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.

Maternal Mental Health

Anna Sabine Excerpts

Wednesday 5th February 2025 Westminster Hall

[Laura Kyrke-Smith]

I agree; we need to shed more light on this, precisely for that and other reasons.

I will touch briefly on my first recommendation, which is to ensure that specialist perinatal mental health services are protected. In the last 10 years, there have been significant steps forward. Mother and baby units in particular can be an important part of someone’s treatment and recovery, as well as having significant benefits for the parent-infant relationship.

Tragically, there are still too many stories of women not being able to access those units. They are perhaps too far away from where a woman lives, or there is not a bed available, or the need for a mother to get that care has not been identified properly. We are still seeing mothers with newborns being put into adult psychiatric units and separated from their babies, despite the national guidance saying that mother and baby units are best practice. Continued support for these services is crucial, both in mother and baby units and in the community, and that must include research to develop the best interventions and robust evaluations of the care provided.

The Mental Health Bill is a sorely needed piece of legislation, and I really welcome it, but I wonder whether it might include a provision to ensure that all women who have given birth within the 12 months prior to admission to a psychiatric unit are given the option of being admitted to a ward where they can remain with their baby. That could help to prevent women from falling through the cracks in the system, as they do currently.

Secondly, I turn to routine maternity care, which is where the mental health support for the vast majority of women can and should sit. Again, we have seen progress, with some vital new services in place, including care for women experiencing baby loss, severe fear of childbirth, birth trauma and loss of custody at birth.

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

I thank the hon. Member for calling this debate, which is clearly so important to her. In my constituency there is an excellent charity called HeartTalks that works with mothers who have experienced baby loss. Would she agree that post-partum check-ups are really important for all women, but particularly those who have suffered baby loss, regardless of the trimester it occurred in?

[Laura Kyrke-Smith]

I absolutely agree. A recent report from the Maternal Mental Health Alliance highlighted huge variation in the support services available locally, with confusing referral pathways, inequitable referral criteria and long waiting lists—some women have to wait six months for an assessment and up to a year for treatment. Too often, as I have noted, women are cared for unequally. Those who have existing disadvantages experience stubbornly poorer outcomes.

We need better integration of mental health into all routine contacts during pregnancy and after birth for all women who need it. During that period, women have an average of at least 16 routine contacts with health professionals, including GPs, midwives and others, and they are an ideal opportunity to ensure that women are routinely and compassionately asked about their mental health. I wonder if any healthcare professionals asked Sophie not just how the baby was but how she was. I wonder if the discussions about her baby’s feeding were had in a way that sought to reduce her anxiety. I wonder if she was given less attention because this was her third child, and her earlier experiences had been smoother—but I will never know.

In the same way that many physical health complications are dealt with by multidisciplinary maternity services, the same should be true for mental health care. That means midwives, health visitors and others being trained to ask the right questions and assess the risks, and then psychological therapists, equivalent to those employed in talking therapies, integrated into maternity teams to support women’s care where necessary. They would understand the specific needs and risks of the perinatal period, and be able to intervene quickly where that is needed.

Thirdly, I want to acknowledge the importance of community support for pregnant and new mums, as we have heard from other Members, and I recommend its expansion. There are fantastic voluntary groups providing some support, and in some places family support hubs are up and running, but often the postcode lottery kicks in again. We are a long way from the broader and more reliable provision that was established under the last Labour Government—notably the Sure Start model, which all the long-term evidence shows was so effective. As part of our national health mission to shift care from hospital to the community, we need to rebuild those community services, including for pregnant and new mums. We need them to be across the country and widely accessible, with clear maternal mental health guidance embedded in them.

Finally, it is incumbent on all of us to keep building a society where everyone understands the mental health challenges in the perinatal period, including the suicide risk in the most serious cases. Crucially, we all need to learn to be good allies to people who are struggling. I think about that a lot in relation to Sophie. When Sophie sent me messages saying, “Feeling desperate today”, and,

“I’m just not sure I have it in me to keep going”,

did I do enough? Did I worry about her anxiety? Yes. Did I worry about her being depressed? Yes. Did I worry about suicidal thoughts? Honestly, yes. But did I think she might take her own life? No. I have struggled with the guilt that I did not somehow do something to stop it, but I also recognise how ignorant I was and how hard this is.

I have had good conversations with Sophie’s dad about what needs to change. He is part of a group called Facing the Future—a support group for people who have lost family to suicide. One of his group members said:

“I think what I’d like to see is a more proactive and visible campaign to target those who are at risk. Not just for those at risk, but for their families/friends/carers/loved-ones. Let people know that it’s okay not to be okay...Give people the knowledge and confidence to ask someone they are concerned about how they are feeling, to know what to look for and ask, and to know where to go for help.”

That is absolutely right. There are some fantastic charities and campaigns out there. I know the Government are listening; I am particularly pleased that not just mental health, but suicide prevention are woven into our health mission, where moving from treatment to prevention is such an important focus more broadly. But there is more to do.

I conclude by saying that I do not want Sophie’s life to be defined by her death. I want it to be defined by her first-class Cambridge degree, her talents as a writer and actress, her Foreign Office career, her friendships, her playful sense of humour, and the beautiful family that she began to raise. I talk about her death because I hope her experience can be a catalyst for change.

While her story—every story like hers—and the wider statistics can seem bleak, the real story here is one of hope and potential. With the right support in place at this crucial and pressured time in women’s lives, they do surmount great mental health challenges and recover, often quickly and well—and their babies get off to a good start in life. The Government have embarked on transformative work to improve the country’s health, and better maternal mental health outcomes must be one test of our success.

