NHS Dentistry: Bristol and the South-west
(Limited Text - Ministerial Extracts only)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to respond to this important debate and I thank the hon. Member for Bristol North West (Darren Jones) for securing it. I acknowledge many of his points but reassure him that dentistry is an absolute priority for the Government. He said he has previously tried to make contact with Ministers; he has not formally asked me for a meeting but I am happy to meet him should that be of assistance.
Let me touch on two of the main reasons why patients up and down the country currently struggle to see dentists. The first relates to covid. This is not a lame excuse for why there are currently difficulties: dentistry and dental services have gone above and beyond during covid. I am sure my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is a dentist, will back me up when I say that many dentistry procedures are aerosol-generating, so significant infection-control measures have been in place to protect patients and dentists and their teams.
At the start of the pandemic, when we first went into lockdown, only urgent procedures were allowed, so no routine procedures could be carried out. It was not until 8 June 2020 that infection-control measures allowed the reintroduction of some routine care. Even then, dental practices were able to work at only 20% of normal activity. That has of course had knock-on effects throughout England in respect of patient access to routine care.
Later that year, infection-control measures allowed up to 45% of normal activity, but it was not until last year that that proportion went up to 60%. Just before Christmas, NHS England and the chief dental officer wrote to practices to say that they could go up to 85% of normal activity and 90% of orthodontic activity. They are still not up to 100% of activity so they are literally treading water to try to keep the service going. I pay tribute to all those who have done such significant work to try to deliver services to the patients who have needed them.
Urgent care has been back at pre-pandemic levels since December 2020, so the backlog is in respect of routine services, whether fillings, caps, crowns or routine dental-hygiene work. Covid has significantly contributed to that backlog.
Wera Hobhouse
I understand from the dentists I speak to in my Bath constituency that the Government funding provided per patient just covers hygiene, not any of the repairs or dental work the Minister has just mentioned. Can she confirm or deny that?
Maria Caulfield
I will come to that in a moment, but let me first conclude on the impact of covid on dental services. The hon. Member for Bristol North West may be reassured to hear that the proportion of adults and children accessing dentists in Bristol, North Somerset and South Gloucestershire remains higher than the average for access to dentistry in England. It is probably no consolation to his constituents, but access is slightly higher.
Darren Jones
Is the average acceptable or below where the Minister would like it to be?
Maria Caulfield
I have been clear that covid means we are not yet operating at 100% of normal activity. We need to get back to pre-covid levels, when the majority of patients were able to access a dental appointment and around 28 million people saw an NHS dentist every 24 months. That is where we need to get back to but we will struggle, because of infection-control measures due to covid, to get there until we are at 100% of activity.
I reassure the hon. Gentleman that NHS England is supporting local commissioners. There was an intervention about helping to get more service provision; provision is commissioned at a local level, not by the national Government. National Governments provide the funding and then local commissioners commission the services. It is important that Members talk to their local commissioners to understand what services are being commissioned. NHS England provides flexible commissioning toolkits to local commissioners to help to focus the available capacity.
Darren Jones
Does the Minister recognise that local commissioners can only commission dental services if the NHS dentists exist and are willing to provide NHS dental services? The core of my debate this evening is not about the impact of the covid pandemic, which we all recognise; it is about the underlying issues of the dental contract and the shortage of dentists. Does she recognise that?
Maria Caulfield
I will come on to the contract, which was developed in 2006 under the last Labour Government, and highlight the impact it is still having on dentistry—
Maria Caulfield
This Government are always clearing up the mess of the last Labour Government. I am hoping to have a constructive debate but obviously Opposition Members are not willing to engage in that.
Despite all our efforts to increase services, we know that patients are experiencing difficulty gaining access to dentists. There are a number of options that are helping patients to locate their nearest dentist. Patients can call 111 to find out which dentists are taking on patients. [Interruption.] If Opposition Members are not serious about this and make funny head-in-hands gestures, it is really not helpful.
Maria Caulfield
No, I will not give way. The right hon. Gentleman is obviously not interested in my response.
In Bristol, North Somerset and South Gloucestershire, a dental helpline has been set up to help patients to find an NHS dentist for routine care and to arrange urgent treatment. In addition, we have written to dental practices asking them to update their online information on the nhs.uk website. It is really important that this is available so that patients can find out which dentists are taking on NHS patients and which are not. It is crucial that that is kept up to date because it does change on a significant timescale.
Dentists are also being asked to maintain a short-notice cancellation list so that they can proactively contact patients who are on their waiting list if a patient cancellation occurs. All these measures help with the underlying problem of gaining access to NHS dentists. Later this week, there will be an announcement on some extra funding so that local commissioners will be able to commission services, because in some areas there would be more capacity if extra funding were available. Colleagues across the House will see the details of that in the coming days. My hon. Friend the Member for Thornbury and Yate (Luke Hall) intervened on a similar point. I am happy to meet him to discuss the issue around Frampton Cotterell, as I am happy to meet all Members if they want to raise specific local issues around dentist availability in their constituencies.
