(1 day, 8 hours ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Alex Easton (North Down) (Ind)
I am grateful for the opportunity to draw the attention of the House to an issue that affects millions of British people and families right across our country: the current state of NHS dental services throughout the UK.
Our NHS dentistry, from which I and so many others in North Down have benefited, as have countless people across our United Kingdom, was founded on the basic principle—indeed, I would call it a promise—that everyone regardless of income, background or postcode should be able to access essential dental care when they need it. It is a foundational pillar of our wider health system and a critical measure of our nation’s public health. Every Member of this House would do well to ask where that basic principle and promise now stands in Britain in 2026.
Our NHS dentistry is under severe and unsustainable strain. I want to speak plainly about where we are, why and how we have reached this point, how it is affecting both patients and professionals alike, and, if we are truly serious about saving NHS dentistry for future generations, what must be done if it is to be resolved.
Across North Down, Northern Ireland and, indeed, the whole United Kingdom, the picture is deeply disturbing and for too many, painfully familiar. Finding an NHS dentist has become increasingly difficult. My constituents in North Down, like so many in England, Scotland and Wales, are joining waiting lists that stretch for months and in some cases even years. Some are ringing multiple practices in their area only to be met with the same response: “We are not taking on NHS patients.” Others are told that their only option is to go private or travel long distances simply to access basic dental care.
I would love to tell the House that this is a marginal problem that affects only a small minority, but it is increasingly becoming the lived reality of British families, older people and children in towns, cities and rural communities across England, Scotland, Wales and Northern Ireland. The reality in Britain is that fewer practices are offering NHS appointments, there are growing backlogs for routine check-ups, and increasing numbers of patients are turning up with dental pain and infection at GPs or accident and emergency departments—places that were never designed for dental care.
Warinder Juss (Wolverhampton West) (Lab)
Does the hon. Member consider that part of the problem as to why dentists do not offer NHS appointments is because contracts have not been updated and perhaps they feel that when they do NHS work they are not properly paid?
Alex Easton
That is certainly one of the major issues that needs to be addressed. Shockingly and frighteningly, people are resorting to DIY dentistry because their pain is so great and they simply cannot afford treatment. No MP can sleep easily in 2026 when British people are pulling out their own teeth at home.
Our NHS system is under pressure. Why is this happening? Is the reality not that funding has not kept pace with demand or with the cost of prioritising high-quality dental care?
Linsey Farnsworth (Amber Valley) (Lab)
I commend the hon. Member for securing this important debate. In Amber Valley, recruitment and retention continue to be the main barriers to NHS dental access, despite £240,000 of additional funding that I have managed to secure from Derbyshire locally. Does the hon. Member agree that the Minister should set out how the new NHS dentistry contract will include concrete, funded measures to increase the workforce so that my constituency and his, and those up and down the country, will finally see a material improvement in access to NHS treatment?
Alex Easton
I congratulate the hon. Member on securing that funding. I totally agree with all her sentiments. Maybe you can give me a clue how to get that funding as well for Northern Ireland.
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Not “you”, Mr Easton—it was not me that you were referring to. You have lots of time, so enjoy it.
Alex Easton
Apologies, Madam Deputy Speaker. We all understand that there are regional differences in how dental contracts work across our UK nations. However, a common theme is identified: many of our NHS dentists feel that they are being asked to do more to address complex needs with resources that simply do not match the reality on the ground. My research indicates that in some parts of the United Kingdom, the very way that dentists are paid actively works against the long-term interests of patients. The current system rewards quick, high-volume work rather than the kind of long-term, preventive care that is essential if we are serious about keeping mouths in Britain healthy.
Many of our newly qualified dentists tell me that the NHS contracts are inflexible, overly bureaucratic and in many cases financially unsustainable for anything beyond the most basic level of service.
Adrian Ramsay (Waveney Valley) (Green)
The hon. Member is making a strong case. The number of dentists leaving the NHS across the UK is driven by chronic underfunding and the failed dental contract. Last month, the Minister suggested that long-term fundamental reform might only be introduced from 2027 onwards. Does the hon. Member agree that that reform must be brought forward as soon as possible and that we need clarity on when? Does he also agree that the one-third cut in real terms of the dentistry budget that we have seen since 2010 must be reversed by this Government?
