NHS Dentistry: South-west

Caroline Johnson Excerpts

Tuesday 12th November 2024 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I congratulate the hon. Member for Honiton and Sidmouth (Richard Foord) on securing a debate on this important subject, starting at the significant time of two-thirty—I thought that was particularly skilled of him. [Laughter.] I thought you would like that one, Mr Vickers.

Nobody should have painful teeth and nobody should have difficulty accessing an NHS dentist. Lincolnshire, which is home to my constituency, suffers similar challenges with access to NHS dentistry; indeed, I led an Adjournment debate on the topic in October 2021. It has been pointed out that the number of dentists is not the issue; in fact, we have more dentists per capita than we did 10 years ago. Rather, dentists are either in the wrong place—concentrated in urban rather than rural and coastal areas—or they do not perform NHS work, for a variety of reasons. That leads to the underspend that has been described.

There has been some progress, with 500 more practices accepting NHS patients as a result of the dental recovery plan, and 6 million more dental treatment processes completed in 2023 than in 2021-22. One thing that helped with that was the patient premium for new patients, who are more likely than repeat patients to have a problem with their teeth that requires treatment. They are also more expensive for dentists to treat, so the current contract disincentivises the seeing of new patients. The patient premium is funded until April 2025. Will the Minister say whether he plans to continue it beyond that date? Another help has been the golden hello of up to £20,000 for dentists working in underserved areas, including the south-west, the midlands and East Anglia. Will the Minister say whether that scheme will continue?

A number of hon. Members have mentioned a long-term workforce plan. There are already additional dental training places in the south-west, but, as my hon. Friend the Member for South West Devon (Rebecca Smith) pointed out, there can be challenges in the way the training is organised, which means that people do not stay in the local area—although more do stay than if they had been trained elsewhere. Will the Minister look in detail at the problems my hon. Friend raised?

Ultimately, we have more dentists than ever before, but private dentistry is much more lucrative than NHS dentistry, and the NHS contract is complicated, offers disincentives and needs reform. The previous Government began reforming the 2006 contract by increasing the UDA rate to £28 as a minimum. The Labour party had a manifesto promise to negotiate with the BDA. Will the Minister confirm if negotiations have started and, if they have not, when he expects them to start?

[Tom Hayes]

I have just been rereading the 2010 Conservative manifesto—a delightful read. On page 47, it promises full dental contract reform. I then looked at comments by Conservative Ministers in 2024, when they promised to “consider” dental contract reform. Can the hon. Lady explain why no meaningful reform happened over those 14 years of Conservative government?

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[Dr Johnson]

It is unfair to say that there was no meaningful reform. There was reform, but it has not been enough to ensure that everyone gets a dental appointment, and we need further negotiation and reform. We can relitigate the election, but the Labour party won a majority for this term and it needs to use it to do what it promised. One of those things is reforming the contract, and that is why I am asking the Minister to tell us whether he has entered negotiations to do so.

One thing the Government have done—this was brought up by the hon. Members for Mid Dorset and North Poole (Vikki Slade) and for Mid Sussex (Alison Bennett)—is increase national insurance contributions and lower the thresholds at which they are paid, which presents a challenge for dentists across the country. I know the BDA has written to the Chancellor to ask for an exemption, and I wonder whether the Minister can comment on that. I have tabled a number of written questions, and the answers I have received have been less than satisfactory; they are really not proper answers at all. The Government do not seem to have worked out how much they intend to mitigate the increase in national insurance contributions, for whom they might do so, or how much it might cost. That is clearly a great worry.

The Health Service Journal published a leaked letter suggesting that the cost of the 700,000 extra appointments —and presumably, in many cases, the national insurance contributions—will have to be found within the current budget. The Department of Health and Social Care has suggested that the letter was never sent and therefore may be inaccurate. Will the Minister put on the record the reality of the situation? Will the funding be expected to come from the current budget, or will there be extra money—and, if so, how much?

The Minister has said himself that water fluoridation is safe and effective and reduces tooth decay, so will he be adding fluoride to our water? He said in answer to a parliamentary question that he would do so “in due course”. Will he tell us what that means and how quickly he expects to do it? The Government have talked the talk on prevention; now they need to take action.

The previous Government conducted a consultation on whether newly qualified dentists could be tied into working for the NHS for a period of time. What is the Government’s assessment of that consultation, and what do they intend to do about the issue? Supervised toothbrushing is an interesting plan, but what about children of other ages? What is being done to encourage parents to take responsibility for ensuring that their children’s teeth are cleaned?

Armed forces families move around the country a huge amount, and our forces do an excellent job keeping us safe. The Conservative Government brought in the armed forces covenant to protect our armed forces and their families. What plans does the Minister have to ensure that families can access NHS dental care as they move around the country, and that they do not have to wait for a place only to not get one, and then move again and have the same problem?