To get to the crux of the long-term issues, we hope to get to 100% capacity at some point post the pandemic. However, as mentioned by many colleagues, there is an issue with the dental contract, which has perverse disincentives within the UDA—units of dental activity—system, which dentists struggle with because they are paid similar rates when they are taking out one tooth or doing one filling as compared with doing extensive dental work. This is a disincentive to dentists to take on NHS patients, or sometimes to hand back NHS contracts.
Work has already commenced on dental contract reform. The Department and NHS England are working with key stakeholders, including the British Dental Association, to look at alternative ways of commissioning services, because only when we address the fundamental of the contract that dentists are working on will we get to the crux of the matter of the poor uptake of dental contracts and the reluctance of dentists to take on NHS work. Our aim in contract reform is to improve patient access, reduce health inequalities and make the NHS a more attractive place to work for dentists, making them feel more valued and helping to recruit and, more vitally, retain the experienced dentists who do so much to protect and promote oral health in this country. I am sure that the hon. Member for Bristol North West will welcome that. We are making some building blocks in terms of work that is already happening.
A number of Members touched on the issue of recruitment and retention of dentists. Only in September last year, Health Education England published its “Advancing Dental Care” review report on a four-year programme of work to recruit, retain and train not just dentists but dental teams. We have identified more effective ways of utilising the skills mix in the dental workforce. We are widening access and participation to training, we are allowing more flexible entry routes, including for overseas dentists, and we are developing training places for dental professionals, not just dentists; we want to upskill dental technicians and dental associates by providing them with more skills so they can provide a greater range of services. We are also looking at providing training in areas where we have dental deserts—where we do not have dental provision that local commissioners can commission. Importantly, we know from GP trainees that those who train in an area are more likely to stay in the area. We want to facilitate that. Health Education England is doing a huge amount of work to make that happen.
Darren Jones
I thank the Minister for her answers. One specific question I asked was about the recognition of EU qualifications and the 22% of dentists in the UK who originate from the EU. Can she answer that specific question please?
Maria Caulfield
Absolutely. We want to encourage everyone who wants to come and work in the United Kingdom to be able to do so, and we are working with the General Dental Council to make sure that happens. Currently a period of continued automatic recognition is in place for dentists with EEA and Swiss qualifications wishing to work in the UK and we want that to continue. Those with qualifications which were previously automatically recognised will continue to be recognised in the UK. I have heard from dentists from abroad who want their qualifications to be recognised here and we will work hard as part of the contract reform to make sure that that process is easier than at present.
On preventive work, my hon. Friend the Member for Mole Valley was absolutely right to point out that, as well as dealing with dental issues, oral health is crucial, and the Health and Care Bill is introducing proposals that will transfer the power to bring forward the new water fluoridation schemes, which will transform the oral health of many in the most deprived parts of our country, and could reduce the level of decay among five-year-olds by up to 28%. Simple measures such as that will make a big difference.
Although tonight I am unable to present colleagues with a quick-fix solution, I want to assure them that we are dealing with the issues covid has brought to us and we will be announcing further funding in this financial year to help to deal with some of that backlog, but there are issues with the current dental contract that unless addressed will continue some of the problems Members have raised this evening.
Darren Jones
I thank the Minister for giving way one last time. Might I gently suggest that the advice the Minister has this evening given my constituents in Southmead and across Bristol and the south-west who cannot get access to an NHS dentist is to call 111—they have tried that; it has not worked—to try to find a local NHS dentist, which they have tried too, and has not worked, and to wait for reform of the NHS dental contract, which has been in place since 2006 and this Government have been in office since 2010? They have been waiting for many years for that and I am not sure they are going to see it any time soon. I have constituents who are in pain waiting for dental care, and children who are not being seen. What are the immediate interventions the Minister can make? She has not offered any this evening.
Maria Caulfield
I would strongly disagree with the hon. Gentleman. He wants to work in a constructive way to deal with the issues facing his constituents, and he has already said that he wanted to meet the Minister, but he has never made an approach to meet me ever—
Maria Caulfield
I will not give way any further; I think the hon. Gentleman has made his points fairly clear. I have said to him that we are issuing a range of help. I have said there will be announcements later this week about funding in this financial year to help patients to be able to access dentists. I have also said that we are—
Madam Deputy Speaker
That is not a point of order for the Chair, but I understand why the hon. Gentleman wanted to clarify that. [Interruption.] Order. We will not have any more shouting from people who are sitting down.
Maria Caulfield
I think it is very disappointing for the right hon. Member for Exeter (Mr Bradshaw) to say that there is no point in meeting or that it would be a pointless meeting. That is the sort of constructive engagement that Labour MPs in Bristol have. I have been very constructive and very open in offering to meet—my very first line in the response to this debate was that I was willing to meet—the hon. Member for Bristol North West to discuss that. If he was not serious about it, it is a shame that he has not been more constructive this evening. However, I am very clear that we are offering a range of options for patients. I have put on record and I have not shied away from the fact that patients are struggling to see their dentist. I have not shied away from the fact that dentists are not happy with the current contract, and we are instigating contract reform. I have not shied away from the fact that, with the current infection control measures, restrictions are still in place. However, as the Minister responsible for dentistry, I remain committed to playing my part to ensure patients can access NHS dentistry no matter where they live.
Question put and agreed to.