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Clive Efford (in the Chair)
Before we begin, I remind Members to observe social distancing and to wear masks. There is clearly a lot of interest in the debate. We will work out roughly how long people have to speak, but I do not intend to impose a strict time limit, unless people abuse the timings. We will give you an indication of how long to speak for, and if you could roughly stick to it that would be really helpful. I call Peter Aldous to move the motion.
Peter Aldous (Waveney) (Con)
I beg to move,
That this House has considered access to NHS dentistry.
It is a pleasure to serve under your chairmanship, Mr Efford. I thank the Backbench Business Committee for granting this debate. I am grateful to the hon. Member for Bradford South (Judith Cummins) for her work in helping to secure it.
NHS dentistry has been the No. 1 issue in my inbox for the past nine to 10 months. This is a national crisis, though the problem in my constituency—in Lowestoft and Waveney—is acute. Dentists have retired, which has led to resources and dental capacity being taken away from the area, notwithstanding the increased need and demand following the pandemic. Many of the remaining practices are experiencing difficulties in recruiting and retaining dentists, and the situation has been exacerbated by a lack of funding, with net Government spending on general dental practice being reduced by a third over the past decade. That said, the overall situation locally has improved since I first raised concerns in an Adjournment debate on 25 May last year, and I will outline the improvements later. They are welcome, but I am concerned that they might be a short-term sticking plaster and might not provide a long-term solution.
As we emerge from covid, the situation both locally and nationally has reached crisis point. Locally, that is due to covid, as well as retirements in two NHS dental practices in Lowestoft and the closure of the mydentist practice in Leiston, in the constituency of my right hon. Friend the Member for Suffolk Coastal (Dr Coffey). That practice closed due to the difficulty of recruiting dentists to work in the NHS in the area—a theme that is repeated across the country.
Access to NHS dentistry is a problem that has been brewing for a long time. The situation can be likened to a house built on shallow and poor foundations. The earthquake of covid has led to that house falling down. There are now parts of the country—particularly in, though not confined to, rural and coastal areas—that are dental deserts.
Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)
I thank the hon. Gentleman for securing this important debate. On that point, my constituents in the city of Birmingham have hugely suffered through the covid. People like myself, who suffer from diabetes, have had huge issues with dental treatment. I hope that we can move forward and return to treating people in the best way possible.
Peter Aldous
While there are particular problems in rural, coastal and more peripheral locations, which it is difficult to get dentists to move to, it is clear from looking around the Chamber today that the problem is not confined to such areas and is an issue in metropolitan areas as well. Sir Robert Francis, chair of Healthwatch England, has commented:
“Every part of the country is facing a dental care crisis, with NHS dentistry at risk of vanishing into the void.”
I believe there are five issues that need to be tackled to address the problem. First, a secure, long-term funding stream must be provided. Secondly, we need to step up the recruitment and retention of dental professionals. Thirdly, it is vital that work on the new NHS dental contract, which has been being developed for more than a decade, is completed as soon as practically possible. Fourthly, it is important to highlight the role that water fluoridation can play. Finally, there is a need for greater accountability and for dentistry to have a voice in the emerging integrated care boards and partnerships.
Kevin Hollinrake (Thirsk and Malton) (Con)
I congratulate my hon. Friend on securing this important debate. Another point that needs developing is that in Helmsley, in my constituency, the commissioners have still not recommissioned services after 20 months. The commissioning of dental services by the NHS is simply too slow and too bureaucratic. It is a real deterrent for new dentists to take these contracts.
Peter Aldous
I thank my hon. Friend for that intervention, and he is right. There has been a recent procurement process in East Anglia, but it has been only half successful. There are places that have not been able to get dentists to fill those voids.
Figures published in March 2020, before the pandemic, show that 25% of patients new to practices in England could not get an appointment. The situation has got worse: the most recent figures, from 2021, show that that number has increased to 44%; in my area, it is 56%. Dentistry was locked down from March to June 2020 and the ongoing restrictions on dentists—fallow time between appointments—are still limiting the ability to see more patients.
The latest figures on workforce, published in August 2021, show that 951 fewer dentists performed NHS dental activity than 12 months earlier, with 174 of those losses in the east of England. Those figures confirm that parts of England are becoming dental deserts; beyond Suffolk and Norfolk, that includes the east Yorkshire coastline, Cornwall, Portsmouth and the Isle of Wight.
The lack of access to NHS dentistry has a fivefold impact on patients. First, millions are missing appointments. Secondly, there has been a significant increase in DIY tooth extraction. Thirdly, the poor are hit hardest. Fourthly, mouth cancers are going undiagnosed. Finally, children are suffering. This very serious situation has been confirmed by the “Great British Oral Health Report” carried out by mydentist.
I apologise for going on at length, Mr Efford, but it is important to emphasis the crisis we are facing. I will now briefly outline some of the solutions. The first issue that must be tackled is getting more dentists and dental practitioners working in the NHS. The Association of Dental Groups has put forward its “six to fix” proposals for solving the workforce crisis, which I will summarise. First, we need to increase the number of training places in the UK. That is a long-term measure. Secondly, in the short term, the Government should continue to recognise EU-trained dentists. Thirdly, there needs to be a recognition of other overseas qualifications. We have an opportunity to make more of our links with Commonwealth countries such as India, which has a surplus of highly skilled English-speaking trained dentists.
Fourthly, the process for overseas dentists to complete the performers list validation by experience—or PLVE—so that they can practise in the NHS must be simplified and sped up. Fifthly, whole teams in dental practices should be allowed to initiate treatments. The largest barrier to better use of the skills mix under the current NHS contractual arrangements is that allied dental professionals are unable to open a course of treatment, which means they cannot raise a claim for payment for work delivered.
Finally, the Government must create a new strategy for NHS workforce retention. The current contract through which NHS dentistry is provided was introduced in 2006 and for some time it has been widely recognised as not being fit for purpose. It is a major driver of dentists leaving NHS dentistry. Reforming the NHS contract is needed to deliver better access and preventive care so as to improve the nation’s oral health. Flexible commissioning, aimed at increasing access to vulnerable groups such as those in care homes should be an important part of the reform. The current dental contract is target-based, and it was accepted before the pandemic that it needed to be reformed. We must complete that reform as soon as possible. I would welcome an update from the Minister as to progress on that and when we might see a new contract.
It is important that NHS dentistry receives a sustainable long-term financial settlement and not a short-term fix. Additional funding is vital if long-term and sustainable improvements to NHS dentistry are to be secured. The pledge of £50 million on 25 January for a dentistry treatment blitz is welcome, and £5.73 million is available to the east of England. However, that is a time-limited one-off injection of funding that is available only until the end of March, and there is a concern that it will barely make a dent in the unprecedented backlogs that NHS dentistry now faces. The British Dental Association estimates that it would take £880 million per annum to restore dental budgets to 2010 levels.
Since my Adjournment debate on NHS dentistry in Waveney last May, there have been improvements to the local service, which it is important to acknowledge. A temporary contract was awarded to a Lowestoft-based NHS dentist to see additional patients, which has definitely helped prevent the situation from getting any worse. Tomorrow I shall be with Community Dental Services, which along with Leading Lives, a Suffolk-based not-for-profit social enterprise, is launching its toolkit to help improve the oral health of people with learning difficulties. It is also good news that from 1 July a contract has been awarded to Apps Smiles for the delivery of NHS dentistry in Lowestoft, but it is concerning that it was not possible to do that in nearby Leiston and across the border in Norfolk, in Fakenham and Thetford. It will be interesting to receive further details as to why that happened, but one can speculate dentists might not have been interested in those opportunities and might have been put off by the existing, unattractive contract.
I have concerns about the procurement process that go back a long time. I am concerned that it does not encourage traditional partnerships to put forward proposals. I urge the Minister to carry out a whole review of the procurement process.
A vital strand of NHS dentistry should be the prevention of oral health challenges—prevention rather treatment. Fluoridation of water supplies can play a vital role in that, so it is welcome that the Health and Care Bill allows for it. There is also a need for greater accountability.
Mr Mahmood
I apologise for intervening on the hon. Gentleman twice, but I just want to make the point that John Charlton, with Severn Trent Water, has worked on getting fluoridation in water for the past 30 years. We should pay tribute to him for the great work that he has done.
Peter Aldous
I am very grateful that the hon. Gentleman intervened on me, because Birmingham is the model of how to do this. As a Birmingham MP, it is right that he highlights that, and I thank him for it.
Duncan Baker (North Norfolk) (Con)
As I will set out in my speech, my father was an NHS dentist for 23 years. He trained a long time ago in Manchester, and he told me that the advent of sugary foods and drinks had had an enormously detrimental effect on children’s teeth over the years. The one thing we can do to solve that problem is fluoridation of our waterstream. It has made such a difference, and I thank the hon. Member for Birmingham, Perry Barr (Mr Mahmood) for raising that point.
Sir Paul Beresford (Mole Valley) (Con)
Birmingham is an interesting case. Not all of Birmingham is fluoridated, so when a child arrives, dentists can tell which part of Birmingham they have come from. No cavities, no fillings—fluoridated. Fillings and cavities—non-fluoridated.
Giles Watling (Clacton) (Con)
I thank my hon. Friend for being so generous in giving way so many times.
There is another point that ought to be mentioned here. As far as I am aware—I hope my hon. Friend can confirm this—no detrimental effects from fluoridation have yet been found anywhere, and we ought to scotch any rumours to the effect that they have.
Clive Efford (in the Chair)
Order. Before the hon. Gentleman responds, I should just point out that a number of Members who have their names down to speak are intervening. To respect others who want to speak, could you please refrain.
Peter Aldous
I am grateful because, with those four interventions, we have re-emphasised the importance of fluoridation.
There is a need for greater accountability, and the Health and Care Bill can provide the framework within which that can be secured. It is welcome that the commissioning of dentistry is set to move to integrated care systems. That can make for a more transparent system, but there is a risk that dentistry and its impact on overall health could be overlooked in the integrated care proposals. It is important that dentists are properly represented on integrated care system boards.
At Report stage of the Health and Care Bill, I tabled new clause 18, which called on the Secretary of State to publish an annual report on access to NHS dentistry, to collect data on the length of waiting times for primary dental care treatment and, if necessary, to take action. The Minister for Health declined to accept the new clause. I do not know whether a similar clause will be introduced in the other place. If it is, I would urge the Government to give it serious consideration. Such a reporting mechanism can drive sustainable and meaningful improvement in access to NHS dentistry.
Mr Efford, you will be delighted to learn that I am coming to a conclusion. Tackling access for NHS dentistry, which has been neglected for 15 years, is an opportunity that we must grasp in order to demonstrate the levelling up of healthcare right across the UK. We must put in place an NHS dentistry system that is fit for the 21st century, instead of reversing into the 19th century.
Clive Efford (in the Chair)
I am grateful to the hon. Member. It looks like we have six minutes each for Back-Bench speeches. If anyone can deliver their speech in less time, it would be very helpful.
Judith Cummins (Bradford South) (Lab)
It is a pleasure to serve under your chairmanship, Mr Efford. It is also a pleasure to follow the hon. Member for Waveney (Peter Aldous), with whom I co-sponsored today’s debate. I thank the Backbench Business Committee for granting valuable time for this valuable debate.
I have spoken many times in this place about my serious concerns about the state of NHS dentistry in England. Covid has had a devastating impact on our NHS dental services. According to the British Dental Association, it has caused more than 40 million NHS dental appointments to be lost since the start of the pandemic, which amounts to a whole year’s worth of dentistry in pre-covid times—a year’s worth of dentist appointments lost to the people and the system. Even before covid began, enough dentistry was commissioned for only half the adult population in England to see an NHS dentist just once every two years. With capacity now even more severely limited by covid, access problems have reached an unprecedented scale in every community, with existing inequalities in access and outcomes widening even further.
I received a briefing from Bupa, which tells me that across its 306 practices with an NHS contract in England it has a growing number of loss-making sites. It points out that these NHS practices would not be sustainable if they were independent—they are kept afloat by Bupa’s private practices. To be clear, that is private healthcare subsidising the NHS. The current dental contracts make dentists’ work highly stressful and do not allow them to provide the quality of care that they want to provide for their patients. According to the BDA’s surveys, that is the No. 1 reason why dentists are leaving the NHS or reducing the amount of work they do in it.
Only last week, I spoke to the owner of a dental practice in my constituency—he is my dentist—who told me that he has just learned that one of his dentists is leaving NHS practice to move to private dentistry. He also told me that the recent £50 million funding announcement for urgent dental care is virtually unusable, as it requires either persuading an already overstretched workforce to work overtime or recruiting new staff or hiring expensive locums—all of which has to be delivered by March 2022. It is just unworkable.
Bupa said the same about the funding package. To qualify for the funds, dentists must first have met their NHS contract thresholds, a system that excludes practices that have dealt with large numbers of patients with urgent needs, or faced higher staff and patient sickness, or who have struggled to recruit staff who are prepared to do NHS work. Only 134 of Bupa’s 306 practices were eligible under the criteria. Of those 134, only two so far have felt able to take up the extra funding.
It is clear that this funding package is not new funding—it is drawn from the £169 million that was clawed back from contract holders in 2020-21 for not meeting contractual targets. In my view, clawback is a failure of the system. It is not a failure of the NHS to spend money allocated through budgets but a failure to properly target resources to where they are needed, such as in my constituency in Bradford South and in the district of Bradford. The Government should not expect applause for creating a pot of funding for urgent care that simply cannot be spent in the time allocated, or in the areas where it is needed most, because of the strings that have been attached.
The BDA estimates that it would take £880 million per year just to restore NHS dental budgets back to 2010 levels. Chronic underfunding and the current contract are to blame for the long-standing problems with burnout, recruitment and retention in NHS dental services, with almost a thousand dentists leaving the NHS in England in the last financial year.
I know that the Minister is committed to reform, but I stress the urgency of this work. The Minister said earlier this week that the Government had
“started work on dental contract reform.”—[Official Report, 7 February 2022; Vol. 708, c. 780.]
The process has been under way since 2011. It is simply no longer good enough to say, “We’re working on it.”
I urge the Minister to commit today to a firm date when dentists will see the end of units of dental activity and a better contract, focused on prevention and increasing access. That needs to be rolled out now, as the targets set in the current contract are leading to the wrong outcomes. Unless what the Government are seeking is the ultimate demise of NHS dentistry, we really need to see a change in the contract. NHS dentistry was in trouble before covid-19 and is now facing an emergency.
