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Tim Farron's Recent Appearances in Parliament

Tim Farron speaking on unaccompanied refugees (Liberal Democrat Newswire)Content supplied and updated by theyworkforyou.com

  • Aug 5, 2019:
    • Social Rented Housing: Standards | Ministry of Housing, Communities and Local Government | Written Answers

      To ask the Secretary of State for Housing, Communities and Local Government, with reference to recent English Housing Survey statistics which show that four per cent of local authority housing and 13 per cent of social housing fail to meet the Decent Homes Standard, if he will make an assessment of the potential merits of restoring central Government funding for housing providers to enable the remaining non-decent homes to be improved.

  • Jul 31, 2019:
    • Housing: Carbon Emissions | Department for Business, Energy and Industrial Strategy | Written Answers

      To ask the Secretary of State for Business, Energy and Industrial Strategy, what assessment he has made of the implications for her policies of the findings of the February 2019 Energy & Climate Intelligence Unit Zero Carbon Homes report that had the Zero Carbon Homes policy not been cancelled, occupants of new homes built since the intended policy start date of 2016 would be saving more than £200 per year on their energy bills, and that the total extra cumulative energy costs paid by those homeowners to date is more than £120 million.

  • Jul 25, 2019:
  • Jul 23, 2019:
    • Rural Areas: Health Service Funding | Health and Social Care | Commons debates

      The huge rural area covered by the Morecambe Bay NHS Foundation Trust has and needs three hospitals, but it is funded as if it had only one. As a result, the trust has been fined more than £4 million in debt interest over the past three years. That money could have been spent on nurses, paramedics or doctors. Will the Minister intervene to stop this at once?

  • Jul 18, 2019:
    • Non-Invasive Precision Cancer Therapies | Commons debates

      It is a great pleasure to follow my hon. Friends the Members for Easington (Grahame Morris) and for Chichester (Gillian Keegan), who are vice-chairs of the all-party parliamentary group on radiotherapy, of which I am honoured to be the chair.

      Many of us know too well the pain, hardship and heartbreak that cancer causes. As my hon. Friend the Member for Easington said, it is widely accepted that half of us will get cancer in our lifetime. While I am on my feet, there will be people getting their diagnosis and families coming to terms with it, and lives turned upside down. Most of us have been affected by cancer in some way; cancer took my mum, far too young. But increasingly cancer is a condition to be overcome, not a death sentence. Advances in medical science mean that there are often a host of possible treatments when the diagnosis comes.

      Perhaps the form of treatment of which we hear the least is radiotherapy. It is widely accepted that 50% of those who suffer from cancer will require radiotherapy at some point in their treatment. However, in its recent radiotherapy specification, NHS England reduced the figure for cancer patients needing radiotherapy to 40%. It reached that figure on an interpretation of the Malthus model; if only 40% of cancer patients need radiotherapy, then the current level of investment will be just about adequate, as everyone who could benefit from radiotherapy would receive it, so we might as well conclude this debate and go home-only that figure is wrong, as NHS England has had to admit.

      The APPG on radiotherapy recently held a number of evidence sessions, in part to get to the bottom of this inconsistency. We heard from a wide range of experts, including one of the authors of the Malthus model, who explicitly stated that NHS England's interpretation of the model underestimates the number of patients requiring treatment, because it takes into account only those patients whose initial treatment is radiotherapy, not those who need it after the initial point. When pressed, NHS England accepted that, acknowledging that the 40% estimate was not accurate and fell shy of the true figure. This matters, because the real figure is roughly 50%, which means that NHS England is not commissioning sufficient radiotherapy treatment to meet the needs of cancer patients. The Government must plan on the basis of true demand, not of a figure discredited by the experts and now disowned by NHS England. The Royal College of Radiologists has confirmed that this combination of factors means that, as my hon. Friend the Member for Easington said, 20,000 people in Britain are not receiving the radiotherapy that they need.

      The major issue in my patch is access. Those needing radiotherapy across our communities in south Cumbria have to travel to the Rosemere unit in Preston. That unit is excellent. The staff are wonderful and the kit is brilliant. There is only one thing wrong with Rosemere: it is far too far away. The National Radiotherapy Advisory Group has said that it is bad practice for people normally to have to travel more than 45 minutes to receive radiotherapy treatment. I drove Kate from Kendal to her treatment in Preston the other week; it was a three-hour round trip. She had been doing that every day for six weeks. For those living in Garsdale, Langdale or Coniston, those trips could be five or six hours, or far longer on public transport, every day for weeks. Those are ludicrous distances to travel to receive vital treatment, and that is why we want a satellite of the Rosemere unit to be based at Westmorland General Hospital.

