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Peter Aldous (Waveney) (Con)
I beg to move,
That this House is concerned by the growing crisis in NHS dentistry; notes that nine out of ten dental practices in England do not accept new NHS patients; regrets the number of dentists moving away from NHS practice; welcomes the Government’s commitment to levelling up health outcomes and dental health across the country; calls on the Government to take urgent steps to improve retention of NHS dentists and dental accessibility for patients; and further calls on the Government to report to the House on its progress on the steps it has taken to address the NHS dentistry crisis in three months’ time.
I thank the Backbench Business Committee for granting this debate, and the hon. Member for Bradford South (Judith Cummins) for her work in helping to secure it. I also highlight e-petition 564154, signed by 11,067 people, calling for an independent review of the NHS dental contract.
Colleagues have been securing debates on the state of NHS dentistry for the past two years. This crisis has been brewing for a long time, and the situation can be likened to that of a house built on shallow and poor foundations that has come crashing down with the earthquake of covid. The King’s Fund describes NHS dentistry as being on “life support”, while the British Dental Association describes it as undergoing a “slow death”. In its monthly report for October, Healthwatch repeats that NHS dental care continues to be one of the main issues it hears about from the public, who across the country are clamouring for NHS dentistry that is both affordable and accessible.
In Suffolk, there are 70 dental practices with NHS contracts, but not one is taking on new patients. Locally, there has been some welcome support in that, in Lowestoft, a local practice was granted additional units of dental activity that allowed it to see emergency patients until the end of September, and in July the Dental Design Studio was awarded a contract to deliver NHS dentistry for up to eight years. However, very quickly both practices were fully booked up and have had to turn away patients. There is a need for root and branch reform, and I shall briefly set out the issues that need to be included in a blueprint plan for NHS dentistry.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my hon. Friend on securing this debate. Would he agree with me that the fundamental problem with NHS dentistry at the moment is the 2006 contract and the units of dental activity? Does he share my disappointment at the statement made in the summer about how to resolve the situation based on the consultation launched last year, and furthermore, does he hope that UDAs will be expunged from all of this so that dentists can be properly rewarded for the job they do and thus return to the NHS?
Peter Aldous
I thank my right hon. Friend for that intervention, and I agree wholeheartedly with him on that point. I will come on to it as I set out what I believe needs to be done to improve the situation, but I think he and I are very much on the same page on that issue.
First, I will address the issue of funding. There is a need to secure a long-term funding stream. In recent years, the NHS dental budget has not kept up with inflation and population growth. Since 2008, NHS dentistry has faced cuts with no parallel elsewhere in the NHS, and the British Dental Association states that it will take £880 million per annum to restore the service to 2010 levels. I acknowledge the budgetary challenges that the Chancellor faces, but the reform process is doomed from the start without an appropriate level of investment. There is a need for a protected budget, and any funding that is clawed back must be kept in dentistry.
Secondly, a strategic approach should be adopted towards recruitment and retention, with a detailed workforce plan being put in place.
Jeff Smith (Manchester, Withington) (Lab)
I congratulate the hon. Member and my hon. Friend the Member for Bradford South (Judith Cummins) on securing this debate. There is a crisis in south Manchester and across the country in trying to access NHS dentists. There are highly trained dentists from abroad who can help. I have some constituents who were trained at the dental faculty of the University of Hong Kong, which is among the top three faculties in the world—it has an English curriculum—but they cannot get registered or access the licence exams. I understand that the Government have said they are going to simplify the registration process. Would he join me in urging the Government to act very quickly to make that happen?
Peter Aldous
I thank the hon. Gentleman for his intervention, which came at an appropriate time. Indeed, he may well have been reading my speech, because that was the next point I was coming to. In the short term, we need to be stepping up recruitment from abroad. Although the legislation tabled earlier this month to streamline the process of recognising overseas qualifications is welcome, that will not address the problem on its own, and I hope that when he responds to the debate, the Minister will address that issue. In the longer term, we must improve dentistry training ourselves and ensure that it is available throughout the country. In that regard, the proposals being worked up by the Universities of East Anglia and of Suffolk are to be welcomed.
Thirdly, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, there is a need for a new NHS dental contract. It is welcome that discussions have started on revising the contract, but there is a worry that the Government are looking only at marginal changes, when ultimately a completely new contract is required. At present, the NHS contract is driving dentists away from doing NHS work. Its target-based approach is soul destroying for so many, and it needs to be replaced with an agreement that has prevention at its core.
That leads me to the fourth and penultimate component of a new system of NHS dentistry: the public promotion of the importance of good oral health, and looking after our teeth from the cradle to the grave. Denplan proposes that the Government and NHS should lead a public education campaign to emphasise the importance of oral health. There should be provision in the aforementioned new contract for dentists to go into schools, as well as into care and nursing homes. When economic conditions allow, let us be imaginative and exempt children’s toothbrushes and toothpaste from VAT. That can embed good oral healthcare at an early stage of life. It is welcome that the Health and Care Act 2022 facilitates the roll-out of water fluoridation projects, and the Government should work proactively with water companies to ensure that is universal.
Finally, there is a need for clear transparency and full local accountability for overseeing and commissioning NHS dentistry services. I acknowledge the hard work and great effort of those working at NHS England, but we need to replace a system that is inaccessible, opaque, and confusing. The Health and Care Act provides us with the means of doing that, and it is welcome that from next April, many integrated care systems will be taking on responsibility for local NHS dentistry. That is the right approach, as good oral healthcare is essential for good general health and wellbeing, and inextricably linked to primary, mental and emergency care. It is vital that those involved in dentistry are represented on integrated care boards.
Across the country there are a multitude of dental deserts. If we do nothing, if we apply the odd sticking plaster here and there, those will turn into one large Sahara. We owe it to those we represent to ensure that does not happen. That means that we need as a matter of urgency a blueprint plan for new NHS dentistry. That will not be delivered in one fell swoop, but we need clearly to lay down the route path and start taking meaningful strides down it. With that in mind, the motion calls on the Government to embark on that journey and report back on their progress in three months’ time.
Several hon. Members rose—
Madam Deputy Speaker (Dame Rosie Winterton)
Order. As colleagues will see, there is substantial interest in this debate. I do not want to put on a time limit, but I suggest that contributions are confined to about 10 minutes.
Sir George Howarth (Knowsley) (Lab)
May I, too, express my gratitude to the Backbench Business Committee for the opportunity to debate this important matter today?
On 22 September, during a statement by the Health and Social Care Secretary, I raised these problems on behalf of the people of Knowsley and the Liverpool city region, and described the experiences they are having. I cited BBC research that showed that, to use the Secretary of State’s own term, Liverpool city region is a “dental desert”, with not one dental practice taking on NHS patients. In response, she said that she had
“set out in the plan today what we are seeking to do with dentists. First of all, it is the role of the local NHS—the ICB—to take responsibility for such provision, and I expect it to do so.”—[Official Report, 22 September 2022; Vol. 719, c. 839.]
Earlier this week, my office carried out a survey of dental practices in Knowsley to measure what, if any, progress had been made since that exchange. We found that, of the 13 dental practices in Knowsley, it is still the case that none—I repeat, none—is accepting new NHS adult patients, and only two are accepting children under the age of 18. I am therefore bound to conclude that no progress has been made in the ensuing weeks.
Also on 22 September, I urged the Secretary of State to take measures in the short, medium and long term to address this disgraceful situation. Since then, the British Dental Association has pointed out that
“the Government needs to show real ambition to bring NHS dentistry back from the brink.”
Although the new Administration—goodness knows there will be another new Administration shortly—has placed dentistry as a top ABCD—ambulances, backlogs, care, doctors and dentists—priority, no new proposals have been made
“to halt the exodus of dentists from the NHS”
to care for patients. Moreover, the British Dental Association points out that the key issues of contract referral, chronic underfunding and growing oral inequalities have yet to be addressed. This is not just a matter of cosmetic treatment, important though that may be in many cases. As the association pointed out, this is also about how to spot oral cancer earlier, which is one of the fastest rising types of cancer and claims more lives than car accidents. That is a particular concern for Knowsley. As the British Dental Association went on to say:
“People in the most deprived communities are significantly more likely to die from it than those in more affluent areas.”
Our dentists are in many cases the first medical professionals to detect cases. Access to NHS dental treatment can in such cases be the difference between life and death. Knowsley is one of the most deprived boroughs in the country and it is consequently in a very vulnerable position regarding the early detection of oral cancer.
