NHS Dentistry: Waveney

Peter Aldous Excerpts

Tuesday 25th May 2021 Commons Chamber

[Peter Aldous (Waveney) (Con)]

Thank you, Mr Deputy Speaker.

There has been an underlying problem with NHS dentistry in the Lowestoft and Waveney area for a long time, with dentists retiring, leading to resources and dental capacity being taken away from the area, notwithstanding the need and demand for NHS dentistry. Many, but not all, of the remaining practices have difficulties in recruiting and retaining dentists. The situation has been exacerbated by a lack of funding, with net Government spending on general dental practice reduced by a third over the past decade. In recent months the situation has reached crisis point, due partly to covid but primarily to the closure due to retirement of two NHS dentist practices in Lowestoft and the closure of the mydentist practice at Leiston in the constituency of my right hon. Friend the Member for Suffolk Coastal (Dr Coffey). The latter was due to the difficulty of recruiting dentists to work in the area.

This is a national crisis. Official figures in March 2020 showed that 26% of new patients could not get access to an NHS dentist. The situation has worsened during covid, with more than 20 million NHS dental appointments lost nationally since the start of the pandemic. As has been reported today, the British Dental Association’s members survey reveals that almost half the respondents intend to stop working in NHS dentistry in the next 12 months, and two thirds estimate that they will not meet the new 60% activity targets they have been set. This is the worst survey that the BDA has ever carried out, and urgent action is required to stop dentists leaving the NHS in their droves.

The situation is worse in Waveney. Community Dental Services, an employee-led social enterprise, has recently opened a new dental clinic in the old magistrates court in Lowestoft. That investment is greatly welcomed, although CDS highlights the challenges that it is facing in the area. It is concerned about the lack of access to NHS dental services. Lowestoft and Waveney is an area of high need for dental services, yet there is a serious lack of provision, which has been exacerbated by the backlog caused by covid and, as I have mentioned, by the retirement of well-established local general practitioners. The perceived remote location of the Waveney area and the distance from all the existing centres of dental training make recruitment difficult.

CDS emphasises the need for a focus on prevention, particularly among children. The treatment of children under general anaesthetic for the removal of teeth that cannot be saved is the highest cause of admittance to hospital for general anaesthetic treatment in England and Wales. CDS advises that the reduction in local authority funding to support targeted or universal prevention—I am not attacking local authorities for this—has had a significant impact on the Waveney population due to reduced oral health improvement services. This limits CDS’s ability to reach out to all the people who need its services.

The impact on young people needs particular focus. In Suffolk, the proportion of children who saw an NHS dentist fell by half due to the pandemic: 60% in 2019 compared with just 31% in 2020. This translates to 43,000 local children missing out on their dental appointments compared with the year before. CDS, which is a paediatric dental specialist, has a high number of referrals from other practices of children with multiple decayed teeth that require complex treatment, quite often under general anaesthetic. The lack of general dental services locally makes safe discharge difficult, if not impossible, thereby creating further pressure on services. This has a devastating impact on children’s life chances, and could well prevent them from achieving the best start in life.

Covid has made the situation worse. The interruption of routine dental care and the subsequent reduction in patient appointments has created a backlog of patients. The pandemic has also meant the cancellation of and significant interruption to the dental general anaesthetic list at the James Paget Hospital at Gorleston in the constituency of my right hon. Friend the Member for Great Yarmouth (Brandon Lewis), which causes greater problems. The list will recommence on 1 June, and the backlog of patients needing urgent care is substantial, but this increases the pressure on dental practices, which have responsibilities for their patients’ dental care. It should also be pointed out that there has been no consultant orthodontist at the James Paget since mid-2020, resulting in patients having to travel further for care, and for children this disrupts their education.