In Bradford, almost 1,000 children under the age of 10 had to be admitted to hospital to have decayed teeth removed under a general anaesthetic in 2019-20. Thousands of children in Bradford and across the country are waiting in pain, taking painkillers and potentially multiple rounds of avoidable antibiotics to control their infection while they await surgery. No figures for the size and length of waiting lists for hospital tooth extractions in children or vulnerable adults are currently collected, but I am told that people are routinely waiting as long as two to three years—that is two to three years in acute pain. I hope that the Minister will touch on this issue in her response and explain why data on this crucial service for some of the most vulnerable people in our society is not routinely monitored and collected.
The lack of access to NHS dentistry is impacting some regions more than others. Yorkshire and the Humber is currently the worst performing area in terms of child oral health, with more than one in seven children in the region suffering from decay by the time they are just three years old. That is more than double the rate in the east of England, where only one in 15 children are affected by that age. According to a recent survey by mydentist, nearly 10% more people were able to access routine dentistry in the south of England than in the north.
Since the current Government took office, their unspoken policy has been to rely increasingly on rapidly rising patient fees while they drastically cut Government funding for dental services. Net funding to NHS dentistry fell by around one third in real terms in the last decade. An acceptable level of access can be secured only by prolonged and serious commitment, and proper, long-term funding to and for NHS dentistry. We need, in essence, a new deal that treats dentistry as an equal member of the NHS family, not a Cinderella service. I ask the Government to commit to a properly funded all-age NHS service.
However, I believe that we can and must go further. We must work to achieve a fully-funded dentistry service, with NHS dentistry available to all. As the chair of Healthwatch England, Sir Robert Francis, QC, said:
“We won’t build back a fairer service until access to NHS dentistry is equal and inclusive for everyone.”
I agree with Healthwatch, and believe that the guiding principle in NHS dentistry must be that good oral health must not be restricted by either postcode or wealth.
Sir Peter Bottomley (Worthing West) (Con)
I agree with Sir Robert Francis and with the hon. Member for Bradford South (Judith Cummins). I also agree with, and am grateful to, my hon. Friend the Member for Waveney (Peter Aldous).
Mr Efford, I would just clear my throat by saying that I am only Father of the House because of 1992, so I pay tribute to you for your part in my still being here. I would also say that, after Stephen Lawrence was attacked, I did the right thing in going to see the Commissioner of Police, but I also did not do the right thing; I should have gone with you to ask the Home Secretary for an inquiry into the attack. I pay you public tribute for that, and I shall forever be grateful that you did what I had not done.
I hope that the Minister has met the Toothless campaigners, Mark Jones and Steve Marsling, who have given some of us leaflets spelling out some of the things that are required.
With the participation of patients, we ought to be able to get this right. It needs dealing with, first as an emergency, then in the medium and long term. Fluoridation should not be delayed, but the beneficial impact will come later. Getting more dentists through training and getting more well-qualified dentists from overseas will help in the medium term, but the emergency goes beyond the end of March this year.
I will send to the Minister the letter that I received on 10 February from NHS England and NHS Improvement about the situation. It is a well-meaning letter, but it does not deal with the problem, as she will know, because, on the south coast, we face the same problems as in East Anglia and in Yorkshire—and throughout the country, for that matter.
We know the impact that covid had in reducing the number of sessions that were possible, with the space required between treatments, but as the hon. Member for Bradford South said, it is not just about covid; the problems were there before. I take the view that the general practitioners contract in 2006 was wrong; the dentistry contract was wrong. Those watching this debate may hear about UDAs—units of dental activity. Why is it that one filling attracts three UDAs, and yet five fillings, a root canal and an extraction get the same?
I am grateful to those dentists who have written to me, many of whom are doctors. One says:
“I spend around 40-50% of my time on NHS work (clinical and non-clinical) but it only accounts for around 10% of my income.”
My mother used to explain to me that young dentists would take on a lot of NHS work and work really hard and intensively, then, as they grew through middle age and towards their last 10 or 15 years, they would go more private and have more time, and others would come up and take over their work. There would be a sort of succeeding life cycle of dental activity.
I am not against private dental treatments and attention, but I do not believe that it should be required. People ought to have the option of NHS treatment. My wife and I always used that for our family, until we were a bit older, and others should be able to do the same. We need a system in which anybody who asks for an NHS examination can get one, without significant delay.
One dentist talks about an awful lot of time spent on data capture for the NHS Business Services Authority—at least it is one; it was combined from five other bodies. It is important that the amount of admin that dentists complete be reduced as far as possible.
Those practices that still provide NHS dentistry try to continue with their contract but say that they are unable to take on new patients due to UDA limits. They get many calls a day from people saying that they cannot get care because their practice no longer accepts NHS patients. That has to change, and it has to change fast.
Another of my dentists has sent me some pretty clear figures. They say that they cannot find the 1.5 to 2 full-time-equivalent dentists that they need to recruit. They also bring up the issue of training and the flawed contract, and note that contract reform has been promised by every Government since the current contract was introduced in 2006.
We cannot delay any longer. Even if it were just an interim contract, that would provide an incentive, money, encouragement, recognition and a change to patients’ circumstances. As has been said, many more things need to be done.
I have found the British Dental Association to be very co-operative and positive, acting in the interests of patients and of its members as clinicians and as businesses.
Let us try to get people together and take an urgent approach. And when we meet in six months’ time, let us be able to say that significant improvements have been made and that more are coming. Then, perhaps in three or four years’ time, we will not have to have these discussions.
Mr Virendra Sharma (Ealing, Southall) (Lab)
It is an honour to serve under your chairmanship, Mr Efford, and I congratulate the hon. Member for Waveney (Peter Aldous) on securing the debate.
We urgently need to find a long-term, sustainable solution to the crisis that NHS dentistry faces. Covid has been tough on it, but the trouble did not start in March 2020. Parveen Kapoor, a dentist working in my constituency, is at his wits’ end. His surgery is inundated with patients, many of whom have not been able to see a dentist for years. In his words:
“Covid made a bad situation even worse.”
Parveen is so proud of the work that he and his colleagues do. He cares so deeply about his patients. However, as he says,
“we are a caring profession, but the crisis is making offering our patients the care we need difficult, and it won’t take much more to make it impossible.”
A long-term solution starts with making NHS dentistry a place where people want to work. We also need to see a reshaping of NHS dentistry that ensures that patients can access surgeries and that prevention is effectively prioritised.
Over the past decade, both staff and patients have suffered the consequences of chronic underfunding. NHS dentistry has suffered unprecedented cuts not seen elsewhere in the NHS, with net Government spending on general dental practice in England cut by about a third in the past decade. This crisis is a result of Government choices.
Contracts are failing while staff suffer burnout, and dental practices struggle to navigate recruitment and staff retention. The British Dental Association’s general dental practice committee chairman has described NHS dentistry as “hanging by a thread”. Close to 1,000 dentists left the NHS in England alone in the last financial year. Morale is at an all-time low, as dentists turn to private practice, opt for early retirement and seek career changes.
As a result, communities across the UK face alarming access problems. Pre-pandemic, Healthwatch England concluded that 85% of dental practices were closed to new adult patients. The situation was exacerbated by the pandemic; a full year’s worth of appointments were lost between April 2020 and December 2021. Dentists still see only a fraction of the number of patients they usually see due to social distancing measures and underfunded efforts to improve ventilation. This has lasting consequences for our communities.
Good oral health is essential to general health and wellbeing. Oral health inequality is widening, while patients turn to dangerous DIY dentistry. Despite ongoing restrictions related to the pandemic, NHS dentistry in England continues to suffer the consequences of harsh funding cuts. Surgeries in England have been set extreme targets, or have to pay back funding; they are overstretched and struggling. Dentistry should be treated not simply as an afterthought but as a central pillar in upcoming reforms of the healthcare system. We need sustainable, long-term action focused on prevention before it is too late.
A sector that is key for health has borne the brunt of austerity cuts. One-off investments, such as the Government’s £50 million so-called dentistry treatment blitz last month, are not enough. The treatment blitz barely made a dent in unprecedented backlogs and runs the risk of further overwhelming pressurised practices and staff. This Government, in office for 11 years, have created this crisis in dentistry. I hope the Minister will take steps to resolve it.
Richard Fuller (North East Bedfordshire) (Con)
It is a pleasure to serve under your chairmanship, Mr Efford, and to follow the hon. Member for Ealing, Southall (Mr Sharma), although I did not agree with the premise of his argument. I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing this important debate. He and other hon. Members have mentioned a number of problems. I do not mean to reiterate any, but I will add one issue for consideration by the Minister: infrastructure first, and the pressure of additional housing development. House building in my constituency is at five times the national average. That is not only disruptive to our natural environment but means that people cannot access their GP, a school place or a dentist. Maybe she can address that.
I wanted to speak for a number of reasons. One thing I put on the record—many colleagues will have had this—is that a number of dentists contacted me through lockdown desperately wanting to serve and provide services. They found it exceptionally difficult to be able to do that. They literally knew that there was a growing problem, and they wanted to serve. I thank dentists in my constituency, as I am sure do all Members, for their efforts during the period of covid. In addition to infrastructure first, I would like to hear from the Minister specifically how we are going to address the difference between registration for a service and actually accessing a service. It seems that there is a problem in the contracting around that at the moment.
Where I perhaps disagree with the hon. Member for Ealing, Southall, who just left his place, is that I think we have to control taxpayer support for dentistry. Public finances are stretched and have been for considerable time—in my time as a Member of Parliament, both currently and during my time as the Member for Bedford. We have tried to deal with some aspects of excessive public expenditure. We have record debt. We have record levels of taxation. It is a fantasy for Members of Parliament to come here or to the Chamber time after time and say how wonderful it would be to spend more money on whatever is the topic of the day. In that way lies financial ruin. The Labour party has no answer to that. We need to find creative solutions to use existing levels of expenditure more wisely than currently.
On the way dentistry contracts work, as the British Dental Association and others have shown, there is plenty of scope for spending existing resources more efficiently and more effectively, by looking at a better form of contract than drill and fill or by looking at preventive dentistry, rather than reacting once problems have occurred. I was amazed to see—I do not know whether other colleagues have seen this; I am not sure I read it right—that one of the main reasons for young people ending up in A&E right now is tooth decay. How on earth did we get into that situation? There must be a better way for us to spend resources if that is the result those resources are having.
May I also make a point about recruiting people into dentistry? I supported Brexit and I support the Home Secretary’s points-based immigration system. What on earth are we doing to ensure that we have an adequate supply of people from across the world? My hon. Friend the Member for Waveney talked about people coming from the Commonwealth. I do not mind where they come from. I want the best and brightest to come to this country. How can we eliminate some of the restrictive practices to ensure that we make that an interesting and attractive option?
Finally, I will make a point about the contract. One issue in our health services is that most contracting is done, in essence, through what I would call production contracts between a producer and the state for how taxpayers’ money should be allocated. However, there are other ways to do that, such as by putting the power of the money with the consumer. We started to do that in elder care through personal budgets, and I know that the Opposition spokesperson, the hon. Member for Bristol South (Karin Smyth), has a lot of experience in care, so she might address that issue, too.
Can we find a new way to contract with our dentists that empowers consumers with the financial resources that are to be spent, so that they can choose where to use the money? They could have competitive pricing from dentists, rather than every particular production item in dentistry having a particular price, with all the frailties mentioned by my hon. Friend the Member for Worthing West (Sir Peter Bottomley), the Father of the House, with one filling versus the whole thing ending up at the same production price. If we empower people through the budget, that might be a better way to approach any change to our contracts, rather than just rehashing another producer contract for dentistry.
Munira Wilson (Twickenham) (LD)
It is a pleasure to serve under your chairmanship, Mr Efford.
I, too, congratulate the hon. Members for Waveney (Peter Aldous) and for Bradford South (Judith Cummins) on securing this important debate. Lots of important points have been made about the situation nationally and about the contract, and some solutions have been offered.
I will use the short time available to pay tribute to Healthwatch Richmond, which back in the 2020 was the very first Healthwatch in the whole network to express concerns about dentistry. It was the first to produce a report on it, which prompted Healthwatch England and various local Healthwatches to do so. I pay tribute to Healthwatch Richmond’s lobbying of Healthwatch England and NHS England for bringing us to the point where we have the information to hand and can put pressure on NHS England and on Ministers. I thank Mike Derry for his work.
I also want to give a voice to my constituents. Yes, the London Borough of Richmond is a relatively affluent borough. That does not mean that there is not need and that everyone can afford to go to a private dentist. Our borough has the lowest funding for NHS dentistry in London, apart from the City of London, and the Healthwatch Richmond survey found that less than half of those seeking NHS care could get a routine appointment. One in three could not even access urgent or emergency care; private patients were 16 times more likely to be able to access treatment. Clearly, the problem is not with the supply of dentists, because those who needed to get treatment, if they are able and willing to pay, could access care in the space of a week. Hundreds of others, however, could not access such care.
I want to bring two or three examples to light. Only last month, a resident of Hampton wrote to me. She is a full-time carer for her daughter and they both have special needs. She was tearing her hair out, because she had phoned scores of NHS dental practices but no one would take her daughter. She said:
“I have to use my disability money and my heating money and food money to pay £700.00 to help my daughter. I even wanted my dental practice to give my daughter my place at the practice as she is in so much pain.”
They have various special needs and are concerned, as so many are, about the cost of living crisis—she has heating bills and food bills, but here she is having to pay for care.
Another recently retired individual, whose income dropped significantly in retirement, said that they ended up paying
“£1000 for x-rays and the 30 second removal of the implant! The second dentist I went to in Twickenham quoted me £6k for removal of a wobbly tooth and replacement”.
That is simply not affordable, and it is unfair to say that affluent boroughs such as Richmond do not need additional NHS provision. There are countless more stories. As we have heard, prevention is important. Another resident who wrote to me eventually ended up getting referred to hospital for emergency treatment months after they should have been treated.
I have sympathy for the argument made by the hon. Member for North East Bedfordshire (Richard Fuller) that, clearly, there is not a bottomless pit of taxpayer cash allowing everybody as much NHS treatment as they need all the time. We know it is a false economy to restrict NHS access because people are, as he pointed out, ending up in A&E and with far worse problems down the line, which costs the NHS a lot of money.
I agree with what the Father of the House, the hon. Member for Worthing West (Sir Peter Bottomley), said about everybody being entitled to NHS care. I know the Minister will talk about the recent £50 million injection of cash into NHS dentistry, but that will offer just 350,000 appointments. Nine million children missed dental appointments in the year following the first lockdown. The Liberal Democrats are calling for a minimum standard of service, with a personal dental plan that helps people to understand how frequently they need a check-up, gives them good advice on looking after their teeth and, critically, includes access to an NHS dentist. I look forward to hearing what the Minister has to say to my constituents and millions of others around the country who cannot access the care that they need.
