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The Minister for Care (Stephen Kinnock)
It is a real pleasure to serve under your chairship, Mr Vickers. I congratulate the hon. Member for Honiton and Sidmouth (Richard Foord) on securing this very important debate on NHS dentistry in the south-west.
My right hon. Friend the Secretary of State has said that this Government will be honest about the problems facing the NHS and equally serious about tackling them. The truth is that we are very far from where we want and need to be. Lord Darzi’s report laid bare the true extent of the challenges facing our health service, including NHS dentistry. Even he, with his years of experience, was shocked by what he discovered.
I pay tribute to all the hon. Members from across the House—too many to name in the short time available to me—for helping to highlight and elucidate their concerns. In many ways, those reflected what Lord Darzi set out, but we have also heard today some heartbreaking examples of the experiences our constituents are having. Colleagues across the House have brought those to life today.
Lord Darzi’s report is vital because it gives us the frank assessment we needed to face the challenges honestly. Lord Darzi is clear that rescuing NHS dentistry will not happen overnight, but we will not wait to make improvements to the current system, to increase access and to incentivise the workforce to deliver more NHS care.
We inherited a broken NHS dentistry system. It is truly shameful and nothing short of Dickensian that the most frequent reason for children of between five and nine years old to be admitted to hospital is to have their rotten teeth removed. That is, frankly, disgraceful. Those are the sort of challenges that we need to face.
Some 13 million people in England have an unmet need for NHS dentistry. That is 28% of our country. It is absurd that people cannot access NHS dentistry when each year the budget is underspent—in recent years, that has been to the tune of hundreds of millions of pounds-worth of care going undelivered. That is why we need to reform the dentistry contract.
In NHS Devon integrated care board, which includes the constituency of the hon. Member for Honiton and Sidmouth, 34% of adults were seen by an NHS dentist in the 24 months to March 2024, compared with an average of 40% in England. In 2023-24, there were 40 dentists per 100,000 of the population, whereas the national average, across all integrated care boards, was 50 in the same year.
We acknowledge that there are areas of the country that are experiencing recruitment and retention issues—including many rural areas, where the challenges in accessing NHS dentistry are exacerbated. As Lord Darzi said, we have enough dentists and dental care professionals at an aggregated national level; the problem is that not enough of them are doing NHS work in the right parts of the country, where they are most needed.
The mountain that we have to climb is daunting, but this Government are not daunted and we are working at pace. Take for example the golden hello scheme, which will see up to 240 dentists receiving payments of £20,000 to work in those areas that need them most for three years. ICBs have already started to advertise those posts through that scheme. Nationally, there have been 624 expressions of interest and 292 of those have since been approved. Thirty-eight posts are now being advertised with the incentive payment included. Or take our rescue plan, which will help to get NHS dentistry back on its feet by providing 700,000 additional urgent appointments as rapidly as possible.
We know that rescuing NHS dentistry means acknowledging that we need more dentists doing NHS work and we know from survey data that morale among NHS dentists is low. We must turn that around. This Government will do all we can to make NHS dentistry an attractive proposition. Strengthening the workforce is key to our ambitions, but for years the NHS has been facing chronic workforce shortages and we have to be honest that bringing in the staff we need will take time.
We are committed to reforming the dentistry contract to make NHS work more attractive, boost retention and deliver a shift to prevention. There are no perfect payment models, and careful consideration needs to be given to any potential changes to the complex dental system, so that we deliver genuine improvements for patients and the profession. We are continuing to work with the British Dental Association and other representatives of the dental sector to deliver our shared ambition to improve access to treatment for NHS dental patients.
The Secretary of State met with the BDA on his first day in office, and I engage with it regularly, including at a meeting earlier this month. I share the BDA’s desire for a timeline for negotiations, but we have had to wait for the Budget and the ensuing discussions with the Treasury to initiate and conclude those discussions.
Stephen Kinnock
As the hon. Gentleman will understand, we are in a sequence: we have the Budget, then the complex negotiations around the spending review. We cannot engage in meaningful, formal discussions and negotiations until we are clear on what exactly the financial envelope is. We are working at pace on that. However, we have been meeting informally to sketch it out, so I would say that the scope of the negotiations is agreed. The formal negotiations will really start only once we have the detailed budget in place.
We will listen to the sector and learn from the best practice to improve our workforce and deliver more care. For example, the integrated care boards in the south-west are applying their delegated powers to increase the availability of NHS dentistry across the region 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.
There are two dental schools in the south-west: Bristol Dental School, and Peninsula Dental School in Plymouth. I recently had the pleasure of visiting Bristol Dental School and seeing the excellent work that they are doing there, training the next generation of dental professionals, supporting NHS provision by treating local patients, and reaching underserved populations through outreach programmes. I also know that Peninsula Dental School, which first took on students in 2007, is doing the same for Plymouth and its surrounding areas.
I would also like to pay tribute to Patricia Miller of NHS Dorset, Lesley Haig of the Health Sciences University and council leader Millie Earl for working so constructively with my hon. Friend the Member for Bournemouth East (Tom Hayes) on improving oral health in his constituency.
A number of hon. Members have rightly highlighted the importance of prevention, and we are working around the clock to end the appalling tooth decay that is blighting our children. We will work with local authorities and the NHS to introduce supervised toothbrushing for three to five-year-olds in our most deprived communities, getting them into healthy habits for life and protecting their teeth from decay. We will set out plans in due course, but it is clear that to maximise our return on investment, we need to be targeting those plans at children in the most disadvantaged communities. In addition to that scheme, the measures that we are taking to reduce sugar consumption will also have a positive effect on improving children’s oral health.
Separate from the national schemes, I was pleased to note that NHS Devon integrated care board has committed £900,000 per annum for three years to support further cohorts of children for supervised toothbrushing, fluoride varnish and Open Wide Step Inside, with a new fluoride varnish scheme due to go live in September 2025. Open Wide Step Inside is a local scheme in which a dental outreach team, run by the Peninsula Dental Social Enterprise, goes into schools to deliver 45-minute oral health education lessons across Devon and Cornwall. It is a truly commendable scheme.
The steps we take in NHS dentistry will feed into the wider work we are doing to fix our broken NHS. We have committed to three strategic shifts: from hospital to community, from sickness to prevention and from analogue to digital. Our 10-year plan will set out how we deliver those shifts to ensure that the NHS is fit for the future.
Dr Johnson
The Minister has iterated the problem, and he has spoken warm words about listening, talking and working with people. However, he has said little that is concrete, except about things that were happening already, either locally or as a result of the previous Government. With a minute left to answer all the questions he has been asked, can he commit to answering in writing those he does not have time to answer in the remaining minutes?
Stephen Kinnock
The first thing I will say is that I am not going to take any lectures from any Conservative Member about the state of our dental system. What brass neck we see from that party, both in the Chamber and in this place—lecturing us, given the disgraceful state of our NHS and the fact that the biggest cause of five to nine-year-olds going to hospital is to have their rotten teeth removed! I will not be taking any lectures on that from the Conservative party. Of course, I am more than happy to answer the hon. Lady’s detailed questions, many of which I feel I have already answered in my preceding comments. I will not take any more interventions from her because I need to finish shortly.
Our 10-year plan will set out how we deliver these shifts to ensure the NHS is fit for the future. To develop the plan, we must have a meaningful conversation with the public and those who work in the health system. We are going to conduct a range of engagement activities, bringing in views from the public, the health and care workforce, national and local stakeholders, system leaders and parliamentarians. I urge hon. Members from across the House to please get involved in this consultation—the largest in the history of the NHS—at change.nhs.uk. I urge them to make their voices heard in their constituencies, through the deliberative events.
Vikki Slade
I have been on to the survey, and it is incredibly limited. It would be helpful if there were a way for the public to be encouraged to introduce more freeform responses.
Stephen Kinnock
I am slightly surprised to hear that. The presentation I received on the portal showed there was a clear channel through to having a more discursive engagement with the platform. I will take that feedback away and, through officials, will come back to the hon. Lady on that point.
I thank the hon. Member for Honiton and Sidmouth once again for bringing the issue of dentistry in the south-west to this debate. On 4 July, we inherited a profoundly challenging fiscal position, but I can assure him that we remain committed to tackling the immediate crisis facing NHS dentistry, and that we are taking steps to make delivery more efficient through long-term reform.
To recap, we are committed to providing 700,000 more urgent dental appointments, delivering the golden hello scheme to recruit more dentists in areas of greatest need, bringing in preventive measures to improve our children’s oral health and negotiating long-term contract reforms to make NHS dentistry more attractive. Those steps will help tackle the place-based disparities commonly seen in dentistry, and ensure that everyone who needs to access NHS dentistry can get it, including in the south-west.
Our NHS dentistry is broken after 14 years of Tory neglect and incompetence, but it is not beaten. In 1945, it fell to Clement Attlee’s Labour Government to create a health system for the 20th century. Now, 79 years later, it falls to this Government to clear up the mess we have inherited, to get NHS dentistry back on its feet and to build an NHS dentistry service fit for the 21st century. That is what we shall do.