I am receiving approximately 10 emails a week from constituents, many of whom are in agony, looking for an NHS dentist. Some will go private, but for many who are on relatively low wages this option is not open to them and is one they cannot afford. One constituent has been quoted £2,400 for a new front tooth and £2,000 for a bridge repair. Others who are in need of urgent attention, as I have mentioned, go to A&E at the James Paget in Gorleston. There, all that the exasperated consultants can do is to prescribe them antibiotics and painkillers. This is completely unacceptable. Another constituent, who had a new denture fitted in 2019, needed it to be adjusted as it made his mouth sore and had a poor bite. He had no option but to use his old dentures, which were worn down and had a tooth missing. He has only just seen a dentist and is now awaiting the new dentures. These are just a few cases that highlight the agonies that many people are going through.

Andy Yacoub, the chief executive of Healthwatch Suffolk, summarised the situation well. He said:

“We are living through a dental disaster, with little to no clear sign of when these problems will ease.”

He also said:

“This latest review by Healthwatch England strongly supports our own local view that there is huge inequality in the availability of NHS dental care amongst our population…This includes that some people have waited unreasonable lengths of time to get an NHS dentist appointment, while being told private appointments were available within a week.”

In Suffolk, he said that we are being

“inundated by feedback on a daily basis from those struggling to access these services. One individual revealed to us”—

Healthwatch Suffolk—

“that they required urgent hospital treatment after overdosing on painkillers to combat their symptoms,”

while another

“told us they couldn’t find a dentist to treat a tooth which had reached a point where it was decaying.”

[Duncan Baker (North Norfolk) (Con)]

I confess I have a slight self-interest in this, because my father was the NHS dentist in Fakenham for 34 years. The problems in North Norfolk with dentistry are terrible, with long waiting lists and people not being able to be seen. The Healthwatch report from the past day or so corroborates that. It strikes me that the contracts are some of the root causes of that, as is the disparity between the private and public sectors. What can we do to try to get more people to join this profession? I have one example in North Norfolk where, for more than 10 years, no newly recruited dentist has wanted to come and work at the surgery.

[Peter Aldous]

I thank my hon. Friend for that intervention. The situation is very bad in Waveney. It is also bad in other parts of East Anglia, not least in North Norfolk and in the constituency of my hon. Friend the Member for Peterborough (Paul Bristow). It is particularly bad in East Anglia, and one reason for that is that we are perhaps a little away from the centre of things, and it can be difficult to recruit people to work in the area. My hon. Friend is right that one solution is to reform the existing contract, which dates from 2006, and I will come on to that as I look at some short and long-term solutions that need to be instigated immediately.

In the short term, I urge my hon. Friend and Suffolk colleague the Minister to take the following actions. First, we must reduce units of dental activity targets. The previous target of 20% was appropriate, but the new 45% target is wholly unrealistic. Many practices will be forced substantially to reduce the number of emergency cases that they provide and to replace them with routine check-ups that are less time-consuming, resulting in an even longer backlog of outstanding emergency and urgent care cases.

Money that is currently clawed back by the NHS if dentists do not deliver UDAs must be reinvested in the Waveney area. Dentists under-delivering does not indicate low local demand, and any clawback should be reinvested into local dental services, not transferred to other areas. That situation is particularly prevalent in East Anglia. In 2019-20, 9.1% of total contract value was clawed back in the region, compared with 4.8% nationally across England.

I confess that I do not completely understand the opaque world of UDAs, but I know that the system is short-changing my constituents, many of whom are in agony. For children, there could well be lifelong consequences. Some NHS dentistry practices in the Waveney and Norfolk area want to take on more patients, but they are not able to do so as the UDAs are not available. John Plummer & Associates is a privately owned family dental practice with 10 NHS practices in Norfolk and Waveney. As NHS dental practices in the Lowestoft area have closed in recent years, dentists from those practices have joined John Plummer. Naturally, their patients would like to follow them, but because no more UDAs are now available, the dentists have been unable to treat them, as they will not be able to provide adequate treatment for their regular patients. Those UDAs are then lost to the Waveney area forever. So much more NHS dentistry could be provided in the Waveney area if more NHS dentistry was allowed. John Plummer & Associates would open a walk-in emergency NHS dental service, but it is not able to do so as it is not allowed to do any more NHS work.