Mrs Maria Miller (Basingstoke) (Con)
It is a great pleasure to serve under your chairmanship, Mr Efford. I thank my hon. Friend the Member for Waveney (Peter Aldous) for his leadership on the issue. I pay tribute to my everyone at my local dentist for the work that they do—the technicians, the hygienist and the staff in both the private and NHS practices. I particularly pay tribute to them for everything they tried to do during the pandemic, as mentioned by my hon. Friend the Member for North East Bedfordshire (Richard Fuller).
Let us be under no illusion about the importance of dental health. It is not some cosmetic thing. The science shows that the health of our teeth and gums is integral to our overall health. Gum disease is linked to strokes, diabetes and heart disease, so the health of our teeth really matters. The Government spend more than £3 billion a year on NHS dentistry, including around £500 million in my own region of the south-east. Why does it feel, from all the conversations we have had, that that part of our health system is a distant cousin in comparison with the rest of our community health services?
Certainly in my own part of North Hampshire, that came into stark relief during the pandemic, showing the systemic fault line in the dental system and how it is semi-detached from the rest of our local NHS services. Despite being one of the sectors of the NHS that is most experienced with infection control, it was effectively shut completely for almost three months, and for many more months measures were put in place to significantly reduce the number of patients that could be seen. There was almost no way of accessing support, despite the fact that many professionals were very willing to put it in place, including dentists from my own area who contacted me at the time.
There are three systemic issues that the Minister needs to touch on. We need to be clearer about the role of the NHS in providing dentistry. The hon. Member for Bradford South (Judith Cummins) touched on the importance of private and NHS provision, but let us not fudge it. We need a mixed economy in the sector if we are going to go forward. Although I agree with the Father of the House that there should always be an NHS option, we need a system that embraces both private and NHS services and enables them to work together.
The second issue is around NHS contracts, which we have heard a lot about in the debate. There are no incentives in the current contracts for prevention or continuity of care set out by the National Institute for Health and Care Excellence. There is no real requirement to develop a relationship with patients, which would be beneficial for the long term. Surely that has to change. Can the Minister update us on that?
When it comes to scrutiny and accountability, dentistry is simply not the same as the rest of the NHS. I asked my local regional commissioner in the south-east for some data about 10 days ago when the debate was announced. I still do not have any local data on waiting times for appointments. Why? Because it is not collected. That is appalling. We are spending £500 million in my region, but we are not collecting any data on waiting times. Commissioning the service at a distant, regional level not only failed us in the pandemic, but fails us on an ongoing basis. Will my hon. Friend the Minister, who is really diligent in her work, touch on that in her speech?
We have to see a way forward. The people who access NHS dentistry rate it really highly. We welcome the additional funds that the Government have put in place to provide catch-up, but even though my constituency has two of the three Hampshire dentists who provide those extra services, I am still seeing a spike in problems in accessing the extra dental appointments. I do not think we are out of the woods yet with the hangover from the pandemic.
We need more accountability. We need dentistry to be part of our local health system, we need regional commissioning to be a thing of the past and we need a contract that really works. The 2020 NAO report on the subject is really important, demonstrating that in some areas there are significant under-deliveries of contracted dental services, making it even harder for patients to get NHS services that the NHS is actually willing to pay for. Indeed, the NAO report estimated that almost 1,000 practices fell into that category, delivering up to 40% fewer dental units than they should be in some areas. Let us have a contract that means that people get what they need, that prevention is in place, and that there is continuity of care. Others have touched on the need for more dentists. We have significantly fewer dentists per head than Germany and France. I welcome the work that the Government are doing on that but we need more.
The short-term problems created by the pandemic have shown much more significant and fundamental problems in our dental services. Let us use this opportunity to capitalise on that understanding of where the problems lie and get change that will deliver, for the long term, better dental service for everybody in the private and NHS sectors.
Justin Madders (Ellesmere Port and Neston) (Lab)
It is a pleasure to see you in the Chair, Mr Efford. Access to NHS dentistry has been raised with me throughout the pandemic, and judging by turnout for the debate, it is something that a lot of Members are keen to get their teeth into—[Interruption.] I promise to make no more dental puns.
I have met dentists and made representations to Ministers numerous times. The overwhelming feeling that I have had from such discussions is of a disjuncture between the two. Dentists and patients do not feel listened to, and Ministers are not offering the solutions needed to ensure that NHS dentistry is accessible for much of the population. While that is not being addressed, waiting times build, preventive dental action is not taken and health inequalities rise.
I pay tribute to all dentists and dental staff in my constituency, who have worked in a high-risk environment throughout the pandemic. I know that they are doing all they can to deliver those services. The correspondence I have had with them shows how passionate they are about ensuring good access to NHS dentistry.
As the Father of the House, the hon. Member for Worthing West (Sir Peter Bottomley), explained, a lot of the issues relate to the UDA system, which does not encourage dentists to take on new patients, especially those who require a lot of treatment. That scenario is increasingly common in the light of the difficulties that we have had over the past two years. The UDA system accommodates only 50% of the population. To my mind, that means that we start from a position of knowing that many people will be denied access to dental care. We need a functioning NHS dental system, and that will be possible only through contract reform recognising the realities of the difficulties that the sector faces, and if services are commissioned for a much higher proportion of the population.
I am told that the local commissioning figure sits at around 55% of the population, but of course that was pre-pandemic, so the number of people who have been able to access services is actually lower. Unless more of the population is covered, constituents will continue to struggle to access dentistry. One patient advised my local Healthwatch that they had contacted 45 practices in one day, and was told by all of them that there was no capacity as
“they only have a small NHS contract and are therefore not taking on patients at present”
but would be happy to take that person on as a private patient. The system actually encourages greater privatisation.
One constituent, who contacted me because of the pain she was experiencing from a hole in her tooth, described her attempts to register at a practice as a fight, which sums the situation up perfectly. We would not accept people having to ring around A&E departments to see if there was any space for NHS patients, so I do not see why we should accept it for dentists.
Since January 2021, there have been several increases in the UDA targets placed on dental practices. Between January and March 2022, it is expected that 85% of the UDA should be met. Last year, a practice in my constituency had to refund £45,000 because of activity that simply could not be delivered. I understand there is nervousness across the sector about the levels that will need to be refunded given that practices are expected to meet the 20% UDA increase at a time when we still have omicron-related staff sickness and appointment cancellations.
I recently asked whether any assessment had been made of the impact of short-notice cancellations on the ability of dental practices to meet their UDA target. The answer I received simply stated that that was considered within the 85% target and suggested that dental practices keep a short-notice cancellation list. However, the practices I am in contact with already do that and are proactive in trying to fill the slots. It seems, once again, that there is a disjuncture between what the Department says and what is happening on the ground.
Given that infection rates and community spread of covid-19 have been at their highest level in recent months, setting the target at 85% at this time seems questionable. There is little surprise that we are hearing of more dental practices leaving the NHS and operating on a purely private basis when there seems little financial incentive or, indeed, financial feasibility in continuing to deliver NHS services. We face the very real prospect of growing privatisation of dental services and people being priced out of receiving dental care. I have heard of price increases as high as 100% on previous NHS fees for those going private. Together with the cost of living, that is simply pricing people out.
Healthwatch Cheshire West confirmed that deregistration from dental practices is the primary cause of people needing to contact other NHS dentists and being unable to find one locally. The reality is that waiting lists locally sit in their thousands. One practice quoted a total waiting list of more than 3,000 people, demonstrating the significant challenge to be addressed.
In the last six months of 2021, I was contacted by 25 different constituents who faced that challenge. Many were writing on behalf of their whole families as well as themselves. One constituent, whose son was in pain after cracking his tooth, was told to keep ringing back each month to see if there was any capacity to reregister, another resorted to carrying out a temporary filling repair themselves at home and one lady, who had been shielding, was removed from the register due to inactivity. Many were shocked to find out how few rights or guarantees they have to remain registered at a practice. Healthwatch has suggested that clear information is needed so that patients are fully aware of the risk following inactivity or missed appointments. I agree that there needs to be greater information. However, there also need to be greater guarantees of access for individuals.
I will conclude by sharing the words of Cherie, a dentist who operates in my constituency.
“The only way to save NHS dentistry in England is to listen to dentists. It’s currently financially unviable for dentists in high need areas with large UDA contracts...this is only going to widen the oral health inequalities further.”
I urge the Minister to do just that: listen to dentists and act accordingly.
Selaine Saxby (North Devon) (Con)
It is a pleasure to serve under your chairmanship, Mr Efford. I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing this important debate.
I am all too aware of the issues surrounding the availability of dentists in North Devon. I could not find an NHS dentist when I moved there in 2017. I continued to travel back to my previous dentist in Wiltshire for 18 months until I was lucky enough to find one. On election in 2019, my first surgery was with a dental nurse detailing the discrepancies between her terms and conditions and those of other nurses in our healthcare system, as well as the issues surrounding the contracts making NHS dentistry unattractive to a growing number of dentists.
The lack of availability of dentists in North Devon significantly precedes the pandemic. The south-west is particularly poorly served when it comes to dentists. At 0.5%, the south-west average for hospital dental extractions for nought to 19-year-olds exceeds the England average of 0.4%. The figure for North Devon of 0.8% is double the England average, which is unacceptable.
In Devon, just 36% of children and only 43% of adults have seen a dentist in the last year, compared with 60% of children and 51% of adults before the pandemic.
William Shakespeare wrote in “Much Ado About Nothing”:
“For there was never yet philosopher
That could endure the toothache patiently”.
It is not just philosophers who cannot endure toothache patiently—neither can we. My constituents write in their droves to me about their problems accessing dental services.
Only this morning, I was contacted by a retired couple who have recently moved to my constituency. They cannot afford private dental treatment. Despite being mydentist patients in their former home, they have been advised that there is a five-year wait for a place with the same company in North Devon.
Another constituent wrote:
“I moved to Devon in Sept 2018 transferring into the area where my skills were required. I am an average wage earner and in this time have been on a waiting list for an NHS Dentist. I now have a dental problem. I used an emergency service yesterday and paid the £23 fee to sit in the chair for a little over a minute and told I need to find a dentist and have a crown fitted ASAP. The dentist kindly disposed of the chunk of tooth that broke away. I can’t even register with a private dentist let alone an NHS one. I have been warned private treatment will cost around £600.”
Another constituent has been a patient at Barnstaple dental practice for seven years and has paid for private treatment ever since moving there. They told me that they never thought they would be in situation whereby their children were not able to receive NHS treatment. In August 2021, they received three letters advising them that there would be no further NHS treatment for children at the practice.
A school holiday trip to the dentist was part of my childhood. I find it deeply concerning that children in my North Devon constituency are unable to do the same. All too many children have never seen a dentist. Given the statistics I have shared regarding young people in North Devon needing hospital extractions, we are storing up even greater dental issues for the future.
Surely it is possible for dentists to attend schools and check our youngsters’ teeth. There has to be a way to facilitate that. I hope that the Minister is looking into innovative solutions, including whether the 100 community diagnostic centres promised by her Department will also house a dentist facility, as the oral health backlog seems to predate the pandemic.
During lockdown, I met Dr Vinay Raniga from mydentist, who had some suggestions for what more could be done to secure more dentists in the short term. Additional training places for UK dentists are to be welcomed, but the time lag is far too long. We know that the contract needs addressing, but the fundamental issue in my constituency is a lack of actual dentists.
One suggestion is to simplify the processes that enable internationally trained dentists to come to work in the UK. We should take advantage of Brexit and harness the power of the Commonwealth, in particular the over-supply of dentists in India who are available to come to work in the UK. I very much hope that steps are being taken to work with our Indian friends to rebalance this dental supply inequality.
The Minister and I have already exchanged correspondence on this matter, and I know that steps are under way, but I fear that the magnitude of the problem in remote coastal constituencies such as mine needs bigger and bolder interventions. The £50 million is warmly welcome. After speaking with the Minister yesterday, I checked with my clinical commissioning group whether steps were under way to ensure that my local dentists are able to access that funding. NHS England has written to all dental providers in the region and has gathered 51 expressions of interest, of which only 31 meet the criteria set. I am not sure what is wrong with the other 20, but that raises further concerns.
In the south-west, we have retained our urgent dental hubs and have an urgent dental care initiative, providing an extra 1,100 appointments a week. That is of course welcome, but those appointments are for the whole of the south-west of England, and the contents of my inbox tell me that it will go nowhere near covering the demand in North Devon.
Last summer, the chief medical officer Professor Chris Whitty highlighted the health disparities in coastal communities compared with their inland neighbours. It is not just positive dental health outcomes that are hard to come by in my North Devon constituency. I know that the Minister is aware of the issues, but we urgently need our children to be able to access dental check-ups. As the social activist, Geoffrey Canada observed:
“Good dental care doesn’t make you a good student, but if your tooth hurts, it’s hard to be a good student.”
The depth of dental decay cannot wait. We need more dentists available to see us now.
Rachael Maskell (York Central) (Lab/Co-op)
Thank you, Mr Efford, for allowing me to speak in this debate to highlight how the dental crisis is impacting on my city of York.
Healthwatch York has been at the forefront of campaigning on dental services, and I pay tribute to York dentists and the wider dental community, who have been generous in sharing the challenges that they face on a daily basis. I have also been inundated with correspondence from constituents, asking me for help. I hasten to add that they do not want me to get out my Black & Decker. They want me to stand in the gap between my city and the Minister in order to find the solutions. It is getting harder, because dentists are disappearing, waiting lists are growing and oral health is deteriorating rapidly.
Healthwatch York carried out a study in 2018. It found that it taken over two years for 45% of York residents to find a dentist, so none of this is new. Back then, 84% of respondents had an NHS dentist; last year, that figure fell to just 59%. Of those who did not have an NHS dentist, 71% could not find an alternative. The number of people who have not seen a dentist in the last two to three years has risen sixfold. According to the national data, the number of children who have seen a dentist has fallen by 44%. In York, it can take five years before people can see a dentist, and no practices are seeing new patients. Out of 39 practices, only one is accepting NHS patients on to a waiting list, but it already has 2,000 people on it.
In the midst of this crisis, many are receiving letters to say that their NHS dentist is going private, and they are therefore left without. One constituent said that they had spent their burial savings on tooth treatment, and another extracted his own tooth. This is a time of real crisis.
Some of my constituents have found a dentist 40 miles or more away, and some say it is cheaper to travel abroad. Many have no dentist at all. The cost of living crisis is bearing down on York because of housing costs, meaning that people simply cannot afford to go private. And nor do they want to. The principle of the NHS is so important to them, so they seek solace at A&E or with their GP in order to address the pain that they are experiencing, at a time when, as we all know, oral health inequality is growing sharply.
A third of people now see a dentist privately, but 71% of them say that it is not by their choice. Accessing NHS healthcare is really important for them. People just cannot afford it any more. There is also a two-year waiting list for an appointment at the only orthodontic practice for children in York.
