forwards, the “Building the right support” delivery board will maintain focus on quality of care and on reducing long stays.
Barbara Keeley (Worsley and Eccles South) (Lab)
It is vital for the Government to do more to move autistic people and people with learning disabilities out of in-patient units and back to their communities. Recently, in the trial of staff at Whorlton Hall, we saw staff who were cruel and uncaring. Delivering sentences, the judge said that Whorlton Hall was an
“unpredictable and…frightening place to live”.
Is it not time for the Government to close down those units and move the majority of people into the community?
Victoria Atkins
I thank the hon. Lady for raising that point. We were all dismayed and upset to see the experiences of residents in those units, and we saw the correct criminal outcomes—if I am allowed to say that—for those involved in those assaults. A review is going on as to how those issues are affecting the estate as a whole, but we are clear that in-patient stays should happen only when they are strictly necessary. We must be mindful that clinicians will be taking many situations into account, including not just the safety of the patient but the safety of the wider community.
Ruth Cadbury (Brentford and Isleworth) (Lab)
The Secretary of State for Health and Social Care (Victoria Atkins)
Women’s health needs are often overlooked and under-researched. Through our women’s health strategy, the Government are changing that. Last year, we made menopause a priority, helping almost half a million women get hormone replacement therapy for less than £20 a year. This year, we are building on that work and will have a women’s health hub in every integrated care board area in England. We will promote research into conditions that only affect women, such as endometriosis and lobular breast cancer, and those that affect women differently from men, such as heart attack symptoms.
We have also launched the first research challenge—worth £50 million—to tackle maternity disparities that have no place in modern Britain. Following the brave campaigns of my hon. Friends the Members for Hyndburn (Sara Britcliffe) and for Stafford (Theo Clarke), by March we will make dedicated maternal mental and physical healthcare available to every woman in England.
Ruth Cadbury
I recently met two constituents with experience of invasive lobular breast cancer. Invasive lobular carcinoma is the second most common form of breast cancer, but it is not generally picked up by mammograms, and it behaves differently from other breast cancers. However, lobular breast cancer has been understudied and underfunded, and it urgently needs research funding. Will the Secretary of State tell the House what specific actions her Government are taking to address those gaps? Will she also reply to the Lobular Moon Shot Project, to which she—
Victoria Atkins
I gently remind the hon. Lady about the statement that I just gave. Last week we held the women’s health summit, at which I announced that we are encouraging research into conditions such as lobular breast cancer. I made that announcement because of two amazing women I met recently who were living with the condition. They were introduced to me by my right hon. Friend the Member for Horsham (Sir Jeremy Quin) and my right hon. Friend—
Andrew Jones (Harrogate and Knaresborough) (Con)
Victoria Atkins
I would be delighted to meet my hon. Friend to discuss that. As always, he is an excellent advocate for his constituency, and I will enjoy listening to the results of his survey.
Andrew Lewer (Northampton South) (Con)
Victoria Atkins
We understand how worrying the possibility of medication shortages can be. There is a supply issue with riluzole 50 mg tablets, caused by a supplier experiencing manufacturing issues. We have a well-established procedure in place to deal with such issues, and are working with the industry, the NHS and others to resolve it as quickly as possible. We have contacted alternative suppliers and have secured sufficient volumes of stock.
Amy Callaghan (East Dunbartonshire) (SNP)
Cancer Research UK has found that too much UV radiation is the third biggest cause of cancer across these isles. Does the Secretary of State recognise that cost is a barrier for people wishing to protect their skin from the sun, and will she commit to having conversations with Cabinet colleagues to remove VAT on sun protection products, which will help protect NHS budgets and ultimately save lives?
Victoria Atkins
We see that as part of a much wider campaign to ensure that we treat the sun safely, by reducing the amount of time we spend in the sun, particularly during peak hours of the day in summertime. I keep all these discussions in play with my Treasury colleagues.