Alex Easton
I agree that reforms need to be brought forward a lot quicker.
What is the result? I will tell hon. Members what it is: we are seeing a growing number of dentists reducing the amount of NHS work, handing back NHS contracts altogether and leaving the profession earlier than they intended. I do not, for one moment, accept that that is a question of dedication or commitment. Our dentists, dental nurses, therapists and practice staff put in a hard shift day after day in a system that too often feels stacked against them. Their burnout is real; their morale is low. They are left apologising to patients, not only in North Down but right across the United Kingdom, for a system that is not of their own making and not under their control.
There is a human cost here. This must never be reduced to a dry debate about contracts and budgets, because behind every statistic is a person. Let us think of the elderly person in a British care home struggling to eat properly because they cannot get regular dental visits and their dentures no longer fit; the British parent trying desperately to get their child seen for a broken tooth, only to be told that their nearest NHS dentist is many miles away; or the low-income British citizen—the person who never missed an NHS check-up—now being told they can only be seen privately, at a fee far beyond their means.
Let me be absolutely clear: dental health is not a luxury; it is integral to our overall health and wellbeing. The facts are stark. Poor oral health is linked to heart disease, diabetes, respiratory infections and complications in pregnancy. Untreated tooth decay can cause severe pain, days lost from work or school, and a serious blow to confidence and mental health. Let us be honest: inequality runs through this story like lettering in a stick of rock. People on low incomes and those living in our most deprived areas are more likely to suffer the consequences of poor oral health and less likely to be able to escape them. Regrettably, the British reality in 2026 is this: children from our most deprived communities are still far more likely to be admitted to hospital for tooth extraction under general anaesthetic than anything else—an experience that is traumatic and, in many cases, entirely preventable.
I recognise that health is a devolved matter and that the four nations of our United Kingdom have taken different approaches to organising and funding NHS dentistry. In Wales, new contract models focused on prevention and patient-centred care are being piloted. Yet, as I understand it, patients still report serious difficulties in finding an NHS dentist and securing regular check-ups.
Terry Jermy (South West Norfolk) (Lab)
Is the hon. Member aware that the east of England is the only region of the UK that has no dental school, which severely impacts the availability of dentists? Will he join me in pressing the Government and the Minister to do all they can to expedite a proposal by the University of East Anglia to open a new dental school in the east of England to help address that recruitment and supply issue?
Alex Easton
The hon. Member makes a valid point, which I urge the Minister to pick up.
In Scotland, efforts have been made to reform the system and expand free dental care for certain groups, but workforce challenges persist, as do the difficulties of sustaining practices in rural and remote areas. In England, some of the most acute access problems are reported. Many practices say that the current contract does not reward preventive care, nor does it adequately reflect the complexity of modern dentistry.
In Northern Ireland, we have our own contractual framework. The concerns we hear, however, are strikingly familiar: rising costs, mounting workforce pressures and an unsustainable gap between what the NHS pays and what it actually costs to provide care. Northern Ireland is at a crossroads in NHS dentistry. We see a steady erosion of NHS dental provision, more practices moving to private models, longer waiting times at those practices that remain in the NHS, greater pressure on community dental services and growing inequalities between those who can pay and those who simply cannot. But it does not have to be like this.
The lessons we draw for Northern Ireland are equally applicable across the rest of the UK. Let us work with dentists, patients, commissioners and independent experts to design a modern contract and funding model that can reward prevention and continuity of care; recognise the complexity of treating people with additional needs and vulnerable groups; support high street NHS practices as the backbone of accessible care; and provide a clear, attractive pathway for young dentists to enter and remain in NHS-focused practice. This House can shape what is needed in Northern Ireland and apply those principles right across the UK.
To conclude, let me underline some urgent UK-wide actions. First, we need a realistic, sustainable funding settlement. Let us address this with honesty: if we truly desire a meaningful NHS dental offer, this Parliament must fund it.
Secondly, we must move beyond temporary uplifts and crisis top-ups and design a long-term settlement. The real question before us is, are we prepared to put NHS dentistry on a stable footing not just for this Parliament, but for future generations?
