Oral Health and Dentistry: England

Hannah Bardell Excerpts

Tuesday 25th May 2021 Westminster Hall

[NB: [V] denotes a Member participating virtually.]

[Hannah Bardell (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will be suspensions between debates. I remind Members participating, physically and virtually, that they must arrive for the start of a debate in Westminster Hall and are expected to remain for the entire debate. I must also remind Members participating virtually that they are visible at all times, both to one another and to us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks at [e-mail]. Members attending physically should clean their spaces before using them and before leaving the room. I remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall.

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[Sir Paul Beresford (Mole Valley) (Con) [V]]

I am delighted to serve under your guidance, Ms Bardell. I congratulate the hon. Member for Bedford (Mohammad Yasin) on obtaining this debate. His speech was a barrage of negativity, and it is not all negativity in this field. I am a practising dentist—part-time at the moment; very little. I am a member of the British Academy for Cosmetic Dentistry, the British Fluoridation Society and the British Endodontic Society. That is wet-finger dentistry, though in a glove.

For decades, the dental profession, especially NHS dentists, has felt that dentistry as a health service has, as far as the Department is concerned, been seen as a Cinderella service, or an expensive minefield, or both. This has gone on for decades under Governments of various and even mixed complexions. However, I believe this has markedly improved with my hon. Friend the Minister and the current chief dental officer. There has been a visible change of attitude. Both ladies recognise the importance of improving the oral health of the nation and of the status of dentistry as a health service. To use the chief dental officer’s banner statement, at last

“Putting the mouth back in the body”.

Covid has had a dramatic effect on the ability to provide dental services, whether NHS or private. Waiting lists for all dental patients have dramatically exacerbated, and we have just heard a tirade on this. Covid meant that for a period all dental surgeries were closed. Only emergency services and specialised clinics were open. When the surgeries were permitted to start resuming covid protection, actions such as furloughed time, PPE and so on added to the delays, complications and diminished throughput. Clinical teaching of final year students was diminished, such that there is doubt that some of them are ready to graduate.

All the dental team should have been double vaccinated by now, whether private, mixed practices or NHS. The R factor is going down. An increasing proportion of patients have been vaccinated. Dentists are following a careful triage system. Deaths are down, hospitalisations are down and the 21 June release is still on, we hope.

My hon. Friend the Minister can see my request coming like a big balloon because I have already discussed it with her. The time has come for a road map to release dentists from PPE and all the restrictions. We need a return to the pre-covid treatment of patients and we need SAGE to look at it and get on with it. That will be the biggest single action in enabling dentists to get this backlog into line.

My second wish is a push at an open door with the Minister. Dental care is preventable, but while there has been progress, we are badly behind, especially in caries prevention for children. Pre-pandemic, these children occupied 177 clinical general anaesthetic extraction cases in hospital—a complete waste of our services. The latest figure that I have seen is that 23,529 children between the ages of five and nine were admitted to hospital because they had tooth decay.

I first started practising dentistry in a deprived area in east London. The state of dentition there shocked me, especially the state of children’s dentition. It was not the deprivation that caused the poor dentition; it was the diet and the almost complete lack of oral hygiene. Put simply, kids and parents did not toothbrush. Some parents did not even know that toothbrushes existed. And if you went into the supermarket, the shelves were packed with biscuits and cakes, whereas there was little meat or vegetables; go to less deprived areas and it is the other way round. So, it is not the deprivation; it is the shoppers—the parents.

The Minister will know where I am going with this. She and the chief dental officer are already embarking on teaching children in teams throughout the country to brush their teeth. Coincidental with this, most children are accompanied by their parents, some of whom are stunned to see this little thing called a toothbrush. But the message is getting through; as the hon. Member for Bedford said, we are starting to get some progress, and it is happening quite quickly.