      I spoke to one lady over 80 years of age who was recommended a course of radiotherapy. She decided to forgo that treatment because of the distance she would have to travel. She did not have the option of a shorter journey, so she has instead taken the option of a shorter life. And she is not alone.

      A group of leading UK professionals at the British Institute of Radiology met to discuss their experience of setting up satellite centres. They calculated an average 20% uplift on top of the projected figures for those using the service, while the centres of which they were satellites saw no decline in numbers. That means that in areas such as mine, where access to radiotherapy is poor, 20% of people who should be getting radiotherapy are not getting it, but if a satellite centre was built, they would get that treatment. This is not about convenience; it is about saving lives.

      My hon. Friend the Member for Easington has already raised the problems with commissioning. I will simply say that 100% of radiotherapy centres in the UK are equipped with SABR-stereotactic ablative body radiotherapy-technology. That is the best technology, giving the most focused and concentrated treatment that is most effective at killing cancerous tissue and causing the least damage to surrounding healthy tissue. That means fewer treatments, fewer side-effects and better results. The scandal, however, is that only 25 of those 52 centres are commissioned to use it.

      Is it any wonder that cancer survival rates in this country are among the worst in Europe? We have the second lowest survival rate for lung cancers and below average survival rates for nine of the 10 main cancers. Don't hear me wrong-I know that radiotherapy is not the only solution. Surgery is vital, as are drugs and chemotherapy. We are very proud of the battle we won to deliver chemotherapy to Kendal-countless people have benefited from that-but when chemo improves survival by 2% whereas radiotherapy improves survival by 16%, we need to think carefully about the disparity in investment.

      The simple fact is that radiotherapy lacks the financial backing to be heard. Drugs companies lobby passionately and legitimately for the treatments they provide. Radiotherapy has no such lobby. The all-party group has been struck by the realisation that we are the entire UK radiotherapy lobby, along with those people who work in the industry. Radiotherapy has become a Cinderella service because it lacks a champion. We invite the Minister to become that champion.

      Finally, enthusiastically we welcome the Government's focus on earlier cancer diagnosis, but earlier diagnosis will increase demand for radiotherapy. When tumours are spotted earlier and are smaller, they will need more precise and focused treatment-they will need radiotherapy. Twenty thousand people a year are missing out on radiotherapy already, but if we do not invest now, as more and more cancers are diagnosed earlier, that figure will rocket and this secret scandal will become painfully public.

      Our cancer survival rates are distressingly low. Radiotherapy is, after surgery, the most effective cure for cancer-far more so than drugs. It has been left behind in terms of investment for many years under many Governments. This is the moment when that shameful state of affairs must end. People should have the best treatment for their cancer, and where at all possible they should have it close to home-because shorter journeys equals longer lives.

    • Community Transport Operators | Oral Answers to Questions - Transport | Commons debates

      In places such as Sedbergh and Dent, community bus services have become a lifeline for people who would otherwise be isolated from the communities around them, and I am massively grateful to the volunteers who make those services possible. Community bus services have become essential because over the past 30 years Governments of all colours have chosen to stop seeing the provision of bus services as a service at all, and have allowed rural communities such as mine to become increasingly cut off and stranded. Will the Minister agree to launch a new transport deal for rural communities, with new investment for bus services that are regular, reliable and affordable?

  • Jul 17, 2019:
    • Small and Village School Funding | Westminster Hall debates

      It is a pleasure to serve under your chairmanship, Sir David, and I congratulate the hon. Member for Harborough (Neil O'Brien) on securing this important debate. My constituency has two secondary schools with fewer than 200 pupils, 10 primary schools with fewer than 50 and, by my reckoning, three primary schools with fewer than 30 pupils. They are all really good schools. They are small because the area that they serve is sparsely populated and we live huge distances away from one another. However, small schools are enormously vulnerable.

      If a school with a decent-sized population to serve has a bad Ofsted report or a difficult period of leadership, or if there is a dip in the birth rate, that does not kill it, but if a small village school that is absolutely vital experiences any one of those things, that could be the end of it, and the damage to the community is immense. Just two summers ago, we lost Heversham Primary School, which had once had 60 kids. It had a period of difficulty, went down to 11 or 12 kids and was closed. The ongoing damage to that village and its community is huge. Small schools are vulnerable, yet utterly vital.

