Access to NHS Dentistry

James Morris Excerpts

Tuesday 19th July 2022 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (James Morris)]

Access to dentistry was severely impacted by the pandemic. The Government provided unprecedented financial support to the sector during the covid-19 pandemic to ensure that practices remained viable and able to offer treatment during the pandemic and to continue now, as we learn to live with covid-19.

Taking into account the evolving guidance on infection and prevention control NHS England has worked, throughout the pandemic, with the sector to increase levels of dental activity, while keeping dentists, patients and their teams safe. From the beginning of July this year, NHS England has set the expectation that practices will return to delivering treatment at pre-pandemic levels.

With NHS dentists operating at below 100% capacity for over two years, many people have not been able to regularly access a dental professional. We are taking action to address this, in a way which is fair for patients, dentists and the taxpayer.

In April 2021, the Government set out that any changes to NHS dentistry must meet six tests:

Be designed with and enjoy the support of the profession

Improve oral health outcomes (or, where sufficient data are not yet available, credibly be on track to do so)

Reduce perverse incentives for dental care that is not clinically necessary

Demonstrably prevent the loss of NHS commissioned dental activity to private pay

Improve patient access to NHS care, with a specific focus on addressing disparities, particularly those linked to deprivation and ethnicity

Be affordable within available NHS resources made available by Government, including taking account of dental charges

NHSE fully engaged the profession and patient representatives through an advisory board, technical groups and engagement events from May to September 2021 to fully understand the issues and potential solutions. The improvements set out here result from that engagement and have been refined through consultation with the British Dental Association and wider dental sector representatives.

These initial changes are aimed at improving information for patients; improving the incentives in the contract to deliver more complex care; and enabling the NHS to better work with the sector to ensure that dental care is delivered.

Improve care for high-needs patients

We have responded to the call from dentists to improve the remuneration system to incentivise complex preventive and restorative treatment. We will make changes to the way dentists are remunerated for the range of treatments that are currently covered in band 2 treatments. Dentists will be paid more when they need to do three or more fillings or extractions and provide endodontic care.

To provide the capacity to deliver the additional care required by higher-needs patients, we will support practices to adhere more closely to the National Institute of Clinical Excellence guidance on recall intervals which indicate that a healthy adult with good oral health need only see a dentist every two years and a child every one year. We want to decrease the volume of any low-value clinical care provided through NHS dentistry, for the NHS and patients themselves.

These changes will support dentists and patients in getting the care they need as we start to tackle the pandemic backlogs in care.

Promote more effective use of skill mix

Dental care can be provided by a wide range of dental professionals including dental nurses, dental hygienists, and dental therapists. We will make clear that there is no legal barrier to the increased use of these professionals in the provision of NHS care and seek to increase their use in the provision of NHS care, as is already the case in private practice. NHS England will issue clear guidance on how to utilise these team members to provide NHS care that is within their scope of practice and which they have the skills, competence and experience to deliver safely and effectively in the best interests of patients. We will also work with the NHS Business Services Authority to make sure there are no administrative barriers to more effective use of this skill mix in practices providing NHS care.

This will help improve access to NHS care and make dental care professional roles including dentists more fulfilling and rewarding, and help to tackle workforce challenges in underserved areas.

Maximise patient access from available dental resources

NHS England will work with local commissioners to help ensure that dentists are able to deliver high-quality care to patients. Most dental practices consistently deliver their contracted amount of dental activity, but there are some that do not, and some that want to deliver more NHS dentistry.

We want to enable high-performing practices to expand to deliver more NHS care, particularly in those areas where NHS dentistry is less prevalent. To incentivise this, we will enable, subject to commissioner agreement, practices to deliver up to 110% contracted activity.

Where contractors are unable to deliver their contracted activity in-year or persistently across years, commissioners are currently limited in their ability to recommission that activity to contractors better able to do so. In 2019-20,13% of contractors had consistently failed to deliver. This lost activity represents around 4.6 million units of dental activity per annum.

As an initial step NHSE will encourage commissioners and contractors to work together so that where a practice has not delivered 30% of contracted activity by mid-year, 10% of annual activity will be rebased with agreement of the contractor. For contractors that consistently do not meet their targets over a number of years, we will enable NHSE to rebase contracts to achievable levels and release unused funding to commission care from other providers.

Improve communication with patients

Patients told us that they have difficulty finding an NHS dentist, in part because of the limited information on the NHS website. We will make the updating of the NHS website and directory of services a contractual requirement for dental practices. This will make it easier for patients to find a dentist who can deliver the care they need and for the system to refer patients to practices with capacity.

Recruitment of dentists

International professionals form a large proportion of joiners to the General Dental Council (GDC) register—indeed, in 2020, 35% of new GDC dentist registrants qualified outside the UK. They are a vital part of the UK’s dentistry workforce, ensuring that there is more capacity for dental treatment than UK graduates can provide alone

As part of the ongoing reforms to healthcare professional regulation, officials have identified prescriptive detail which restricts the GDC from modernising its international registration processes. This may in turn deter safe and competent professionals from seeking registration to practise in the UK. The Department is therefore taking forward a legislative change which will:

support flexibility for the GDC to ensure that international processes are proportionate and streamlined, while continuing to robustly protect patient safety;

enable the GDC to increase the number of overseas registration exam (ORE) seats it offers by charging a fee which covers the cost of the exam, explore alternative ORE providers, and make changes to the structure of exam and applicant information which will support an increased pass rate; and

allow the GDC to explore alternative pathways to international registration, such as recognition of programmes of education delivered outside the UK, or registration based on recognition of the qualification held by an applicant, as it considers appropriate.

