Covid-19: Dental Services

Alex Norris Excerpts

Thursday 14th January 2021 Commons Chamber

[Alex Norris (Nottingham North) (Lab/Co-op)]

Thank you, Mr Deputy Speaker. I join colleagues in commending my hon. Friend the Member for Putney (Fleur Anderson) for securing this important debate. Timing is everything in politics, and this is well timed indeed. I will cover the point that she made about imposed targets shortly, but I do not want to miss the contributions that she made about health inequalities and cancer, which I thought were really important.

I do not think that it is a great surprise that there was cross-party coverage and, frankly, a lot of consensus. Concerns about the targets were expressed by my hon. Friends the Members for Portsmouth South (Stephen Morgan) and for Bradford South (Judith Cummins), the hon. Members for Loughborough (Jane Hunt) and for Don Valley (Nick Fletcher), my hon. Friends the Members for Luton North (Sarah Owen), for Luton South (Rachel Hopkins) and for Sheffield Central (Paul Blomfield), and the hon. Members for North Norfolk (Duncan Baker) and for Totnes (Anthony Mangnall). I must say, though, that a spirited case for the defence was made by the hon. Member for Mole Valley (Sir Paul Beresford).

I was glad to hear dental labs brought up by my hon. Friend the Member for Brent North (Barry Gardiner). I will address them myself, but they are too often lost in this conversation. I also thought that important contributions were made by the hon. Members for North West Norfolk (James Wild), for North Cornwall (Scott Mann), for Waveney (Peter Aldous) and for Edinburgh West (Christine Jardine) about the pre-covid status quo not being what we should aspire to. Again, I shall address that myself.

Dentistry, like every industry, has had to battle its way through this pandemic—closed at first, worried for jobs and livelihoods, reopening desperate to address growing need, and innovating to do that as safely possible in challenging circumstances. We should be very grateful for the work that dentists and their staff have done and are doing, but even with that work 20 million appointments were lost between March and November. That is a backlog that we will live with for many years.

Although the dental profession has adapted well to provide urgent care through covid, the crisis has highlighted the need to do things differently and to do things better. As we rebuild post covid, we have a unique opportunity to not return to business as normal but instead shift the focus of dentistry in this country from the short term to the long term, and from the reactive to the preventative. I strongly believe that a more prevention-focused approach is something that many dentists across the country want for the benefit of their patients. I know that the chief dental officer is a big advocate of prevention being at the heart of NHS dentistry.

[Jim Shannon (Strangford) (DUP)]

I spoke to the hon. Gentleman beforehand. There are some 6,000 registered dental technicians who provide dental implants such as crowns and bridges to 80% of UK patients. It is predicted that 1,000 of them will lose their jobs by July 2021. If that happens, we will be unable to address the issue of dentistry in the future.

[Alex Norris]

I completely share that perspective, and I will cover that in my final points.

On prevention, I hope that the Minister will make a commitment that the Government want to move towards a preventative model. If she does that, the Opposition will work with her to deliver it.

Of course, there is a more immediate issue at hand. On 17 December, as colleagues have said, NHS England imposed new activity targets on NHS dental practices, which took effect at the beginning of this month. At the beginning of the pandemic the Government were right to step in and offer dentists their full contract for a much smaller proportion of their usual activity. We supported that then and we still do. It is also right to seek to increase capacity to help tackle the backlog, and avoid NHS patients being pushed into the private sector. However, what has followed is a mess, with negotiations between NHS England and the General Dental Practice Committee breaking down, and so targets being imposed on the sector, with practices needing to hit 45% of their pre-pandemic activity targets in the first quarter of this year.

Allowing negotiations to break down like that, rather than intervening to ensure that an agreement was found, is a failure of leadership by this Government. Where have they been on this issue? Whether we think that dentists are right or wrong in their perspective, and whether we think the figure should be 45%, 55% or 35%, surely we would agree that an imposed target is a failure of leadership.

It simply will not do that such a crucial part of our health service has working arrangements that discomfort it so greatly. NHS England would never pursue a work pattern that is dangerous, but there are reasonable questions about how practical it is. It is not just dentists raising that; we have had public pronouncements of concern from the faculty and the colleges. There should have been a negotiated deal that found common ground. I know the Minister is a consensus builder and I enjoy working with her. I hope she will say that she will step in to build consensus and fix this, and Labour will support her in that venture.

In the meantime, I hope the Minister can offer some reassurance on areas of concern relating to this: first, if practices do not hit that 45% of pre-covid activity, and instead land at between 36% and 45%, any reduction will be proportionate to the full payment; it will be downscaled in ratio. However, below 36%, a practice will drop off the cliff edge and not get its contract. That is concerning because in November that would have applied to 40% of practices. Those targets were put in prior to the third wave of the pandemic gripping, and we know that is having an impact. Eight in 10 practices have seen increased cancellations or missed appointments, and three quarters of practices have experienced staff absences this month alone.

Will the Minister therefore reassure the House that she will look again at that element to ensure that dentists have a fair chance of meeting targets and are not unfairly penalised if they do not, through no fault of their own? I know there will be a regional analysis of whether there are extraneous factors. I hope the Minister will endorse and double underscore that today.

Secondly, will the Minister offer reassurances that the use of units of dental activity will not incentivise just the treatments that fit in a little more easily—for example, check-ups that do not require fallow periods—while disincentivising more urgent complex care, and care that does not count towards the target? Thirdly, I am concerned about the wellbeing of dentists and their staff, because 45% of UK dental professionals feel that their mental wellbeing is worse compared with the start of the pandemic. What steps are in place to support our workforce? We have a duty of care towards them.

I will conclude with a point about dental laboratories. They make the crowns, bridges, dentures, and more, on which dentistry relies. While the Government acted quickly to protect the dental industry—as I said, we supported them on that—there has been nothing for dental labs, which have seen their orders collapse. Many have shuttered and will never reopen. People are leaving that skilled profession, but we are going to need them again, and in greater volumes as we catch up. Instead, we will now buy those products from the continent and beyond, all around the world, and we will have lost skilled work because we let it wither. I hope that the Minister will use this opportunity today to announce relief for that.

Dentistry is a vital part of our NHS. Dentists and their staff have fought valiantly to keep the industry going in unprecedented times. Now they are at a crossroads and need political help. The Government must step up and resolve the contracting issue, and work with dentists to build a new exciting future for dentistry, preventing ill health, rather than chasing it. If they meet the moment, we will support them, but if they do not we will call them out.