      In my time in Parliament, and in my time as a parent, a local school governor and what have you, and as somebody who worked in education, in teacher education, for many years, I have never known schools' budgets to be as tight as they are today, particularly for small schools, because they do not have the wherewithal to get through difficult periods. I think that what happens is that because headteachers keep quiet, the Government take advantage. Headteachers keep quiet for two reasons. First, teachers do not like to get overly political by talking about the level or lack of funding that their school has to cope with.

      Also, headteachers do not want to risk any competitive advantage that they have. If I, as a headteacher, say that I have had to sack three teaching assistants this year, pupils or parents looking at my school will think, "Well, I'll go somewhere else instead." I think that all of us, but particularly the Government, take advantage of headteachers' perfectly understandable reticence about talking about the state of play at the schools they serve so admirably.

      I therefore want to pick out what was said by the 16 schools in the Kendal area that wrote a collective letter to all of us. They said that Westmorland and Lonsdale had seen school funding cuts of £2.4 million, which was equal to a cut of £190 per pupil per year, and that that had led them collectively to reduce the numbers of teaching and non-teaching staff and support for the most vulnerable pupils; to make reductions in small group work for children who need additional support, reductions in teaching resources and equipment, reductions in subject choices in secondary schools and reductions in the range of activities at primary schools; and to cut back on repairs to school buildings and so on.

      One head of a small school told me that his school income had gone down by £204,000 since 2014. Staffing costs had gone up by £232,000 in the same period. He had got rid of teaching assistants and reduced administrative support time and had had to increase charges for school meals, the breakfast club, music tuition and so on. There were reductions in catering hours and in midday hours. Anecdotally, another head brings her husband in at the weekend, outside his own job, to do all the maintenance and janitor work for the school, because it cannot afford anybody to do that full time.

      Underpinning all the problems is the ongoing issue of special educational needs funding, which hits schools of all sizes, but particularly the smaller schools, because proportionally it is a bigger blow. The Government make schools provide and pay for the first 11 hours of special educational needs support. That means that they hit and they hurt and they punish those schools that do the right thing and they reward those schools that do not take children with special educational needs. That is wrong and it needs to be changed.

      The quality of experience of a young person at a small school is so obviously so wonderful and so treasured and something that parents will travel out of area to take advantage of. The quality of teaching and leadership and the diversity of skills that are needed to teach in and to run a small school are that much greater, but the failure to fund schools properly across the board hits smaller schools the worst, even though smaller schools, especially in Westmorland and Lonsdale, are the best.

    • NHS Workforce: England - [Mrs Madeleine Moon in the Chair] | Westminster Hall debates

      Yes, the hon. Gentleman makes an extremely important point. I am certain it is felt across the country. If it is made too difficult to get to the nearest NHS dental surgery-if that is 60 or even 100 miles away, as has been the case on occasion for constituents of mine-people go without treatment, and so do their children.

      Last November I managed to secure the agreement of the commissioners to increase the value of the contracts to NHS dentists in Kendal so they could see and treat more patients. "Brilliant," we thought, "that is really good news." When NHS England contacted our local NHS dentists they found that not one of them was able to take up their offer. I was told that the practices were already working to capacity within the staffing resources they had available, and were reporting difficulties in recruiting additional staff. Those staff exist, by the way. They are working in the private sector. The treadmill of a contract that is unfair to patients and dentists, and not fit for purpose, keeps them out of the NHS. As the hon. Member for Hartlepool (Mike Hill) says, that hits young people particularly.

      The reasons for those difficulties include a contract that pays a set amount for a particular type of treatment, regardless of the number of teeth that a dentist treats. A dentist will get paid, on average, £75 for an entire course of treatment including six fillings, three extractions and a root canal. That is not enough to cover overheads. That is a serious disincentive to people entering NHS dentistry. It hits all areas, but particularly deprived areas, and has a massive impact on the size of the workforce. According to the Department's website, the Secretary of State for Health and Social Care is responsible for

      "oversight of NHS delivery and performance"

      but if he is unable or unwilling to intervene to correct such absurd commissioning we have to ask what real power he has to perform the role. That is the kind of systemic problem that adds up to the workforce crisis we have all talked about and which proper accountability would go some way to solving.

