Neil Carmichael: Levelling up must include improving access to NHS dentistry

22 Nov

Neil Carmichael is the former Conservative MP for Stroud 2010–2017 and the Executive Chair of the Association of Dental Groups, the trade association representing dental groups whose members are delivering NHS and private dentistry across the UK.

Every MP from across the political divide will have heard the growing crisis in access to NHS dentistry from their constituents this year. As Government grapples with the meaning of “levelling up” it is clear that equitable access to NHS dentistry has long been left behind.

In response to the tax rises to clear the NHS backlog in September a voter from Blyth, speaking to LBC stated, “it still won’t help get me an appointment or see a dentist.” These are the real world voter expectations that have to be met in the next two years as the stories of “DIY dentistry” mount.

The findings of Public Health England’s report Inequalities in oral health in England published this year are stark – for example, relative inequalities in the prevalence of dental decay in five-year-old children have increased from 2008 to 2019. These inequalities will only now be deepening as the impact of the pandemic becomes clearer – latest figures show around nine million children in England have missed dental treatment in the 12 months to March 2021.

The report also confirms a North/South divide exists running through the former “Red Wall” (together with pockets of deprivation in London and coastal communities in the South). It is at its worst in rural and coastal communities, as highlighted by MPs from Lincolnshire, Norfolk, Cumbria and Yorkshire in recent parliamentary debates. The challenge for a Government so committed to “levelling up” is clear.

There is no one simple explanation for this divide. Over the last 10 years, government net spend on NHS dentistry has been flat with no increase with inflation, which in real terms represents a cut. However, current NHS spending can be used more wisely. It is widely accepted, all the way to ministerial level that the current NHS dental contract of UDA activity is broken and the time has clearly come for more local flexible commissioning for hard to reach groups such as children and care homes.

But the immediate crisis is in the workforce – 951 dentists across the whole of England chose to cease NHS activity last year, many due to burnout and the NHS contract. Recruitment is no longer a “local” problem. We agree with Jeremy Hunt who argues for proper long term workforce planning by the NHS and incentives for dental teams to raise outcomes where need is highest. Put simply, “we need more dentists.”

MPs in Lincolnshire, the Isle of Wight and Yorkshire have called for new dental schools. But training a dentist takes over five years. To date, recruitment challenges have been met through overseas professionals coming to work in UK dentistry. This will remain part of the solution in dentistry and healthcare as a whole. A Global Britain should attract the best clinicians from the rest of the world. However, the registration process administered by the General Dental Council for overseas dentists to work here has been suspended for two years due to the pandemic, choking off recruitment. It urgently needs reforming and restarting.

Finally, nearly a decade has been lost whilst responsibility for water fluoridation stagnated at local authority level. Now the Government is following the example of New Zealand and taking powers directly to roll out fluoridation this can change. The British Society of Paediatric Dentistry estimate that water fluoridation could reduce tooth extractions in children by as much as two thirds in the most deprived areas.

Lack of access to NHS dentistry is a real and visible example for communities that sense they are “left behind” and addressing this must be part of “levelling up” health. Failing to do so will see dentistry become the next workforce crisis in the headlines. Doing so will begin to narrow the gap of inequality and “put the mouth in the body” across the whole country.

Conservative PCCs back Townsend’s attack on Stonewall

24 Aug

I have reported previously on how many local authorities and police constabularies have ceased funding Stonewall. Surrey County Council is an exception among Conservative councils in continuing to send over Council Taxpayers’ money to the controversial lobby group. However, Lisa Townsend, the newly elected Conservative Police and Crime Commissioner for Surrey, has given some robust comments in the Mail on Sunday:

“Everybody has told me not to speak-out about this, that the debate is incendiary, but if women like me can’t or don’t speak up who will? 

‘Stonewall, which has drifted so far from its original mission is now a threat to women and risks putting feminism back 50 years.