We need to address the real challenges. First, we need a workforce plan. Things are getting much worse. Last month a BDA survey showed that over 40% of dentists plan to change career or seek early retirement in the next year, so this is urgent. We need dentists, hygienists, technicians, nurses and receptionists. A practice in my constituency has already lost three receptionists because of the abuse they get from very frustrated members of the public. And, of course, they are only on the minimum wage. We need to fill those vacancies. One practice in York has only one and a half full-time-equivalent dentists, rather than the required six, to see 10,000 patients. This is detached from reality.
We also need to make sure that the failed dental contract goes. Since covid, things have got much worse. The need will not be addressed simply by setting compliance at 85% or, as might happen in the coming days, at 100%. Putting more pressure on dentists will make them more stressed and more sick, while also heaping more stress on their colleagues as they take up the slack. Things will just spiral downwards. That approach will not work. It provides the wrong incentives and no solutions.
In York, we have been working through opportunities and plans, because at this point it is really important to look to the future. First, we need to create a national dental service; the system is so broken that we need to build it from scratch. The service must be free at the point of need and should never be dependent on people’s ability to pay.
Secondly, the school service must be reinstated. The Government are struggling to institute the supervised toothbrushing programme that they promised in the general election. Let us get that in place, because prevention is better than cure. And while we are at it, let us make sure that older people also access those services, because poor dental health leads to malnutrition and is actually one of the leading causes of premature death in older people.
We also need to look at the new structures emerging in our health system. I appreciate that this is still going through Parliament, but the integrated care system footprint should have responsibility for those services and we need to take advantage of the opportunities. The York Health and Care Alliance will cover the footprint of our city and integrate mental health, physical health and social care—and I would add dental care to that list. Supporting the alliance will enable us to deliver an integrated healthcare service. That is, of course, important, because our mouths are not divorced from the rest of our bodies. In York we are looking at how to pull all the services together, as we have done with diagnostic and treatment hubs and vaccines. There is a community of expertise that knows about integration, and we need to make sure that it pulls things together for dental services, too.
Finally, our city has called for a new dental school. Our city’s medical school is a unique model. We believe that we should not just look around the world but grow our own talent in order to provide dental services. That is why York—along with Hull, given the shape of our medical school—should have a dental school.
Our dental service has decayed. Oral health is regressing, and now we need a national dental service.
James Wild (North West Norfolk) (Con)
I congratulate the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) on securing this important debate. Our constituents in Norfolk and Waveney face similar challenges in getting access to NHS dentists.
This is a long-running problem, which my predecessor also pursued following the closure of a dentist in Snettisham. I raised this issue in my maiden speech and I have focused on it ever since due to the inadequate provision in west Norfolk. Of course, the restrictions put in place during covid have further reduced access, as others have said. The British Dental Association estimates that 40 million appointments were lost overall, but the situation before covid was poor.
The National Audit Office found that my constituency had the lowest number of dentists per head in the country. Moreover, Norfolk had the lowest level of dental activity delivered in the country, with only 65% of contracted NHS activity delivered compared with the national median figure of 96%. My right hon. Friend the Member for Basingstoke (Mrs Miller) also made that point. And, at 17.5%, Norfolk had the highest percentage of people who were unsuccessful in trying to get an NHS dental appointment.
Since being elected I have met the NHS East of England team regularly to press for better access to dentists, particularly following the closure of the mydentist practice in King’s Lynn. I am pleased that those discussions led to a procurement process, which, although delayed by covid, took place from summer last year, and that that procurement has been successful, with the NHS having just announced two new contracts for Smile Care Norfolk to increase access to dentists in King’s Lynn. I want to put on the record my thanks to the NHS East of England team for its efforts in successfully completing the procurement, which will mean that from 1 July my constituents will have better access.
As my hon. Friend the Member for Waveney said, it is disappointing that Fakenham and Thetford have not been successful in the procurement process. If my hon. Friend the Member for Broadland (Jerome Mayhew) catches your eye, Mr Efford, I am sure that he will speak about that.
Members have also touched on the supply of dentists. Office for Students figures show that there were 895 dental students in 2020, rising to 983 in 2020, compared with 810 in 2019. The 2022 intake, however, is just 809. Given the challenges in dentistry provision, we should be increasing that number, not reducing it. We should consider measures that enable those who are undertaking training to spend time in those areas where coverage is weakest. We should also be more direct and require those who have qualified to spend time in those areas as well.
I note that none of the 11 dental schools in England is in East Anglia. Given the low levels of dental coverage, I join the hon. Member for York Central (Rachael Maskell) in putting in a bid for one in East Anglia, Norfolk, King’s Lynn, to help address that gap.
Another issue that has been raised is that the contract dates from 2006. My hon Friend the Minister candidly referred to it last month as a “disastrous contract” with perverse incentives—or disincentives—for NHS dentists to take on NHS work. I am sure she will be able to update us on when new measures will be introduced to provide a greater focus on prevention and care for individual patients.
In conclusion, the new services coming to King’s Lynn are warmly welcome and will improve access. However, further reforms are needed, including to training and the contract, to ensure that people have the access to dentistry that they need and deserve.
Clive Efford (in the Chair)
You have all been very disciplined in keeping speeches brief, so I am grateful for that. We are well on time. I call Wera Hobhouse.
Wera Hobhouse (Bath) (LD)
I congratulate the hon. Member for Waveney (Peter Aldous) on securing this debate. He is almost an hon. Friend: we work on many cross-party issues together, so even though we are on different sides, I call him my friend.
It is important to say that this is not a debate to criticise dentists. It is about criticising a system that does not work. I want to pay tribute to all the dentists in my constituency, who have worked very hard, particularly during the pandemic, to keep the oral health of my constituency in as good shape as possible, but they have really struggled.
Oral health is an essential component of everybody’s health and wellbeing. Dentists play a crucial role in the early detection of a number of diseases, as we have heard, including mouth cancer. Problems accessing NHS dental services are on an unprecedented scale in every community. Morale among NHS dentists is at an all-time low, and 40 million NHS dental appointments have been lost since the start of the pandemic. All this has been made worse by the pandemic, but the dental crisis in our country far predates covid. It is a result of chronic underfunding and an unsustainable target-based dental contract.
My constituents have been contacting me about access to NHS dental services since I became elected. The biggest concern is that they simply cannot find an NHS dentist. One constituent told me:
“My disabled partner and I have been told that our dental practice will no longer do NHS dentistry for us after 35 years. We are on income support and cannot afford the private fees that are quoted to us.”
Another constituent told me that they could not find a dentist in Bath that could take their child. The closest practice they could find was a 40-minute car journey away. When another constituent needed fillings, she was given two temporary ones and told that anything more would incur private fees. She told me she was afraid to eat. This is the extent of my constituents’ misery.
According to a Healthwatch survey carried out in November, no NHS dentists in Bath and North East Somerset reported that they were taking on NHS patients. No practices reported that they were able to take on children under 18, and no practice reported that it would be able to take on new patients in the next three months. What is happening in Bath is happening across the country.
The single biggest problem with dentistry in the UK is that it has become privatised over decades. I do not want to accuse any particular party of this. It has been going on for a long time, and that privatisation has started to take over. There are around 12,500 dental practices in the UK, of which 30% are private, 15% are mostly private, and 15% are evenly mixed. That means that just 40% are NHS practices, but many of these have elements of private provision.
Fewer than 40% of adults in Bath and North East Somerset have seen an NHS dentist in the two years leading up to June 2021. Those who cannot afford private dental care often do not go until it is too late, and they end up needing emergency care. It is not that there are not any dentists in the UK. I know that there is a problem with the distribution of dentistry, but the biggest problem is that, increasingly, dentists do not want to work for the NHS.
The current crisis will not improve unless we make it viable for dentists to provide NHS treatments and make NHS dentistry a place where people want to work. Bath and North East Somerset, Swindon and Wiltshire CCG has lost 9% of its NHS dentists in the last year alone—the highest proportion in the south-west and over twice as high as the national average. Dentists in my constituency have told me that they want to provide NHS treatment but just cannot make it viable under the current conditions. They are hugely worried about the increase in the percentage of the pre-pandemic treatment levels that they are now expected to meet, and the mental health toll on our dentists is enormous.
The Minister has committed to reforming the system. This is welcome, but the pace of change is too slow and practices cannot increase the number of patients they are seeing on promises alone. Not only must the Government reform the current contract; it must do so urgently. The bottom line is funding. The Government must provide adequate resources as a matter of urgency to reverse the alarming decline of NHS dentistry and guarantee its long-term sustainability.
The current situation is nothing short of a scandal and simply unacceptable. Healthy teeth should not be a privilege only for those who can afford to pay for private dental care. More than 70 years ago, the founding fathers of the welfare state envisaged a country where the gross injustices between rich and poor would be eliminated for good. Let us not turn our backs on the principles on which our NHS is based. Oral health is as much a matter of access and equality as the rest of NHS care. To the hon. Member for North East Bedfordshire (Richard Fuller), we Liberal Democrats absolutely understand the importance of being prudent with the public purse, but equality should never be sacrificed on the altar of balancing the books.
Giles Watling (Clacton) (Con)
It is an honour to serve under your chairmanship, Mr Efford—[Interruption.] I will try to stand up without knocking the furniture over. I thank my hon. Friend the Member for Waveney (Peter Aldous) for bringing this important debate. It is impressive that so many have attended. I have been listening to your entreaties from the Chair, Mr Efford. Many points have been made about the expansion of housing, covid, fluoridation and the UDA system, so I will not repeat all that, you will be delighted to hear; I will cut my speech very short.
Of the most common issues in my mailbag that constituents write to me about, at the very top is dental care, and NHS dental care in particular. That this issue is widespread is evidenced by all the Members here. I will bring out a few points that I mentioned in the Adjournment debate the other day, because they are so shocking. Some 85% of dental practices are now closed to new NHS patients. Nearly half of patients are forced to get private treatment because of access problems, as reflected in my mailbag. This horrifies me: one child is admitted to hospital every 10 minutes for tooth extractions. Imagine the cost of that, let alone the trauma involved. That is why we have to be proactive, rather than reactive, and why I was pleased to hear fluoridation mentioned.
Some 1,000 clinicians have left the profession in the last year, with yet more significantly reducing their NHS hours, as we heard. That is utterly unacceptable. I welcome the levelling-up agenda, but I do not believe we are being levelled up in an entirely fair manner. Areas such as Clacton are often considered to be rich and well-heeled because we fall into the wider eastern region—Essex is lovely and leafy and is an economic powerhouse—but the coastal areas have pockets of deprivation. I am not proud of it, but my constituency has the most deprived ward anywhere in Britain. Something has to be done about that. If we really want to level up public services, we must consider areas such as Clacton when it comes to dental care. We need to make sure that levelling up follows the data, if we can get it, and not just the rhetoric, and gives coastal communities the help they need.
To my mind, there are two key areas we really need to hit. In an age of integrated care systems and devolving more and more power over primary and acute care to local leaders, I increasingly question the role of certain state monoliths such as NHS England and NHS Improvement. My constituents do not need more national mandarins, they need local, empowered leaders with proper devolved budgets. I reflect on the outstanding leadership of my former CCG and its accountable officer, Ed Garratt; I mentioned him the other day, but I have to again, because he is so good. He has provided a great service to us locally. Thanks to his and his team’s work, Clacton primary care is in a much better state. I want to give local systems the commissioning powers and budget so that we will level up in a local, focused and measurable manner. The PCTs had their day and local care leadership is now delivering. It is time for NHS England to be devolved in the same manner.
Let us move on to the workforce. Increasing the number of UK-trained dentists will help but will take at least six years to make the difference. Urgent action is now needed to increase places on the overseas registration exam, develop an adaptation programme and recognise qualifications from top dental schools around the world.
Our membership of the EU forced us to look away from people in areas such as our wider Commonwealth who are being trained in first-class dental care, and the Asian subcontinent. We could see more of those practitioners in areas such as Clacton, which would be the very Brexit dividend we were led to expect.
I am delighted that Clacton has been selected as a pilot area for new dental training courses, but clarity is needed on how existing budgets can be used to support and improve dental access in constituencies such as Clacton.
To conclude, Mr Efford—I am doing this very quickly—
Clive Efford (in the Chair)
Order. I do not want the people of Clacton to miss out on this debate. You have all been so disciplined that we can be a little bit flexible with the six-minute limit. Please do not cut your speech too short so that we miss out on any points.
Giles Watling
Mr Efford, with all due respect, I have deliberately gone to the shorter version of my speech. If the Minister wishes to visit the wonderful constituency of Clacton, with its 35 miles of glorious coastline, I would love to discuss dental services with her.
Levelling up is not just about expanding employment outside London. It must be about addressing inequalities wherever we find them, such as decreasing NHS dental care in coastal communities such as Clacton. We can do that by forcing cash and power out of NHS England, alongside using our Brexit freedom to open the nation to the dentists of the world we have so long spurned.
Finally, I put in a plea—a plea for sympathy. In a couple of weeks, I am having root canal treatment. Our dentists are excellent, but I hope it goes well—[Laughter.]
Clive Efford (in the Chair)
I know I am going to regret saying that we can be quite relaxed about the six-minute limit, but we can. If you run over by a little bit, it should not cause too many problems for people speaking later in the debate, but do not abuse that generosity. I call Tan Dhesi.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
Thank you, Mr Efford. It is a pleasure to serve under your chairmanship. I thank the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) for securing this important debate and the Backbench Business Committee for ensuring valuable parliamentary time is dedicated to the issue.
I place on record my gratitude to dentists, nurses, technicians, hygienists and all those who have worked in dental practices across our country, and in particular in my Slough constituency, over the pandemic, continuing to serve people throughout such uncertainty and disruption as best they could.
As hon. Members know, although clinics were not shut for long, the ongoing repercussions nearly two years later have been astronomical. An estimated 38 million appointments were missed during the pandemic. Despite best efforts, such as opening more than 600 urgent dental hubs and staff working overtime on weekends and evenings, achieving a pre-pandemic level of service has certainly not happened for my Slough constituents, with nearly two thirds of practices estimating that they are continuing to operate at less than 70% of pre-covid capacity.
[Rushanara Ali in the Chair]
Returning to so-called normal was never going to be straightforward, but the chronic lack of support for dentists now and prior to the pandemic is taking its toll. As hon. Members have eloquently highlighted, shockingly, Government spending on NHS dentistry has decreased by more than a third in the past decade. As with other health services, we cannot allow Government to use covid as a smokescreen for what was already a decimated profession.
In the five years before the start of the pandemic, the number of practices providing NHS dentistry fell by 1,253. In December 2021, a survey showed the true toll that has taken on dentists, with more than 40% planning a change of career or retirement over the next year. Tory cuts have consequences, and the pandemic has drastically revealed them.
