NHS: Dentistry Services

Baroness Jolly Excerpts

Thursday 25th July 2019 Lords Chamber

[Baroness Jolly (LD)]

My Lords, this has been a really interesting debate and—not always unusually for your Lordships’ House—very well informed. The noble Baroness, Lady Gardner of Parkes, who must have been a really inspiring role model as a young dentist, set the tone for the debate and painted a clear picture of dentistry in the past. To add to her point about having all your teeth extracted because it was the cheaper option, I have a friend who got married in 1975—the same year as I did—and for her wedding present, she had all her teeth extracted in her twenties and her father gave her dentures. I cannot get my head around the fact that that happened to a contemporary of mine in 1975, when the NHS was very well established.

My noble friend Lord Storey spoke—with all the understanding that comes with his background not only as a councillor but as a head teacher—about the scandal of tooth decay in children, and he mentioned fluoride in milk. I confess that I was not aware of milk containing fluoride—that was very interesting. He mentioned the closure of Sure Start centres, and I would like to throw in for good measure the reduction in the number of health visitors. Certainly when I had my babies, once the midwife had moved out, the health visitors came in and we were told quite clearly that sugar was not good for our children. Across the country we are several thousand health visitors light—4,000, I think—so this sort of information is not getting to young parents.

The noble Lord, Lord Colwyn, was a practising dentist for many years, so he too really knows what he is talking about. He emphasised the importance of fluoridisation and pointed out that all sorts of health problems are connected to poor dental health. During the time in which he practised, there was a decline in funding and a rise in charges, as well as a decline in children’s access to services. I am a bit puzzled about that. I appreciate that it is not always easy to find a dentist and I can understand why adults might resist going to the dentist because of the charges, but there are no charges for children’s dentistry, so in a sense there is no excuse for that.

The noble Baroness, Lady Masham, has an interest in dentistry going back many years and, like the noble Baroness, Lady Gardner, has spoken several times in debates on the subject. She raised the interesting issue of Brexit. Clearly, many dentists now come from EU countries and they need to stay—we cannot afford to lose them. The other issue that she raised, which I had not even thought about when preparing my notes, was prison dentistry. As people are captive—that is not quite the right expression, but they are in one place—there is an opportunity to sort out their health as well as their dentistry while they are in prison.

My early recollection of dentists, in the 1950s, is of a big van pulling up and parking in the car park opposite my primary school. We all trooped over for an inspection and were terrified, lest there be a problem to which the solution would be the pedal-driven dentist drill. It might not have hurt but it made a devil of a clatter, and that experience has stayed with me.

I declare my interest as in the register. When both doctors and dentists are being trained, they are not always told how to treat adults or children who have a learning disability. That is something well worth mentioning, and I am sure others would say the same. Dentistry is now light years away from that 1950s image that prevented me being a regular attender. It was not until I was at university—where, if you went to the dental school for your treatment, it was free, modern and overseen by professional teaching dentists—that I overcame my fear. My teeth were crowded and out came my wisdom teeth; I had a car accident and they were straightened. My student dentist was a rugby player and sang rugby songs to keep me calm.

All this is light years away from the treatment I receive now from my dentist in Horseferry Road. She is a tiny lady who comes up to only my shoulder, but she is absolutely forthright about my care, what I need, what she is going to do and why. We talk through options of NHS or private care for my treatments, and I am not allowed to leave without making an appointment for my next check-up.

I am fortunate: I can afford the treatment. It is worth mentioning that I live in Cornwall, where I have not been able to get an NHS dentist for 15 years. I was chair of a PCT and we tried very hard to attract dentists to come to live in Cornwall. It is a lovely place but it is a long way from everywhere and, very often, if dentists are married, their other half cannot get a job in Cornwall, and so it is not an option. That cuts across a whole load of things, and I suspect the situation is much the same in the Lake District. Areas of outstanding natural beauty are fine, but they are not always an ideal place for professionals of any sort to get jobs.

I shall talk today about the concerns of the dental profession about contracts and add something about the treatment given to old and disabled people living in care settings, and I have just mentioned the shortage of dentists in many parts of the country. A lot of this is linked to the need for a new contract for dentists and is a response to the issue of adults living in poverty and unable to afford treatment, which I shall mention as well. My noble friend Lord Storey has pretty thoroughly covered the issues around children and their oral health.

It is a sad fact that many people in the UK do not access regular dental care. Many homeless and vulnerable people are not registered with a dentist and put up with severe dental pain and infections, often masked by drugs or alcohol. Others who work long and unpredictable hours feel that taking time off work to visit a dentist is unaffordable and impractical; people with a history of mental health problems often face personal barriers to accessing dental care; and those who cannot afford treatment just do not register.

Until preparing for this debate I was not aware of the amazing charity Dentaid. Originally set up to recycle donated dental equipment to charitable dental clinics across the world, it has now set its sights back on the UK. It has equipped a mobile dental unit—I suspect a rather more modern version of the one I visited all those years ago—which visits homeless shelters, day centres and soup kitchens to screen, advise and treat those not registered for NHS care and, it goes without saying, unable to pay NHS fees. Volunteer dentists run the service, and it has been working in Kirklees for nearly five years. Since it began it has visited schools, community centres and Dewsbury town hall, offering free access treatment on a pay-what-you-can-afford basis. Patients just turn up and wait to be seen. It was commended to me by my noble friend Lady Pinnock, herself a councillor on Kirklees Council. This year, Dentaid received funding from the council to run a series of clinics in accessible locations. They are very busy and have treated hundreds of people.

On the one hand, I applaud Dentaid and Kirklees Council for the initiative, but on the other I really despair that these initiatives should be necessary at all. What work has been done to assist those who are unable to pay NHS dental fees? There is an NHS low-income scheme covering prescriptions and dental treatment, but it is not as widely advertised as it might be. Often the retort is, “Well, they can just look on the NHS website”, but it is unlikely that the first point of access for such patients is the website.

I turn to those living in care centres, which the noble Baroness, Lady Masham, mentioned. Has the Minister had an opportunity to read the CQC report on oral health called Smiling Matters? Three years on from when the NICE guidelines on oral health in care homes were published, the CQC carried out an inspection and concluded that poor oral health can affect people’s ability to eat, speak and socialise normally—though I am sure that the noble Lord, Lord Colwyn, will say that he could have told us that anyway. Most care homes had no policy to promote and protect people’s oral health. Nearly half were not training staff to support daily oral healthcare, and nearly three-quarters of care plans reviewed only partly covered oral health or did not mention it at all. As has been mentioned by the noble Baroness, Lady Masham, it can be difficult for residents to access dental care, and 10% of homes had no way to access emergency dental treatment for their residents. Given that most care homes are privately run, what can reasonably be done to turn this situation around? Could the Minister give some thought to that question?

I do not have enough time to adequately express the profession’s concern about its contract, which has been an ongoing issue for several years. My noble friend Lord Storey and the noble Lord, Lord Colwyn, covered this quite well. Why is this issue taking so long to resolve? Will the Government reassess both funding and charges in the new contract? The noble Lord, Lord Colwyn, said that the current contract is detested and discredited. It is all about interventions, not prevention, which sounds terribly old-fashioned in this day and age when everything about health is about promoting prevention. There are also perverse incentives.

How long must dentists wait? Could the Minister give us an indication of a timescale for this? Happy dentists will be less likely to leave the profession, and new dentists will join if there is a contract that is modern and suits not only patients but the profession. That is, after all, something that all of us want.