Wednesday 22nd June 2022

(1 week, 5 days ago)

Westminster Hall
Read Hansard Text Read Debate Ministerial Extracts

Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.

Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.

This information is provided by Parallel Parliament and does not comprise part of the offical record

[Graham Stringer in the Chair]
[Relevant document: e-petition 564154, Independent review of the NHS dental contract.]
00:00
Derek Thomas Portrait Derek Thomas (St Ives) (Con)
- Hansard - - - Excerpts

I beg to move,

That this House has considered NHS dentistry in England.

It is a privilege to serve under your chairmanship, Mr Stringer. I am delighted to bring this debate to Parliament and to combine it with a petition that has been signed by more than 10,000 members of the public. The petition calls for

“an independent review of the existing”

NHS dental

“contract and a radical rethink of the way in which dental services are delivered.”

We may not need an independent review to tell us that NHS dental services need a radical rethink; we all know that they do.

NHS dentistry is a huge concern for all Members here today, and the number of us present reflects what a huge concern it is for our constituents. I already had a good indication of how significant the lack of dentistry was across my constituency, but to grasp the detail and the scale of it, I posted a survey at the beginning of the year asking constituents about the problems they had faced in accessing NHS dentistry. Within a day, it had received more responses than any other survey I had run—more than surveys on bus services, post office closures, noise pollution, or whether the Cornish flag should appear on a Cornish numberplate.

The picture that came out of my survey was shocking. Nearly half of respondents had been waiting more than three years for an appointment. Tim has had temporary crowns awaiting replacement for eight years; the teeth underneath have rotted away. Robert’s solution was to wait until a tooth was

“beyond repair and intolerably painful before getting an appointment with the emergency dentist to have it extracted. Last time they removed three in one go.”

Other people tried DIY solutions. Looking up how to make temporary fillings on YouTube was commonplace. Mark pulled out his wisdom tooth himself.

Other constituents have given up completely. They do not show up on the waiting lists because they have given up on waiting. Lauren told me:

“I don’t use the right side of my mouth to chew as it’s sensitive and causes me pain but it is too difficult to get an appointment so I am having to live with it”.

Anna racked up three times her usual phone bill trying to get through to the appointments line before she gave up. One constituent comes from a family of seven, of whom only the youngest has ever seen a dentist, and only then because he went to hospital for urgent surgery; the oldest is 20. Patients who can afford to go private do so, but so do patients who cannot afford it. The fees for Anthony’s private dental care represent a tenth of his pension; that is not affordable. The fees that Megan paid to remedy just one of her abscesses equated to a month’s rent. She has just had a baby, and cannot afford to pay another two months’ rent for the other two abscesses.

The situation is particularly grave in Cornwall. Last week, NHS England and NHS Improvement presented a report to Cornwall Council showing that in 2020-21 only 24% of the dental activity commissioned in Cornwall was delivered. In 2021-22, it has increased, but only to 59%. By the end of this month, we should be returning to 100% of normal activity, but that is simply not happening in Cornwall. The total number of adults with access to an NHS dentist dropped from 188,000 in June of last year to 155,000 in December.

John Hayes Portrait Sir John Hayes (South Holland and The Deepings) (Con)
- Hansard - - - Excerpts

I congratulate my hon. Friend on securing the debate. Things are clearly not as they should be in Cornwall, but in Lincolnshire they are even worse. Greater Lincolnshire has three of the four worst dental deserts in the United Kingdom, according to the Association of Dental Groups, with just 38 dentists per 100,000 people. Finding a dentist in Lincolnshire is like finding the holy grail. It is vital that we have more dentists, for the reasons my hon. Friend set out. People deserve better.

Derek Thomas Portrait Derek Thomas
- Hansard - - - Excerpts

I completely agree. My right hon. Friend will know that in Cornwall we are very competitive; we always want to win, but I do not want to win this competition. This tragedy for both Cornish residents and his constituents highlights the fact that something needs to be done urgently. I thank him for his intervention.

Damian Green Portrait Damian Green (Ashford) (Con)
- Hansard - - - Excerpts

I am very grateful to my hon. Friend for giving way again and allowing me to continue this tour of woe around the country. I can tell him that the situation is equally bad in Kent; it is almost impossible in Ashford to find an NHS dentist. My frustration and that of my constituents about this is compounded by the lack of response of the health service generally. The clinical commissioning group refers me to NHS England, and NHS England—the Minister may take note—just does not reply. I have before me an email I sent seven weeks ago regarding someone who could not find a dentist, but there has not even been a reply from NHS England. From top to bottom, this system needs complete reform.

Derek Thomas Portrait Derek Thomas
- Hansard - - - Excerpts

I appreciate that intervention. In my case, NHS England, and commissioners for the south-west have been fairly good and engaged with the challenge. However, it is a tale of woe, as my right hon. Friend says. Perhaps we can all commit to coming back to this place in a year or two to commend the Minister and celebrate the fact we have a new contract that addresses exactly the challenges that we are all quite rightly highlighting today.

Dan Poulter Portrait Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)
- Hansard - - - Excerpts

I congratulate my hon. Friend on securing this debate. He is right to highlight this national challenge. We have substantial challenges with access to NHS dentistry in Suffolk. Part of that, as our right hon. Friend the Member for Epsom and Ewell (Chris Grayling) said, relates to the quality of the commissioning and monitoring of contracts by the local commissioner. Will my hon. Friend join me in urging the Minister to put pressure on local commissioners to take this issue seriously? Also, does he agree that we need to ensure that dentists who are commissioned to perform NHS services do actually provide the services that they are commissioned to provide? Some of them are not doing so at the moment.

Derek Thomas Portrait Derek Thomas
- Hansard - - - Excerpts

I thank my hon. Friend for that intervention. He is right to say that there are commissioned units of dental activity that are not being delivered. There are all sorts of reasons for that, which I hope to cover in my speech. Ultimately, however, we need to look at the contract itself and consider whether it actually works for patients. The contract was introduced by the Labour party in 2006. We know that it does not work today and is in urgent need of reform, which I will come on to in my remarks.

Jim Shannon Portrait Jim Shannon (Strangford) (DUP)
- Hansard - - - Excerpts

Will the hon. Gentleman give way?

Derek Thomas Portrait Derek Thomas
- Hansard - - - Excerpts

I will make a little progress first and then I will give way to the hon. Gentleman.

We have heard about other examples and concerns elsewhere, but in Cornwall we do not have the capacity to assess the patients in the backlog, let alone to treat them. This is not just about dental health. Dental examinations pick up the early warning signs of mouth cancer, or poor periodontal health associated with diabetes, for example. I should declare an interest, Mr Stringer, as the chair of the all-party parliamentary group on diabetes. It is estimated that 60,000 people with type 2 diabetes had their diagnosis missed or delayed because of the cancellation of dental examinations.

I will now give way to the hon. Member for Strangford (Jim Shannon).

Jim Shannon Portrait Jim Shannon
- Hansard - - - Excerpts

I know that this debate is about NHS dentistry in England, but may I say—regionally—that the problems are just as real in Northern Ireland as they are anywhere else? My concern is that there is no access to NHS dentistry any more in Northern Ireland; either people pay for dentistry, for example through a subscription, or they do not get it.

Does the hon. Member agree that dental care should not be restricted to those who have the money to pay? The impact of this situation will clearly fall on those who see dentistry as being the bottom of the list when it comes to paying? People in the poverty trap who feel the pressures of rising prices will be even more detrimentally affected than ever. Does he feel that now is the time for Government all across the United Kingdom of Great Britain and Northern Ireland—although I appreciate that the Minister who is here today does not have responsibility for Northern Ireland—to do something specifically for people on the breadline?

