Dentistry: Access for Cancer Patients

Andrea Leadsom Excerpts

Wednesday 17th April 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Stretford and Urmston (Andrew Western) on securing this really important debate on behalf of Michele and all the other petitioners. I would of course be delighted to meet Michele to hear her views, and I particularly take note of her call for all cancer patients to be advised of the potential impact of cancer treatment on their oral health. That is a really solid and actionable thing that I undertake to take away today. I look forward to meeting Michele and the hon. Gentleman in due course.

I wish to take this chance to pay tribute to the Mouth Cancer Foundation, the Oral Health Foundation and Dentaid, to name just a few of the excellent charities that provide support and advice to so many.

I thank all Members who have spoken in what has been an excellent debate. I say to the hon. Member for Tiverton and Honiton (Richard Foord) that I fully appreciate the challenges in Devon. He will no doubt welcome the fact that a mobile dental van, which will be quite a boost for very underserved and geographically distant areas, will be forthcoming for Devon in the near future. In addition, one of the real problems in Devon—this is not the hon. Gentleman’s fault at all—is that in his area on average only around 57% of commissioned units of dental activity are actually undertaken by dentists. I am sure he might like to talk to his local integrated care board about that, if I can help in any way, I would be delighted to.

As I will come on to talk about, our dental recovery plan attempts to incentivise further NHS dentists to really ramp up delivery. In fact, we have already seen hundreds of thousands of new dental treatments just since 1 March, when the plan went live. Unfortunately, the data is not publishable as yet, but I feel really optimistic. I totally understand what Members say about it being not good enough—I totally get that—but we are seeing rapid improvements and I encourage the hon. Gentleman to talk to his local ICB.

[Richard Foord]

On the Minister’s point about only 57% of the units of dental activity being taken up in Devon, is that not a workforce issue?

[Dame Andrea Leadsom]

No. How it works is that the ICB commissions dentists to provide NHS dentistry, and the NHS contractor undertakes to fulfil a number of units of dental activity. If they do not do that, for whatever reason, at the end of the financial year the ICB claws back the money they gave the NHS dentist to fulfil that contract. I am not judging anything; I am merely giving the hon. Gentleman information that I hope is helpful to him.

[Yasmin Qureshi]

Will the Minister give way?

[Dame Andrea Leadsom]

Yes, but I do not want to run out of time.

[Yasmin Qureshi]

On that point, it is very much an issue of being able to survive: many dentists say they return the units because if they took on all the NHS appointments, they would not be able to survive financially.

[Dame Andrea Leadsom]

I hear what the hon. Lady says. My own assessment is slightly different, but I obviously respect her view.

The hon. Member for Birmingham, Erdington (Mrs Hamilton) and I have worked together for many years on all matters to do with early years intervention. She made a really good point about less survivable cancers, but I would highlight to her the 160 diagnostic centres that are being opened, which will help with early detection. She also made some good points about the importance of good oral health assessments, and she is right to raise that. One thing I would point out to all hon. Members, which was astonishing to me when I came into this role in November, is that since 1948, when the NHS started, only between 40% and 50% of adults in England have ever received NHS dentistry. It is not like Scotland, where the hon. Member for Aberdeen North (Kirsty Blackman) said the number is 90%—is that the right number?

[Kirsty Blackman]

95%.

[Dame Andrea Leadsom]

Yes, 95% of people in Scotland receive NHS dentistry. In England, it is extremely different, and it always has been under Governments of all parties. I would just put that to hon. Members as a piece of information that it is really important to know.

To the hon. Member for Bolton South East (Yasmin Qureshi), I would highlight SMILE4LIFE, which is a big part of the dental recovery plan. The shadow spokesman, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), also raised the SMILE4LIFE. It focuses on the earliest years, including getting pregnant mums to have their teeth checked, and on good oral health in babies and toddlers, so that by the time they go to school they are used to brushing their teeth twice a day. Good oral health is absolutely critical. In answer to the point raised by both the hon. Member for Bolton South East and the shadow spokesperson, I should say that the Secretary of State and I both made very clear and full responses to the Health and Social Care Committee on the issue of where funding for the dental recovery plan has come from.

Moving on to the things that I actually intended to say, I am absolutely aware that almost everyone in our country has been personally affected by cancer, whether themselves or through a friend or relative, and that includes members of my own family, so I really do understand the issue. Last year, just over 340,000 new cancer patients were diagnosed in England—almost 1,000 every single day or one every 90 seconds. We know that receiving a diagnosis can be terrifying, and we should never lose sight of what those patients and their families are going through. I am really glad that the petition has been brought forward to highlight the terrible disease of oral cancer and the impact on the oral health of those with other cancers.