Thirdly, we must reform the dental contract with a new model that prioritises prevention; encourages regular check-ups, fluoride use and early intervention; creates clear incentives to take on new NHS patients; and rewards quality with a focus on outcomes and patient experience, not just on volume and throughput. Children, particularly those growing up in poverty, could benefit from school and community-based prevention schemes. People with disabilities and complex needs could access specialist attention and the longer appointments that they require. Older citizens, including those in care homes, could receive routine, dignified dental healthcare. We also need a credible solution focused on workforce planning that is based on real need, not short-term firefighting, as well as training pathways that support and prioritise NHS services, and effective retention measures so that experienced staff are not driven out of the system.
The decline of NHS dentistry is not inevitable. We must answer these questions honestly. Are we prepared to drift into a future in which NHS dentistry is an optional extra, while the majority are pushed towards private care, or do we commit clearly to inclusive and universal NHS dentistry in which cost is not a barrier and postcode lotteries do not determine success? Let the UK lead in addressing this problem. Let this House reaffirm for the whole country the enduring British principle that good dental care is not a luxury but a right and entitlement of every British citizen.
The Minister for Care (Stephen Kinnock)
I congratulate the hon. Member for North Down (Alex Easton) on securing this important debate. I thank him for his work to raise awareness of the challenges facing dental patients in his constituency and across the United Kingdom. It is vital that we work together, across the four nations of the United Kingdom, to tackle the long-standing problems that adults and children have been facing in accessing an NHS dentist when they need one. I also thank other hon. Members and hon. Friends for their powerful contributions to the debate. I know that access to dentistry is a matter of continuing concern for Members and their constituents.
The concerns Members have raised support the many testimonies I have heard directly from patients, dentists, members of the wider dental team, and their representatives. In July 2024, we inherited a dental system in crisis. That is evident in the adult oral health survey of 2023, which provides the first picture of adult oral health in England for more than a decade, and shows poor oral health in adults. Among adults with their own teeth, over two fifths—41%—showed evidence of obvious decay, 93% had some form of gum disease, and 19% had one or more potentially urgent dental conditions. This Government are determined to fix that.
Our 10-year health plan confirms our commitment to transforming NHS dentistry so that it is fit for future generations. We have established a platform for future success by reducing the NHS dentistry underspend from £392 million in 2023-24 to just £36 million. The decrease in underspend is leading to an increase in NHS dentistry, but I absolutely accept that there is still a long way to go. Over the past 18 months, the Government have made great strides in improving NHS dentistry, not just for patients but for the dental workforce delivering oral care to our nation. My immediate priority when taking up this ministerial post was to ensure that people who need an urgent dental appointment are prioritised and able to access the care that they need quickly. It is essential that we direct care towards those who need it most.
We all have a duty to reduce health inequalities, which are sorely felt in NHS dentistry. That is why, since last April, we have been making extra urgent dental appointments available to ensure that patients with urgent dental needs can get the treatment they require. Those extra appointments are available across the country, and are more heavily weighted towards the areas in which they are needed most. We are also incentivising high street dentists to offer further appointments in order to maximise availability for those in need of urgent care.
We recognise that access to NHS dental services remains a challenge in certain parts of the country. In addition to our urgent appointments, integrated care boards are recruiting dentists through the dental recruitment incentive scheme—known as the “golden hello” scheme. That initiative offers a financial incentive to encourage dentists to work in underserved areas for a minimum commitment of three years.
This Government have heard dentists’ concerns that they do not think the current dental contract is fit for purpose. Talks are under way, including with the British Dental Association, to scope our plans for potential changes. We remain open-minded and keen to consider how different payment models could best improve the delivery of care to dental patients. In reforming the dental contract, we want to focus on matching resources to need, improving access, promoting prevention and rewarding dentists fairly. We also want to enable the whole dental team to work to the top of their capabilities.
But reforming the dental contract is a significant challenge, and there are no quick fixes or easy answers. That is why in our 10-year health plan, we committed to fundamental reform of the dental contract by the end of this Parliament, with significant steps in 2026-27. Talks are under way with the British Dental Association, and we are making progress on these matters.
In addition to delivering fundamental contract reform over the longer term, we have already made significant progress through our 2026 reforms. We held a public consultation last summer on changes to the current NHS dental contract to address the pressing issues that dentists and dental teams said they were experiencing. The Government’s response, published in December, took account of the views of the dental sector as well as people with lived experience. Our reforms will utilise the existing dental contract to deliver the right care to the right people, while incentivising dentists to provide more NHS care. By prioritising patients with the greatest needs and making more efficient use of dentists’ time, the changes will ensure that the NHS dentistry budget delivers value for money for the taxpayer.
