Reforms to NHS Dentistry

Jerome Mayhew Excerpts

Thursday 27th April 2023 Commons Chamber

[Jerome Mayhew (Broadland) (Con)]

We have had a full debate today. This is the third Backbench Business debate on the subject, but not the third debate on dentistry; I have had an Adjournment debate on dentistry, for example. The subject is well rehearsed. The reason why so many people are keen to speak today is that the issue affects areas right across the country. We all know that there is a problem with NHS dentistry, that the Government are focusing on it, and that they are coming up with a dental plan. We anxiously look forward to its publication in the next two to three months. In the few minutes available to me, I will not focus on the national problem so much as recognise that within the national difficulties, there are regional crises. In rural areas such as North Devon, but also in the east of England and Norfolk in particular, we can see that what is already a challenging picture nationally is exacerbated. To identify the issue, we have only to follow the money. I will look at funding for the east of England, then I will talk about recruitment and retention.

I know that funding has been impacted by covid, and the ability to undertake units of dental activity was restricted because of the covid pandemic and the aerosol activity of much of dentistry. I also know that funding has subsequently been increased because of the catch-up bid, so the numbers for the year 2018-19 give a more accurate reflection of the level of investment by the Government in dentistry in the region. The national average gross spending per mouth in England was £66 in that period. The best performing region was the midlands, which received £78 of expenditure per mouth. The figure for the east of England was £39 per mouth. That is exactly half the amount of money spent on dentistry per head of the population in the midlands. Now, there are many unconfirmed rumours about the number of fingers and toes that we have in Norfolk, but we do not have half as many teeth as those in the midlands—not yet, anyway.

My request to the Minister is to follow the numbers, to look at where the expenditure has been taking place and, more importantly, to look at the places where the expenditure has not taken place, and then to ask the question of his officials, “Why is that?” Why is it that even though in many parts of the east of England we have the worst dental health, the expenditure by the Government is fully half what it is in the midlands, and £20 less than the national average per person?

Looking to recruitment and retention, a potential answer to my first question is that there are physically not enough dentists in the east of England to carry out the work. The national average number of dentists per 100,000 of the population is 43. In the east of England, we have just 39. That compares to Devon, where there is a dental training school, which has 49. Why is it that people do not want to be dentists in Norfolk? The answer is because it is rural, and for those who grow up there, the nearest place they can train is Birmingham.

People cannot train to be a dental technician or a dentist anywhere in the east of England. It is the only region of the country, other than the south-east, which is next door to London, that has no dental school at all. People can go either to London or Birmingham. Is it surprising, then, that we do not have an indigenous population of would-be dentists growing up, training to be dentists in Norfolk and then staying there for their working life? We are reliant entirely on people relocating to the east, and to Norfolk in particular, to supply our dental needs.

When people qualify as a dentist in their mid-20s, the overwhelming majority do not wish to move to a rural location. Even though it is without question the best place in the country in which to live, to grow up, to learn and to bring up a family, it is not immediately attractive. A policy that relies on importing foreign-qualified dentists does not satisfy the need in rural locations either, because overwhelmingly the data tells us that when we import, say, South African or Australian dentists, they relocate to the cities. They set up their new life where there are already expat communities. They do not move to Fakenham, and the problem is very real in Fakenham. I persuaded the NHS to write a wholly new NHS dental contract for Fakenham. That contract went out, and not a single organisation bid for it. The money is there, but there is physically no supply of NHS dentists.

The issue goes further than that, because the lack of dentistry spreads out into the private sector as well. There are many examples right across the county of where private dental practices, whether in my constituency or in those of my hon. Friends the Members for North Norfolk (Duncan Baker) and for North West Norfolk (James Wild), have been advertising for years—in one case I am familiar with, for a decade—and are yet to fill the place. While the short-term answer to the national issue may well be to improve access to international dentists, the medium and longer-term solution for the east of England, and Norfolk in particular, surely is to establish dental training in the county. There are two ways to do that.

There are two ways to do that. In the short term—the very short term, I hope—there is a bid by the University of East Anglia to create a centre for dental development: a postgraduate training establishment that would help to draw in newly qualified dentists from other parts of the country. The hope is that if they do their postgraduate training in the east, a percentage of them will remain. There is also what I hope is not a competing but a complementary application from the University of Suffolk in Ipswich. Those bids should not be in competition; they should be working together to improve access in both Suffolk and Norfolk.

However, the real solution in the medium term is to unite with the University of East Anglia and its existing medical school to create a dental school at UEA, which already has the Quadram Institute—the world’s leading centre for the study of the gut biome, which of course begins with the mouth. The Norfolk and Norwich University Hospital is right next door. We would then have the ability to bring people in and train them in the city of Norwich; as evidence from the medical school demonstrates, a percentage of them would remain thereafter to develop their careers.

The hybrid nature of the UEA bid would mean that even in the first year of the five-year training period, people would be spending at least a day a week working in practices, helping work through the dentistry backlog, and developing community relationships that will make them more sticky to the region once they qualify. All that will go towards the long-term solution to the dental desert in Norfolk.

I very much look forward to the publication of the dental plan in the next few months, but it would be the most monumental wasted opportunity if that plan did not include training for dentistry in Norfolk.

[Mr Deputy Speaker (Mr Nigel Evans)]

Last but not least from the Back Benches, I call Robbie Moore.