Derek Thomas Portrait Derek Thomas
- Hansard - - - Excerpts

I thank the hon. Gentleman for his intervention.

It is probably fair to say that although the responsibility lies with the Minister here today, it is not her responsibility, or even in her power, to ensure that every member of the British public can access NHS dentistry, simply because NHS England, or indeed any part of the NHS, does not commission enough dentistry to cover the whole population. Perhaps the Minister will clarify today the Government’s expectation regarding access to NHS dental care, and say whether there is a right for everybody, whoever they might be, to access that care. However, it is a very important point that has been raised. It surprises people that we do not commission enough dentistry to meet the needs of every one of our constituents.

It is not enough to blame the pandemic, although it has certainly not helped. I was raising the state of NHS dentistry in Cornwall before we had a single case of covid in this country. Over two years ago, I spoke about the difficulty of recruiting and retaining dental staff. At Prime Minister’s questions two years ago, I raised the shocking results of the lack of access to NHS dentistry for children in Cornwall. I also told hon. Members that these inequalities needed to be addressed quickly and creatively.

Outside this House, I have been working to improve access to dentistry in the constituency, most recently by getting the council to overturn a decision not to allow electrical works to proceed in St Ives that would have delayed the opening of a new dental surgery until the autumn. I have been meeting the regional health commissioners and Cornwall’s public health officers to discuss dentistry on a regular basis, and I cannot fault their speed and creativity. Their south-west dental reform programme has been working hard to improve access by helping to reopen a surgery in Hayle and in St Ives, piloting child-focused dental practices, and developing its own evidence-based workforce plan, but the Government must lead the way. Resolving these oral health inequalities is not just this Minister’s responsibility; it will require a cross-Government approach.

NHS England has launched a drive to recruit dental professionals to the south-west, but a key challenge in Cornwall, and maybe other parts of the country, is finding housing for those who want to take up a job in dentistry. I am working on that issue with the Department for Levelling Up, Housing and Communities. The national food strategy was a wasted opportunity. We could have extended the sugar tax, which has successfully incentivised the reformulation of sugary drinks. That would have helped oral health as much as health in general. I shall continue to argue for a national food strategy that is truly strategic, even if the Government have made a tactical withdrawal from tax rises to support public health.

The Minister has responsibility for the dental contract. In oral questions in January, she agreed that the contract was

“the nub of the problem”.—[Official Report, 18 January 2022; Vol. 707, c. 195.]

She said in February,

“there is no doubt that the UDA method of contract payments is a perverse disincentive for dentists. The more they do, the less they seem to be paid. I for one certainly do not underestimate the problems that that causes dentists, and I can see why many hand back their NHS contracts.”—[Official Report, 7 February 2022; Vol. 708, c. 780.]

I could not have put it better myself. I have asked dentists in my constituency if they would prefer to see increased budgets or reform of the UDA contract, and they asked for reform.

There are two main issues with the dental contract, both of which are not just obstacles to dental health but actively create problems for the future. First, the current system does not focus on prevention. When units of dental activity are the sole measure of contract performance, there is no incentive for preventative work; nor is there an incentive to make the best use of the whole dental team’s skills when the practice cannot make a claim for payment for a course of treatment purely because it was initiated by someone other than a dentist.

I made sure that the title of the debate referred to NHS dentistry not NHS dentists. We need to recognise the contribution of the whole team of dental professionals —dental nurses, hygienists, therapists and technicians—and use them. Again, this is about not just saving money, but using professionals in the best way we can. Yesterday I spoke to a dental nurse who works with people in care homes. If she wants a resident to switch to a high-fluoride toothpaste, she has to get a dentist to prescribe it. Our regional dental commissioning team has been running a pilot to take supervised toothbrushing conducted by dental nurses out to the community. Given that more five to nine-year-olds are admitted to hospital for tooth decay than for any other reason, this work should be at the heart of NHS dentistry, not something that is topped up by flexible commissioning.

Second, the UDA method does not properly reward dental practices for their work. A dental practice is faced, in effect, with a UDA cap for an entire course of treatment, which means when a patient has complex needs, the money involved does not even cover the overheads of the practice. The predictable result is that dental practices are moving away from NHS work. Around 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. Every time a dentist leaves the NHS and is not replaced, approximately 2,000 people lose access to dental care. If you cannot do the arithmetic in your head, Mr Stringer, 3,000 times by 2,000 is 6 million, so 6 million patients have lost access to a dentist just over the course of the pandemic. For every dentist leaving the NHS, another 10 are reducing their NHS commitment by a quarter on average; that is another 500 patients losing access to an NHS dentist. According to the British Dental Association, 75% of dentists plan to reduce the amount of NHS work they do next year.

The fewer dental practices there are doing NHS work, the more pressure the remaining practices are under. A recent BDA members survey found that nine in 10 owners of dental practices committed to NHS work found recruitment difficult, with 29% of vacancies going unfilled for more than a year. That is nationwide, but one provider in Cornwall told me that their surgeries were unused 52% of the time due to shortages of dentists and nurses. The vast majority said that it was the UDA contract that was the biggest factor in their recruitment difficulties. The Minister said last week that the Government are serious about reforming the dental contract, but I want to press that point. It is not enough to be seriously planning a reform; we must be planning serious reform. Tweaks to the existing system are not enough when the contract is fundamentally flawed.

I have focused on the contract because we need the Minister to focus on the contract. Other Members will no doubt raise the issue of recognising overseas qualifications, passing the section 60 order that would give the General Dental Council discretion over qualifications, maintaining the mutual recognition of professional qualifications with Europe and extending that to the Commonwealth, and expediating the process for experienced candidates to register with the NHS. Dental care professionals need to be allowed to initiate treatments. The issue of funding will come up—for a catch-up programme of overseas registration exams in the short term, and university places in the long term—but it is striking how many of those proposals are cost neutral. We could even save money by catching mouth cancer in the early stages when it is more easily treated.

To quote the Minister, the contract is the nub of the problem. I urge her to commit to a firm date when we will see the end of units of dental activity, and a better contract focused on prevention and increasing access.

Graham Stringer Portrait Graham Stringer (in the Chair)
- Hansard - - - Excerpts

I have indications from six Members who wish to speak. I intend to call the Opposition spokesperson at 3.40 pm. You can do the arithmetic—it is fairly straightforward—I do not intend to impose a time limit unless Members indulge themselves.

14:47
Rachael Maskell Portrait Rachael Maskell (York Central) (Lab/Co-op)
- Hansard - - - Excerpts

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for St Ives (Derek Thomas) for opening the debate and making many of the points that I intended to make. The simple fact is that we do not have time for further delay. We have four and half weeks left until the summer recess, and our constituents want answers. They want answers because they need to see a dentist but they are experiencing the deficit of NHS dentistry across the country. I would add to the list of areas mentioned that Yorkshire is also deeply affected, and my city, York, is struggling.

In 2009, Labour committed to reform the dental contract, realising that it was not going to deliver what it aspired to. The coalition Government followed in 2010 with a similar commitment, yet here we are in 2022 still making the same argument that we desperately need reform. As has already been said, this is not just something that has emerged through the pandemic; it is an issue that predates us. That is why it is essential that we have a pathway from today showing how we are going to move out of the crisis. Our constituents deserve to know what the Government’s agenda is.

