Oral Health and Dentistry: England

Alex Norris Excerpts

Tuesday 25th May 2021 Westminster Hall

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

It is a pleasure to serve with you in the Chair, Ms Bardell. I thank my hon. Friend the Member for Bedford (Mohammad Yasin) for securing this important debate. Like much of our health service and, indeed, British life during the pandemic, dentistry has had to stretch and adapt and tackle its own unique challenges. It is welcome and important for us to have the opportunity to discuss this today; the steps required to recover and rebuild; and the wider oral health issues that we have not been able to deal with during the pandemic.

My hon. Friend led us in a strong manner and clearly laid out for those watching the gravity of the situation and the amount of pain that has been building up. He made important points about contract reform that I will return to. I have felt among friends and perhaps, even the usual suspects, as a number of us have talked about dentistry throughout the pandemic and before: my hon. Friends the Members for Norwich South (Clive Lewis), for Bradford South (Judith Cummins), for Stockport (Navendu Mishra), for York Central (Rachael Maskell) and for Putney (Fleur Anderson). Their points were very pertinent, particularly the points made by my hon. Friend the Member for Norwich South about finances; by my hon. Friend the Member for Bradford South about prevention; and by my hon. Friend the Member for Stockport about disadvantage and his frustrations on data, to which I will also return. My hon. Friend the Member for York Central spoke about the crisis prior to the pandemic and my hon. Friend the Member for Putney has just spoken about recruitment. They were all very well-made points and I will be returning to them in my contribution.

On the Government Benches, we are very lucky to have the professional insights of the hon. Member for Mole Valley (Sir Paul Beresford). His points about fluoridation were excellent—I share much of them and will be returning to them. I could not agree with his points about decoupling deprivation and personal choice. Of course, personal judgments are always critical, but if we decouple deprivation, it would not explain why we see poor oral health generation after generation, year after year on the same streets and on the same estates, which are always the poorest ones. The hon. Member for Isle of Wight (Bob Seely) was dogged in his persistence around equity of access. His points were unique to the Isle of Wight but I share a lot of commonalities in my community, and from what I have heard, so do other parts of the country.

Where do we stand today? Two in three adults in the UK have visible plaque. Almost one in three have tooth decay. Three in four have had a tooth extracted—including me. Over 3 million people suffer from regular oral pain and there are over 8,300 new cases of mouth cancer every year. That is the scorecard for Britain’s oral health as we meet today. That is why it is so important that we act in this area. We are talking today about oral health and dentistry, but you cannot decouple those two things. Support for dentistry is support for our oral health, and good oral health in this country will mean that we are in a better and stronger position around dentistry.

I will begin with dentistry. In January, my hon. Friend the Member for Putney secured a debate in the main Chamber about the future of dentistry. It was well-timed and came just as the Government’s newly imposed activity targets on the profession were under way and just as we had re-entered another lockdown. I will reiterate what I said that day. Of course, activity is needed to ramp up to start to tackle the growing backlog of need in this country, but the failure of the Government to ensure that NHS England and those who negotiate for the dentists came to a workable, mutually agreeable deal was a significant failure of leadership. It led to significant anxiety and weakened dental services in the long run.

When the debate was announced, I submitted a number of written questions to help us to establish the facts regarding what has happened since that debate in January and they were named for response yesterday. I am sad and disappointed that the Department came back last night to say that we would not be able to get an answer in time, which is a shame. I am surprised the data is not more readily available and hope the Minister will help us with that today. The four questions were: how many practices hit the 45% target; how many missed the 45% target but hit the 36% figure to avoid clawback; how many have given their NHS contract back; and how many have served notice that they intend to do so? I hope that data is readily available. It would help us in our discussions about the future.

I understand that the mean UDA performance between January and March was 59%. The British Dental Association reports that the majority of practices have hit these targets by adopting approaches—such as working beyond contracted hours, cancelling annual leave and prioritising routine care over complex cases—that are at best unsustainable, and at worst dangerous.