Mrs Sheryll Murray (South East Cornwall) (Con)
Victoria Atkins
I thank my hon. Friend sincerely for her question. The good news is that community diagnostic centres have now delivered over 6 million additional tests and scans since July 2021 thanks to the hard work of NHS staff, but I will of course be delighted to meet her to discuss her plans for her local constituency.
Derek Twigg (Halton) (Lab)
Sarah Dyke (Somerton and Frome) (LD)
Victoria Atkins
We are ensuring that community pharmacists have an even greater role in primary care than they have already. For example, we saw the first stage of the roll-out of Pharmacy First in December, with blood pressure checks and contraceptive care being rolled out. I am very pleased that we are on track to deliver the full roll-out of Pharmacy First by the end of the month.
Sir Sajid Javid (Bromsgrove) (Con)
The colour of someone’s skin should not have an impact on the reliability of medical devices, but we know that that is what happened during the pandemic for many black and Asian patients. When I was the Health Secretary, I commissioned an independent review of the equity of medical devices from Professor Dame Margaret Whitehead. Her report was handed to the Department in June last year, but the Department has not yet published it or responded to it. I know that my right hon. Friend cares about health inequalities as much as I do, so may I ask her to publish the report, along with a full Government response, as a matter of urgency?
Victoria Atkins
I thank my right hon. Friend for commissioning that vital piece of work. I am giving the matter my closest attention, and I hope very much to be in a position to respond to his points in due course.
Kerry McCarthy (Bristol East) (Lab)
Victoria Atkins
I am delighted that the House is as happy about that expansion as the hon. Gentleman and I are. I will meet him to go through his plans, because I know how carefully he has campaigned for this important asset in his constituency.
Cat Smith (Lancaster and Fleetwood) (Lab)
Victoria Atkins
The hon. Lady is aware of my knowledge not only of that hospital, but of her local area. I will look into this matter for her, because I want to ensure that the good people of Lancashire, Mr Speaker, are looked after as we would all hope and expect.
Sir Jeremy Quin (Horsham) (Con)
I warmly welcome what my right hon. Friend said last week about encouraging research on lobular breast cancer, and I look forward to meeting the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), shortly to work out how we can operationalise what is her clear ambition.
Victoria Atkins
I thank my right hon. Friend and my hon. Friend the Member for Bishop Auckland (Dehenna Davison) for bringing two amazing women to talk to me about the impact of lobular cancer. For the benefit of Members on both sides of the House, last week we sent out a “Dear colleague” letter and graphics about the women’s health strategy so that we can all help our constituents to understand what this Conservative Government are doing to ensure that the healthcare of women is faster, simpler and fairer.
Women’s Health Strategy
Victoria Atkins Excerpts(3 months, 4 weeks ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Victoria Atkins)
After a successful first year implementing the women’s health strategy for England, I am pleased to update on our priorities for 2024.
Improving care before, during and after pregnancy
We will continue to deliver NHS England’s three-year plan for maternity services and empower women with information on the improvements that they should expect and deserve during pregnancy and after giving birth.
We will work to prevent and improve support for women who have experienced physical and mental birth trauma. By March, new services to avoid tears during childbirth and to improve maternal mental health will be rolled out across England, alongside updated guidance for GPs.
We will improve post-natal contraception provision and awareness of hyperemesis gravidarum during pregnancy. We will also continue to support for women and their partners who have experienced pregnancy loss, including through the baby loss certificate service that will be available shortly.
Improving care for gynaecological conditions and menstrual problems
Guidance will be updated this year for gynaecological conditions such as endometriosis and we will work to improve women’s experiences of gynaecological procedures including hysteroscopy. Access to contraception will also be improved through Pharmacy First, which will play a vital role in managing menstrual problems.
The Office for National Statistics will carry out work to improve our understanding of endometriosis diagnosis times and the impact on women in the workforce.
Expanding women’s health hubs
We are investing £25 million in women’s health hubs to improve women’s access to care, improve health outcomes and reduce health disparities.
