The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I congratulate my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) on securing this important debate. I am really pleased to hear dentistry getting some more parliamentary time and being put on the radar, because it is such an important issue. I am aware that there are long-standing concerns around dental access in parts of the east midlands. In my response I will consider the impact of covid on access to dentistry. We are aware of this, and I will focus on it initially. However, we have to acknowledge that there were problems in accessing NHS provision before covid. Even once we are through the recovery from the pandemic, we will need to address those issues once again. They will not disappear once the pandemic has passed.
As my hon. Friend highlighted, dentistry posed a significant risk during the pandemic because of the aerosol-generating procedures. I thank all the dental teams across the country who showed such resilience and dedication during this period, because they kept going and provided urgent care while facing considerable risk and anxiety. The steps we took during the pandemic ensured the safety of both dental patients and staff, but they have led to a reduction in the number of patients who can be seen.
We have worked closely with NHS England to consider the level of NHS dentistry that can be safely delivered in the environment of a pandemic. The thresholds that have been set for dental practices since the start of the year are based on what is achievable while maintaining infection control measures.
My hon. Friend will be pleased to know the UK Health Security Agency published new guidelines on 27 September that include three pragmatic changes to infection prevention and control measures, with a focus on elective care that allows providers to start making further safe changes to open up their services. I take her point, and I will consider what more support can be given for ventilation to help dentistry premises open up further still.
In the light of the reduction in activity, dental practices have now been asked to deliver as much care as possible, prioritising urgent care, care for vulnerable groups and children, and delayed planned care. Practices are now being asked to deliver 65% of their units of dental activity and 85% of contracted units of orthodontic activity from 1 October. Our figures suggest that we are starting to see a natural return to pre-covid levels of activity in dentistry, and I am pleased to see that in England urgent care has been back to pre-pandemic levels since December. We have made real progress there.
Sir John Hayes
It is widely acknowledged that the Minister brings both understanding and diligence to her role. Does she recognise that there are particular problems in rural areas such as Lincolnshire? We hear a lot in the place about urban deprivation and metropolitan needs, but we hear rather less about rural deprivation. In healthcare, public services and dentistry in particular, our county is peculiarly deprived. Will she take particular measures to help rural places such as Lincolnshire?
Maria Caulfield
My right hon. Friend makes an excellent point, which I was going to address. Officials tell me that the areas where we are seeing significant gaps are referred to as “sheep” and “seagulls,” with the sheep being rural areas and the seagulls being coastal stretches. They are the two areas of the country with a significant shortfall in NHS dentistry provision, and they are the two areas on which we will particularly focus.
Martin Vickers (Cleethorpes) (Con)
My constituency contains both sheep and seagulls. One of the problems, of course, is that rural villages and market towns are attracting increasing populations and we are seeing massive planning applications. I cite Barton-upon-Humber in my constituency as one example. What work is the Department doing with local authorities to make sure that, where there are major planning applications, public services and particularly dentistry are sufficient to meet the need?
Maria Caulfield
My hon. Friend makes a good point, and across Government Departments we are discussing the provision of both general practitioners and dentists for new developments. I am keen that dentistry is on a par with GP provision, because it is often an afterthought. I am keen that we push it up the agenda, and this debate helps.
Dr Caroline Johnson
Will dentists have a voice on care panels in the new integrated care systems?
Maria Caulfield
I thank my hon. Friend for that query. I am keen that dentistry has a louder voice than it does now.
As I was saying, part of this debate is about raising the profile of the issue. I reassure her that there are a number of things happening, particularly in her region. NHS England Midlands and East, which covers the east of England, is putting in place a number of initiatives, about which I wish to reassure her. Additional weekend dental sessions are going to be commissioned, to take place up to March next year. There will be additional clinical capacity to reduce waiting lists where a general anaesthetic is required, particularly for children. NHS England has also begun a procurement exercise to address the lack of orthodontic access across the region, particularly in Lincolnshire. To get us through the pandemic recovery phase, we will work closely with NHS England to ensure that that is happening as fast as possible.
