Access to Dentistry: Somerset

Anna Sabine Excerpts

Tuesday 1st April 2025 Westminster Hall

[Graham Stuart (in the Chair)]

I will call Anna Sabine to move the motion, and I will then call the Minister to respond. I remind other Members that they may make a speech only with prior permission from the Member in charge of the debate and the Minister—that is often forgotten. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Anna Sabine (Frome and East Somerset) (LD)]

I beg to move,

That this House has considered access to dentistry in Somerset.

It is a pleasure to serve under your chairmanship, Mr Stuart. My grandfather might not have been a toolmaker, but he was dentist. He worked near Slough, and as a child I loved visits to the dentist because we got to play in the electric chair and dissolve bright pink mouthwash tablets in plastic cups, and we always got a Lambrusco and lemonade afterwards, which was of course entirely appropriate.

That regularity of dental treatment means that, at 45, I am lucky enough to have no fillings at all, and I am not particularly scared of dentists. Many children growing up today in my constituency of Frome and East Somerset are not so lucky: one in five children in Somerset has tooth decay by the time they are five. Although we know that difficulty in accessing an NHS dentist is a nationwide challenge, data reveals that the south-west is particularly neglected. The most recent Office for National Statistics data shows that it has the worst access problems of all regions in England, with 99% of people without a dentist failing to secure the NHS treatment they needed in the last month.

Furthermore, only 32% of adults in Somerset saw an NHS dentist in the two years to June 2024, which is much lower than the national average of 40%. The picture for children in Somerset is equally shocking: only 42% were seen by a dentist in the year to June 2024, well below the national average of 55%, and way below pre-covid averages.

[Richard Foord (Honiton and Sidmouth) (LD)]

My hon. Friend’s point about the south-west is absolutely right. Some 217 visits per 100,000 to accident and emergency are for dental-related issues, compared with 154 for the next highest region. So the south-west is a real outlier, and not in a good way. Does my hon. Friend think that that is having a detrimental effect on hospitals and A&E?

[Anna Sabine]

Yes, I absolutely agree, and I will talk later about how poor access to dentistry impacts other parts of the health sector.

Yesterday, I was lucky enough to visit a local primary school in Frome, along with a friend who is a dentist. We started with an assembly about the many superpowers the mouth has, in which I was delighted to be given the leading role of saliva. Then we moved on to taking two reception classes through a supervised toothbrushing session. The school is part of the Government’s supervised toothbrushing scheme, an initiative I welcome. Sadly, of the 30 children in the room, 10 did not have consent for the toothbrushing—some because forms had not been returned, and some because there was a parental objection to the activity or to the use of fluoride. To ensure that they did not feel left out, my dentist friend played a game where they counted their teeth instead. She said that, based on what she could see from that game, that group of 10 children had 50 obviously decayed teeth, and one child had at least 10 teeth that would need to be removed under general anaesthetic. Those children were four and five years old. Although the scheme overall is to be welcomed, I hope consideration will be given to having an opt-out rather than an opt-in, to ensure that the children who most need the scheme are actually benefiting.

Somerset used to be well above the national average on access to dentistry. As recently as 2018, 55% of adults were seen by an NHS dentist in a two-year period, compared with 50% nationally.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing the debate, and she is right to highlight the issue affecting children but also adults. Does she agree that the news that some pensioners are carrying out their own barbaric dentistry should send shockwaves about the affordability and accessibility of NHS dentistry? Does she also agree that there is a need for immediate intervention in each trust area, whether in Somerset, Scotland, Wales or Northern Ireland?

[Anna Sabine]

Yes, there are certainly some horror stories about tooth removal. It does beg the question as to why NHS dental services in Somerset and the wider south-west have deteriorated in the last seven years. It seems to me that that is symptomatic of a lack of investment in the region, in terms of not only health and social care but withdrawn levelling-up funding and diverted rural England prosperity funding.

[Steff Aquarone (North Norfolk) (LD)]

My hon. Friend talks about the need for investment, and much of that will be in training new dentists. Does she therefore agree that it is baffling that a brand-new dental school at the University of East Anglia could be delayed by a full year because the Treasury refuses to release funding until a month after the deadline for UCAS course listings, and that another year’s delay is unacceptable for her constituents in Somerset and mine in North Norfolk?