The motion contains good points that I would happily endorse, but I am concerned that in terms of specific actions it calls for a progress report in three months’ time. My concern—I do not make this point to be at all mischievous—is that I do not know, and nobody in the House will be able to tell me, who is likely to be the next Secretary of State for Health and Social Care, and whether they will have a different strategy on NHS dental care. So we need something to be done more speedily. The Government have to take responsibility for the current turmoil, but the fact is that there is so much uncertainty and such issues are simply not being dealt with.
The motion does not address what the Government could be doing in the short term to alleviate the problems confronting people in Knowsley and elsewhere. I have two suggestions on short-term action that could and should be taken. First, I urge the Secretary of State to introduce a procedure to enable those in need of urgent NHS dental treatment to be referred to a suitable dental practice, preferably locally. My constituency office recently dealt with the case of an 18-year-old constituent who needed urgent root canal treatment on two front teeth, which she was unable to afford. The problem was exacerbating an existing mental health problem. Since she was in constant pain and probably barely able to eat and drink, I contacted NHS North West. I am grateful that it was able to make arrangements for her to receive the treatment she needed at a local dental practice. I suggest that that approach, which I just happened to stumble across, should be added as a matter of urgency for those in need of urgent dental treatment.
Secondly, I am aware that many NHS patients have been culled by dental practices, often on the basis that they were not making use of the service on a regular enough basis. I cannot give accurate figures for Knowsley, but I suspect that thousands of people are former NHS patients. However, no appeal process is available to such patients, who have just been struck off and there is nothing that they can do about it, other than pay to be treated privately. I am aware of one case involving a Knowsley resident who, as a result of extremely debilitating, extended cancer treatment, was unable to contemplate much-needed dental treatment. When he felt strong enough to do so, however, he tried to make an appointment as an NHS patient, only to discover that he had been struck off the list.
My second short-term suggestion is therefore to urge the Secretary of State to institute an appeal process whereby such patients could apply to NHS England in order for it to prevail on the medical practice concerned to reinstate NHS patients who had good reasons for not being able to visit the dentist during lockdown, or who could not do so for medical reasons, such as those I have referred to. On the medium term and longer term, and the national problems to which I referred, I simply urge Ministers to enter into meaningful discussions with the British Dental Association to help to resolve the issues that I are so bedevilling NHS dental services nationally.
I hope that Ministers will accept that I have tried in my approach to deal with this important matter as constructively as I can. I sincerely hope that they will respond in a similar way and try to help to resolve the short-term problems that my constituents are experiencing in ways that can be easily implemented.
Sir Paul Beresford (Mole Valley) (Con)
First, I must congratulate my hon. Friend the Member for Waveney (Peter Aldous). This is the second time that I have heard him pronounce on NHS dentistry—I think he has done it more often than that—and he is becoming something of an expert. I wonder whether the British Dental Association might give him an honorary medal or something for that. I also have an interest—a very part-time interest—that means that I have to speak on this; otherwise, the profession would ask me what the heck I was doing. I welcome my hon. Friend the Minister to the Government Front Bench to become our voice on dentists and dentistry. It might not last as long as he anticipated a few days ago, but it is a dubious honour and one in which he will find many friends and many on the other side of the argument.
The problem we face is that there are not enough dentists. Many suggestions will come from the debate, so I will just skip through a few. The problem is not so much that there are not enough dentists—there are not enough dentists prepared to do NHS dentistry. That has been exacerbated by covid, but it is far from new. It has been a problem to a greater or lesser degree for more than five decades. I arrived in this country in 1970, produced my certificate from my university in New Zealand, got it rubber-stamped by the General Dental Council and went straight into business. I cannot see why we cannot do that now. I was one of a stream of New Zealand and Australian doctors and dentists. Once we moved into the common market, that stream was shut off.
The practice of dentistry is complex and intricate if it is done properly. A small group of members of the all-party parliamentary group for dentistry and oral health recently visited King’s College dental school. I think it was enlightening for many to discover how complex and difficult dentistry is. The staff provided our members with a high-speed drill with a tungsten carbide bit and virtual molars. It is just as well that they were virtual molars—I have never seen so much tooth destruction in my life.
As I said, the problem has been exacerbated by the covid backlog, and that will be with us for some time, but we are—I hope—looking at the long term and the short term. I will touch on the short term. Some with dental interests such as the organisation My Dentist are campaigning to increase the number of NHS dentists and other groups providing facilities, surgeries and so on. But there are—I hope that the Minister is aware of this—many dental firms working hard to pull dentists out of the NHS and into the private sector.
As has been said, we must maximise the output from our dental schools. I am sure this has been done. I have heard calls for new dental schools; we have heard one today. Dental schools are enormously expensive organisations to build, stock and run. I was just in New Zealand, where there is a new school on the same site as the old one. It is fantastic, but it took years to build, stock and run it. A new school probably takes two to four years to set up and then it is four to five years before the graduates emerge. As with how a person gets their driving licence and then learns to drive, a dentist gets their certificate from the school and then starts to learn dentistry. In the short term, it would be faster and more productive if the General Dental Council were given the ability to enable overseas dentists with good English from competent overseas dental schools to enter the United Kingdom as practising dentists, without having to go through the insulting rigmarole and costs of further exams. It is an insult to most people from most of the top university dental schools to have to sit examinations here when the competence of their own schools is at least as good as those here. It would take only a small movement to enable that to happen.
A large-ish number of elderly-ish dentists who are about to retire have pulled out of dentistry because of the bureaucratic overload. Many have retired because of the strain of the job. The regulatory strictures of the Care Quality Commission in particular have added to that. Of course, that applies to small practices. The CQC is necessary. We must have it, but its extensive, detailed, time-consuming form filling has been the final straw for many dentists, especially those in small practices. Many have just retired in disgust. For my tiny part-time practice, I pay an independent company £150 a month to help me ensure all regulations are met and documented as met. It is time-consuming, expensive and unnecessary. I would therefore rather like to see an opportunity for the GDC, with outside help, to look at the bureaucratic requirement and consider whether it could ease and reduce the strain on practitioners. When it has finished with that for the dentists, it could also start looking at how hospitals and medical surgeries are treated.
Negotiations on the revision of the contract have been mentioned. It is a massive gripe among the profession in England, because of the use of the semi-mythological coinage called “units of dental activity”. They are a mythical thing. How many dentists get them to actually come together and work, and balance them so they are fair, is beyond me. Negotiations on the revision of the contract have been going on for many years. There have been many trials and heaps of tribulations. Over the past decades, dentistry has moved forward. Materials and techniques have been developed and adopted. The service available on the NHS dental menu has enlarged with that, but I question that some items on the menu are not strictly health, especially when alternatives are an option and would ease the strain on NHS dentists. If we accept that there is an NHS dental emergency, then I suggest the Government, for a short period of time, run a simple separate contract on a reduced NHS menu of strictly dental health items. A simple fee per item would remove arguments about those mythical units of dental activity. A simple contract could specifically target the NHS patients looking for a check-up and simple dental health care, particularly if it involves pain relief. At the same time, we ought to accept, because of the change in the nature of dentistry, that mixed private and NHS services are here to stay and should be encouraged, as that actually helps the NHS service.
Finally, on two really positive points, one has already been mentioned and that is teaching children, even little children, how to brush their teeth. When I first came here, I spent a lot of time in east London. When I mentioned a toothbrush, the blank stares made it quite apparent that they just did not have a toothbrush, let alone use one. The excitement, in the schools that I and other dentists have been into, of little children with toothbrushes and toothpaste is really worth watching. And the mess is phenomenal!
My final point is on fluoridation. We have now got to the stage where we can install fluoridation in our water supplies. We are an absolute disgrace in the western world. Much of the western world has 60%, 70% or 80% of their water supplies fluoridated, while we have 10%. The obstructions have been taken away and I ask the Minister to rapidly move forward with that. The payback period will be obvious after about two years and will make a tremendous difference, along with toothbrushing, as it progresses. We can be a nation with some of the best teeth in the world if we have 100% fluoride and if we teach every child, “This is a toothbrush and this is toothpaste—get on with it!”
Judith Cummins (Bradford South) (Lab)
I thank the Backbench Business Committee for granting this important debate and I thank my co-sponsor, or co-conspirator, the hon. Member for Waveney (Peter Aldous).
If you might indulge me this once, Madam Deputy Speaker, I did, in preparing for this debate, look up my past remarks on this issue; a sort of compendium of forecasting doom for NHS dentistry that, as it turns out, is entirely accurate. As we have heard, Members from across the House and across the country are raising concerns on behalf of constituents who are simply unable to access an NHS dentist. The current system remains unfit for purpose. Recent BBC research found that in the south-west, the north-west and Yorkshire and the Humber, just 2% of dental practices were taking on NHS patients.