Since the reopening of practices, I have been contacted by dentists concerned about meeting their targets without adequate support, and patients waiting months, sometimes years, to be seen. The long-term lack of support has created a double-edged sword, failing both patients and practitioners, so I welcome the Government’s recently announced funding, which I hope will achieve their aims of securing 350,000 extra dental appointments, particularly for more vulnerable groups. We are the only country in the UK that failed to provide such support until now, so I fear that it is too little too late. As with all catch-up plans, we need to listen to those who are impacted.
Following the announcement, the British Dental Association noted:
“After a decade of cuts, a cash-starved service risks being offered money that can’t be spent. Hard-pressed practices are working against the clock and many will struggle to find capacity ahead of April for this investment to make a difference.”
I have seen that happening for constituents who contact me: the waiting list for appointments in Slough is more than a year long, orthodontist referrals go back to 2018, and patients are asked to go private if they wish to receive any treatment promptly, paying hundreds of pounds just to be pain-free. That situation is sadly going to get worse, as more than half of dentists state that they are likely to reduce their NHS commitments because they are overworked and undervalued. Is this privatisation by stealth?
The managed decline of Britain’s public services, overseen and supervised by this Conservative Government, has to stop. We all know who will lose out if it continues: the most vulnerable in our society, particularly young people. If we do not properly address this now, we lay the path for a litany of future health issues for children and young people. In my Slough constituency, which is officially the youth capital of Britain as it has the lowest average age of any town or city in our country, this will be devastating. In 2019, 41.5% of five-year-olds in Slough suffered from tooth decay, compared with the national average of 23%, and often required general anaesthetic to remove the impacted teeth, leading to other health risks and impacting their education through missed school days.
Even prior to the covid pandemic, tooth decay was the No. 1 reason for hospital admissions among young people, with a waiting list of a year being standard for the procedure. We already know the disproportionate impact that the pandemic has had on certain groups, including older people; people living in deprived areas; black, Asian and minority ethnic groups; and the most vulnerable groups in our society.
Sadly, that impact has extended into dentistry. NHS England and the Office of the Chief Dental Officer have highlighted that
“Evidence suggests that existing health inequalities have been compounded by COVID-19…The long-term economic impact of the pandemic is likely to further exacerbate oral health inequalities.”
If dentistry moves towards a privatised model, or patients simply cannot be seen due to NHS demand, that widens and entrenches inequalities in our society and, in the long term, it doubles pressure on the NHS for avoidable treatments. Our NHS dentistry should function on the founding principle on which it was created: being accessible for all, regardless of one’s ability to pay.
Andrew Selous (South West Bedfordshire) (Con)
Like other colleagues, I pay tribute to my local dentists and the whole team of dental staff who support them. They do amazing work, and almost all of them went above and beyond during the pandemic.
I have to express a bit of concern about the information that the Minister’s officials may be feeding her. I got a letter on 16 December from NHS East of England direct commissioning, which said: “Having conducted a search of dental practices in the Leighton Buzzard area, I can confirm that of the 47 dental practices, six are accepting new NHS patients.” The letter goes on to say that there are 30 others that have not been heard from. I received an email only this morning from a couple in Leighton Buzzard who said that they have given up trying to find an NHS dentist. A lady in Dunstable wrote yesterday to say that the local waiting list is two years. Another constituent wrote to say that they had been turned away by emergency dentists to which NHS 111 had referred them.
Sir Peter Bottomley
Would it be too difficult for the NHS to have a list, for every constituency, of every dental practice and its situation? That way, the NHS, patients and MPs would know what the situation is, and we could change that situation.
Andrew Selous
The Father of the House is absolutely right; the point was also made by my right hon. Friend the Member for Basingstoke (Mrs Miller) earlier. I do not think that the data are nearly good enough, and I do not see how Ministers can have proper oversight if we do not actually know what is happening.
When the letter of 16 December says, “having conducted a search of dental practices in the Leighton Buzzard area,” I fear that the person who wrote it sat at their desk and went on Google to find out. I do not think they actually came to the town. I do not think that they walked around and spoke to the dentists, the local Healthwatch, or the people in the town. How can the Minister have accurate information if what we get from the officials—that was from an official letter from the NHS to me—does not actually reflect what is happening in the town?
We are struggling now, but my area, like that of my hon. Friend the Member for North East Bedfordshire (Richard Fuller), is scheduled to have another 14,000 houses; they have been consented and are being built now. I have a major campaign on ensuring that general practice capacity keeps up with major new housing developments. How can we do that for dentists too if we already have a deficit? Will the money follow those huge new housing developments in many of our constituencies? We need answers on that too. If the Minister is able to give further information on that, either when she replies, or perhaps by letter afterwards, that would be really helpful.
We have heard from many colleagues about the issue of children’s teeth. I am informed that tooth decay is the No. 1 reason for hospital admissions of young children. That shows the importance of prevention and getting it right, and the whole issue of sugary drinks. I recognise the help that fluoridisation gives, but children’s oral health is a huge issue.
One or two colleagues—including, I think, the hon. Member for York Central (Rachael Maskell)—mentioned older people’s dental care; I had a debate on that in the Chamber. It is a subject that we often do not talk enough about, particularly with people in care homes. Do the managers of those homes ensure that staff help the patients to brush their teeth? What about the oral care of people receiving domiciliary care? Is that budgeted in? It is serious; it can lead to malnutrition and all sorts of problems. There was a major Care Quality Commission report, which was only on the care home sector, in June 2019, called “Smiling matters”. It would be good to have an update from the Minister on how we are doing in ensuring that older people’s dental care is also taken proper care of.
We know that the current contract, about which most of us have been complaining, was introduced in 2006—so quite some time ago—but back in June 2009, there was an excellent independent review about what we needed to do about it by Professor Jimmy Steele. I will quote from one paragraph of it:
“Through the NHS, dentistry could take a huge step forward but in order to do that, one concept is critical. So long as we see value for taxpayers’ money as measured by the production of fillings, dentures, extractions or crowns, rather than improvements in oral health, it will be difficult to escape the cycle of intervention and repair that is the legacy of a different age.”
I think that the Steele report got it right. However, that was under the previous Administration, in June 2009. I am told that the work on reform started in 2011, and yet here we are, in 2022. I think that what we are all saying to the Minister—who is diligent and I know cares about these matters—is that we really need some urgency.
On the number of dentists, perhaps slightly surprisingly, and perhaps contrary to some of what we have heard today, I had an email yesterday from the British Dental Association saying,
“We don’t really have a shortage of dentists in England—the number of dentists registered with the General Dental Council is in fact almost 2,000 higher now than it was in 2018. The key problem is that these dentists increasingly don’t want to work in the NHS—almost 1,000 quit the NHS in the last year alone.”
The email goes on to say that if dentists move to private provision, they do not actually earn any more. They are not just leaving NHS work because of the money but because they cannot look after their patients properly under the contract. It says that it is soul destroying, chasing these NHS units of dental activity. It is stressful and demoralising, so what do they do for the same money—not for more money? They go—this is what the British Dental Association says—to private practice, where they can spend more time with their patients, providing the level of care that their patients deserve.
We are not doing it right. To try to guard taxpayers’ money through efficiency, we are driving dentists out of the service. We are measuring the wrong things. I do not think that we are measuring enough, as we do not seem to have enough measurement, and where we are measuring, we are measuring the wrong things. It is not possible to get improvement unless we have the correct data. I have confidence in the Secretary of State and in the Minister, but I think we are all saying that this is urgent and please get on with it with proper reforms.
Daisy Cooper (St Albans) (LD)
I, too, congratulate the hon. Members for Waveney (Peter Aldous) and for Bradford South (Judith Cummins) on securing this well-attended and important debate.
I want to relay some of the desperate accounts that have come from my constituents. One moved to St Alban’s with his fiancée in November 2020—15 months ago. They needed dental care and tried eight NHS dental practices in the area, but not one could add them even to the waiting list. They have checked with the practices every single month for the past 15 months and still no joy. My constituent’s fiancée has now registered with some student dentists at a hospital in London. She is desperate to get some treatment. The good news is that she is on the waiting list; the bad news is that it is still a very long waiting list.
Another constituent, a mother, has a very young daughter. The mother has spent two and a half years trying to get her daughter an appointment with a dentist. She wrote that she was surprised that NHS practices do not even have an obligation to take in children, especially when they have a dental issue. She herself has gum disease, which got worse during her pregnancy. She has had to spend all her savings and money to go private.
Another person who has been trying for ages to get a dentist appointment rang the NHS phone number, which tells people to call it if they cannot get an appointment. All the people there did was to search the websites for her, which she had already done. Their only advice was that she should wait until she was in agony and then call NHS 111. What kind of advice is that? It is unfair and counterproductive, and it costs the taxpayer more.
The local dentistry committee in Hertfordshire wrote to me. It had written to NHS England, along with the dental committees of Bedfordshire and Milton Keynes. They were begging for the payment system to be reformed. It is absurd that, if dentists carry out more work for their community than the outdated cap allows, they simply cannot be paid. That is an absolutely absurd system. Dentists are unable to provide the care that their patients need. The units of dental activity skew the dental system. It is now more attractive for practices to deal with less complex patients: in many cases, they are paid the same flat rate for such treatments as they would for helping those with higher needs.
The Local Dental Committees confederation has sent its plans to the Government and to many MPs, saying that the system has to be reformed. I sincerely hope the Minister will give us a better answer than the one I was given to my written parliamentary question earlier today, which simply confirmed that the system was being reviewed along with lots of other options. We need to hear more positive noises from the Minister this afternoon.
What needs to change? The Association of Dental Groups has made some recommendations on workforce. Some Members have alluded to those recommendations—the “six to fix”. The association talked, first, about the need for more training places here in the UK, which I am sure we all support. Secondly, it called for—some Members have not referenced this—the recognition of EU national dentists to be extended beyond the end of this year, when it will otherwise run out. Thirdly, the association has called for the UK to look at recruiting from countries that have a surplus of high-skilled dentists. Unfortunately, it appears to be news to some Members in the Chamber that we were always able to recruit from some of those countries, and it did not require Brexit to be able to do so.
I would like to put three questions to the Minister. First, when will my constituents be able to see a dentist? Secondly, when will this absurd payment system be scrapped and reformed? Thirdly, when will there be a workforce strategy so that dental deserts, which we have heard so much about, become a thing of the past and this Dickensian system of years-long waiting is finally brought to an end?
Duncan Baker (North Norfolk) (Con)
I echo other hon. Members in thanking my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) for bringing this debate forward. My hon. Friend is a good friend and has been a real champion in bringing these debates to this Chamber and other places on many occasions, and I thank him for all the work he has done.
As I said in my intervention, I might have a bit of a vested interest in this topic given that my father was an NHS dentist for 34 years. As a retired dentist, he is probably sitting at home with a cup of tea watching this debate, so I shall try to say some nice things about him. He worked in the constituency of my hon. Friend the Member for Broadland (Jerome Mayhew), who is my neighbour in north Norfolk. The facts from when he retired 10 years ago are still prevalent today. In fact, it is arguable that the problems he encountered back then are now even worse. That is a sad state of affairs.
It is fair to say that we have a crisis in dentistry—-we certainly do in my constituency. Not a week goes by when I do not receive casework from people who are in pain or who simply cannot get an appointment with an NHS dentist and cannot afford to go private.
There are acute problems in certain parts of the country. We have heard from hon. Members from all over the country today, but the south-west and East Anglia are well known to have some of the worst problems. The fact is, we simply cannot get dentists to come and work in some of these rural locations.
The Minister wants to have answers, not always problem, and I would echo my hon. Friend the Member for North West Norfolk (James Wild), who said that a dental training college in our part of the country would be very worth while. Alongside the Norwich Medical School, such a college would create jobs and opportunities and filter those into our part of the country. There is nowhere in the east of England to train dentists at the moment. We are crying out for some kind of provision to help us. Why can we not make it a requirement for newly qualified NHS dentists to have to do a year of training in an area of high need before they pass with flying colours?
I also echo what was said by my hon. Friend the Member for South West Bedfordshire (Andrew Selous). He is absolutely right: it is not simply that we cannot get dentists into the country or that we are not training enough. Many will call for dentists to be trained or imported from other countries to ease the crisis, but the truth is that we do not simply have a shortage. Of course, we can make it easier for dentists coming across from India to have their qualifications recognised so that they can perform their work straightaway. We do need to streamline that process. However, that is not at the heart of the issue.
The simple facts are that the General Dental Council found that almost 2,000 more dentists are registered now than in 2018. The problem is that those dentists—just like my father, who retired 10 years ago—have simply had enough and do not want to work in the NHS any more. We have to establish why that is and address that as a key problem.
Of course, we could talk about many different areas. My hon. Friend the Member for Waveney listed five, and I will not go over those again. I will focus on one issue that we have heard a lot about today. I am not going to apologise for calling it the dreadful UDA contract. It was bad a decade ago and it is still bad today.
Almost 1,000 dentists quit the NHS in the last year alone, and the motivation to do so, as has been said, is not purely financial. Those dentists, like my father, are doctors; they care about patients’ health. They want to spend time with their patients and treat them properly. The bureaucracy of getting points for giving out prizes is not the right way to deal with people. Dentists are not being treated with care. They do not want to be chasing these dental activity targets—that is highly stressful and demoralising. The delays in the contract reforms are leading to their motivation plummeting and going through the floor. That is why they are turning away. The lack of urgency in helping them is the real root cause of the problem.
Let me put that into some kind of context. In the Norfolk and Waveney CCG area, which also covers the constituency of my hon. Friend the Member for Waveney, we lost 40 NHS dentists between 2018-19 and 2020-21—a 9% drop in just two years. If we carry on at that rate, we will be in an absolutely shocking predicament. We therefore need to make a decision, and I heard what my hon. Friend the Member for North East Bedfordshire (Richard Fuller) said earlier. However, NHS dentistry is not free—that is a myth. We need to make a decision: either we will continue with this decline, effectively privatising dentistry and sending it down the opticians route, or we need to urgently get on and reform the dentistry provisions in the contracts we keep talking about. There is a simple reason why: we cannot do this to our children, our elderly, our vulnerable and people on low incomes. They are the ones who need access to good dentistry, and it is not acceptable in the 21st century, and in a modern country, that they cannot get help and support from this service.
Less than 25% of children in Norfolk saw an NHS dentist in the year to June 2021, and that is significantly lower than the national average of 33%. Imagine if it was your child who had excruciating pain and could not get to see a dentist. That goes back to what I said earlier: this is a particular problem in East Anglia.
I know that the Minister is keen on reforming the system and that negotiations are under way, but I urge her to grab this issue with huge vigour. The number of Members sitting here this afternoon—on a Thursday, and when we are waiting to get away for the recess—shows just how important this is for so many of our constituents up and down the country.
