NHS Dentistry and Oral Health Inequalities

Barry Gardiner Excerpts

Wednesday 25th November 2020 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

I beg to move,

That this House has considered access to NHS dentistry and oral health inequalities.

It is a pleasure to serve under your chairmanship, Mr Gray. I am delighted to have secured this debate on access to dentistry and oral health inequalities. I have spoken about this issue many times in this place, and it is more urgent now than ever. I will shortly turn to the effects of the coronavirus pandemic on dentistry in this country and, in particular, on access and oral health inequalities, but first I would like to set the scene a little.

In 2017, I held an Adjournment debate entitled “Access to NHS Dentists”. In that debate, I said:

“Millions of people each and every year are being left without access to an NHS dentist.”—[Official Report, 12 September 2017; Vol. 628, c. 812.]

I urged the Government to get on with dental contract reform and bring forward a coherent strategy to tackle the inadequacies and inequalities in the dental health system. That was three years ago, and of course no one could have foreseen the events of this year, but I am making the point at the outset of this debate that NHS dentistry in this country was already in a sorry state before covid struck. It was therefore extremely vulnerable to what has happened since March, the effects of which have been disastrous. The crisis in access that people were experiencing prior to March has been turbocharged. Solving it now requires the Government to dramatically change their approach to oral health treatment and prevention. In discussing the impact of covid on dentistry, I will focus mainly on England.

[Barry Gardiner (Brent North) (Lab)]

My hon. Friend is a student of the Old Testament, and she will know Proverbs 25, verse 19:

“Confidence in an unfaithful man in time of trouble is like a broken tooth”.

We are certainly in a time of trouble. It is not for me to call the Prime Minister an unfaithful man—

[James Gray (in the Chair)]

Certainly not. You must be brief.

[Barry Gardiner]

But the lack of support for dentistry and dental technicians has certainly resulted in a few broken teeth. What does my hon. Friend believe is the single most important thing that the Government can do to support dentistry and the oral health of the nation?

[Judith Cummins]

The single most important thing that the Government can do is reform the dental health contract with a view to more prevention.

During the initial period of lockdown, between March and June, all routine dental care in England was paused and urgent dental care hubs were set up to provide emergency treatment to patients. That period of closure has clearly led to an enormous backlog of patients requiring treatment. The British Dental Association estimates that in April and May only about 2% of patients were able to access dental care, compared with last year, and that between March and October 19 million appointments were lost. One local Bradford dentist told me:

“Our phones are ringing hot with new patients who have no dentist access, which has certainly been made worse by this year’s lockdown. On top of this we are facing significant staffing pressures, due to increased triage requirements and the need to thoroughly clean the practice between patients.”

Just yesterday, I was contacted by one of my constituents who has been trying to get a dental appointment for five months and is living with gum disease and toothache. That is simply unacceptable.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Bradford South (Judith Cummins) on securing this important debate. I know her long-standing and grounded interest, shared by many across the House, in helping individuals access better health care broadly and in particular for their oral health. She has much support, as my hon. Friend the Member for North Cornwall (Scott Mann) showed.

This is a challenge which, as the hon. Lady neatly articulated, has become much worse under the pandemic. I hope to go into more detail about the fact that dentistry has faced specific challenges while delivering what care it has been able to. There are particular long-standing concerns about access to dental treatment in Yorkshire, including the hon. Lady’s area. She gave credit to my hon. Friend the Member for Winchester (Steve Brine) for the work that he did with her, because flexible commissioning has been operated in that area, and it is agreed that most dentists would prefer to move in that direction. As she said, there are challenges with units of dental activity, and arguably an evolution towards capitation, looking at dentistry in the round, and highlighting prevention would start to address those. The Department, NHS England and NHS Improvement are committed to the growth of access to dental services. There have been a number of actions, and seeing them come to fruition in Yorkshire is helpful in understanding how they might benefit a wider population.

As I said, the pandemic had a significant impact on dentistry. That reduced drastically, as the hon. Lady explained, the number of patients whom dentists can safely see each day. The dental risks were new. At the start of the pandemic we stopped dentistry because of the risk of transmission being much higher, owing to the aerosol-generating procedures used. That applies to extraction, but there is even such a risk in scaling and polishing.