The continuing problem with covid is limiting the number of people that dentists can see each day. That can be eased by installing high-capacity ventilators in dental surgeries. That will reduce the period between appointments, during which the rooms are cleaned, but most practices cannot afford that. I recognise that there is quite a bit of devil in the detail, but the Government can directly increase access to NHS dentistry by providing capital funding for this equipment, as the devolved Administrations in Wales and Northern Ireland plan to do.

In the long term, root-and-branch reforms need to be instigated immediately. There is a need to get more NHS dentists practising in this area, and the Association of Dental Groups has put forward a six-point plan to achieve this. First, the number of training places should be increased. Earlier this month, Healthwatch Norfolk called for a dental school to be set up: based in Norwich, it would be able to serve the Waveney area and, indeed, the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker). As quickly as possible, the Government must instigate a recruitment drive, increasing the number of UK dentistry training places and introducing incentives for dentists to relocate to areas such as Suffolk and Norfolk.

Secondly, EU-trained dentists should be recognised. Their role is vital, and there must be continued access to NHS dentistry for EU-trained professionals, thereby preventing further shortfalls from arising. Thirdly, overseas qualifications should be recognised. The General Dental Council’s recognition of dental qualifications should be automatically extended to approved dental schools outside the European economic area, ensuring a smooth process for suitably qualified dentists to work in the UK—notably those from countries such as India. That should also include the doubling of places available under the overseas registration examinations.

Fourthly, the complex and lengthy process of completing the performers list validation by experience examinations—known as the PLVE—for overseas dentists should be speeded up, simplified and harmonised right across the country, with additional measures introduced to ensure that the process takes no longer than eight weeks.

Fifthly, whole dentistry teams should be allowed to initiate treatments. Allied dental professionals are, at present, not able to open a course of treatment. This means that they cannot raise a claim for payment of work delivered, with many practices unable to fully utilise therapists as a result; allowing whole dentistry teams to initiate treatments would address this problem.

The Association of Dental Groups’ sixth and final point is that the Government should create a new strategy to promote NHS workforce retention. They must reform the NHS contract, which is the major driver of dentists leaving NHS dentistry. A new contract, focused on the oral health needs of patients and targeting improved access and preventive care, should replace it.

With regard to the forthcoming health and social care Bill, with the commissioning of dentists set to move to integrated care systems, it is vital that dentists have a voice and are properly represented on ICSs. There is a worry that the possible pooling of budgets across primary care could lead to further cuts to NHS dentistry, and everything must be done to ensure that this does not happen.

Fluoridation of water can play a key preventive role in oral health, and it is very important that changes to the framework under which fluoridation schemes are carried out are accompanied by the capital funding that is necessary for those schemes to actually be put in place. I anticipate that we will consider this matter in more detail over the next few weeks when we debate the Bill.

I now come to the topic of new dental contract arrangements. As mentioned, underlying most of the problems of NHS dentistry is the fact that the current contract, which dates from 2006, is inadequate and now completely unfit for purpose. It must be replaced as quickly as possible. The BDA is looking for this to happen by April 2022 at the latest, and the new contract must break with the units of dental activity, ensure that NHS dentistry is available to all those who need it and prioritise preventive care.

My hon. Friend and Suffolk colleague the Minister is faced with a major task. From her perspective, it is unfortunate that the music has stopped on her watch. In summary, there are three things we need to be doing. I urge her, in the very near future, to provide practices, such as John Plummer & Associates, that will tackle the enormous the backlog of work with the resources to do so. We must end the cycle of retirements leading to funds being removed from the Waveney area, never to return. Secondly, we must tackle the growing scandal of children having to undergo major dental surgery. That requires much work in the short term in hospitals such as James Paget University Hospital, but in the longer term the introduction of major public awareness preventive initiatives is vital. Thirdly, the dysfunctional 2006 contract should be replaced as soon as possible.

