NHS Dentistry

George Howarth Excerpts

Thursday 20th October 2022 Commons Chamber

[Sir George Howarth (Knowsley) (Lab)]

May I, too, express my gratitude to the Backbench Business Committee for the opportunity to debate this important matter today?

On 22 September, during a statement by the Health and Social Care Secretary, I raised these problems on behalf of the people of Knowsley and the Liverpool city region, and described the experiences they are having. I cited BBC research that showed that, to use the Secretary of State’s own term, Liverpool city region is a “dental desert”, with not one dental practice taking on NHS patients. In response, she said that she had

“set out in the plan today what we are seeking to do with dentists. First of all, it is the role of the local NHS—the ICB—to take responsibility for such provision, and I expect it to do so.”—[Official Report, 22 September 2022; Vol. 719, c. 839.]

Earlier this week, my office carried out a survey of dental practices in Knowsley to measure what, if any, progress had been made since that exchange. We found that, of the 13 dental practices in Knowsley, it is still the case that none—I repeat, none—is accepting new NHS adult patients, and only two are accepting children under the age of 18. I am therefore bound to conclude that no progress has been made in the ensuing weeks.

Also on 22 September, I urged the Secretary of State to take measures in the short, medium and long term to address this disgraceful situation. Since then, the British Dental Association has pointed out that

“the Government needs to show real ambition to bring NHS dentistry back from the brink.”

Although the new Administration—goodness knows there will be another new Administration shortly—has placed dentistry as a top ABCD—ambulances, backlogs, care, doctors and dentists—priority, no new proposals have been made

“to halt the exodus of dentists from the NHS”

to care for patients. Moreover, the British Dental Association points out that the key issues of contract referral, chronic underfunding and growing oral inequalities have yet to be addressed. This is not just a matter of cosmetic treatment, important though that may be in many cases. As the association pointed out, this is also about how to spot oral cancer earlier, which is one of the fastest rising types of cancer and claims more lives than car accidents. That is a particular concern for Knowsley. As the British Dental Association went on to say:

“People in the most deprived communities are significantly more likely to die from it than those in more affluent areas.”

Our dentists are in many cases the first medical professionals to detect cases. Access to NHS dental treatment can in such cases be the difference between life and death. Knowsley is one of the most deprived boroughs in the country and it is consequently in a very vulnerable position regarding the early detection of oral cancer.

The motion contains good points that I would happily endorse, but I am concerned that in terms of specific actions it calls for a progress report in three months’ time. My concern—I do not make this point to be at all mischievous—is that I do not know, and nobody in the House will be able to tell me, who is likely to be the next Secretary of State for Health and Social Care, and whether they will have a different strategy on NHS dental care. So we need something to be done more speedily. The Government have to take responsibility for the current turmoil, but the fact is that there is so much uncertainty and such issues are simply not being dealt with.

The motion does not address what the Government could be doing in the short term to alleviate the problems confronting people in Knowsley and elsewhere. I have two suggestions on short-term action that could and should be taken. First, I urge the Secretary of State to introduce a procedure to enable those in need of urgent NHS dental treatment to be referred to a suitable dental practice, preferably locally. My constituency office recently dealt with the case of an 18-year-old constituent who needed urgent root canal treatment on two front teeth, which she was unable to afford. The problem was exacerbating an existing mental health problem. Since she was in constant pain and probably barely able to eat and drink, I contacted NHS North West. I am grateful that it was able to make arrangements for her to receive the treatment she needed at a local dental practice. I suggest that that approach, which I just happened to stumble across, should be added as a matter of urgency for those in need of urgent dental treatment.

Secondly, I am aware that many NHS patients have been culled by dental practices, often on the basis that they were not making use of the service on a regular enough basis. I cannot give accurate figures for Knowsley, but I suspect that thousands of people are former NHS patients. However, no appeal process is available to such patients, who have just been struck off and there is nothing that they can do about it, other than pay to be treated privately. I am aware of one case involving a Knowsley resident who, as a result of extremely debilitating, extended cancer treatment, was unable to contemplate much-needed dental treatment. When he felt strong enough to do so, however, he tried to make an appointment as an NHS patient, only to discover that he had been struck off the list.

