NHS Dentists: South-West England

Wednesday 24th May 2023 Westminster Hall

[Julie Elliott in the Chair]

14:30

[Chris Loder (West Dorset) (Con)]

I beg to move,

That this House has considered the provision of NHS dentists in the South West.

It is a pleasure to serve under your chairmanship, Ms Elliott. I am grateful to colleagues from across the House for attending this very important debate. If someone living in Dorset rings their nearest NHS dentist looking for an appointment, there is a 22% chance that they will be told the practice has gone private. If someone living in Dorset rings their nearest NHS dentist, there is also a 42% chance that they will be told the practice is not taking new patients with special or additional needs. There is a 50% chance that they will be added to a waiting list that is over 12 months, so half the constituents calling today could be waiting until May or June 2024 before they are seen. Finally, if someone living in Dorset is calling to book a dental appointment for their child, there is a 77% chance that they will be told the practice is not accepting new child patients.

The reason for these unacceptable statistics is because access to NHS dentistry in the south-west has been on an alarming downward trajectory for some time. Today, rural parts of Dorset, many of which can be found in West Dorset, experience worryingly low access to vital and sometimes life-saving dental treatment on the NHS. This is no doubt a widespread issue across the country, which is plain for all to see in the recent flurry of debates and questions on this subject in the House. Following this debate, there is an Adjournment debate in the House this evening examining dental care in the north-east, which shows how this issue is affecting constituents across the country.

According to recent reports, a quarter of the adult population in England have unmet dental needs, despite there being 24,272 active NHS dentists. That is enough for one for every 539 people, but these statistics can be misleading, because, importantly, even though there has been a 2.3% increase in the number of NHS dentists this year compared with last year, productivity has slowed. As many as half of these 24,000 dentists have cut back on their NHS work, according to the British Dental Association, forcing more people to either choose to go private and shoulder the burden of these additional costs themselves, or to go without and face the risks of poor dental hygiene that that can bring, such as tooth decay and gum disease.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman and his team of MPs who come along to support one another on these issues. I am really impressed by how well they do their job. They did it yesterday, and they are doing it today; well done to them.

Across the whole of the United Kingdom of Great Britain and Northern Ireland, there are issues. The hon. Gentleman referred to the figures in his constituency; in my constituency, 100% of people cannot get an NHS dentist. Paying online for a whole year’s subscription to a dentist is not possible for many, including people who are elderly. Does he agree that the Minister should liaise with the devolved Administrations, in Northern Ireland in particular and in Scotland and Wales, on how we can better do this together? Clearly, it does not matter where we are in the United Kingdom of Great Britain and Northern Ireland—dentist appointments cannot be got for those who need them most.

[Chris Loder]

I thank the hon. Gentleman for his short and succinct intervention, as ever. He is absolutely right and confirms that this issue needs to be addressed across the United Kingdom, not just in the south-west. I am delighted that he has attended this debate on dentistry in south-west England.

The south-west region was recently rated fifth out of seven for adult NHS dental coverage, with only 35% of adults covered by access to essential dental services, which is below the national average. Dorset fares slightly better, but adults in my constituency and those immediately neighbouring it also experience below the national average coverage for an NHS dentist.

The inequality is also affecting children, whom I am particularly concerned about. Although they are faring better than adults, with a coverage rate of 46% in both Dorset and the south-west, that is still below the national average for access to NHS dental services. Without those services, almost one third of five-year-olds are suffering from tooth decay, which is the most common reason why children aged between five and nine are admitted to hospital. Tooth decay is mostly preventable, so its effects serve to demonstrate what a lack of access to NHS dentistry is doing to our children.

Why are we faced with this difficulty? Why is dentistry in England, and particularly the south-west, under such pressure? Although the answer is multifaceted, I believe the reason is primarily threefold: first, the National Health Service Act 2006 and the subsequent dental contract; secondly, the lack of institutional services and the knock-on effects; and finally, the NHS backlog following the covid-19 pandemic.

The National Health Service Act 2006 set out the provisions for agreement between NHS England and dental practices in relation to services that would be provided and the renumeration for those services. Before the Act became law, the National Audit Office and the Public Accounts Committee both produced reports to the then Government on reforming NHS dentistry, which raised concerns about the 2006 changes. Those concerns included the urgent need to change the incentive mechanism for dentists to increase their commitments to NHS dentistry, the difficulty for patients in better-off areas in accessing public health services, and the difficulty for those in more deprived areas in accessing any services at all.

The reports also raised concerns that there would be a shortage of NHS dentists, a glut of people who would be left without access to NHS dentistry, and no guarantees that the reformed contract would be enough to commit dentists to the NHS rather than private practice.

[Simon Jupp (East Devon) (Con)]

My constituents in East Devon regularly contact me about difficulties getting NHS dentist appointments in places such as Sidmouth, Budleigh Salterton and Exmouth. Problems with recruitment and contracts have been compounded by the pandemic, but that excuse will not wash forever. Does my hon. Friend agree that additional reforms of the NHS dental system cannot come soon enough for the south-west?

[Chris Loder]

I thank my hon. Friend for his intervention. I wholly agree with him that reforms are needed urgently, which is the main point I will be sharing with the Minister towards the end of my contribution. It is clear that some of the measures from the 2006 Act do not go far enough. In many cases, they actually deter NHS dentistry provision.

Many of these issues are evident up and down the country today. Discussions with my own integrated care board in West Dorset—which, as of 1 April this year, has taken delegated responsibility for commissioning dental services from NHS England—have confirmed to me that the dental contract signed in 2006 is simply not fit for purpose. It actually restricts the ability of the board to respond to the current situation. That is because the terms and structure of the contract make it incredibly difficult for the integrated care board to attract new dentists to work in Dorset. I am sure that other integrated care boards across the south-west share that problem. The ability to attract new dental talent, especially those who are working on NHS contracts, is further hindered by our specific circumstances in Dorset. We do not have adequate training infrastructure.

[Selaine Saxby (North Devon) (Con)]

Does my hon. Friend agree that this problem is particularly exacerbated for those of us in very rural parts of the south-west? Would the Minister consider putting dentists on a bus and bringing the dental service to us, so that our young people can see a dentist? Realistically, we will not be able to attract the new dentists we need in some of the remote locations that we love to live in.

[Chris Loder]

I thank my hon. Friend for her kind intervention, and I wholly agree. Her constituency of North Devon is not dissimilar to mine; we share many challenges and many wonderful things. I am sure the Minister has heard what she has to say, and I look forward to his contribution.

Without a dental school in Dorset, recruitment continues to be a real problem, as staff often leave the county, and indeed the region, after receiving their training. That leaves Dorset residents short-changed, especially given that our council tax is among the highest in the country.

The third impacting factor is the backlog following the covid-19 pandemic. We are all well versed in that, but I wonder whether we fully appreciate the pressure on dental services since then. It is estimated that as many as 40 million NHS dental appointments have been lost since the start of the pandemic, and that is exacerbated by the fact that 45% of dentists in England have reduced their NHS commitments since the start of the pandemic, which puts more pressure on an already strained system. A reported 75% of dentists say that they are thinking of reducing their NHS commitment this year, so it is important to look at what needs to be done to help the dentists still committed to NHS work and the people up and down the country—particularly in the south-west—who rely on those services. To my mind, there are two primary actions: contract reform and quick investment.