Peter Dowd (Bootle) (Lab)
Is my hon. Friend aware that not a single dental practice in either the current former Prime Minister’s constituency or the Health Secretary’s constituency is accepting new NHS patients? Should it not spur on the Government that the former Prime Minister’s constituents and the current Health Secretary’s constituents cannot get access to NHS dentistry?
Judith Cummins
I am indeed aware of that fact, as my hon. Friend the Member for Bolton South East (Yasmin Qureshi) raised it with me yesterday. Sadly, she cannot be here today to make that very point, so I thank my hon. Friend for doing so.
In Bradford, 98% of dentists are closed to NHS patients, forcing people to go either to accident and emergency or to go private, whether they can afford to or not, often taking out a payment plan because they do not have the luxury of an NHS dentist available to them. In Bradford, 16% of three-year-olds and over a third of five-year-olds are now suffering with visible signs of tooth decay. In Yorkshire and the Humber, over 2,700 children under 10 had teeth extracted in hospital between 2020 and 2021. In fact, children born in Bradford are eight times more likely to be admitted to hospital with dental decay before their sixth birthday than if they were born in the former Prime Minister’s region. The truth is that NHS dentistry in its current form is just not working anywhere for anyone.
How did we get to this position? The answer is threefold: a contract not fit for purpose, dramatic underfunding and an exodus out of the NHS workforce. During my time in this place, Minister after Minister after Minister has stood here accepting that fundamental reform of the contract is needed. And yet we are still waiting. After years of delay, the Government announced in July some small contract changes, but unfortunately those quick wins completely failed on the fundamentals. NHS dentists in my constituency tell me that the financial uplifts are minor to the point of insignificance. The Government are conducting a polish and a clean when what is needed is root canal treatment. Will the Minister tell us exactly why the Government have not delivered the long-awaited full-scale contract reforms? Is it still their intention to conduct those reforms? If so, when can we expect them? If not, why not?
It is important to put on the record that the issue here is not a shortage of dentists. The number of registered dentists is at a record high. We have the dentists, but they are working in private practice. Until the Government fix the problems with the contract, which sees highly qualified and experienced dentists squeezed out of the system, they are simply pouring water into a bucket with a giant hole at the bottom of it.
My next point is on funding cuts. We saw funding to NHS dentistry fall by around a third in real terms over the last decade and that was before the cost of living crisis. In January, the Government announced a £50 million catch-up fund for dentistry, funded from clawback, that gave practices three months to offer urgent care appointments to deal with the pandemic backlog. I warned the Government at the time that their strategy was flawed and that the funding to tackle the covid backlog would prove to be unusable and the system unworkable. ITV recently revealed that approximately £14 million of the promised £50 million was actually spent. That is just 28% of the funding allocated, which delivered only 18% of the 350,000 appointments it was meant to. In Yorkshire and the Humber, my region, only 16% of the allocated funding was actually spent. The shortfall was clawed back by the Government once again and not reinvested back into dentistry in my region. That is less than a third of the money spent, not because it is not needed, but because the Government set up a system that was unworkable.
We need targeted funding to address an acute problem in areas of high need. The successful Bradford project that I developed with former Ministers back in 2017 really worked. It was a transformative project that meant we got 4,200 extra NHS dental appointments for people who had not had a dentist appointment for over two years. In the long term, however, we need fundamental change, and a comprehensive reform of the contract to push prevention is absolutely critical to that reform. Good oral health must not be restricted by either postcode or wealth. Going to A&E cannot be an alternative to NHS dentistry.
Although I welcome the Minister to his new role and, indeed, welcome the Secretary of State’s new emphasis on dentistry in her ABCD of priorities, whoever the Secretary of State is, in whatever Government, they should learn the lessons of targeting and invest in NHS dentistry, as prevention really is better than the cure. We simply cannot go on like this. The public are fed up to the back teeth with inaction and excuses.
John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)
The dental services that my constituents use are the responsibility of the Scottish Government in Edinburgh. My comments will focus on the challenges that we face in Scotland in accessing NHS dentistry.
I begin by thanking the dentists in my constituency, who are doing the best they can and working hard to provide essential services for people across the Scottish Borders. There is no doubt, however, that dentists, dental staff and medical professionals are hamstrung in their ability to meet the needs of every constituent because of the lack of support and help they get from the Scottish National party Government in Edinburgh. Although the SNP would like to pretend otherwise to deflect from their failures, Scotland’s NHS is devolved and is the sole responsibility of the SNP Government in Holyrood.
However, instead of focusing on improving waiting times in Scotland’s NHS for dentists and GPs, the SNP Government are again distracted by their endless obsession. They are again banging on about another referendum when people across the Scottish Borders and across Scotland want the focus to be on their everyday needs. Whether we are talking about nationalists or Unionists, the SNP or Scottish Conservatives, would it not be better for everybody if the Scottish Government’s No. 1 priority was to deliver better public services for the people across Scotland? We know that that will not happen with the SNP. Its first, last and only real priority is another referendum to break up the United Kingdom, as it proved again this week.
If SNP Members were here to represent the SNP, I would tell them that those who talk about division all the time are letting down my constituents. They fail my constituents across the Scottish Borders every day and every week. One constituent wrote to me recently about the lack of emergency care on weekends. While in pain and clearly in need of help, they were told to go to the shops and buy a temporary filling repair. If any Members were here to represent the SNP, I would ask them to tell me how that person is helped by another independence referendum when the SNP Government are failing to deliver for them right now.
Another patient wrote to me about the closure of dental services in Berwick-upon-Tweed just across the border. As a result of the lack of local services, she was not offered a spot for treatment nearby in the Scottish Borders. She was told that the only dentist available was miles and miles away. It was far too far away for her to travel there. That is another direct result of the SNP Government in Edinburgh not understanding the needs of local people in the Scottish Borders and rural areas across Scotland.
My constituents should be able to see a dentist in person when they need help. Local people in the Scottish Borders deserve the same access to the NHS that people in the rest of Scotland and the United Kingdom receive. Despite the best efforts of healthcare staff, that is simply not happening. Too often, the needs of people in the Scottish Borders have been overlooked by the SNP Government in Holyrood. So I would ask SNP Members, if they were here—I add again, for the Hansard record, that they are not—how the flimsy economic plan for independence revealed this week helps my constituents get access to the health services they need.
Another constituent wrote to me about her two-year-old son, who has not been able to see a dentist since he was born. The next time the SNP is making big, overblown promises about the future of Scotland, why does it not try delivering for future generations of Scottish people by doing the day job and providing the basic services that people need?
The SNP Health Secretary, Humza Yousaf, is completely failing to deliver for Scotland. Recent statistics revealed that one in four people in Scotland have tried and failed to get a dental appointment over the past year. In rural areas, the problem is even more acute. Access to the NHS is a big problem for local people in the Scottish Borders. It is time that the SNP recognised that, accepted responsibility for its failures and got a grip on the situation. To conclude, will the UK Health Minister engage with colleagues in the Scottish Government to ensure that my constituents are given the best support possible to access the dental services they deserve?
Kate Hollern (Blackburn) (Lab)
I share the concern of the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins), who tabled the motion. Many of my constituents in Blackburn are at the sharp end of this crisis, because there are currently no practices accepting new NHS patients in Blackburn or Darwen and families are facing the consequences. Children end up in hospital because they cannot get the dental treatment that they need. Between 2020 and last year, 135 children under 10 were admitted to hospital for tooth extraction. That is an appalling state of affairs. Constituents in Blackburn and many around the country are being forced into DIY dentistry.
Although we are here to discuss NHS dentistry, Members will be painfully aware that these sorts of fires are burning throughout primary care and throughout our health system. The workforce and access inequalities are driving health inequalities between the regions. The Government have let the problem get out of hand, because they cannot introduce a serious workforce plan to ensure that we have the staff we need to treat patients on time.
A recent briefing from BUPA stated:
“There is a lack of data about the dental workforce to inform a clear, centrally driven plan focused on improving recruitment and retention…the registers of the General Dental Council only list dental practitioners, but not whether they are practicing.”
It is important to have meaningful data so that we can start making the plan to deliver the dentists that this country needs.
A constituent of mine, who works for the NHS, said that she is
“expected to provide a minimum standard of care to all patients”—
and asked:
“Where is the support for dentists to provide the same?”
She asked me to ask the Minister: where is the additional support to train and retain NHS dentists, especially for areas in the north—such as Blackburn—to which it is traditionally hard to recruit?