Covid-19 Update

Peter Aldous Excerpts

Tuesday 9th February 2021 Commons Chamber

[Peter Aldous (Waveney) (Con) [V]]

I commend my right hon. Friend on his statement. The Norfolk and Waveney clinical commissioning group, local NHS staff and volunteers are to be commended on rising to a challenge which on Sunday resulted in 1,000 people being vaccinated at Kirkley Mill in Lowestoft in very difficult weather conditions. There is a plan to significantly increase the number of daily vaccinations for more sites; so that this can be delivered can my right hon. Friend confirm that there will be a consistent and increased supply of vaccines and that the initial difficulties some have experienced with the national online booking system will be ironed out?

[Matt Hancock]

Yes, absolutely. I want to thank everybody across Norfolk and Waveney for the work they have been doing to roll out this vaccine. It is a critical part of the country in terms of the covid response, and the work done locally has been absolutely exemplary. I commend my hon. Friend on the part that he has played and the leadership he has shown in Lowestoft in making that happen; the uptake has been superb. I have seen some of the reports locally, and the emotional impact on people of getting vaccinated is absolutely fantastic. I will absolutely take away the points my hon. Friend has made.

Covid-19: Dental Services

Peter Aldous Excerpts

Thursday 14th January 2021 Commons Chamber

[Peter Aldous (Waveney) (Con)]

I congratulate the hon. Member for Putney (Fleur Anderson) on securing the debate.

Before the pandemic, my engagement with the dental sector led me to form a number of views on how it served our communities. Those who work in dentistry are highly competent and well qualified professionals, but there are problems in recruitment, and it is increasingly difficult to find an NHS dentist. When good and highly respected dentists retire, they are hard to replace. There is a lack of accountability in NHS England and NHS Improvement, and the world of UDAs—units of dental activity—is opaque and difficult to understand.

One readily reaches the conclusion that in normal times, the system does not work in the best interests of local communities and public health. Covid-19 presents those working in dentistry with enormous challenges. They are placed in a position of significant health risk, there is a dramatic reduction in capacity, and there have been some problems with those working in the sector being recognised as key workers.

The Government were right to set up a network of urgent dental centres, and in many respects this has worked well, although I have received a lot of complaints about where and how to find them, being kept waiting on the phone for seemingly hours on end, and then difficulties getting an appointment. Not only is there the challenge of getting through the current lockdown, but the shadow of covid will hang over the sector for a very long time. There is an enormous backlog of work, and yes, although some of that may be classed as non-emergency, it is important to bear in mind that it is often a routine visit to the dentist that picks up cancer at an early stage.

The position has been exacerbated by the Government writing to dentists before Christmas seeking to impose a 45% target of UDAs for January, February and March. The proposal has been described to me by dentists in my constituency as “completely irresponsible”, “disrespectful”, “neglectful”, “unsafe” and “inconsiderate”. It should be dropped. The Government need to work with dentists to come up with, first, a short-term plan to get through the immediate crisis, and then a long-term plan that is easy to understand, provides proper accountability and full national coverage of NHS dentistry, and ensures the recruitment and retention of highly trained professional staff.

Covid-19 Update

Peter Aldous Excerpts

Thursday 26th November 2020 Commons Chamber

[Matt Hancock]

Of course, we have been hugely supportive. In fact, the UK is the biggest supporter internationally of providing vaccines in countries that would not be able to afford them themselves. I am sure that that will continue, because we will continue to have one of the largest international aid budgets in the world.

[Peter Aldous (Waveney) (Con)]

I know that my right hon. Friend will thank everyone in both East and West Suffolk for getting down the level of infections, and that it is with a heavy heart that he has concluded that the county cannot exit to tier 1. Will he ensure that there are clear indicators as to what else needs to be done so that Suffolk may move to tier 1 as quickly as possible, and will he liaise with the Chancellor of the Exchequer to put in place additional support for the hard-hit hospitality sector?

