Dental Healthcare: East Anglia

Wednesday 11th December 2024 Westminster Hall

11:00

[Peter Dowd (in the Chair)]

I will call Jerome Mayhew to move the motion and the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

I beg to move,

That this House has considered dental healthcare provision in East Anglia.

It is lovely to see you in the Chair, Mr Dowd. I am grateful to colleagues from East Anglia for supporting this debate and, I hope, making some interventions. I am also grateful to the Minister for Care for coming yet again to Westminster Hall, because this is not the first time that we have had a debate on dentistry in the east of England, and in East Anglia in particular. The reason for those numerous debates is the significant problem of access to NHS dentists in particular, but also to private dentists.

Peter Aldous, who I am sorry to say lost his seat at the recent election, was a doughty campaigner on the issue. I pay tribute to him for the numerous debates he brought forward. Most recently, in September, the hon. Member for Norwich South (Clive Lewis), who is not here today, held a debate on the topic. Time is short, so I will not focus on the need as much as I normally would, but the Minister has been here before and knows very well how significant the need is for increased access to NHS dentistry in East Anglia.

I will give highlights, however, because the Secretary of State for Health and Social Care has described Norfolk not only as a dental desert, but as the “Sahara of dental deserts”. The Minister—the noble Baroness, Lady Merron—confirmed in the other place on 25 November that the Norfolk and Waveney area has

“the worst ratio of NHS dentists to patients in England”.—[Official Report, House of Lords, 25 November 2024; Vol. 841, c. 479.]

In my last debate in this forum, I was shocked to report that in Norfolk and Waveney the ratio of dentists per 100,000 population was 39, when the national average was 52. Now I have to update those figures, because the Secretary of State has recently confirmed that the figure of 39 has dropped to 36 per 100,000 of population, while the national average has increased to 53. It is getting worse, not better.

The data from this month is even more concerning. The British Dental Association confirms that there are 3,194 NHS dentists in the east of England, which are the statistics we previously used. BDA’s further analysis last month reveals that that equates to just 1,096 full-time equivalent dentists in NHS roles. If those figures are run through the population, there are 17 full-time equivalent NHS dentists per 100,000 population in the east of England. Those are truly shocking figures.

The issue can be sliced and diced in another way. The amount of money that the Government spend on people’s mouths in the east of England makes for sobering reading. The national average is £66 per mouth spent on dental treatment by the NHS. In the east of England, that figure is just £39. What is it? Is it that our fillings and dental work are cheaper in the east of England, or are we doing less? It is not due to less demand; we have the greatest demand. We had more than 1,000 people presenting in the past year at NHS A&E with significant dental problems. I believe I am right in saying that dental concerns are the single biggest reason why primary school children present at hospitals.

[Jim Shannon (Strangford) (DUP)]

On that critical point, dental care must start in primary school. When I was at school—that was not yesterday, of course—they came in to check the children’s teeth. We had that the whole way through, but that process is missing today. Does the hon. Gentleman think that primary school should be the first stage of response?

[Jerome Mayhew]

This debate is about the east of England, not the east of Northern Ireland, but I will take the hon. Gentleman’s intervention anyway. He is right that we learn our oral hygiene habits as children. It is primarily the responsibility of parents to look after their children’s oral health, as well as their general health; that has always been the case, and that should always remain the case. However, we recognise, as did the last Administration, the increasing role of primary schools in reinforcing the role of parents.

[Jess Asato (Lowestoft) (Lab)]

Does the hon. Member agree that it is appalling that my constituents have had to resort to pulling out their own teeth because no NHS dentists in my constituency are accepting new patients, and that we need urgent action now?

[Jerome Mayhew]

I am shocked to hear that. An example of that in my constituency was reported to me, but that was in the height of the covid lockdowns; I have not heard an example since then. However, irrespective of the headline-grabbing anecdote, it is almost impossible for new applicants to register to an NHS dentist, and I have the figures to back that up. Office for National Statistics data for November indicates that 98.4% of those who were not registered to a dentist but who wanted to access NHS dental care in the east of England were unable to do so. That is the worst rate of all English regions, yet over that period there was a £58 million underspend in the east of England’s NHS dental budget. That is not because the Government do not want to spend the money, and it is not because the money is not available; it is simply because we do not have enough dentists to satisfy the huge need.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

Does the hon. Member agree that the absolute early priority must be to sort out emergency dentistry? Everybody must be able to contact an NHS emergency dentist for terrible toothache or dental emergencies, and that will prevent so many children from being admitted to hospital for their abscesses to be drained, which I have had to do as an ear, nose and throat surgeon.

[Jerome Mayhew]

My answer is yes and no. Over the past 18 months to two years in Norfolk and Waveney, a lot of money has been spent on increasing access to emergency dentistry. Although I welcomed that and it has helped to deal with some acute issues, there is a much more fundamental problem. We must fix the system rather than decide on the least worst form of emergency care once the problem has become acute.

The big question is why the east of England is in this position. The wrong analysis of how we got here will lead to our imposing the wrong solution. Some people say, “Well, it’s because Norfolk is a remote, rural area with lots of coastline, and that brings problems. If you’re a newly qualified dentist, it’s probably a rather unfashionable place to go to make your new career if you’re not from that neck of the woods. It has a more elderly demographic, which may put off young dentists. It’s not where they want to go to set up their new home.”

Yet compare Norfolk with similar counties, such as Devon. I often use Devon as an example because it shares many characteristics with Norfolk: a slightly older population, a large rural coastline and a pretty similar population size. Look at the number of dentists in Devon: they have 49.6 per 100,000 people, which is far more than we have in the east of England. What is the difference? The answer is obvious. Since 2005, Devon has had a dental training school at Plymouth, which was the last one to be set up. The east of England made a bid for that contract and lost out to the Peninsula bid, and we can see the consequences of that in the teeth of Norfolk residents.

If someone wants to train as a dentist in Norfolk, Suffolk or elsewhere in East Anglia, the nearest place they can go to train is either Birmingham or London. That means that our home-grown talent has to go off somewhere else, several hours away, to train and qualify. The usual things happen: they develop their professional relationships in that region; they meet someone, fall in love and settle down; they put down roots in the community and they stay there and do not come back. The exact opposite is the case for people not from our region who qualify elsewhere. What is the incentive for them to come and set up home in a part of the world that they do not know and that is perhaps not attractive to newly qualified people in their mid-20s?

We also know that about 40% of graduates tend to stay where they train. We have that data from the University of East Anglia and its medical school, because each year it surveys graduates to see where they get their first job and each year about 40% of them take a job locally. This is the really important question for the Minister: do he and his Department accept that analysis? If they do not accept it, what is his explanation for the dearth of NHS dentists and even private dentists in East Anglia?

[Steff Aquarone (North Norfolk) (LD)]

I congratulate the hon. Gentleman, my constituency neighbour, on securing this debate. I cannot speak for the Minister, although I certainly welcome the comments about the importance of a dental school. However, is the issue in East Anglia not a result of the region’s disproportionate failure under the previous Government’s dental recovery plan? It was said that East Anglia would miss its targets and that, even if it did hit them, it would still be 2.6 million dental appointments short of pre-pandemic levels. The hon. Gentleman was on the Government Benches in the last Parliament. Does he not understand why many people across East Anglia hold the Conservatives to account for the situation having become this bad?

[Jerome Mayhew]

I accept the hon. Gentleman’s argument, but I do not think that it is particularly helpful. We are trying to work out what the solution is now and going forward. A huge amount of money was spent by central Government on NHS dentistry. The problem we had, as we can demonstrate by the £58 million underspend of the budget that was available, is that there are physically not enough dentists now. That is not a short-term brickbat that can be chucked around for party political points in a Westminster Hall debate at 11.11 on a Wednesday morning. I submit that it is a rather more serious issue that deserves a slightly more serious approach.

[Several hon. Members rose—]

[Jerome Mayhew]

I will take an intervention from my other constituency neighbour, the hon. Member for Norwich North (Alice Macdonald).

[Alice Macdonald (Norwich North) (Lab/Co-op)]

Does the hon. Member recognise the support from all parties for a new dental school in Norwich? Does he welcome the £1.5 million that was announced last week by the Greater Norwich Growth Board in support of the bid for a new dental school?

[Jerome Mayhew]

That is the kind of intervention that I find constructive and helpful, and I am very grateful to the hon. Member for making it. She is, of course, quite right. We disagree on many things, as I do with the hon. Member for North Norfolk (Steff Aquarone), but there are some things that bring us together, and the need for a dental training school at the University of East Anglia is one of them.

[Pam Cox (Colchester) (Lab)]

Down the road from Norwich is the University of Essex, which is based in Colchester and already offers degrees in oral science. I think a collaboration between the two universities is really important, and I would be very happy to facilitate it. The University of Essex degree is not a dentistry degree, but an oral health degree. The university also has a community dentistry clinic that is already operating in Colchester, which could provide some very interesting examples of good practice. I invite the Minister and his team to come and visit both the university and the clinic.

[Jerome Mayhew]

The hon. Member is absolutely right. This is not about one organisation over another; there has to be a collaborative approach. We have plenty of dental need to go round, I am sorry to say, in Suffolk, Essex and Norfolk. The more we can collaborate and provide a synthesis of offers—some in dental health qualifications, some in straightforward dentistry and others in dental hygiene, another key part of this jigsaw that we have to put together—the better.

[Terry Jermy (South West Norfolk) (Lab)]

I am all for cross-party working, but I was struck by the hon. Member’s earlier comments about children. Does he accept that, because of the legacy of so many years of failure, any solutions will be much more difficult to find because we will have dental issues progressing as children grow older?

[Jerome Mayhew]

I thank the hon. Gentleman for his intervention. There is a difference between milk teeth and grown-up teeth, as I will call them, although I know that is not the technical term. I hope that that assessment is wrong, but undoubtedly there will be problems. If there is a long-term lack of access to dentistry, it builds up problems, whether in the teeth or in the gums, both for children and for adults.

We can all talk about how we got here, and I can defend lots of very good things that the previous Administration did, but did we get everything right? No, we did not. What I am more interested in is how we can encourage the Government and work with them across the parties to solve the problem in the very near future.

I hope we have got to a reasonable analysis of why we are in this position. If it is substantially because of a lack of dental training facilities in the east of England, an obvious solution, although not the sole solution, would be a school of oral health at the University of East Anglia. The Minister knows that the UEA is ready to go. He knows that there is a building under construction and that a large amount of funding has been applied for, some of which has been already agreed. He knows that the UEA is making an application for registration with the General Dental Council and that it will be completed within the next six weeks at the latest.

That brings us to the crucial next step, which is the Office for Students. I recognise that the Minister is important and impotent at the same time. He is important because as the dental Minister he sets direction and gives impetus to change, but I accept that in some sense he is impotent because the Office for Students is an arm’s-length independent body. I hope he will take these requests in the light of my acknowledgment of his constraints, but it would be helpful for the UEA and the residents of our area to have his confirmation on the following three points.

First, can the Minister confirm whether additional dental training places will be made available by the Office for Students in 2025? It is a political decision how much funding the Government are prepared to put into the overall number of dental training places in the country in 2025. What is the pot that the Office for Students has to work with? Can he confirm that the number will be increased to take account of increased need?

Secondly, if that is the case, will there be a regional allocation within that global figure specifically for the east of England, given that the need is not national? There are regional variations, and in the east of England it is worst of all. There is precedent for that approach: recently, medical training places had a regional allocation, although I accept that historically it has not happened with dental places. It is an important point and would be of huge encouragement to our residents.

Thirdly, can the Minister give some indication of the timetable on which he and the Office for Students will work to process the 2025 allocations?

[Adrian Ramsay (Waveney Valley) (Green)]

I welcome the hon. Member’s comments. Indeed, the funding for the dentistry school at the University of East Anglia is a welcome step in addressing our chronic shortage of dentists in the region, but we need to ensure that there are strong incentives for those dentists both to stay locally and to stay within the NHS, which means meaningful contract reform to make it economic for dentists to practise in the NHS in the long term. In addition to his points, does the hon. Member agree that we need the Minister to set out the timescales for the Government’s pledge to review the dental contract?

[Jerome Mayhew]

The hon. Member is absolutely right. The school is not the only answer, but it is part of the answer. Part of how it will encourage graduands and then graduates to be sticky—to stay locally—is through its training process. From year one, students will be placed in local dental practices, so they will be providing benefits to real people right at the start of their practice, but also developing professional relationships with those practices so that they can walk into good-quality, local jobs. That should help with the stickiness, but the hon. Member is right that it is not the full solution. We need reform of the 2006 NHS dental contract, but that is not specific to East Anglia and it does not explain why we are in a particular pickle in the east of England. That subject would happily take up another debate, so although I recognise its importance, I will not get too distracted.

The other problem, which is slightly more recent in origin, is the imposition of national insurance contributions on dental practice. The British Dental Association has outlined that the recent Budget could have a devastating impact on struggling NHS practices. A local practice in Norfolk says that

“the recent changes to employers’ NI and raising of the living wage will lead to bankruptcy and breakdowns. We have been trying to keep our 100% NHS dental practice open under very difficult circumstances, being unable to fill our vacancy for a full-time dentist. This post has been empty since April 2023 and we can no longer go on with only one dentist and pay the bills.”

I recognise that it is above the Minister’s pay grade, but I do hope that in his advocacy to His Majesty’s Treasury he will ensure that it is fully aware of the negative impact of the NI increases on dentistry, as well as on GP practices, and that that will be taken into account in future decisions.

11:20

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Dowd. I thank the hon. Member for Broadland and Fakenham (Jerome Mayhew) for securing this vital debate on dental healthcare provision in East Anglia, and I thank hon. Members on both sides of the House for their important interventions.

The debate follows hot on the heels of a debate on 3 September that my hon. Friend the Member for Norwich South (Clive Lewis) led on healthcare provision in the east of England. We know that huge swathes of the region are dental deserts. These areas are facing great pressures from challenges in the recruitment and retention of dentists, leaving patients struggling to access the NHS dental treatments that they need. As has been pointed out, it is a scandal—frankly, it is Dickensian—that the No. 1 reason for children aged five to nine to be admitted to hospital in our country in 2024 is to have rotten teeth removed.

Norfolk and Waveney integrated care board had 31.5 dentists per 100,000 of the population in 2023-24, which is the lowest number in England. That is why I have met with colleagues from the east of England, including the hon. Member for Broadland and Fakenham, to discuss the specific challenges in the region and to discuss the University of East Anglia’s plans to open a dental school. The UEA’s proposal to begin training dental students is very welcome news. As I said to all the colleagues I met recently, and to the hon. Gentleman at oral questions last month, the Government strongly encourage the UEA to continue its progress towards establishing a dental school by submitting its bid to the General Dental Council as rapidly as possible.

The independent Office for Students is another key player. It has statutory responsibility for allocating funded training places to dental schools. As the hon. Gentleman has pointed out, the OfS is independent from the Government. I cannot make specific commitments about allocating additional training places for future years, because to do so would be to cut across the independence of the OfS. The OfS makes decisions based on its own assessments, following guidance issued by Government. What I can say to the hon. Gentleman is that our guidance is influential, but I cannot guarantee its outcome.

The guidance for the 2026 academic year will be published in due course. Provided that the UEA meets those requirements, it would absolutely be considered for Government-funded dental training places. That would certainly help to retain local dentists in East Anglia. As a Member for a rural constituency, I absolutely understand how important that is to the hon. Gentleman and to the many other hon. Members present who represent his part of the country.

We also need a clear-headed diagnosis of where we are. It is beyond doubt that NHS dentistry was left in an appalling state of disrepair by the previous Government. As the Prime Minister said last week, the precious contract between the state and the British people has been broken. He rightly said that our public services are

“in crisis, unable to perform their basic functions”

and that they are

“unable to provide the timely care and dignity that Britain relies on”.

Almost five years on from the beginning of the pandemic, NHS dentistry has still not recovered to pre-pandemic levels. Only 40% of adults were seen by an NHS dentist in the 24 months to June this year, down from almost 50% before the pandemic. Although 34 million courses of dental treatment were delivered in England in 2023-24, that is down from almost 40 million courses five years ago. As I say, it is disgraceful that having rotten teeth removed is the single most common cause of hospital admissions for children aged five to nine, causing them untold pain and suffering and affecting their ability to sleep, speak and socialise.

On the subject of the general state of dentistry, I thank the National Audit Office for its recent investigation of the previous Government’s dental recovery plan. Its report lays out in black and white something that was already apparent to millions of people across the length and breadth of our country: the dental recovery plan that we inherited did not go far enough. We are reflecting on every line of the NAO report as part of our efforts to rebuild dentistry, get it back on its feet and make it fit to serve people of all ages. We have launched the largest ever national conversation to inform our 10-year plan to reform the NHS, and our workforce will play a central role, because they are key to unlocking improvements across our communities.

The golden hello scheme offers dentists £20,000 to work in underserved areas of the country for three years. The recruitment process is well under way, with posts being filled by dentists in those areas as we speak. As of 7 November, 64 posts had been advertised. Our manifesto pledged 700,000 more urgent dental appointments, and we are working to ensure that patients can start to access them as soon as possible. They will be targeted at the areas that need them most.

Strengthening the workforce is key to our ambitions, but for years dentistry has faced chronic workforce shortages. We have to be honest that bringing in the staff we need will take time. To rebuild dentistry in the long term and increase access to NHS dental care, we will reform the dental contract with a shift to focusing on prevention and the retention of NHS dentists. There are no perfect payment systems, and careful consideration needs to be given to any potential changes to the complex dental system, so that we deliver a system that is better for patients and the profession.

[Adrian Ramsay]

I thank the Minister for reiterating the Government’s commitment to reforming the dental contract. Please will he set out a timescale for that work commencing?

[Stephen Kinnock]

I was just going to say that we are continuing to meet the British Dental Association and other representatives of the dental sector to discuss how we can best deliver our shared ambition to improve access for NHS dental patients. We are working on this as a matter of urgency. I cannot give a specific timeframe, but it is a top priority for the Department.

[Charlotte Cane (Ely and East Cambridgeshire) (LD)]

I understand that the Government have inherited a big problem, but the situation is urgent. I have a constituent who has heart problems, so his oral health is really important to him. He cannot get an NHS dentist, so constituencies such as Ely and East Cambridgeshire need urgent action.

[Stephen Kinnock]

I share the hon. Lady’s belief that we need urgency and focus. We have a big mountain to climb, but we have to crack on. I completely take her point about the need for urgency.

We need to ensure that the process to register a dentist in the UK is as efficient and fast as possible, while retaining robust safeguards for patient protection. The Department regularly engages with the General Dental Council to understand what it is doing to improve the waiting times for the overseas registration exam. Earlier this year, the Department ran a consultation on introducing a further piece of legislation to give the GDC powers to provisionally register overseas qualified dentists, which will help to address some of the workforce challenges.

In summary, this is an immense challenge. There are no quick fixes or easy answers, but we will choose change, not because it is easy but because it is what we have to do. We have to do the hard yards, and I look forward to working with the hon. Member for Broadland and Fakenham and other colleagues to deliver what is needed.

Question put and agreed to.

11:29

Sitting suspended.