Dental Training College: East Anglia
(1 year, 6 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Jerome Mayhew (Broadland) (Con)
It would be all too easy to focus any speech on dentistry on a call for the renegotiation of the NHS—[Interruption.]
Madam Deputy Speaker (Dame Rosie Winterton)
Order. Could colleagues leave quietly? Otherwise we will not be able to hear what the hon. Gentleman is saying.
Jerome Mayhew
As I was saying, it would be all too easy to focus any speech on dentistry on a call for the renegotiation of the NHS dental contract. Every Member of Parliament will know from their postbag the suffering that ordinary people are experiencing every day because they are simply unable to see a dentist.
The pandemic has caused the loss of 40 million dental appointments—more than an entire year’s worth of standard pre-covid treatment—but covid is not the cause of our problems. Ever since Labour imposed its NHS dental contract on the profession back in 2006, trouble has been brewing. Dentists have been voting with their feet, moving in their thousands away from NHS treatment into private work.
That trend has only accelerated through covid. Between the start of the pandemic and May 2022, 3,000 dentists have stopped doing any NHS work. Three quarters of those who are left say that they are likely to reduce their coverage further over the next year, so we simply cannot ignore the problem any longer. The pain and suffering are too great. Labour may have created this bad system, which fails to pay for the cost of complex work, but our job is to fix it, and the sooner the better.
The purpose of this debate, however, is not to moan about the state of NHS dental provision, but to put forward a positive case for solving the long-term problems in Norfolk and the east. Put simply, we have a desperate shortage of dentists of any description. Too few dentists and too few dental technicians—whether NHS or private—are choosing to work in East Anglia.
Nationally, the General Dental Council says that we have more dentists than ever before, with a national average of 43 for every 100,000 of the population, but in Norfolk and Waveney, that figure is just 38. That is the fifth lowest ratio of the 106 clinical commissioning groups around the country. Dental practices are crying out for new staff, but they simply cannot get them.
In the town of Fakenham in my constituency, I lobbied successfully for the NHS to award a brand-new NHS dental contract to increase local NHS provision. That was the Government being prepared to pour new money into increasing NHS provision. However, when that contract was advertised, not a single company bid for the work. There simply was not the staff to supply the need.
That is not just an NHS issue. In the same town, a private dental practice has been advertising for a private dentist for two years, but without success. In the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker), there is a dentist in Sheringham who operates practices both in London and Norfolk. He has not had a newly qualified dentist come to work in his Sheringham practice for 10 years. Job vacancies in London are snapped up, but he simply cannot get them to take the jobs in Norfolk.
Why can we not produce dentists in East Anglia? The answer is that there is nowhere for them to train. If someone who lives in East Anglia wants to become a dentist, the nearest place they can train is Birmingham or London. None of the 10 training facilities around England is in the east of England.
That has to change. We know from our experience with the University of East Anglia that graduates tend to stay and build their lives close to where they have studied. Each year, the UEA does a survey of its graduates to see where they go to accept their first employment. If we look at that survey for doctors coming through the medical school of the University of East Anglia, we see that more than 40% end up taking jobs locally every year. That is great for us in relation to doctors and particularly for the Norfolk and Norwich University Hospital, which is based in Norwich. Unfortunately, however, the same problem is true in dentistry.
Let us look at the number of dentists working near existing dental training schools. As I said, Norfolk has 38 dentists per 100,000 of the population. Devon is a broadly similar county—it is largely rural, with coastal communities and one major conurbation, Plymouth—but there is a big difference: Plymouth has a dental school, which was installed in 2005, and Devon’s ratio of dentists per 100,000 of the population is not 38, but 49.6. If we look at the north-east, where there is a school in Newcastle, we see that its ratio of dentists to the general public is 56 per 100,000 of the population. In Cheshire and Merseyside, there is a school in Liverpool, so the whole area benefits from 58 dentists per 100,000 of the population. We can see from the hard data that people tend to settle down where they have trained.
So if that is the data, surely the solution to East Anglia’s problems is obvious: first, we need to open a dental school in East Anglia. I raised that need directly with the University of East Anglia some months ago and I have been enormously encouraged and impressed by their response, strongly supported by the NNUH, the region’s training hospital. The University of East Anglia has developed an innovative solution to our dental training problems that would minimise cost and get students out into the workplace from the start of their training, helping with capacity in the short term and dealing with the training deficit in the long run.
Tom Hunt (Ipswich) (Con)
As a Suffolk MP, I welcome the idea of an East Anglian training centre. I also want the University of Suffolk to play a role. It recently outlined its plans for a Suffolk centre for dental development. Does my hon. Friend agree that, actually, a dental training college in Norwich could work hand in glove with the new centre in Ipswich to make sure that people are trained locally but, when needed, they are pooled to provide services on the NHS for our constituents?
