NHS Dentistry: South-west
Gideon Amos Excerpts(1 month ago)
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Mr Gideon Amos (Taunton and Wellington) (LD)
It is a pleasure to serve under your chairmanship, Mr Vickers. I congratulate my hon. Friend the Member for Honiton and Sidmouth (Richard Foord) on leading a genuinely important debate. I also congratulate my hon. Friends the Members for Glastonbury and Somerton (Sarah Dyke), for Frome and East Somerset (Anna Sabine), for Bath (Wera Hobhouse), for Tiverton and Minehead (Rachel Gilmour), for South Devon (Caroline Voaden), for Chippenham (Sarah Gibson), for Wokingham (Clive Jones) and for Mid Dorset and North Poole (Vikki Slade)—to mention but a few. I also thank Government Members for their contributions to this important debate.
Nearly three years ago, in 2022, long before I was a Member of Parliament, I launched a survey of dental provision for the NHS in my Taunton and Wellington constituency. It showed that fewer than half of people there had access to an NHS dentist. Nearly three years on things have, incredibly, got worse. There are 64,000 children in the county who did not see a dentist last year. That puts Somerset in the worst-hit 5% of local authorities in the country.
As has been mentioned, access to NHS dentists in Somerset has fallen from more than half of people back in 2015 to less than a third—32%—this year. Over half the constituents who contacted me did have an NHS dentist but were then told it was going private, so they lost it. That decline has been consistent. My constituents are having to travel out of county and, as I said in the Chamber a couple of weeks ago, one of my constituents, a stage 3 cancer sufferer, is having to use her savings to pay for dental treatment that she is entitled to for free on the national health service.
Taunton and Wellington has many of the same problems as other areas of the country, in particular the terrible state of the dental contract, which is at the root of much of this issue. I have met the BDA chair, as have Government Members, and it definitely wants a timescale for the negotiation of the new dental contract. I hope the Minister will give a clear timetable for the negotiations so that we can have a new contract, which is what is needed to unblock this situation. If we are to train and equip the profession for the future, which we need to do, we have to end the uncertainty that is exacerbating the drain from the profession and the retention crisis we have seen over the past few years. It is vital that that uncertainty comes to an end.
Uncertainty hits in other ways as well. For example, we all want more housing built—certainly, those on the Liberal Democrat Benches do, and I know that Government Members do too—and we want new housing developments to be infrastructure-led, with GP surgeries and dental surgeries. Developers could contribute to those surgeries, but what would be the point in building them if they are to lie empty, unstaffed by the dentists we need? Will the Minister consider whether ICBs can be required to support the finding of dentists to staff those facilities, when they are provided?
I put on the record the fact there was a huge £11 million underspend in Somerset last year. Children, pregnant women and cancer sufferers are all being denied free treatment and £11 million is sitting in the coffers—it is a scandal. I hope the Minister will consider ensuring that that money is ringfenced year on year, so that it is ultimately spent on the patients who need treatment.
I urge the Minister both to give a timetable for the negotiation of the new contract and to safeguard the underspends so that the money can be used to help patients in Taunton and Wellington, in Somerset and in the south-west as a whole.
The Minister for Care (Stephen Kinnock)
It is a real pleasure to serve under your chairship, Mr Vickers. I congratulate the hon. Member for Honiton and Sidmouth (Richard Foord) on securing this very important debate on NHS dentistry in the south-west.
My right hon. Friend the Secretary of State has said that this Government will be honest about the problems facing the NHS and equally serious about tackling them. The truth is that we are very far from where we want and need to be. Lord Darzi’s report laid bare the true extent of the challenges facing our health service, including NHS dentistry. Even he, with his years of experience, was shocked by what he discovered.
I pay tribute to all the hon. Members from across the House—too many to name in the short time available to me—for helping to highlight and elucidate their concerns. In many ways, those reflected what Lord Darzi set out, but we have also heard today some heartbreaking examples of the experiences our constituents are having. Colleagues across the House have brought those to life today.
