NHS: Dentistry Services

Baroness Wheeler Excerpts

Thursday 25th July 2019 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, this has been an excellent and comprehensive debate, made particularly authoritative by contributions from former dentists. I thank the noble Baroness, Lady Gardner, for securing it.

The noble Baroness is quite right that there are many serious problems related to accessing NHS dentistry services that must be urgently addressed. We share her concern that large swathes of the country have been left without a dentist following the closure of multiple NHS dental practices. There are 14 areas where residents have to travel more than 20 miles to get a dentist as they are unable to register as a new adult patient locally. The noble Lord, Lord Storey, is right to stress both the health and personal effects of this, such as the cost of travelling expenses, which many will simply be unable to afford.

As we have heard, this is not a rural phenomenon confined to a handful of small villages; on the contrary, it is also true of large towns. The city of Portsmouth, which, I remind the House, has a population of nearly 400,000, is without a single NHS dentist accepting new patients, leaving over 1 million NHS patients with the option to travel or to miss out on the care that they need. That is simply unacceptable.

Regular dental checks, recommended at least every six months, are key to good oral health, disease prevention and early diagnosis of routine or complex conditions affecting the mouth, jaw and other parts of the body, given that dentists are able to spot early warning signs in the mouth that may indicate systemic conditions such as AIDS, cancer and diabetes. I liked the description from the noble Lord, Lord Colwyn, that a healthy mouth is the gateway to a healthy body. I think we would all agree with that.

Not being able to visit the dentist can potentially be very harmful to your health. It is imperative that the Government take urgent action to ensure that everyone has access to an NHS dentist locally. NHS England is responsible for helping people find a dentist locally through its customer contact centre. Can the Minister tell the House how many dental cases the centre deals with annually, what analysis is made of this information in terms of gender, age, ethnicity and location, and how the information is used to improve patient services and outcomes?

The sheer cost involved in accessing NHS services is another huge barrier. Free universal healthcare is a source of national pride but, despite falling under the banner of the NHS, dental treatment is not free at the point of need for the vast majority of adults, who do not meet the increasingly narrow exceptions criteria. NHS dental prices have risen by 5% this year—the fifth annual price increase. As a result, a check-up in England and Wales now costs £22.70, a filling or extraction costs £62.10, and a crown or false tooth costs £269.30. These are significant outlays, which are of course much higher in many surgeries.

We echo the British Dental Association’s concern about the increase in so-called DIY dentistry. While accurate figures on the extent of this are hard to find, there are alarming anecdotal accounts of people being forced to pull out their own teeth, resorting to long-term use of painkillers to delay going to a dentist, visiting their GP, as the noble Baroness, Lady Jolly, said, or going to A&E for emergency treatment. Such A&E visits form 1% of all hospital attendances in England.

Even adults who are NHS-exempt experience considerable administrative barriers to accessing NHS dentistry services. Every year, more than 40,000 people in England receive fines of £100 from their dentists through the automated system designed to stop people fraudulently receiving free treatment. The fines are applied by a random screening process to check eligibility and amount to approximately £4 million a year. Many vulnerable people who we have heard about today, including dementia sufferers and those with learning disabilities, are inadvertently falling foul of this system and being unfairly fined. Fines have been levied for minor misdemeanours such as ticking the wrong box or confusion about the forms that had to be filled in. Even when patients are eligible for free treatment, an incorrect identification of specific benefit payments or a failure to renew documents can trigger the £100 penalty, which rises to £150 if there is a delay in payment.

Many vulnerable patients such as those with dementia, learning difficulties or other health conditions will be brought to the dentist by a carer, who might not have detailed information about types of benefit and exemption certificates, or may be overwhelmed by the complexity of a patient being migrated from one benefit to another under the universal credit rollout. The noble Baroness, Lady Jolly, rightly highlighted the dental care problems experienced by homeless people. I was very interested to hear what she said about the work of Dentaid.

It is clear that the system has become a significant barrier to vulnerable people accessing care, through lack of awareness as to eligibility, inability to provide required documentation or the fear of being wrongly accused of fraud. Even when patients—or, more likely, a carer or someone on their behalf—have been able to navigate the equally complicated and confusing appeals process, about 90% of appeals are overturned as having been incorrectly applied for. Does the Minister agree that the system is not fit for purpose and needs urgent review? Will she undertake to work with dentists, GPs and the Department for Work and Pensions on this?

The noble Baronesses, Lady Masham and Lady Jolly, referred to the Care Quality Commission’s recent report Smiling Matters: Oral Health in Care Homes, which is of particular concern. As we have heard, on 100 routine inspections the CQC found that most homes had no policy to promote or protect people’s health; nearly half were not training staff to support daily oral healthcare; 73% of care plans reviewed only partly covered or did not cover oral health; and 10% of homes had no way to access emergency dental treatment for patients. As both noble Baronesses stressed, residents in care homes may have difficulty brushing their teeth due to poor manual dexterity, limited mobility, vision problems or cognitive difficulties, and long-term conditions such as Parkinson’s disease or dementia exacerbate those difficulties. Residents may be left unable to eat, drink or communicate. As the Alzheimer’s Society says:

“Mouth pain can have a huge impact on people with dementia, and can lead people to stop eating completely. Looking after a person with dementia’s oral health is vital”.


Can the Minister tell the House what action is being taken to address this very serious problem? The noble Baroness, Lady Blackwood, told the House on 11 July that dental care in care homes is being considered in the social care Green Paper—our old friend. Can the Minister tell us what areas are being addressed and what actions will be taken to ensure that NICE standards for oral health in care homes are being adhered to? Does she support the CQC’s call for mandatory staff training in oral care and check-ups for all residents upon admission? Does she have any insight as to when the Green Paper will finally be published?

For far too long the Government have treated NHS dentistry as an optional extra, with patients throughout the country ultimately paying the price of failed contracts and year-on-year budget cuts. Despite high-profile announcements and repeated pledges to put prevention at the heart of NHS strategy, the Government have failed to invest or make any tangible commitment to dentistry, while the long-awaited NHS Long Term Plan, published in January, largely ignored oral health. Indeed, there was no dedicated chapter or even a heading on oral health, while dental care is mentioned only twice in its 136 pages.

Access to an NHS dentist remains a key challenge. I hope the Minister will be able to assure the House that the new Prime Minister intends to make access to NHS dental services a domestic policy priority. It is vital that he commits to reviewing the level of NHS dentistry funding, and to working with the sector and stakeholders to remove the barriers faced by vulnerable patients in particular.