We are working closely with NHS England and the network of women’s health champions to support the establishment of women’s health hubs, and we expect all 42 local systems in England—each integrated care system—to have at least one hub operating this year.
Tackling disparities and improving support for vulnerable women
We will focus on improving support for patients and staff who are victims of domestic abuse and sexual violence. NHS trusts and local systems will review their policies, training and support systems for domestic abuse and sexual misconduct this year.
The new acquired brain injury strategy coming later this year will consider the needs of victims of domestic violence with acquired brain injuries. We will implement the recommendations in the NHS England and HM Prison and Probation Service joint national women’s prison health and social care review.
We will also work to reduce maternal disparities, given that data continues to show that black women are almost three times more likely to die during or shortly after pregnancy than white women. Women of Asian ethnic backgrounds are 1.67 times more likely to die than white women.
Boosting research on women’s health
Through the first ever National Institute for Health and Care Research—NIHR—challenge fund of its kind, we will provide £50 million to unite researchers, policy-makers, and women, to tackle maternity disparities. The NIHR will continue to encourage bids for better representation of women in research and more research into under-researched women’s health issues such as lobular breast cancer as well as conditions that affect women and men differently, such as heart attacks.
The NIHR recently published a statement of intent for developing policy and practice which sees sex differences fully accounted for in research.
Continuation of existing priorities
Since my the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield) wrote to parliamentarians in summer last year outlining the significant achievements made so far, we have made further progress in other areas:
We have published a tool to help people find local fertility commissioning policies in England. We have recently announced changes in the law to remove financial barriers to female same-sex couples accessing IVF, and will continue to work with NHS England to improve access to NHS-funded fertility treatment.
We launched our new women’s health area on the NHS website, a new HRT hub and for the first time new pages on conditions such as adenomvosis.
NHS England announced its aim to eliminate cervical cancer by 2040 by making it easier to get the lifesaving human papillomavirus—HPV—vaccination and increasing cervical screening uptake.
The NHS England Pharmacy Contraception Service relaunched to enable community pharmacies to initiate oral contraception. Almost 3,000 contractors have already signed up to the expanded service.
Between its launch on 1 April and 31 December 2023, 484,082 hormone replacement therapy prescription prepayment certificates were purchased, saving women millions of pounds in ongoing prescription charges.
NHS England will continue its work to improve menopause care by piloting new guidance for nurses, GPs and other staff in the midlands to better recognise and treat symptoms.
Helen Tomlinson, the Government’s Menopause Employment Champion, published a plan for the next six months in her role. The Government also launched online resources for employers.
In autumn we ran a reproductive health survey, which received 52,000 responses from women telling us about their experiences across all areas of reproductive health.
The upcoming major conditions strategy will consider the differences between men and women in conditions such as osteoporosis and dementia.
I am delighted to announce the reappointment of Professor Dame Lesley Regan as Women’s Health Ambassador for England for a further two years to December 2025. She will provide expert clinical leadership and support implementation of the strategy.
[HCWS192]
NHS Dentistry
Victoria Atkins Excerpts(4 months, 1 week ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Victoria Atkins)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“recognises the impact of a once-in-a-generation pandemic on NHS dental services, with 7 million fewer patients seen in England across 2020 and 2021; notes these challenges were reflected in both Scotland and Wales; acknowledges the steps already taken to recover services in England including the introduction of a minimum rate and increased payments for complex dental activity to better reward dentists for their work; welcomes the publication of the Long Term Workforce Plan which committed to expanding dental training places by 40 per cent; and supports the upcoming publication of the Government’s plan to further recover and reform NHS dentistry and promote good oral health throughout life.”
It is a pleasure to update the House on the work the Government are doing to strengthen NHS dentistry across the country. We are reforming our NHS and social care system to make it faster, simpler and fairer. Dentistry is a vital part of our NHS and improving dentistry is one of my top priorities. The hon. Member for Ilford North (Wes Streeting) represents a deeply urban seat, so I am pleased that he has presented me with an excuse to boast about the fact that I represent, and am very proud to represent, a rural and coastal constituency. That is why fairness is one of my three priorities for our NHS. I know the challenges that rural and coastal communities face when it comes to accessing an NHS dentist appointment, and the disparities in health that we see between rural and coastal communities and city centres. I will come to some statistics in a moment.