Covid-19 Update

Peter Aldous Excerpts

Thursday 17th September 2020 Commons Chamber

[Matt Hancock]

It is the task of the companies that the hon. Lady mentions and many more, and of the British Armed Forces, the NHS, the Department, Public Health England and many local councils, including her own, to get as much capacity as possible. That is what their job is, and they are doing that at record levels.

[Peter Aldous (Waveney) (Con)]

The feedback I am receiving from local schools is that the problems that staff and pupils are experiencing in getting tests could make it very difficult for some schools to remain open. To prevent this, can my right hon. Friend first liaise with the Secretary of State for Education to ensure that clear guidance is provided to schools about when to request a test? Secondly, can he do all he can to ensure that local testing programmes, such as that provided by the Norfolk and Waveney clinical commissioning group, continue to operate, as they do provide much-needed additional capacity?

[Matt Hancock]

Yes, I agree with both points made by my hon. Friend.

Covid-19 Update

Peter Aldous Excerpts

Tuesday 24th March 2020 Commons Chamber

[Peter Aldous (Waveney) (Con)]

I commend my right hon. Friend for the sterling work he is doing. Will he provide some clarification on the definition of essential retail? The general store that purchases a freezer and says that it is a food store quite clearly is not, but the garden centre that incorporates a farm shop that may serve a local community might well be.

[Matt Hancock]

These things will inevitably end up being a judgment at the boundary, but if there are two types of shop in one organisation, we will sometimes require some parts of it to close. If there is a café in a shop that sells essential supplies, the café must close but the essential-supplies part can stay open.

Coronavirus Bill

Peter Aldous Excerpts

2nd reading & 2nd reading: House of Commons
Monday 23rd March 2020 Commons Chamber

[Peter Aldous (Waveney) (Con)]

I think it is important to recognise what the Government have done so far. They have produced a 321-page Bill at very short notice. There is no template for this; they have moved very quickly. They have listened to concerns from all around this Chamber, and they are leaving no stone unturned in minimising the impact of coronavirus on both the British people and their businesses. There is still work to be done to address the needs of the self-employed and to ensure that our world-leading charitable sectors can be sustained, but we need to get this Bill on the statute book as soon as possible. The brief comments I will make are intended to seek reassurance, not to thwart.

In order to beat this virus, our statutory services need all the help and support possible from the voluntary sector. As a former member of the St John Ambulance Suffolk county board, I would like to highlight the work that St John can do working alongside the NHS. There are 15,000 St John volunteers, of whom 8,500 are clinically trained. They can provide ambulances, first aiders in emergency departments and support for the homeless with outreach clinics. However, to make full use of their services, St John volunteers need access to paid leave, ready access to emergency volunteering certificates, as required by schedule 6 to the Bill, and inclusion within the definition of key workers so that the children of St John volunteers can attend school.

This Bill has the very best of intentions, but the Government must guard against unintended consequences. Many groups are worried that the disabled and the vulnerable will be disadvantaged, and left both without essential support and any right to request that support. This could put lives at risk. There are concerns about possible delays in carrying out assessments for the eligibility of NHS continuing care, and that local education authorities may suspend a child’s education, health and care plan. Reassurances from the Government on these two points would be welcome, and funds must be provided for, not diverted from, this vital work.

A final unintended consequence, based on the evidence from China, is that lockdown conditions created by the pandemic could lead to a significant increase in the number of victims of domestic abuse. SafeLives has set out a number of actions that the Government can take to prevent this, and I urge them to give these full and very serious consideration.

We must not dither and delay—we must get on and enact this Bill—but in doing so we should continue to seek to build consensus and to guard against unintended consequences.

