Oral Health and Dentistry: England

Fleur Anderson Excerpts

Tuesday 25th May 2021 Westminster Hall

[Fleur Anderson (Putney) (Lab)]

It is a pleasure to serve under your chairship, Ms Bardell, and I congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on securing this hugely important and timely debate. It is certainly very important for my constituents in Putney, Roehampton and Southfields.

I sponsored a Back-Bench debate on this topic back in January, and here we are again. In that debate, there was real agreement from Members from different parties that there was an impending crisis facing UK dentistry, and that the actions that needed to be taken to avoid it were clear, yet the crisis remains. Patients in my constituency and across the country still have huge concerns about accessing dentistry and getting the care that they need.

Not enough action is being taken, so the Government should not have been surprised to wake up and find this morning’s front pages covered in reports of a three-year waiting list for some patients to see an NHS dentist. According to a new survey of dentists in England, nearly half indicate that they are now likely to seek a change of career or early retirement in the next 12 months should the covid restrictions stay in place. The same proportion say they are likely to reduce their NHS commitment. That is very important, because we particularly need to save NHS dentistry.

In the five years before the start of the pandemic, the number of practices providing NHS dentistry fell by 1,253. Some 85% of dental practices are now closed to new NHS patients, and 60% are closed to child patients. I can see this in my constituency in London and across the country. It is no exaggeration to say that the future of NHS dentistry hangs in the balance right now, and it is people who are on lower incomes who are the most affected. The Government have been warned time and again by MPs, the British Dental Association, mydentist, patients and dental practitioners, yet we feel that their warnings are falling on deaf ears. I hope we hear differently from the Minister.

As colleagues know, and as has been said, 20 million appointments were lost between March and November, which has created a huge backlog that will take years to clear unless it is addressed now. In my own borough of Wandsworth, nearly 6,000 fewer courses of treatment took place in the final quarter of 2020. One child is hospitalised for a tooth extraction every 10 minutes. I am a mother who took my child to hospital for a tooth extraction. I have seen many other children there and I know how devastating it is at the time. It can have long-term implications for the child’s health as well, but that can be prevented, so I will go through some of the preventive measures.

I welcome the Government’s renewed commitment to dental contract reform, which is essential. The new contract must break with units of dental activity. It must prioritise prevention and ensure that NHS dentistry is available to all who need it. After a decade spent developing new systems, it is crucial that the Government deliver on their commitment to roll out new contractual arrangements by April 2022. It is also important to make it clear that the roots of the crisis we face go back to well before the pandemic. This is not just about covid prevention measures. It has been a long time coming and the pandemic has only lit the touchpaper.

There is a huge disparity in funding across the UK. The Labour Government in Wales spend approximately £47 per year on primary care dentistry per head of population compared with only £34 in England. As capacity across the service continues to be severely limited by infection control measures, access problems have now reached an unprecedented scale in every community, with the existing deep inequalities of both access and outcomes set to widen even further. When the Minister responds, I would like to hear reassurances about action on prevention, about current practices and ventilation, and about dentist retention, especially recruitment, which I will focus on.

First, prevention. There has been a lack of face-to-face health visiting, especially for early years. In early years settings, supervised brushing and encouraging parents and teaching them about supervised brushing has been limited. There needs to be a real upgrade and fast tracking of check-ups in the early years settings so that we do not have a huge backlog of issues in later years. There needs to be dedicated funding for new water fluoridisation schemes, as many other Members have said—I am fully in favour of those—and further measures to reduce sugar consumption.

On recruitment, my dentist is the main provider of NHS dental care, and they consider this a priority issue for now. There are not enough places to train UK dentists in the UK, and the intake is dropping, not increasing as we need it to. Even if the numbers were to increase, it would take six years to have an effect because it takes six years to train a dentist, so there needs to be secondary legislation to change the overseas registration process. That would not cost anything, which I am sure the Minister would welcome. It has a huge amount of support from dental associations and practices, and it could be relatively simple and quick to see an effect with more dentists coming from overseas to this country. A simple change in the way that dental qualifications are recognised would make a difference.

The overseas registration process has to be carried out in the UK. It costs £4,000 and takes 12 months. If the overseas registration exam process could be equivalent for dentists and medics, including part 1 to be carried out overseas and increasing spaces on that exam, it would make a huge difference. Such small changes could transform dental care in this country.

Prior to 2001, the General Dental Council pre-approved certain dental qualifications outside of the European economic area. That was due to our membership of the European Union, but it changed because of Brexit. Now—I do not say this very often—we could take advantage of Brexit and return to the pre-2001 system of prioritising Commonwealth dental schools by recognising select qualifications.

We must support all practices to enable them to increase the number of patients. As the hon. Member for Mole Valley (Sir Paul Beresford) and others have said, they must have capital expenditure for new ventilation equipment and also a road map out of the use of heavy-duty PPE, which is bringing down morale and will not be needed in future. Also, the fallow times need to be brought down. We need to prioritise dentistry in the upcoming reforms of the healthcare system, particularly in the health and social care Bill, and we need an urgent review of the whole system, especially new targets—not for dental activity but for increased retention of NHS dentists.

It is time to stop the slide into the privatisation of dentistry. It is time to stop treating dental health as a kind of luxury instead of there being free oral health at the point of need. We are sleepwalking into the biggest oral health crisis since the creation of the NHS. It is time the Government took responsibility and rescued UK dentistry before it is too late.