I am determined to fix these issues, and the other problems facing NHS dentistry, so that anyone who needs to can always see an NHS dentist, no matter where they live. Indeed, one of my very first acts as Secretary of State was to respond to the Health and Social Care Committee’s recommendations on dentistry. We agreed to the majority of those recommendations, and we stand firmly behind the ambition that NHS dentistry should be accessible and available to all who need it.
Victoria Atkins
I am going to make a little progress, but I promise to give way later.
The whole House understands that the pandemic placed a long-lasting and heavy burden on NHS dentistry. [Interruption.] I hear groans from Opposition Members, but they cannot ignore the fact that some 7 million people did not come forward for appointments during that long period of the pandemic because dentists had to shut, and we were unable to accommodate those needs within the system because of the severe strictures under which we were all placed as a society. We shepherded the sector through the pandemic with £1.7 billion of direct support to compensate for NHS activity that could not be delivered. As we recover from the pandemic there are no quick fixes, but our recovery is well under way. Let me give the latest statistics, because the hon. Member for Ilford North missed them out in his speech. The Government delivered 6 million more courses of NHS dental treatment in 2022-23 than in the previous year. [Interruption.] In the two years to June 2023, the number of adults seeing a dentist increased by 1.7 million compared to the number in the previous year, and 800,000 more children saw a dentist in the year to June 2023.
Opposition Members cannot have it both ways. While I was reading out those statistics they were saying, “You cannot make those comparisons because of the pandemic”, but that is the point: people did not come forward during the pandemic, so, as we must all know from experience in our own constituencies, there is a backlog that dentists around the country are having to work through—and they are making progress.
Victoria Atkins
In fairness, I will give way to the hon. Member for North Shropshire (Helen Morgan) first, because she rose earlier.
Helen Morgan
Like the Secretary of State, I represent a rural community, and the reason dentists are handing back their NHS contracts where I live is that they cannot recruit another dentist to come and help them. They have not had a day off, they cannot meet their commitments under their contracts, and they cannot recruit. They have offered golden hellos of 25%, but they have not been able to get anyone to come and work with them. What will the Secretary of State do to recruit the dentists whom we need to see the people in dental deserts such as North Shropshire?
Victoria Atkins
As I have explained, in relation to dentistry but also in relation to wider healthcare, the long-term workforce plan, which was requested by NHS England and by clinicians, is the means of laying those foundations for the future of the NHS. I will now give way to the hon. Member for Wallasey (Dame Angela Eagle).
Dame Angela Eagle
I thank the Secretary of State. I wanted to intervene earlier when she was talking about the pandemic. In my constituency many people were thrown off their dentists’ lists during the pandemic, often with no notice, and then found that they could not register anywhere else. That is what happened, I believe, all over the country. Can the Minister explain what she is going to do about it? It was not that people were not visiting their dentists; they were denied access.
Victoria Atkins
The hon. Lady has raised an interesting and important point, because, of course, dentists are independent contractors to the NHS, and I have to work with the levers that are available to me. As I have said, we have already invested £1.7 billion to try to help with the recovery, and the House will, I hope, look forward to our dentistry recovery plan when it comes to other ways in which we can improve that. The important point, however, is that because those dentists are independent contractors, we must work with the profession to encourage them back to the NHS to offer the services that we all want to see.
Sir John Hayes (South Holland and The Deepings) (Con)
Is not the root of the problem the contracts that the NHS has with dentists? The roots of that, of course, lie with the previous Government, a Labour Government, rather as they do with the GP contracts. Does my right hon. Friend not need to revisit the genesis of this problem, as well as training more dentists here in the UK?
