Access to NHS Dentistry

Clive Efford Excerpts

Thursday 10th February 2022 Westminster Hall

[Clive Efford (in the Chair)]

Before we begin, I remind Members to observe social distancing and to wear masks. There is clearly a lot of interest in the debate. We will work out roughly how long people have to speak, but I do not intend to impose a strict time limit, unless people abuse the timings. We will give you an indication of how long to speak for, and if you could roughly stick to it that would be really helpful. I call Peter Aldous to move the motion.

[Peter Aldous (Waveney) (Con)]

I beg to move,

That this House has considered access to NHS dentistry.

It is a pleasure to serve under your chairmanship, Mr Efford. I thank the Backbench Business Committee for granting this debate. I am grateful to the hon. Member for Bradford South (Judith Cummins) for her work in helping to secure it.

NHS dentistry has been the No. 1 issue in my inbox for the past nine to 10 months. This is a national crisis, though the problem in my constituency—in Lowestoft and Waveney—is acute. Dentists have retired, which has led to resources and dental capacity being taken away from the area, notwithstanding the increased need and demand following the pandemic. Many of the remaining practices are experiencing difficulties in recruiting and retaining dentists, and the situation has been exacerbated by a lack of funding, with net Government spending on general dental practice being reduced by a third over the past decade. That said, the overall situation locally has improved since I first raised concerns in an Adjournment debate on 25 May last year, and I will outline the improvements later. They are welcome, but I am concerned that they might be a short-term sticking plaster and might not provide a long-term solution.

As we emerge from covid, the situation both locally and nationally has reached crisis point. Locally, that is due to covid, as well as retirements in two NHS dental practices in Lowestoft and the closure of the mydentist practice in Leiston, in the constituency of my right hon. Friend the Member for Suffolk Coastal (Dr Coffey). That practice closed due to the difficulty of recruiting dentists to work in the NHS in the area—a theme that is repeated across the country.

Access to NHS dentistry is a problem that has been brewing for a long time. The situation can be likened to a house built on shallow and poor foundations. The earthquake of covid has led to that house falling down. There are now parts of the country—particularly in, though not confined to, rural and coastal areas—that are dental deserts.

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[Clive Efford (in the Chair)]

Order. Before the hon. Gentleman responds, I should just point out that a number of Members who have their names down to speak are intervening. To respect others who want to speak, could you please refrain.

[Peter Aldous]

I am grateful because, with those four interventions, we have re-emphasised the importance of fluoridation.

There is a need for greater accountability, and the Health and Care Bill can provide the framework within which that can be secured. It is welcome that the commissioning of dentistry is set to move to integrated care systems. That can make for a more transparent system, but there is a risk that dentistry and its impact on overall health could be overlooked in the integrated care proposals. It is important that dentists are properly represented on integrated care system boards.

At Report stage of the Health and Care Bill, I tabled new clause 18, which called on the Secretary of State to publish an annual report on access to NHS dentistry, to collect data on the length of waiting times for primary dental care treatment and, if necessary, to take action. The Minister for Health declined to accept the new clause. I do not know whether a similar clause will be introduced in the other place. If it is, I would urge the Government to give it serious consideration. Such a reporting mechanism can drive sustainable and meaningful improvement in access to NHS dentistry.

Mr Efford, you will be delighted to learn that I am coming to a conclusion. Tackling access for NHS dentistry, which has been neglected for 15 years, is an opportunity that we must grasp in order to demonstrate the levelling up of healthcare right across the UK. We must put in place an NHS dentistry system that is fit for the 21st century, instead of reversing into the 19th century.

[Clive Efford (in the Chair)]

I am grateful to the hon. Member. It looks like we have six minutes each for Back-Bench speeches. If anyone can deliver their speech in less time, it would be very helpful.

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[James Wild (North West Norfolk) (Con)]

I congratulate the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) on securing this important debate. Our constituents in Norfolk and Waveney face similar challenges in getting access to NHS dentists.

This is a long-running problem, which my predecessor also pursued following the closure of a dentist in Snettisham. I raised this issue in my maiden speech and I have focused on it ever since due to the inadequate provision in west Norfolk. Of course, the restrictions put in place during covid have further reduced access, as others have said. The British Dental Association estimates that 40 million appointments were lost overall, but the situation before covid was poor.

The National Audit Office found that my constituency had the lowest number of dentists per head in the country. Moreover, Norfolk had the lowest level of dental activity delivered in the country, with only 65% of contracted NHS activity delivered compared with the national median figure of 96%. My right hon. Friend the Member for Basingstoke (Mrs Miller) also made that point. And, at 17.5%, Norfolk had the highest percentage of people who were unsuccessful in trying to get an NHS dental appointment.

Since being elected I have met the NHS East of England team regularly to press for better access to dentists, particularly following the closure of the mydentist practice in King’s Lynn. I am pleased that those discussions led to a procurement process, which, although delayed by covid, took place from summer last year, and that that procurement has been successful, with the NHS having just announced two new contracts for Smile Care Norfolk to increase access to dentists in King’s Lynn. I want to put on the record my thanks to the NHS East of England team for its efforts in successfully completing the procurement, which will mean that from 1 July my constituents will have better access.

As my hon. Friend the Member for Waveney said, it is disappointing that Fakenham and Thetford have not been successful in the procurement process. If my hon. Friend the Member for Broadland (Jerome Mayhew) catches your eye, Mr Efford, I am sure that he will speak about that.