The Minister needs to publish the Government’s health and social care workforce plan as soon as possible. It needs to account for how communities in places such as Blackburn are often under-served by the primary care system. Dentists, like GPs, often want to practise and work in more urban communities. It is important that the right incentives are delivered to get them practising and staying in the most under-served communities, like Blackburn.
Richard Graham (Gloucester) (Con)
This is the first debate for a long time in which I have agreed with every single word of the motion, so I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins). Frankly, we and all our constituents are concerned about the growing crisis in NHS dentistry. We are worried that nine out of 10 practices are not accepting new NHS patients, including large numbers of children. We also regret the number of dentists who are moving away from NHS practice. Those are all issues to which all hon. Members could strongly relate, if they were here.
I have been asking myself how the problem came to be and what can be done. First, it strikes me that there is a wider issue with the delivery of public services. Governments will always be judged on the same things: whether they can achieve economic growth to provide jobs and fund public services; whether they can manage those public services competently; and whether they can do so with compassion so that our most vulnerable constituents are looked after. In the health and care sector as a whole, there is no doubt that there are significant challenges in all three aspects. Dentistry is just one aspect of the effective delivery of public services, an issue that we all recognise from emails and telephone calls with often very frustrated constituents.
However, there is a particular aspect of dentistry that is unique. With acute hospitals, mental health services, ambulance trusts and so on, MPs have some agency: we can organise regular meetings with NHS trusts, hold them to account, ask difficult questions, discuss problems and find out what they need from the Government. With dentistry we have no agency, because the local NHS organisations—they are currently known as integrated care systems, but frankly in most of our constituencies it is easier to refer to them as the local NHS—have no agency. They have no say in the contracts between NHS England and the dentists.
As my hon. Friend the Member for Mole Valley (Sir Paul Beresford) helpfully pointed out, the contracts go back to 2006. Most of us have no idea what is in them. I have never seen them; I was not aware of them. No dental association, nationally or locally, has ever contacted me—or, I suspect, many of us—to say that there is a problem that needs to be resolved or to ask for help. The first we hear of it is when constituents contact us to say, “I cannot get an NHS dental appointment for myself, my children or my family.” At that stage, we go back to the local dentists and ask what the problem is.
This is what a local dentist in Gloucester has come back with:
“The majority of dentists move away from the NHS because of the continual pressures that the NHS contract places upon them in terms of requirements, payments, audits…and many other factors”.
She writes that an NHS dentist in her surgery, who has ceased to be an NHS dentist,
“was under a prototype contract that was patient-centric and when this was discontinued and changed to align with the usual NHS contract, the dentist did not feel this gave the best type of care for patients”.
She goes on to say:
“I’ve continually battled”—
she has been doing this for 25 years, by the way—
“to ensure that any patients who want NHS dental services should be able to access them, but there needs to be correct remuneration for the time and quality of services, removing a treadmill of patient care.”
That suggests that there is a problem with the contract, as my hon. Friend the Member for Waveney rightly says, as well as the problem of there being no local NHS involvement.
I welcome the Minister to his role. I know that he will bring to it the same quality of analysis and compassion that he brought to his role in the Department for Work and Pensions. I hope that he will look closely at how the contracts can and should be changed—I believe that there is a window of opportunity in April—to allow all local NHS organisations to play a key role in the distribution of resources, emphasis, recruitment and so on. We will then finally have some agency, so we can do better than replying to our constituents with “I am very sorry to hear this, but there is absolutely nothing I can do,” which frankly is more or less the situation at the moment.
Several colleagues have helpfully indicated solutions beyond the contract. I agree with the point about making it far easier for dentists, whether they come from the nations of the Commonwealth, such as New Zealand and Australia—mentioned by my hon. Friend the Member for Mole Valley—or from India or Hong Kong, which is another example that was given earlier. The Government clearly have an opportunity to do something about this if they wish, not just in the short term but in the longer term, and I hope the Minister will give us some good news in that regard.
There is also the issue of skills and training. Setting up a new dental school, first, takes time; secondly, is expensive; and thirdly, will not solve short-term problems, although we do need to look at capacity for the longer term. There is a continuing problem with longer-term thinking—in the context of public services, and indeed in other contexts—to which all Governments have been susceptible for too long.
The private sector certainly has a role to play. At the risk of plugging a particular organisation, I will mention an organisation of which I think the Minister will be aware: Genix, which has a training facility in Leeds. Its founder and CEO, Mustafa Mohammed, has a strong track record of supporting the whole business of upskilling and training dentists and providing NHS dentistry services around the country. Let me reassure my constituents and others who feel that dentistry is an entirely public-sector activity by saying that just as the private sector, through GP surgeries, plays such an important part in, for example, the delivery of covid vaccinations, it can play an important part in dentistry as well.
There is, in fact, a role for a mixed economy, and, as was pointed out earlier, there is an opportunity for some short-term contracts. Perhaps the Department could step in directly, with NHS England, to provide relief for those in pain and for those with children who may never have seen a dentist in their short lives. I am sure we would all welcome that.
That leads me to the question of what some term the nanny state—the role of education and proselytising about the value, particularly for young families, of getting stuck in with toothpaste and toothbrushes, and, perhaps, the opportunity to relieve them of VAT. We know that, just as with education, if things start well there is a strong likelihood that they will continue well, whereas if they start badly and people’s teeth do not get the treatment they need at an early stage, there will be problems later. I believe that the Government have an opportunity to play a part in this, although not uniquely, for everyone can play a part; and I hope the Minister will allude to that as well when he winds up the debate.
Let me finally say that dentistry clearly needs to be represented in local NHS bodies—especially if they are actually going to play a role in it, which I very much hope they will—and that cash will be crucial. Nothing comes cheaply, but I think we can all agree that sorting out dentistry and making sure everyone has access to NHS dentists is a very precious cause, and we all hope we will find solutions fast.
Wera Hobhouse (Bath) (LD)
I have been horrified—honestly horrified—to hear reports of people pulling out their own teeth because they are unable to see a dentist. Unfortunately, that is now a reality as a result of Government underfunding of dentistry over many years. In my constituency, only three in 10 patients have seen an NHS dentist in the past two years and only six in 10 children have been able to see a dentist in the past 12 months, although the NHS continues to recommend that all under-18s see a dentist at least once a year.
The way in which the Government have let the NHS dentistry system collapse is a national scandal. Nearly a quarter of all British people have failed to secure a local NHS dentist appointment in the last year. Of those, one in five have resorted to what we now call DIY dentistry, which is terrible. Our public services are so starved of funding that people are being forced to stop trying, or to pay for private treatment. The British Dental Association says that we are facing an “existential threat”. People’s health is at risk if they do not have access to dentistry. Tooth decay is the No. 1 reason for hospital admissions among young children. Oral cancer is one of the fastest-rising types of cancer, and claims more lives than car accidents in the UK: we should remember that.
People in deprived communities are the most likely to suffer. Healthwatch research shows that those on lower incomes are worst hit by appointments shortages. The problem has been made worse by the pandemic, which increased the backlog, but the problem was there before. Limited access to such primary care means that problems cannot be caught early. People should not be facing a choice between being left in pain and paying for private care as we head into this difficult winter. We must do all we can to make sure that they can access the right services and that we address these profound health inequalities.
One of the major reasons for the backlog is staff shortages in the NHS. The number of NHS dentists is falling: one in eight is approaching retirement and 14% are close to leaving the profession. My constituents have been particularly affected: nearly 15% of dentists have been lost from Bath clinical commissioning group since 2016. At a time when demand for NHS services is increasing, we urgently need a strategy to plug these very big staffing gaps.
The Government admit that they do not know how many dental practices applied to access the extra £50 million of funding announced earlier this year. To me, that means that they are asleep at the wheel. The Government must make sure that we have enough dentists if support for the sector is to be effective. We need increased numbers of dentist training places in the UK and continued recognition of EU trained dentists’ qualifications. Dentists must be incentivised to take NHS payments and there needs to be more funding for the sector to meet patient demand. Everyone in the UK should be able to access a dental health check-up on the NHS. Proper workforce planning for health and social care must be written into law, including projections for dentists and dental staff.
The crisis facing NHS dentistry is on an unprecedented scale. Although it has been worsened by the pandemic, the emergency is not new. Most importantly—I am repeating what many have said this afternoon—the Government must reform the NHS dental contracts, which create absurd disincentives for dentists taking on new NHS patients. A review was promised earlier this year. Where is it? Oral health cannot be treated as an afterthought and my constituents cannot wait any longer.
