Dental Services: East of England

Andrew Selous Excerpts

Tuesday 16th May 2023 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

I congratulate my colleague and good friend, my hon. Friend the Member for South Norfolk (Mr Bacon), on an excellent and passionate speech. I agreed with every word that he said.

I, too, am a veteran of these debates. I dusted off the speech that I made on this subject—probably in this very chair—on 10 February 2022, and things are not better, so I am back, as we all are. It is the duty of Back-Bench Members of Parliament to speak out on behalf of constituents. In February 2022, I had been told a month or two before by NHS England that of the 47 dental practices in my constituency, six were taking NHS patients, but I do not think that was accurate because it was not the experience of my constituents. When NHS England told me that it had done a search on dentists available to take NHS patients in my constituency, I do not think that it had knocked on doors and gone in and asked them. I think it had sat and looked at what an out-of-date website said, and that is not good enough. For a public service that matters, it should not look at an out-of-date website and give Members of Parliament inaccurate information.

The situation is still not better. If we look at the figures from the House of Commons Library briefing on the percentage of children who have seen a dentist, just before the pandemic in September 2019, it was not high enough—it was 58.5%, so just under six out of 10 children saw a dentist every year. The pandemic has a lot to answer for in a lot of areas of our national life, and the latest figures that we have from the Library show that in June 2022, the figure for children seeing a dentist in the last year had declined from 58.5%, which was not high enough anyway, to 46.2%. Less than half of the children in England see a dentist every year, yet we know how important it is for them to do so. Children go to hospital to have teeth taken out, and so on, but regular trips to the dentist, proper prevention and proper brushing could prevent that.

The situation is no better for adults. We have similar figures for adults going to see a dentist in the last two years; I am not sure why it is two years for adults and one for children. In September 2019, just before the pandemic, 49.5% of adults had been to see a dentist in the past two years. That has crashed down and, as at June 2022, is now barely more than a third at 36.9%. Just over a third of adults in England go to see a dentist every two years.

Serious work clearly must be done, because oral health matters. It matters for young children, as I have said, far too many of whom turn up in hospital having to have teeth taken out. It is important that we teach children to brush their teeth well, and we all need to be reminded of that. A Radio 4 programme that I was listening to the other day reminded us that we should not rinse the toothpaste out of our mouth but should only spit it out. You might think that is rather piffling, Sir Mark, but if it helps the nation’s teeth to be a bit healthier by leaving the fluoride on our teeth, it is actually quite important information. There is a job to be done of educating the whole nation about how to look after our teeth properly.

I am passionate about dental care for older people as well. With busy adult social care staff, it can get forgotten, and in nursing homes and care homes it has not always been given the priority that it needs. I had a debate in the main Chamber a while ago on this subject and domiciliary care. The care needs to be there, because poor oral health can contribute to a whole host of other problems and can make them worse. For example, someone might have a low-level bacterial infection in their mouth because they do not have good dental hygiene. We need to get this right.

I was very taken with the suggestion from my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) about NHS dental students giving some time to the NHS. I think five years was suggested. I am conscious that, unlike when I went to university, there are grants and that students leave with quite a lot of student debt, but there is something we could and should do there. If someone is training to be a doctor or a dentist, they receive a large amount of taxpayers’ money, and taxpayers can reasonably ask what they are getting back in public service. Whether we could do something on the amount of debt they have, or vary or pause the interest rate, if they gave those five years to the NHS, that would be worth looking at, and having a greater supply of dentists would make a significant difference.

I come back again to say that the situation is not as I would want it to be. I want my constituents to be able to see a dentist easily. I spoke to the Minister before the debate, and I know the Government are earnestly working on the subject and will come up with a plan in the next few months. I have particular confidence in this Minister—sparing his blushes—because he has been incredibly helpful to me on general practice provision in my constituency. He is an outstanding Minister: highly intelligent, does the detail, delivers and asks the questions that need to be asked. I have hope and confidence in him, but I say to him today, as all hon. Friends do, that this is urgent and it matters. Please deliver—deliver properly and deliver quickly.

--- Later in debate ---

[Jerome Mayhew (Broadland) (Con)]

One of the unifying features of the speeches today is that we have heard them all before. Not only have we all heard it before, but we have all said it before, so I will try—I may fail—not to do that. However, I do have to highlight some elements of the problem, which has been ably covered by my hon. Friend the Member for Waveney (Peter Aldous).