As I have said, tooth decay is essentially highly preventable. Water fluoridation is the single most effective public measure that could be taken to prevent tooth decay. At the moment, implementation of fluoridation is in the power of local authorities. Little progress has been made. We lag behind every other western nation. Most of our western nation comparators have a fluoridation rate of domestic water supplies of between 60% and 80%, but we have a rate of only 10%. It is the system; the costs are to the local authorities and the cost-benefits are to the national health service.

The process of consultation over fluoridation is lengthy and tedious, and it is providing a platform for protesters of the same type as the anti-vaccination people. Some of the things that they say are quite extraordinary. I had to listen to a man explaining to me that he had done some research. He said that he had been to a town with young people and no fluoride, and to a town with older people with fluoride, and the venereal disease rate in the town with young people was higher than that in the town with older people. Therefore, according to him, if we put fluoride into the water supply, people got venereal disease. And to my astonishment, there were other people there who actually believed that nonsense.

To make a more practical point, there are considerable difficulties for both local authorities and water companies, in that their boundaries are rarely, if ever, coterminous. So, it makes eminent sense for the implementation process for the new schemes of fluoridation to be put in the hands of central Government and driven by central Government, which is the Minister’s proposal.

In doing so, however, I hope that the Government will curtail the procedures on consultation. In every period of consultation, in every place of consultation, the same thing is said by the same people, and I believe that the same nutters come out. If we continue with that process, we will have a repetition of the scaremongering stories from people who are basically cranks.

The safety, efficiency, cost-effectiveness and benefit of fluoride in water supplies, whether it is achieved naturally —as is the case in many parts of the world—or artificially, is proven to be workable and to achieve dramatic reductions in tooth decay. With this proposed step and the Government’s determination, rather than our lagging behind the rest of the world we could actually lead, and I hope that we move to do so.

[Hannah Bardell (in the Chair)]

Before I call the next speaker, I ask Members to keep their remarks to within eight minutes, to allow equal time, and I hope to call the Opposition spokespersons by 10.35 am.

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[Rachael Maskell (York Central) (Lab/Co-op) [V]]

Thank you, Ms Bardell, for the opportunity to speak in today’s debate with you in the Chair. I thank my hon. Friend the Member for Bedford (Mohammad Yasin) for putting the debate into context. Here I am again debating dental services with the Minister and, yet again, championing the needs of my constituents and the dentists who have worked relentlessly throughout this pandemic in extremely difficult circumstances.

York had a dental crisis before the pandemic. Constituents now tell me that they have to wait at least three years to receive NHS treatment and that those trying to register struggle or simply search for treatment outside the area. We have serious problems in York, as the Minister knows. NHS treatment needs to be available for all and, tragically, it is not. Many are now turning to accident and emergency services to get pain relief or a course of antibiotics. Private care is not an option, nor should it ever be.

Successive Ministers have failed to address this crisis. This month, the Minister was unable to tell me, as my hon. Friend the Member for Stockport (Navendu Mishra) has said, how many NHS dentists there are in my city. The fact that she does not have that basic data gives me little hope that the Government have really got a grip on the scale of this crisis and the needs that must be addressed.

It is perplexing that oral health is seen to be different from other areas of healthcare, and that we have to pay for things that are done to our mouths but not to the rest of our bodies. It did not start that way. When Nye Bevan established the NHS, dentistry was free at the point of need and everyone was entitled to have their check-ups and treatment on the NHS. It was transformative. In 1951, the first assault on our NHS occurred when charges were introduced. That caused Bevan to resign in disgust, and sadly since then the divorcing of oral health from the rest of medical care has failed to serve us well.

Evidence from the BDA—I thank it for the work it does—shows that the pattern of health inequalities in other areas of healthcare is reflected in dentistry and oral healthcare, so it is time for integration, not segregation. Although I understand the point that the hon. Member for Mole Valley (Sir Paul Beresford) made, he did not suggest a solution. Of course, we need to ensure that good-quality, healthy food is available for all, particularly those living in deprivation, but it is wrong to blame those individuals for their lack of choice due to their financial circumstances.