Victoria Atkins
I thank my right hon. Friend, and indeed my friend, my Lincolnshire neighbour, who knows as well as I do the pressures that we face in ensuring that our constituents receive the same quality of care that we expect across England. He was right to draw attention to the—I would argue—badly drafted contract of 2006, but he also touched on the complexity involved in finding systems that would work better.
Victoria Atkins
I cannot wait to reach the part of my speech that will deal with the hon. Gentleman’s suggestions, but first I will allow him to intervene, because I enjoy this back and forth.
Wes Streeting
So do I. The Secretary of State is far more entertaining than her predecessor. Given that she is painting a picture of improvement, how does she explain the story in The Times which revealed that NHS dentistry activity is now falling in 2023-24 compared with 2022-23? Is it not the case that things are going backwards rather than forwards? How does the Secretary of State explain that, and when are we going to see her plan?
Victoria Atkins
I am grateful to the hon. Gentleman for raising that point, because according to the latest statistics available to me, 18.1 million adults were seen by an NHS dentist in the 24 months up to 30 June 2023. That is an increase of 10%, and what does it mean in reality? It means that over 1.7 million more adults were seen than in the previous year. I know that we are all concerned about the health of children; some 6.4 million children were seen by an NHS dentist in the 12 months up to 30 June 2023, an increase of 14%, which means, in real terms, an increase of 800,000 on the previous year.
I accept, of course, that there is more to do, and we will be setting that out in our dental recovery plan shortly, but this is not just about big numbers. [Interruption.] The hon. Gentleman asks when “shortly” will be. As he knows full well, “shortly” is a little shorter than “in due course” and a little longer than “imminently”.
We have introduced several simple and effective measures to improve the nation’s dental health. The Health and Care Act 2022 made it simpler to expand water fluoridation schemes, because raising the fluoride level to 1 mg per litre is a straightforward way to prevent tooth decay. It has proved effective in parts of England as well as Canada, the United States, Ireland and Australia, and the chief medical officer has concluded that there is “strong scientific evidence” that water fluoridation can drive down the “prevalence of tooth decay”.
Anthony Mangnall
I congratulate the Secretary of State on the progress that has been made, while, obviously, recognising that there is more to be done. I wonder if she will help me to ask the shadow Minister to correct the record. He said that in 2010 and 2015 Labour had a plan for dental practice, but there is no mention of that in the Labour manifestos. I will come back and correct that if necessary, but the hon. Gentleman is out there stating that Labour has had a plan for dental recovery since 2010, and that is not in those manifestos.
Victoria Atkins
My goodness me! My hon. Friend has identified a “cavity” in the shadow Minister’s so-called plans.
Several hon. Members rose—
Victoria Atkins
I am going to make some progress.
I am very pleased that, subject to a public consultation which will be published shortly, we have secured funding to expand water fluoridation schemes across the north-east of England. [Interruption.] The hon. Member for Ilford North may be interested to know why we have identified the north-east, given that he read out so many constituency names in his speech. The north-east was chosen because natural fluoride levels there are among the lowest in the country, and the proportion of five-year-olds with teeth extracted because of tooth decay is among the highest. We have wanted to address that very real health inequality to ensure that more than 1.6 million people in the area can benefit from this expansion, subject, as I have said, to a public consultation.
Supervised tooth brushing has been raised. That has indeed been proven to drive down oral health inequalities, which is why we have already introduced a toolkit that local authorities are using to introduce supervised tooth brushing across schools, nurseries and family hubs. We have been clear that we want to see that happening in more areas. I would encourage any colleague who is concerned about that, rather than waiting for some mythical date in the future, to ask our local authorities whether they are using these toolkits, because they are freely available, and they can and should put them in place.
Catherine West
The Secretary of State rightly talks about prevention, but what about the opposite, where rates of oral cancer have gone up because prevention has not been in place? What assessment has she made? If she does not have the data to hand, will she write to me with the assessment that the Department of Health and Social Care has made of the link between failure on prevention and cancer?
