NHS Dentistry: Salford and Eccles
(1 year, 6 months ago)
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Rebecca Long Bailey (Salford and Eccles) (Lab)
The British Dental Association states that NHS dentistry is facing an existential threat. It says that the threat predates the pandemic, when only enough dentistry for about half the population of England was commissioned. Access to NHS dental services was already very poor in many parts of the country, but access problems have now reached an unprecedented scale, with existing deep inequalities in access and outcomes set to widen. Sadly, nowhere are those access problems more acutely felt than in my constituency of Salford and Eccles. I have been receiving unprecedented levels of casework from people who simply cannot access an NHS dentist.
One constituent works night shifts on minimum wage. She had required urgent root canal treatment for some time but could not find an NHS dentist and could not even contemplate the cost of a private dentist, so, like millions across the country, she struggled on. The problem is now so severe that her tooth is beyond saving with root canal treatment. She is having to consider having it removed, which she is told will cost her several hundred pounds. She has not got several hundred pounds. She does not know where to turn.
Another constituent, who is also on a low income, had been trying to find an NHS dentist for over two years. They had two broken teeth and other dental issues that they could not afford to have treated privately, so they called the emergency dentist helpline. The helpline advised them to go for private treatment. Now, at only 21 years of age, my constituent cannot afford any dental treatment at all, and they fear that they will end up losing their teeth.
Another constituent, who is registered with a disability and who works full-time for the NHS on low pay, tried as far as Rochdale and Oldham but eventually had to pay £250 for a private tooth removal that left her with little money to live on until her next pay cheque.
To assess the severity of the situation, my office rang every single dental practice listed on the NHS website as falling within my constituency, to inquire if they were accepting new adult NHS patients. Every single one said no, and only two said that they were taking on new NHS child patients. What is worse, when I raised that very issue with the Government back in October 2021, I was informed that they had not made an assessment of the numbers of people refused NHS dental treatment, nor did they hold any waiting list data at all on access to NHS dental services in Salford or Greater Manchester. Not even to be aware of the scale of the problem is, in itself, somewhat staggering.
As I am sure the Minister is aware, this is not just a Salford problem, but a national one. Researchers for the BBC documentary “Disappearing Dentists”, which aired in August, attempted to call every one of the dental practices in the UK that holds an NHS contract.
Of the 26 dental practices with NHS contracts across Salford, 96% were not taking new adult NHS patients, and UK-wide, 90% of practices were not taking new adult NHS patients.
I must pay full credit to the local staff and teams across Salford: all the dentists, hygienists, therapists, nurses and administrators, and the Greater Manchester integrated care partnership’s dental commissioning team. They are giving their absolute best in incredibly difficult circumstances. However, our dental services are under unprecedented strain.
I would be grateful if the Minister addressed the following issues in his response. First, there has been chronic underfunding of NHS dental services. In real terms, net Government spend on general dental practice in England was cut by over a quarter between 2010 and 2020. It is also important to note that England invests significantly less in dental services per head of population than other parts of the UK. For example, before the pandemic Government spend on NHS dentistry per capita was £37 in England, compared with £49 in Wales, £56 in Northern Ireland and £59 in Scotland. The Minister might respond by saying that in January the Government pledged £50 million for a “dentistry treatment blitz”. However, that was a time-limited, one-off injection of funding which had very modest take-up, as practices were so overstretched in trying to hit unrealistic activity targets that they struggled to find any additional capacity. The British Dental Association estimates that it would take £1.5 billion a year just to restore dental budgets to their 2010 levels. I hope that the Minister will agree to take back a proposal to his Department for the ringfencing of long-term funding on that scale.