During spring, urgent dental care centres were quite rapidly set up. Up to 635 centres were set up across the country and the remainder of high-street practices were asked to deal with the three As—telephone advice, antibiotics and analgesics. I understand that that was a challenge for patients, but I am sure that the hon. Lady will agree that it was vital to ensure the safety of dentists, dental technicians, nurses and entire teams at the beginning of the pandemic.

[Barry Gardiner]

It is really good to hear the Minister giving a straight response to the questions raised by my hon. Friend the Member for Bradford South (Judith Cummins). She mentioned dental technicians. Is she as concerned as many of us are that because of the lack of work for them now, people are leaving that employment, and the skills base is being lost in such a way that it will be difficult to cope with the expansion of demand once we move from present circumstances beyond the epidemic?

[Jo Churchill]

I believe that the workforce, more broadly, is something we must look at properly in the round.

Aerosol-generating procedures present a high risk, as I said, and under initial guidance issued by Public Health England, infection control required that rooms should be rested for up to an hour, as the hon. Member for Bradford South said, to allow the airborne spray to settle. NHS dental practices were allowed to start offering services from 8 June providing that they had appropriate PPE and infection prevention and control measures in place.

In response to the hon. Member for York Central (Rachael Maskell) I would say that all NHS dentists can access the portal. Registration is voluntary, and 5,500—equating to about 81% of all NHS dentists—have signed up, and 50 million items of personal protective equipment have been dispensed. Making sure that our frontline services have what they require is vital, but the e-portal is being used, and I urge the remaining dentists to sign up.

There are more than 6,000 NHS practices in England that should now be offering face-to-face care, in other than exceptional circumstances. Guidance to practices has made it clear that during the difficult period they should prioritise care for vulnerable groups and then address the delayed routine check-ups; but that remains a challenge.

I recognise the comments that the hon. Member for Bradford South made about expectant mothers; I have asked my officials to look at that at speed, and I will come back to her on that. I am determined that we mitigate widening oral health inequalities as much as we can during this difficult period because, as we have alluded to, we know we had a problem beforehand.

NHSEI is keeping more than 600 urgent dental centres stood up to provide additional capacity in the system. My hon. Friend the Member for North Cornwall said he has problems too—and we have them across the country—so making sure that we have that universal coverage with UDCs is important. I must put on record my gratitude to dentists, dental nurses, technicians and all the team, because this has been a really difficult period. Dentists and their staff have kept vital care going through the initial peak, both remotely and in frontline urgent dental centres; many also volunteered to be deployed if needed on the frontline of covid services, and their contribution was very much appreciated.

It is important to ensure that NHS dentists are financially supported as businesses. NHSEI has continued to pay dental contracts in full, minus the running costs for downtime in the initial lockdown, whatever the volume of service to be delivered, and NHS dentists holding NHS contracts have welcomed that support. However, I am mindful that that support was for NHS dentists, and there are challenges in the private sector—and many practices are a mixture of both.

The focus now is on increasing dental provision as fast and as safely as possible. Key work has been done to establish ways to reduce room resting times, and that advice has been made available to the profession. I regularly meet with the chief dental officer, the BDA and other stakeholders, because it is vital that we keep looking at how we can get volumes up. That also means updating the existing dental infection prevention and control guidance, but it does not solve the challenge of delivering dental care at volume through the pandemic. It is an important step forward, but part of the problem is the variability in the estate, as the hon. Member for Bradford South alluded to—the different sizes of practices, where they are located, and so on. NHSEI is in discussion with the profession and is taking clinical advice on the expectations for delivery of services to the end of March.

I met the BDA and other dental stakeholders last week to progress conversations further, and I heard those messages. The challenge is to make sure that we can get the optimal amount of care for our constituents and patients while safely ensuring that dental teams can be protected, but we do need to see increased provision. I am keen to understand what further work can be done to solve the challenges in dentistry and how it faces the pandemic, and I have asked officials and NHSEI to look at potential solutions, including testing, increased use of ventilation and the financing thereof.

I understand the constraints under which the profession is operating and how vital services are. We know without doubt that oral health inequalities are likely to have increased over the period of the pandemic and NHSEI is working hard to ensure that caring for vulnerable communities is prioritised. Poor oral health can have a devastating impact on somebody’s quality of life, particularly a child’s, and dental disease is entirely preventable. In the Green Paper published in 2019 we committed to looking at those barriers, to fluoridation and to consulting on rolling out supervised tooth-brushing schemes in more preschool and primary settings. We are working as hard as we can to make sure we hit the consultation dates, but there are challenges.