Access to NHS Dentistry

Wera Hobhouse Excerpts

Thursday 10th February 2022 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I congratulate the hon. Member for Waveney (Peter Aldous) on securing this debate. He is almost an hon. Friend: we work on many cross-party issues together, so even though we are on different sides, I call him my friend.

It is important to say that this is not a debate to criticise dentists. It is about criticising a system that does not work. I want to pay tribute to all the dentists in my constituency, who have worked very hard, particularly during the pandemic, to keep the oral health of my constituency in as good shape as possible, but they have really struggled.

Oral health is an essential component of everybody’s health and wellbeing. Dentists play a crucial role in the early detection of a number of diseases, as we have heard, including mouth cancer. Problems accessing NHS dental services are on an unprecedented scale in every community. Morale among NHS dentists is at an all-time low, and 40 million NHS dental appointments have been lost since the start of the pandemic. All this has been made worse by the pandemic, but the dental crisis in our country far predates covid. It is a result of chronic underfunding and an unsustainable target-based dental contract.

My constituents have been contacting me about access to NHS dental services since I became elected. The biggest concern is that they simply cannot find an NHS dentist. One constituent told me:

“My disabled partner and I have been told that our dental practice will no longer do NHS dentistry for us after 35 years. We are on income support and cannot afford the private fees that are quoted to us.”

Another constituent told me that they could not find a dentist in Bath that could take their child. The closest practice they could find was a 40-minute car journey away. When another constituent needed fillings, she was given two temporary ones and told that anything more would incur private fees. She told me she was afraid to eat. This is the extent of my constituents’ misery.

According to a Healthwatch survey carried out in November, no NHS dentists in Bath and North East Somerset reported that they were taking on NHS patients. No practices reported that they were able to take on children under 18, and no practice reported that it would be able to take on new patients in the next three months. What is happening in Bath is happening across the country.

The single biggest problem with dentistry in the UK is that it has become privatised over decades. I do not want to accuse any particular party of this. It has been going on for a long time, and that privatisation has started to take over. There are around 12,500 dental practices in the UK, of which 30% are private, 15% are mostly private, and 15% are evenly mixed. That means that just 40% are NHS practices, but many of these have elements of private provision.

Fewer than 40% of adults in Bath and North East Somerset have seen an NHS dentist in the two years leading up to June 2021. Those who cannot afford private dental care often do not go until it is too late, and they end up needing emergency care. It is not that there are not any dentists in the UK. I know that there is a problem with the distribution of dentistry, but the biggest problem is that, increasingly, dentists do not want to work for the NHS.

The current crisis will not improve unless we make it viable for dentists to provide NHS treatments and make NHS dentistry a place where people want to work. Bath and North East Somerset, Swindon and Wiltshire CCG has lost 9% of its NHS dentists in the last year alone—the highest proportion in the south-west and over twice as high as the national average. Dentists in my constituency have told me that they want to provide NHS treatment but just cannot make it viable under the current conditions. They are hugely worried about the increase in the percentage of the pre-pandemic treatment levels that they are now expected to meet, and the mental health toll on our dentists is enormous.

The Minister has committed to reforming the system. This is welcome, but the pace of change is too slow and practices cannot increase the number of patients they are seeing on promises alone. Not only must the Government reform the current contract; it must do so urgently. The bottom line is funding. The Government must provide adequate resources as a matter of urgency to reverse the alarming decline of NHS dentistry and guarantee its long-term sustainability.

The current situation is nothing short of a scandal and simply unacceptable. Healthy teeth should not be a privilege only for those who can afford to pay for private dental care. More than 70 years ago, the founding fathers of the welfare state envisaged a country where the gross injustices between rich and poor would be eliminated for good. Let us not turn our backs on the principles on which our NHS is based. Oral health is as much a matter of access and equality as the rest of NHS care. To the hon. Member for North East Bedfordshire (Richard Fuller), we Liberal Democrats absolutely understand the importance of being prudent with the public purse, but equality should never be sacrificed on the altar of balancing the books.

--- Later in debate ---

[Peter Dowd]

I will come back to that in a minute. I am an optimist—hope springs eternal, as Alexander Pope said—and I hope the Minister will accept that there is a crisis. Perhaps then we can all move on, in a very collegiate way, as the hon. Member for Thirsk and Malton (Kevin Hollinrake) says, towards finding a solution, which he knows I am more than happy to do.

[Wera Hobhouse]

For the purpose of giving everybody a voice, would it not be most collegiate if we actually acknowledged that the dental contract was introduced under a Labour Government? It is important to address that, but it is also important to address the fact that the bottom line is public funding for a good service.

[Peter Dowd]

Frankly, the coalition, including the Liberal Democrat party, which the hon. Lady serves, could have sorted that problem out in the last 10 years, but they dithered, ducked and dived. Let us not go there. She is on dodgy ground in relation to that, I have to say.

Facts are stubborn, and here are a few. The Government have cut dental budgets by a third in real terms over the last decade. They are making a meal out of their recent time-limited £50 million injection into the service, or the so-called dental treatment blitz—a blitz that will barely blow the top off a toothpaste tube. I suspect that that £50 million—a veneer if ever there was one—is unlikely to be fully spent.

The bottom line is that we are in a crisis. The British Dental Association estimates that it will take £880 million a year to put things back to where they were in 2010—that is a fact, and it does not account for the huge impact of the pandemic. We also need to address the chronic underfunding and to have a clear commitment to ending the system based on units of dental activity that has been going on since 2011—it has been discussed today so I will not go into it any more. It has been over a decade, and the Government really need to get a grip of that.

In my constituency, 5% of dentists in South Sefton CCG stopped providing NHS services in the last two years. That vastly underestimates the loss of local provision, as most dentists tend to reduce the size of their NHS contract gradually before they quit the NHS completely. Across the country, 40 million NHS dental appointments have been lost since the pandemic. That is a whole year of dental provision. Without better support from the Government and, crucially, an end to the chronic underfunding, and without a clear commitment to and progress on contract reform, there is no way dentistry will be able to recover.

The covid alibi is beginning to wear a bit thin. This is all about pre-covid. Covid has exacerbated the situation, but pre-covid is also significant. Enormous backlogs began pre-covid. Let us get a grip of that. I ask hon. Members across the way to press the Minister and ask the Secretary of State and the Prime Minister—their colleagues—to listen to the facts, because, unless Members opposite can get that message across to an indurate Government, things can only get worse. No more excuses, no more prevarication, no more procrastination, no more pretext or self-exoneration—as I have heard today. The Government need to pull their finger out. We need action now. There is no excuse for letting the opportunity go by.

In closing, perhaps I can re-jig what Ian Fleming said to make a point about the Government’s lack of action in this crisis. He said:

“Once is happenstance. Twice is coincidence. Three times is enemy action.”

Which one does the Minister think it is? I cannot speak for the dental profession, but I think I know which one it is, and it is not one of the first two.