There are clearly a number of issues with the NHS dental contract, as we have said. I recently wrote to all 17 dental practices in my constituency, and I am in regular dialogue with the local integrated care board, and they all tell me that the dental contract needs urgent reform. It seems that the current terms of the contract make it incredibly difficult for local boards to recruit new dentists to meet local demand. I worry that the situation for our integrated care boards is not sustainable and could become worse.

The contract also seems to include irregular and sometimes near-nonsensical patterns of remuneration, which are undoubtedly playing on the minds of dentists considering their commitment to NHS work. For instance, dental practices are often remunerated for one filling only, regardless of the number of fillings needed for a given patient, which reduces the incentives for dentists to stay working with the NHS. That cannot be right.

Behind-the-scenes work is often missed when the work that a practice has carried out is calculated. For example, if a patient were to require one X-ray examination, two fillings, one extraction and two appointments for root treatment, that would total more than four hours of clinical time and would be counted as five units of dental activity or UDAs, which is the way that the NHS measures practice activity. Not included are the cost of materials, the nurses’ time setting up the procedures or the receptionists’ time booking the appointments and chasing patients should they not attend, all of which are hidden from the current contract. Transparency is key. As part of a wider reform of the NHS dental contract, West Dorset constituents who have got in touch with me would appreciate greater transparency in the requirements for such treatment.

One of my constituents recently had an abscess in their jaw. Like many in that situation, they called the nearest dental practice. As I said earlier, there was a 22% chance that they would be told that the practice had gone private, a 42% chance that they would be told that it was closed to new patients, and a 50% chance that they would be added to a 12-month waiting list, leaving them with an abscess until this time next year. Fortunately, those things did not happen. My constituent got through and made an appointment, although the dentist informed them that they did not regard the situation as an emergency, so my constituent was forced to go elsewhere, which reset the clock on their waiting list.

The dental practices that have contacted me have also shared stories of the abuse that their staff receive on a daily basis due to the lack of capacity, of how 111 continues to tell people to call their dental practices despite them not holding emergency contracts with the NHS, and of how the unfair UDA system acts as a direct negative contributing factor to the current situation faced by NHS dentistry.

Reformation of the service is clearly vital. When we previously debated the Health and Care Act 2022, I said that simply throwing money at the problem will not make it go away. Yet funding is, of course, the other vital area of improvement in this equation. Between 2010-11 and 2021-22, total funding for dental services in England fell by 8% in real terms, from £3.36 billion to £3.1 billion. Further, where practices have underperformed in the past, NHS England have not released the funding, resulting in an underspend of the national dental budget. I therefore urge the Minister to maintain his commitment to reforming the unpopular 2006 dental contract, to make vital and necessary changes to unfair remuneration, and to act before the situation gets any worse and more dentists are lost. That is very important.

[Anthony Mangnall (Totnes) (Con)]

I apologise for interrupting my hon. Friend’s concluding remarks. Does he agree that it is also worth considering whether we can improve the role of dental therapists so they can take on some of the roles, whether the £50 million underspend in the south-west should be delegated across the whole area to deal with that issue, and whether those graduating from the Peninsula Dental School—something we are proud to have in the south-west—should be encouraged to stay in the area, given that the demand there is greatest? Above all, given my hon. Friend’s excellent speech and the points he has made, does he agree that the dental recovery plan, which we have been promised and for which we have been waiting for too long, must be brought forward immediately?

[Chris Loder]

My hon. Friend gives me no chance to do anything other than agree. He is right. I hope the Minister is hearing loud and clear from the south-west that we cannot go on with this situation. There is no need, especially when we have dental underspends, for us not to take advantage of those opportunities as they arise. I also agree with him that we need to find more new and innovative ways of solving the issue and help a broadly willing dental team across the south-west.

To conclude, I urge the Minister to take note of all that I have said and what all my hon. Friends and hon. Members will have to say. I will also leave the Minister with a clear idea of what we need in West Dorset. First, I understand that there are plans for a substantial dental school in Dorset. I am pleased to hear that and am eager to lend my support. Can the Minister share more details? Secondly, NHS 111 needs to understand the situation of our dental practices and stop directing frustrated patients to those practices’ already swamped telephone systems, causing busy staff to receive unnecessary abuse for problems that are not necessarily within their power to fix. Finally, the contract and the amount of compliance within it, as my hon. Friend the Member for Totnes (Anthony Mangnall) pointed out a moment ago, needs an immediate review and immediate reform. Otherwise, we will continue to lose NHS dentists and the situation will worsen dramatically. I look forward to hearing from my hon. Friends and hon. Members in this debate and, indeed, the Minister at the end.

[Several hon. Members rose—]

[Julie Elliott (in the Chair)]

Order. A lot of people want to take part in the debate so, to try to avoid a formal time limit, I ask Members to keep to an informal five-minute limit.

14:49

[Kerry McCarthy (Bristol East) (Lab)]

It is a pleasure to see you in the Chair, Ms Elliot. I congratulate the hon. Member for West Dorset (Chris Loder) on securing the debate; the turnout shows why he felt compelled to do so.

Let me quickly outline the key problems that I see in my constituency. People who are not registered with an NHS dentist cannot get treatment now because almost all practices in the area are not accepting new patients. There are patients who are registered with a surgery but cannot get an appointment because there is no longer an NHS dentist working there. In my case, I left my NHS dentist because every time I had an appointment it was cancelled, because the practice was moving dentists around other surgeries in the chain where there was higher demand.

Practices are deregistering NHS patients—that is, removing them from the active patients record—if they have not seen the dentist within a set period of time, to make room for patients on the NHS waiting list. They are legally allowed to do that. Some practices are closing down, including the Bupa surgery in the constituency of my hon. Friend the Member for Bristol West (Thangam Debbonaire), which is used by a lot of my constituents and is about to close.

There is also an issue for pregnant women, who are entitled to free dentistry on the NHS yet cannot see a dentist at all. I have asked a number of parliamentary questions about that. Pregnant women are more likely to suffer particular dental issues and there is an increased risk of certain health complications if the dental problems worsen. An estimated 1 million pregnant dental care patients in England missed out on dental care between March 2020 and March 2022, and they are still finding it very difficult.

On the underlying issue of the shortage of dentists, they say they are not incentivised to work for the NHS. They intend to leave for better pay and working conditions in the private sector, or are considering going overseas. An estimated 2,000 dentists—10% of the workforce—left the NHS last year. As a consequence, patients in pain are being forced to seek private treatment because they cannot see a dentist. They have to wait for tooth problems to become emergencies before they can get urgent treatment at the University of Bristol Dental Hospital, which can offer only a certain number of emergency appointments per day.

Those who cannot afford a tooth extraction with a private dentist and cannot get an emergency NHS appointment are pulling out their own teeth in agony. Constituents have told me that that is a fact. Dentists are seeing more people with higher levels of dental need, because the wait for an NHS appointment means that a minor problem drastically worsens over time so that, in the end, they find they need to have their teeth removed. Some patients say that because they have not been able to get an appointment since lockdown, they have been kicked off the dentist’s records for not attending.

I would like to quote a few constituents. John says he was due a check-up in January 2023. It was cancelled and he was offered a new appointment for April 2023. That, too, was cancelled, and he has been told to phone again in November to make a new appointment. He has a refugee from Ukraine staying with him who managed to go back to Lviv for Christmas. She says she was almost as pleased about getting a dental appointment in Lviv as she was to see her family. John says:

“Dental care in a war zone is functioning better than”

it is in Bristol.

