NHS Dentistry in England

Dan Poulter Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Derek Thomas]

I appreciate that intervention. In my case, NHS England, and commissioners for the south-west have been fairly good and engaged with the challenge. However, it is a tale of woe, as my right hon. Friend says. Perhaps we can all commit to coming back to this place in a year or two to commend the Minister and celebrate the fact we have a new contract that addresses exactly the challenges that we are all quite rightly highlighting today.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing this debate. He is right to highlight this national challenge. We have substantial challenges with access to NHS dentistry in Suffolk. Part of that, as our right hon. Friend the Member for Epsom and Ewell (Chris Grayling) said, relates to the quality of the commissioning and monitoring of contracts by the local commissioner. Will my hon. Friend join me in urging the Minister to put pressure on local commissioners to take this issue seriously? Also, does he agree that we need to ensure that dentists who are commissioned to perform NHS services do actually provide the services that they are commissioned to provide? Some of them are not doing so at the moment.

[Derek Thomas]

I thank my hon. Friend for that intervention. He is right to say that there are commissioned units of dental activity that are not being delivered. There are all sorts of reasons for that, which I hope to cover in my speech. Ultimately, however, we need to look at the contract itself and consider whether it actually works for patients. The contract was introduced by the Labour party in 2006. We know that it does not work today and is in urgent need of reform, which I will come on to in my remarks.

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[Peter Aldous (Waveney) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing the debate. Access to NHS dentistry remains an enormous problem right across England, from his constituency, which is the most westerly, to the Waveney constituency that I represent, which is the most easterly. There is not only a so-called perfect storm, but also a perfect symmetry, which hits the most vulnerable hardest.

The Government have brought in measures to address this crisis, which have had some partial success; but what is needed is a long-term strategic plan for NHS dentistry, which I would suggest should meet the following criteria. First, a secure long-term funding stream. Secondly, a strategic approach to recruitment and retention. Thirdly, replacement of the dysfunctional NHS dental contract. Fourthly, a prevention policy, promoting personal oral healthcare. And fifthly and finally, transparency and full accountability, through the new emerging integrated care systems.

The issue on which I wish to focus falls in the last of those categories. It is the procurement of NHS dentistry, which at present is opaque and has, over a long period, led to some outcomes that are not in the best interests of local residents and do not meet the standards of probity that one is entitled to expect in the award of public contracts.

In 2009, the late Dr David Johnson, a much-loved local dentist with a thriving practice in the high street of Lowestoft, was refused a contract to continue to offer a service that he had provided to the local community for many years. That happened in highly unsatisfactory circumstances, which caused much personal upset and ultimately led to units of dental activity being taken away from Lowestoft, where they were much needed, and reallocated elsewhere.

More recently, approximately two years ago, a contract was awarded for the out-of-hours service in Norfolk. The company that won the contract still does not have either regular dentists or premises, and does not work anywhere near the hours stipulated in the contract.

[Dr Poulter]

My hon. Friend is absolutely right when he speaks of the challenges that patients face throughout Suffolk in accessing NHS dentistry. Does he agree that there is availability of emergency out-of-hours dentistry, but that some companies are not taking the correct steps to provide it—and that some dentists are not opening up the number of slots that they are contractually obliged to, to provide it?

[Peter Aldous]

I thank my hon. Friend and neighbour for that intervention. He is correct, and the example I have just provided illustrates that point.

On the issues with the probity of procurement arrangements, I will move forward to the present. It is welcome that a new, long-term NHS dentistry contract has been awarded for the Lowestoft area, and the locally based Dental Design Studio will deliver the contract to a high standard for the benefit of local people. However, before DDS was awarded the contract, it was initially won by a limited company with no local presence, no dentists and no premises. That company then offered the contract to local practices, seeking bids, initially of £400,000, which it then reduced to £250,000. When it was unable to sell on the contract, it withdrew from the process.

Procurement arrangements that allow such blatant profiteering are quite clearly not fit for purpose. There is also a worry that the process is skewed against partnerships, which have been the traditional means of providing primary healthcare in local communities. Only single legal entities and limited companies are able to tender for NHS dental contracts, with partnerships excluded from doing so. The feedback that I am receiving is that the tender documents are far from straightforward and discourage some local NHS dentists who remain in practice from bidding for contracts.

The transfer of responsibility from NHS England to the new integrated care systems, which will start operating in just over a week’s time, provides an opportunity to carry out root-and-branch reform of the procurement and oversight arrangements for NHS dentistry. We need to ensure that they are fair, transparent and in the best interests of local people. It is vital that we seize this opportunity.

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[Maria Caulfield]

I am very happy to meet MPs. Once we get through the contract announcements before the end of recess, it has to be a priority to look at how we increase the number of dentists in specific parts of the country, whether in York or in coastal or rural areas. I am very willing to do that. Many parts of the country do have enough dentists, but they do not want to take on NHS work, so we are also going to look at the procurement and commissioning of services. That is where the ICSs will come into their own. At last, local commissioners will be accountable for commissioning dental work. There is no ring-fenced budget for dentistry. We spend about £3 billion a year and the work can be commissioned at a local level. The problem up until now is that no one has taken responsibility for that, so the ICSs will be a key change to make that happen.

[Dr Poulter]

I want to clarify one point. Does my hon. Friend anticipate the new dental contract being a sticking plaster, or does she think that it is here to stay that it will put right these challenges?

There is a real problem with the commissioning of dental services. I am afraid that I do not have faith that ICSs will be a panacea to sort things out, because local CCGs, some of which were not good commissioners of a number of services, have simply been cut and pasted into the same posts on the ICSs. Will my hon. Friend reassure me that she will personally look at the commissioning process and hold those commissioners to account, to ensure that they deliver proper dental services?

[Maria Caulfield]

Absolutely. The whole point of the ICSs is that the commissioning service has not worked up until now. Some commissioners are very good at commissioning dental services, while others do not have anyone with dental experience on their boards and are not so good. ICSs will be accountable, which is the difference from what we have now. I will meet ICSs to ensure that they understand the responsibilities.