NHS Dentistry in England

Graham Stringer Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Derek Thomas]

I thank the hon. Gentleman for his intervention.

It is probably fair to say that although the responsibility lies with the Minister here today, it is not her responsibility, or even in her power, to ensure that every member of the British public can access NHS dentistry, simply because NHS England, or indeed any part of the NHS, does not commission enough dentistry to cover the whole population. Perhaps the Minister will clarify today the Government’s expectation regarding access to NHS dental care, and say whether there is a right for everybody, whoever they might be, to access that care. However, it is a very important point that has been raised. It surprises people that we do not commission enough dentistry to meet the needs of every one of our constituents.

It is not enough to blame the pandemic, although it has certainly not helped. I was raising the state of NHS dentistry in Cornwall before we had a single case of covid in this country. Over two years ago, I spoke about the difficulty of recruiting and retaining dental staff. At Prime Minister’s questions two years ago, I raised the shocking results of the lack of access to NHS dentistry for children in Cornwall. I also told hon. Members that these inequalities needed to be addressed quickly and creatively.

Outside this House, I have been working to improve access to dentistry in the constituency, most recently by getting the council to overturn a decision not to allow electrical works to proceed in St Ives that would have delayed the opening of a new dental surgery until the autumn. I have been meeting the regional health commissioners and Cornwall’s public health officers to discuss dentistry on a regular basis, and I cannot fault their speed and creativity. Their south-west dental reform programme has been working hard to improve access by helping to reopen a surgery in Hayle and in St Ives, piloting child-focused dental practices, and developing its own evidence-based workforce plan, but the Government must lead the way. Resolving these oral health inequalities is not just this Minister’s responsibility; it will require a cross-Government approach.

NHS England has launched a drive to recruit dental professionals to the south-west, but a key challenge in Cornwall, and maybe other parts of the country, is finding housing for those who want to take up a job in dentistry. I am working on that issue with the Department for Levelling Up, Housing and Communities. The national food strategy was a wasted opportunity. We could have extended the sugar tax, which has successfully incentivised the reformulation of sugary drinks. That would have helped oral health as much as health in general. I shall continue to argue for a national food strategy that is truly strategic, even if the Government have made a tactical withdrawal from tax rises to support public health.

The Minister has responsibility for the dental contract. In oral questions in January, she agreed that the contract was

“the nub of the problem”.—[Official Report, 18 January 2022; Vol. 707, c. 195.]

She said in February,

“there is no doubt that the UDA method of contract payments is a perverse disincentive for dentists. The more they do, the less they seem to be paid. I for one certainly do not underestimate the problems that that causes dentists, and I can see why many hand back their NHS contracts.”—[Official Report, 7 February 2022; Vol. 708, c. 780.]

I could not have put it better myself. I have asked dentists in my constituency if they would prefer to see increased budgets or reform of the UDA contract, and they asked for reform.

There are two main issues with the dental contract, both of which are not just obstacles to dental health but actively create problems for the future. First, the current system does not focus on prevention. When units of dental activity are the sole measure of contract performance, there is no incentive for preventative work; nor is there an incentive to make the best use of the whole dental team’s skills when the practice cannot make a claim for payment for a course of treatment purely because it was initiated by someone other than a dentist.

I made sure that the title of the debate referred to NHS dentistry not NHS dentists. We need to recognise the contribution of the whole team of dental professionals —dental nurses, hygienists, therapists and technicians—and use them. Again, this is about not just saving money, but using professionals in the best way we can. Yesterday I spoke to a dental nurse who works with people in care homes. If she wants a resident to switch to a high-fluoride toothpaste, she has to get a dentist to prescribe it. Our regional dental commissioning team has been running a pilot to take supervised toothbrushing conducted by dental nurses out to the community. Given that more five to nine-year-olds are admitted to hospital for tooth decay than for any other reason, this work should be at the heart of NHS dentistry, not something that is topped up by flexible commissioning.

Second, the UDA method does not properly reward dental practices for their work. A dental practice is faced, in effect, with a UDA cap for an entire course of treatment, which means when a patient has complex needs, the money involved does not even cover the overheads of the practice. The predictable result is that dental practices are moving away from NHS work. Around 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. Every time a dentist leaves the NHS and is not replaced, approximately 2,000 people lose access to dental care. If you cannot do the arithmetic in your head, Mr Stringer, 3,000 times by 2,000 is 6 million, so 6 million patients have lost access to a dentist just over the course of the pandemic. For every dentist leaving the NHS, another 10 are reducing their NHS commitment by a quarter on average; that is another 500 patients losing access to an NHS dentist. According to the British Dental Association, 75% of dentists plan to reduce the amount of NHS work they do next year.