Jerome Mayhew
I am grateful to my hon. Friend for that intervention, and I agree entirely. There can be collaboration between the university in Norwich and the University of Suffolk, which is based in Ipswich. People can start training in Norwich and, once they are qualified, have career and professional development taken care of by the proposed unit in Ipswich. I will come on to that in further detail.
To return to the plans of the University of East Anglia, its idea is that students would work in the community for at least one day a week throughout their five-year training course. In that way, dental students will increase the capacity of associated NHS practices right from the get-go. Too often, it is suggested that a dental training school is too long term to solve the problems now. In a sense, it is, of course, but under this plan, we would have increased capacity right from the first year of the students’ five-year course.
There are more benefits, too: students would not only increase the capacity, but develop employment relationships locally, increasing their stickiness, and provide training income to stretched NHS practices. For that reason, MPs from North Norfolk, North West Norfolk, Mid Norfolk, South Norfolk and Norwich North all support the proposal. If there were an East Norfolk constituency, I am sure that that Member would support it as well.
Peter Aldous (Waveney) (Con)
I speak as an MP with a foot in both camps: I am a Suffolk MP but I also represent the Norfolk and Waveney integrated care system area. Does my hon. Friend agree, as my hon. Friend the Member for Ipswich (Tom Hunt) said, that it is very important that the two proposals being put together by the University of Suffolk and the University of East Anglia are collaborative and worked on together, so that they come through with a solution for the whole of East Anglia?
Jerome Mayhew
I am grateful to my hon. Friend. The only phrase that I would pick him up on is that he has “a foot in both camps”. I do not think there should be two camps. This is an East Anglian solution, whereby the proposals are complementary and, in time, they should both be implemented.
George Freeman (Mid Norfolk) (Con)
I commend my hon. Friend and constituency neighbour for raising this issue and highlighting the huge pressures that the dental service in his area and mine is experiencing on the ground. Many of our constituents are struggling and this proposal would not only make our region a leader in the science and technology of dentistry, but help to meet that demand and need on the ground. With new housing, the pressure will only get more acute in the next few years.
Jerome Mayhew
My hon. Friend is entirely right. There is a further point to be made about the collaboration between the University of East Anglia and the Norfolk and Norwich University Hospital, because they also have the Norwich research park co-located. I am thinking particularly of the Quadram Institute, the sole focus of which is world-leading research on the gut microbiota. I cannot pretend to know exactly what the gut microbiota are, but I know that they start with the mouth. There is huge capacity for proper, hard research in the area, and it could be assisted by a dental training school in Norwich. That is the first solution.
The second solution, which is also needed, is for the dental school in Norwich to complement the University of Suffolk’s plans to build a centre for dental development in Ipswich to support further career development in the region, attracting and retaining newly qualified dentists. My hon. Friends the Members for Bury St Edmunds (Jo Churchill), for Waveney (Peter Aldous) and for Ipswich (Tom Hunt) and others have all pushed for that.
The truth is that we need both to attract qualified dentists in the short term and to find a long-term solution to the wider training problem. It may be that an assessment is made nationally that there is no need for additional dental training seats, but people are human. We have to look beyond the empirical analysis and recognise that training needs to be offered in a location of real shortage. That location is East Anglia, and Norfolk in particular.
As a Conservative, I believe that people should have power over their own lives and that communities should not be dictated to by national Government. Rather, they should be empowered to come up with their own solutions to their local needs. We know what the problem is, and we have a solution to fix it locally; we just need the Government to trust the people to let us get on and do it.
We simply need more dentists and dental technicians in East Anglia. We recognise that budgets are tight and that timings may have to be stretched. We accept that short-term fixes are sometimes more powerful arguments in politics than long-term solutions. We simply ask the Minister to agree to meet the University of East Anglia team to learn at first hand how we can make East Anglian dentistry better, and to be inspired by their practical vision.
Madam Deputy Speaker (Dame Eleanor Laing)
I cannot quite tell whether the hon. Gentleman wishes to contribute.
Peter Aldous (Waveney) (Con)
I will contribute very quickly, Madam Deputy Speaker, if you will give me the opportunity.
My hon. Friend the Member for Broadland (Jerome Mayhew) has set out a great vision of a future in which East Anglia, Norfolk and Suffolk have high-quality dentistry schools. That is great, but we need a bridge to get to that future, because two dentistry schools will take some time to set up. Does he agree that we need to look at other strands to address the crisis in NHS dentistry in East Anglia, including recruitment and retention in the short term, making it easier for people from overseas to come and work in local dentistry; contract reform, which I think my hon. Friend referred to; a fair, long-term funding settlement; a focus on prevention; and improved local accountability through the fledgling integrated care systems?
