NHS Dentistry

Derek Thomas Excerpts

Tuesday 9th January 2024 Commons Chamber

[Derek Thomas (St Ives) (Con)]

I listened carefully and with interest to what the shadow Secretary of State said in his opening remarks. I like the man, but he clearly sees this matter as a potential political football, which comes as no surprise to me. As for me, my interest is in the constituents I represent. They do not care so much about the bickering between us, but they do care about their oral health.

I am glad to have the opportunity to speak in this debate. As we have heard, every constituent will need access to dental activity during the course of their lives. I have taken a great interest in this matter and spoken about it to hundreds of constituents and several dentists. In fact, over the weekend I spoke to some dentists who do not support Labour’s plans and want to see the Government advance their reforms—I was glad to hear more about those reforms today. I have raised the matter of NHS dentistry several times in the House with two separate Prime Ministers, including in January 2022, June 2022, April 2023 and September 2023, and also with several Ministers, including the one on the Front Bench, and the Secretary of State.

The Secretary of State’s predecessor said it was a priority to increase the number of dentists in specific parts of the country, and mentioned the south-west in particular. We are seeing some early green shoots appear. None the less, people in the south-west and Cornwall are struggling to get access to a dentist. I still receive weekly emails from constituents who are not getting the treatment that they need, or who are spending their time and money travelling to NHS practices in Manchester or London, or even abroad, to pay for private care. I have witnessed dental practices giving up NHS contracts, or vastly reducing NHS treatment, forcing some people to fully fund their own care and others, who cannot afford that, to go without treatment. I have raised this issue with the Health Secretary in the Chamber quite recently.

When I spoke to people in dental practices, they said they were as frustrated as I am. They have a contract with the NHS to provide thousands of units of dental activity, but the funding allocation is clawed back by the NHS if they cannot deliver those units. They cannot deliver the units, as we have heard already, because the value is too low to attract the staff that they need. Last year, a practice that I was working with paid more than £132,000 in clawbacks to our integrated care board. That is enough funding to treat 1,600 patients.

Nationally, underspend in the NHS dental budget could reach £500 million. We know that the NHS dental contract needs reform: it does not work for dentists and it certainly does not work for our patients. None the less, I am pleased that integrated care boards are taking ownership of dentistry and driving the delivery of dental care in our regions. In Cornwall, the ICB has already gripped the issue, using what resources it has to increase capacity. I was disappointed by the shadow Secretary of State’s reference to the work going on in Cornwall. The ICB does not see the work that it is doing as restricting NHS dentistry just to children, the elderly and vulnerable people. That is absolutely not the case. What it is doing is looking at where the shortages are and seeking to address them with the resources it has. The truth is that one third of adults in Cornwall are still accessing NHS dentistry. We have seen new NHS dental provision in Helston and in St Ives—two of my major towns—and there is a real ambition among dentists to take on more once they are allowed to do so.

The workforce plan needs to set out not just the number of dentists, dental nurses and other dental professions, but where they are located. We have a brilliant dental suite in Truro, but graduates rarely stay in the south-west once they have been trained. We are seeing a slight improvement, with dental practices offering foundation placements for graduates in Cornwall, including in St Ives, where the potential is greater.

I recognise that the Minister is just as keen as I am to empower the entire dental team to work to their full potential for NHS patients, but there remain barriers to fully implementing direct access in NHS-funded dental care. As I understand it, medicines can be administered by dental care professionals when they provide care to patients who pay privately, but this does not apply to NHS dental patients. On a recent visit to a practice in St Ives, the owner explained to me the impact of this disparity.

We have therapists in most locations in the south-west ready to increase NHS access, especially for young children, as most of the work for that patient cohort is within their scope of practice. It is disappointing that we cannot use those therapists fully. Dentists are reluctant to sign off prescriptions because of time issues and because of not understanding the process. Our therapists are doing only hygiene work, and some of them are leaving because of the lack of work.

My understanding is that a statutory instrument is required, which is in the gift of the Minister. This simple piece of legislation would provide the opportunity for NHS dental practices to use the full skillset and competencies of their dental staff to increase the delivery of desperately needed dental care. Will the Minister indicate today whether she is able to bring such an SI to the House and unleash an army of dental professionals to do what they believe they are trained to do?

Finally, in 2021-22, £4.5 million of unmet dental care was returned from Cornwall to the NHS. It is now lost in the NHS system. Will the Minister assure me that never again will that kind of money be grabbed or stolen from Cornwall’s dental patients, returned to the NHS and not used to deliver the dental care that they need?