Two years ago, NHS dentistry fell by 13%. Since covid-19 there has been a mass exodus in my city of York, but I realise that has also occurred across the country. Last April, NHS dentistry fell by a further 19%. It is believed that since the start of the pandemic, NHS commitments have fallen by 45%. Next year, 75% of dentists are planning to make changes and reduce their NHS commitments. Of those, some 45% say they will go fully private and 47% say they will change career or take early retirement, so if we wait another 12 months we will be in a deeper mess than we are now.

Since the start of the pandemic, we have lost 43 million dental appointments, 30 million of which were for children. In my constituency, 41% of children have not seen a dentist in the last year—they are the children who are now presenting in more acute services, requiring even more expensive interventions.

To put the situation in York into context, 9,695 UDAs were delivered in March 2021, at a time when 45% of UDAs needed to be delivered. A year later, in April 2022, 8,730 UDAs were delivered, fewer than the year before, and yet the requirement was for 95% of UDAs to be delivered. Instead of the number of my constituents accessing NHS dentistry going up when the number of UDAs that were expected to be delivered more than doubled, it has gone down. With 965 fewer UDAs, despite a doubling of the expectation, will the Minister explain how my constituents are meant to get access to services?

Fewer than half my constituents have seen a dentist in the last year. Of course, dentists have offered them private dental plans but my constituents simply cannot afford that, not least because of the cost of living crisis and the housing crisis in my city. Some travel long distances and others get nothing at all, and we know about other health inequalities that are similarly embedded.

John Hayes Portrait Sir John Hayes
- Hansard - - - Excerpts

It is the least well-off people who suffer most, as the hon. Lady rightly said. Working-class people cannot afford these expensive plans. Surely the answer is that we should train more of our own dentists and make it more attractive to work for the NHS, rather than go private. My own dentist is Turkish by origin. He is a fine NHS dentist, and I could not speak more highly of him, but we cannot simply import dentists; we need to train more.

Rachael Maskell Portrait Rachael Maskell
- Hansard - - - Excerpts

The right hon. Member is absolutely right that we have to train more dentists. One reason for that is that it takes about 10 years for somebody to be fully professionally competent and able to provide the highest level of dentistry. We must not look just at what is happening now, but into the future too.

Before we get to that point, we have to look at retention and at bringing people back from private contracts and services into NHS contracts. With fewer dentists available, the toll and the mental stress felt by those who have stayed in the NHS and remained committed to it is building. Some 87% of dentists experience mental stress, and 86% have experienced abuse as a result of people being so frustrated by the time they reach the dentist’s door. The people working in dental reception areas are at the forefront of that, and I know of a practice in York that cannot recruit anyone to be on the front desk. We need significant changes to be brought forward, and that will require money and dedication.

It is not just about the contract; it is also about having a complete strategy around dentistry. I have never understood why oral health was taken outside the wider NHS, and I believe that the solution to the problems we face is to have a proper NHS dental strategy and to put the NHS dental service back into the heart of the NHS. However, while we are working on those issues, we have to look at the crisis before us.

In Parliament last week I mentioned a practice that has been fantastic at accommodating people with dental needs throughout the pandemic. I said that three dentists were leaving that practice; I was wrong—it is now four. That is the pace of people leaving the profession. We have heard about the wider consequences for oral health, and particularly oral cancers, for which a delayed diagnosis means the worst prognosis. Therefore, it is absolutely right that we see a move on this issue.

I want to raise a couple of issues about dentists waiting to come to the UK. We know that 700 dentists are waiting to sit exams. The Government have had a consultation, which has closed, and we are awaiting a response. I am sure everybody in the House would want to accelerate legislation on that, but we need to know the Government’s plan. I hope the Minister will be able to tell us about that today.

However, 700 dentists will not fill the gap. Just last week, I was speaking to Ukrainians who have come to the UK. They want to work, they want to put their skills into practice and they want to have fast-track English language training so that they are competent in terms of their language skills. They want to see their qualifications passported, so that they can get to work and practise their profession. They do not want to deskill or de-professionalise. They want to learn the clinical language that they will require, and therefore to shadow dentists getting ready for practice. However, I have not seen a strategy from the Government on how we will work with refugees who have those skills and can put them to work. Perhaps the Minister will share that in her closing remarks, because it seems such a waste of talent when many refugees absolutely want to address that local need but cannot do so.

I turn now to the future training of dentists—a point raised by the hon. Member for St Ives. I have had discussions with Hull York Medical School, which is a fabulous partnership between the two cities, and it would be prepared to help support a dental school. Of course, that would need investment, so we need proper investment for the future. To look at how that would work, I spoke to the commissioners, and there certainly is an appetite in our city to host such a school in the future. That would be helpful in bringing dentists onstream, but we also must recognise that students currently in training are struggling to get placements in the NHS. Of course, the more dentists who leave, the harder it will be to train the current cohort. Unless we see a quick increase in the number of NHS dentists, we will be in even more difficulty. That is why the urgency is there now. We must build back an NHS service for the future to ensure that we have those professionals in place.

Finally, we know that integrated care systems will be taking over the commissioning of dental services next year. My concern is that Government are waiting for that moment to act. We must see action now, because the integrated care systems will not be able to solve a problem that the national Government won’t.

14:57
Peter Gibson Portrait Peter Gibson (Darlington) (Con)
- Hansard - - - Excerpts

It is a pleasure to serve under your chairmanship, Mr Stringer, and to follow the hon. Member for York Central (Rachael Maskell). I am pleased to report that my own dentist is in the hon. Lady’s constituency, and I have had excellent service from them for the past 25 years.

I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing the debate. As we have heard, many Members across the House have had significant correspondence on this issue from constituents. Since the start of the year, I have been contacted by 26 constituents raising their difficulties in obtaining access to NHS dentistry. I therefore welcome the opportunity to discuss this important issue.

The problem of access to NHS dental services has sometimes been put down to a lack of adequate staff numbers. Across the Tees Valley CCG area over the last 11 years, the number of dentists carrying out NHS activity has remained static, at around 330. Moreover, issues with access to care have undoubtedly been compounded by the pandemic, with waiting times increasing significantly due to the infection control measures that were required to keep services going. However, those are not the main issues.

Instead, we must look at the shortcomings in the current system of dental contracts, which was introduced by Labour in 2006. Under that system, a dental provider agrees to provide a set number of units of dental activity from April until the following March, and the annual contract value is paid in 12 monthly instalments. Those units are not related to numbers of patients or the extent of the work that needs to be performed, and similar rates are paid for taking out one tooth or doing one filling and for doing extensive dental work.

Therefore, dental providers effectively end up being paid less money for more work, with it not being financially viable to provide NHS dental services. That results in providers not taking on NHS patients, or sometimes handing back NHS contracts and concentrating on private dental care. Furthermore, the nature of the employment of many associates—who are retained on a decreasing percentage share of the income they generate—further reduces the incentive for those coming up through the profession to remain doing NHS work. I understand from the Minister that the British Dental Association and NHS England are in discussions to reform the contract. I wish those negotiations well for the sake of all our constituents.

I would also like to focus on the fact that the main causes of tooth loss are decay and gum disease. Prevention is definitely better than cure. Improved dental hygiene gives a better chance of keeping teeth for life. I hope that any changes to the NHS contract include a shift to focus more on prevention and pre-emptive care in order to reduce demand for routine and urgent dental care.