‘Police forces, in an attempt to correct many of the wrongs committed against minorities in the past, are being naive if they believe that Stonewall are anything but a well-funded lobby group for a dangerous ideology that threatens the safety of our women and girls.

‘The single biggest issue that filled-up my inbox when I first announced I was standing as police and crime commissioner were concerns about gender self-identification.

‘They raised concerns about safeguarding, the recording of crime, the placement of trans women in women’s prisons and men identifying as women in changing rooms.

“Some were mothers alarmed about the influence of trans lobby groups in schools.“The women who contacted me were shocked that someone was finally listening to them. Some were anonymous – genuinely terrified to put their names to emails because the backlash for speaking out can be brutal.”

Townsend has been brave to raise her concerns – even though the majority of people would quietly agree with her. But it is heartening that other PCCs have expressed their support. Those backing Townsend on Twitter include Donna Jones, the PCC for Hampshire & Isle of Wight. Also Marc Jones, the PCC for Lincolnshire, who tweeted:

“Some services quite simply can’t function in a gender neutral way and we mustn’t put women and girls at risk by trying to make them.”

Rupert Mathews, the PCC for Leicestershire, emails me to say:

“I agree with the views my colleague in Surrey expressed when she said that ‘Stonewall pushes a dangerous transgender ideology’. We cannot, on the one hand, be focusing on tackling the scourge that is violence against women and girls, all the while ignoring their concerns and safety when it comes to allowing biological men into women’s spaces such as prison and changing rooms. Stonewall’s influence had become part of the problem.”

There could be some tension, of course, should the PCC and chief constable have different views. Or, more plausibly, that the chief constable is used to following whatever politically correct demands the National Police Chiefs’ Council or the College of Policing come up with. As Paul noted yesterday the PCC can sack the chief constable but it “might be just a bit excessive” to do so purely on this issue. However, the PCC is responsible for setting the budget and setting policy. Surely the issue of giving funding to Stonewall and of following its edicts comes under that category. Quite rightly, the chief constables have responsibility for “operational policing” – but if that definition is stretched to cover everything then the PCC is impotent.

Chief constables might be reluctant to disregard the wishes of someone who has been democratically elected. That applies all the more when those wishes have been publicly and strongly expressed. We shall see what actions follow the words. But words are a start. Townsend is to be commended for speaking out.


Robert Halfon: Patriotism is important to people – whatever the liberal elite thinks – and there’s nothing wrong with that

24 Mar

Robert Halfon is MP for Harlow, a former Conservative Party Deputy Chairman, Chair of the Education Select Committee and President of Conservative Workers and Trade Unionists.

Pride and Prejudice

I have tended not to engage in the cultural wars raging at the moment. This is, in part, because I have been focused on education and Covid and, second, because I remember the words of a close friend, “You don’t need to don your armour for every battle.”

However, the skirmish over our Union flag and the sneering about ministers’ flag displays from BBC presenters really got my goat.

I remember some years ago (pre-2010) when I was a parliamentary candidate, a BBC journalist came to visit Harlow. I happened to show him a leaflet I was sending to residents, containing some key campaign messages about cutting the cost of living and the like. The front of the postcard displayed my face superimposed on a Union flag. The reporter looked at my leaflet in absolute horror and questioned whether I was pandering to the far-right. Completely gobsmacked, I replied how on earth can a leaflet with our national flag be seen as any way promoting racism?

I never forgot this moment because, to me, it symbolised all too clearly that so many of the London professional classes were out of touch with the decent patriotism and pride of most citizens. The infamous 2014 “Rochester” Tweet by Shadow Cabinet member Emily Thornberry served as another example.

In many overseas countries, I have seen flags proudly displayed on government buildings and in ministers’ offices. No one raises so much as an eyebrow. Yet, when ministers choose to do so in this country, this is something to be mocked and laughed at.

The reason I care about this is because I think the knocking and disdain for our flag by the “liberal elite”, is a small example of the gulf between their views and those of millions of voters – and one of a number of reasons why so many voters turned against Labour.