Madam Deputy Speaker
Order. Perhaps I am confused, but I thought that the hon. Member for Broadland (Jerome Mayhew) had finished. [Interruption.] Ah, so now he is intervening on the hon. Member for Waveney (Peter Aldous). That is absolutely fine.
Jerome Mayhew
Thank you for that clarification, Madam Deputy Speaker.
Does my hon. Friend agree that all those aspects are very important, but that perhaps there is another proposed solution that he has not mentioned? As we have learned today, there are inducement payments for teachers in special areas that are struggling to recruit. Perhaps we could apply the same approach to dentists in special areas that are struggling to recruit.
Peter Aldous
I thank my hon. Friend for that intervention and apologise for hijacking his debate. Yes, I agree wholeheartedly. This is a multifaceted challenge; there is no one solution and no one golden bullet. We need to address all the points, and he is right to raise that one.
George Freeman (Mid Norfolk) (Con)
As a former Minister for life science and for science and research, I rise very briefly to highlight the point that my hon. Friend the Member for Broadland (Jerome Mayhew) made about the microbiome and the mouth—the buccal cavity—as a primary diagnostic for our understanding of the role of the biome and of gut flora and fauna, not only in good health but in diseases such as cancer. As a diagnostic tool, it could make our region a leader in the diagnostics of the digestive system and the gut biome, which would have a whole bunch of other important secondary health benefits. For that reason, I commend my hon. Friend’s case to Ministers on the Front Bench.
The Minister of State, Department of Health and Social Care (Will Quince)
I congratulate my hon. Friend the Member for Broadland (Jerome Mayhew) on securing this debate on the potential merits of establishing a dental training college in East Anglia. It is clear that he has support from his neighbouring MPs—I know that one of them cannot be here this evening, but very much supports this endeavour—and from colleagues further afield and across East Anglia. I also thank him for raising the issue of access to dentistry in rural and coastal areas, particularly the challenges of seeing a dentist in Norfolk.
As the new Minister for dentistry, I understand that areas across our country, as my hon. Friend has highlighted, have faced difficulties with recruitment and retention, including in his constituency of Broadland and in the east of England more widely. Those challenges have a significant impact on the provision of NHS dentistry and on patients’ ability to receive NHS care. My hon. Friend is right that we cannot ignore the problem, which I can assure him is a priority for me and for the Secretary of State. I hope that it will not have escaped my hon. Friend’s notice that dentists are a key element of the Secretary of State’s ABCD approach and of “Our plan for patients”.
I am aware that my hon. Friend, alongside my hon. Friend the Member for North Norfolk (Duncan Baker), attended meetings with my predecessor, and I think even with my predecessor’s predecessor, to discuss the construction of a dental school in Norfolk. It is a testament to the character of my hon. Friend the Member for Broadland that he brought the issue to my attention just days after my appointment as a Minister in the Department of Health and Social Care. If I may say so, his constituents are fortunate to have such a passionate and persistent advocate in their corner.
My hon. Friend set out in his speech to make a positive case for doing something about a long-term problem, and I think everyone in the Chamber this evening will agree that he has done so. He makes the case for a new dental school in Norfolk—a case that I know has the backing of my hon. Friend the Member for North Norfolk, who cannot be here this evening. On the face of it, it is a compelling case and is worth further exploration.
I think that my hon. Friend the Member for Broadland knows me well enough to know that I am not someone who likes saying no to parliamentary colleagues, although sadly that is a responsibility that all too often comes with the job. On this occasion, it is a no, but it is “No for now, and let’s very much keep talking.” Let me explain why.
Establishing a new dental school takes several years and would not influence service provision in the short term, as my hon. Friend rightly identified. Notwithstanding the strong case that he makes, it also would not guarantee the ongoing sustained retention of dentists or support staff in the area. Our focus is not just on training more dentists, important as that is, but on the better use of the full dental team and the progression and retention of all dental care professionals in the NHS. There is, of course, an argument about the medium to long term, which is why I suggest that we keep talking, and of course I would be delighted to meet my hon. Friend, as he requests, to further discuss his ideas and plans.
My hon. Friends the Members for Broadland, for Waveney (Peter Aldous) and for Ipswich (Tom Hunt) all mentioned centres for dental development, the alternative training model identified by Health Education England in its 2021 “Advancing Dental Care” review report—that is a mouthful! The centres for dental development model would specifically benefit localities in which there is a shortage in provision and there are no nearby dental schools—as is the case in East Anglia, as my hon. Friend the Member for Broadland rightly pointed out.