My second short-term suggestion is therefore to urge the Secretary of State to institute an appeal process whereby such patients could apply to NHS England in order for it to prevail on the medical practice concerned to reinstate NHS patients who had good reasons for not being able to visit the dentist during lockdown, or who could not do so for medical reasons, such as those I have referred to. On the medium term and longer term, and the national problems to which I referred, I simply urge Ministers to enter into meaningful discussions with the British Dental Association to help to resolve the issues that I are so bedevilling NHS dental services nationally.

I hope that Ministers will accept that I have tried in my approach to deal with this important matter as constructively as I can. I sincerely hope that they will respond in a similar way and try to help to resolve the short-term problems that my constituents are experiencing in ways that can be easily implemented.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

I thank the Backbench Business Committee for granting this important debate, and congratulate the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) on having secured it. We support the motion in the form in which it has been moved; there is nothing in it that we disagree with. If some of the political arguments are removed from the debate, I think there is consensus across the House as to what the problems are and what needs to be done.

[Sir George Howarth]

I am sorry to interrupt my hon. Friend so soon. I agree with him about the motion, but I did make the point that there were some short-term measures that could, and should, be taken within the three-month period that the motion envisages before the Government report back on progress.

[Andrew Gwynne]

My right hon. Friend is absolutely right. There is no reason why the Government cannot expedite action on the issues he mentioned in his contribution and get those improvements in place.

I pay tribute to my right hon. Friend and to my hon. Friends the Members for Blackburn (Kate Hollern) and for Bootle (Peter Dowd), as well as the hon. Members for Bath (Wera Hobhouse), for Mole Valley (Sir Paul Beresford), for Berwickshire, Roxburgh and Selkirk (John Lamont), for Gloucester (Richard Graham), for Salisbury (John Glen), for North Devon (Selaine Saxby) and for Loughborough (Jane Hunt), for their contributions.

I welcome the Minister to his place. I am not sure how long he is likely to be at the Department of Health and Social Care, but I hope he is there long enough to implement some of the changes. I am all for a bit of stability in the Department. He is a good person and a good friend, and I wish him well. However, when he comes to the Dispatch Box, he will no doubt seek to deflect from the situation that has been described my Members across the Chamber by saying that we are here today because of the pandemic.

The backlog has not helped—we all acknowledge that; it goes without saying—but the Government’s spend on general dental practices in England has been cut by more than a third over the past decade, with the number of NHS dental practices in England falling by more than 1,200 in the five years prior to the pandemic. My hon. Friend the Member for Bradford South (Judith Cummins) raised that, and it cannot be ignored. It creates the regional imbalances and dental deserts we have heard about. This is not a rural-urban thing; it is a rural and urban thing, sadly. My right hon. Friend the Member for Knowsley (Sir George Howarth), the hon. Member for North Devon (Selaine Saxby) and the right hon. Member for South Holland and The Deepings (Sir John Hayes) spoke about those dental deserts, which are very real.

The Minister’s next line of defence, if I were to guess what the officials have put in his red folder, will be, “It’s all because of the dental contract.” There is some truth in that. It is 16 years since that dental contract was introduced, and it was introduced for a perfectly good reason. There was no golden age of NHS dentistry before it. There is a reason why people of my age have a mouth full of fillings and my children do not. It is not because I did not brush my teeth as much as my children do, and it is not because I ate more sweets than my children do. It is because the emphasis for paying dentists prior to the introduction of the changes was on early treatment that was perhaps not necessary—“drill and fill” is what they called it. We recognised in 2010 that the contract had not worked in the way we hoped it would, and we proposed changes. Of course, we lost that election, but after 12 years of this Government, I am afraid the line will not wash that it is solely the contract, because they have had plenty of time to make changes to that contract and have not.

We hear about the ABCD plan, and I certainly welcome the “D” in it; at least there is a recognition of dentistry. However, like my right hon. Friend the Member for Knowsley, I worry that this kind of “Sesame Street” strategy does not come close to tackling the scale of the emergency that is gripping dental care. All we have heard from the Secretary of State is sticking-plaster solutions that tiptoe around the edges while failing to address the root cause. That is apparent in the Government’s “hit and hope” approach to dentistry. The £50 million of emergency funding announced earlier this year is a prime example. As my hon. Friend the Member for Bootle said, it is a time-limited, inaccessible pot of money that has done precious little to improve access. In fact, figures obtained by the British Dental Association showed that just 17.9% of that funding was drawn down. This is indicative of a sector that has completely lost faith in the Government’s ability to act, and to be frank, I do not blame them, because when we do see action, it does not meet the scale of the crisis, and in some cases it makes things worse.