I firmly believe we need a far greater focus on education in dental care. Early years foundation stage is a child’s first experience with oral health impacting on the rest of their life. Setting good dental hygiene standards and practices early on often leads to far less need for care in later life. Schools should do more to emphasise good dental health, and dentists should do more to educate parents on how they can set high standards for their children and on the vital role they play in normalising dental visits, putting their children at ease with the dentist, as a person they can trust.

I welcome the steps the Government have taken to try to deal with the backlog of NHS dental care, including the provision of £50 million to provide up to 350,000 additional dental appointments in England. It is welcome that that funding was targeted at those groups most in need of dental treatment, with children and people with learning disabilities, autism or severe mental health problems being prioritised. But I fear that that is not enough to ensure that everyone who needs to be seen can be.

This is a hugely important issue in Darlington, and one we cannot afford to get wrong. It is essential that those in the most need of care and those in the most deprived areas are prioritised. The current system is simply not working in that regard. I trust that the Minister has listened closely to the points I have raised, and recognises the importance of expediting the reform of NHS dentistry contracts and of focusing on preventive care, so that we can create a system that works for all.

15:02
Paul Blomfield Portrait Paul Blomfield (Sheffield Central) (Lab)
- Hansard - - - Excerpts

It is a pleasure to see you in the Chair, Mr Stringer. I pay tribute to the hon. Member for St Ives (Derek Thomas) for the way he introduced the debate and covered so much of the ground we need to pay attention to.

This is a funny old place. We wait for months to talk about dentistry, and now we have had two debates in two days. I spoke in yesterday’s debate and I do not want to repeat the points I made then, but I do want to develop some of them. We clearly face an extraordinary crisis in dentistry. It was fascinating to see all the Members intervening on the hon. Member for St Ives, telling their stories about constituents who had contacted them, unable to access NHS dentistry. We had that yesterday throughout the debate, with some horrific stories about the self-treatment that some people have been driven to carrying out with pliers. That emphasises the scale of the crisis across the country.

If we had all hung about after Prime Minister’s questions, and the Speaker had asked, “Has anybody here not had a constituent contact them about access to NHS dentistry?” no hands would have gone up. We all face this problem. I met our local dental committee last week. I said yesterday that, in response to that meeting, it commissioned a survey across the city, speaking to about half the practices. Only one could offer a waiting time shorter than a year. For 29%, it was up to two years; for 32% it was more than two years. The biggest number—35%— said, “At this moment, we simply can’t take anybody on to the waiting list.”

It is a shocking situation that we find ourselves in. I will not repeat everything I said yesterday, but I cited the example of a pregnant constituent who wrote to me. She said:

“I have a MATB1 form entitling me to free dental care whilst I’m pregnant and for a year after birth. Unfortunately, I can’t use this as I can’t find an NHS dentist”.

There is a reason why pregnant women are given access to free dentistry: they face particular problems with oral health during pregnancy, which will give rise to long-term problems unless they are addressed. We know, too, that unless people get the dental service they need when they need it, that creates all sorts of other long-term health problems that are not only hugely damaging to them individually, but ultimately costly to the NHS. Not getting the money in the right place at the right time just causes more problems for budgets further down the road.

The most shocking part—I am overusing that word, but perhaps it is appropriate—of the contributions we heard yesterday was about children. The No. 1 cause of child admissions to hospital is rotting teeth, which arise from the failure to get children dental treatment when they need it. The hon. Member for St Ives made a really good point about our lack of ambition, which is a point we can make about successive Governments. The fact is that we do not have the ambition for NHS dentistry to cover the entire population, in the way we would expect for all other aspects of health provision—even if we do not always get that provision right. We need to have a fundamental debate about dentistry.

There are two ways of addressing the problem, which Members have alluded to. One is the contract. Yes, the contract was introduced by a Labour Government in 2006—let’s be honest—and it became fairly clear fairly soon that it was not working. In 2008, the Health Committee described it as not fit for purpose. Alan Johnson, who was then Health Secretary, commissioned the Steele inquiry, which reported in 2009. In 2010, we committed to reform the contract, and the Conservative Government made the same commitment, so this issue is cross-party and involves successive Governments, and we need to sort it out.

When I was going through the problems in the contract yesterday, I was pleased that the Minister nodded at each point I made. I would be grateful if, in her summation today, she could give us an insight into the contract reform that the Government are looking at, because we do not simply want to see tinkering, a little bit of shifting here and there, or—as I said yesterday—tweaking at the edges. Since the Health Committee reported in 2008, the contract has needed fundamental reform. Yesterday, I said that it was wrong that the contract was based on units of dental activity using figures from the two years previous to 2006, which are now massively outdated, and the Minister nodded. I said that it contains huge discrepancies in remuneration rates between practices doing the same work, and she nodded. I said—this was particularly relevant during covid—that the contract provides penalties, through financial clawback, for underperformance and not achieving targets, even if the reasons for non-achievement are completely beyond the control of practitioners, such as an inability to fill a job or the infection protection measures that were put in place. However, there is no reward if a dental practice overperforms—if it sees more people or deals with more teeth. The Minister nodded at that one, too.

The contract limits how much NHS treatment a practice can provide because of the quotas and the way that providers are contractually obliged to spread their NHS work and not be responsive to demand as and when it arises—the Minister nodded at that point, too. I would be grateful if she confirmed in her summation that the Government intend to address all those points, and indeed others, in reforming the contract.

The second aspect is the lack of funding for dentistry, which has fallen further than in any other part of the NHS. We should all recognise that it is a Cinderella service in the NHS. According to the BDA, funding for NHS dentistry has fallen by 25% since 2010, which, as I say, is completely out of line with the rest of the NHS. Alongside reforming the contract—we do not simply want a sleight of hand in solving these issues—what do the Government intend to do on funding? We heard about the £50 million Government investment for emergency funding as a result of covid, but there were problems with that—I say that with respect to the hon. Member for Darlington (Peter Gibson), who raised it in our debate yesterday. It was time-restricted funding for one quarter and was offered in a very short timeframe, which made it difficult to implement and involved work in addition to the contract. Practices were told that if they tried to help and then did not meet their standard contract target as a result, they would face financial penalties.

Unnecessary restrictions were imposed on the emergency funding by some commissioning teams—for example, in Sheffield, it had to be for out-of-hours access. The Minister is shaking her head. That might not have been what was required by the Government, but it was required by many commissioning teams. The net result was that lots of that money was not drawn down. I asked the Secretary of State yesterday to indicate how successful the initiative had been by telling us how much money had been drawn down, and he was not able to. I hope that officials have been able to provide the Minister with that number today, so that she can give us an indication of the success of that initiative.

I will say no more now because I am conscious that other Members want to speak, and we should all share our experiences from across the country, but I hope that we will not kick the issue down the road again and that the Minister, in her winding-up remarks, will commit to a comprehensive statement on where the Government intend to move on contract reform and funding to solve the crisis. If they do not make a statement before the summer and if we do not take action urgently, we will really be seeing the potential death of NHS dentistry.

15:13
Anthony Mangnall Portrait Anthony Mangnall (Totnes) (Con)
- Hansard - - - Excerpts

It is a pleasure to serve under your chairmanship, Mr Stringer. I will be very brief because many points have already been made, but I want to try and give a further south-west example of the problems that we face, particularly in rural and coastal communities. The problem is sizeable and the requirement to respond to it is urgent. As has been said by so many colleagues from across the House, we must grip the issue now. If we let it slide, it will get worse and worse, and the backlog will get bigger and bigger.