Peter Dowd (Bootle) (Lab)
I thank the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) for raising this issue and for their tenacity. It is a pleasure to see you in the Chair, Ms Ali.
As many hon. Members have said, dentistry is not just about teeth; it is a vital component of our health. The hon. Member for North Devon (Selaine Saxby) shared a Shakespearian quote, and there is another one worth mentioning. In Shakespeare’s “As You Like It”, Jaques says:
“Sans teeth, sans eyes, sans taste, sans everything.”
If the Government carry on the way they are, it will be “sans dentists” as well. They need to get a grip of the situation.
The hon. Member for North East Bedfordshire (Richard Fuller) talked about the cash and the expenditure. I am happy to have a debate with him on this issue, and if he wants to secure a Westminster Hall debate on public expenditure, I will join him. I will give him an example of what he was talking about: the £10 billion-worth of covid-related fraud. That is equivalent to £153 for every person in his constituency—the best part of £50 million, which would be better spent on dental services in his constituency.
Peter Dowd
I am more than happy to come back to the hon. Gentleman in a moment.
Last week, I took part in a debate on the energy crisis. This week, I took part in debates on the crisis in children’s mental health services, the food insecurity crisis and the cost of living crisis. Today, it is about the access to dental services crisis. There is a bit of a theme beginning to develop here—it is about crisis, and all these crises are not isolated.
It is not as though the Government are having a run of bad luck through no fault of their own and have an otherwise impeccable record; there is something systemic and even endemic going on. I get a bit tired of the Government’s default approach to any deficit in policy application, and we have heard it a bit here: it is the CCGs, the NHS, the officials—it is everybody else’s fault bar the Government’s. They have to take responsibility.
Peter Dowd
In a moment. I am happy to give way, but we were told earlier that we did not have much time.
I do not want to detract from the substance of the debate, but it would be remiss of me not to talk about the crisis in health and social care more generally. Specific recognition from the Government of a crisis in access to dental services would give me a bit more confidence that they have a handle on it. More importantly, it would give me confidence that they are actually going to do something substantive about it. I wait with bated breath.
Peter Dowd
In a moment.
Any denial by the Minister that there is a problem is itself a part of the problem. I really do not want to hear any denials.
Kevin Hollinrake
The hon. Gentleman is not making a particularly collegiate speech, but never mind. I have a lot of time for him. I do not know where the £10 billion fraud figure he throws out has come from. If it is about PPE, he should look at the facts behind that: £4.6 billion of that was write-down of current value versus value at the time of the pandemic. If we are going to debate in this place, it should at least represent the facts.
Peter Dowd
I am pleased that the hon. Gentleman raises that. The bottom line is this: look at the Public Accounts Committee documents. There are more to come out. If the hon. Gentleman wants to have a debate on fraud, I am more than happy to have one. Perhaps he can put in the application and I will come and speak to him about it.
Mrs Miller
What would the hon. Gentleman have done differently in 2006 when the current dental contract was put in place? Of course, at that point, he would have been able to influence the Labour Government.
Peter Dowd
I will come back to that in a minute. I am an optimist—hope springs eternal, as Alexander Pope said—and I hope the Minister will accept that there is a crisis. Perhaps then we can all move on, in a very collegiate way, as the hon. Member for Thirsk and Malton (Kevin Hollinrake) says, towards finding a solution, which he knows I am more than happy to do.
Wera Hobhouse
For the purpose of giving everybody a voice, would it not be most collegiate if we actually acknowledged that the dental contract was introduced under a Labour Government? It is important to address that, but it is also important to address the fact that the bottom line is public funding for a good service.
Peter Dowd
Frankly, the coalition, including the Liberal Democrat party, which the hon. Lady serves, could have sorted that problem out in the last 10 years, but they dithered, ducked and dived. Let us not go there. She is on dodgy ground in relation to that, I have to say.
Facts are stubborn, and here are a few. The Government have cut dental budgets by a third in real terms over the last decade. They are making a meal out of their recent time-limited £50 million injection into the service, or the so-called dental treatment blitz—a blitz that will barely blow the top off a toothpaste tube. I suspect that that £50 million—a veneer if ever there was one—is unlikely to be fully spent.
The bottom line is that we are in a crisis. The British Dental Association estimates that it will take £880 million a year to put things back to where they were in 2010—that is a fact, and it does not account for the huge impact of the pandemic. We also need to address the chronic underfunding and to have a clear commitment to ending the system based on units of dental activity that has been going on since 2011—it has been discussed today so I will not go into it any more. It has been over a decade, and the Government really need to get a grip of that.
In my constituency, 5% of dentists in South Sefton CCG stopped providing NHS services in the last two years. That vastly underestimates the loss of local provision, as most dentists tend to reduce the size of their NHS contract gradually before they quit the NHS completely. Across the country, 40 million NHS dental appointments have been lost since the pandemic. That is a whole year of dental provision. Without better support from the Government and, crucially, an end to the chronic underfunding, and without a clear commitment to and progress on contract reform, there is no way dentistry will be able to recover.
The covid alibi is beginning to wear a bit thin. This is all about pre-covid. Covid has exacerbated the situation, but pre-covid is also significant. Enormous backlogs began pre-covid. Let us get a grip of that. I ask hon. Members across the way to press the Minister and ask the Secretary of State and the Prime Minister—their colleagues—to listen to the facts, because, unless Members opposite can get that message across to an indurate Government, things can only get worse. No more excuses, no more prevarication, no more procrastination, no more pretext or self-exoneration—as I have heard today. The Government need to pull their finger out. We need action now. There is no excuse for letting the opportunity go by.
In closing, perhaps I can re-jig what Ian Fleming said to make a point about the Government’s lack of action in this crisis. He said:
“Once is happenstance. Twice is coincidence. Three times is enemy action.”
Which one does the Minister think it is? I cannot speak for the dental profession, but I think I know which one it is, and it is not one of the first two.
Jerome Mayhew (Broadland) (Con)
It is a pleasure to speak in this debate. I, too, want to give my congratulations to the hon. Member for Bradford South (Judith Cummins) as well as my hon. Friend the Member for Waveney (Peter Aldous). One of the great advantages to speaking late on in a debate is that we can jettison all the interesting facts and figures we have carefully researched in preparation for a speech like this, because they have all been mentioned several times already. I want to focus instead on providing the Minister with some local feedback from my constituency of Broadland, so that she, when deliberating on how best to improve the dental contract and provision for all our constituents, can hear from the horse’s mouth the nuances that are experienced in Broadland and Norfolk and Waveney more widely.
Of all healthcare issues, dentistry is the most prominent in my inbox week after week. It is not just about the ability to register to get initial access, it is about getting dental work completed. I have a huge list of constituents’ casework, which I am not going to bring to Members’ attention, save for one, which gives a flavour of the seriousness of the missing treatment. A constituent of mine had two fillings fall out, which is a fairly common experience. She was unable to get any dental treatment to deal with that, so she ended up having to ring 111. She was told that, because of the lack of dental provision in the county of Norfolk, she was encouraged to do a DIY filling—that was by 111.
Every day is a school day in this job. I now understand that using the wax from Babybel cheeses is the way to perform a DIY filling recovery. Should we be in that sort of position? I, for one, think we should not. There are all sorts of examples I could have shared with Members. I want to drive home the real impact. For whatever reason, we are in the position we are now; some of it is covid, but a lot of it is not. We must, as a Government, address it in support of all of our constituents, however they voted.
I also have feedback from dentists. I have the honour of representing a fantastic town called Fakenham, which has been referred to already. One of the two NHS dentists announced a few months ago that she was no longer accepting NHS patients and that she was going private. I rang her up to find out what was the reason behind it. She is a very decent woman, who has worked tirelessly for the community of Fakenham for many years. What she said to me was not primarily about money. It was actually about the way she was treated by her NHS managers, which caused her frustration that reached such a pitch that she thought, “Stuff it. I am not putting up with this any longer.”
One thing that the dentist referred to that particularly stuck in my mind was that even a year ago, she had a person she could talk to directly as part of her management team; when there was a problem, she could ring up and talk to someone. That call was replaced by an email. She said that she had emailed every week for the previous 12 weeks about a really serious issue and she had not even had a reply. If we treat professional providers in that offhand way, can we be surprised that they decide to move to private provision? That is an option that every single NHS dentist has, and they have been voting with their feet.
I have already mentioned that this is not primarily about money—at least not in this instance—but I welcome the £50 million of additional spending that the Department has announced, and the 350,000 further treatments that that is apparently going to provide. I also very much welcome the decision by the Department to award a new contract for dentistry for Fakenham, because it is the largest town in my constituency and we were down to a single NHS provider. However, as has already been mentioned, I think by my hon. Friend the Member for North West Norfolk (James Wild), we have not been able to entice any dentist to take up that contract, even though the money is available.
Why is that? Why is it that a fantastic town such as Fakenham, which is a brilliant place to live, 5 miles from the gorgeous north Norfolk coast, with a really lovely quality of life and relatively low housing costs—it is a great place; it has its own racecourse—
Jerome Mayhew
It also has a good golf course—I thank my hon. Friend and neighbour. It is genuinely a really gorgeous town, so why is it that it cannot attract anyone to take on the NHS dentistry contract that is available? As my hon. Friends have pointed out, one of the reasons is that we have no training facility—not just in Norfolk or Suffolk, or even in Cambridgeshire or Bedfordshire; the nearest is in London. People have to go up to Birmingham or to London.
When we are trying to persuade young dentists to set out on their professional life in a certain place, moving to a rural or small town is not automatically attractive to them. We have to encourage people via training, and we know from our experience with the medical provision at the University of East Anglia and the Norfolk medical training in Norwich that someone is much more likely to stick around afterwards in the place where they train, because they have established relationships, they have contacts in the community—and, frankly, they know what great places Fakenham and other parts of Broadland are. One of the primary reasons I wanted to speak today was to encourage the Minister to consider the provision of a dental training facility in the east of England.
I will leave it to others who are much more professional than I am to comment on how we properly reform the 2006 NHS contract, save for saying that we need to treat dentists with respect. It is not all about money; it is about how we treat people. And please can we have some training in Norfolk?
Siobhan Baillie (Stroud) (Con)
I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing the debate. I enjoyed the spirited contribution by the hon. Member for Bootle (Peter Dowd)—particularly the characteristic political attacks. That highlights part of the problem that we are dealing with here. If we are unable to recognise the failures by a number of different Governments across a number of decades, we will never get solutions. Equally, if we continue constantly treating the NHS or anything about it as a political football, we will paralyse this country and things will not get done.
I know that the Labour party likes to blame everything on the Government, but today’s debate has been really useful for hearing all the different elements of what is going wrong for NHS dentistry, including the part that the NHS itself can play in handling HR, looking after staff and retention. I think that is important.
This is a critical, crucial health issue for my constituents in Stroud, as it is for other Members’ constituents. We have a number of different points of casework related to this issue, and we get emails about it all the time. Anybody who has had toothache knows that it is debilitating: we cannot get on with our day, we start off grumpy, and we end up not speaking—my husband likes that bit. Anybody who has seen a child with decaying teeth starts to worry about what is going on at home, and about the health and future of that child. They are right to do so, because once those teeth are decaying, it is very difficult to repair them.
I thank all of Stroud’s dentists: like other Members, I had so many dentists contact me during covid to offer help. They were some of the first people to be frustrated by the restrictions placed on them, but also the first to offer help. In Gloucestershire, the CCG has seen a drop of 17 NHS dentists between 2019-20 and 2020-21. That is a drop of 5% in one year, so it is a very worrying development, as colleagues have said. We believe that it is also likely to under-represent the real fall in capacity, because most dentists tend to reduce their NHS contracts before leaving the service, and only 33% of adults in Gloucestershire saw an NHS dentist in the two years to June 2021.
To provide some colour and some real-life experience, one of my constituents moved to Stroud in January 2020. She fell pregnant and was entitled to free dental care, but by the time she had obtained her MAT B1 certificate, she was unable to find a dentist. She could not find a dentist throughout her pregnancy, when she would have had that free dental care, and still has not found one. She spoke to 15 dentists in the local area—Stroud, Wotton, Stonehouse and Gloucester—all of whom told her that they were not accepting new NHS patients. One interesting and worrying point that she raised with me is that all of the dentists’ surgeries she spoke to that were accepting children as NHS patients—her little one is about one year old now—were doing so only if their parents joined them on a private basis. She and her husband have found themselves having to join on a private basis and pay the fees to make sure that her little one has NHS cover. So many parents would not have that option, but I do not think it should be my constituent’s only option for getting support for her child.
There are three key areas I would like the Minister to cover, and I have no doubt that she will do so. Norfolk desperately wants a training centre, just in case she has not got that point. First, what is the explanation for the delays in creating the improved new contracts for NHS dentists? We are spending £3 billion: why are we still in a situation where the actual terms of the contract—the piece of paper—are preventing people from getting into this worthy, skilled and amazing profession?
Secondly, what is the plan to address the recruitment issues? We have heard that almost 1,000 dentists quit the NHS last year; we have heard about the people going back to European countries; and we have heard that people are not coming from further afield abroad. Can existing resources be used to improve recruitment and retention? The Minister has responded to me very clearly: we have similar problems with midwifery services. We have lots of recruitment and retention issues in the NHS, so there are similarities; what can we do?
Thirdly, how are the Government using the post-pandemic period to reimagine NHS dentistry in both areas, the preventive action and the responsive package? With preventive action, we are hoping to bring in family hubs around the country that children can access from birth. Can those hubs be used to improve children’s and families’ awareness of healthcare and dental health? Also, turning to the responsive package, the points about data collection really worry me. As we have heard from a number of colleagues, we are never going to improve services if our CCGs around the country do not have the information they need.
Finally, I want everybody to think about the pain of toothache. It is absolutely awful to go through, and our constituents are really worried about this. I think we can make changes: I do not think that this is just a money issue, and given that there is so much cross-party support to make a change, I hope that we can do so.
Sir Paul Beresford (Mole Valley) (Con)
I am delighted that we are being guided by you, Ms Ali. As a dentist—extremely part time—I am fascinated by the interest in this issue. I hope that some dentists read Hansard and find out that somebody actually cares about them. One of my hon. Friends asked why they were leaving the profession. It is a tough job—a really tough job. If I want relief from a couple of hours of dentistry in a week, I come into the House of Commons—it is a lot easier.
I thank my hon. Friend the Member for Waveney (Peter Aldous) for his introduction to the debate. It was a real expedition, right across the whole scene. I will suggest that we create an honorary degree in dental administration especially for him, because he covered it so beautifully.