Another constituent, from St George, has not been able to register since she moved to Bristol a year and a half ago. A colleague of hers tripped and knocked out her front tooth. She had not been able to register with an NHS dentist and had to spend her entire £4,000 of savings on a visit to a private dentist.

Katy, another constituent, is halfway through her pregnancy and entitled to free dental care. She spent hours scrolling through lists of dentists, phoning all the ones that might take on NHS patients. She says:

“I cannot find a single dental practice which is accepting NHS patients.”

The final constituent I want to quote is a dental practice manager who says their practice is a little better able to attract and retain dentists because it holds a contract with a UDA—units of dental activity—rate of £30.92, which is well above the area average, which is £25.98. Even then, the practice has been able to fill only half of it NHS dentist vacancies. She says:

“Without long-term workforce planning and meaningful reform of the NHS General Dental Service contract, the system and those who rely on it most will continue to suffer.”

I have taken this issue up with the Government, NHS England and the local integrated care board. Generally, the Government recommend that people visit the NHS “Find a dentist” website. Local NHS services have been working hard to commission more urgent dental care appointments. They are also offering stabilisation sessions for those who do not have an NHS dentist, cannot afford to go private and need an urgent fix to a problem like a broken tooth or a damaged filling. But clearly this is not good enough.

I reiterate the point the hon. Member for West Dorset made. We need to work on retaining as well as recruiting NHS dentists and we need to reform the dental contract which, as he said, is simply not fit for purpose. Given the time, I will leave it to others to raise some of the other questions. I could talk for a very long time about the problems my constituents are suffering from.

14:55

[Kevin Foster (Torbay) (Con)]

It is a pleasure to serve under your chairmanship, Ms Elliot. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this debate on a vital issue for our region.

The issues with getting a new NHS dentist in the south-west are, sadly, all too well known. I have regularly been contacted by constituents who, when their current NHS dentist has retired, or in one case converted to a fully private practice, are unable to find a new practice accepting NHS patients. Last night, when I checked the NHS website for Torquay, there were no practices listed as accepting new NHS patients. Although many were listed as not having recently given an update, their position is easy to work out from the feedback I receive. As has already been set out, the issue is not limited to Torbay.

For me, there are two key areas of focus for tackling this issue: ensuring that more of the existing dental workforce and practices offer NHS services, including by accepting new patients for registration; and expanding the future dental capacity in the south-west through training and recruitment. On the first point, the key will be to ensure that contract arrangements are attractive and provide a viable proposition to those who will provide the services.

I am aware that NHS England is holding further discussions with the British Dental Association and other stakeholders for contract reforms that are planned to take place this year. The Government talk about aiming to reduce barriers to patients trying to access dentists by changing the arrangements for treatments such as root canals, improving patient communication and recruiting overseas dentists—although we should not always assume there is a pot of skilled labour available over an immigration bridge—so it would be good to hear more about the progress being made. Where it is not possible in some areas to secure new contracts with providers, will the Government consider looking at more direct provision? We simply cannot allow deserts of treatment to exist.

On expanding future capacity, the Association of Dental Groups has said that the key to easing the burden of the unmet need for dental services is simply going to be more dentists, which includes creating more training spaces. I am aware that in England the Government fund the training of around 800 dental students per year. In the past, the Government have said that places are capped to ensure that teaching, learning and assessment standards are maintained, as well as to ensure that there are enough high-quality placements for each student.

It is clear that the current level of supply is not going to meet future demand. There does, though, appear to be more capacity for training. In 2020, the cap on the number of dentistry school places in England was lifted, to accommodate the higher number of students meeting their university offers following changes to exam arrangements prompted by the covid-19 pandemic. Similarly, in 2021 the cap was adjusted again. That suggests that capacity is available.

In 2022, the Dental Schools Council called for an increase in the number of dental school places. The DSC presented three proposals agreed by the deans of UK dental schools to safeguard dental training and secure and improve the supply of future dentists by increasing dental school places. Again, that suggests that there is capacity to expand good-quality training here in the UK, ideally in the south-west.

[John Penrose (Weston-super-Mare) (Con)]

Does my hon. Friend agree that it is essential that dentistry, along with other medical disciplines, is included in the upcoming NHS staffing plan, which we all hope will involve a substantial increase in the number of people being trained at all grades of medical discipline, including dentistry?

[Kevin Foster]

Yes.

I look forward to the Minister’s response, and have two specific questions for him, in addition to those already raised. First, what progress is being made with renegotiating the contract, and what results is he expecting to see in the south-west this year from those renegotiations in terms of the increased accessibility of NHS dental services? Secondly, what plans does he have to create additional training spaces in the south-west, given that we know that where people train is where they are likely to stay and practise?

For too many in the south-west, NHS dentistry has become a service that is difficult to access and hard to register for. I hope that in his response the Minister will set out clearly the action we will see to get more dental practices to provide NHS services, and more dentists providing NHS services across the south-west region.

15:00

[Wera Hobhouse (Bath) (LD)]

It is a pleasure to serve with you in the Chair, Ms Elliott.

In Bath and North East Somerset, more than 105,000 adults have not been seen by a dentist for two years. That is 44% higher than the number in 2018. Children are not faring any better: nearly 15,000 were not seen by an NHS dentist last year, which is an increase of 90% since 2018. Routine dental check-ups are a vital first line of defence against more serious problems such as oral cancer, which is one of the fastest rising types of cancer and claims more lives than car accidents in the UK. Meanwhile, tooth decay is now the most common reason for hospital admissions for young children.

The British Dental Association has said that NHS dentistry is facing an existential threat that long predates the pandemic. The shortage of NHS dentists means that it is now nearly impossible to get a dentist appointment in Bath. Last year’s NHS statistics for England show that my Bath constituency is one of the worst places for NHS dentistry in the country. There were just 44 NHS dentists per 100,000 people living in the area. The Association of Dental Groups described my constituency as a “dental desert”. It stated that this already dire situation will worsen unless the Government take urgent action.

Staff are leaving NHS dentistry at an alarming rate. One in eight are approaching retirement and 14% are close to leaving the profession. Nearly 15% of dentists have been lost from Bath’s clinical commissioning group since 2016. Committed dentists are being forced out of the NHS. The Prime Minister boasted that 500 new dentists are practising in the NHS because of a Government reform; in reality, more than 500 dentists do just one NHS check-up a year.

The British Dental Association described official data on NHS dentistry as a work of pure fiction. Recent polls indicate that more than half of dentists in England have reduced their NHS commitments since the start of the pandemic. That is not tracked in official workplace data: dentists doing one NHS check-up a year are weighted the same as an NHS full-timer. The British Dental Association says the Government have never attempted to collect data on the workload of NHS dentists, or on how much time they spend seeing private or NHS patients. I would like a commitment from the Minister that such data will be collected. We need it urgently to understand the extent of the crisis.

However, we need more than just data: we need urgent reform. We Liberal Democrats are calling for an NHS dental healthcare plan to ensure that everyone can access affordable dental care when they need to. To start, we must immediately invest the money set aside for NHS dentistry and focus it on boosting the numbers of NHS appointments. The Health Service Journal reported that the national dentistry budget is set to be underspent by a record £400 million this year. How can that be when we are facing such a crisis?