The premise is that the centres would build on any existing dental infrastructure in the area, bringing together training and the resultant provision of NHS treatment to patients in a co-ordinated way. Things like postgraduate training opportunities are more likely to be compatible than early undergraduate placements, as they would increase access to the more complex and specialist care that we know is often most lacking in certain areas of the country, otherwise known as dental deserts. This would work towards the aim, specified in the “Advancing Dental Care” report, to produce the skilled “multi-professional oral healthcare workforce” that could best support patient and population needs within the NHS. A further advantage of the centres for dental development model is that they would be tailored to suit the local workforce requirements, in addition to the education and training needs of the area, contributing to stronger, multi-disciplinary dental teams and local area workforce retention.
Given that the centres would focus on postgraduate training or the later stages of undergraduate training, they could provide support in transitions from undergraduate to dental foundation training and more specialised training beyond those, all of which involve—as my hon. Friend mentioned—important decision-making moments in terms of career development and where dentists are likely to base their careers and practices. We believe that a broader range of placements across the country and in different clinical environments would enhance the student experience. The centres could offer a constructive alternative to dental schools, while acknowledging and addressing recruitment, retention and training gaps. I am sure my hon. Friend will be pleased to learn that Health Education England has now moved into its four-year implementation stage through its dental education reform programme—another mouthful!—following the “Advancing Dental Care” report and its recommendations.
My hon. Friend rightly raised the subject of collaboration. With regard to establishing a centre for dental development in East Anglia—this has been mentioned by my hon. Friend and others—the University of Suffolk and the NHS Suffolk and North East Essex integrated care board have announced plans for a centre in Ipswich. I am informed—this also covers my area, so I have an interest in it as well—that the initial plans include proposals to offer postgraduate educational opportunities as well as wider training opportunities for newly qualified dentists, alongside the training of the dental therapists, hygienists and dental technicians who form a vital part of the dental workforce. I pay tribute to my hon. Friends the Members for Waveney and for Ipswich for the work that they have done in pushing so strongly for that development, along with the integrated care board, which is a trail-blazer in this regard. It would be wrong, at this juncture, for me not also to pay tribute to my hon. Friend the Member for Bury St Edmunds (Jo Churchill). She has pushed strongly for this as well, and, moreover, is—dare I say—a much-missed Minister at the Department of Health and Social Care. She has a passion for dentistry, and, within the Department, she really put it on the map. That is a legacy that I intend to continue.
I strongly encourage my hon. Friend to meet the NHS and HEE regional teams for his areas, as centres for dental development are very much a local solution, tailored to the existing infrastructure and needs of an area. I, and those in my office, would be delighted to help facilitate such a meeting.
I have mentioned integrated care systems and integrated care boards. As we make the transition to integrated care systems—this point was made by my hon. Friend the Member for Waveney—commissioning roles for dentistry will be delegated. This will ensure that dentistry decisions are considered at a local level, and that, for example, local workforce as well as local population health requirements are taken into account. I therefore encourage my hon. Friend to meet the integrated care board—I am sure he has already done so, but I think an ongoing dialogue would make sense—to discuss its plans further, and to talk about how they will affect Broadland and the rest of East Anglia.
My hon. Friend touched on recruitment and retention, which I know is a particular issue in his constituency and more broadly. I have referred to the changes that we have made nationally through system reform, but NHS England in the East of England region has been working closely with the organisations that train dentists to improve the recruitment and retention of NHS dentists in East Anglia, and will continue to help those training organisations to develop the dental workforce. I am pleased to say that, in 2021-22, there was an increase of 539 dentists performing NHS dentistry compared with the previous year. In the East of England, there was a 3.5% increase, with an additional 105 dentists. However, as my hon. Friend pointed out, that is not enough: we need more dentists, and we need more dentists on NHS contracts.
More broadly, I know that my hon. Friend will want to know what improvements are being made now which will improve access to dentistry for his constituents. He rightly focused on the medium to long term, but I know from my postbag that the pressing concern is often the here and now. We plan for the dental system improvements announced on 19 July as part of “Our plan for patients” to begin to take effect by the end of this year, and some of the improvements in the package have already taken effect and are beginning to bear fruit. The Secretary of State and I are looking at a number of further measures that we can take to aid recruitment and retention—I know that that is one of the key concerns of my hon. Friend and others, and I think my hon. Friend touched on one of the ideas that we are considering—and, in turn, improve access for constituents. As I have said, this is a priority for me, and I hope to share more details with my hon. Friend and the House in due course.
I am committed to playing my part to improve access to NHS dentistry, particularly for those most in need of dental care, and I know that recruitment and the dental workforce will play a pivotal role in that. I hope my hon. Friend has been reassured that action is being taken to address the challenges in recruitment and retention across the country, and particularly in his constituency. I look forward to working with him as we develop our ambitious plans, and I know he will continue to be a champion for his constituents and hold the Government’s metaphorical feet to the fire as we deliver the improvements in dentistry access that we all want to see.
Question put and agreed to.