Access to NHS dentistry in Norfolk, which is the worst in the east of England, was surveyed in 2020 to 2021, and of the 150 sub-regions of the country, Norfolk came 147th. As I said to the Minister in a previous speech, we have to follow the money. As my hon. Friend the Member for Waveney pointed out, the best areas spend nearly £80 per mouth per year on dentistry; in the east of England, the figure is £39—a full 50% less. Does the Minister have an explanation for that? I genuinely struggle to understand how spending on NHS dentistry in the east of England is so far below that in the rest of the country. It seems to be without explanation.

More locally still, in Broadland the lack of dentists of any description is profound. I was lucky enough to persuade the Department to advertise a new contract for NHS dentistry in Fakenham last year. The money was available and the contract was advertised; not a single organisation applied for the contract, and it is still vacant. In Sheringham, in the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker), who is unable to speak in this debate, there is a dental practice that is owned by an organisation that has an equivalent practice in London. The organisation has been advertising consistently for a new private dentist in Sheringham for 10 years, and it has yet to fill the role, whereas during the same time multiple positions in its London practice have been advertised and filled. It is therefore not just a regional issue; geography really matters.

I am sorry to say that just last week the latest in long and ignoble line of announcements came when Brundall Dental Practice, which is an NHS practice, contacted patients to say that it would no longer be accepting adult NHS patients from 1 September this year. People are being asked to move on to monthly subscriptions for dental care, which are between £150 and £400 a year. I struggle to know what to say to the many constituents who have contacted me, because not a single NHS practice in the county of Norfolk is currently accepting new patients under an NHS contract. The £11 a month is only for check-ups and hygienists; it is not for dental care, which is an extra charge.

People might say that many can afford to pay for dentistry if they have to, but we have to also consider those who are excluded from paying dental charges because of their financial circumstances. What are we asking of those constituents? Where are they to turn not a single provider in the county of Norfolk is accepting NHS dentistry? The answer, of course, is that they will go to the Norfolk and Norwich University Hospital when their dental problems become acute, and we merely transfer the problem from the dentistry budget to the NHS and acute budget. The problem will be so much worse, and so much harder and more expensive to treat, because we are not nipping things in the bud but dealing with acute emergencies. That cannot be the right answer.

The reason I do not want to prolong the agony of discussing the problem is that I know that the Minister gets it. If he was not educated before, he has certainly been educated on numerous occasions, either here or in the main Chamber, by many of the Members present—the problem has already been fed back. Government Members have great confidence in the Minister and in his grip, grasp and focus on the issue. We know that a dentistry plan is imminent—the sooner that it is published, the better, and more power to the Minister’s elbow—but there are a number of suggestions I hope will find their way into the plan.

In the short term, we need additional improvements to the current dentistry contract—other Members have spoken eloquently about that, and I would highlight it as being very important. As regards the medium term, we have had reference to centres for dental development. The University of Suffolk has progressed far in its application, and there is a necessity for a similar venture at the University of East Anglia, or at least similar work in Norwich. However, in the long term, we simply have to train more dentists. We have to open the market to allow people to access a lucrative and fulfilling career that is currently not being explored in the east of Anglia and in Norfolk, in particular.

We need to train people in the east of England. The University of East Anglia has put forward proposals for a dental school. The medical school it founded in Norwich about 10 years ago knows definitively, from surveying all its graduates each year, that about 40% go on to take their first job locally. The single act of setting up a dental school in Norwich, linked to the Quadram Institute and the research work at the Norwich Research Park on the human microbiome, is the long-term solution.

I hope the medical plan will look beyond the national numbers. I was told by the NHS that roughly the right number of dentists are being trained each year, but I dispute that. It has been seven years since it surveyed what those dentists are up to. It has no idea whether the dentists notionally on its books have retired, gone abroad, are working in the NHS, are working part-time in the NHS, are working privately, or none of the above.

[Andrew Selous]

My hon. Friend is making a powerful point about the link between where people train and where they work. I would gently make the point to the Minister that the east of England is quite a large area. Norfolk and Suffolk are deeply wonderful places, with which I have a great affiliation, but they are quite a long way from Bedfordshire, which is also in the east of England. If we were to think that it was job done because we had trained dentists in Norwich or wherever, I would want to know what that meant for the good people of Leighton Buzzard, Dunstable, Houghton Regis and the surrounding villages. I put that marker in the Minister’s mind.