Members have also touched on the supply of dentists. Office for Students figures show that there were 895 dental students in 2020, rising to 983 in 2020, compared with 810 in 2019. The 2022 intake, however, is just 809. Given the challenges in dentistry provision, we should be increasing that number, not reducing it. We should consider measures that enable those who are undertaking training to spend time in those areas where coverage is weakest. We should also be more direct and require those who have qualified to spend time in those areas as well.

I note that none of the 11 dental schools in England is in East Anglia. Given the low levels of dental coverage, I join the hon. Member for York Central (Rachael Maskell) in putting in a bid for one in East Anglia, Norfolk, King’s Lynn, to help address that gap.

Another issue that has been raised is that the contract dates from 2006. My hon Friend the Minister candidly referred to it last month as a “disastrous contract” with perverse incentives—or disincentives—for NHS dentists to take on NHS work. I am sure she will be able to update us on when new measures will be introduced to provide a greater focus on prevention and care for individual patients.

In conclusion, the new services coming to King’s Lynn are warmly welcome and will improve access. However, further reforms are needed, including to training and the contract, to ensure that people have the access to dentistry that they need and deserve.

[Clive Efford (in the Chair)]

You have all been very disciplined in keeping speeches brief, so I am grateful for that. We are well on time. I call Wera Hobhouse.

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[Giles Watling (Clacton) (Con)]

It is an honour to serve under your chairmanship, Mr Efford—[Interruption.] I will try to stand up without knocking the furniture over. I thank my hon. Friend the Member for Waveney (Peter Aldous) for bringing this important debate. It is impressive that so many have attended. I have been listening to your entreaties from the Chair, Mr Efford. Many points have been made about the expansion of housing, covid, fluoridation and the UDA system, so I will not repeat all that, you will be delighted to hear; I will cut my speech very short.

Of the most common issues in my mailbag that constituents write to me about, at the very top is dental care, and NHS dental care in particular. That this issue is widespread is evidenced by all the Members here. I will bring out a few points that I mentioned in the Adjournment debate the other day, because they are so shocking. Some 85% of dental practices are now closed to new NHS patients. Nearly half of patients are forced to get private treatment because of access problems, as reflected in my mailbag. This horrifies me: one child is admitted to hospital every 10 minutes for tooth extractions. Imagine the cost of that, let alone the trauma involved. That is why we have to be proactive, rather than reactive, and why I was pleased to hear fluoridation mentioned.

Some 1,000 clinicians have left the profession in the last year, with yet more significantly reducing their NHS hours, as we heard. That is utterly unacceptable. I welcome the levelling-up agenda, but I do not believe we are being levelled up in an entirely fair manner. Areas such as Clacton are often considered to be rich and well-heeled because we fall into the wider eastern region—Essex is lovely and leafy and is an economic powerhouse—but the coastal areas have pockets of deprivation. I am not proud of it, but my constituency has the most deprived ward anywhere in Britain. Something has to be done about that. If we really want to level up public services, we must consider areas such as Clacton when it comes to dental care. We need to make sure that levelling up follows the data, if we can get it, and not just the rhetoric, and gives coastal communities the help they need.

To my mind, there are two key areas we really need to hit. In an age of integrated care systems and devolving more and more power over primary and acute care to local leaders, I increasingly question the role of certain state monoliths such as NHS England and NHS Improvement. My constituents do not need more national mandarins, they need local, empowered leaders with proper devolved budgets. I reflect on the outstanding leadership of my former CCG and its accountable officer, Ed Garratt; I mentioned him the other day, but I have to again, because he is so good. He has provided a great service to us locally. Thanks to his and his team’s work, Clacton primary care is in a much better state. I want to give local systems the commissioning powers and budget so that we will level up in a local, focused and measurable manner. The PCTs had their day and local care leadership is now delivering. It is time for NHS England to be devolved in the same manner.

Let us move on to the workforce. Increasing the number of UK-trained dentists will help but will take at least six years to make the difference. Urgent action is now needed to increase places on the overseas registration exam, develop an adaptation programme and recognise qualifications from top dental schools around the world.

Our membership of the EU forced us to look away from people in areas such as our wider Commonwealth who are being trained in first-class dental care, and the Asian subcontinent. We could see more of those practitioners in areas such as Clacton, which would be the very Brexit dividend we were led to expect.

I am delighted that Clacton has been selected as a pilot area for new dental training courses, but clarity is needed on how existing budgets can be used to support and improve dental access in constituencies such as Clacton.

To conclude, Mr Efford—I am doing this very quickly—

[Clive Efford (in the Chair)]

Order. I do not want the people of Clacton to miss out on this debate. You have all been so disciplined that we can be a little bit flexible with the six-minute limit. Please do not cut your speech too short so that we miss out on any points.

[Giles Watling]

Mr Efford, with all due respect, I have deliberately gone to the shorter version of my speech. If the Minister wishes to visit the wonderful constituency of Clacton, with its 35 miles of glorious coastline, I would love to discuss dental services with her.

Levelling up is not just about expanding employment outside London. It must be about addressing inequalities wherever we find them, such as decreasing NHS dental care in coastal communities such as Clacton. We can do that by forcing cash and power out of NHS England, alongside using our Brexit freedom to open the nation to the dentists of the world we have so long spurned.

Finally, I put in a plea—a plea for sympathy. In a couple of weeks, I am having root canal treatment. Our dentists are excellent, but I hope it goes well—[Laughter.]

[Clive Efford (in the Chair)]

I know I am going to regret saying that we can be quite relaxed about the six-minute limit, but we can. If you run over by a little bit, it should not cause too many problems for people speaking later in the debate, but do not abuse that generosity. I call Tan Dhesi.