Lord Darzi’s report is vital because it gives us the frank assessment we needed to face the challenges honestly. Lord Darzi is clear that rescuing NHS dentistry will not happen overnight, but we will not wait to make improvements to the current system, to increase access and to incentivise the workforce to deliver more NHS care.
We inherited a broken NHS dentistry system. It is truly shameful and nothing short of Dickensian that the most frequent reason for children of between five and nine years old to be admitted to hospital is to have their rotten teeth removed. That is, frankly, disgraceful. Those are the sort of challenges that we need to face.
Some 13 million people in England have an unmet need for NHS dentistry. That is 28% of our country. It is absurd that people cannot access NHS dentistry when each year the budget is underspent—in recent years, that has been to the tune of hundreds of millions of pounds-worth of care going undelivered. That is why we need to reform the dentistry contract.
In NHS Devon integrated care board, which includes the constituency of the hon. Member for Honiton and Sidmouth, 34% of adults were seen by an NHS dentist in the 24 months to March 2024, compared with an average of 40% in England. In 2023-24, there were 40 dentists per 100,000 of the population, whereas the national average, across all integrated care boards, was 50 in the same year.
We acknowledge that there are areas of the country that are experiencing recruitment and retention issues—including many rural areas, where the challenges in accessing NHS dentistry are exacerbated. As Lord Darzi said, we have enough dentists and dental care professionals at an aggregated national level; the problem is that not enough of them are doing NHS work in the right parts of the country, where they are most needed.
The mountain that we have to climb is daunting, but this Government are not daunted and we are working at pace. Take for example the golden hello scheme, which will see up to 240 dentists receiving payments of £20,000 to work in those areas that need them most for three years. ICBs have already started to advertise those posts through that scheme. Nationally, there have been 624 expressions of interest and 292 of those have since been approved. Thirty-eight posts are now being advertised with the incentive payment included. Or take our rescue plan, which will help to get NHS dentistry back on its feet by providing 700,000 additional urgent appointments as rapidly as possible.
We know that rescuing NHS dentistry means acknowledging that we need more dentists doing NHS work and we know from survey data that morale among NHS dentists is low. We must turn that around. This Government will do all we can to make NHS dentistry an attractive proposition. Strengthening the workforce is key to our ambitions, but for years the NHS has been facing chronic workforce shortages and we have to be honest that bringing in the staff we need will take time.
We are committed to reforming the dentistry contract to make NHS work more attractive, boost retention and deliver a shift to prevention. There are no perfect payment models, and careful consideration needs to be given to any potential changes to the complex dental system, so that we deliver genuine improvements for patients and the profession. We are continuing to work with the British Dental Association and other representatives of the dental sector to deliver our shared ambition to improve access to treatment for NHS dental patients.
The Secretary of State met with the BDA on his first day in office, and I engage with it regularly, including at a meeting earlier this month. I share the BDA’s desire for a timeline for negotiations, but we have had to wait for the Budget and the ensuing discussions with the Treasury to initiate and conclude those discussions.
Stephen Kinnock
As the hon. Gentleman will understand, we are in a sequence: we have the Budget, then the complex negotiations around the spending review. We cannot engage in meaningful, formal discussions and negotiations until we are clear on what exactly the financial envelope is. We are working at pace on that. However, we have been meeting informally to sketch it out, so I would say that the scope of the negotiations is agreed. The formal negotiations will really start only once we have the detailed budget in place.
We will listen to the sector and learn from the best practice to improve our workforce and deliver more care. For example, the integrated care boards in the south-west are applying their delegated powers to increase the availability of NHS dentistry across the region through other targeted recruitment and retention activities. That includes work on a regional level to attract new applicants through increased access to postgraduate bursaries, exploring the potential for apprenticeships and supporting international dental graduates.