The hon. Member for Sheffield Central (Paul Blomfield) was right to say that, like buses, it is good to have two debates on this. I was sorry not to be able to make my comments known yesterday. I was particularly struck by some of the positive developments that have come out of the Department, most notably that urgent care is back to pre-pandemic levels. There are also 700 centres for urgent care, £50 million has been made available to encourage 350,000 extra appointments, and there is an urge and a push to upskill dental nurses, assistants and technicians. Those are all very welcome steps.

I do not mean to be critical of the Government, because the Minister, who has responded to my letters, has spoken to me at length on the issues that we face in south Devon. There are a few outstanding issues that I hope she might be able to take on board. I hope she might also be willing to listen to some of the suggestions that colleagues and I are making.

One the five areas where I see a significant problem, which has already been raised, is children not getting access to dentists. On pensioners, countless constituents have contacted me who cannot get access to the very necessary dentistry services that they require. We must find a way to address that, for children and pensioners alike. We can find a way through this. The problem in my patch is that dentists are not taking on new patients. In fact, to give a concentrated example, there is one practice within 15 miles of Totnes that is accepting patients, and in that instance it is only children. I understand that the practice is already oversubscribed and therefore unable to see people in a reasonable timeframe. This is a real problem that, as others have said, is becoming exacerbated as time goes by.

My next point is about urgent dental care centres. I have heard about 700 of them being set up across the country, but I am not aware of one that is dealing with my constituents. In fact, when people use the hotline to even contact the NHS to discuss it, they cannot get through. I have constituents in considerable pain contacting the helpline and not being able to even get through to convey their point. That needs to be addressed. It is bad enough not being able to see a dentist; it is perhaps even worse not being able to talk to someone about the help one needs. It is also reflected in why we see so many people ending up in A&E with problems with their teeth. Addressing this issue would help the A&E numbers.

The Minister, as ever, is assiduous in responding to our correspondence. I hope she will not take this the wrong way, but she responded to one of my letters that it may be helpful to know that patients are registered with a dental practice only for the course of their treatment, meaning there are no geographical restrictions on which practice a patient may attend. She has been to south Devon, I am sure. If she has not, she is very welcome—it could not be a better time to visit over the summer. Our geography is very difficult at the best of times. We do not have rail lines—they were all ripped up in the 1950s. Our bus services have been cut back. There are no major routes even between the major towns in my constituency and the hospitals—I think of Dartmouth and Kingsbridge.

If we do not have the transport system to help people to get to those practices, the geography matters a great deal. We need to focus on a response for the rural and coastal communities, because they are at a significant disadvantage, as my right hon. Friends the Members for Ashford (Damian Green) and for South Holland and The Deepings (Sir John Hayes) said.

The £50 million made available is welcome, but the percentage awarded to the south-west is 9%, which, if my maths is good enough—probably not as good as my hon. Friend the Member for St Ives (Derek Thomas)—is £4,762,000. That will not be enough to deal with the sizeable issues in what is classed as the south-west, which is Somerset, Dorset, Devon and Cornwall.

I said I would not speak for long, but I have a few points that I hope the Minister will take on board. I hope we can find a solution on the basis of cross-party consensus and co-operation and of the urgent need to address this issue. Evidently, we need more dentists. There is no doubt about that. Training takes time. It is great that we are looking at how to retrain people, but what steps are we taking to encourage the creation and set-up of dentist schools across the country?

People want to train and work in this country. The NHS is a draw to medical students around the world. We should be able to train them here and encourage them to work in our system, at least for a certain amount of time. What steps are being taken to recognise the equivalent level of qualification that might be found in other countries to encourage them to come to this country?

I have mentioned it three times, but for added effect I will make the point again: we need a robust response for rural and coastal areas. Is the Minister willing to meet all coastal and rural MPs, on a cross-party basis, who have an issue with dentistry to discuss this issue? It is significant that, from Cornwall to elsewhere in the country, we all make similar points about how we are disadvantaged. That is no disrespect to the hon. Members for York Central (Rachael Maskell) and for Sheffield Central, but I hope the Minister will take that on board, because it is becoming more urgent.

Contract renegotiation has already been mentioned. We need more details on that, and it has to be sped up. Nobody wants us to sit here pointing the finger—I accept that Labour brought in this terrible decision in 2006; there we are, I have pointed it—but what we want is a solution. We can find a solution. If yesterday’s debate and this debate are anything to go by, there are sensible options being put forward. The time to act is now. Too many people have been in significant pain for too long.

15:20
Scott Benton Portrait Scott Benton (Blackpool South) (Con)
- Hansard - - - Excerpts

It is a pleasure to speak under your chairmanship, Mr Stringer. In the last few months, I have received dozens of letters and emails from constituents about their difficulties in securing NHS dentistry, and I thank my hon. Friend the Member for St Ives (Derek Thomas) for securing this important debate.

A key part of levelling up is ensuring that health inequalities are addressed and that people’s access to vital dental treatment is not based on a postcode lottery. Only yesterday, I received an email from a constituent, Kayleigh. She was told by her dentist that she and her family would no longer be able to access routine NHS appointments. Kayleigh did exactly the right thing and called up other dentists in Blackpool and all along the Fylde coast, but time after time, the response she received was the same: “We are not taking on NHS patients, there is no waiting list, and there is no intention whatsoever to change that in the near future.”

Kayleigh works part time to help to support her young family, but private dental appointments are completely unaffordable and totally out of the question. She is one of thousands of my constituents in Blackpool who do not or cannot access NHS dentistry. It is difficult to establish a figure for how many of my constituents do not have an NHS dentist, but it is likely to be in excess of 10,000, or at least one in five adults.

The problems that our constituents are reporting to us are not being caused just by a lack of trained dentists. The number of dentists registered to provide care with the General Dental Council is actually at a record high, having increased by 2,000 since the start of the pandemic. The problems are being caused by two main issues, the first of which is the massive impact of the pandemic on dentistry.

The BDA estimates that more than 43 million dental appointments—more than a year’s-worth of dentistry in pre-covid times—has been lost due to the pandemic. There are of course steps that the Government could take to relieve that backlog, such as training more dentists or making it easier to bring in accredited foreign dentists to work in this country. I know that the Government are investigating these possible solutions, and the Minister has stated that legislation may be brought forward at the end of this year to address those points.

The second major issue is dentists opting to carry out more private dental work than NHS care. Nine out of 10 dental practices with significant NHS commitments report problems recruiting staff. When I was on a recent visit to a dental practice in Blackpool, the owners stressed the difficulty they have in recruiting and retaining trained dentists. This is a particularly acute problem for many coastal communities, as my hon. Friend the Member for Totnes (Anthony Mangnall) just mentioned, and exacerbates the challenges we have in providing NHS appointments in particularly deprived coastal communities.

The number of registered dentists is increasing, but many are now taking on a higher proportion of work in the private sector, and around 3,000 dentists in England have stopped providing NHS treatment altogether. There is not a shortage of dentists, rather a shortage of dentists motivated to take on NHS work. One example is Ivory Dental Care in my constituency, which recently wrote to patients informing them that from July it will no longer be offering NHS dentistry. That will result in an additional 2,000 Blackpool residents no longer being registered with an NHS dentist.

I am pleased that the Minister recently stated that an announcement on reforming the NHS dental contractual framework will be made soon, with the aim of paying dentists more fairly for their work. This is a vital step to stop a steady stream of NHS dentists leaving for more profitable, private work. It should also address the issues with low morale among dentists and turn the tide, so that the NHS is a more attractive place for them to work.