      The website states that the other part of the Secretary of State's role is

      "oversight of social care policy".

      Social care policy is key to NHS workforce planning and supply in England. We all recognise that social care provision is in crisis, and that the crisis gets worse the longer we do not address it. As it grows, so does the pressure on the NHS, which is left dealing with the serious health problems of those who did not receive the routine care they needed. The Government cannot go on delaying simply because of the personal embarrassment of having failed so far. To be fair, they are not the only ones responsible. Neither are they the only ones who can come up with a solution. We need to reach across divides and look for a cross-party solution.

      I have written to the Secretary of State for Housing, Communities and Local Government and to the hon. Member for Denton and Reddish (Andrew Gwynne), the shadow Secretary of State, to invite them to join me so that between us we can constructively use this deadlocked Parliament to reimagine and then redesign a social care system that could provide us with the care we might want for our parents, ourselves or, indeed, in the future, our children. I hope that we can work together to create a new deal for social care and a chance to turn this logjammed Parliament into one of the most productive in history.

      The lack in the workforce has a profound impact in each of the areas I have talked about. Common themes and problems emerge: there is a lack of planning, as well as short-sightedness and a failure to invest in preventive care or to understand that providing healthcare is harder in rural areas, as are recruitment and retention. The Government must plan to overcome those specific challenges as part of their overall strategy. The Government, in not taking responsibility for the workforce crisis, are creating huge problems for generations to come. We need accountability, both for the current workforce crisis and to ensure that we invest in long-term solutions beyond the next Prime Minister, the next Government and even the next generation.

    • NHS Workforce: England - [Mrs Madeleine Moon in the Chair] | Westminster Hall debates

      It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate the hon. Members for Wolverhampton South West (Eleanor Smith), for Lincoln (Karen Lee) and for St Ives (Derek Thomas) on their eloquent speeches.

      The crisis in the NHS workforce is deeply concerning. Its effects are felt nationally, locally and personally. Like others here, I want to pay tribute to the people working at every level of my national health service within the south lakes: the hospital in Kendal, Westmoreland General Hospital, and the district generals that we travel to in Barrow and in Lancaster. Of course, there are the GPs, dentists, paramedics and those providing mental health services. They do an outstanding job, but it is particularly challenging in rural areas, where we have specific problems with workforce planning and supply, which are at the heart of the problems that we are challenged by.

      There are several key elements to workforce planning, including accessible and high quality training, as well as affordable training, as has just been mentioned so eloquently. Effective recruitment is another. Alongside both of those is the issue of staff retention. The Secretary of State must surely be held to account for each of those. The huge shortages in the NHS workforce are felt heavily in numerous areas of healthcare provision in the local communities in Cumbria, and I briefly want to touch on a few of them.

      The provision of ambulances and ambulance crews has been hit particularly hard. It is vital that we recruit and deploy more paramedics and ambulance technicians. Rural communities such as mine suffer because of the sheer distances that ambulances have to travel to reach patients. According to the review of NHS access standards, it is the responsibility of ambulance trusts to respond to category 1 calls within seven minutes on average. That is a tall order when there are half the number of ambulances per head in the north-west of England as there are in London, despite the fact that my constituency alone is bigger than the whole of Greater London. It leaves communities living in fear for their safety and takes a serious toll on the physical and mental health of our outstanding ambulance crews. Our local paramedics and ambulance technicians are being pushed beyond their capacity. As a result, I have had an influx of local people contacting me about having to wait hours for an ambulance to arrive to give them the treatment that they so desperately need. That is why local health campaigners have been calling on the Government to deliver two new fully crewed ambulances to south Lakeland to stem the crisis and ensure the safety of the community. It is not right that people in Grasmere, Dent or Hawkshead might be an hour away from the nearest available ambulance.

      We met the Minister to raise the issue a few weeks ago. He was incredibly helpful and I thank him for his time and his response. I very much welcome the commitment to procure additional emergency ambulances. I understand that as a result of our campaigns an additional £8 million has been allocated to the North West Ambulance Service. That could be good news for south Cumbria, but only if the ambulance service allocates it in the way that we have asked. Ministers should be held to account for whether the ambulances materialise.

      Mental health is another element of workforce planning that I want to raise-particularly provision for children. Four years ago the Government promised a bespoke one-to-one eating disorder service for young people in Cumbria. For young people in south Cumbria that promise remains nothing more than words. The specialists have not been recruited and the service still does not exist. I should love it if the Minister would tell me exactly when we can expect our young people to have access to the service. When will the promises be kept?