Let me start very simply. I will not go through all the bits and pieces that everybody else has talked about; I will just cruise across the surface. We have three different groups of dentists: fully private, fully NHS, and mixed. The last group is the largest by far; and, to a considerable degree and in spite of some of the accusations today, that is by patient demand. It is what the patients want. It is not always the case that they feel forced into it because they cannot get the service elsewhere. The comment was made that we do not have enough dentists, but the BDA says that we have. I do not agree with the BDA, but this will not be the first time. We do need more dentists. If we had more dentists, we would get over the problem that my hon. Friend the Member for Broadland (Jerome Mayhew) had of finding someone to live in his little rural area, because if they were looking for a job and there were not jobs in the other areas, they would go there.
It is worth pointing out that dentists working in the NHS are not actually in the NHS; they are independent dentists working for the NHS. That makes quite a difference to the relationship and makes it somewhat more difficult for the Minister to influence dentists as she might well like to. It is also worth pointing out that a number of dental plan organisations are encouraging dentists to abandon the national health service and provide services within their private plan system. I still get dental magazines as a bit of light relief—well, lightish relief—and every one that I get has advertisements promoting dentists coming out of the national health service, for all sorts of reasons, some of which are fictitious.
Covid, in spite of what one hon. Gentleman said, has been a huge problem—not just for medical services but for dentistry. With the initial lockdown, all dental surgeries were required to close. Emergency clinics were set up and they were successful, but extremely limited—“a bit brutal” would be one way to put it. Fortunately, the closure of surgeries was relatively short-lived. After a period, they reopened—understandably, under heavy covid hygiene procedures. Those procedures really jammed up the works. This is of course understandable, because at that stage we did not have vaccinations, and with the aerosol spray from the dentist working on the patient’s mouth, you could almost see covid spread across the room. The cleaning down and waiting time between patients—fallow time—really damaged productivity. But we are getting past that now. I hear the Prime Minister is going to tell us that we are all lovely, everything is fine, covid has gone and so on. That is slightly tongue in cheek—sorry, I should not really say “tongue in cheek”, should I? By the way, the hon. Member for York Central (Rachael Maskell) talked about dentistry and teeth being part of all health. The chief dental officer has a lovely saying, which is that we should put dentistry, or the mouth, back in the body. That is really important.
The combination of the restrictions, all the rules and then, as I have discovered, the extremely heavy regulation requirements of the Care Quality Commission meant that a considerable number of dentists thought, “I have had enough” or, “I’ve possibly had enough,” and then said, “I’ve had enough,” and retired. Progressively, the surgery cleaning down and fallow time has been better understood by dentists and they have been quicker at it and faster, but I still feel that there is an opportunity now, with what the Prime Minister is going to tell us, for us to cut that out. The Government do not always do very nice things for dentists, but one nice thing that they did for dentists was that they gave them the inoculations early on. They gave them not just for the dentists but for all the staff, even down to the cleaner. That is vital, because it will, I think, give us an opportunity to remove the fallow time—get rid of it.
For decades pre-covid, there was a shortage of dentists. There was certainly a shortage of dentists providing NHS services in particular areas. The way to get around that, as I have said, is to have more dentists. If we have more dentists for fewer jobs, they will go to other areas to work. Dentists are independent, so they have an opportunity to change that. Sourcing and increasing the number of dental practitioners is slow and relatively limited.
The most obvious solution is dental schools; we have touched on that. Every second place in the country wants a new dental school next to its hospital. I am sure that would solve the problem, but goodness knows how we would afford it, let alone get the people to teach in them. We have to remember that the basic dental degree takes five years, and the practitioner that comes out after five years needs a two-year apprenticeship before I would let them loose on my cat or dog, let alone one of my children.
Another way to get dentists is to attract them from overseas. My hon. Friend the Member for Waveney mentioned that; it is a great source. When I came here, every second dentist had an Australian accent. The practice I worked at for many years—quite a big one in south-west London—was staffed only by Australians and New Zealanders, and occasionally a South African. The principal got into real trouble with the Commission for Racial Equality. He rang up the agency and said, “I want another dentist. Can you find one? They’ve got to come from Australia or New Zealand.” He was told, “That’s racist. You can’t do that,” but there were hundreds if not thousands of them coming over from the Commonwealth.
The problem with people coming over here has been touched on: they have to go through courses and all the rest of it to become registered. We did not have that then and we do not have to have it now. Wherever the school is, it is the school that needs to be assessed. If the school passes its assessment, any student that passes and becomes a qualified dentist should be allowed in—just like that. That is what happened when I came. I handed over my certificate and the General Dental Council, bless it, stamped it and said, “Thank you very much. Off you go.” We should be doing that.
I had a complaint from the GDC that the people it sent out to assess the University of Otago in New Zealand, for example, did a quick tour of the dental hospital and then disappeared off to the vineyards. I am sure there was no truth in that. But we could get dentists from the Commonwealth, and we could keep bringing people in from the EU. People from the Commonwealth stopped coming when we joined the EU and they went to the United States. I ran a big function here for Otago graduates, and a vast number of professors of dentistry from Otago University came over from the United States. Normally, they would have come here; normally, we would have had them. Normally, we understand their English a little bit better, even if they are Australian, than the Americans do. That has to be an attraction. We should still be able, as I have said, to get European and Scandinavian dentists. That has to continue, because it would help massively.
We have to recognise that we will not have an instant or even a fast solution to the problems laid out today. Everybody has laid out problems, and a few people have come up with ideas. I am sorry for the Minister, because she is getting hammered for the problems, and she will not be able to provide a fast solution. It is not a case of money; it is a case of having the dentists to do the work.
Our best long-term hope, which one or two people have touched on, is prevention. The chief dental officer and others have an ongoing campaign to teach children, especially little children in day nurseries and so on, about toothbrushing. Having worked in the east end for some time, I know that when we ask a child, “What’s your toothbrush like?”, they sometimes say, “What’s a toothbrush?” We have to get that across to the kids. Kids love brushing their teeth. The mess is phenomenal, but they love it. The campaign is really starting to work. Wales and Scotland are ahead of us on that, but we are catching up, and it is making a noticeable difference. We can actually see the difference.
Our second hope, of course, is fluoridation. In other countries—Australia, New Zealand, Canada and so on—fluoride is in between 60% and 80% of water supplies. It makes a huge difference, and with no possible detriment to health. In this country, 10% of water supplies are fluoridated. It is pathetic. The Bill going through at the moment represents an opportunity to change that, but some nations have suddenly realised the real difference that can be made. New Zealand, if I dare mention that country again, is thinking of saying that every single water supply throughout the nation—it is a biggish country, about the same size as this one, but the population is tiny—will be fluoridated. That is a dramatic step, but we could do it. If we did, along with promoting fluoride toothpaste and teaching kids how to brush their teeth and cut down on sugar, then instead of being one of the worst dental states in the western world, we could be one of the best. It is a real opportunity and something we could achieve.
I know that the Minister cannot do anything overnight, and we have to accept that—
Rushanara Ali (in the Chair)
Order. Can I ask the hon. Gentleman to wrap up his speech?
Sir Paul Beresford
I am wrapping up right now.
I know that the Minister cannot do anything overnight, but I wish her the best of luck with the struggle.
Rushanara Ali (in the Chair)
I am most grateful. I have two more speakers to get in. To ensure that the Minister and shadow Minister have time to respond, I would be grateful if hon. Members could adopt an informal limit of three to four minutes.
Kevin Hollinrake (Thirsk and Malton) (Con)
I thank the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) for securing this important debate. It is clearly a huge, topical, cross-party issue that has largely been discussed in a collegiate fashion.
On the rare occasions that I get any press coverage for my work as a Member of Parliament, I am often referred to as “senior” or “veteran”, which I think says more about my age than my experience. When I got here in 2015, this was one of the first things I raised with the then Minister for dentistry, Alistair Burt. To be fair, things have changed since then; they have actually got a lot worse. The reality is that it is impossible for most people in my constituency to get on an NHS waiting list. We must be honest with the public: either we open the gates so that more people can access treatment, or we tell them that dentistry is for some people and not for others.
The Father of the House said that it would be helpful to be able to search for availability in each of our constituencies. I agree, but I know exactly what it would say for my constituency, because this morning I checked across North Yorkshire—which is larger than my constituency—and there is simply no availability on NHS waiting lists. It has been like that for most of the seven years I have been in Parliament. The pity is that I have dentists who will accept NHS patients, but they just cannot get the units of dental activity. There is a real impasse between the issues and our honesty in saying whether NHS dentistry treatment is available in our constituencies.
Of course, that has real-world effects, and I will read from a couple of emails. A Mrs Weston wrote to me this morning:
“My son, an adult with special needs… is on universal credit and PIP, and he has to pay for private treatment as we cannot get on an NHS list… He has had to have a tooth removed because of an abscess, something that could well have been avoided if he had had regular check-ups.”
Even worse than that, a lady from Rillington wrote:
“My daughter has a toothache and needs to see a dentist… Our dentist ceased providing NHS services and there is nowhere else we can get into… They advised us to ring 111… and we were told a dentist would get back to us within 7 days. No one did. Tonight we rang again. We were on hold for 2 hours before we got through to the Yorkshire and Humber Dental Services, who told us they have no capacity to help.”
This is simply unacceptable.
Somewhat different from most of today’s speeches, the key thing that I want to talk about is commissioning. In my constituency—my hon. Friend the Minister knows this, and she has been very responsive on it—the NHS dentist on Bondgate in Helmsley closed totally in September 2020. It will not reopen until April ’22 at the earliest—that is the predicted date of opening—so it will have taken 20 months for the NHS people who commission services to reopen the service, despite the fact that we had someone who was willing to take the contract right from the start. On Kirkgate in Thirsk, it will have taken six months, so that is slightly quicker—apparently, that will open in March this year.
The contract is wrong. This “five plus two” contract, rather than a general dental services contract, deters investment and is very bureaucratic, having to be revisited consistently. We must simplify the commissioning process. We must put a rocket up the people commissioning this—20 months is simply not acceptable. I agree with others who suggest devolving this stuff back to local areas: we can look after it and commission the treatment, rather than having it all done centrally by super-regional managers.
Robert Largan (High Peak) (Con)
I am very grateful to be called to speak, Ms Ali. I had to step out of the debate briefly to have an urgent meeting with the Business Secretary about energy prices. Thank you so much for fitting me in. I will be as quick as I can.
I am grateful to my hon. Friend the Member for Waveney (Peter Aldous) for securing this important debate on a subject that comes up frequently on the doorsteps of High Peak. I thank the dentists, orthodontists, hygienists, technicians and all those who have worked incredibly hard in dental practices over the past two years through the pandemic. We are lucky to have some excellent dentists in High Peak, including Dean Kennedy dental practice, which happens to share an entrance with my constituency office in Whaley Bridge.
We all know that dentists work hard for their communities. Nevertheless, a large number of local people have been in touch with me about how difficult it is to get a dental appointment. The response to a freedom of information request by the British Dental Association indicates that 70% of appointments, or 28 million courses of treatment, have been missed in England since the start of the pandemic. Making up that backlog is essential.
I therefore welcome the recent announcement of an additional £50 million investment in NHS dentistry, including nearly £9 million for my region, to help patients access dental treatment and to catch up on that backlog. Beyond the short term, however, it is important for the Government to take steps to guarantee the long-term sustainability of NHS dentistry. Far too many people are finding it impossible to get registered at a new NHS dental practice. I have experienced that difficulty at first hand, in how difficult it was to get registered with an NHS dentist near my home in Glossop.
According to “The Great British Oral Health Report”, carried out by mydentist, 53% of the public have not had a routine dental check-up in the past year. Of those who had not seen a dentist, 28% said that they could not get an appointment and 14% that they were unable to register with an NHS dentist. Those are worrying figures.
I fear that we could be storing up real long-term problems for public health, as relatively routine dental problems go unchecked and untreated, and develop into much more serious conditions, which will need much more expensive treatments in future. Several hon. Members also identified concerns about mouth cancers going undiagnosed in the long run, which is a big worry.
Part of the problem is that there are simply not enough dentists. We need a serious drive to improve both the recruitment and the retention of dentists. I have raised the issue directly with Ministers previously, including making the suggestion—as other Members might have done today—that the Government should look again at the recognition of overseas dental qualifications.
The long-term plan for the NHS rightly emphasised the importance of preventive healthcare, and dentistry should be at the frontline of that effort. I hope that NHS dentists will be represented properly in the governance of the new integrated care systems, including in Derbyshire, so we can have a truly integrated and joined-up approach to public health. I look forward to hearing the Minister’s response to the points that I and other Members have made today. Swift action is needed.
Karin Smyth (Bristol South) (Lab)
It is a pleasure to serve under your chairmanship, Ms Ali.
I am delighted to respond to this brilliant debate, in which we have had 23 speakers from all parties. Before I go further, however, I feel that I ought to thank my own dentist. Aidan has served me and my family well for more than 20 years. I will always follow him, wherever he sets up practice, and I have told him that he is not allowed to retire, ever.
I pay tribute to the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) for their diligent work in this area and for securing the debate. It is clear that the current situation simply is not working. As we have heard, staff are leaving the profession in droves, patients are struggling to access the appointments they need, and staff have been left undervalued, under-resourced and under-appreciated for far too long. This Government are putting the future of NHS dentistry at risk, and we have heard about some of that today in the choices confronting the sector.
I am sure that the Minister will tell us about a plan, I am pretty sure that she will tell us that she has heard the concerns that have been expressed today, and I am very sure that she will blame the last Labour Government. However, I think we need to ask, “Where is the action?” We welcome the additional funding for the NHS—the £50 million injection—but it ignores the wider structural issues affecting dentistry. It will fund less than 1% of the 40 million appointments we have lost since the start of the pandemic; it is a mere drop in the ocean. The impact of those lost appointments is clear. “The Great British Oral Health Report”, published in August, showed that a third of the population is estimated to be suffering from undiagnosed tooth decay. That is particularly problematic among children, as we have heard, with a child being admitted to hospital for tooth extraction every 10 minutes in the UK. That is a shocking statistic.
We know that some of our most vulnerable communities rely on NHS dentistry, and increasing barriers to access only fuel inequality. My hon. Friend the Member for York Central (Rachael Maskell) spoke particularly cogently about that inequality. Before the pandemic, tooth decay among children in the most deprived communities was 3.8 times higher than among those in the least deprived communities. That severely affects my constituency of Bristol South.
Again, as many have said, we need a proper long-term strategy to address the workforce crisis affecting the whole of our NHS, as well as reform of the broken contract system. The Minister has said on many occasions how broken that contract system is. It has been in place since 2006. As we know, it was negotiated by the Labour Government. We know times have changed, but we also know the Government have been trying to change the contract since 2011, which may give some indication of how difficult it is. I have some sympathy with that, but a decade should be enough time to get on with sorting the problem.