John Glen (Salisbury) (Con)
I rise to speak on behalf of a number of dentists in my constituency. Nicola Jones, an oral surgeon at Salisbury District Hospital, contacted me to say that the lack of available NHS dentists is causing significant challenges in the constituency. I recognise that from my mailbox over recent weeks. I met Matthew Clover, a specialist orthodontic practitioner, in February. He took me through the challenges of the “units of dental activity” model: it does not discriminate properly when it comes to the classification of the different activities that he has to undertake.
The challenges derive primarily from the lockdown two years ago and the interruption to supply: 38 million appointments were lost. I welcome the Government intervention earlier this year to provide the additional £50 million and 350,000 additional dental appointments. I also welcome the Government’s statement in July, but this is an opportunity for the new Minister to challenge his officials and work with industry representatives to find a deeper and more enduring set of changes that address some of the ongoing challenges that have existed for a very long time.
I would not suggest that I have anything like the expertise of my hon. Friend the Member for Waveney (Peter Aldous), the hon. Member for Bradford South (Judith Cummins) or, particularly, my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who has a lifetime of experience at policy level and as a practitioner. But I am aware that since 1951 there has been a model of co-payments, in which dentists act as independently contracted professionals to the NHS but also typically receive an income from private practice work as well.
Wera Hobhouse
The hon. Gentleman makes a very good point that, basically, private patients have been cross-financing NHS patients, but that model is no longer sustainable.
John Glen
I respectfully say to the hon. Lady that my mother is a resident of Bath and has received excellent service from her NHS dentist. Although I recognise this problem exists in different spots of intensity across the country, it needs a comprehensive solution.
The fundamental point is this: how can the model of rewarding dentists incentivise the maximum amount of engagement? All dentists start their professional life wanting to help people and wanting to do as much good as they can. I totally embrace what my hon. Friends the Members for Mole Valley and for Gloucester (Richard Graham) said about the need to deal with the oral health and education of young people, including how to clean their teeth at an early age. There will need to be a focus on how those practices can be embedded in a funding model that has to pay some respect to the geographic coverage of a dentist, while ensuring that each cohort of the population has access to basic dentistry.
The proposed new dental contract goes some way towards dealing with some of the challenges of the UDA model, but it probably does not go far enough. I urge the Minister to go beyond what his officials may be suggesting to him, to think radically and to take this opportunity to ask, “How can we reset after the dislocations caused by covid?” I urge him to come up with something that incentivises dentists to offer an holistic service to people of all means and to help those communities that have cold spots of dentistry supply.
I would like to make a few observations about supply and, again, my hon. Friend the Member for Mole Valley made some very good points about streamlining bureaucracy to ensure more people qualify as dentists in this country. Of course, it is right that we have ongoing quality assessments through the CQC, but that organisation’s focus, as across all industries, needs to be on where there are vulnerabilities and risks. When we think about NHS medical and dental services, I feel we are continually trying to be perfect and to remove all the risk, which sometimes has a cost because it involves using resources to fill in bureaucratic processes that might not necessarily, in most cases, give us much return.
My message to the new Minister is to build on the good start made by his predecessor in the summer, but to consider a more radical and fundamental review of the UDA funding model, to consider the volume of patients and to consider the real dynamics of the choices a dentist makes about how to maximise the number of patients they see who cannot afford to make a contribution.
I feel hopeful that the enthusiasm to provide the service I saw from my dentist in Salisbury means there will be a solution. I wish the Minister well, and I acknowledge the contribution of my hon. Friend the Member for Waveney, who showed a mastery of this subject.
Peter Dowd (Bootle) (Lab)
Where are we to begin with this? We have been here before, time after time. I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for bringing us this debate. We have discussed this many times and we had a debate in Westminster Hall in the summer, but nothing has really moved on. Nothing at all seems to have changed.
I want to read out part of a letter I received from a constituent, and this is typical of the problem we are facing. I have received even worse horror stories, to the extent that one local dentist told me that they may close in the next few weeks. That is typical and symptomatic of this bigger problem. My constituent said:
“I wanted to take the time to get in touch with you over my experience of getting on the books for an NHS dentist. I have had no luck and have had to have private dental visits. I have luckily not had to have any treatment as I would not be able to afford it. I have reached out to a few dental practices in the area…to be told that they are only taking on children on the NHS.”
That is typical of the experience of everyone in this Chamber. I exhort Conservative Members to stop dealing with this in the abstract, as though it is only affecting individual Members of Parliament; it is a collective issue, and it needs a thorough review and a thorough push by the Government. It is not in the abstract. The hon. Member for Salisbury (John Glen) referred to covid. I completely accept that covid had an impact on the provision of dental services—it hothoused an already challenging situation—but dental services in all our constituencies were under huge pressure before covid. Let us not pretend that covid was the be all and end all of the dental health problem.
Sir John Hayes (South Holland and The Deepings) (Con)
I agree with the hon. Gentleman that there are systemic problems, part of which goes back to the contracts agreed with dentists donkey’s years ago, under the Labour Government—the same applies in respect of GPs. That genesis of the problem was there, but we then face the problem of training too few dentists, which I think we do, and the problems in particular parts of the country, including, Lincolnshire, which is among the worst affected. My constituents cannot get an NHS dentist and they need to have one. That particularly applies to young people and children. He is absolutely right on this.
Peter Dowd
I am grateful to the right hon. Gentleman, who reinforces the point that I am trying to make. We are being contacted by constituents, as I have just set out. We are being contacted by Bupa—I suspect that Members will have had a briefing. We have had a briefing from the British Dental Association. We have had contact directly from dentists. They are all saying exactly the same thing and the Government have to listen. Not only do they have to listen—it is dead easy to do that—but they have to act. The Government have to put their hand in their pocket. So let us stop pretending that £50 million just before the summer is going to do anything in any significant or substantive way to resolve this problem—it is not.
The hon. Member for Bath (Wera Hobhouse) referred to an existential threat, and there is one—dentists are telling us that, as is the BDA. In practical terms our constituents are saying that to us, because their experience shows that there is an existential threat. The contract is a discredited one and it needs to be put right; it puts targets ahead of patient care. But this is also down to the fact that, whether we like it or not, and whether the Government like it or not, cuts in dentistry have not had any parallel to any other cuts in healthcare. We are talking about cuts of more than 25% between 2010 and 2020. That factors in and it creeps up on us year after year until we get to the situation where access to dentistry is the No. 1 issue raised with Healthwatch.
Wera Hobhouse
I was pleased to hear that the mother of the hon. Member for Salisbury (John Glen) has had excellent NHS dental care in Bath, and of course dentists are excellent practitioners and professionals. The thing is that his mother will have been a long-term NHS patient and the problem is that dentists do not take on new NHS patients, because the dental contract completely disincentivises them to do so.
Peter Dowd
That is a point well made. Another factor is that there are deep inequalities in access to dentistry. In my constituency, it is difficult to get to see an NHS dentist for love or money. I am not blaming the dentists; they are doing a fantastic job in the circumstances. They are going over and above their duty. I put on the record my thanks—as I am sure we all would—to my dentist practice, which I have been with for over 45 years. Dentists are doing a fantastic job, but they have both their hands tied behind their back at the moment. That has to change.
Some 91% of people, including 80% of children, are not able to access a dentist, and 75% of dentists are reducing their NHS engagement. The new contract announced before the summer did not really do anything and there was no new money with it. There is a significant gap—potentially as much as £750 million—in the resources that dentists need.
Another aspect is dentists’ morale, with 87% having experienced stress, burnout or depression in the last 12 months. That is a dreadful situation to put a committed profession in. We have a scenario in our country in which dentists who trained for seven or eight years—possibly more—and practised for many years are now getting to the stage where the majority are stressed, burned out or depressed. That is dreadful. According to one study, half of them are considering changing career. Some of them are seeking early retirement or going fully private. They are getting stressed out because they just cannot move the dial. They are waiting for the Government to move it, but the Government are not moving it.
Children in my constituency are three times more likely to have their teeth extracted in a hospital because they do not have access to a dentist. My right hon. Friend the Member for Knowsley (Sir George Howarth) and the hon. Member for Bath referred to oral cancer. That is identified very early on—and who does the identification? Surprise: it is often the dentist. We need substantive support from the Government, not tinkering around with the contract. We need them to provide adequate funding.
Dentists must not be an afterthought. They are a vital component of the health of the nation. We must build on the historical commitment to prevention; that is key—as the saying goes, prevention is better than cure. Dentists have had enough; they are under pressure. My constituents have had enough; they are under pressure. The Government have to do something about it.