The fewer dental practices there are doing NHS work, the more pressure the remaining practices are under. A recent BDA members survey found that nine in 10 owners of dental practices committed to NHS work found recruitment difficult, with 29% of vacancies going unfilled for more than a year. That is nationwide, but one provider in Cornwall told me that their surgeries were unused 52% of the time due to shortages of dentists and nurses. The vast majority said that it was the UDA contract that was the biggest factor in their recruitment difficulties. The Minister said last week that the Government are serious about reforming the dental contract, but I want to press that point. It is not enough to be seriously planning a reform; we must be planning serious reform. Tweaks to the existing system are not enough when the contract is fundamentally flawed.

I have focused on the contract because we need the Minister to focus on the contract. Other Members will no doubt raise the issue of recognising overseas qualifications, passing the section 60 order that would give the General Dental Council discretion over qualifications, maintaining the mutual recognition of professional qualifications with Europe and extending that to the Commonwealth, and expediating the process for experienced candidates to register with the NHS. Dental care professionals need to be allowed to initiate treatments. The issue of funding will come up—for a catch-up programme of overseas registration exams in the short term, and university places in the long term—but it is striking how many of those proposals are cost neutral. We could even save money by catching mouth cancer in the early stages when it is more easily treated.

To quote the Minister, the contract is the nub of the problem. I urge her to commit to a firm date when we will see the end of units of dental activity, and a better contract focused on prevention and increasing access.

[Graham Stringer (in the Chair)]

I have indications from six Members who wish to speak. I intend to call the Opposition spokesperson at 3.40 pm. You can do the arithmetic—it is fairly straightforward—I do not intend to impose a time limit unless Members indulge themselves.

--- Later in debate ---

[Feryal Clark]

I will make progress because I have a lot to say in only five minutes.

Here we are again. After more than a decade in power, the Conservative party has absolutely nothing to show for it, other than a record of complete and utter failure. The Tory Government made a commitment to reforming the contracts in their 2010 and 2017 manifestos, so I would be fascinated—as, I am sure, would other hon. Members—to hear from the Minister what on earth has been happening for the past 12 years. If she is happy to associate herself with that record, that is her decision, but I would be embarrassed and ashamed, to be frank.

The Minister is presiding over a national scandal. It is simply not good enough to keep shirking responsibility. Whenever the Government have had something that looks like a plan, it has been woefully inadequate. I am sure that the Minister will—as other Members have—tell us about the £50 million of extra funding that we have heard so much about, but if she thinks that it has made a blind bit of difference, she is very much mistaken. I have been made aware that Yorkshire and the Humber, for which £8.3 million was allocated, drew down just £2.3 million. Barely any of that money was used by general dentists; it was used predominantly by hospitals.

I would be grateful if the Minister could confirm or deny whether yesterday, after being asked about this matter by my hon. Friend the Member for Sheffield Central, her answer was simply that we should wait for the data. At best, we have had a mixed response on when we will receive the full breakdown of how much of that £50 million was taken up. Can she confirm whether we will receive that data before the summer recess?

If that funding was designed to regain the confidence of dentists and encourage them to increase their NHS activity, it has completely and utterly failed. Across England, the number of patients being seen by an NHS dentist actually dropped by 22% overall between March and April. As the Minister will be aware—I mentioned this yesterday—there was a 34% drop in her own constituency. I ask her again: how can she expect dentists across England to have confidence in her when it is clear that she does not even have the confidence of dentists in her own patch?

One way of building trust would be to communicate with the profession. Yet just eight days before the start of the next quarter, dentists have no idea of the targets that they will be working to. Can the Minister confirm whether that announcement will be left until the eleventh hour once again? Furthermore, can she confirm that, as the Secretary of State said yesterday, the target will be 100% of pre-pandemic activity?

Let me remind colleagues of a story that my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith) told in yesterday’s debate. A constituent of hers came to her surgery and placed on her desk the teeth that he had pulled out of his own mouth with pliers. Does the Minister think that such stories, which are now disturbingly common, are acceptable in 21st century Britain?

I am sure that the Minister will say once again that the Labour party is just shouting from the sidelines and does not have any plans, but when it comes to NHS dentistry, her Government have nothing to show for their 12 years of shouting from the centre circle. “Shouting” is a generous description, in the light of the Minister’s refusal even to speak to dentists at the Association of Dental Groups conference just a few weeks ago.

This Government might have a track record of failure, but it does not need to be that way. It is time for meaningful action that will make a difference to patients. I look forward to hearing the Minister’s answers.

[Graham Stringer (in the Chair)]

We are not short of time, but will the Minster leave a minute or two at the end of her speech for the mover of the motion to wind up?