Before I turn to cancer, I want to quickly outline the steps we have taken to improve access to dentistry across the country since publishing our recovery plan on 7 February. As colleagues will know, access has simply not recovered fast enough since the covid lockdowns, and the issue was my top priority on appointment to this role in November. I am really proud that the plan is creating around 2.5 million additional NHS appointments. We are supporting dentists through a new patient premium to take on patients who have not seen a dentist for two years. We are increasing the minimum value of a unit of dental activity to £28. We are helping patients to find a dentist through a new marketing campaign. We are bringing dental care to our more isolated communities through mobile dental plans and by encouraging dentists to work in underserved areas through golden hellos for 240 dentists. As I have mentioned, the SMILE4LIFE initiative is designed to get in early and help families to understand the importance of good oral hygiene.

Not only that, but we are also making progress to increase the workforce and, in fact, there were 1,352 more dentists doing NHS work in 2022-23 than in 2010-11. It is not the case that dentists are disappearing from the NHS; there are 1,350 more. As announced in the long-term workforce plan, we are going to increase dentistry training places by 40%, so that there are over 1,100 places by 2031-32. We are also increasing training places for dental therapists and hygienists to more than 500 a year by 2031-32. Importantly, we are exploring whether the prospects for a tie-in could ensure that dentists spend a greater proportion of their time delivering NHS dental care, rather than receiving that very expensive training and then perhaps going off to do private dentistry, which means fewer people have access to NHS dentists. It is great to see that, since we published the plan on 7 February, and it went live on 1 March, hundreds more dental practices are already opening their doors to new patients. I look forward to giving the House a full update on the recovery plan shortly, when I will be able to talk to colleagues about the significant increase in the number of patients able to access an NHS dentist.

In the hon. Member for Stretford and Urmston’s own integrated care board in Greater Manchester, there is the second highest number of dentists doing NHS work in England. That is almost 71 dentists per 100,000, against a national average of 53.5. I understand that the ICB there is supporting a local initiative called the dental quality access scheme to improve access to NHS dentistry, which requires practices to commit to seeing new NHS patients and, importantly, to providing urgent care access. The practices have been asked to prioritise vulnerable patients and patients with serious conditions, including cancer. That is a fantastic scheme by the ICB, and I encourage other ICBs listening to this debate to follow suit. The scheme brought over 200,000 extra appointments for patients in the last financial year, which I am sure the hon. Member is delighted about.

Turning to the hon. Member’s specific points on charges, the Government responded to a petition on 9 November that requested

“Free Dental Treatment for All Cancer Patients”.

Our reply pointed out that, in 2022-23, 47% of all courses of treatment for NHS dental patients were delivered free of charge, and those who do pay for dentistry are providing an important contribution to NHS budgets. I am sure the hon. Member will know that dentistry charges have been in place almost since the foundation of the NHS 75 years ago. Also, as I have already pointed out, under Governments of every party only about 40% to 50% of adults have ever received NHS dental care.

Despite inflation and other spending pressures, we froze charges between December 2020 and April 2023 to help all our constituents with cost of living pressures, and since then we have raised the charges only proportionately. The hon. Member is right to say that cancer patients face additional financial burdens, and that is why the Government are committed to supporting every patient who faces financial hardship with full or partial exemptions from dental patient charges, which are available through the NHS low income scheme. As the hon. Member for Aberdeen North pointed out in the case of Scotland, those also apply to people being treated in hospitals, and that will not change.

I am sure that the hon. Member for Stretford and Urmston will appreciate that, at a time when NHS budgets are under extreme pressure, it is not feasible to offer free dental care to every patient regardless of their means. We are instead focusing our efforts on continuing to ensure that the most vulnerable are supported to access NHS dentistry, including patients with cancer. In 2021, there were just over 9,100 oral cancers, which was equal to around 3% of all cancers. It is clear that cancer must be caught at the earliest opportunity to give people the best possible chance for recovery. Dentistry plays a crucial role because dentists check for signs of oral cancer in every routine check-up, and it is a contractual requirement for dentists to prioritise patients at a higher risk of oral cancer for more frequent recalls.

Turning to the hon. Gentleman’s specific point about prioritising dental appointments for cancer patients, I am aware of instances where patients have faced unacceptable delays to the start of their treatment because of a lack of dentistry appointments. I agree with all hon. Members that such delays are just unacceptable, and we are committed to making sure that everyone who needs a dentist should get one. That is why, along with the raft of measures we are introducing to improve access to NHS dentistry across the country, we are also publishing new guidance to make it crystal clear to every integrated care board that they have a responsibility to commission additional specific services in their local area when they identify problems such as cancer patients being unable to access timely treatment.

As soon as we published our dentistry recovery plan on 7 February, I turned my attention to seeking out the expertise and knowledge of dentists and their representative bodies to understand their perspectives on the need for dental contract reform. I am specifically looking now at what reforms would improve access to dentistry and encourage greater capacity, as well as how at we can consult the dental profession and prepare for further announcements later this year. I can assure hon. Members that, in every decision, I will keep pushing for every patient in our country to have access to the dental care they need, while protecting our cast-iron guarantee to support those most in need with full or partial exemptions from dental patient charges for those on low incomes.