Dentistry: Access for Cancer Patients

Andrew Western Excerpts

Wednesday 17th April 2024 Westminster Hall

[Andrew Western (Stretford and Urmston) (Lab)]

I beg to move,

That this House has considered access to dentistry for cancer patients.

As always, it is a pleasure to serve under your chairmanship, Mr Dowd. I want to start this debate, which I am delighted to have secured, by paying tribute to my constituent Michele Solak-Edwards, who is here to listen to the proceedings. Her phenomenal campaigning on these issues is the reason that we are all here.

Back in 2016, after a routine health assessment, Michele found out that she had triple negative breast cancer—a devastating diagnosis, followed by nine months of gruelling chemotherapy. Among the many, many challenges that Michele faced in that time was a deterioration in her dental health. That is a common yet rarely discussed side effect of chemotherapy and radiotherapy.

Unlike other physical side effects of cancer treatment, which may be medicated with the free prescriptions that cancer patients are entitled to, any side effects requiring dental treatment must be paid for. As we all know, the costs of dental treatment, even if someone is lucky enough to be registered with an NHS dentist, can be overwhelming. For Michele, the significant costs of her dental treatment had to be paid for at a time when, like many other cancer patients, she was unable to work because of her condition.

When Michele was going through one of the most difficult experiences a person can face, she found that accessing affordable dentistry was yet another obstacle for her and others in her position to overcome. So like all great campaigners, she took action to make a difference. She set up an online petition calling for better access to dentistry for cancer patients and for dental care to be free for cancer patients for five years from diagnosis, or until the end of life, if the diagnosis is terminal. This is crucial, given that dental issues do not always become apparent straight away at the outset of cancer treatment, and the issues caused can take a number of years, in some cases, to present themselves.

Within weeks, Michele had more than 130,000 signatures on the petition, with support from dentists, surgeons and oncologists. The petition now has the backing of almost 200,000 people, many of whom are cancer survivors. It is a privilege to be able to highlight its importance to the Minister today. Why is it important? Primarily, because there is an indisputable link between cancer and dental health issues. As the National Cancer Institute said, chemotherapy and radiotherapy can cause dental side effects, with both therapies altering the balance of bacteria in the mouth, leading to ulcers, tooth decay and potentially serious infection.

The link between cancer and dental health does not end there, because existing dental problems can worsen during cancer treatment, which can then impact the effectiveness of treatment or lead to it being delayed. That is why it is widely recommended, including by the British Dental Association, that a dental health assessment should take place after a cancer diagnosis and before the start of treatment.

While the link between cancer and dental health is clear, the pathway from a cancer diagnosis to dental health treatment is often blocked. The biggest issue is the crisis in accessing affordable dentistry. This challenge is not unique to cancer patients, with one in four of Britain’s adult population unable to see an NHS dentist in 2022. In my and Michele’s local authority area of Trafford, only 4% of dental practices are accepting new adult patients on the NHS, and that is by no means a low number, based on current availability. What this means for most people is the choice of going private or going without. When the costs of private dentistry are so high, that is not really a choice at all for many, especially for those on lower incomes.

Even if someone is lucky enough to access NHS treatment, costs can still be sky high, with the price of dental charges increasing by 45% over the past decade. I am not attempting to be party political, but I am suggesting that there is a link between being a cancer patient and being on a lower income because, as I mentioned, many do need to give up work. Macmillan Cancer Support estimates that a cancer diagnosis leads to a person being around £570 a month worse off, with 33% of patients having to give up work because of their condition. Cancer patients are more likely to be priced out of the dental treatment they need, and in cases where dental treatment is required before cancer treatment can begin or continue, that can have potentially life-changing consequences. Every day lost risks lives.

Let us look at some specific examples, such as the case of one of Michele’s campaign supporters, Kelly. Kelly is waiting to start bisphosphonate treatment, which is needed to strengthen bones that are at risk of breaking due to cancer. To start that vital treatment, she must undergo important dental work, which is proving impossible as she cannot see a dentist. The fact that a person’s cancer treatment can be delayed, impacting their life quality or even survival chances because they cannot access dental care is clearly unacceptable.