I know that this Government are serious about tackling health inequalities. It is appalling that children from the most deprived areas are already three times more likely to have hospital extractions, and oral cancers are obviously less likely to be spotted among those who have fewer routine dental appointments. We simply cannot allow such health inequalities in dental care to persist. One of the reasons I was elected to this House was because of the Government’s pledge to increase spending on our NHS, with the help of the budget rising from £133 billion at the start of this Parliament to £177 billion by the end of it. To that end, I welcome the additional £50 million that the Government made available for providing dental services earlier this year, but the reality is that this is actually falling in comparison with the overall health budget. We cannot put at risk the Government’s plans to level up the nation’s health by letting this continue. Dental health should be considered on an equal footing to the rest of our healthcare, so that we can further improve on the solid progress being made in towns such as Blackpool to reduce health inequalities.

15:26
Peter Aldous Portrait Peter Aldous (Waveney) (Con)
- Hansard - - - Excerpts

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing the debate. Access to NHS dentistry remains an enormous problem right across England, from his constituency, which is the most westerly, to the Waveney constituency that I represent, which is the most easterly. There is not only a so-called perfect storm, but also a perfect symmetry, which hits the most vulnerable hardest.

The Government have brought in measures to address this crisis, which have had some partial success; but what is needed is a long-term strategic plan for NHS dentistry, which I would suggest should meet the following criteria. First, a secure long-term funding stream. Secondly, a strategic approach to recruitment and retention. Thirdly, replacement of the dysfunctional NHS dental contract. Fourthly, a prevention policy, promoting personal oral healthcare. And fifthly and finally, transparency and full accountability, through the new emerging integrated care systems.

The issue on which I wish to focus falls in the last of those categories. It is the procurement of NHS dentistry, which at present is opaque and has, over a long period, led to some outcomes that are not in the best interests of local residents and do not meet the standards of probity that one is entitled to expect in the award of public contracts.

In 2009, the late Dr David Johnson, a much-loved local dentist with a thriving practice in the high street of Lowestoft, was refused a contract to continue to offer a service that he had provided to the local community for many years. That happened in highly unsatisfactory circumstances, which caused much personal upset and ultimately led to units of dental activity being taken away from Lowestoft, where they were much needed, and reallocated elsewhere.

More recently, approximately two years ago, a contract was awarded for the out-of-hours service in Norfolk. The company that won the contract still does not have either regular dentists or premises, and does not work anywhere near the hours stipulated in the contract.

Dan Poulter Portrait Dr Poulter
- Hansard - - - Excerpts

My hon. Friend is absolutely right when he speaks of the challenges that patients face throughout Suffolk in accessing NHS dentistry. Does he agree that there is availability of emergency out-of-hours dentistry, but that some companies are not taking the correct steps to provide it—and that some dentists are not opening up the number of slots that they are contractually obliged to, to provide it?

Peter Aldous Portrait Peter Aldous
- Hansard - - - Excerpts

I thank my hon. Friend and neighbour for that intervention. He is correct, and the example I have just provided illustrates that point.

On the issues with the probity of procurement arrangements, I will move forward to the present. It is welcome that a new, long-term NHS dentistry contract has been awarded for the Lowestoft area, and the locally based Dental Design Studio will deliver the contract to a high standard for the benefit of local people. However, before DDS was awarded the contract, it was initially won by a limited company with no local presence, no dentists and no premises. That company then offered the contract to local practices, seeking bids, initially of £400,000, which it then reduced to £250,000. When it was unable to sell on the contract, it withdrew from the process.

Procurement arrangements that allow such blatant profiteering are quite clearly not fit for purpose. There is also a worry that the process is skewed against partnerships, which have been the traditional means of providing primary healthcare in local communities. Only single legal entities and limited companies are able to tender for NHS dental contracts, with partnerships excluded from doing so. The feedback that I am receiving is that the tender documents are far from straightforward and discourage some local NHS dentists who remain in practice from bidding for contracts.

The transfer of responsibility from NHS England to the new integrated care systems, which will start operating in just over a week’s time, provides an opportunity to carry out root-and-branch reform of the procurement and oversight arrangements for NHS dentistry. We need to ensure that they are fair, transparent and in the best interests of local people. It is vital that we seize this opportunity.

15:31
Feryal Clark Portrait Feryal Clark (Enfield North) (Lab)
- Hansard - - - Excerpts

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for St Ives (Derek Thomas) for securing this important debate and praise hon. Members for their powerful contributions, which contained a lot of personal experiences setting out just how dire the situation is across the country.

Here we are again. The problem with NHS dentistry has come up time and again over recent months. No matter how much the Minister wants to bury her head in the sand, issues with access to NHS dentistry are just not going away. The situation is a national scandal, as recognised by Members from across the House, by the sector and by our constituents, whose heartbreaking cases continue to fill our postbags. One cannot help but feel emotional at the immense pain people are having to live with.

Shamefully, we know that children are particularly badly affected. Half of all children in England have no access to an NHS dentist, with 78 children under 11 going to A&E every single day for a tooth extraction. The hon. Member for St Ives described a family with three children, none of whom had ever seen a dentist, with one child only seen because they had to go to A&E. In Wakefield, a fifth of children suffer from tooth decay before the age of three. This is not just unacceptable; it is a downright disgrace.

In yesterday’s debate, the Minister held her hands up and recognised the problem in primary care. Frankly, I was delighted to finally hear something akin to humility from the Minister on access to NHS dentistry. However, just as it seemed we would make some meaningful progress, the same old script was rolled out and the blame was laid at the door of the Labour party. I put it to the Minister yesterday, and do so again today, that her party has been in government for 12 years. When Labour was in government and saw that the contract was not working, we committed to reforming it, as set out by my hon. Friend the Member for Sheffield Central (Paul Blomfield), and put that in our 2010 manifesto, just as this Government did in theirs.

Anthony Mangnall Portrait Anthony Mangnall
- Hansard - - - Excerpts

How does the hon. Lady explain the Labour performance in Wales, where dental practices are going down and the system is not being addressed? It is clear that the Labour party has no suggestions.

Feryal Clark Portrait Feryal Clark
- Hansard - - - Excerpts

I thank the hon. Gentleman for his intervention. If he wants to know about Labour’s performance on the NHS, he should look at the performance of the Labour Government between 1997 and 2010. Waiting times went from 18 months to 18 weeks.

None Portrait Several hon. Members rose—
- Hansard -

Feryal Clark Portrait Feryal Clark
- Hansard - - - Excerpts

I will make progress because I have a lot to say in only five minutes.

Here we are again. After more than a decade in power, the Conservative party has absolutely nothing to show for it, other than a record of complete and utter failure. The Tory Government made a commitment to reforming the contracts in their 2010 and 2017 manifestos, so I would be fascinated—as, I am sure, would other hon. Members—to hear from the Minister what on earth has been happening for the past 12 years. If she is happy to associate herself with that record, that is her decision, but I would be embarrassed and ashamed, to be frank.

The Minister is presiding over a national scandal. It is simply not good enough to keep shirking responsibility. Whenever the Government have had something that looks like a plan, it has been woefully inadequate. I am sure that the Minister will—as other Members have—tell us about the £50 million of extra funding that we have heard so much about, but if she thinks that it has made a blind bit of difference, she is very much mistaken. I have been made aware that Yorkshire and the Humber, for which £8.3 million was allocated, drew down just £2.3 million. Barely any of that money was used by general dentists; it was used predominantly by hospitals.