This patchwork of failed contracts has courted privatisation and created a dependency on labour from other countries which, simultaneously, this Government are spurning. In the past year, I have been on a journey with many of York’s dentists to learn why, unless we see radical change to the delivery of dental services, the system will collapse. Dentists will burn out or leave—indeed, they are doing so as we speak—and the nation’s oral hygiene will deteriorate further. Even during the pandemic, dentists have been told that they will be penalised if they fail to deliver unrealistic contractual targets while practising in a covid-risk environment.

The NHS dental contract fails to pay. The Minister sets unrealistic targets—units of dental activity—without consideration of the scale of the barriers that dentistry is facing, and without providing mitigation. Ministers in Wales, Scotland and Northern Ireland seem to have understood that, but this Minister has not. In a post-covid world, and against a backlog of more than 20 million appointments—think about the scale of that; we are rightly exercised by the 5 million outstanding secondary-care appointments that we are having to grapple with at the moment—it is baffling that the Government have failed to grip the scale of this deepening crisis and have not instituted an emergency service.

The tightening of the thumbscrews on dentists through their contracts shows no mercy, despite their call for ventilation equipment funding, high-grade PPE and an understanding that requiring treatment rooms to lay fallow before a deep clean can commence due to the aerosol- generating procedures eats into dentists’ ability to deliver their contract obligations. The arbitrary, unevidenced targets require dentists to work round the clock, cancel leave and often their whole lives. They force dentists to focus on high-volume, low-risk work such as check-ups, while patients requiring treatment, not least complex treatment, are made to wait. It is unethical and wrong.

To top it all, the Government’s net spend on dental services, as we have heard, has been cut by more than a third in the past decade. Evidence shows that every pound invested can save over three, as well as teeth. This is the moment to start again, and I am glad the Minister is in listening mode. We have the diagnosis. We know the problems and the scale of the challenge. It is not time to tweak locum contracts or drive our dental staff harder. It is time to get a real, pragmatic solution in place. There is an opportunity to legislate for a national dental service in the forthcoming health and care Bill to solve this problem.

Oral health should be seen as a public health matter. It should attract the planning and preventive approach that any other public health emergency would. Fluoridation, as we have heard, is a no-brainer and brings universal benefits. I urge the Minister to introduce that without delay and end the postcode lottery. A principle needs to be made that everyone should be able to receive free oral health at the point of need—no barriers, and no excuses. Good oral health has to be accessible for all—nationally determined on the what, and locally determined on the how. We need to increase significantly the number of training places for dentists in the UK and ensure that the benefit they gain from training is tied in with their commitment to serve in a national dental service under NHS terms. Training bonds are not unique, and they ensure reciprocity. Therefore, they will bring real benefit to the service. What plans has the Minister executed in order to train more dental staff and ensure that we have sufficient numbers in our dental schools? What discussions are taking place? We would like to know.

Delivery is something that this pandemic has taught us all about. We need a collaborative approach—a place-based system approach—to ensure that we address the scale of the issues. The vaccine programme has settled the debate about emergency provision once and for all, and we are in that space now with dental care. Every child and young person should be able to access dental inspections in school each year, and this should be routine from when children start school. Early prevention would not only save the NHS a lot of money; it would also save children a lot of trauma.

Similar plans could be put in place for care homes. For adults, an accessible check-up service would clear the backlog and enable cases to be triaged, population-wide, into treatment. For some people, light treatment could be provided simultaneously, with more complex cases referred to a booking system.

As we have seen with this pandemic, there are collaborative ways to address health crises. A place-based approach, whereby barriers can be removed, can be enabled to provide the solutions. Rather than struggling to design ever-more challenging contracts and systems to serve a fair model, the Minister could create a national dental service and use this framework to work with local delivery partners. In a matter of months, she could start turning this vital service around for all.

[Hannah Bardell (in the Chair)]

Before I call the next speaker, may I gently and politely remind Members to turn off their phones or put them on silent during the debate?