      I welcome the Government's commitment to preventive healthcare, set out in the NHS long-term plan. However, again, promises are not being fulfilled. In our area, cuts to the public health budget mean that the NHS in Cumbria currently spends only £75,000 a year on tier 1 mental health preventive care for children. That works out at just 75p per child per year. Proper investment in public health would ensure enough money for a mental health professional for every school and college, if we could recruit them, keeping young people mentally healthy and making sure that problems did not become so severe further down the line. It would also ease the burden on our massively oversubscribed local child and adolescent mental health services, and relieve the pressure on our brilliant but overworked teachers.

      In our area, there is a problem with people moving out of NHS provision to work privately, particularly in the delivery of dental services. More than half of adults in Cumbria have not had access to an NHS dentist in the past two years, while one in three children locally does not even have a place with an NHS dentist. Much as with ambulances, the impact of the lack of a workforce of sufficient size is felt particularly acutely in rural areas. Insufficient NHS dentistry provision has resulted in families having to make ludicrously long journeys to reach the nearest surgery with an available NHS place. Often, people are unable to make those long journeys, or to afford to make them.

  • Jul 16, 2019:
    • No Deal: Agriculture Tariffs - [Mr Philip Hollobone in the Chair] | Westminster Hall debates

      The export tariffs for UK farmers, including Cumbrian hill farmers, into the single market worry me the most. Would the Minister consider the potential for increasing the powers of the Groceries Code Adjudicator, so that it can prevent supermarkets from taking advantage of the loss of export markets by paying our farmers a pittance after 31 October, should we have no deal?

    • No Deal: Agriculture Tariffs - [Mr Philip Hollobone in the Chair] | Westminster Hall debates

      I am grateful to the hon. Gentleman for being so generous. The added threat of tariffs, as he suggests, is that British supermarkets will think they have farmers over a barrel because of the loss, in effect, of our export markets. Does he agree that Ministers ought to take action now and increase the powers of the Groceries Code Adjudicator to ensure that supermarkets cannot exploit the situation?

    • Tourism Sector Deal | Business, Energy and Industrial Strategy | Commons debates

      Given that 20,000 non-UK staff work in tourism in the Lake District, there is a desperate need for home-grown talent, whether we leave the EU or not. However, the Government have watered down the already delayed catering and hospitality T-level, which no longer includes hospitality. Will the Secretary of State undo that backwards move, and fast-track a catering and hospitality T-level to next year?

  • Jul 10, 2019:
  • Jul 3, 2019:
    • NHS Dentists: Cumbria | Westminster Hall debates

      Just so the Minister is fully aware of the facts-I know this predates her time in this role-the NHS talked in its long-term plan about its vision for early identification of conditions of all sorts, and about preventive care, and then literally a fortnight later, just before Christmas, the settlement for public health spending for Cumbria was reduced by £500,000. I would be grateful if the Minister intervened to ensure that that does not happen again, because it has a huge impact on our ability to keep children in good practice in their early years so they have good dental health.

    • NHS Dentists: Cumbria | Westminster Hall debates

      The Minister made a very interesting point about people who under-deliver on their contract. It is important that we do not misunderstand what that means. A dental surgery can be working flat out, but if it is, for example, spending more of its time doing preventive work or reacting to people who want consultations and so on, it gets only one unit of dental activity for that. It could be absolutely full to the brim but be doing the lower-tier work just because that is how it is, reactively. That dental surgery is not failing or not working hard enough. It is doing the preventive stuff that we want it to do more of, but the UDA system, with its perverse incentives, does not reward that.

    • NHS Dentists: Cumbria | Westminster Hall debates

      The hon. Gentleman makes an excellent point, which I will come to. He is absolutely right that the distance from the nearest available treatment affects urban as well as rural areas. It is a problem across the country that relates specifically to the NHS dental contract, which I will come to in a moment.

      According to the most recent data available, taking a child living in Windermere to their nearest NHS dentist will involve a 60-mile round trip to Morecambe in Lancashire. That will mean a three to four-hour journey by public transport, with multiple changes. However, poor signposting by the NHS-it was not easy to decipher-means that that place is not obviously available. The nearest place advertising for new child NHS patients is in Appleby, which is an 87-mile round trip-two hours in the car or a five to six-hour round trip by public transport. It was only with the help of the BDA that we managed to identify availability at the far-distant yet ever so slightly closer practice in Morecambe.