From 1 April, we will start to implement the reforms. For the first time, we are introducing provisions in the dental contract to embed urgent dental care appointments, making it easier for patients to access this care. We are increasing payments to dentists to deliver that care from £42 on average to £75 for that unit of dental activity. We are providing new treatment pathways for patients with complex treatment needs, paid at a set fee of around £250 or £700 depending on the pathway, while enabling and encouraging dentists to deliver more preventive care. These reforms will make full use of the existing dental contract, to ensure that patients receive the right care at the right time, while creating clear incentives for dentists to provide more NHS care. As I say, they will kick in from 1 April.
England has more than 38,000 registered dentists, of whom 10,700 are full-time equivalent general dentists delivering NHS care. As we take forward our reform programme to rebuild NHS dentistry, we are clear that strengthening the workforce is key to achieving our ambitions. This Government are committed to publishing a 10-year workforce plan to set out actions to create a workforce that is ready to deliver the transformed service set out in our overall 10-year health plan.
We are taking steps to increase the capacity of our dental workforce. As announced in our 10-year health plan, we will make it a requirement for newly qualified dentists to practise in the NHS for a minimum period. We intend that minimum period to be at least three years. That will mean more NHS dentists, more NHS appointments and better oral health.
Adrian Ramsay
I thank the Minister for highlighting the need for the dental workforce to be strengthened. We have a dental desert in East Anglia. The University of East Anglia stands ready to open a new dental school. It has permission from the General Dental Council but is awaiting the funded undergraduate dental places that will be needed to start training new dentists from 2027. Can the Minister set out how those places will be made available on the basis of regional need, so that dental deserts such as the east of England can start to build a sustainable dental workforce?
Stephen Kinnock
I congratulate the University of East Anglia on its accreditation through the GDC as a dental school. That is a huge step in the right direction, and we strongly support it. The next step is that the Office for Students has to allocate places. The Government have not funded any new dental school places since 2007. I am fighting hard for those dental places to be made available. We are quite close, I hope, to being able to share some positive steps on that. The OfS makes the decisions about allocating the places, but it does take advice from Ministers. My counterpart in the Department for Education and I will be sending a letter to the OfS, with some advice on how it should make decisions about where dental places should be made available, and the fact that UEA has a new dental school is an important factor in those considerations.
I welcome the General Dental Council’s recent announcement confirming the appointment of a new provider for the overseas registration exam—the ORE. The new arrangements are set to more than double the annual number of dentists able to join the register via that route, and it represents a significant step forward in addressing workforce shortages and NHS patient access. I met the General Dental Council at the end of last year to discuss its comprehensive plan to address the current ORE waiting list, and to urge it to get that waiting list sorted, because frankly the backlogs were not acceptable. We are looking at an increase in the supply of overseas qualified dentists joining the GDC register. I expect the measures to be taken by the GDC to deliver substantial improvements to the international registration processes, enabling increased numbers of overseas qualified dentists to join the register more swiftly and efficiently.
We know that prevention is better than cure. Alongside urgently needed reforms to treat existing poor oral health, I am committed to improving oral health in this country, not just for children, but the wider population too. Water fluoridation is an effective public health intervention for reducing the prevalence of tooth decay and improving oral health inequalities. Under this Government, we will see much needed expansion of water fluoridation in the north-east of England, with further feasibility studies for other parts of the country.
We are already investing in integrated care boards to support supervised toothbrushing for three-to-five-year-old children, and our innovative partnership with Colgate-Palmolive will support up to 600,000 children to develop good oral health habits for life. We are working with all sectors of the food industry to make further progress on reducing levels of sugar in the everyday food and drink that people buy. This is to ensure that it is easier for people to make healthier choices. Oral cancer and periodontal diseases are directly caused by tobacco. Dental teams and local stop-smoking services can work collaboratively in a variety of ways.
We have already made important progress, but I accept that there is still a lot more to do and a long way to go. We are determined to ensure that everyone who needs an NHS dentist can secure one. Delivering that ambition will take time, and it is vital that we put in place solutions that work for both patients and the dental professionals who care for them.
Question put and agreed to.