Far from being the first refuge of the scoundrel, patriotism is an anchor that roots all of us in our communities and provides stability and cohesiveness from one generation to the next. Pride before prejudice.

Schools Disgrace

Over the past week, horrific allegations have emerged about sexual abuse, assault, harassment and “a culture of rape” (predominantly conducted by male students and directed towards females) in certain leading private schools. At the time of writing, over 5,500 testimonies from current and former pupils have been documented on the “Everyone’s Invited” website.

Even worse, it appears that school staff have not always taken adequate action upon learning of allegations (until it reached the media). At first, it looked like this was confined to one or two schools. Now, it seems this problem is much more widespread. As I write, a state school in Lincolnshire has hit the press because of students sharing abhorrent rape “jokes” online.

There must be a national inquiry led by the Department for Education or Ofsted to establish exactly what has gone on, the scale of the abuse and how the failings of protection of female pupils, of care and safeguarding have gone unchecked.

It is my view that Ofsted should inspect all schools – public or private – rather than having different inspection regimes. These schools, some with a great history, should be ashamed that they have allowed these things such abuse and harassment to occur, letting down so many of their pupils, without repercussions for the perpetrators.


Over the years, I have tried to explain my own definition of Conservatism to (extremely patient) ConservativeHome readers. It usually involves the phrases “ladder of opportunity” or “The Workers’ Party”.

Given the upcoming local elections, I would like to propose a challenge to readers: how do you explain what Conservatism means on the doorstep?  In other words, if a resident asks you while canvassing, “what is it to be a Conservative”, what is your reply?

The only conditions are that your answer:

  • cannot mention Brexit;
  • must not be more than two sentences; and
  • must also pass the Ronseal Test (i.e. it does what it says on the tin).

Comment below. With JRR Tolkien Day on Thursday, it seems only appropriate that the winner will receive a Tolkien novel.

Marc Jones: ‘Sobriety’ tags on offenders who commit crimes while under the influence of alcohol can makes us safer

21 Sep

Marc Jones is the Police and Crime Commissioner for Lincolnshire

Alcohol fuelled crime has always been and remains a significant concern across the United Kingdom.

Creative thinking and a determination to find new solutions by Conservative Ministers and Police and Crime Commissioners (PCCs) has provided a genuine opportunity for change which must be grasped.

This year the Government is rolling out a programme to allow courts to impose ‘sobriety’ tags on offenders who commit crimes while under the influence of alcohol. These tags are a true innovative game changer in supporting real behavioural change that can help make our communities safer than ever before.

From May this year, Magistrates’ and Crown Courts can require offenders to wear the tags by executing an Alcohol Abstinence Monitoring Requirement (AAMR) as part of a community or suspended sentence.

These tags perform around-the-clock monitoring of an offender’s sweat to determine whether alcohol has been consumed and if the presence of alcohol is detected in the system, probation services are alerted, and the individual is sent back to court.

No-one should be in any doubt that innovation is needed in the approach to this problem which is a blight on communities across the UK.

Crime fuelled by alcohol is estimated to cost £11 billion per year in England and Wales, with 40 per cent of all violent incidents are committed by those believed to be under the influence of alcohol rising even higher in a domestic setting.

In 2018, a staggering 8,700 people were killed or injured in crashes involving at least one drink driver on our roads. How many innocent lives were torn apart?

Excessive alcohol is not just an issue for the criminal justice system. Public Health England (PHE) estimated that in 2018/19 there were 358,000 estimated admissions where the main reason for admission to hospital was attributable to alcohol.

The overall social and economic cost of alcohol-related harm is calculated by PHE as £21.5bn per year and with the total budget for the NHS standing at £130bn next year the scale of the problem is obvious.

While we recognise solutions are required are sobriety tags a solution? Well, on their own they cannot provide a panacea, I can testify that they do work – and have made significant improvements to the lives and wellbeing of my constituents in Lincolnshire.

