Dentist Industry and NHS Backlogs

Debate between Andy Carter and Maria Caulfield

Monday 7th February 2022 Commons Chamber

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

I congratulate my hon. Friend the Member for Warrington South (Andy Carter) on securing the debate and on raising such an important issue. I answered another Monday Adjournment debate on dentistry recently, and on Thursday there will be another debate on it in Westminster Hall, so it is obviously a significant issue for many hon. Members across the House. I also thank my hon. Friends the Members for Clacton (Giles Watling) and for Isle of Wight (Bob Seely) for raising issues on behalf of their constituents.

I am not going to stand here and say that there is not an issue around dentistry, because there absolutely is —it has been significantly affected by the pandemic. I will touch first on the short-term problems that the pandemic has created for dentistry and for patients, before going on to the longer-term problems around the contract, which my hon. Friend the Member for Warrington South raised and which have existed for a significant time.

A significant backlog has been created during covid. The majority of dental procedures are aerosol-generating, so covid creates a significant risk both for patients and for dental teams. When the lockdown measures initially came into force, only urgent dental procedures were allowed to go ahead. It was not until 8 June 2020 that non-urgent procedures were allowed, and only 20% of normal activity was allowed to go ahead at the time because of infection control measures. Even at that stage, we could see that a significant amount of work was backing up.

For most of last year, dental teams were allowed only up to 40% of normal activity. It was not until the end of last year that they could go up to 65%, and just around Christmas time that they were able to go up to 85% of normal activity. Even today, they are still not allowed to go back to 100% of normal activity, simply because infection control measures make it important that space, intervals between patients and cleaning between patients continue. Even with dentists working at pace and as hard as they can, a backlog is still accumulating nearly every day because those measures are in place.

[Andy Carter]

I thank the Minister for setting out very clearly how dentists have come back to operate in their surgeries. As she mentions and as I said in my speech, dentists were asked just before Christmas to deliver 85% of the UDAs for the three-month period from January to March. A number of small dentistry practices operating with one or two people are saying that we have increased the amount that they are required to deliver in order to be paid, at a time when covid is at its highest with the most infections ever. If a staff member, dentist or patient is unable to attend, the risk that the dentist will not be able to deliver is very significant, which means that they could be financially penalised. Does the Minister understand that the way the contract has been set up can really work against the current timeframe?

[Maria Caulfield]

I absolutely have a lot of sympathy for dentists. It is due to their and their teams’ hard work that, since December 2020, urgent care is back to pre-pandemic levels. I reassure my hon. Friend that when we were at 20%, 40% and 65%, dentists were getting paid 100% of their contract value; it is only since the Christmas period, when we went to 85%, that they have not been paid the full 100%. Throughout most of the pandemic, even though they were seeing fewer patients than their contract allowed because of infection control measures, they were getting 100% of their contract value.

[Andy Carter]

I understand what the Minister says. The way dentists are paid is not that dissimilar to the way MPs are paid: they get a chunk of money and have to pay their rent and pay their staff, as they have had to do all the way through the period. If they get to the point where they are required to deliver 85%, but where covid and the infection levels mean that they cannot physically deliver it because they are not there, they still have all those outgoings—they still have to meet their contractual requirements to pay the rent and pay their staff. That is the issue that I think many dentists are very concerned about.

[Maria Caulfield]

I take my hon. Friend’s point of view, but during the pandemic there has been significant support that many other sectors did not get. That is not to detract from the problems that dentists are facing, however, and no one is a bigger supporter of dentists than I.

I will just move on to some of the other points that my hon. Friend raised. We are not up to 100% of pre-pandemic activity simply because of covid, and that is taking a toll on access to NHS dentistry. A number of patients have waited and waited during the pandemic and now need urgent care, and we are seeing that reflected in A&E attendance and in surgical elective lists, because patients have got to a stage where they need surgery to rectify some of their problems.

I fully take on board many of the issues that have been raised in the debate this evening, but I reassure colleagues that we are trying to support dentistry as much as possible. NHS England is providing local commissioners with help and support to direct patients to where there is availability. It may have been my hon. Friend who mentioned this, but dentists have been asked recently to update their information on the NHS website that records where NHS dentists are, so that we can direct patients to those surgeries that are taking patients. Dentists have also been asked to operate a cancellation list, so that, should someone pull out, the next person on the list is proactively contacted to be offered that appointment. It is difficult for patients to navigate the system and find out where NHS dentists are.

Members may be aware—I hope they are—that just a few days ago, a one-off additional £50 million was secured for NHS dental services, the first pot of money that they have received in a long time. It is specifically focused on this financial year, so it has to be spent by April. It is targeted at those NHS dental teams to ask them what availability they have in increasing capacity, so that those waiting for treatment can start to access some of it. My hon. Friend’s area in the north-west has been allocated £7.3 million to be spent by April. NHS England is working at pace with local commissioners to deliver that and to try to tackle some of the backlog.

The difference between that funding and the contract is that the rates of pay are significantly different, and we are seeing huge uptake from dentists who are keen to do NHS work when they are rewarded accordingly. That additional £50 million will secure up to 350,000 additional dental appointments and will be targeted at those in most urgent need of dental treatments, whether it is oral pain, disease or infections, to help them get the care they need. Children, who a couple of Members mentioned, are being prioritised, as are other vulnerable groups. We are seeing some take-up of that offer, and I hope that shortly we will be able to update colleagues on where exactly that take-up has happened and the difference it has made in accessing NHS dental provision.

I will move on to some of the longer-term dental issues, which have been eloquently set out this evening.