I would be grateful if the Minister could confirm or deny whether yesterday, after being asked about this matter by my hon. Friend the Member for Sheffield Central, her answer was simply that we should wait for the data. At best, we have had a mixed response on when we will receive the full breakdown of how much of that £50 million was taken up. Can she confirm whether we will receive that data before the summer recess?

If that funding was designed to regain the confidence of dentists and encourage them to increase their NHS activity, it has completely and utterly failed. Across England, the number of patients being seen by an NHS dentist actually dropped by 22% overall between March and April. As the Minister will be aware—I mentioned this yesterday—there was a 34% drop in her own constituency. I ask her again: how can she expect dentists across England to have confidence in her when it is clear that she does not even have the confidence of dentists in her own patch?

One way of building trust would be to communicate with the profession. Yet just eight days before the start of the next quarter, dentists have no idea of the targets that they will be working to. Can the Minister confirm whether that announcement will be left until the eleventh hour once again? Furthermore, can she confirm that, as the Secretary of State said yesterday, the target will be 100% of pre-pandemic activity?

Let me remind colleagues of a story that my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith) told in yesterday’s debate. A constituent of hers came to her surgery and placed on her desk the teeth that he had pulled out of his own mouth with pliers. Does the Minister think that such stories, which are now disturbingly common, are acceptable in 21st century Britain?

I am sure that the Minister will say once again that the Labour party is just shouting from the sidelines and does not have any plans, but when it comes to NHS dentistry, her Government have nothing to show for their 12 years of shouting from the centre circle. “Shouting” is a generous description, in the light of the Minister’s refusal even to speak to dentists at the Association of Dental Groups conference just a few weeks ago.

This Government might have a track record of failure, but it does not need to be that way. It is time for meaningful action that will make a difference to patients. I look forward to hearing the Minister’s answers.

Graham Stringer Portrait Graham Stringer (in the Chair)
- Hansard - - - Excerpts

We are not short of time, but will the Minster leave a minute or two at the end of her speech for the mover of the motion to wind up?

15:40
Maria Caulfield Portrait The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
- Hansard - - - Excerpts

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank my hon. Friend the Member for St Ives (Derek Thomas) for securing this important debate—even if it is two days in a row that we have highlighted some of these issues. I thank hon. Members on both sides for speaking on the matter.

I am slightly disappointed in the response of the shadow Minister, the hon. Member for Enfield North (Feryal Clark). In yesterday’s debate, it was acknowledged that in all four nations, no matter who is in charge—whether it is the Labour Government in Wales, the SNP in Scotland, or in Northern Ireland, where the Assembly is still being formed after the election—there are exactly the same problems. In my speech yesterday I made reference to the fact that in Labour-run Wales there has been a 71% reduction in dental activity in the last year. The shadow Minister spectacularly failed to answer the intervention from my hon. Friend the Member for Totnes (Anthony Mangnall) on that very point.

It is important to recognise that, yes, there have been problems since before covid, but covid has dramatically impacted—

Feryal Clark Portrait Feryal Clark
- Hansard - - - Excerpts

Here we go.

Maria Caulfield Portrait Maria Caulfield
- Hansard - - - Excerpts

The hon. Lady says, “Here we go,” but it is important to recognise that for two years there were no routine appointments available due to infection control measures. We are now back up to 95% of activity, but the backlog that existed before is significantly larger than it was.

It is also important to recognise that the nub of the problem around covid has been the dental contract. The shadow Minister may not have heard what I said yesterday, but we have been negotiating a new contract with the BDA; we started those negotiations on 24 March, a final offer went to the BDA on 20 May, and we are awaiting its response. We have been in negotiations; we have not just been waiting for the work to be done. We expect to make an announcement before the summer recess—I said that both at oral questions last week and in the debate yesterday. We will be making an announcement in the coming weeks on those contract reforms.

Paul Blomfield Portrait Paul Blomfield
- Hansard - - - Excerpts

It is helpful that the Minister has given us that information about the offer made to the BDA. Can she confirm that the offer addresses the four points I asked her about on flaws in the contract? I raised those points in the debate yesterday, and they reflect concerns across the House. Is it the sort of fundamental reform of the contract that will stop dentists being driven out of the NHS and into private practice?

Maria Caulfield Portrait Maria Caulfield
- Hansard - - - Excerpts

I obviously cannot comment while there are live negotiations ongoing, as I am sure the hon. Gentleman will appreciate, but the offer will drive some reforms in respect of the issues raised by a number of colleagues around fair payment for dentists’ level of activity. It will also look at the whole dental team and not just dentists. We have looked into whether we need legislation to be able to upskill dental technicians and dental nurses, for example, and we do not, so we are able to make progress on some of those areas, reward them for the work that they are doing and enable them to take on more work. A number of the issues that the hon. Gentleman raised will be covered by that.

The hon. Member for Enfield North may not know this, but before the latest round of negotiations, there had been a number of pilot studies over the last few years looking at completely reforming the UDA model and moving to a capitation model. Those pilot studies unfortunately did not produce the results we were hoping for. They did not increase access for patients, they did not reduce inequalities and they did not point to a sustainable model, so we did not go forward with that model. That is why we started new negotiations earlier this year on reform.

It is wrong of the shadow Minister to say that nothing has been done over the last 12 years. We had two years of covid where there was no routine dental activity; only urgent appointments were undertaken. Before that, there were three years of pilot studies on the capitation model; those were not successful, which is why we have not driven forward those changes. It is important that when we introduce changes, they address the fundamental issues that have been raised in this afternoon’s debate.

Paul Blomfield Portrait Paul Blomfield
- Hansard - - - Excerpts

Could I press the Minister in particular on the point that I made on financial clawback? It has been made clear to many of us who have talked to dentists that one of the most demotivating factors in the current contract is that while they are not rewarded for additional performance with NHS patients, they face clawback if they underperform, including for reasons that are completely beyond their control. I understand that for the last quarter that is currently being considered, 57% of dentists are going to face financial penalties. Those are the sorts of issues that are tipping them out of NHS dentistry. Will that issue be addressed?

Maria Caulfield Portrait Maria Caulfield
- Hansard - - - Excerpts

We are looking at the issue of clawback. Obviously we are in negotiations, so I cannot say what the final outcome will be. However, on the point that the hon. Gentleman makes about clawback during the last quarter, when the omicron variant was a particularly significant factor, we made clear to commissioners and dentists that if there were issues arising from omicron—patients who could not attend their appointments, or dental teams that were unable to be at work—they would not be subject to clawback. I would be disappointed if dentists who could not undertake their units of dental activity for covid-related reasons were penalised with clawback for that, because we made it very clear that there needed to be a flexible mechanism to mitigate some of those issues. If the hon. Gentleman has examples of that, I would be happy to take them away and ask officials to look into them.

Peter Aldous Portrait Peter Aldous
- Hansard - - - Excerpts

There is some ambiguity about where the negotiations stand. Can my hon. Friend clarify whether a letter has gone to the BDA to start the negotiation process, or whether there are finalised heads of terms ahead of an announcement on a new contract?

Maria Caulfield Portrait Maria Caulfield
- Hansard - - - Excerpts

The negotiations started back in March and there have been a number of meetings with the BDA. The BDA has been sent final recommendations, but we have not yet heard back, so I encourage the BDA to respond.