[Anna Sabine]

That sounds very frustrating, particularly when, as we are seeing, there are so many crises in our dental services.

A constituent emailed me in February to say that four weeks previously her husband, who is in his late forties, had had a massive stroke. He collapsed into the sink in the kitchen and hit his face on the taps, breaking his teeth. He was discharged from hospital on 14 February, but cannot speak, is partially paralysed, needs continuing care, rehabilitation and adjustment, and is suffering dental pain. He is not registered with an NHS dentist and cannot afford private dental care, so they called 111 and, after four calls, drove to an appointment where the dentist was given just 30 minutes to treat only one tooth, which he had to remove. My constituents will have to call 111 again to get treatment for the next tooth. The husband needs dentures, is on soft foods and is still in pain. As that case shows, and as my hon. Friend the Member for North Norfolk (Steff Aquarone) pointed out, a failure to invest now in dentistry not only causes more pain for the individual, but gets more expensive and adds to pressure on other areas of the NHS in the longer term.

[Steve Yemm (Mansfield) (Lab)]

A constituent in Mansfield, who works in a local NHS practice, wrote to me to suggest that dental therapists, hygienists and other professionals could be utilised a lot more effectively to deal with capacity. Does the hon. Member agree that to free up more appointments, such as those her constituent needs, and to ensure that people get better and more timely care overall, it would be better to utilise the skills of other people in the dental profession, in the south-west and throughout the UK?

[Anna Sabine]

Yes. That is one of the things I have talked about extensively—or rather I have been talked at extensively by my dentist friend about the way in which we manage staff and who does which bits of work in dentistry. It is really important that the Government engage with the British Dental Association about that to understand some of the complexity of how the contracts are working at the moment and what could be improved.

If we do not deal with people’s dental pain, we get more pressure on the NHS in the long term: cancers go undiagnosed, and people are forced to use 111 or A&E. It cannot make sense that people have to use 111 to organise their dentistry if they do not have an NHS dentist. People are simply being pushed around the system instead of being treated and instead of illness being prevented. I absolutely understand and appreciate the financial situation the Government inherited from the Conservative Administration, but I am concerned that not enough is happening fast enough on dentistry.

[Helen Morgan (North Shropshire) (LD)]

The previous Government tried to tackle this problem by offering golden hellos to dentists in rural areas to encourage the uptake of NHS dentistry, but in reality that did not work. What we really need the new Government to do is to advance at pace with renegotiating the dental contract. Does my hon. Friend agree that if the new Government can get on with that rapidly, we might see an improvement in rural areas and, indeed, the whole UK?

[Anna Sabine]

I do agree. Golden hellos are all very well, but the challenge—as I hear from dentists in my constituency—is that once dentists leave NHS dentistry and go into the private sector, which more and more are doing, nothing will ever get them back again. That is a loss that we do not recover from.

[Sir Ashley Fox (Bridgwater) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I thank the hon. Member for Frome and East Somerset (Anna Sabine) for securing this important debate. Does she agree that Somerset benefits enormously from Bridgwater & Taunton College, where nurses and midwives are trained? Will she join me in asking the Minister whether dental hygienists, and in due course dental students from the University of Bristol Dental Hospital, might also train there and provide a service to the whole of Somerset?

--- Later in debate ---

[Anna Sabine]

I was not actually aware that we had those facilities there, and I am happy to know more about them. Yes, I would certainly join any call for more dentistry skills to be brought into the Somerset area.

The Health Secretary made a point of meeting the British Dental Association on his first day in office, but the BDA tells me that there has been little follow-up. Could the Minister confirm whether the Government have now entered into formal negotiations to reform the dental contract? If they have not, when do they expect to do so? I am sure the Minister will rightly highlight in his reply the roll-out of the 700,000 extra urgent appointments.

[Adam Dance (Yeovil) (LD)]

The 700,000 new urgent dental appointments cover only a third of the need for urgent care, and are being funded by simply recycling underspends in an already stretched budget. Does my hon. Friend agree that what we actually need in Somerset is new money to invest in NHS dentistry, as promised at the election?