Accessibility of Radiotherapy

Anna Sabine Excerpts

Tuesday 4th February 2025 Westminster Hall

[Tim Farron]

My hon. Friend is absolutely correct. Back at the time of the last Labour Government, the national radiotherapy advisory group recommended that it was bad practice for anybody to live beyond 45 minutes of a radiotherapy centre one-way, or a round trip of an hour and a half, yet so many people—7.5 million people—including his constituents and my constituents, live beyond that.

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

On that specific point, I do not want to show off about who has the worst travel times for radiotherapy, but nobody in my constituency of Frome and East Somerset who does not own a car lives within that recommended 45-minute NHS travel time. Does my hon. Friend agree that reliable, quick and affordable public transport is key, and that the recent increase to the bus fare cap has not helped with the situation?

[Tim Farron]

Yes. By definition, almost all of the radiotherapy deserts—those places that are beyond sensible and safe travelling times—are rural communities. As a result, they have terrible public transport. It is not just about the cost. The increase in the bus fare cap is hugely damaging, but for many of our communities—my hon. Friend’s and mine alike—it almost does not matter what the bus cap is; if there is no bus to spend the fare on, people are stuffed, really. That has a huge impact on their cancer outcomes, which means whether they survive or not.

NHS Dentistry: South-west

Anna Sabine Excerpts

Tuesday 12th November 2024 Westminster Hall

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

I thank my hon. Friend the Member for Honiton and Sidmouth (Richard Foord) for securing the debate. As the MP for a rural constituency in Somerset, I do not need to repeat the well-known fact that the south-west is one of the worst dental deserts in England.

As a mum, and as someone who received excellent dental care as a child because my grandad was a dentist, I particularly worry about the effects on children. With such a scarcity of NHS practices accepting new patients and with the rising cost of living, working families simply cannot afford to go private. More often than not, that means that parents have to unwillingly forfeit their children’s health.

This is a topic that people care about up and down the country. The regular emails I receive about it from my Frome and East Somerset constituents normally describe the same regrettable situation: they cannot get a space, there is no room anywhere in the vicinity and they are forced to go to hospital. However, one recent casework email was particularly stark: it was from a retired man and his wife who have recently become kinship carers for their two grandchildren following the sudden death of their daughter. Although one child had “luckily” already started orthodontic treatment prior to their mum’s death, the grandparents cannot find a single NHS practice that will onboard the other child. They receive the state pension and one child benefit. Luck should never be a factor in the question of children’s health, let alone set two siblings apart. NHS dentistry should be there to level the playing field and give access to all, regardless of background or family set-up.

I know from having met local dentists and national dentist groups that the growing consensus is that there are two reasons why there are so few spaces in NHS dental practice. One reason is budget; the other is the availability of NHS dentists, many of whom are leaving the NHS or leaving dentistry altogether because of low morale and stress. Recruitment is already difficult, but retainment is even more so. NHS dentistry has been chronically underfunded. The UK spends the smallest proportion of its health budget on dentistry of any European nation, and England spends almost half less per head than other parts of the UK.

Just as working families in the south-west are struggling with the rising cost of living, high inflation, energy costs and the cost of everyday household items, so are NHS dental practices. The chronic underfunding has coincided with rising overheads. Most notably, the rise in employer’s national insurance contributions announced in the Budget will have a severe impact on NHS dental practices, which are already on their knees. That tax rise will significantly affect health and care services for patients. The Liberal Democrats fear that it will only make the crisis in our NHS and social care sector even worse.

We have urged the Chancellor of the Exchequer to urgently rethink the rise in employer’s national insurance contributions, either by cancelling it for all employers or at the very least by exempting those employers that provide vital health and care services, including GP services, dentists, social care providers and pharmacies. Without that exemption, the health and care crisis will only worsen and regional disparity will widen. Children in the south-west region will depend on good fortune. Parents will feel helpless and will be forced to make sacrifices. It risks setting apart and setting back thousands of children.

Access to Primary Healthcare

Anna Sabine Excerpts

Wednesday 16th October 2024 Commons Chamber

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

Before I make some brief comments about dentistry, I must say that some Government Members seemed genuinely confused about our claims that the Liberals had anything to do with the founding of the NHS. I urge them to google the Beveridge report.

My grandfather was a dentist, so as a child I was privileged enough to have access to dental care as and when I needed it, although when I was eight I did fall down the stairs at his surgery and break my arm while he was doing my dad’s fillings, so possibly his health and safety was not as good as his dentistry. Many children nowadays do not have the same access to dentistry as I did as a child. In the past year in Somerset, the percentage of children seen by a dentist was just 42%, when the English average is more than 55%. The percentage of adults seen in the past two years is still only 32%.

The Darzi review revealed that only about 30% to 40% of NHS dental practices are accepting new children and adult registrations. That is leaving many with no option but to go private. My constituency of Frome and East Somerset is also considered a dental desert. It is predominantly rural, which means that access to services is even more limited. The lack of public transport means that accessing dental services is difficult already, and with practices not taking on new patients, they are pushed even further afield. I had an email from two constituents from Frome earlier this month. They have been unable to see an NHS dentist for four years due to a lack of availability for new patients. They said in their email that

“it not only affects our oral health, but contributes to broader health issues that can arise from neglecting dental care”,

and they are anxious about potential long-term impacts.

Getting a dentist appointment should never be as hard as it is now, and I urge support for our motion to help reduce dental deserts and rescue NHS dentistry from disaster.