I will touch on a number of other issues that have been raised, the first of which is overseas dentists. For obvious reasons, no overseas registration examinations took place during the pandemic, creating a backlog of over 800 overseas dentists waiting to take their exams. Exams restarted earlier this year, and extra sessions are being held to get through that backlog of dentists so that we can get them into the system and working as dentists as quickly as possible.

We have also been working with the General Dental Council, which is the regulator, on recognition of overseas qualifications. The GDC did a consultation on regulation and recognition of overseas dentists, which I think closed on 5 or 6 May. We are waiting to hear the feedback from that consultation, but we are happy to lay regulations in this place—if necessary, we can do so by the end of the year—to give the GDC the power to mutually recognise overseas dentists according to its judgment. It is not for the Government to mutually recognise qualifications; it is for the regulator. However, we are happy to give the GDC the power to do so, and we look forward to its feedback on the consultation it undertook, because our overseas dentists are a rich source of the talent and skill that we need.

When it comes to getting more dentists into certain parts of the country—obviously, one of those areas is the south-west, whether that is Cornwall, Devon or Plymouth —significant work is going on. I met with Health Education England this morning to look at how we can set up centres for dental development. Those centres are different from dental schools, which are often very expensive and take a long time to set up, and, as was said during the debate, there are not always dentists available locally to supervise the training. Centres for dental development can be much more flexible and meet existing local needs while also looking at what needs could develop.

As such, we will be working up a programme, looking at what we can do in those specific parts of the country with the greatest need. In Norfolk, I recently met a group of local MPs and representatives from the local university and the local enterprise partnerships, all of whom are willing to work together to make that happen. I am going to Portsmouth on Monday, to Gosport, to see exactly the same thing—dentists coming together to come up with local solutions that will make a difference.

Anthony Mangnall Portrait Anthony Mangnall
- Hansard - - - Excerpts

I am grateful to the Minister for giving way, and I thank her for those words. Far from burying her head in the sand, she is putting her head above the parapet. That is most welcome. As mentioned by my right hon. Friends the Members for Ashford (Damian Green) and for South Holland and The Deepings (Sir John Hayes), there is clearly significant data that highlights the worst affected areas. Given that the data is there, could we expedite that roundtable meeting as quickly as possible?

Maria Caulfield Portrait Maria Caulfield
- Hansard - - - Excerpts

I am very happy to meet MPs. Once we get through the contract announcements before the end of recess, it has to be a priority to look at how we increase the number of dentists in specific parts of the country, whether in York or in coastal or rural areas. I am very willing to do that. Many parts of the country do have enough dentists, but they do not want to take on NHS work, so we are also going to look at the procurement and commissioning of services. That is where the ICSs will come into their own. At last, local commissioners will be accountable for commissioning dental work. There is no ring-fenced budget for dentistry. We spend about £3 billion a year and the work can be commissioned at a local level. The problem up until now is that no one has taken responsibility for that, so the ICSs will be a key change to make that happen.

Dan Poulter Portrait Dr Poulter
- Hansard - - - Excerpts

I want to clarify one point. Does my hon. Friend anticipate the new dental contract being a sticking plaster, or does she think that it is here to stay that it will put right these challenges?

There is a real problem with the commissioning of dental services. I am afraid that I do not have faith that ICSs will be a panacea to sort things out, because local CCGs, some of which were not good commissioners of a number of services, have simply been cut and pasted into the same posts on the ICSs. Will my hon. Friend reassure me that she will personally look at the commissioning process and hold those commissioners to account, to ensure that they deliver proper dental services?

Maria Caulfield Portrait Maria Caulfield
- Hansard - - - Excerpts

Absolutely. The whole point of the ICSs is that the commissioning service has not worked up until now. Some commissioners are very good at commissioning dental services, while others do not have anyone with dental experience on their boards and are not so good. ICSs will be accountable, which is the difference from what we have now. I will meet ICSs to ensure that they understand the responsibilities.

Maria Caulfield Portrait Maria Caulfield
- Hansard - - - Excerpts

I will take one last intervention, because I am conscious of the time.

Rachael Maskell Portrait Rachael Maskell
- Hansard - - - Excerpts

I am grateful to the Minister for giving way. When I wrote to her, she kindly replied and said that York could well be one of the areas for a centre of dental development. I would like to know the timescale for such considerations, and what progress has been made since our correspondence.

Maria Caulfield Portrait Maria Caulfield
- Hansard - - - Excerpts

I met Health Education England this morning and we are working through that system. I will be able to update the hon. Lady shortly, because I am keen that we make progress.

A number of Members mentioned prevention. The Health and Care Act 2022 includes provisions relating to fluoridation as standard, and we are working to make progress since it became law recently. We are also working with education colleagues on supervised toothbrushing. As we speak, some of the 75 family hubs that are being set up in the most deprived parts of the country as part of the Start4Life programme are looking at initiatives such as supervised toothbrushing. Where it is not happening at home or where parents need more support, we are ensuring that children are getting that toothbrushing experience.

On the subject of upskilling dental teams, this is about more than just dentists. My hon. Friend the Member for St Ives (Derek Thomas) made the key point that it is about the whole team. At the moment, part of the contract means that only dentists can do certain work. We need to change that. Centres for dental development will be about not just training dentists but upskilling whole teams.

I hope that I have reassured Members from across the House that we are taking this issue extremely seriously. To answer the question put by my hon. Friend the Member for St Ives, the contract changes that we are going to announce will not be the end of it, because there is more reform that we need to do. The Secretary of State is looking at a wider piece of work to provide a long-term, sustainable solution. We are happy to work with the other three nations if they have suggestions and solutions. We are not precious about sharing best practice.

I say to the shadow Minister, the hon. Member for Enfield North, that it would be good if she could come to a dental debate with some suggestions and solutions, rather than constantly criticising. We are determined to solve this issue and I appreciate the urgency that every single one of my colleagues has expressed today.

Rachael Maskell Portrait Rachael Maskell
- Hansard - - - Excerpts

I raised the issue of Ukrainian refugees. The Minister seemed to indicate that she had a response, so could she provide it before she closes?

Maria Caulfield Portrait Maria Caulfield
- Hansard - - - Excerpts

The response is that every overseas dentist, apart from those in the European economic area, currently has to take the overseas registration exam, and that is without exception. That is the work that we are trying to do with the General Dental Council. We are enabling those from Ukraine or Afghanistan, or any refugee from any country, to take part in that process. I am very keen to see mutual recognition with some countries. We are working on that and will enable the legislation to make it happen, but it will be for the regulator to decide; it is not a Government decision.

I hope that I have reassured colleagues that we are on this and appreciate the urgency. I have no doubt that we will return to this Chamber to debate this matter further in the coming weeks and months.

15:55
Derek Thomas Portrait Derek Thomas
- Hansard - - - Excerpts

First, I thank and commend the Minister for her response and for the way in which she has engaged with this subject since taking up her role. I have found her determination to get this matter right really refreshing, because this has been a long battle.

I thank all colleagues, from all parties, for their contributions and for going into things—not just the problem but the solution—in great detail. I will leave the shadow spokesperson, the hon. Member for Enfield North (Feryal Clark), out of that assessment, because I do not think that that came across from her at all.

I wish the Minister all success with trying to get a new NHS dental contract. We know that getting new contracts can be very tricky and fraught with problems, so I wish her the very best, on behalf of all of our constituents, who urgently need good dental care.

Question put and agreed to.

Resolved,

That this House has considered NHS dentistry in England.

15:57
Sitting suspended.