--- Later in debate ---

[Mr Richard Bacon]

I enjoyed listening to the remarks of every contributor, including my parliamentary neighbour, my hon. Friend the Member for Waveney (Peter Aldous). I was going to say “the Member for Aldous”—going around my constituency, one finds quite a lot of Aldouses; I have not yet established whether they are all related, but if one scrapes under a stone in East Anglia one quickly comes across an Aldous. He gave us a tour d’horizon—a tremendous summary of the expertise that he has gathered over the last few years. Together with the hon. Member for Bradford South (Judith Cummins), he has led the way in drawing the issue to the attention of other hon. Members. I pay tribute to him for that, and I am deeply in his debt, because reading his speeches was a great way to read my way into the subject—one that I was drawn to not because of any expertise, but because of my constituency postbag. We have heard that the same is true for all hon. Members.

Opinion pollsters are sometimes behind the curve on what is a salient issue, but hon. Members on both sides of the House know that this is the top issue facing us. My plea to the Minister is not to go so fast that he gets it wrong, but to bide his time and ensure that he has taken everything into account. He should talk to his Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay)—an east of England MP who has the same problems in his constituency postbag—and come up with an answer that is attractive and provides lasting change. That is what we want to see.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), another of my parliamentary neighbours, raised the interesting point of how we encourage people who have had money spent on them by the NHS to stay in the NHS, even if they are paying fees themselves, as my hon. Friend the Member for South West Bedfordshire (Andrew Selous) said. I would be open to a wide variety of methods for doing that, including forgiveness of part of or perhaps all student loans. We need to make radical changes.

My hon. Friend the Member for Broadland (Jerome Mayhew) quoted a startling statistic: £80 per head is spent on dentistry in the areas that have the best dental care, and only £39 in parts of the east of England. What annoys me more than anything else is that, outside London and the south-east, the east of England is the fastest growing area of the country. It contributes the most gross value added to the economy outside London and the south-east. That is an argument that MPs in Norfolk and elsewhere in the east of England have been making for many years. We have been saying for years, “Give us the infrastructure, give us the broadband, give us the rail connectivity and give us the mobile telephony that actually works, without the need to go 100 yards down the road, stand on one leg and hope there is an “r” in the month to get a mobile telephone signal. Then we will provide the economic growth.”

Going back to the Prime Minister’s points, I seem to remember that one of them is about economic growth. Here we are contributing so much to the economy and yet not getting our fair share back, when the opportunity in the east of England is unrivalled in the UK. A golden triangle could exist between the economic heat, innovation and intellectual firepower of Cambridge; the Norwich Research Park in my constituency, where scientists look at world-leading advances in genomics and plant science; and technology in Ipswich at the BT labs at Martlesham. That golden triangle represents an extraordinary opportunity for the whole United Kingdom.

I was recently at the Cambridgeshire Development Forum, where I heard people talking about east-west rail and comparing themselves with Boston and Silicon Valley, but saying that they do not have enough room to grow. I say to my hon. Friend the Member for Boston and Skegness (Matt Warman) that that is, of course, Boston in America. The obvious answer is, “You have got loads of room to grow. You have got the whole of the east of England.” To an investor from Dubai or Shanghai, it all looks like Cambridge. We have a huge opportunity, but we need not only the infrastructure but the world’s best medical and dental services.

[Andrew Selous]

In an uncharacteristic slip and momentary lapse of memory, my hon. Friend forgot to mention the world-leading research in Cranfield, which I am sure he was going to add to his golden triangle of opportunities in the east of England. I am sure that that slipped his mind accidentally.

[Mr Richard Bacon]

It might make it more of a pentagram, but I did mean to mention Cranfield, of course. My hon. Friend knows that in South Norfolk we speak of little else. I do not want to take up too much time, although we are slightly ahead.

My hon. Friend the Member for Boston and Skegness said that he is not technically in the east of England. I had a mad great-great aunt who lived in Brigg in Lincolnshire, and Lincolnshire has always been in the east of England, as far as I am concerned. He is very welcome at this debate, and I had a great interest in what he said. However, if it is true that the wilder fringes of the internet have got worse in recent years, and if my hon. Friend was responsible for 5G, to whom should we attribute the extra growth in the wilder fringes of the internet, if not to him? I only pose the question.

The hon. Member for Denton and Reddish (Andrew Gwynne) surprised me. I remember when he was shadow Secretary of State for the Ministry of Housing, Communities and Local Government portfolio. He mostly appeared at the Dispatch Box like an angry avenging angel. The fact that he is capable of sounding rather rational and sensible was a surprise to me. I am afraid he also confirmed my worst fears—