Victoria Atkins
I thank the hon. Lady, and particularly for the constructive tone of her intervention, because she is right. This is not simply about teeth health; it is also about the conditions that dentists check for—probably without anyone quite realising that they are doing so. I will take the hon. Lady up on her invitation to write to her on the figures, but that is why we are looking at health inequalities across the country and, importantly, focusing on encouraging dentists to re-register with the NHS if they have left, because it is vital for tackling much wider health conditions in addition to the pain and discomfort that tooth decay can bring.
Ashley Dalton (West Lancashire) (Lab)
Will the Secretary of State give way?
Victoria Atkins
No, I will give way to my hon. Friend the Member for North West Norfolk (James Wild) and then I will make some progress.
James Wild (North West Norfolk) (Con)
My right hon. Friend mentioned levers. One issue facing recruitment in North West Norfolk is the time involved in getting on to the NHS performers list. Newly in post, will she look at that issue and bring forward proposals as part of the plan to speed up that process and boost recruitment?
Victoria Atkins
I am extremely grateful to my hon. Friend. His intervention shows the level of detail that colleagues on the Conservative Benches have gone into in trying to address the understandable concerns that local NHS providers are voicing. I will look into that. I am very keen on my three words: faster, simpler, fairer. I want to make it as simple as possible for dentists to rejoin and join the NHS. I will say more on that later.
The choice of whether patients are offered NHS exams and treatment lies with the dentists, who are independent contractors to the NHS. As well as making simple, common-sense changes, in July 2022 we announced a package of far-reaching reforms to make NHS work more attractive to dentists. We have created more bands for units of dental activity, so that dentists are properly rewarded for taking on more complex care, and the best-performing practices can see more NHS patients.
Previously, regardless of the amount of time the dentist took on each patient, they received the same payment for every individual treatment package in band 2, which covers fillings and tooth extraction. Perversely, that meant they received the same payment for doing one filling as for three. That left many dentists unable to afford to take on patients who had not seen a dentist for some time and therefore needed extensive treatment. That needed to be put right for the sake of both patients and dentists. Thanks to our reforms, dentists now receive five units of dental activity when they treat three or more teeth, which is a significant increase from the old maximum of three. Root canal treatment on molar teeth is now rewarded with seven units of dental activity, as opposed to three, meeting one of the British Dental Association’s key demands.
We also recognise the barriers that too many communities have faced when accessing NHS dentistry, with people left phoning around practices to see who was taking on NHS patients. That is why we have made it a contractual requirement for dentists to update the NHS website regularly, making it clear whether their practices are taking on new patients, as well as explaining the services that they offer, thus making it easier for patients to find a dentist that can deliver the care they need. These reforms have improved access to dentistry and ensured that the system better supports dentists and their teams, so they were well received by dentists, their representatives and patient groups across England, with Healthwatch’s national director recognising that these reforms show that the Government are listening to patients and taking action, and these reforms can help ensure that dental care is accessible and affordable to everyone who needs it.
Wera Hobhouse
I am pleased to hear about some of the reforms that we have raised in this Chamber many times, particularly on changing the dental contracts and units of dental activity, but may I raise another point? In official workplace data, dentists who do just one NHS check-up a year are counted the same as an NHS full-timer. Does the Secretary of State recognise that that is a problem, because that workplace data hides the scale of the problem?
Victoria Atkins
I am extremely grateful to the hon. Lady, who makes a fair point about measuring within the system how much work NHS dentists are doing. As I say, we are looking at all of this in the work that we are doing on the dentistry recovery plan. I repeat that I want to make it as simple as possible for dentists to register with the NHS, to continue offering the care that we all want them to, so I am grateful to the hon. Lady for her intervention.
Victoria Atkins
I am going to plough on, I am afraid.
Earlier, Labour Front Benchers—perhaps not understanding that they were doing so—set out the philosophical difference between our two parties on how to grow the economy. As our economy grows, we on the Conservative side of the House want to attract the best and the brightest from around the world to work in our NHS, in our tech sector, in our life sciences industry, in our movie industry—hon. Members may know that it filmed “Barbie” this year—and in many other thriving industries. Labour, however, apparently wants to shut the door by taxing such people on earnings they make outside the UK. I speak, of course, of non-domiciled tax status.