Even as recently as Monday’s Adjournment debate, we have heard Ministers say, “We’ve started work on that reform.” We are all desperate to hear how it is progressing and, to be honest, for the Government to get a bit of a move on with it. It was a commitment in the Conservative manifesto of 2010—12 years ago. It would behove the Minister, after the number of debates that we have had, to come forward and say when we can expect to see the fruits of that decade of discussion. It is a problem that urgently needs tackling, not kicking further into the long grass.
When the Minister talks about there being a shortage of dentists wanting to do NHS work, I wonder whether she really understands why that is the case. Surveys by the British Dental Association have shown that 80% of owners of predominately NHS practices say that morale is low or very low. The hon. Member for Bath (Wera Hobhouse) talked about the mental health stresses of the workforce. Some 76% said that their job was extremely or very stressful, and 45% want to leave dentistry within the next 12 months. Of the 93% who struggled to recruit a dentist to work in their practice, more than half cited associates’ reluctance to work in the NHS as the main reason they struggled to fill the vacancy. With morale through the floor and recruitment near impossible for many practices, is it any wonder that NHS dentistry is in the state it is?
Of course, this is true across so much of our NHS and social care sector: workforce is the critical problem. Many hon. Members—notably the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—frequently urge the Government to bring forward a credible workforce strategy for all parts of the NHS. It is long, long overdue.
I will briefly share some testimonies from NHS dentists working on the frontline. One dentist in Shropshire said that the date of this debate
“exactly matches the last day that I will be providing NHS dentistry after 17 years of service.”
They said that the contract has not been fit for purpose for a long time and that covid has broken what was already a strained system. We thank them for their service and wish them well, but we are sad to lose them.
A dentist in east Devon who had lost two members of staff said:
“A large number of our patients are on benefits or have low incomes and with a huge increase in energy bills on the horizon this number is bound to increase. I have had 3 days off during the last 12 months…I’m tired, not sleeping, close to burning out.”
These are shocking testimonies from the frontline.
It is not just dentists who are seeing these problems; patients are feeling the impact of this situation harshly, as hon. Members across the House will know from their casework. In a recent Adjournment debate about Bristol and the south-west, I raised the issue of a pregnant constituent who was unable to access care at that critical time. This is the No. 1 issue raised by Healthwatch. Patients are struggling. As we know from YouGov and as we have heard today, 20% of patients are resorting to DIY dentistry. The security that NHS dentistry provides to so many people in this country is being eroded, and it will be eroded until that safety net is no longer there.
We have heard some severe challenges from Government Back Benchers about the Government’s long-term view on the survival of NHS dentistry. With the cost of living crisis squeezing households across the country, people will be faced with choosing between their health, heating their homes or putting food on the table. As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) said, people are being priced out.
The hon. Member for North East Bedfordshire (Richard Fuller) was very kind about some of my expertise in the field. We have worked together collegiately in other areas—on trailer safety, notably. Generally, I think devolved budgets and personal budgets are a good thing, and I have always advocated empowering patients, but, sadly, their use has been reduced in social care and they are not being utilised. I am not sure that they are the answer in this particular area, but something radical clearly needs to be done about the contracts.
I say gently to the Conservative party that that the Labour party does not think it acceptable that young children are in hospital or toothless while £4.6 billion-worth of loans float out of the Treasury, while the personal protective equipment contract is written down, or while whatever other ill management of the Budget we have seen from this Government happens. I personally look forward to a debate between the hon. Member for Thirsk and Malton (Kevin Hollinrake) and my hon. Friend the Member for Bootle (Peter Dowd) on the efficacy of the Government’s management of the economy. That would be a well-informed debate and I would certainly back it.
I say to the Minister that we have seen no evidence about dentistry being a priority for the Department of Health and Social Care. The new White Paper, which came out yesterday, talks about better integration across primary and community health, adult social care, public health and housing, but there is no mention of dentistry. Again, as a lot of people have said, making dentistry part of our general community service would be a good thing.
The debate has highlighted that the problem was urgent even before the pandemic. There is no data; it is clear that dentistry is an outlier of public and community health. That is a long-term problem. I am afraid that I do not think that the Government have taken it seriously in their recent White Papers. We would all support the Minister in that battle at the Department of Health and in bringing forward something to address referrals to the contract much more urgently.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Ms Ali. I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing the debate and I am pleased that he is seeing a local improvement after we met recently. I also thank the hon. Member for Bradford South (Judith Cummins) for securing the debate.
I agree with my hon. Friend the Member for Stroud (Siobhan Baillie) that we have seen a level of interest in and concern about the matter across the Chamber, and that we need to ensure that we take some of the politics out of it because there are some difficult steps to take to improve dental services across the board. I welcome the contribution from my hon. Friend the Member for Mole Valley (Sir Paul Beresford), whose clinical experience is so helpful in the debate. I reassure colleagues on both sides of the House that since I came into post in September, dentistry has absolutely been a priority for me. I have been working night and day to try to make some short and long-term improvements, because I am live to all the concerns that have been raised.
We have set up some joint working, which was not happening before, between NHS England, the chief dental officer and the Department, and I meet the BDA regularly because we are serious about reform. I say to any dentists watching the debate that I absolutely understand the problems that make delivering an NHS contract unbelievably difficult. The contract is the No. 1 long-term issue that we have to deal with, and we are starting progress on that as soon as possible. I will come to some specifics shortly, but first let me mention covid.
I know that there has been some concern that covid is a lame excuse but, as my hon. Friend the Member for Mole Valley said, it has had a significant impact on access to dental services in the past 18 months. When lockdown happened, services were immediately reduced; only urgent services were allowed. That continued for a significant period. It was not until 8 June 2020 that practices were allowed to open for up to 20% of normal activity and it was not until last year that that went up to 60% and, towards the end of the year, to 65%. Although dentists were compensated for their loss of income during that period, the backlog that that generated is shown in all our postbags right now.
I place on record my thanks to dental teams up and down the country. Urgent appointments went back to pre-pandemic levels in December 2020, but with only 85% of activity allowed the backlogs will only grow. We need to be honest about that; the impact is significant. I completely understand the pressures that that is putting on dentists. We are keen to support dentistry where we can to get it up to 85%. It has been difficult during omicron with staff sicknesses and patients having to cancel when they become covid positive, and I absolutely recognise the stress and strain that covid has put on the system, but we have to be honest. I think it was the hon. Member for Bootle (Peter Dowd) who mentioned this, and I am happy to accept the difficulties we face. There were problems before covid and there are those same problems post covid, and we are absolutely focused on starting to tackle them.
Let me make a couple of points. There is no patient registration system for dentistry—that is one of the myths. It is not like GP practices, where someone signs up and is then on the list. Patients can go from dentist to dentist if there is one available, and we are making sure that we open up capacity where it exists.
We have written to all dentists to ask them to update their capacity so that we can put it on the website mentioned by the Father of the House, my hon. Friend the Member for Worthing West (Sir Peter Bottomley), and we have also asked them to run a cancellation list. If someone cancels, the practice will be able actively to contact the next person on the list. Capacity is being generated by that, but I am aware of the problems with capacity across the board. We have talked about many parts of the country, such as Norfolk and Devon, that are experiencing capacity issues, but all parts of the country have experienced a squeeze in the number of appointments available.
A couple of weeks ago, we announced £50 million to help with some of those issues. I know that some Members have been quite dismissive of that this afternoon, but we know that it will cover the period to the end of this financial year to buy some urgent capacity for the system and to help deliver more than 300,000 appointments that currently cannot happen. There has been good uptake, even in the few weeks since the money was announced. Regions across the country are signing up and because the payments to dentists are much better than under the current contract, there is an appetite among dentists. That shows that if we remunerate dentists adequately they have an interest in taking on NHS work.
I encourage Members from all parties to contact their local commissioners, because we want to ensure that that money is used. If there is no interest, or if they are struggling to spend the money, they should let us know. NHS England has been in contact with local commissioners to get that feedback so that we can make the best use of the money and buy as much capacity as possible.
Kevin Hollinrake
Does the Minister think that it is acceptable for commissioners to take 20 months commissioning a service when we have dentists who want to take that work and take on that surgery?
Maria Caulfield
Absolutely. I will come on to that point, which is valid. We want to increase capacity and there are dentists who want to take on NHS work. When contracts are handed back, we have to do the whole procurement process, and when there is an interested party, even when they are ready to sign on the dotted line, that takes a considerable amount of time. In the Department, we are looking at how we can change the procurement process. It often falls in the lap of local commissioners, but they are stuck with the procedures they have to follow. I am keen to see how, when someone is willing to take up a contract, we can enable that to happen as quickly as possible.
We have also relaxed the upper tolerance threshold and increased activity from 104% to 110% of dental activity. The current contract penalises dentists if they go over their contracted work, which is a perverse disincentive when dentists have capacity and want to take on extra work.
Before I touch on the nub of the problem, I will mention prevention. I am pleased that prevention is being considered and that the Government’s proposals on water fluoridation are part of the Health and Care Bill. I hope Opposition Members will support us when the Bill comes back from the Lords. We are also looking at options for how to introduce supervised tooth brushing in parts of the country where there is the greatest need. I reassure hon. Members that the prevention and oral health element is as key as getting dental procedures done.
The dental contract is the crux of the matter, and we are absolutely committed to reform. I met the BDA this week to start negotiations. We are looking at some quick wins over the next 12 months and some long-term contractual reform to the UDAs. We have started informal negotiations, and the formal negotiations will start in April. We all—the BDA, patients, MPs and the Department —know the urgency. It cannot be a long, protracted negotiation. However, we are working well with the BDA. We are keen to get negotiations under way and to reach a resolution as quickly as possible. We have to make the NHS a better and more attractive place to work, because dentists have other options; I cannot remember which Member said it, but dentists are voting with their feet when it comes to where they want to practice.
On the recruitment, retention and training of dentists, Health Education England published its “Advancing Dental Care Review” in September. It is working through how we can train not just more dentists but the whole dental team, and on how we can upskill dental technicians and dental nurses. We will bring forward legislative changes to enable other members of the dental team to take on more roles. We are setting up centres of dental development in those areas of the country with the biggest shortages, which tend to be coastal and rural. I take the point made by my hon. Friend the Member for Broadland (Jerome Mayhew) about Norfolk—I think I heard that several times. We are looking at where in the country those dental deserts are and whether we can match them to centres of dental development.
Members may not realise that this week the Department announced a consultation with the General Dental Council on the registration of international dentists and whether we can put in place a process to recognise the qualifications of dentists from around the world, as my hon. Friend the Member for Mole Valley mentioned. The overseas registration exam, which they have to take, was suspended throughout the whole of covid, so we have a backlog of around 700 dentists waiting to take it. The first exams started a couple of weeks ago, and there are exams in place for the rest of the year to try to get through that backlog. We are confident that we can do that.
We need to work on how we recognise existing qualifications to remove the barrier of having to do an exam. Again, I encourage colleagues to respond positively to the consultation on the GDC website and to the developments it is making. My hon. Friend the Father of the House has written to me about international dentists having to take the exams within five years of their first attempt, and whether those rules can be relaxed. That is also part of the consultation. We very much recognise that covid has had an impact on those rules too.
I reassure colleagues that I am working on bringing NHS England, dentists and the BDA together so that we can make a difference as quickly as possible. The changes in the Health and Care Bill on integrated care systems and having accountable people for commissioning locally are crucial. Integrated care boards will be statutory from 1 July, and will have accountable officers. I strongly urge colleagues to speak to their ICBs or CCGs, because there are differences in practice across the country. Some commission dentistry really well, some not so well. Very often, if the money allocated to dentistry is not ringfenced, and if it is not spent locally, it goes into other healthcare provision and is lost from dentistry. I encourage Members to hold the feet of their local commissioning bodies to the fire on what they are doing with the money given to them. We are here to support them, and work will be done on dentistry commissioning going forward.
In the short time I have had, I hope I have been able to provide assurances that dealing with the situation is not without its challenges. There is no silver bullet that will resolve all the problems. There is not a quick-fix solution, but I am working at pace, as is the Department, to reform the contract. Work is starting in April on the formal negotiations, and I hope that will improve recruitment and retention in dentistry. We value the work that dentists do, which for too long has gone unrecognised and has been a Cinderella part of the service. The people who have suffered are not just the dentists, but the patients.
Peter Aldous
It has been a very interesting debate, and we have heard some great ideas. It has largely been consensual, although I welcomed the little bit of sparring, because it added to proceedings. One thing I did not do was thank the dentistry heroes during the covid pandemic. They are the people who have really been on the frontline.
I enjoyed the interludes into Shakespeare from my hon. Friend the Member for North Devon (Selaine Saxby) and the hon. Member for Bootle (Peter Dowd). Ian Fleming was also quoted, and I could cornily reply by saying the whole debate should leave us very shaken and stirred.
Some interesting issues on funding have been raised. I take on board a lot of what was said by my hon. Friend the Member for North East Bedfordshire (Richard Fuller), who is no longer in his place, about creating innovative funding solutions. He is right to say that there is not endless money, but I feel that NHS dentistry has been the Cinderella service when it comes to funding. I sense that part of the problem is that it has been shunted off into the sidings of the NHS.
We heard three very useful points from my right hon. Friend the Member for Basingstoke (Mrs Miller), who basically said that the health of our teeth is inextricably linked to our health service. The hon. Member for York Central (Rachael Maskell) said that our mouths are not divorced from our bodies. My hon. Friend the Member for Mole Valley (Sir Paul Beresford), whose contribution was really significant, said that dentistry and the mouth need to go back into the body. I sense that if we do that, the funding issue will begin to be solved. The primary and secondary parts of the NHS, and the mental health side, will realise that we need to get dentistry right, because that will have a positive knock-on impact on the remainder of the service.
Prevention is vital. It was striking that I had four interventions on the importance of fluoridation, innovative working such as supervised toothbrushing, and getting into schools and care homes—that is so important as well.
We keep coming back to the need for contract reform. It was striking that we heard that it is not a question of dentists going out into the private sector, having been lured by large sums of money. It is a question of their being driven out by the soul-destroying system under the existing contract. It was helpful to hear the Minister say that there were some quick wins being put in place and that the negotiations start in earnest in April.
We do not want to just go away, pat ourselves on the back and say that we have had a great debate. We want meaningful progress. When I proposed my amendment to the Health and Care Bill, one of the things that I wanted was annual reporting, to see where we are. My hon. Friend the Member for Worthing West (Sir Peter Bottomley), the Father of the House, talked about coming back in six months’ time for a progress report, and I hope that the Government will agree to that. We can look at how we do that—perhaps through another Backbench Business Committee debate.
Ms Ali, you are looking at me. I have summed up as best I can. It has been a great debate, but let us not stop here.
Question put and agreed to.
Resolved,
That this House has considered access to NHS dentistry.