I was one of three PCCs to run the first tagging scheme outside London to trial the technology and the support system that works alongside it and the results have been astonishing.

A review of the project carried out for my office found that of the 226 individuals issued with an AAMR order a staggering 94 per cent successfully completed the order and 97.4% of all the days monitored were free of alcohol.

One offender claimed the wearing of a tag gave him three months sobriety in which his life has changed forever as it gave him the space he needed to seek help for his issues.

Much praise for this initiative should go to Kit Malthouse, the Minister of State for Crime and Policing.

During a lecture in Oxford University, Malthouse first heard of an experiment in South Dakota which was utilising such tags to tackle drink driving.

Malthouse, Deputy Mayor of London and de facto PCC at the time, quickly identified the ingenuity of such a system and a decade later we are now seeing his determination to bring this initiative forward pay dividends.

Now it is the turn of Police and Crime Commissioners to see this project through. Since 2012 PCC’s have a unique remit to protect and improve the communities they serve.

Unlike Chief Constables, a PCC has the responsibility to look beyond the operational necessities of fighting crime on a daily basis and to work with agencies and partners to explore and commission new ways to safeguard residents through crime prevention and rehabilitation in the long term.

This project offers that opportunity.

If I haven’t convinced you of the worth of this system then listen to the words of one offender who wore a sobriety tag during the pilot project in Lincolnshire:

“Since I had the tag removed I feel 100% in control of my drinking. I was worried to begin with that when I had the tag taken off I might go back to drinking again but the process gave me a better understanding of alcohol. I also didn’t want to go back to court.

“I no longer need a drink to manage my emotions which is down to the tag and my probation officer – I’m much happier with my life now and pleased that more people can benefit from my experience of wearing the tags.”

As Malthouse so eloquently says:

“This policy represents a revolution in our approach to alcohol crime, and part of the solution to a stubborn and ugly domestic abuse problem”.

“More importantly, it’s simple, corrective and it works.”

I could not agree more.

Neil O’Brien: Introducing the new Levelling Up Taskforce – and its first report on how we can measure progress

7 Sep

Neil O’Brien is MP for Harborough.

Were you still up for Penistone? One of joys of election night last December was winning so many seats we’ve not held for decades.

The constituencies we won over in 2019 are quite different from the party’s traditional base, in the deep red bits of the map above. Seats we gained last year don’t just have lower earnings than the seats we held, but earnings five per cent lower than Labour seats. Of the bottom quarter of seats in Great Britain with the lowest earnings, more are now held by us than Labour. Compared to seats we gained, homes in Labour constituencies are a third more expensive.

Many of the places we won have felt neglected for a long time. And led from the front by the Prime Minister, the new Government has committed to “levelling up” poorer places. But what does that really mean? How can we measure if we are succeeding? How can we get the private sector growing faster in these places, making the country stronger overall?

To help the Government answer these questions, I and 40 other Conservative MPs have formed a new Levelling Up Taskforce.

Our first report is out today, looking at how we can measure progress. It also examines what’s been happening in different parts of the UK economy over recent decades.

Income per person in London (before paying taxes and receiving benefits) grew two thirds faster than the rest of the country between 1997 and 2018: it’s now 70 per cent higher in London than the rest of the country, up from 30 per cent higher in 1997.

While the divergence seen since the 90s has been a story of London pulling away from all of the rest of the country, it follows decades in which former industrial areas in the north, midlands, Scotland and Wales fell behind. Between 1977 and 1995 South Yorkshire, Teesside and Merseyside saw GDP per person fall by 20 per cent compared to the national average, and most such areas haven’t caught up that lost ground.

Why does this matter?

It matters, first, because opportunity is linked to the economy. There are fewer opportunities to climb the ladder in poorer places. Not just fewer good jobs, but less opportunity in other ways.