In the debate before the summer, I referred, in relation to the lack of substantive action by the Government, to a rejigging of what Ian Fleming said about crisis: if once is happenstance and twice is coincidence, three times is friendly fire and four times is enemy action. We are now in a situation where the Government are perceived as the enemy because of their lack of action.
Rachael Maskell (York Central) (Lab/Co-op)
I apologise that I was not able to be here for the whole debate; I have been in a Bill Committee. In York, people have to wait six years to see a dentist. Of course that is completely unacceptable, but my real concern is that, with the transition of dental services into integrated care systems, ICSs will not have the powers—the levers—to make the difference on training, funding and the contract and, ultimately, dentistry will be pushed into a tug of war between ICSs and the Government.
Peter Dowd
I am glad that my hon. Friend raised that matter because it is something that I was going to raise. The health service, because of the reorganisation, is in an element of flux. It is feeling under a bit of pressure. Potentially, people are having to reapply for jobs in the broader sense in the NHS because of the reorganisation. That is a fact. I am not sure whether we should be having a reorganisation of the NHS in the post-covid environment, but that is a different argument for a different day. The broader dissonance in the system now multiplies the problems that we are having in dental practices, because they are getting pushed further away, which is why practices need representation on these boards. I am glad that my hon. Friend highlighted that point.
As I said in the debate before the summer, we do not want any more excuses from the Government. We do not want any more prevarication, any more procrastination, any more pretext or any more self-exoneration. I hope the Government and the Minister, whom I welcome to his place, really get the sense of the frustration and, in certain situations, anger in the Chamber today. They really must pull their finger out—if not people’s teeth.
Selaine Saxby (North Devon) (Con)
Like other colleagues, I have spoken out many times in this House about dentists, including in the debate earlier this year. Indeed, the very first letter that I wrote as an MP back in 2019 was about the dental contract, which was brought to my attention by one of the dental practices in Barnstaple. I cannot stress the severity of the dental desert that is now Devon, with not a single NHS practice accepting new patients. Not a week goes by without correspondence from a constituent in distress. As William Shakespeare himself said in “Much Ado About Nothing”:
“For there was never yet a philosopher that could endure the toothache patiently.”
And nor should they. It really is time that something is done. I thank the current Health and Social Care Secretary for recognising dentistry within the ABCD and that there is a problem. I thank, too, the current Minister’s predecessor for at least taking some steps towards redressing the issue of the contract, which is clearly the undermining problem. However, that is a long-term solution. The steps outlined there and the training of more dentists are not going to address the current situation.
Only last weekend, a friend, who was already registered at a dentist, told me that they had actually managed to get a dental appointment. When they got there, they were told that they needed to see the dental hygienist. They went to book an appointment and were told that there was a six-month wait to see the hygienist, who then told them that they needed to have a second appointment to do the other half of their mouth. They went to book, only to be given another six-month wait before they could see the hygienist, so it took a full year. As they said, it is a bit like cleaning the Forth bridge. This is not how our constituents’ teeth should be treated.
My concern extends to my younger constituents. The No.1 reason youngsters under 18 are admitted to hospital in my patch is linked to their teeth. At a time when our hospitals are under such duress anyway, could we not do something to help to ensure that people are able to see a dentist?
My frustration is extended by the fact that I have now managed to secure and find two separate methods for getting dentists into North Devon. Although I do not mind doing this for my constituents—indeed I welcome doing anything I can to help my constituents—I do not quite understand why it is coming down to us as individual MPs to deliver the dentistry that our constituents so desperately need.
Less than 13% of the covid catch-up funding in Devon was spent because there is no one to deliver the treatment. My NHS dentists who train up new dentists at the nearest dental schools advise that these youngsters do not wish to remain in NHS dentistry. We need to address that. Those who train to become dentists under the public purse should have to serve as NHS dentists for a certain period, but they wish to go on to do cosmetic dentistry, which pays much better. The good people of North Devon in the main are not looking for cosmetic dentistry. We are much more interested in fillings and dentures and in ensuring that our young people go on to have good-quality teeth when they get past the age of 10. I urge the Minister to push forward some of these changes, and I hope the new team remain in place long enough to do so.
We need dentists on buses or similar to get to remote rural communities and into schools, to enable every child to have the dental check-up they deserve and to provide emergency access for those people who have failed to secure a dental appointment—not because they have not tried or because of covid, but simply because there is not a dentist available to see them and many people cannot afford to pay for the treatment that they now need after waiting so long.
Sir John Hayes
My sons, who are now 21 and 18, have access to NHS dentistry, as I have, at the excellent Fen House dental practice in Spalding, but many of my constituents’ children do not, as my hon. Friend says. She talks about dental deserts in rural areas, and Lincolnshire is among the worst of those, with 38 dentists per 100,000 population. She is right both about young people and about the particular problems of rural areas. The Minister, for whom I have high regard, needs to give us very firm answers to those questions and a clear plan for what the Government intend to do about them. There is a plethora of private dentists, but too few NHS dentists.
Selaine Saxby
My right hon. Friend’s comments are wise, as always.
On international dentists, during the first lockdown, I had an Indian dentist come and meet me privately, and I forwarded that information back to the Department; apparently, there are many, many Indian dentists who would be delighted to come. We would welcome them to North Devon with open arms—indeed, we would welcome dentists from anywhere into North Devon, such is the need. I urge the Minister to look at what else can be done to speed up access for those people who are well trained internationally to come over and look at our teeth.
I will finish by reminding hon. Members how important our teeth are. I ask the Minister to do anything that can be done to help both our youngsters and those people who have struggled to see a dentist, so that we can again say that the dentist will see us now.
Jane Hunt (Loughborough) (Con)
I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) on securing what is clearly an important debate.
I take this opportunity to thank those in the dental profession in Loughborough and across Leicestershire for everything they have done over the past few years and particularly for the way they adapted to implement the huge changes needed to ensure the safety of their patients throughout the covid-19 pandemic. This year I have met with nearly all the dentists in my constituency, who have highlighted a number of issues they face and the impact they have on the profession and the patient experience more broadly.
Richard Graham
The points my hon. Friend is making are particularly important to constituencies such as hers, which have towns but are also rural.
Jane Hunt
I thank my hon. Friend, who is a true hero in every way.
One concern is about the UDA system, with the recurring message being that the system in its current form is not fit for purpose. I welcome the package of initial reforms to the NHS dental contract announced in July, in particular the introduction of enhanced UDAs to support higher-needs patients.
However, the reforms do not address my local dentists’ concerns that the current system is based on rewarding reactive treatment, rather than preventive, meaning that dentists are driven to do the minimum necessary to meet the terms of the target. That is a source of frustration for some, who have expressed their preference for being remunerated for using their initiative and working in the best interests of their patients.
Furthermore, while it is welcome that a minimum indicative UDA value of £23 has been introduced, UDA payments are not rising in line with increasing overhead costs, which is devaluing contracts and, in some cases, leaving dentists out of pocket. That was highlighted recently during a conversation I had with Bupa in Loughborough. Bupa expressed that that is compounded by the fact that UDA payments vary geographically, so that a UDA is worth £36 in its Sheffield practices but only £24 in its Loughborough one. Finally, the reforms do not address the issue of dentists not being given leeway under their contracts for last-minute cancellations and no-shows, even though they can lead to missed targets. I ask that this be urgently reviewed, so that we do not punish dentists for trying their hardest to continue to provide the care needed.
It is clear that there is still a way to go to make NHS dental contracts more attractive, both in terms of the nature of the dentistry performed and the level of financial reimbursement received for services performed. I fear that if the Government do not continue to work at speed, we will lose even more NHS dentists through early retirement, a reduction in time spent completing NHS work, or a full move into private practice. That would be detrimental to patient care and the availability of NHS appointments. I know that the former Minister of State for Health, my hon. Friend the Member for Lewes (Maria Caulfield), was working hard to review UDA contracts, and I would welcome confirmation from her successor that they will continue that hard work.
As well as difficulties retaining dentists, I have been informed that locally, we are having difficulties recruiting them. One reason for that is that there is no dentistry school in the east midlands, our nearest being in Sheffield and Birmingham, and students are choosing to enter into the workplace close to where they study. That is causing supply issues in the NHS service, and has created a gap in the market that is being filled by private dentists with a focus on cosmetics. We therefore need to ensure we are training up enough dentists and providing them with incentives to move away from where they are studying to areas with greater demand. Bupa has also advocated for putting dental practitioners on the shortage occupation list in order to increase overseas recruitment and fill shortages, then upskilling those practitioners via short courses to meet UK standards. Could the Minister please comment on the actions being taken to increase the number of dentists from overseas?