As we have heard, the geographic, ethnic and socioeconomic disparities affecting access to NHS dentistry are becoming starker by the day. What does the new Health and Social Care Secretary do in response to that problem? She scraps the health disparities White Paper. It is beyond bizarre that in the face of such overwhelming evidence, the Government will not even consider possible solutions—let alone implement them.

I fully support what the hon. Member for Waveney and other hon. Members on both sides of the House have said about education. Dentistry in schools, a prevention strategy and an emphasis on good oral health is absolutely crucial. We would support the Government in implementing that—hopefully sooner rather than later. The consensus and mood is there to get that done, so I hope the Minister will take that up and get going on that opportunity.

As for many issues facing our NHS, much of the problem with NHS dentistry can be traced back to one thing: workforce. Several hon. Members raised that point. Any hope of an NHS recovery must be underpinned by a comprehensive workforce strategy. Where is that strategy? Was it accidentally shredded with the mini-Budget? I am sure the Minister will hail the fact that NHS stats show an increase of 539 dentists practising in 2021-22, compared with the year before. When we drill down beneath the surface, however, there is not much to be positive about.

Those stats are rendered worthless by the fact that a dentist performing a single check-up on the NHS in a 12-month period is weighted the same as one with a full cohort of NHS patients. BDA survey data shows that for every dentist leaving the NHS altogether, a further 10 are significantly reducing their NHS commitment. No matter how much Ministers might try to fudge the numbers, they simply do not add up. We cannot afford more bluff and bluster. We need action, which the Opposition will support.

The outgoing Prime Minister said that dentistry was in her top three priorities for her first 90 days. That now seems rather optimistic given that she is Liz of 44 days, but we really want the Government to act on that commitment. Can we have an update on how things are going?

The Labour party will fund one of the biggest NHS workforce extensions in NHS history. We will double the number of district nurses qualifying every year, train more than 5,000 new health visitors and create an additional 10,000 nursing placements every year. We will fund this transformative expansion by abolishing non-dom tax status. We will give dentistry the staff, equipment and modern technology it needs to get patients seen on time. Labour has a plan. Where on earth is the Government’s?

--- Later in debate ---

[Will Quince]

Of course I take that point—it is a fair one—and when those who seek NHS treatment have an ongoing relationship with a dentist, they are more likely to get seen. When considering reforms to the system we will certainly take that point on board.

[Sir George Howarth]

The description that the Minister gave of the existence, or otherwise, of lists is accurate, but when anyone seeking to get NHS treatment in a dental practice rings up, they are most likely to be told by the receptionist that the practice is not taking NHS patients. The difference between the two situations, while technically correct, is not there in practice. Before he concludes his remarks, will he address the issue I raised about the short-term measures that can be, and I believe should be, taken to improve the situation?

[Will Quince]

I am conscious of your advice, Madam Deputy Speaker, but I am certainly willing to meet the right hon. Gentleman to consider what short-term measures we can take.

There is so much I want to say about the contract and my ambitions for the future, but politics is the art of the possible and deliverable, and I will be honest and frank with the House, and with stakeholders across the sector, about what we can deliver. We will then work towards what is within the art of the possible. International dentists are a vital part of the UK’s dentistry workforce, and I am happy to meet hon. Members to set out exactly what we are doing. I hope to bring forward legislative changes later this year. On dental training, I would love to talk more about the Advancing Dental Care review and the centre for dental development, but that may have to wait for another day—you have advised me about the time, Madam Deputy Speaker.

Prevention and oral health has been raised by many Members and is an important part of our strategy. I am looking closely at what more we can do with other Departments, especially around supervised toothbrushing, but also fluoridation, which was raised by numerous Members. Access to urgent care is important, and if people struggle to get an appointment they should call 111. This is the beginning of our work to improve NHS dentistry, not the limit of my ambition. This is just the start, and we are committed to long-term improvements, including changes to improve access to urgent care, and further work on workforce and payment reform. In the meantime there is lots we can do to improve access to urgent care, provide better access for new patients, and make important changes to workforce and payment reform. With that short response I hope I have assured hon. Friends and Members that action is being taken now to address the challenges of access to dental care, especially around recruitment and retention. I also want to reassure Members of my personal ambition and passion for bringing about the medium to long-term positive change that we want for NHS dentistry.