The current NHS dentistry contract does not encourage dentists to take on NHS patients. Many dentists simply earn more in the private sector, but frankly many dentists tell me that they can afford to stay open and take on NHS patients only because they are cross-financing NHS and private patients. How can that be? We Liberal Democrats would carry out wholesale reform of the dental contract so that dentists are incentivised to work as NHS dentists without the fear of having to close their doors.

The Government must also encourage those who are ready and able to be dentists to enter the profession. The cap on the number of dental school places available in the UK has remained static since 2013, despite increased demand for dentists. We cannot let this crisis escalate any further. We Liberal Democrats would put into law a proper workforce plan, which would include protections for dentists and dental staff. Dental care is a right that everyone in Bath and beyond should be entitled to. It is time the Government’s response matched the scale of the crisis.

15:04

[Richard Drax (South Dorset) (Con)]

It is a pleasure to serve under your chairmanship, Ms Elliott. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this excellent debate. He, like me, has been concerned about this issue for some time. As he said, NHS dentistry left NHS England on 1 April, so dentistry in our area has now been delegated to NHS Dorset integrated care board, with which we have close connections and work a lot. It has been in place for only a short time and is already looking carefully at this major issue. I hope my hon. Friend and I can get the desired result.

At risk of spouting too many statistics, I think it is worth noting that in my seat of South Dorset there are only 10 dental practices, in Swanage, Weymouth and Portland. None of them is NHS, one is now private, and none was accepting new NHS patients when contacted by Healthwatch six months ago. There are only two surgeries in Swanage. My constituents write to me regularly on this issue, and I am ashamed to say that I did not realise how shocking the situation was until we started to look into it. The figures are shocking, and I hope the Minister will respond today not least on the contract issue, which every Member has mentioned, because this has to change. It simply is not working.

Let me share what four of constituents wrote to me. One said:

“It’s impossible to find a dentist in Weymouth”.

Another wrote:

“I haven’t had a dental checkup in person for two years due to covid”.

A third said:

“Our appointment has been cancelled again and now, our dentist is retiring early”.

And another wrote:

“After telephoning 14 practices ranging from Portland to Poole, Blandford, Sherborne and Wareham in Dorset through to Castle Cary in Somerset, I was met with 12 straight negative replies and 2 offers of being placed on very slow moving waiting lists or private treatment offers”.

That is completely unacceptable.

The hon. Member for Bath (Wera Hobhouse) mentioned that children are being affected, and how right she is. I heard in a telephone call today that 300 children in Dorset have been waiting for months not for dental treatment but to go to Dorset County Hospital to be knocked out by general anaesthetic because their problems are so severe. Because of the pandemic and the backlog, they are waiting in pain. These are children. That is really, really shocking.

Healthwatch also looked at the situation in wider Dorset. I hope Members will forgive me for giving more statistics, but they are quite interesting. Of the 95 practices in Dorset, two have gone out of business, 13 did not reply and 78 responded. Of those, no dentists are taking on new adult patients; two have closed since last year; 17 are now entirely private; 18 accepted new child NHS patients; seven accepted patients with additional needs; 23 have waiting lists, although some did not know how long; 50% have waiting lists longer than 12 months; Purbeck is particularly short of dentists; 75% of registered patients are still receiving routine check-ups, which is good; and most private practices would accept urgent referrals from NHS 111.

The British Dental Association has said—and I agree, from what I am learning—that NHS dentistry is facing an “existential threat”. It shocked me to discover that before the pandemic there were only sufficient funds for dentistry to look after 50% of the population—even before the pandemic, only half the population had their teeth looked after. That is extraordinary. Some 11 million—almost one in four—adults are not having their needs met, and 10% of the £3 billion budget is set to be returned to the NHS this year, not because of lack of demand but because practices are unable to fulfil contractual commitments. Burnout and issues with retention and recruitment are causing a lack of dentists.

As I understand it, the contract, which has been touched on, is based—I hope I have this right—on a quota system, and dentists are penalised if they overperform. They are penalised if they underperform, and their funds are taken away. They are penalised if they take on patients with high needs, because they get paid the same for treating patients with fewer needs. This really is a serious issue, and I very much hope that the Minister can respond, not least on the issue with the contract.

15:10

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to serve under your chairmanship, Ms Elliott, and to follow the hon. Member for South Dorset (Richard Drax), who made some excellent points that get to the heart of why the Government are failing us on NHS dentistry. I will follow him by using some examples and giving a voice to some of the constituents in my part of Devon who have written to me to appeal for help.

Chrissy Evans from Seaton wrote:

“I don’t understand why there has been no effort to address the problem of thousands of British children without free access to a dentist…We have tried all the dentists in our area and none are taking on new patients unless they are private.”

John Mason from Branscombe received an email advising him that his check-up was booked, only to be telephoned by the practice in Sidmouth a few weeks later. He wrote:

“I had been an NHS patient in Sidmouth for many years. I was telephoned by the practice”,

which told him that his options were to become a private patient, to try to find another dentist, or to call NHS Devon if he needed emergency treatment.

A woman from Honiton, who I do not have permission to name, has had dental issues since 2011. She wrote to me:

“I have been trying to sort this since 2011, I believe now I am considered too old to matter. I cannot eat, I don’t wish to be seen trying. I hide my face when possible. I don’t smile, I avoid friends and family, my speech is affected, this has ruined my life for the past 12 years and consumes my every thought.”

Finally, Edward Roberts from Tiverton puts it very plainly:

“The situation which prevails is unacceptable but no one in Government seems to be concerned about it.”

People are living in pain. The examples I have just given are a small snapshot of the heart-rending emails that I have received about people’s dental misery. As we have heard already, many in the west country do not have access to an NHS dentist. A survey by the British Dental Association in March laid bare the challenges we face. It found that across the south-west, nearly three in five dentists reported having reduced their NHS commitment by an average of 30%, but a staggering 75% also reported their intention to further reduce the amount of NHS work they undertake this year.

Why is this happening? Because the NHS work that dentists take on simply does not pay enough to be viable. Many NHS dentists are simply overwhelmed by the soaring costs of their work and, on this trajectory, the problem is only going to get worse. The BDA reports that 49% of south-west dentists say that they are likely to go fully private, with 41% likely to change career or seek early retirement. Fifteen per cent say that they will move abroad. Unless the Government take swift action now to start to address the situation, we could see NHS dentistry effectively disappear within a decade.

It is pretty infuriating to see the Government’s lack of recognition of the issue. Ministers at the Dispatch Box should not hide behind the outrageous claim, which I and others will have heard, that the Government have reformed the NHS contract. They have not. In July 2022, they simply paid dentists for a few more units of dental activity—for example, a dentist who is treating a mouth full of teeth that need repair will get paid the same as somebody who is treating a mouth that needs three teeth worked on. Instead, the Government should engage constructively with dentists and overhaul the NHS contract to compensate sufficiently for dental work carried out on the people who need it. Unless those steps are taken, people will continue to suffer in pain. Dentistry should not be only for those fortunate enough to win the postcode lottery.

I hope to hear from the Minister some unequivocal plans to reform the NHS dental contract, and I am curious to know what steps the Government will take to address the crumbling state of NHS dental services—I hope that they will include some measures that my Liberal Democrat colleagues and I have been calling for over many years. Above all else, I want some honesty from this Conservative Government: either reform the NHS dental contract properly, or simply admit that an NHS dental service for our constituents in the west country is a thing of the past that this Government are not willing to prioritise.

15:15

[Anne Marie Morris (Newton Abbot) (Con)]

Healthy teeth are a critical part of a healthy body; we cannot really separate one from the other. It has always surprised me that when the NHS was established, the concept of free at the point of delivery excluded dentistry, for which there has always been a charge. There is something about dentistry, because it is either too complex or too expensive, that has led it to be somewhat second class.

As the decades have gone by, Governments have recognised how important teeth are, and I am pleased to say that there is a much more enlightened view as to their inclusion. There has also been a recognition over the years of the importance of healthy teeth for children particularly, hence the free care for the under-18s. That is why it is particularly worrying that colleagues say—I have heard exactly the same comment—that although children need to be prioritised, they are not being prioritised as things stand. Indeed, on one of my more recent visits to one of my local practices, I came to understand that dentists cannot take on private patients and only child NHS patients; if they go for NHS, they have to do everybody. That is a fundamental piece that ought to be changed.

As colleagues have already said, covid has effectively exposed a pre-existing weakness in the system. There is a shortage of dentists. We have heard a lot—it is absolutely true—about the cap on training numbers and the challenge to which that has given rise. We have heard about how, year on year, more dentists are moving away from the NHS into private. Across the country, the NHS has lost 10% of its dental coverage.

In Devon, in my constituency, there are no NHS dental appointments. The situation is at least as bad in Devon as it is in Dorset. Indeed, on that same visit to the dental practice, I asked how long people would have to wait to get on the patient list—the answer was seven years. That strikes me as even worse than the position in Dorset. Our proportion of dentists, which appears to be accepted, is extraordinarily low. In Devon, there are 51 dentists for every 100,000 patients. That seems very low, but, believe me, it is actually quite good—many places are worse than that. If that is the starting point, it is the wrong starting point and needs to change.

Dental health is absolutely fundamental to the whole body. Reference has already been made to hospital admissions for children. As I understand it, certainly in my part of the country, most admissions for children between six and 10 are caused by the health of their teeth. It is not just that they happen to have a problem with their teeth that is spotted when they are in hospital.

What has to change? Clearly we need more recruitment. The cap has to go. I know that it costs £230,000 to train a dentist, but, frankly, that is good value for each dentist. We need better retention, and the contract, which has been referred to, is clearly one of the biggest reasons why we do not have the retention that we need. We need to broaden the profession. The Government have taken steps, such as the “Advancing Dental Care” review in 2017 and a dental education reform programme. But that is too slow. The ambition is right—more flexible entry, more apprenticeship, new centres of development and putting the training together as dentists get to the secondary stage of their training—but it is not enough. My hon. Friend the Member for Totnes (Anthony Mangnall) suggested that dental therapists should be better used, which is absolutely right. 

The trouble with the contract is, as we have heard, the challenge of how it is constructed. Dentists are not paid per patient, nor for all the work done; they are paid for the most complex work, and that decides the amount paid, which generally does not cover the value of the work they have done. The second problem is that when someone enters into the contract, if they do more work, they do not get paid for the extra, but if they do less they have to give a refund. Effectively, the challenge for dental practices—certainly, for the one I recently visited—is that they cannot use all their contracted hours because they cannot get the dentists to fulfil them.

There is work to be done. The Government absolutely need to deal with the backlog, the contract and the payments. They need to deal with the children issue and to allow individuals to treat children in the NHS, even if they cannot treat adults.

15:20

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a pleasure to serve under your chairmanship, Ms Elliot. I congratulate the hon. Member for West Dorset (Chris Loder) on securing an important debate and opening it very well. Access to NHS dentistry is becoming harder across the country, but, as we can sense from the contributions we have heard, especially so in rural communities such as those in Cornwall, Devon, Somerset, and Dorset, as well as in areas such as my own, in Cumbria.

Rural communities struggle more than others with access to dentistry because of pressures such as high housing costs and lower working-age populations, which mean there is a smaller dental workforce. Access to dental care in rural communities is also worse because we are dealing with sparsely populated areas and fewer economies of scale are available for the surgeries in question. There is the additional and crucial matter of the physical distances that people have to travel to receive treatment. Last week, I did a quick search and found that for a family in Coniston in my community the nearest available NHS dental place was in Hexham in Northumberland, which is a 160-mile round trip.

Every month it seems that we lose another NHS dental practice. I am sure that is the case for Members in every part of the country—from the contributions so far, especially in the south-west. I have recently lost a surgery in my community that saw 5,800 patients lose their NHS status overnight. The private plan that those patients were offered to replace those places would have cost a family of four £1,000 a year just to stay registered and on the books. With increasing prices, such as the rise in mortgage costs, rental costs, fuel duty and food—the cost of just living in any respect—how is that acceptable or affordable, given that that family, like everybody here, have already paid for their NHS dentistry through taxes?

People across our country have paid for a service, as my hon. Friend the Member for Tiverton and Honiton (Richard Foord) said, that the Government have not delivered. It is about not just the financial costs to families if they have to go private when an NHS dental service is no longer available but the physical pain, the anxiety and the sense of guilt, for parents, that their child is not seeing a dentist because they cannot afford to send them because NHS dentistry is not available. My hon. Friend the Member for Bath (Wera Hobhouse) talked about oral cancers and the fact that many dentists are the first to spot them and provide life-saving treatment.

For what it is worth, I do not blame the dentists, because I speak to so many of them. They are as angry as the rest of us, for many reasons. First, the Government take the public’s money but do not pass it on to the dentists. There is not enough money in the system, as the hon. Member for South Dorset (Richard Drax) wisely pointed out. That is true nationally, but it is also true surgery by surgery. Dentists tell me that it is often the case that the Government’s funding per unit of dental activity may be less than what a patient paid over the counter for their treatment. Dentists and patients, then, are both being ripped off.

A unit of dental activity payment, at the most basic level, could net perhaps £20 or £30 for a single examination. Diligent dentists seeking to do a good job might do three of those in an hour. Let us do the maths—that funding is not enough to pay to keep the lights and heating on, pay the rent and pay for staff salaries and materials. Many dentists feel that treating patients at a good standard therefore costs them and their practice more money, and that they have to subsidise the NHS. There are incentives to cut corners, to be on a treadmill, to rush through more patients and to do a job that the dentists themselves feel professionally dissatisfied with. As we have heard, good dentists who are committed to the NHS find that they cannot afford to stay, so they leave and it breaks their heart. That leaves thousands of our constituents without access to adequate, affordable dental care, which leads to more expensive, painful and damaging emergency hospital dental care further down the line.

There are many things that we can do as local MPs. I have written to my local surgeries to encourage them to take advantage of things that the integrated care system has offered to bring some back to the NHS, but unless there is radical reform of the system, good dentists will leave the NHS and thousands on thousands of our constituents will not be able to access the dental care that they have already paid for through their taxes for themselves and their children.

15:25

[Sir Robert Syms (Poole) (Con)]

I congratulate my hon. Friend the Member for West Dorset (Chris Loder), who set out not only the problems but some of the solutions to the crisis in NHS dentistry, and my hon. Friend the Member for South Dorset (Richard Drax) reinforced his arguments.

If one is honest, there has never been an ideal NHS system. Before covid, people still needed a degree of luck and persistence to find an NHS dentist, but one of the main impacts of covid was to create a crisis in dentistry that was not there before. There is a massive backlog and a lot of people are leaving the profession. It is certainly one of those issues that needs to be higher on the political agenda.

The Government have already done one or two things to help. The changes to the annual allowance and lifetime allowance for professionals, particularly those in dentistry, will keep more people in the profession. We need a short-term and a longer-term plan to increase the number of people in the profession. Most of my hon. Friends have come up with solutions. My hon. Friend the Member for Torbay (Kevin Foster) said that we need to train more people, not just generally in the national health service but in dentistry.

We have a common problem. Parents find it difficult to find NHS dentists for their children. I get a lot of emails from pregnant women in Poole and those with special care needs who tell me that, because a number of NHS practices have packed up, they are shuttling around trying to find treatment that is not there.

Like my colleagues, I think the Government need to speed up the dental recovery plan to give those who at the moment are not getting treatment some hope of better times ahead. That is the short-term solution. In the long term, we will simply have to spend more to train people in the dental profession and raise the cap on dental schools. About 20 years ago—not too long after I was first elected—there was a proposal for Southampton to have a dental school, and the rationale for that was that dentists tend to stay in the area they train. That did not go through because the Blair Government decided not to go ahead, but I am interested in the proposals for a dental school in Dorset. We need more in the south-west of England so that people come in, train, like the communities they are living in and stay.

In our inboxes, we get a sense of our constituents’ urgency. There are people in need of treatment, so we need fundamental reforms and possibly some additional money from the Government. I know the Government and local health authorities are looking at this issue seriously. There is no magic bullet, but the sooner we get proposals from the Government to start to recover the situation, the better it will be for my constituents who are struggling to get the services they thought they would be provided with.

15:29

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

It is rare for every single party in the south-west to agree, but we do all agree on this: NHS dentistry in the region is broken, and it is getting worse. There is a huge crisis facing NHS dentistry in Plymouth, and everyone who has tried to access a dentist in my city knows it. After 13 years of Tory government, it is getting harder and harder to see an NHS dentist. Many children in Plymouth are in pain at home, having never visited a dentist.

Hundreds of our kids are having their teeth removed under general anaesthetic at Derriford Hospital every year. Some patients, unable to afford private dental care, are resorting to pulling out their own teeth. NHS dentistry in Plymouth is an endangered species. For many, an NHS dentist appointment is already a mythical beast, spoken about only when prefaced with, “Do you remember when you could get one?” Ministers have broken NHS dentistry over the past 13 years. If they do not do something serious soon, we are not far away from the extinction of NHS dentistry in Plymouth.

I thank all the people who work in NHS dental surgeries and practices, from dentists, to hygienists, to receptionists—who often get the brunt of angry people unable to access an appointment—to trainees and students. Our NHS dental waiting list in Plymouth is now over seven years long. It has an estimated 22,000 people on it, and it is growing each and every day. That is 10% of our population. The Dental Access Centre at Seven Trees Court in Plymouth—the only emergency dental service in the city—handles demand that far exceeds the supply of appointments. It takes over 300 calls a day, but it has only 20 available slots.

We need a proper plan, not more half measures and sticking-plaster solutions. Last year, the Government announced a £50 million dentistry treatment blitz, which all hon. Members present will remember. Of the £4.76 million allocated to the south-west, the Department of Health and Social Care has clawed back £4 million. Our system is so deeply in crisis that we are unable to fulfil the contracts we already have, let alone the extra funding, because we are so short of staff to deliver them. Our NHS dental system is utterly broken.

Ministers have also failed to address the recruitment and retention crisis facing NHS dentistry nationwide, but especially in the south-west. As mentioned by the hon. Members for West Dorset (Chris Loder) and for Tiverton and Honiton (Richard Foord), the British Dental Association estimates that over half of all NHS dentists in the west country are likely to go fully private, and 75% say they are likely to reduce, or further reduce, the amount of NHS work taken this year. It is going to get worse. That is what I am hearing from the dentists.

A professional working in the sector wrote to me with an upsetting account of what it is really like to be in NHS dentistry. She said:

“As with many of my other colleagues, the state of NHS dentistry in Plymouth has broken my spirit. Our service is constantly slated by the public for not doing enough, and my colleagues are subjected to abuse via email and over the phone daily - despite us often going above and beyond what we are commissioned to do. It is not our service that is letting the people of Plymouth down but those in government.”

What on earth would incentivise someone to go to work and stay in NHS dentistry if that is their lived experience every single day?

The last Labour Government opened a new dental school in Plymouth, which is outstanding and superbly led. It is focused on social outcomes and excellent teaching, and it is rated as the best dental school in England. That is a Labour legacy that we can be proud of. However, NHS dentistry in our city is on its knees today, and responsibility for that lies firmly with the Government. Despite the heroic efforts of staff, if NHS dentistry were a hospital, it would be in special measures. That is why we need an emergency rescue plan.

There are ways out of this crisis. First, we need to reform the NHS contract. The changes announced to date are inadequate to address the systemic problems. We know what the solutions are. Let us get on with it. Secondly, we need a national plan for recruitment and retention. At the moment, there is no national plan to address that crisis. Thirdly, I want Ministers to increase the number of dental students in training, reversing the 10% cut from a few years ago. We do not have enough dentists in training to replace those who are leaving practice. The Minister could take an immediate step. The Peninsula Dental School in Plymouth wants to take on an additional dozen students for the next academic year. Please could he help it to do so by granting the funding?

Fourthly—this will be a game changer—we need to properly fund dental therapists. Dental therapists can do 80% of what a dentist can do, but they take only three years, not five, to train. Funding them could have a profound impact on rural and coastal areas across the west country. Finally, we need our fair share of funding. Per capita, the south-west receives less funding for dentistry than nearly every other region in the country. It is not fair. There is a solution to this crisis. Let us just get on with it.

15:34

[Derek Thomas (St Ives) (Con)]

I thank my hon. Friend the Member for West Dorset (Chris Loder) for introducing this debate. Nearly a year ago, I introduced a debate in this place on the same subject. The then Minister said it was a priority to increase the number of dentists in specific parts of the country, and she mentioned our loved area, the south-west. At the same time and soon after, contract changes were announced. I would not say that they were completely hopeless, as has just been suggested, but people in the south-west are still struggling to get a dentist, as we have heard. I still get emails from constituents who are not getting the treatment they need or spending their time and money travelling to London, Manchester or even abroad to access dentistry.

Since my debate, I have witnessed dental practices giving up NHS contracts or vastly reducing NHS treatment, forcing people to fund themselves fully, while others who cannot afford that go without treatment; I raised that issue with the Health Secretary in the main Chamber only recently. This week, a lady told me that she had filled her own tooth, using a kit she bought online and the torch on her mobile phone. She was frustrated, and so was the dental practice. It has a contract with the NHS to provide thousands of units of dental activity—UDAs—but that funding allocation is clawed back by the NHS if it cannot deliver those units. It cannot deliver those units because the value is too low to attract the staff it needs.

This year, that practice alone will pay back £132,000 in clawback—enough funding to treat roughly 1,600 patients in west Cornwall. I have asked NHS regional commissioners where those funds go and whether they can be made available for additional dentists; I have not received a reply. In fact, although I previously appreciated a very healthy and helpful dialogue with NHS England commissioners, their engagement and response rate with me and my office this year has been woeful.

Nationally, the underspend in the NHS dental budget could reach half a billion pounds. If I could get just one commitment from the Minister today, it would be to ensure that that money is spent on the dental care we need. For example, it could be used to raise the UDA value to £30. That would be a small step, within existing budgets, that could help dental practices in my constituency afford to treat more patients.

In the longer term, we know that the NHS dental contract needs reform. It does not work for dentists, and it certainly does not work for our constituents—the patients. We look forward to integrated care boards, but we also look forward to their taking ownership of dentistry and driving the delivery of dental care for their regions. In Cornwall, we have an integrated care board just for Cornwall and the Isles of Scilly. It is really helpful now to know exactly where to go to talk about dentistry. As we heard earlier from my hon. Friend the Member for West Dorset, we must work together to really have local accountability and delivery solutions to address people’s oral health.

We need better workforce data on dentistry as part of the forthcoming NHS workforce plan. We heard yesterday that the British Dental Association reported that the numbers of NHS dentists had fallen. The Minister’s Department says that not all NHS dentists have submitted their data for the year. Whatever the truth is, that shows that we do not have credible data; without data, we do not have a plan. The workforce plan needs to ensure not just the number of dentists, dental nurses and other dental professionals, but where they are located. We have a brilliant dental suite in Truro, but graduates rarely stay in Cornwall once they have been trained. We are seeing a slight improvement, with dental practices offering foundation placements for those graduates in Cornwall—something that traditionally we have not done—including in St Ives, but the potential is far greater.

Finally, I recognise that the Minister is as keen as I am to empower the entire dental team to work to their full potential for NHS patients. However, some barriers remain to fully implementing direct access in NHS-funded dental care. In dental care, a system exists that enables the administration of medicines by dental care professionals when they provide care to patients paying privately. That does not apply for NHS dental patients.

On Friday, I visited a new dental practice. Did you hear that—a new dental practice? It is not all dreadful and miserable. The owner is providing five new treatment rooms. He has two dentists and a hygienist, and he will take on more UDAs and dentists—he will have the dentists if he has the UDAs—but he explained the impact of the disparity that I just raised:

“We have therapists in most locations in the Southwest ready to increase NHS access, especially for young children as most of the work for this cohort of patients is within their scope of practice, and it is disappointing we cannot use them fully. Dentists are very reluctant to sign off prescriptions because of time issues and not understanding the process. Our therapists are only doing Hygiene, and some of them are leaving because of the lack of work.”

My understanding is that a statutory instrument in this place is required. That simple piece of legislation would provide the opportunity for NHS dental practices to use the full skillset and competencies of their dental staff to increase the delivery of desperately needed dental care. I know that the Minister is aware of that and keen to drive that forwards. Will he indicate whether that SI will be forthcoming in the near future?

15:34

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Elliott. I thank the hon. Member for West Dorset (Chris Loder) for securing this really important debate and for the work that he does locally and here in Westminster to raise awareness of the issue. We have had a good, full debate. I thank my hon. Friends the Members for Bristol East (Kerry McCarthy) and for Plymouth, Sutton and Devonport (Luke Pollard) for their contributions, as well as the hon. Members for Torbay (Kevin Foster), for South Dorset (Richard Drax), for Newton Abbot (Anne Marie Morris), for Poole (Sir Robert Syms), for St Ives (Derek Thomas), for Bath (Wera Hobhouse), for Tiverton and Honiton (Richard Foord), and for Westmorland and Lonsdale (Tim Farron). That stretches the geography to the limits, but the hon. Member for Westmorland and Lonsdale has raised some very important points on behalf of his constituents and rural communities across England, not just in Cumbria.

Last week I responded to a debate on behalf of the shadow Health and Social Care team on dental services, but it was about the east of England. A couple of weeks before that I responded to a Backbench Business debate on NHS dentistry in the main Chamber. I do not raise those debates today to fill you in on my diary commitments over the past few weeks, Ms Elliott, but to highlight the strength of feeling across the House about the crisis we are currently experiencing in dental care.

We are all hearing from constituents who cannot access care, about parents trying to get their children seen and, in the most extreme cases, as we have heard today, patients attempting to perform dental treatments on themselves or on loved ones. So-called dentistry deserts are not being eradicated. Instead, they are multiplying, not least of all in the south-west, as we have heard today.

Last summer it was reported that out of 465 dentists across the south-west, just seven were accepting new patients. Indeed, we have heard more up-to-date statistics from Members during this debate. The number of NHS dentists practising across the south-west has fallen by more than 200, and in areas such as Exeter the current wait to get an NHS dentist is now two years. Behind the statistics are human beings who just want to be seen and to be treated, and we owe it to them to act. So my points to the Minister today will be familiar to him, and I fear that I will keep having to make them time and again until we see the Government’s dental plan.

My first point relates to the dental contract. As I have said before, it was the Labour Government who introduced the dental contract, but by the 2010 general election they had recognised that the contract needed to be substantially reformed. That was in our manifesto. The then Conservative Opposition agreed and it was in their election manifesto, too. The Government have been in power now for 13 years and change has moved at a glacial pace. In his response to the debate last week, the Minister said that he was under

“no illusion that there are significant challenges to address”,—[Official Report, 16 May 2023; Vol. 732, c. 353WH.]

but that those would be tackled in a forthcoming dental plan. Given the urgency of the situation, can the Minister provide an update on the development of the plan and when we can expect publication?

The hon. Member for West Dorset highlighted issues with unit costs being disincentives, and that was followed by other Members during this debate. It is true that dental costs have to be looked at on a per-unit basis because there are perverse incentives, but it would also be wrong to pretend that before the dental contract was introduced, there was a golden age of NHS dentistry. As I said last week, there is a reason why I have a mouthful of fillings and my children do not. It is not because I ate more sweets and did not brush my teeth as well as my children, but because of the then even more perverse incentives for dentists to drill and fill. They were paid for every filling that they put in so that people ended up with a mouthful of fillings whether they were needed or not. We need to strike a balance so that we get the public health needs and patients’ needs as well as a financial package that works for dentists to make a living.

On a similar note, can the Minister update us on the workforce plan? We have heard about that from hon. Members across the House today. We know that it has been produced and that it is on the Secretary of State’s desk. It is particularly pertinent, given that it was revealed earlier this week that the number of active NHS dentists in England is now at its lowest level in a decade, in spite of rising demand and in direct contradiction to claims made by the Prime Minister in Parliament.

Given that net Government spend on general dental practices in England has been cut by more than a third in the past decade and the number of NHS dental practices in England has fallen by more than 1,200, it is of little comfort to patients waiting in abject pain and misery to hear the Government say that a plan is coming. We urgently need to see the workforce plan published and implemented and reforms put in place that work for both patients and staff.

Labour knows we need to change if we are to secure the future of NHS dentistry. We want the NHS to become as much of a neighbourhood health service as it is a national health service. To do that, we will encourage joined-up services in the community that include dentistry. We want to see health professionals such as dentists working with family doctors as part of a neighbourhood team. That will not only help people get access to more care on their doorstep but prevent oral health problems before they become acute. It will also dismantle the two-tier system that has been allowed to develop, where those who can afford to pay receive treatment and those who cannot are left languishing. That is being further compounded by the way the cost of living crisis means some families are unable to afford even basic hygiene products. We are witnessing health inequalities widen in real time as a result, and that must not be allowed to continue.