I am very concerned that NHS England has proposed closing the intermediate minor oral surgery service in Loughborough, meaning that local residents will have to go as far as Leicester for treatment. That city is some considerable way away, and there has been a recent cut in bus services, the No. 2 bus service in particular. Loughborough is effectively Leicestershire’s county town, so there is more than enough demand there for that service. Closing the centre will only increase pressures on the Leicester centre, extending waiting times and further impacting on patient care. That centralisation of services does not meet the needs of the patient, and I ask that the Minister look with some urgency at local services’ availability throughout the country, especially throughout Leicestershire.
Having listened to the whole of today’s debate, it has been very interesting: there are a small number of points that need to be addressed, which have been made by Members from all across the Chamber and all over the country. I do not think this is an insurmountable problem to solve, and I feel sure that the Minister will be able to address it.
Andrew Gwynne (Denton and Reddish) (Lab)
I thank the Backbench Business Committee for granting this important debate, and congratulate the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) on having secured it. We support the motion in the form in which it has been moved; there is nothing in it that we disagree with. If some of the political arguments are removed from the debate, I think there is consensus across the House as to what the problems are and what needs to be done.
Sir George Howarth
I am sorry to interrupt my hon. Friend so soon. I agree with him about the motion, but I did make the point that there were some short-term measures that could, and should, be taken within the three-month period that the motion envisages before the Government report back on progress.
Andrew Gwynne
My right hon. Friend is absolutely right. There is no reason why the Government cannot expedite action on the issues he mentioned in his contribution and get those improvements in place.
I pay tribute to my right hon. Friend and to my hon. Friends the Members for Blackburn (Kate Hollern) and for Bootle (Peter Dowd), as well as the hon. Members for Bath (Wera Hobhouse), for Mole Valley (Sir Paul Beresford), for Berwickshire, Roxburgh and Selkirk (John Lamont), for Gloucester (Richard Graham), for Salisbury (John Glen), for North Devon (Selaine Saxby) and for Loughborough (Jane Hunt), for their contributions.
I welcome the Minister to his place. I am not sure how long he is likely to be at the Department of Health and Social Care, but I hope he is there long enough to implement some of the changes. I am all for a bit of stability in the Department. He is a good person and a good friend, and I wish him well. However, when he comes to the Dispatch Box, he will no doubt seek to deflect from the situation that has been described my Members across the Chamber by saying that we are here today because of the pandemic.
The backlog has not helped—we all acknowledge that; it goes without saying—but the Government’s spend on general dental practices in England has been cut by more than a third over the past decade, with the number of NHS dental practices in England falling by more than 1,200 in the five years prior to the pandemic. My hon. Friend the Member for Bradford South (Judith Cummins) raised that, and it cannot be ignored. It creates the regional imbalances and dental deserts we have heard about. This is not a rural-urban thing; it is a rural and urban thing, sadly. My right hon. Friend the Member for Knowsley (Sir George Howarth), the hon. Member for North Devon (Selaine Saxby) and the right hon. Member for South Holland and The Deepings (Sir John Hayes) spoke about those dental deserts, which are very real.
The Minister’s next line of defence, if I were to guess what the officials have put in his red folder, will be, “It’s all because of the dental contract.” There is some truth in that. It is 16 years since that dental contract was introduced, and it was introduced for a perfectly good reason. There was no golden age of NHS dentistry before it. There is a reason why people of my age have a mouth full of fillings and my children do not. It is not because I did not brush my teeth as much as my children do, and it is not because I ate more sweets than my children do. It is because the emphasis for paying dentists prior to the introduction of the changes was on early treatment that was perhaps not necessary—“drill and fill” is what they called it. We recognised in 2010 that the contract had not worked in the way we hoped it would, and we proposed changes. Of course, we lost that election, but after 12 years of this Government, I am afraid the line will not wash that it is solely the contract, because they have had plenty of time to make changes to that contract and have not.
We hear about the ABCD plan, and I certainly welcome the “D” in it; at least there is a recognition of dentistry. However, like my right hon. Friend the Member for Knowsley, I worry that this kind of “Sesame Street” strategy does not come close to tackling the scale of the emergency that is gripping dental care. All we have heard from the Secretary of State is sticking-plaster solutions that tiptoe around the edges while failing to address the root cause. That is apparent in the Government’s “hit and hope” approach to dentistry. The £50 million of emergency funding announced earlier this year is a prime example. As my hon. Friend the Member for Bootle said, it is a time-limited, inaccessible pot of money that has done precious little to improve access. In fact, figures obtained by the British Dental Association showed that just 17.9% of that funding was drawn down. This is indicative of a sector that has completely lost faith in the Government’s ability to act, and to be frank, I do not blame them, because when we do see action, it does not meet the scale of the crisis, and in some cases it makes things worse.
As we have heard, the geographic, ethnic and socioeconomic disparities affecting access to NHS dentistry are becoming starker by the day. What does the new Health and Social Care Secretary do in response to that problem? She scraps the health disparities White Paper. It is beyond bizarre that in the face of such overwhelming evidence, the Government will not even consider possible solutions—let alone implement them.
I fully support what the hon. Member for Waveney and other hon. Members on both sides of the House have said about education. Dentistry in schools, a prevention strategy and an emphasis on good oral health is absolutely crucial. We would support the Government in implementing that—hopefully sooner rather than later. The consensus and mood is there to get that done, so I hope the Minister will take that up and get going on that opportunity.
As for many issues facing our NHS, much of the problem with NHS dentistry can be traced back to one thing: workforce. Several hon. Members raised that point. Any hope of an NHS recovery must be underpinned by a comprehensive workforce strategy. Where is that strategy? Was it accidentally shredded with the mini-Budget? I am sure the Minister will hail the fact that NHS stats show an increase of 539 dentists practising in 2021-22, compared with the year before. When we drill down beneath the surface, however, there is not much to be positive about.
Those stats are rendered worthless by the fact that a dentist performing a single check-up on the NHS in a 12-month period is weighted the same as one with a full cohort of NHS patients. BDA survey data shows that for every dentist leaving the NHS altogether, a further 10 are significantly reducing their NHS commitment. No matter how much Ministers might try to fudge the numbers, they simply do not add up. We cannot afford more bluff and bluster. We need action, which the Opposition will support.
The outgoing Prime Minister said that dentistry was in her top three priorities for her first 90 days. That now seems rather optimistic given that she is Liz of 44 days, but we really want the Government to act on that commitment. Can we have an update on how things are going?
The Labour party will fund one of the biggest NHS workforce extensions in NHS history. We will double the number of district nurses qualifying every year, train more than 5,000 new health visitors and create an additional 10,000 nursing placements every year. We will fund this transformative expansion by abolishing non-dom tax status. We will give dentistry the staff, equipment and modern technology it needs to get patients seen on time. Labour has a plan. Where on earth is the Government’s?
The Minister of State, Department of Health and Social Care (Will Quince)
I thank the hon. Member for Denton and Reddish (Andrew Gwynne) for his kind words. He will be pleased to know that, despite what he said, I scribbled my own speech today and I can confirm that it will be a fudge-free zone. In fact, I have not had any fudge for about three years and I do not intend to start now—not least because it would not be great for my teeth.
I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) on securing time for this hugely important debate. I thank the Backbench Business Committee for allowing the time and all right hon. and hon. Members who have made constructive contributions to the debate. It would be remiss of me not to thank all those who work in NHS dentistry, not just for their work throughout the pandemic, but for the work that they continue to do serving people up and down the country.
In the relatively short time that I have available—I am conscious that there is another important debate to follow—I will endeavour to respond to as many of the points, themes and questions raised as possible. I hope that right hon. and hon. Members know me well enough already, however, to know that my door is always open. I have never turned down a meeting with a parliamentary colleague and I do not intend to start now. This is an important issue and I hope that we can continue to talk about it at length, even if not in this Chamber.
As the new Minister—or new new Minister—for primary care and therefore dentistry, I have spent the first few weeks in post learning more about NHS dentistry, including by meeting dentists; meeting people at the coalface and the grassroots is really important. Of course, I have my constituency experience too. Despite the events of today, I very much hope to be here for some time to come.
Let me say at the outset, in response to I think nearly all of the contributions made today, that I get it—I really do get it. I know that in many parts of our country access to NHS dentistry is difficult or far more difficult than it should be, and I want to make it clear that dentistry is an incredibly important part of the NHS. The Government and I are committed to addressing the challenges that NHS dentistry continues to face across the whole country, and as the hon. Member for Denton and Reddish rightly pointed out, it is in our ABCD strategy.
I turn to some of the themes raised. The first is access, which was raised by my hon. Friend the Member for Waveney, the right hon. Member for Knowsley (Sir George Howarth), my hon. Friends the Members for Mole Valley (Sir Paul Beresford), for Gloucester (Richard Graham) and for Salisbury (John Glen), the hon. Member for Bootle (Peter Dowd) and my hon. Friend the Member for North Devon (Selaine Saxby). Access to NHS dentistry varies across the country—we know that—and it was an issue, as the hon. Member for Denton and Reddish rightly pointed out, even before the pandemic, but the pandemic has exacerbated it and added further pressure to the system.
The Government are taking a number of important steps that will improve dental access for patients and make NHS dentistry a more attractive place for dentists and their teams to work in. I will outline just some of those. These changes include improvements to the current NHS dental contracts—I will come on to that in a moment—and of course to the recruitment and retention of dental professionals. I say dental professionals specifically because this is of course about far more than just dentists, as important as they are. As the hon. Member for Denton and Reddish pointed out, rightly, we have seen an additional 539 more dentists returning to NHS dentistry last year, which of course means they are able to treat more patients, but I recognise the point he rightly made, and we do need to go further and faster.
On the steps taken, notwithstanding the points made by the hon. Member for Bradford South, we made £50 million of extra funding available for NHS dental services at the end of 2021-22, which provided more appointments and increased capacity in NHS dental teams. I noted her points, and we have learned from that. Given that experience, I would certainly want to do things a little differently if we considered such a proposal again. We announced a package of improvements to the NHS dental system on 19 July, as a number of Members have pointed out, which was set out in our plan for patients. These are an important first step to system reform and are designed to improve access to dental care for patients, particularly patients with the most complex treatment needs.
A number of hon. Members raised the much criticised—and that is as far as I will go, the hon. Member for Denton and Reddish will be pleased to know—2006 contract. We are making improvements to ensure that dentists are more fairly remunerated, especially for more complex oral health needs. The one example we hear very often is of dentists getting paid the same for doing one filling as for six fillings. As numerous hon. Members have pointed out, we have also set a £23 minimum UDA value, notwithstanding the points made about the variation around the country.
My hon. Friend the Member for Gloucester raised accountability locally, including to Members of Parliament. In part the answer to that is their coming within the remit and purview of integrated care systems. I have no doubt that my hon. Friend is well aware of the chief executive of his integrated care system, and will know how to contact and meet them on a regular basis.
Richard Graham
The Minister is absolutely right: not only do we know the chief executive, but all Gloucestershire MPs have had regular meetings with them, including one specifically on this issue. That is why I raised the importance of their being given the opportunity to take responsibility, which I hope my hon. Friend will welcome.
Will Quince
I certainly do welcome that, because this is not just about commissioning, but about accountability and oversight.
Our changes will allow NHS commissioners to have more flexibility in commissioning, and I think that is really important, because if they have that flexibility in commissioning additional dental services, they are the ones who know the local need within their area. I want to see far more responsive management of contracts, so if they have underperforming practices and practices that can do more, we should enable such practices to do that. For example, a high-performing practice should be able to deliver beyond its existing contract to make up for the fact that a neighbouring practice is not doing so. That addresses some of the points made by my hon. Friend the Member for Waveney about the clawback of UDA funding at the end of the year, and then its not necessarily being spent on dentistry. As part of that, I also want and expect more transparency. We will make it a requirement for NHS dentists to update the information on their NHS website, so people can see which dentists are accepting new NHS patients for treatment.
On that point, I want to bust the myth about being registered with a dentist. There is no such thing as being registered with a dentist or a dental list. People approach an NHS dentist for specific treatment. They go on their list, register and have the treatment. They can have an ongoing relationship with a dentist, but anyone can book an appointment with any dentist with an NHS contract, regardless of where they live in the country. It is important to get that message out, because when our constituents say to us, “I can’t get a dentist locally”—I want to address that point—I want to ensure that they know that they could travel to a neighbouring town or city. They could travel half way across the country if they wanted to, for example if they had relatives there, if there was a NHS dentist who had capacity to see them.
Wera Hobhouse
Does the Minister recognise that because of the abnormalities of the dental contract, and dentists not knowing which patients they are getting, NHS dentists would rather take a patient whom they already know, and whose history of dental problems or otherwise they know, rather than taking somebody they have never seen? There is a disincentive to take on new patients, but there is a continuity for those who are already with an NHS dentist.
Will Quince
Of course I take that point—it is a fair one—and when those who seek NHS treatment have an ongoing relationship with a dentist, they are more likely to get seen. When considering reforms to the system we will certainly take that point on board.
Sir George Howarth
The description that the Minister gave of the existence, or otherwise, of lists is accurate, but when anyone seeking to get NHS treatment in a dental practice rings up, they are most likely to be told by the receptionist that the practice is not taking NHS patients. The difference between the two situations, while technically correct, is not there in practice. Before he concludes his remarks, will he address the issue I raised about the short-term measures that can be, and I believe should be, taken to improve the situation?
Will Quince
I am conscious of your advice, Madam Deputy Speaker, but I am certainly willing to meet the right hon. Gentleman to consider what short-term measures we can take.
There is so much I want to say about the contract and my ambitions for the future, but politics is the art of the possible and deliverable, and I will be honest and frank with the House, and with stakeholders across the sector, about what we can deliver. We will then work towards what is within the art of the possible. International dentists are a vital part of the UK’s dentistry workforce, and I am happy to meet hon. Members to set out exactly what we are doing. I hope to bring forward legislative changes later this year. On dental training, I would love to talk more about the Advancing Dental Care review and the centre for dental development, but that may have to wait for another day—you have advised me about the time, Madam Deputy Speaker.
Prevention and oral health has been raised by many Members and is an important part of our strategy. I am looking closely at what more we can do with other Departments, especially around supervised toothbrushing, but also fluoridation, which was raised by numerous Members. Access to urgent care is important, and if people struggle to get an appointment they should call 111. This is the beginning of our work to improve NHS dentistry, not the limit of my ambition. This is just the start, and we are committed to long-term improvements, including changes to improve access to urgent care, and further work on workforce and payment reform. In the meantime there is lots we can do to improve access to urgent care, provide better access for new patients, and make important changes to workforce and payment reform. With that short response I hope I have assured hon. Friends and Members that action is being taken now to address the challenges of access to dental care, especially around recruitment and retention. I also want to reassure Members of my personal ambition and passion for bringing about the medium to long-term positive change that we want for NHS dentistry.
Peter Aldous
We have had a full and productive debate. I will quickly run through a few points—I apologise if I miss any hon. Members. The right hon. Member for Knowsley (Sir George Howarth) rightly highlighted the importance of addressing oral cancer quickly. I take on board his proposal for the short-term fast-tracking of emergency support. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) suggested a short-term simple contract to get on top of the backlog. The hon. Member for Bradford South (Judith Cummins) highlighted how £50 million was made available but that the system is so broke we spent hardly any of that.
My hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) highlighted that the problem is not just in England but in Scotland. The hon. Member for Blackburn (Kate Hollern) mentioned the importance of workforce planning. My hon. Friend the Member for Gloucester (Richard Graham) mentioned the importance of the local NHS being involved. The hon. Member for Bath (Wera Hobhouse) highlighted the alarming rise of DIY dentistry.
It was good to have my hon. Friend the Member for Salisbury (John Glen) in his place for the debate. He emphasised the importance of the short-term UDA model. We have been going back to 1951 as a basis, and we need to bring that right up to date. The hon. Member for Bootle (Peter Dowd) is right that we have been here before. There is now a need for action. My hon. Friend the Member for North Devon (Selaine Saxby) mentioned dentists getting on the buses—an interesting way to improve accessibility. My hon. Friend the Member for Loughborough (Jane Hunt) again highlighted the short-term arrangements.
Finally, the Minister said that his door is always open. I welcome that. I hope that he will be in his place for some time, because the last thing we need is more change. If the motion is agreed to, when we come back in three months it must be a question not just of what we will do but of what we have done.
Question put and agreed to.
Resolved,
That this House is concerned by the growing crisis in NHS dentistry; notes that nine out of ten dental practices in England do not accept new NHS patients; regrets the number of dentists moving away from NHS practice; welcomes the Government’s commitment to levelling up health outcomes and dental health across the country; calls on the Government to take urgent steps to improve retention of NHS dentists and dental accessibility for patients; and further calls on the Government to report to the House on its progress on the steps it has taken to address the NHS dentistry crisis in three months’ time.