In the short time available, I wish to turn to the long-term plan to address the shortfall that was there before the pandemic. We are taking up some of the suggestions that my hon. Friend has made so eloquently in this debate. The core of that is about ensuring that the NHS dental contract is renewed, because we are in a perverse situation where the contract sometimes acts as a disincentive. She made points about over-delivering or under-delivering; people can be penalised, and we can understand why dentists walk away from NHS contracts. This Government are focused on addressing that.
Lia Nici (Great Grimsby) (Con)
In my short time as a Member of Parliament for greater Lincolnshire, in Great Grimsby, I have been able to solve lots of constituents’ problems, but the one I have not been able to solve is dental care. A large dental practice went bust and I seem to be involved in some sort of dark art when I ask what is happening with those patients. Nothing has happened, nearly two years down the line. Will the Minister consider them as well, because I have constituents in terrible situations and I am unable to get anywhere to solve this?
Maria Caulfield
I am happy to meet my hon. Friend to discuss that issue with her. She represents a coastal constituency, and this emphasises the point about where there seem to be gaps in provision.
I am pleased that we are being able to take specific action, both nationally and locally, to improve recruitment and retention, because that is key. This includes widening access to dental careers and utilising the skill mix in dental practices. It is not always the dentists who need to be used and we need to upskill some of the dental workers in dentistry too, so that we can understand the oral health needs of patients in specific communities. As part of that work, Health Education England is looking to address regional shortages by ensuring that training place numbers are better aligned with the needs of local populations and that we are targeting provision. I take the point made by my hon. Friend the Member for Sleaford and North Hykeham about a dental school and I will look at that suggestion. She rightly says that students tend to stay where they train, and we need to look at where the gaps are. The number of dental school places is increasing and we are getting more students through, but I will look at her suggestion.
I feel that I have not specifically addressed the situation in Lincolnshire as a whole, which is the subject of the debate, so let me reassure my hon. Friend that a number of measures are in place to address the issues there. We have introduced additional face-to-face weekend dental sessions from August this year through to March next year; there are dedicated urgent dental slots for 111 patients; and we are trying to address some specific local gaps in Mablethorpe by commissioning urgent NHS dental care sessions on a temporary basis. We also want to improve recruitment and retention specifically in my hon. Friend’s area. Health Education England is working in Lincolnshire to recruit newly trained dentists but should perhaps look at a dental school to support that effort even further.
My hon. Friend raised orthodontic issues, which are very important for young people’s health. NHS England Midlands and East has begun a procurement exercise to address some of the backlog. Patients with a clinical need to start treatment quickly will be contacted. I reassure the House that any patient who was referred before they turned 18 but has not yet started treatment will still get free treatment, even after their 18th birthday, because the backlogs are not their fault.
I know that I have not answered all my hon. Friend’s questions, but I hope she knows that we take this issue extremely seriously. The provision of dentistry is a complex policy area for which there is no quick solution, so I shall not make promises tonight that we cannot deliver, but we are serious about trying to address the issues. I hope I have been able to provide some reassurance that, although this issue is challenging, as the new Minister responsible for dentistry I am committed to playing my part in not only supporting the covid recovery but driving forward long-term improvements. We want to see a contract that is attractive for professionals and that ensures equality of access for all, across rural regions and coastal regions.
Dr Caroline Johnson
Before the Minister sits down, may I ask her to meet me later this week, or perhaps next week, to discuss further the impact on military personnel in particular?
Maria Caulfield
Yes, absolutely. I have not been able to address that in my speech but I am keen to meet my hon. Friend and other colleagues who have particular shortages in their areas. I want to hear what is happening on the ground and make sure, as we go forward, that the problems are addressed and we start to see improvements. I would be happy to meet my hon. Friend and other colleagues.
Question put and agreed to.