If I may correct the hon. Member for Ilford North, because I appreciate that he has not spent any time on the Front Bench, last year alone non-domiciled taxpayers paid £8 billion in UK taxes on their UK earnings. That is equivalent to more than 230,000 nurses. Labour wants to put that at risk and put the UK at a disadvantage in the highly paid, highly competitive, highly mobile international labour market. This really is yet another branch of the magic money tree that Labour has always been looking for, to which they apparently want to add £28 billion a year of taxes or increased borrowing and increased inflation.
How they want to spend this money is interesting as well, because in 2022 Labour promised that their non-domiciled taxation would fund a workforce plan. Last September, it became breakfast club meals. Then, by October, it had morphed into 2 million hospital appointments and MRI and CT scanners. Now, apparently, it is funding a dentistry plan. One wonders how all these magic branches on the magic money tree will add up to all the promises made so far.
Victoria Atkins
I will resist, but only because I am going to ask the hon. Gentleman to intervene in a moment—he should be careful what he wishes for. I also notice that he talked about reform of the dental contract but did not give any detail. Government is not as easy as selling a book. It cannot be cut and pasted from Wikipedia, as some on the Labour Front Bench seem to like to do. It is about being clear on what you would do differently. Now, Labour in Wales is of course running the Welsh NHS. They do like to do things differently. People there are almost twice as likely to be waiting for health treatment as in England.
Virginia Crosbie (Ynys Môn) (Con)
The Leader of the Opposition states that the Labour Government in Wales is a blueprint for what Labour can do in the UK. Given that 97% of high street dentists in Wales state that Labour’s reforms are not working, does the Secretary of State agree that NHS dentistry is being destroyed by Labour in Wales, and that if Wales is their blueprint for UK dentistry, we should all be very afraid?
Victoria Atkins
I thank my hon. Friend, who represents a Welsh constituency. The chair of the British Dental Association wrote to the Labour Welsh Government to complain about their plan and, I understand, used words such as “toxic mix of underinvestment” and “untested targets.” The picture in Wales, if it is the Leader of the Opposition’s blueprint, is perhaps not as convincing as the shadow Health Secretary would have us believe.
The fundamental difference between the current systems in England and Labour-run Wales is that Wales has a capitated list system for dentistry. I am willing to give way so that the shadow Health Secretary can clarify whether he wants to bring in that system.
Wes Streeting
I cannot believe that is meant to be the right hon. Lady’s big “Gotcha.” She cannot even tell us when she will bring forward her plan, let alone what is in it. They have had 14 years to come up with a plan. This is absolutely astonishing. As much as I enjoy these partisan knockabouts at the Dispatch Box, the sight of the Health Secretary giggling and laughing at her own jokes will be of small comfort to people who are literally pulling out their own teeth.
Victoria Atkins
Just to cut through all the froth, the hon. Gentleman has not, in fact, answered my invitation. Does he wish to have a capitated list system, as they have in Wales, or does he have other plans? Could he please answer?
Wes Streeting
Like any responsible Government, we would consult the dentistry profession, the BDA, and come up with a serious programme for dentistry reform. If the right hon. Lady wants to ask me questions and have me answer them, the Government should call a general election and I will happily oblige.
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.
Madam Deputy Speaker (Dame Rosie Winterton)
Order. The hon. Lady knows that she must not refer directly to other Members.
Victoria Atkins
I think the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) was raising her voice at me, but it was not me who heckled her. I recognise the passion she brings to her intervention, and I simply made the point that this is an Opposition day debate. The hon. Member for Ilford North understandably set out some of his plans, which is his job, and I was merely questioning him on the detail of those plans. Sadly, he was not able to provide that detail.