Secondly, the current target-based NHS dental contract is causing serious problems in the recruitment and retention of staff. The British Dental Association says that we are facing an “exodus” of dentists from the service: 75% of dentists surveyed are thinking of reducing their NHS commitments next year alone. Central to this is not only the issue of chronic underfunding that I have already mentioned, but the current discredited target-based dental contract that was imposed on the profession in 2006 and was widely considered unsustainable and unfit for purpose even before the pandemic. Indeed, in 2010 both Labour and the Conservatives committed to amending the contract. It sets restrictions on the number of NHS patients that a dentist can see, and it punishes dentists for taking on new patients with high needs.
The Minister may, of course, refer to a package of marginal changes that the Government introduced in November, including dentists’ updating a “find a dentist” website regularly with details of the availability of appointments, a higher reward for treating three or more teeth, and a new payment rate for complex treatment. While those are of course welcome changes, sadly there is little point in setting up a “find a dentist” website for appointments when the Government know that no appointments are actually available.
Furthermore, the British Dental Association states that the changes will do little to arrest the exodus of dentists from the service or to address the crisis in patient access, given that they have been introduced with no additional funding. With that in mind, I would be grateful if the Minister told me when formal negotiations on fundamental long-term reform of the dental contract are due to begin.
A constituent contacted me to express concern about the Government’s plan to go ahead with proposed changes pursuant to the recent consultation on changes to the General Dental Council’s international registration legislation despite the large number of respondents who have raised issues relating to the proposal. I hope that the Minister will take those concerns on board, and will agree to review it.
Thirdly, let me stress to the Minister that NHS dentistry must cease to be treated as an afterthought in healthcare policymaking. Changes in primary care commissioning in the Health and Care Act 2022 must not lead to further cuts, and dental services must be represented adequately in the governance structures of the new integrated care systems.
Let me finally point out that prevention is key, but has lost its way somewhat in recent years. The Government must undertake to build on historical commitments to prevention, in parallel with support for dental services. That must include supervised brushing in early years settings, dedicated funding for new water fluoridation schemes, and measures to reduce sugar consumption.
I hope that the Minister has listened to the concerns I have raised and will address each point in turn, rather than reiterating previous Government responses on what they have done so far. What the Government have done so far clearly is not working. If my constituents cannot get access to an NHS dentist across Salford and Eccles, something needs to change urgently. Access to dental treatment should be a right, not a luxury.
As I set out at the start, NHS dentistry faces an existential threat. My constituents are not receiving the access to care that they deserve. It is clear that urgent action is required. Finally, let me take this opportunity to wish you, Madam Deputy Speaker, a fantastic Christmas and a happy New Year, and the same to the Minister and all staff in the House.
The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
Let me start by congratulating the hon. Member for Salford and Eccles (Rebecca Long Bailey) on securing this important debate. I share her frustration and am aware that some areas in the country face serious difficulties with access to NHS dental care. She used some powerful examples, which are exactly the kinds of things that we are trying to fix.
As we recover from the pandemic, activity is going back up again and we want it to go up faster. Dentistry is an important part of the NHS. We are committed to addressing the challenges that NHS dentistry faces in some parts of the country. We are continuing to take important steps to improve access for patients. There are variations around the country, which was already an issue before the pandemic.
The specific risks from covid in dentistry, for obvious reasons given the nature of the treatment—looking down people’s throats and breathing in the same air—resulted in the need to reduce the amount of care that could be delivered, in line with infection prevention and control measures to keep patients and the workforce safe. The pandemic placed further pressure on the system. However, NHS dentistry provision has been increasing gradually and safely. I am pleased to say that NHS England asked all dental practices to return to 100% of their contracted activity in July this year. Many practices are already delivering at that level and, in some cases, beyond. I will go on to talk about delivering beyond.
To support the industry during this testing time, we took unprecedented action and provided over £1.7 billion in income protection, to ensure that NHS dentist capacity was retained and services were provided and available after the pandemic. We made an additional £50 million available for NHS dental services at the end of last year, to increase capacity in NHS dental teams. Appointments were given to those in most urgent need of dental treatment, including vulnerable groups and children. As a result of that funding, I am pleased that say that an additional 1,110 patients were seen in Salford. To support the provision of urgent care, more than 170 urgent dental care centres remain open across the country. One of those centres is in the Salford locality, as the hon. Lady knows.