Furthermore, they have surveyed their members to find out what impact the last quarter has had on them: 29% say they intend to stop doing NHS work entirely and nearly half intend to reduce NHS work. A similar proportion say that they are likely to change career or retire should the current restrictions stay in place. That is the staggering personal impact of an imposed settlement that has led to unsatisfactory working practices and extraordinary stresses.

Discussing the judgments that have been made in the past is important, but also as we go forward because now that target goes from 45% to 60%, which will last us through to September. I hope that the Minister can tell us what extra support the Government will provide to practices to enable them to increase the number of patients they can see to hit their increased target, to do it safely and to do it in a way that does not incentivise perverse working practices that we would not want to see.

We know how those in the profession feel about this from the same BDA survey. Nearly two thirds of NHS dentists do not think they will hit that target, and 88% of dentists report that the current conditions have had a high impact on their morale. We need to hear from the Minister what extra support they would get, particularly around the operating procedure, or perhaps, as the hon. Member for Mole Valley says, a roadmap from restrictions or access to technology to allow them to do more. Throughout this debate, we have heard that there has been far too much stick and never any carrot. I think it is time to recognise the contribution by working with the profession rather than against them.

As my hon. Friend the Member for York Central said, this pandemic has exposed a service built on sand. The NHS general dental practice is the only part of the NHS in England operating on a lower budget in cash terms than in 2010, as my hon. Friend the Member for Norwich South also said. In real terms, net Government spend on general dental practices in England has been cut by over a third over the past decade, with the number of NHS dental practices in England falling by more than 1,200 in the five years prior to the pandemic—then we wonder why we have an access issue.

Similarly, relentless cuts to the public health budget year on year for a decade have meant that supervised toothbrushing schemes, like the excellent Teeth Team in my community, are a rarity when they should be the norm. That is the Government’s legacy in oral health for the past decade. As we know, that has the greatest impact on the poorest and the youngest. In 2020, more than 70% of children did not see an NHS dentist, despite tooth decay being a leading cause of hospitalisation for 5 to 9-year-olds. We also know the massive impact that has on school absence. This is a serious social issue, and we are letting our children down.

Where can we go from here? I do not think it is hyperbolic to say that we are in the last chance saloon for NHS dentistry. All of the evidence shows that we are clearly on a trajectory that is pushing patients from the public sector into the private sector. This is happening with the workforce too, pushing them from the NHS into the private sector, but there is hope and there are opportunities, and we need to grasp them.

First, we need contract reform. I support what the Minister has said previously and publicly on contract reform. It is welcome that NHS England and the dental profession are in the same place and have agreed very sound basic principles for contract reform. That is very good news indeed. We, as Opposition, will support this process and help build consensus around it. My major call here is that we must go at pace to move beyond UDAs—my hon. Friend the Member for Bradford South made some excellent points there—into a new, more preventative future for oral health. We have got to be ready by April 2022, so I hope the Minister can update us there.

Secondly, I welcome the commitments made around fluoridation. I bear the scars of many years of saying that I believe Nottingham’s water should have fluoride in it, I do. The counter lobby, as the hon. Member for Mole Valley said, are aggressive, vicious and very similar in many ways to the anti-vax movement. However, if the Government bring forward sensible proposals, I would be very keen indeed to build consensus around them. This is a great national prize and a great opportunity for public health.

Thirdly, we need a renewal of oral health as a core element of public health. The Government should reverse their cuts to the public health grant so that local authorities can provide preventative services, particularly in the poorest communities and particularly targeted at their children. I am glad that the Government now want to consult on reintroducing schemes such as supervised toothbrushing, but it is hard not to have a slight sense of grievance given that local communities were already doing this before they had the means to do so taken away. That is what happened, but now we must move forward. Again, we should be doing that at pace.

Finally, we should take a robust look at the supply chain. The Minister knows I have concerns about the dentistry supply chain, particularly for dental labs, which have not been part of any of these contracting conversations but are significantly impacted by them.

To conclude, we entered this crisis having underfunded and under-supported dentistry. We have navigated this crisis by treating the profession as antagonists, rather than partners. If we want to build a new future for oral health and dentistry, we can do it by investing in it and all coming together. I hope to hear a commitment on that from the Minister.