The long-term workforce plan is about not just training more staff but delivering value for hard-working taxpayers. Currently, around a third of dentists do not carry out any NHS work. This simply is not fair on the taxpayers who fund their training, which is why, through the long-term workforce plan, we are exploring the introduction of a tie-in period that encourages dentists, after they graduate, to spend a minimum proportion of their time delivering NHS care. We have also made it easier for experienced dentists from around the world to come to the UK to ply their trade, which is apparently something with which Labour Members do not agree.
Last year, we brought forward legislation to give the General Dental Council greater flexibility in administering the overseas registration exam. The Government welcome its decision to triple the capacity of the next three sittings of part one of the ORE, from August last year, and to increase the number of sittings of the second part of the exam from three to four, creating an additional 1,300 places. Ministers will continue to meet the GDC to discuss how we can make these flexibilities as effective as possible, to get more dentists into the NHS workforce delivering care for patients.
Seema Malhotra
I thank the Secretary of State for giving way. It is worth repeating that the Nuffield Trust has warned that NHS dentistry is at its most perilous point in its 75-year history. That goes alongside recent Healthwatch polling suggesting that one in 10 people in England have ended up paying for private dental treatment in the last 12 months because they could not find an NHS dentist. It has been the same in my constituency, where the majority of dental surgeries are not taking on new patients. Can the Secretary of State explain how on earth things have got this bad?
Victoria Atkins
I trust that the hon. Lady has been listening to the whole debate, because I set this out in some detail at the beginning of my speech. I will not repeat the impact of the pandemic, but I hope she has taken on board the £1.7 billion of investment that has already seen a sizeable increase in the number of adults and children being treated by NHS dentistry.
I do not pretend that this is the full stop at the end of the sentence. We have a plan and I look forward to our debate when that plan is published, because I suspect it will be welcomed across the House.
Dominic Raab (Esher and Walton) (Con)
I commend my right hon. Friend for her powerful speech. The plan will improve financial incentives for NHS dentists and support practices to take on new patients, but to what extent will she and the plan take on board high operating costs and, indeed, the high cost of living in areas where there is high demand for NHS dentistry?
Victoria Atkins
I thank my right hon. Friend for his intervention. I can imagine that the concerns he outlines are very pressing in his constituency, and one important priority behind the dental recovery plan work is addressing health inequalities. Although I have spoken about rural and coastal areas from a constituency perspective, we also understand, of course, that there are differing cost of living pressures in different parts of the country. He makes an important point about the costs for NHS dentists operating in very expensive parts of the country, such as his constituency, and I thank him for doing so.
Our workforce is not just made up of dentists; dental care in England could not function without the vital contribution of dental and orthodontic therapists, dental hygienists, dental nurses and clinical dental technicians. We recognise the importance of harnessing the skills and knowledge of all those professionals. They can support dentists to carry out first-class care, and we must empower them to take on more responsibility and to work at the top of their licences. That is why last year we issued guidance to NHS practices, supporting them to make the most of everyone in the dental team and make a difference to patient care. Since then, NHS England has made it clear that dental therapists and dental hygienists can provide patients with direct care, provided they are appropriately qualified, competent and indemnified. We have also run a consultation to enable dental therapists and hygienists to deliver more treatments. That will boost access to care for patients and support dentists, and we will be setting out our next steps shortly.
Victoria Atkins
I am conscious that Opposition Members will want time today, so I am going to bring my remarks to a close. It is my mission, as Health and Social Care Secretary, to build an NHS that is faster, simpler and fairer, and of course I include dentistry in that work. We have taken the long-term decisions that will improve access to dental care. Delivering 6 million more courses of treatment, expanding dentistry training places by 40% and making it easier for patients to find a dentist to deliver the care they need are just some of the ways in which we are going to achieve that. Of course, we must make sure that dentists are properly rewarded for all the work they do. Through our soon-to-be-published dentistry recovery plan, we will go further, to make NHS dentistry accessible and available for everyone who needs it, no matter where they call home in this great country.
Several hon. Members rose—