I know that the Minister understands the crisis in accessing dentistry and I am aware of the Government’s recently published dental recovery plan, which aims to address that. However, the British Dental Association has said that the plan fails to embrace the fundamental reform that patients and dentists so desperately need, with no new money provided and inadequate measures to tackle the workforce retention crisis. If we are ever to achieve the goals of Michele’s campaign, we must get that right, because the speedy provision of dental care for cancer patients would be significantly undermined if, in practice, many cancer patients were still unable to see an NHS dentist due to an unaddressed workforce crisis.

While addressing the crisis in NHS dentistry and the affordability of dental care is not something that can be achieved overnight, there are more immediate things that could be done to improve the pathway from cancer diagnosis to dental treatment. Currently, there is no guarantee that cancer patients will be informed by their doctor that they should seek a dental check-up before undergoing cancer treatment. That is despite guidance from the NHS Specialist Pharmacy Service, the Royal College of Surgeons, the BDA and the British Society of Special Care Dentistry stating the importance of patients being dentally fit before starting cancer treatment.

Michele’s campaign therefore calls on the NHS to provide information to all newly diagnosed cancer patients, telling them of the need to seek dental assistance prior to their cancer treatments commencing. That does happen in many places, but we want to see it enshrined in law. That information could be provided by GPs and would include a list of dental practices in each area that could treat the cancer patient on the NHS.

I would also like to share the experience of Hayley from Reading. Hayley is another supporter of Michele’s campaign, and her stories sum up the issues that I have tried to raise today. When she was 21, Hayley had chemotherapy and radiotherapy for non-Hodgkin lymphoma. The radiotherapy caused severe dental issues. Now aged 44, Hayley has breast cancer and has had to remortgage her house to spend £11,000 on removing the remaining six teeth in her lower jaw and replacing them with implants. At no stage has Hayley been able to access NHS dentistry. Experiences such as that are why this campaign is so important. No one wants a situation where cancer patients are losing out on the healthcare they need because they cannot afford or access it.

We must act on this underappreciated crisis. I therefore encourage the Minister to address in her response the asks of Michele’s campaign, including not only the long-term aim of free dental care for cancer patients, but, in the short to medium term, the possibility of prioritising cancer patients for NHS dentistry and ensuring that there is clear guidance on the need for cancer patients to receive dental care provided at the first point of contact with their GP or cancer team. I am particularly interested to know what consideration the Minister could give to joining cancer and dentistry services together for cancer patients, offering out-patient appointments for sufferers in hospital alongside their other treatment. That would seem a practical way of ensuring that people can access the care that they need.

I also invite the Minister to meet Michele and myself—as the shadow Minister, my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), kindly did earlier today, and I know Michele was appreciative of that—so that we could discuss these issues in greater detail. She will appreciate that I have not been able to cover all aspects of this important issue. Likewise, I accept that there is an escalator of asks here, some with financial implications. Michele has a mine of further information on the subject, and I know that she would be keen to talk the Minister through some of her ideas for funding these changes.

Ultimately, we must all work together on improving access to dentistry for cancer patients. As I said, I do not consider this to be party political, but it is something that we must get right. It is the least we can do for people who are already facing one of life’s toughest challenges.

--- Later in debate ---

[Andrew Western]

I thank everybody who has contributed to the debate. We have a considerable amount of expertise in the room—in particular, my hon. Friend the Member for Bolton South East (Yasmin Qureshi) is the chair of the all-party parliamentary group and my hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton) is a former nurse and national lead for the Local Government Association on all things relating to health.

I am grateful to colleagues who have contributed to the debate in various ways and focused more generally on the considerable issues facing those seeking to access dentistry. I want to drill down more specifically on the issue of access for cancer patients, and I appreciate the Minister’s offer of a meeting, which will hopefully move us forward. I also welcome her commitment to looking at how we can deal with the information side of this. However, with respect—she would expect me to say this—that is perhaps the easiest of the issues to tackle. I gently say to her that at no point did I ask for all patients to have free dental treatment, but just for cancer patients to have dental treatment because their experience has not come about as a result of not looking after their teeth, but as a direct result of other treatments. [Interruption.]

I am cognisant of the Chair’s clearing of his throat, and I will raise some of the other issues that I was hoping to discuss today in the meeting with the Minister. As I say, I am grateful to her and the shadow Minister for meeting me and Michele earlier, and to everyone who has contributed.

Question put and agreed to.

Resolved,

That this House has considered access to dentistry for cancer patients.