There are two dental schools in the south-west: Bristol Dental School, and Peninsula Dental School in Plymouth. I recently had the pleasure of visiting Bristol Dental School and seeing the excellent work that they are doing there, training the next generation of dental professionals, supporting NHS provision by treating local patients, and reaching underserved populations through outreach programmes. I also know that Peninsula Dental School, which first took on students in 2007, is doing the same for Plymouth and its surrounding areas.
I would also like to pay tribute to Patricia Miller of NHS Dorset, Lesley Haig of the Health Sciences University and council leader Millie Earl for working so constructively with my hon. Friend the Member for Bournemouth East (Tom Hayes) on improving oral health in his constituency.
A number of hon. Members have rightly highlighted the importance of prevention, and we are working around the clock to end the appalling tooth decay that is blighting our children. We will work with local authorities and the NHS to introduce supervised toothbrushing for three to five-year-olds in our most deprived communities, getting them into healthy habits for life and protecting their teeth from decay. We will set out plans in due course, but it is clear that to maximise our return on investment, we need to be targeting those plans at children in the most disadvantaged communities. In addition to that scheme, the measures that we are taking to reduce sugar consumption will also have a positive effect on improving children’s oral health.
Separate from the national schemes, I was pleased to note that NHS Devon integrated care board has committed £900,000 per annum for three years to support further cohorts of children for supervised toothbrushing, fluoride varnish and Open Wide Step Inside, with a new fluoride varnish scheme due to go live in September 2025. Open Wide Step Inside is a local scheme in which a dental outreach team, run by the Peninsula Dental Social Enterprise, goes into schools to deliver 45-minute oral health education lessons across Devon and Cornwall. It is a truly commendable scheme.
The steps we take in NHS dentistry will feed into the wider work we are doing to fix our broken NHS. We have committed to three strategic shifts: from hospital to community, from sickness to prevention and from analogue to digital. Our 10-year plan will set out how we deliver those shifts to ensure that the NHS is fit for the future.
Access to Primary Healthcare
Gideon Amos Excerpts(2 months ago)
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Mr Gideon Amos (Taunton and Wellington) (LD)
I mainly want to talk about dentistry, but first let me support the comments of my hon. Friend the Member for Glastonbury and Somerton (Sarah Dyke). GPs in my constituency are leaving at an alarming rate, which is a problem of great concern across Somerset.
We have heard about the Sahara desert; if Norfolk is the eastern Sahara, Somerset and Devon are the western Sahara of dental deserts. More than half the children in Somerset did not have access to an NHS dentist last year, which puts Somerset in the worst-hit 5% of local authority areas in the country. The picture for adults is pretty similar. I set up a survey back in 2022 to draw attention to the lack of dentistry in Taunton and Wellington. Official NHS figures show that in 2015, the majority—56%—had access to an NHS dentist, but that has gone down to only 32% this year.
As has been said, 99% of people who need an NHS dentist cannot get one. That is a totally unacceptable situation and a primary care time bomb because, as we have heard, the biggest cause of hospital admission for children under six is tooth decay. Also, oral cancers are on the rise year on year, and without early detection by dentists, that will only get worse. Just as the social contract under which people felt that they would get care is broken, so is the dental contract itself. I urge the Government to tell the House how soon they will repair the dental contract and when they will increase the units of dental activity payments so that the contract works. We need a timescale for addressing that.
My constituent Kathryn had been with her NHS dentist for 20 years. Like so many others, she lost them when that dentist withdrew NHS treatment. But unlike many other people, Kathryn is undergoing treatment for secondary breast cancer, the side effects of which mean that her doctor has instructed her to have regular dental treatment. She is now using her hard-earned savings to pay for that dental treatment because it is not possible to get it on the NHS in Somerset. It is disgraceful and totally unacceptable that cancer sufferers are using their hard-earned savings to repair the damage of the legacy of appalling NHS dental services left by the last Government.