      I am sure hon. Members will agree that this is beyond ridiculous. NHS dentistry is a public service. It should not take scouring the internet forensically with a fine-toothed comb and with the expert help of a national professional body to find a space for a child with an NHS dentist. That space has already been paid for through our taxes. Let us imagine for a moment the outrage if it were similarly impossible for people to get access to a GP.

      For adults, the situation in Cumbria is even worse. I was appalled to discover that the nearest practice with available NHS provision for a new adult patient in Windermere involves a 98-mile round trip by car to Wigton-a six-hour round trip by public transport, involving three different trains and bus rides. The nearest practice that is adverting is even further away and involves a 104-mile trip, there and back, to Alston, taking over six hours by public transport. After that, the next option listed involved going 123 miles there and back to Blackpool.

      Despite those obstacles, families in our communities are still trying to secure places at dental practices but are refused. In Sedbergh, Windermere, Grange, Ambleside and Kendal, dentists are working to their full capacity and even beyond, and are doing a brilliant job, but they simply do not have the numbers or the funding to meet demand. The Government have, cleverly or accidentally, dodged confronting the extent of the problem by doing away with official waiting lists. For the last six years, the NHS has held no waiting lists locally or nationally, and patients cannot depend on their clinical commissioning group or NHS England to support them in their quest to find a dentist who will treat them or their children. Will the Minister rectify that and ensure that reliable and up-to-date waiting lists are kept from now on?

      We took the matter into our own hands locally. The Westmorland Gazette and I rang round our local dental surgeries to see whether there was availability, and found that in Kendal, not one of the 10 dental practices in our biggest town had a single space available for an NHS patient. Some 33% of new patients tried and failed to get a dentist appointment in the wider Morecambe bay CCG area last year. That is the equivalent of nearly 16,000 people. When we include those already on the books with a dentist, that figure rises to 18,000 people, and they are just the ones who have tried. That is a disgrace, and the situation is only getting worse.

      The consequences should not be underestimated. Children across Cumbria have some of the worst dental health in England, with one in three suffering tooth decay by the age of five. In some areas, almost 20% of children under three have tooth decay, and a fifth have tooth decay when they are still toddlers. Often, that does long-term damage to their oral health before they even have the opportunity to make decisions for themselves. If children cannot see a dentist in a regular and timely way, preventable conditions become emergency conditions and the pressure is piled on NHS services, along with all their other responsibilities.

      Nationally, tooth decay is the leading reason for hospital admissions among young children, despite being almost entirely preventable. In 2017-18, over 45,000 children were admitted to hospital to have multiple teeth extracted under general anaesthetic because of tooth decay. Children face completely unnecessary pain and distress, and the NHS faces a £36 million annual spend for that dental work. Dentistry in Cumbria is understaffed, underfunded and overstretched. Although this a local problem, it is a symptom of a systematic one, the effects of which are felt right across the country.

      The primary cause of the increasing problems with dental access in Cumbria and across England is the way that this Government choose to commission dentistry. The NHS dental contract is completely perverse. Based on units of dental activity, it sets quotas on the number of patients an NHS dentist can see and the number of dental procedures they can perform in any given year. If a dentist delivers more than they have been commissioned to do, not only are they not remunerated for the extra work, but they have to bear the cost of any materials used, any necessary laboratory work or other overheads from their own pockets.

      That is not the only issue. Last November, I managed to secure the agreement of health bosses to increase the contracts of local NHS dentists in Kendal, so that they could see and treat more patients. It was great news-I thought. However, when NHS England contacted our local dentists, it found that not one of them was able to take up its offer because, as it told me,

      "the practices are already working to capacity within the staffing resources they have available, reporting they are having difficulties recruiting additional staff."

      Additional resources were made available, but there were not the dentists to provide the service for local people.

      The problem is at least in part the result of the contract, which pays a set amount for particular types of treatment, in some cases regardless of the number of teeth the dentist is treating. In practice, that means that a dentist gets paid an average of £75 for an entire course of treatment, including six fillings, three extractions and a root canal, but that is not enough to cover their overheads. They get paid exactly the same amount of money for a single filling. That acts as a serious disincentive for dentistry, full stop, but especially in more deprived areas, where evidence shows that more significant treatment is often required.