NHS Funding Bill

Peter Aldous Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Peter Aldous (Waveney) (Con)]

It is an honour to follow my hon. Friend the Member for Ipswich (Tom Hunt), as Ipswich is both my birthplace and my football club.

The main provision of the Bill is to enshrine in law the Government’s commitment to increase NHS spending by at least £34 billion by 2023-24. Some may say that this is just gesture politics, but it provides the NHS with the certainty that it needs to make long-term plans and strategic investment in front-line services. This contrasts with operating on a hand-to-mouth short-term basis, as it has often done in the past.

If this approach is successful, then in future, as suggested by the King’s Fund, the Government should look at pursuing this approach with other items of health spending, such as capital investment, public health and staff and education training. It is one of these latter items that I wish to highlight—investment in NHS buildings and infrastructure, which is so important in providing a high-quality environment for patients and health professionals.

As well as making commitments to revenue funding, the Government have undertaken to invest in hospital buildings—six new hospitals now and seedcorn funding to work up the plans for 38 more such developments. One of the latter is the James Paget Hospital on the Lowestoft Road in Gorleston in the constituency of my right hon. Friend the Member for Great Yarmouth (Brandon Lewis). The James Paget serves his and my constituencies as well as part of that of my right hon. Friend the Member for Suffolk Coastal (Dr Coffey).

The James Paget is at the heart of our local health economy, and thus this investment is extremely welcome. I understand that the seedcorn funding is due to be paid over to the hospital very shortly, and that it is already mapping out its plans for the future. It has moved quickly since the announcement of the seedcorn funding was made in the autumn. Its board, liaising with the Great Yarmouth and Waveney clinical commissioning group and the Norfolk and Waveney sustainability and transformation plans, is working up its development plans. Although at an early stage, these include developing a health and social care campus, encompassing acute community primary care, mental health and care facilities, it also wishes to expand its education training, investing in its health and care staff, and also to improve its digital services.

As the plans for the James Paget are worked up, it is important to have in mind three requirements. First, it is important that the needs of the people who use the hospital are taken fully into account. Ours is an area with an ageing population that places pressure on local health services. In Lowestoft and Yarmouth, there are deep pockets of deprivation with serious inequalities, which must be addressed. We are a popular tourism area, which puts additional demands on the hospital and its services.

Once the James Paget has fully worked up its provisional plans, a wide-ranging and full public consultation should take place so that the views of local people can be fully considered.

Secondly, while the board of the James Paget is taking the lead in working up the redevelopment plans, it is important that all those involved in health and social care services in the area have their say as we, quite rightly, move towards an integrated health and social care system in which all those involved collaborate and work together. The James Paget recognises this, and doctors, mental health and social care professionals, the CCG, the mental health trust and the county and district councils must be fully involved, as well as the voluntary sector and patient representative groups. Thankfully, the silo mentality of the past is gradually being knocked down.

Thirdly, attracting health and medical staff to the Waveney and Great Yarmouth area continues to be a challenge. The redevelopment of the James Paget provides an exciting opportunity to address that by providing centres of excellence in specialisms for which there is a need in the area. The importance of working with the University of East Anglia and the University of Suffolk cannot be underestimated. The former has a medical and health science faculty that includes the Norwich medical school, which provides clinical rotations at both the Norfolk and Norwich and the James Paget hospitals. There is also a science faculty that includes biological science and pharmacy courses. The University of Suffolk, which is more recently established, includes a school of health sciences, which has courses in adult nursing, mental health nursing and radiography, and postgraduate courses in public health nursing and advanced clinical practice. It would be great if in future more of those courses could be delivered on the Lowestoft and Great Yarmouth campuses of East Coast College.

The seedcorn funding for the James Paget is extremely welcome. We now need to ensure that the hospital’s redevelopment takes place in a timely manner and that bespoke, high-quality facilities are provided for local people that meet their needs. By doing that, we can ensure that we have a resilient district general hospital serving the Waveney and Great Yarmouth area for many years to come.