In London, over 45 per cent of poorer pupils who were eligible for free school meals progressed to higher education in 2018/19. Outside London there were 80 local authorities where richer pupils who were not on free school meals were less likely than this to go to university. Overall, more than 60 per cent go to university in places like Kensington and Chelsea and Westminster. But less than a third go places like in Knowsley, Barnsley, Hull, and Thurrock.

It also matters because more balanced economies are stronger overall. In an unbalanced economy, resources like land and infrastructure are overloaded in some places, even while they are underused elsewhere. This might be particularly true where cities have seen population shrinkage, and have surplus infrastructure and land. If there are greater distances between workers and good job opportunities that makes it harder for people to get on: not everyone can (or wants) to move away from family to find a better job.

More balanced is stronger overall, but on a wide range of measures the UK is one of the most geographically unbalanced economies. In Germany 12 per cent of people live in areas where the average income is 10 per cent below the national average, while in the UK 35 per cent do. It is very striking that there is no industrialised country that has a more unbalanced economy than the UK and also a higher income, while all the countries that have a higher income have a more balanced economy.

What are we going to do about it? Well, that’s the question our new group will try to answer.

The answer isn’t any of the traditional Labour ones: pumping public sector jobs into places, or subsidising low wage employment, or trying to hold back successful places: we’re interested in levelling up, not levelling down.

Different things will work in different places.

For example, transport improvements might make a bigger difference for remote areas. The ONS defines certain places as “sparse”: the north of Devon and Cornwall, most of central Wales, Shropshire and Herefordshire, most of Cumbria and the rural north east, along with large parts of North Yorkshire, Lincolnshire and North Norfolk. In these places income levels are 17-18 per cent lower. Even controlling for the qualifications and age of people living there, these sparse areas have income levels between £600-£1,300 a year lower, likely driven by poor connectivity.

In other places, the answers are different. I’ve written before about how the way we spend money on things like R&D, transport and housing is skewed towards already-successful areas, creating a vicious circle. We should change that.

But tax cuts could also play a bigger role in helping poorer areas. There’s actually been convergence between regions at the bottom end of the earnings distribution, driven by things like the National Living Wage, tax cuts for low income workers, and things like Universal Credit, which have reduced the differences between places by levelling up the poorer areas more. In poorer places, more people benefit from these policies.

The reason there are growing gaps between areas overall is divergence higher up the income scale.
Looking at the gap between earnings for full-time workers in London and the North East, the pay gap shrank for the bottom 30 per cent of workers, but grew for those higher up. For those at the 10th percentile the pay gap between the two places shrank from 32 per cent to 20 per cent. But for richer folks at the 90th percentile, it grew from 62 per cent to 88 per cent.

So how do we get more good, high-paying jobs into poorer areas? There are a million different specific opportunities, but one that’s relevant in a lot of Red Wall seats is advanced manufacturing.

Over recent decades, Chancellors have tended to cut capital allowances (a tax break for investment) in order to lower the headline rate of corporation tax. I’m not sure that was a good idea: Britain has a lower rate of fixed capital investment than competitors and our tax treatment of investment is stingy. But either way, this change has had a pronounced regional impact: it favours services over manufacturing, so helps some areas more than others.

One way to blast our way through the current economic turmoil would be to get businesses investing again by turning capital allowances right up (“full expensing” in the jargon). That would be particularly likely to help poorer areas. Indeed, when we have tried this in a targeted way before it worked.

Government should think more about how tax and spending decisions can help us level up. It should produce geographical analysis of all budgets and fiscal events, setting out the different impact that tax and spending changes will have on different areas. The Treasury’s Labour Markets and Distributional Analysis unit should have geographical analysis added to its remit.

This whole agenda is exciting. But a lot of people are cynical, because they heard New Labour talk the talk – but not deliver. We’ve got to deliver. So let’s hold ourselves to account, and set ourselves some ambitious goals.

Let’s get earnings growing faster than before in poorer areas. Let’s get unemployment down in the places it’s worst. They say that “what gets measured gets managed.” So let’s “measure up” our progress on levelling up.