NHS Dentistry: Recovery and Reform

Baroness Merron Excerpts

Wednesday 7th February 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I associate these Benches with the thoughts and prayers expressed for His Majesty the King. We wish him a full and speedy recovery.

I thank the Minister for this Statement at a time when NHS dentistry is at the most perilous point in its 75-year history. I found yesterday’s scenes in Bristol quite shocking, where the police were called to manage hundreds of people lined up outside a dentist. They had flocked to a newly opened practice, absolutely desperate to secure an NHS appointment. It is a raw illustration of the state of dentistry where more than eight in 10 dental surgeries are refusing to accept adult patients seeking NHS care and where more than seven out of 10 are not accepting under-18s. Tooth decay is the main reason for children between the ages of six and 10 being admitted to hospital.

It is noted that there is some proposed new investment in this plan, although previous funding has not kept pace with inflation. Good practice is to be deployed to improve access to dental care for those who have not seen a dentist for years, through the use of mobile clinics and some preventive measures. But this long-awaited plan which the British Dental Association has described as “sticking plaster” will not address the systemic problems that have led to today’s state of near terminal decline.

In addition to targeting recruitment of dentists to areas most in need and the preventive toothbrushing scheme for three to five year-olds, we have committed to 700,000 extra urgent and emergency appointments. There does not seem to be anything in the plan to address this latter need. This is key, because surveys have shown that 82% of dentists have treated patients who have had to take matters into their own hands since lockdown, by carrying out DIY dentistry. In 2022-23, across England, 52,000 patients were seen in A&E with a dental abscess caused by tooth decay, as well as 15,000 with dental caries. How will this plan work without the provision of more emergency and urgent appointments?

We know that immediate reform of the dental contract is needed. If in government, we will sit down with the British Dental Association in our first week. The Government’s 2010 manifesto made a promise to reform the NHS dental contract. Yet, this Statement confirms that reform will not be on the cards until 2025. Why was progress not made when it could have been? What assessment has been made of the impact of continued delay on dental health?

I turn to some specific points. Dentists are covering costs out of their own pockets, particularly for treatments that require lab work, such as dentures and crowns. This needs to be addressed. What assessment has been made of this situation and what impact does the Minister expect the plan to have in resolving it?

To what extent do the Government expect the new patient premium to make a dent in the scale of the problem of improving access for new patients? As the plan for around a million new patients is time-limited, there are concerns that this risks disincentivising the long-term treatment of the new patients being brought into the NHS. What reassurance can the Government give that this will not happen? The Government state that the plan will deliver care to 2.5 million, but their own data show that 12 million people in England have an unmet need for NHS dentistry. What about the rest?

The plan also includes “golden hellos” to around 240 dentists to work in underserved areas for up to three years. I hope this will help. Across the UK, 90% of dentists are not taking on new, adult NHS patients. In huge parts of the country, new patients are not being taken on at all, while, in others, dentists are refusing to see a child unless a parent is signed up as a private patient. What sort of a dent will 240 dentists make in this? How will these payments be distributed and in what areas? Perhaps the Minister can clarify whether the payments are for new dentists or are they to be used to get existing, qualified ones to move?

The absence of essential NHS dentistry is to the detriment of the health of the nation. As the Nuffield Trust says, this plan appears to be,

“a much-needed scale and polish when what NHS dentistry needs is root canal treatment”.

I look forward to the Minister’s response.

[Lord Allan of Hallam (LD)]

My Lords, from these Benches, I also echo our best wishes to His Majesty the King. We hope that he makes a speedy recovery.

In responding to this Statement, I also reach for that familiar phrase of it being a sticking plaster, before heading in the direction of dental metaphors. Rather than a scale and polish, it seems to me that this is something of a temporary filling when, as the noble Baroness, Lady Merron, says, NHS dentistry needs serious root canal work.

I feel for the Minister because I know he cares about dentistry and understands the scale of the problem. He has to sell the temporary filling hard in the hope that we will trust the Government to deliver on the more comprehensive course of treatment that is in the consulting on and exploring part of the document.

There are three elements in that long-term part of the plan on which I hope the Minister can comment further today or later in writing. First, we are told that the Government will ring-fence the £3 billion of NHS dentistry budgets from 2024-25 which have been underspent because of the lack of dentists willing to work at NHS rates. We cannot see this changing overnight, even with what is announced today. How will this ring-fencing work if an integrated care board has still not been able to get the take-up of the contracts that it wants? What kinds of things could they use these underspends for? Will these include additional local financial incentives on top of the ones we are discussing at a national level today?

Secondly, it is important to realise the benefits of people with dental qualifications moving to the UK. I know that the Minister would wholeheartedly agree. The policy document promotes the idea of a provisional registration of overseas qualified dentists while they are waiting for their full GDC registration. The phrasing in the Statement and in the document is quite hesitant. It talks about the Government working towards introducing legislation. Can the Minister give us more information about the complexity of the legislative changes that will be required and their likely timescale?

Thirdly, failures in emergency care both cause severe patient distress and additional work for NHS hospitals. The noble Baroness, Lady Merron, has already pointed out that many children are referred to hospital for emergency treatment. I looked at the description on the Smile Together website—a good service in Cornwall cited in the plan. It says that:

“Smile Together is commissioned by NHS England to provide urgent and emergency dental care to patients who would otherwise be unable to access treatment. Demand for this service is very high and the criteria set by our commissioners is very strict. We therefore offer emergency appointments that are independent of our NHS service”,


and people who call in who are unable to get an NHS appointment and do not wish to wait and try again the next day can basically go private. I am not sure we want to be in a situation where people needing emergency care are left hanging on the phone day in, day out, or face having to go for the private option. I hope the Minister can explain what the Government intend to do around emergency care. I hope he will agree that making sure people can get NHS emergency care will be better for both the patient and the NHS.

A temporary filling is designed to last a few weeks—or months at most—or perhaps until an election. We are grateful for the temporary relief it provides, but we know that more work is needed, and this has to be done urgently if we are to fix NHS for the long term.