[Anna Sabine]

I totally agree. I was coming on to say something similar: the roll-out of the 700,000 extra urgent appointments is a positive start, but it covers less than a third of the need for urgent care appointments. The Government must put more money into dentistry so that people can get the help they need.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

The area around Minehead, in my constituency, has the smallest number of dentists in the country. Does my hon. Friend agree that the fact that the area is both rural and coastal presents a unique set of problems because of deprivation and neglect, which means that the dental desert there is felt very acutely indeed?

[Anna Sabine]

I absolutely agree. Given the time limitations, I have not come on to discuss the challenges that places such as Somerset face due to their rurality, including the difficulties in getting to services, but my hon. Friend is absolutely right.

The BDA’s asks and policy proposals are clear: the Government must invest in dental services and secure a long-term funding settlement for NHS dentistry that keeps pace with demand, and budgets allocated to NHS dentistry must be ringfenced. The BDA also agrees with the Liberal Democrats that NHS dental practices must be offered relief on the national insurance contributions rise announced in the most recent Budget. The Lib Dems believe that such relief should be extended to the wider health and social care sector, including GP surgeries, care homes, hospitals and pharmacies.

Parents and families across Somerset are crying out for extra support with accessing affordable and reliable dentistry, and access to an NHS dentist should be guaranteed to everyone needing urgent and emergency care. To catch up with the national average, Somerset needs extra investment, and it needs it quickly.

[Gideon Amos (Taunton and Wellington) (LD)]

I am grateful to my hon. Friend for drawing attention to the dental desert that is Somerset and to how keenly it is felt. Does she agree that many families have to choose between putting food on the table and paying to take their child to the dentist? We can expose the reality of the dental desert through more research, which I will be carrying out in Taunton and Wellington very soon.

--- Later in debate ---

[Anna Sabine]

We can absolutely carry out more research, and I urge Members to go and talk to their local school teachers. Yesterday, I found that teachers in Frome have a very clear understanding of why certain children are not going to the dentist. Sometimes that might be down to parental choice, and it is really important that we understand why that is happening as well as why there is not sufficient access to dentistry.

To catch up with the national average, Somerset needs extra investment, and it needs it quickly. We need more NHS practices that are financially viable and exempt from the NICs rise, and we need more dentists who are remunerated and well treated in their work. We cannot let Somerset slip further and further away from the national average, which is already a low bar, and create more pain, misery and costs for generations to come.

--- Later in debate ---

[Stephen Kinnock]

My hon. Friend puts her finger on the fundamental problem, which is that the NHS dental contract simply does not incentivise dentists to do NHS work. That is the fundamental reason why we are in this bizarre situation where demand for NHS dentistry is going through the roof, yet there is a consistent underspend in the NHS contract. It is a classic example of a false economy. The Conservatives thought they were being terribly clever by structuring a contract in a way they thought would deliver value for money, but in fact, it simply failed to incentivise dentists to do NHS work and they drifted more and more into purely private sector work. That is the very definition of a false economy.

[Anna Sabine]

I just draw the Minister back to my specific point about whether he can confirm that he is having discussions with the British Dental Association. The association agrees that the contract is wrong, and it wants to speak urgently to the Government about how it can be amended.

[Stephen Kinnock]

I am pleased to confirm that I am meeting the BDA in the coming days. The negotiations are moving forward. There is no perfect payment system, and there is a need to get the balance right between ensuring that we have a viable system that does not deliver underspends in the NHS contract, which is absurd, and that we deliver as much NHS dentistry as possible to the communities and people who need it. That is a complex process and it will take some time. The Government have taken intermediate measures, such as the 700,000 urgent appointments and supervised toothbrushing, which we will work on at pace over the course of the coming financial year while also working on a radical overhaul of the contract.

By the time I came into government, the Nuffield Trust was describing the state of NHS dentistry as

“at its most perilous point in its 75-year history.”

As of March 2024, there are over 36,000 dentists registered with the General Dental Council in England, yet there are fewer than 11,000 full-time equivalent dentists working in the NHS.