NHS: Dentistry Services

Baroness Masham of Ilton Excerpts

Thursday 25th July 2019 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank the noble Baroness, Lady Gardner of Parkes, for raising this important matter today. She is, and has been over the years, a great campaigner for NHS dentistry services. Many people shy away from the subject, but it needs to be highlighted and I congratulate her on introducing this debate.

There is a shortage of much-needed NHS dentists at the present time, as has been said. Brexit is not helping, and I hope that if we leave the EU we will not lose some of the excellent dentists who come from EU countries. Many people go to Europe for their dentistry treatment because it is good and available.

In June 2019, the Care Quality Commission examined the adequacy of dental support for the elderly in care homes in England. Its findings revealed that 52% of care homes did not have a policy to promote and protect oral health, while 73% of the care plans it reviewed only partially covered oral health or did not cover it at all. In its conclusions, the Care Quality Commission argued that too many people living in care homes were not being supported to maintain and improve their oral health.

One of my part-time secretaries has a mother in a care home in rural north Yorkshire. She has told me that it is very difficult for those in residential care in north Yorkshire to access regular dental care. She noticed that residents with disabilities in the home had difficulties in practising oral hygiene and that overall their oral health is not good.

She tells me that there are long waiting lists at local dentists, some of which are not taking on more NHS patients, and that dentists in north Yorkshire do not routinely visit residential settings. She was told that she would have to arrange a dentist for her mother, but she has not managed to do so over the past seven months because of shortages. Before going into residential care, her mother visited a local dentist every six months, but the home is too far away from her home address to remain with that dentist. When her mother’s dentures were damaged, there was no access to a local dentist for their repair and her mother has had to manage without them. At that home, there does not seem to be a clear policy to protect and promote oral health on a daily basis or to cover residents’ dental health as part of their care plan. It is important for residents to be able to eat a nutritionally balanced diet, but any deterioration in teeth affects the ability to chew fruit, vegetables and meat, so it makes sweet options more attractive, although they are the worst foods for teeth.

Disabled people living in the community can also have problems visiting the dentist. Some time ago, schoolchildren in my part of Yorkshire did a survey of dentist practices and found that many were not accessible. After that, access improved and ramps appeared. The attitude of dentists towards disability can be very varied. Some are helpful, but others just do not want to be involved. How much training in physical and mental disability do dentists and dental nurses have? Understanding disability makes all the difference for people who have so many problems when they come for treatment.

Another vulnerable group where dentistry is concerned is the prison population. Having served for many years on the board of visitors at a young offender institution and having been a member of the parliamentary prison health group—when we had one—I would be interested if the Minister could update us on progress. With the dilemma now facing Feltham young offender institution, where young people are locked up for 22 hours a day, goodness knows what will happen if severe toothache strikes an inmate. There are few published studies on prisoners’ oral health in the United Kingdom, although some national centres have undertaken unpublished work. They have shown increased consumption of sugary drinks and foods, drug abuse and oral neglect in the prison population. The prison population in the UK and the USA is commonly from similar socioeconomic backgrounds but as we know, not all are. Prisoners are mainly socially deprived young males, but the number of older and very young prisoners is on the increase.

Many prison establishments do not have contracts with oral healthcare providers to run sufficient dental care sessions during normal working hours. Out of hours can be impossible. Dental services are generally demand-based, with prisoners requesting to see the dentist or being referred by a prison medical officer. There are services which struggle to meet prisoners’ express demands and have long waiting lists for treatment—that sounds also like the community. The Government’s Strategy for Modernising Dental Services for Prisoners in England needs to be updated as it is out of date. This is particularly important for the section on service provision, which perhaps underestimated the number of dental care sessions required per establishment. Unfortunately, this document is still used by some commissioners when planning dental services. I hope that, if she can, the Minister will update us on how the service is improving.

Three common behaviours among prisoners that have implications for oral health are smoking, excessive alcohol consumption and illegal drug use. There is a great deal of health education that should be promoted throughout the Prison Service. With the Green Paper on public health having just come out, I hope that the section on prevention will include dentistry for vulnerable groups and children’s oral health.

I end by saying that many improvements should and could be made so that the growing elderly population and disabled people living with complex conditions can have good dental care from dentists who understand their special needs, and thus have a better quality of life.