      Perhaps the most significant issue with the current dental contract is that it totally fails to provide any serious recognition or budget for preventive work. The work of educating adults, parents and children to maintain good dental health receives no funding, despite the fact that that would significantly ease the burden on dentists and the NHS as a whole further down the line. Indeed, check-ups are the smallest and least-remunerated part of the unit of dental activity worksheet. As a consequence, there is no massive incentive to up the number that a dentist does.

      None of that is helped by the Government's decision to cut £500,000 in the last few months from Cumbria's public health budget this year, undermining vital preventive work, especially in our schools. Nor does it help that we are currently in limbo when it comes to the future of emergency dental services under the soon to be defunct Cumbria Partnership NHS Foundation Trust. Will the Minister tell me which trust will be responsible for emergency dentistry in south Cumbria after October?

      Morale among dentists practising in the NHS is at an all-time low. The latest British Dental Association membership survey shows that nearly three in five dental practitioners in England are planning to scale down or leave NHS work entirely in the next five years. Those with the highest NHS commitments are the most likely to want to leave. In recent months, I have received countless letters at an increasing rate from residents, many of them very elderly, asking where they can go for dental treatment, as their current dentist has gone private and they have effectively been kicked off the list. A lot of parents have contacted me saying that they have been asked to pay now that they have been kicked of their local dentist's NHS list. If they pay, the dentist might provide NHS provision for their children. It strikes me that that is a form of bribery. Many parents cannot afford to pay for themselves just so their children can get free care. That is not right.

      The current system also fails to use the skills of all dental staff to their full potential. The NHS dentist contract restricts the initiation of a course of treatment to dentists alone. I met the British Association of Dental Therapists, which explained that dentists often refer the patient to a therapist to carry out the treatment if it is within the remit of their qualification. The fact that that can be begun only by a dentist creates a bottleneck that prevents patients from receiving the treatment that they need when they need it. The dental therapists made the case to me-and, I believe, to the Government-for reforming the system to allow them to initiate a course of treatment, ease some of the burden on dentists, and enable patients to be seen more quickly. I ask the Minister to action that request, or at least to look into it as a matter of urgency.

      I welcome the Government's steps to reform the system by beginning to carry out a few pilots and trials in different forms of commissioning, but the pilots have not gone far enough, there are not many of them, and the proposed systems do not provide a complete break from the old "unit of dental activity" system. Rather, they blend it with new systems. In the face of the crisis that we have on our hands, I am afraid that a piecemeal change is simply not enough for the people of Cumbria. We need total system reform. The Government need to sit up, take notice and change the contract so that people get the dental treatment they need. The current system is unjust, not fair to dentists and patients, and not fit for purpose. It is not good enough for Cumbria.

      Urgent action is needed to roll out a system that fairly rewards dentists for the work they do, includes incentives for preventive work and allows all dental practitioners to use their skills to their full capacity. If we want our NHS dentists to feel that their vital work is valued and not to feel encouraged to move into working privately or give up the profession altogether, we need to take swift, far-reaching action. We need a funding system that does not feel like a treadmill, that rewards preventive care and that is not riddled with unfairness, idiosyncrasies and perverse incentives.

      Those of us living in Cumbria are seeing the colossal impact of the current system on the health of children and adults alike, and we are further affected by the huge distances that we have to travel to get care, if we are lucky enough to stumble across an NHS dentists with available space. My question to the Minister is this: what action will she take to provide my constituents with the NHS dental healthcare that they desperately need and that their taxes have already paid for?

    • NHS Dentists: Cumbria | Westminster Hall debates

      The hon. Gentleman makes a good point; in a moment I will come to some answers to those problems. The challenge is especially acute in rural communities when it comes to attracting and retaining dentists to work in NHS practices in places that are relatively close to people's homes.

    • NHS Dentists: Cumbria | Westminster Hall debates

      I beg to move,

      That this House has considered the provision of NHS dentists in Cumbria.

      It is a pleasure to serve under your chairmanship, Sir David. I am grateful for the opportunity to raise an issue of enormous importance to my constituents and many others around Cumbria.

      NHS dentistry in Cumbria has reached breaking point. More than half of all adults in our county have not had access to an NHS dentist in the last two years, while one in three of our children does not even have a place with an NHS dentist. In rural areas such as ours, lack of access to an NHS dentist results in families having to make ludicrously long journeys to reach the nearest surgery with an available NHS place. Often, people are not able to make, and simply cannot afford, those journeys for a simple check-up.

  • Jun 24, 2019: