The Minister for Care (Stephen Kinnock)
I start by thanking the hon. Member for Chippenham (Sarah Gibson) for securing this important debate. As my right hon. Friend the Secretary of State has said, we will be honest about the problems and challenges facing our health and care system, and we will be serious about tackling them.
Mrs Sarah Russell (Congleton) (Lab)
In my constituency, there has been an 11% decline in the number of adults who have seen an NHS dentist in just the last few years—it has been precipitous. There is a specific problem, however, with adults in care homes. I spoke to a local dentist, and she explained that the standard insurance for dentists no longer covers them visiting and performing services in care homes in the community. Can the Minister look into that, and does he agree that it is a huge problem that when vulnerable people cannot come to a dental practice, dentists cannot go to them?
Stephen Kinnock
My hon. Friend points to a specific problem set against the backdrop of the general challenge that we face in dentistry, thanks to the legacy of 14 years of Tory incompetence and negligence. We will of course look into it, and if she would care to write to me, I would be happy to look into the issue.
The hon. Member for Chippenham is right to raise the problem of NHS dentistry in rural areas—a problem that will, sadly, be familiar to Members across the House. The truth is that we are very far from where we need to be. Lord Darzi’s review laid bare the true extent of the challenges facing our health service, including NHS dentistry, and even he, with all his years of experience, was shocked by what he discovered. His report was vital, because it gave us the frank assessment we need to face the problems honestly and properly. It will take lasting reform and a long-term health plan to save our NHS. Rescuing NHS dentistry will not happen overnight, but we will not wait to make improvements to the system, increase access and incentivise the workforce to deliver more NHS care.
The Government have committed to three seismic shifts: from hospital to community, from analogue to digital and from sickness to prevention. Our 10-year plan will set out how we will deliver those shifts to give the country an NHS that is fit for the future.
Tim Roca (Macclesfield) (Lab)
I share the astonishment of other Members that not a single Conservative Member is here, in a debate on NHS dentistry in rural areas. I am a bit old-fashioned and I want a functioning Opposition. It is sad that they are not here to take part in this debate. When I contacted surgeries in Macclesfield to find out the state of play, 15 said that they do not accept NHS patients at all. That is the legacy that the Conservatives have left us. Can the Minister confirm that the Government will move urgently and quickly on NHS dentistry reform?
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Interventions should be short, and the Minister must respond to the Member whose debate it is.
Stephen Kinnock
We are working at pace, and I will say more about that shortly. I share my hon. Friend’s reflections on the complete absence of the Conservatives. They made a complete mess of our public services, called an election and ran for the hills.
On 4 July, we inherited a broken NHS dentistry system. It is a national scandal that tooth decay is the leading cause of hospital admission for five to nine-year-olds in our country. It is truly shameful and nothing short of Dickensian. In the area served by the NHS Bath and North East Somerset, Swindon and Wiltshire integrated care board, which includes the constituency of the hon. Member for Chippenham, 33% of adults were seen by an NHS dentist in the 24 months up to March 2024. That compares to a 40% average across England. In 2023-24, there were 44 dentists per 100,000 of the population there, whereas the national average was 50.
When we look at the problem in the round, it is not so much that we do not have enough dentists, but that not enough of them are doing NHS work, and they are not in the parts of the country that need them most. That challenge is compounded by the fact that some areas of the country are experiencing recruitment and retention issues, including many rural areas, where the challenges in accessing NHS dentistry are exacerbated. That of course includes Chippenham, where Hathaway dental practice has recently had a request granted to reduce its NHS activity, as the hon. Lady pointed out. I understand, thanks to a freedom of information request by the British Dental Association, that the practice had a £4.2 million underspend on its NHS contract. That is precisely the problem that hon. Members have pointed out. There is a quantum of funding, but the way in which it is structured makes private sector dentistry far more attractive than NHS dentistry. That is the root cause of the problem; we are alive to that issue.
Overall, it is clear that we have a mountain to climb. It is a daunting challenge, but we are not daunted, and we are working at pace. The golden hello scheme, for example, will see up to 240 dentists receive payment of £20,000 to work for three years in one of the areas that needs them the most. Integrated care boards have already begun to advertise posts, as we have accelerated that process. In the ICB area of the hon. Member for Chippenham, there have been seven expressions of interest, five of which have been approved. Providers can now include incentive payments when they advertise vacant positions.
Alongside that, we will deliver a rescue plan that gets NHS dentistry back on its feet. That will start with providing 700,000 additional urgent appointments as rapidly as possible, as set out in our manifesto. Strengthening the workforce is key to our ambitions, but for years the NHS has faced chronic workforce shortages, so we have to be honest about the fact that bringing in the staff we need will take time.
Stephen Kinnock
I have very little time left.
We are committed to reforming the dentistry contract to make NHS work more attractive, boost retention, and deliver a shift to prevention. This Government will always make sure that our health and care system has the staff it needs, so that it is there for all of us when we need it.
We are already working at pace with the British Dental Association and the dental sector to improve and reform the dental contract. The Secretary of State met the BDA on his first day in office, and I have met it a couple of times, including yesterday. We will listen to the sector and learn from the best practice out there. For example, I know that the ICB of the hon. Member for Chippenham has applied its delegated powers to increase the availability of NHS dentistry across the south-west through other targeted recruitment and retention activities. That includes work on a regional level to attract new applicants through increased access to postgraduate bursaries, exploring the potential for apprenticeships and supporting international dental graduates. In addition, a consultation for a tie-in to NHS dentistry for graduate dentists closed on 18 July, and we are now considering the responses. The Government position on this proposal will be set out in due course.
We are also working round the clock to end the appalling tooth decay that is a blight on our children, as I have mentioned. We are working with local authorities and the NHS to introduce supervised tooth brushing for three to five-year-olds in the most deprived communities across the country, getting them into healthy habits for life and protecting their teeth from decay. We will set out plans for that in due course, but it is clear that to maximise return on investment, tooth-brushing programmes must be targeted at children in the most disadvantaged communities. In addition to our supervised tooth-brushing scheme, the measures we are taking to reduce sugar consumption will have a positive effect on children’s oral health. We also know that water fluoridation is a safe and effective measure to reduce tooth decay. It currently covers 6 million people in England, and a decision on expanding that will be made in due course.
We find ourselves in an extremely challenging fiscal position, but we remain committed to tackling the immediate crisis, and to fixing NHS dentistry in the long term with dental contract reform. We are committed to: providing 700,000 more urgent dental appointments; the golden hello scheme to recruit more dentists in areas of greatest need; continuing to work with the sector to help find solutions to improve access to NHS dentistry; tackling the disparities that are commonly seen in dentistry; rolling out supervised tooth-brushing for three to five-year-olds in our most deprived communities; making sure everyone who needs a dentist can get one, irrespective of whether they live in a city or in a rural area; and doing the job on long-term dental contract reform, which will take some time. We will clear up the mess we have inherited, we will get NHS dentistry back on its feet, and we will build an NHS dentistry service that is fit for the future.
Question put and agreed to.