Across the nation, the system is recovering and delivery of dental care is increasing. In 2021-22, 24,272 dentists performed NHS activity—an increase of 539 on the previous year. In the 12 months to 30 June this year, 5.6 million children were seen by an NHS dentist, compared with 3.9 million children in the same period the previous year. That represents a 43% increase.
John McDonnell (Hayes and Harlington) (Lab)
There have been reports in a number of our constituencies of almost a dental health epidemic. Can the Minister explain whether there will be targeted resources for a number of our constituencies where there is such a high level of child dental ill health?
Neil O’Brien
I am exploring how we can best target the places with the most acute problems. There are problems in a lot of different places, and we are thinking about that actively at the moment. I will come back to that as I make progress.
Madam Deputy Speaker (Dame Rosie Winterton)
Order. I gently say to the hon. Gentleman that if he wanted to intervene, he ought to have been here right at the beginning, because it is the hon. Lady’s Adjournment debate, and it is about Salford and Eccles? I leave it to him to decide whether he wishes to intervene.
Neil O’Brien
I am happy to take whatever interventions are appropriate.
We know that there are still further improvements to be made. Although I am pleased that over 75% of the patients who tried to get a dental appointment over the last two years were successful, this is not back to the level that we were seeing pre-pandemic, which was 92%. That is why in July and in our plan for patients, which the hon. Lady mentioned, we announced some improvements to the 2006 contract to ensure that patient access was improved, although I want to reassure her that we do not regard those as the end of the story; they were a stepping stone.
Those changes included: making sure that dentists were remunerated more fairly for complex work, which will improve access for patients; implementing a minimum value of £23 for each unit of dental activity, boosting incomes in the places where the UDA value is lowest; and enabling dental practices to deliver up to 110% of their contract levels, to increase activity and allow those practices that are delivering NHS care most effectively to deliver more. This effectively takes away the cap that has been in place since the 2006 contract, which the hon. Lady mentioned.
This package will increase and improve access to dental care for patients across the country. We have already taken action to implement these changes, including through regulations that came into effect on 25 November. The changes have all been decided with careful consideration, working collaboratively with the dental sector. The Department has worked with the General Dental Council on legislative proposals that will make registration processes for dental professionals qualified outside the UK more proportionate and streamlined, making the process to join the UK workforce more efficient for dentists from overseas. These changes are another way in which we are seeking to improve access for patients.
Finally, to make it easier for patients to find dentists taking on new patients, we have made it a requirement for NHS dentists to update their information on the NHS website, which has historically been out of date, but of course we are looking to go further to ensure that those appointments are there. These changes are just the beginning. They are the necessary first steps of our work to improve NHS dentistry. These are the measures that we can take immediately, and they will have a noticeable impact, but we will go further.
Looking forward into the new year, we have been working with NHS England and the sector on further changes to improve access. Our priorities for this next phase of reform include: improved access to urgent care for patients who need to see someone immediately; better access to care for new patients; and further workforce and payment reform. We aim to take the necessary steps to implement these changes next year, but I am keen to seek every opportunity to take action wherever I can, and ahead of those reforms we are also actively considering what support we can offer to help patients who do not currently have access to the dental system and those who are not attached to a practice, who have the worst access. We are also considering how the recruitment and retention of dentists can be improved, particularly in the parts of the country where the need is greater. We are also thinking further about how overseas qualified dentists can be supported to start working in the NHS more quickly.
I am strongly committed to improving our NHS dental system wherever I can for all those who need it. The hon. Lady has set out a powerful case today on why we need to go further, and we will go further. I thank her for raising this important debate, and I hope that she will be reassured that although the reforms we have made so far will make a difference, they are far from being the end of the story, and that we will continue to take action to improve access to NHS dentistry across the nation.
Question put and agreed to.