Current arrangements ensure that UK regulators continue to automatically recognise relevant European economic area (EEA) qualifications of healthcare professionals, including dentists. This enables qualified dentists from other EEA countries to continue to practise in the UK and we want to continue to facilitate their vital contribution to the dentistry workforce. EU exit legislation places a duty on the Secretary of State to carry out a review of the operation of these provisions at the start of 2023. The system of automatic recognition will not terminate unless further legislation is made to bring the current system to an end.

Next steps

These changes are the first steps in our work to support NHS dentistry and patients in areas where they continue to struggle with access. We are committed to working with the sector to consider any further changes which meet the six tests set out above, in particular regarding improved access to urgent care and further workforce and payment reform.

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St George’s University Hospitals Trust: Cardiac Surgery Mortality Review

James Morris Excerpts

Monday 18th July 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (James Morris)]

It is a pleasure to be here in my new role as Parliamentary Under-Secretary responsible for primary care and patient safety, and I start by thanking my hon. Friend the Member for Kensington (Felicity Buchan) and congratulating her on securing this important debate on cardiac services at St George’s Hospital. Before responding to the specific issues that she raised, I wish to extend my sympathies to the bereaved families she mentioned who have been affected by these issues.

It might be useful if I begin by setting out some of the background and history of cardiac services at St George’s University Hospitals NHS Foundation Trust. It is important to consider the mortality review in the context of the growing concerns that there were about the culture that existed across cardiac services at St George’s, and the impact that context may have had on the safety and quality of services and questions over mortality rates. Indeed, a number of reviews of cardiac services at St George’s and a Care Quality Commission inspection were critical of services, and concerns were raised by a large group of cardiologists from the hospital. Following two mortality alerts from the National Institute for Cardiovascular Outcomes Research, NHS Improvement commissioned an independent external mortality review, which my hon. Friend mentioned. The purpose of the mortality review was to verify that the trust had identified and addressed the concerns raised through both NICOR alerts, and to inform the trust’s discussions with the coroner regarding the deaths.

It goes without saying that the review’s aims and methodology differed significantly from those of an inquest. The independent panel for the review was composed of consultant cardiac surgeons, cardiologists and consultant cardiac anaesthetists drawn from across the country. It was chaired by Mr Mike Lewis, and published its report in March 2020. The panel found shortcomings in 102 of the 202 deaths it examined. In particular, it found that problems in care probably, most likely or definitely contributed to the deaths of 67 heart surgery patients. As my hon. Friend mentioned, the structured judgment reviews are a standard way of assessing deaths. There is always learning following such a level of scrutiny of a service, including for the regulators. However, I would argue that it would not have been acceptable for NHSI to have ignored the professional and public concerns that gave rise to the mortality review in the first place. The trust and NHS Improvement jointly referred 67 heart surgery patients identified by the review to the coroner. The coroner decided to hold inquests into those cases, which are ongoing. NHS England received a prevention of future deaths report, dated 9 May 2022, to which my hon. Friend referred.

My hon. Friend has raised serious concerns about the findings of the coroner in relation to the mortality review of cardiac services at St George’s, the subsequent impact on the services available to people in south-west London, and the impact of regulatory action on the professionals involved. I have set out the background to the mortality review and what it found. Since the independent mortality review, St George’s has taken comprehensive action to improve the quality, leadership and culture in the cardiac unit. Importantly, mortality has returned to normal levels, patient care outcomes have improved, and the Care Quality Commission has found that services are safe. The review greatly assisted the trust by making recommendations that helped to improve the service and deliver better outcomes for patients.

NHS England London region is continuing to work with the trust to improve the services and leadership of the cardiac unit. The restrictions that were placed on the cardiac surgery unit’s practice before the mortality review have now been removed, and the unit’s outcomes are now in line with those of other trusts. Enhanced oversight of the unit continues, with a package of support measures in place to ensure that improvements are made.

As my hon. Friend said, on 7 May 2022, the GMC found that the two doctors excluded by the trust had “no case to answer”. It is important to emphasise that the referral of those doctors was not as a result of the mortality review, which considered issues of safety and did not criticise any individual. It would be inappropriate for me to comment on individual cases in relation to that matter because of ongoing legal issues. Finally, NHS England is committed to reviewing the coroner’s prevention of future deaths report of 9 May and will response in due course.

NHS hospitals are working hard to provide the very best care for their patients and families, and they should always seek to learn and take action when they have concerns. The Government are absolutely committed to improving the standard of investigations into serious patient safety incidents in the NHS to create a culture of learning from mistakes and to improve patient safety.

Question put and agreed to.

Patient Safety Commissioner for England

James Morris Excerpts

Tuesday 12th July 2022 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (James Morris)]

In July 2021, the Government published their formal response to the recommendations by the Independent Medicines and Medical Devices Safety review led by Baroness Cumberlege setting out an ambitious programme of change. As part of our response, we committed to appoint a Patient Safety Commissioner with a remit covering medicines and medical devices.

I am pleased to announce the appointment of Dr Henrietta Hughes OBE FRCGP SFFMLM as the first ever Patient Safety Commissioner for England. This appointment was made following an open competition, in line with the Governance Code for Public Appointments, and following a pre-appointment scrutiny hearing with the Health and Social Care Committee. Dr Hughes will continue working as a GP and remain Chair of Childhood First.

The First Do No Harm report, led by Baroness Cumberlege highlighted the need to avoid harm and protect patients. The Patient Safety Commissioner will add to and enhance existing work to improve patient safety in relation to medicines and medical devices by being a champion for patients and helping us to learn more about what we can do to put patients first. The Commissioner’s core duties are to promote the safety of patients, and promote the importance of the views of patients and other members of the public. The Commissioner will act independently, and a memorandum of understanding will be agreed to ensure the Commissioner’s independence is safeguarded.

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