I think it was the hon. Member for Honiton and Sidmouth who brought up international dentists. An international dentist with equivalent qualifications can work in the UK privately, but they need to go through an additional process to work for the NHS and be on the performers list, which is unnecessarily complicated. What will the Minister do to ensure that, if a dentist is able to practise privately in the UK, they can also practise on the NHS—or does he think that is not the right thing to do?

Other Members have mentioned fluoride varnish. Does the Minister have a plan to ensure that young children have access to that treatment? Finally, the Secretary of State for Wales has said that Labour will “take inspiration from Wales”. Given that dental activity is at 58% of pre-pandemic levels in Wales, compared with 85% in England, and that 93% of practices in Wales—a greater proportion than in the rest of the UK—are not taking on new adult NHS patients, will the Minister reassure us that that is definitely not the case?

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[Stephen Kinnock]

As the hon. Gentleman will understand, we are in a sequence: we have the Budget, then the complex negotiations around the spending review. We cannot engage in meaningful, formal discussions and negotiations until we are clear on what exactly the financial envelope is. We are working at pace on that. However, we have been meeting informally to sketch it out, so I would say that the scope of the negotiations is agreed. The formal negotiations will really start only once we have the detailed budget in place.

We will listen to the sector and learn from the best practice to improve our workforce and deliver more care. For example, the integrated care boards in the south-west are applying their delegated powers to increase the availability of NHS dentistry across the region through other targeted recruitment and retention activities. That includes work on a regional level to attract new applicants through increased access to postgraduate bursaries, exploring the potential for apprenticeships and supporting international dental graduates.

There are two dental schools in the south-west: Bristol Dental School, and Peninsula Dental School in Plymouth. I recently had the pleasure of visiting Bristol Dental School and seeing the excellent work that they are doing there, training the next generation of dental professionals, supporting NHS provision by treating local patients, and reaching underserved populations through outreach programmes. I also know that Peninsula Dental School, which first took on students in 2007, is doing the same for Plymouth and its surrounding areas.

I would also like to pay tribute to Patricia Miller of NHS Dorset, Lesley Haig of the Health Sciences University and council leader Millie Earl for working so constructively with my hon. Friend the Member for Bournemouth East (Tom Hayes) on improving oral health in his constituency.

A number of hon. Members have rightly highlighted the importance of prevention, and we are working around the clock to end the appalling tooth decay that is blighting our children. We will work with local authorities and the NHS to introduce supervised toothbrushing for three to five-year-olds in our most deprived communities, getting them into healthy habits for life and protecting their teeth from decay. We will set out plans in due course, but it is clear that to maximise our return on investment, we need to be targeting those plans at children in the most disadvantaged communities. In addition to that scheme, the measures that we are taking to reduce sugar consumption will also have a positive effect on improving children’s oral health.

Separate from the national schemes, I was pleased to note that NHS Devon integrated care board has committed £900,000 per annum for three years to support further cohorts of children for supervised toothbrushing, fluoride varnish and Open Wide Step Inside, with a new fluoride varnish scheme due to go live in September 2025. Open Wide Step Inside is a local scheme in which a dental outreach team, run by the Peninsula Dental Social Enterprise, goes into schools to deliver 45-minute oral health education lessons across Devon and Cornwall. It is a truly commendable scheme.

The steps we take in NHS dentistry will feed into the wider work we are doing to fix our broken NHS. We have committed to three strategic shifts: from hospital to community, from sickness to prevention and from analogue to digital. Our 10-year plan will set out how we deliver those shifts to ensure that the NHS is fit for the future.

[Dr Johnson]

The Minister has iterated the problem, and he has spoken warm words about listening, talking and working with people. However, he has said little that is concrete, except about things that were happening already, either locally or as a result of the previous Government. With a minute left to answer all the questions he has been asked, can he commit to answering in writing those he does not have time to answer in the remaining minutes?

[Stephen Kinnock]

The first thing I will say is that I am not going to take any lectures from any Conservative Member about the state of our dental system. What brass neck we see from that party, both in the Chamber and in this place—lecturing us, given the disgraceful state of our NHS and the fact that the biggest cause of five to nine-year-olds going to hospital is to have their rotten teeth removed! I will not be taking any lectures on that from the Conservative party. Of course, I am more than happy to answer the hon. Lady’s detailed questions, many of which I feel I have already answered in my preceding comments. I will not take any more interventions from her because I need to finish shortly.

Our 10-year plan will set out how we deliver these shifts to ensure the NHS is fit for the future. To develop the plan, we must have a meaningful conversation with the public and those who work in the health system. We are going to conduct a range of engagement activities, bringing in views from the public, the health and care workforce, national and local stakeholders, system leaders and parliamentarians. I urge hon. Members from across the House to please get involved in this consultation—the largest in the history of the NHS—at change.nhs.uk. I urge them to make their voices heard in their constituencies, through the deliberative events.