What does the Minister plan to do to tackle oral health disparities and prioritise prevention? Will that work be part of his dental plan? I am sure this will not be the last dental debate I take part in on behalf of the shadow Health and Social Care team, but I sincerely hope that the next time I am face to face with the Minister in Westminster Hall or the main Chamber, we will have seen some long overdue progress.

It has been demonstrated during today’s debate that this need not be a partisan issue. It is in all our constituents’ interests that the Government crack on now and get improvements to dental care. We all want better dental care for our constituents and, as I said in the last debate and probably the one before that, addressing this crisis cannot wait until we have had a general election. In that vein and in closing, I urge the Minister to recognise that fact and get on with the job.

15:48

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

It is a pleasure to serve under your chairmanship, Ms Elliott. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this incredibly important debate. Dentistry is the No. 1 issue that I am working on, and I reassure hon. Members that we are doing so at pace. We know that there are serious challenges across the country; hon. Friends and hon. Members are quite right about the scale of those challenges, which are particularly acute in the south-west.

I met the commissioners for dentistry in the south-west earlier this week. I met the professions separately, and I had further meetings about our dental plan earlier today. This is absolutely top-priority. I have been talking for some time to hon. Friends present and to south-west Members and others to generate the ideas that will go into the plan. They are the first in my mind when I think about those who are contributing important ideas to our dentistry plan, not just in their speeches today but in our conversations.

We have already started the process of reform, but it is only a start. We have created more UDA bands to reflect the fair cost of work and to incentivise NHS work. We introduced the first ever minimum UDA value to help to sustain practices where they are low, and—to address the point raised by my hon. Friend the Member for South Dorset (Richard Drax)—we have allowed dentists, for the first time, to deliver 110% of their UDAs, to encourage more activity from those who want to do more NHS dentistry. We have also started the process of making it easier for dentists to come and work in the UK. Just last month, legislation came into force that enables the General Dental Council to increase capacity for the overseas registration exam. I have also met the council to discuss how we can bust the backlog that built up during covid.

Plans for the centres for dental development are emerging around the country, which is very exciting and will address the issue that colleagues have mentioned about how to encourage dentists to train and then remain in the south-west and in other areas that find it more difficult to attract dentists. We have started to empower hygienists and therapists as well, exactly as my hon. Friend the Member for St Ives (Derek Thomas) proposes. We stand ready to go further. The reforms to split band 2 and the 110% option have been well received by the profession. They are being used: the proportion of the new band 2b that is being used is going up, which is already having some effect on delivery, although of course that effect is not high enough.

In data published by NHS England this week, the proportion of contracted units of dental activity delivered went up from 85% last March to 101% this March, and the number of NHS patients seen has gone up by about a fifth over the last year, so there is progress, but there is much more to do. We will go further in the forthcoming dental plan, which I hope will be out relatively shortly.

The reforms that I have talked about and the forthcoming dental plan draw on the ideas that Members across the House have put forward today. They will build on those initial banding changes, further improve that payment model and start to take us away from the 2006 contract, which everyone agrees is broken. Exactly as my hon. Friend the Member for West Dorset pointed out, that is the core of what we need to do.

We will also ensure further measures to improve access, particularly for new patients, look at how we address historical UDA variations that are not justified, improve transparency—I think my hon. Friend the Member for Torbay (Kevin Foster) made that point—and take further steps to grow the workforce, not least through the workforce plan, which we will publish very shortly. Fundamentally, we will do everything we can to make doing work for the NHS and NHS patients more attractive to dentists. At the same time—to answer the question that the Opposition Front Bencher, the hon. Member for Denton and Reddish (Andrew Gwynne), quite rightly asked—we will do more to encourage prevention as well.

The devolution of dentistry from the NHS regions to the individual integrated care boards at a more local level is an important improvement that we want to build on. It provides an opportunity for much closer integration with other local care services and much more accountability about what is being commissioned and delivered at the local level. People and MPs can go and see the person responsible for delivery in their area much more easily, and our dentistry plan will build on just that.

[Chris Loder]

I very much appreciate what the Minister is saying about the plan for dentistry going forward. The last time I brought up the issue was in July 2022, almost a year ago. We had these problems then, and we have them much worse now. Will the Minister share with us how some of these great initiatives, which I am pleased to hear about, will be expedited so that they can have the maximum effect as soon as possible for those who are most affected in the south-west?

[Neil O’Brien]

I feel the exact same sense of burning urgency that my hon. Friend feels. I hope our plan will be out very shortly.

[Richard Drax]

The Minister may be coming to this point, but can I ask him about the disincentives—the cap beyond which dentists do not get paid, and the money that is taken off them if they underspend? Is that issue going to be resolved?

[Neil O’Brien]

Absolutely. I mentioned that in the last financial year we brought in the 110% flexibility so that those who do want to go further and deliver more NHS care were able to do so. We are looking at continuing that and also making some further changes to make the system more flexible and give local commissioners more power, so we do not have these rigidities in the system leading to the absurd situation where there is both under-delivery and underspend, which is completely maddening to everyone.

Once again, I thank my hon. Friend the Member for West Dorset for raising this hugely important subject. I am sure all hon. Members will want to see the dentistry plan out as shortly as possible.

[Luke Pollard]

Could the Minister return to the question I raised about additional training places for dentists? We have a really good dental school in Plymouth that wants to take on more dental students. That could deliver a big impact for our region. Is that something that he is minded to look favourably on?

[Neil O’Brien]

We will set out our plans extremely shortly on the future of the workforce and on growing training places. I am sure we will look closely and with great interest at individual proposals such as the one that the hon. Member has just made.

Not just in the south-west, but in the entirety of England, we are looking to improve and build on the NHS service that is so vital to all of our constituents. It is a personal passion of mine, and we are working at pace on it. We know it needs to improve. We have had good ideas coming from Members across the House this afternoon, and we will try to put them in place as soon as we can.

15:55

[Chris Loder]

I thank my hon. Friend the Minister for his kind response, not just to my contribution but to that of every Member here today. I reiterate that we are in a position of quiet desperation in Dorset. I appreciate a lot of the initiatives the Minister has shared with us today, but I must impress on him, on behalf of all those present, the urgency with which they must be expedited. We look forward to seeing some of the initiatives becoming a reality in due course.

I remind the Minister that my hon. Friend and constituency neighbour the Member for South Dorset (Richard Drax) and I see the dental training college in Dorset as an important component of resolving some of the difficulties. I was hoping to hear a little more about that. Maybe the Minister could share that with us, and write afterwards to tell us a little more. That would be much appreciated.

I am delighted that hon. Members from across the United Kingdom came to my debate about dentistry in the south-west. I was particularly pleased to see the hon. Member for Strangford (Jim Shannon), who I was not expecting—he is not in his place now. As for the hon. Member for Westmorland and Lonsdale (Tim Farron), I was getting a bit worried that he might be on a chicken run to the south-west in the next general election. We will see. I know some—anyway, there we go.

I am very grateful to you, Ms Elliott, for chairing the debate, to all right hon. and hon. Members who have contributed, and to the Minister for his response.

Question put and agreed to.

Resolved,

That this House has considered the provision of NHS dentists in the South West.