Dental Services: East of England

Jerome Mayhew Excerpts

Tuesday 16th May 2023 Westminster Hall

[Jerome Mayhew (Broadland) (Con)]

One of the unifying features of the speeches today is that we have heard them all before. Not only have we all heard it before, but we have all said it before, so I will try—I may fail—not to do that. However, I do have to highlight some elements of the problem, which has been ably covered by my hon. Friend the Member for Waveney (Peter Aldous).

Access to NHS dentistry in Norfolk, which is the worst in the east of England, was surveyed in 2020 to 2021, and of the 150 sub-regions of the country, Norfolk came 147th. As I said to the Minister in a previous speech, we have to follow the money. As my hon. Friend the Member for Waveney pointed out, the best areas spend nearly £80 per mouth per year on dentistry; in the east of England, the figure is £39—a full 50% less. Does the Minister have an explanation for that? I genuinely struggle to understand how spending on NHS dentistry in the east of England is so far below that in the rest of the country. It seems to be without explanation.

More locally still, in Broadland the lack of dentists of any description is profound. I was lucky enough to persuade the Department to advertise a new contract for NHS dentistry in Fakenham last year. The money was available and the contract was advertised; not a single organisation applied for the contract, and it is still vacant. In Sheringham, in the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker), who is unable to speak in this debate, there is a dental practice that is owned by an organisation that has an equivalent practice in London. The organisation has been advertising consistently for a new private dentist in Sheringham for 10 years, and it has yet to fill the role, whereas during the same time multiple positions in its London practice have been advertised and filled. It is therefore not just a regional issue; geography really matters.

I am sorry to say that just last week the latest in long and ignoble line of announcements came when Brundall Dental Practice, which is an NHS practice, contacted patients to say that it would no longer be accepting adult NHS patients from 1 September this year. People are being asked to move on to monthly subscriptions for dental care, which are between £150 and £400 a year. I struggle to know what to say to the many constituents who have contacted me, because not a single NHS practice in the county of Norfolk is currently accepting new patients under an NHS contract. The £11 a month is only for check-ups and hygienists; it is not for dental care, which is an extra charge.

People might say that many can afford to pay for dentistry if they have to, but we have to also consider those who are excluded from paying dental charges because of their financial circumstances. What are we asking of those constituents? Where are they to turn not a single provider in the county of Norfolk is accepting NHS dentistry? The answer, of course, is that they will go to the Norfolk and Norwich University Hospital when their dental problems become acute, and we merely transfer the problem from the dentistry budget to the NHS and acute budget. The problem will be so much worse, and so much harder and more expensive to treat, because we are not nipping things in the bud but dealing with acute emergencies. That cannot be the right answer.

The reason I do not want to prolong the agony of discussing the problem is that I know that the Minister gets it. If he was not educated before, he has certainly been educated on numerous occasions, either here or in the main Chamber, by many of the Members present—the problem has already been fed back. Government Members have great confidence in the Minister and in his grip, grasp and focus on the issue. We know that a dentistry plan is imminent—the sooner that it is published, the better, and more power to the Minister’s elbow—but there are a number of suggestions I hope will find their way into the plan.

In the short term, we need additional improvements to the current dentistry contract—other Members have spoken eloquently about that, and I would highlight it as being very important. As regards the medium term, we have had reference to centres for dental development. The University of Suffolk has progressed far in its application, and there is a necessity for a similar venture at the University of East Anglia, or at least similar work in Norwich. However, in the long term, we simply have to train more dentists. We have to open the market to allow people to access a lucrative and fulfilling career that is currently not being explored in the east of Anglia and in Norfolk, in particular.

We need to train people in the east of England. The University of East Anglia has put forward proposals for a dental school. The medical school it founded in Norwich about 10 years ago knows definitively, from surveying all its graduates each year, that about 40% go on to take their first job locally. The single act of setting up a dental school in Norwich, linked to the Quadram Institute and the research work at the Norwich Research Park on the human microbiome, is the long-term solution.

I hope the medical plan will look beyond the national numbers. I was told by the NHS that roughly the right number of dentists are being trained each year, but I dispute that. It has been seven years since it surveyed what those dentists are up to. It has no idea whether the dentists notionally on its books have retired, gone abroad, are working in the NHS, are working part-time in the NHS, are working privately, or none of the above.

[Andrew Selous]

My hon. Friend is making a powerful point about the link between where people train and where they work. I would gently make the point to the Minister that the east of England is quite a large area. Norfolk and Suffolk are deeply wonderful places, with which I have a great affiliation, but they are quite a long way from Bedfordshire, which is also in the east of England. If we were to think that it was job done because we had trained dentists in Norwich or wherever, I would want to know what that meant for the good people of Leighton Buzzard, Dunstable, Houghton Regis and the surrounding villages. I put that marker in the Minister’s mind.

--- Later in debate ---

[Jerome Mayhew]

That is fair enough. However, if someone grows up in the east of England, whether in Norfolk, Suffolk or even Bedfordshire, there are only two places where they can train: Birmingham and London. There is no other place in the entire east of England where they can train, so is it surprising that we have a dearth of dentists? Is it surprising, particularly in rural areas, that we do not attract dentists who are newly qualified and therefore likely to be in their early to mid-20s? Do they wish to relocate in large numbers at that stage to a rural location? Many do not, so we need to bring the beauties of East Anglia, including Bedfordshire, to trainees so that we can benefit from the stickiness of tertiary education and location.

Finally, my hon. Friend the Member for Waveney raised the issue of fluoridation, which I wish to develop. There is no fluoridation in Norfolk at the moment, and perhaps it shows. The data suggests that the level of decay across the teeth of Norfolk is not universal but is substantially located towards west Norfolk and King’s Lynn. All sorts of factors may account for that, but areas of higher dental decay correlate with those that have reduced natural levels of fluoridation in the water, with the lowest levels around King’s Lynn. I raise that as an issue that I hope the plan will address.

[Matt Warman (Boston and Skegness) (Con)]

I congratulate my hon. Friend the Member for South Norfolk (Mr Bacon) on securing the debate. Although my constituents use the facilities of the east of England, I welcome his hospitality in the debate as well. This is a shared issue, especially for many in the southern part of my constituency.

I wanted to speak today because, as we have heard from many other hon. Members, this is not just a top issue, but the top issue, in the postbag and particularly on social media. We all feel the immense frustration of our constituents on this important issue. In Lincolnshire, nearly a quarter of five-year-olds are suspected to have tooth decay. Last year, a dozen Boston children had teeth removed. The problems we have heard about in the east of England are present in my part of the world too, and the burden of that partly falls on the services provided in the east of England, which is why it is relevant for me to speak today. These are real problems.

I asked my office to do what I called a secret shopping exercise because, like my hon. Friend the Member for South West Bedfordshire (Andrew Selous), I did not trust the data NHS England had provided. On that secret shopping exercise, we see that just a single NHS practice is offering access to new patients and, even then, only to children. There are huge problems with local provision. When I spoke to the ICB, which has recently taken on the responsibility, it said that there are particularly acute issues in coastal and rural areas and, as we have heard, that there are no silver bullets. However, it raised a few issues, which I will use to augment previous speakers’ excellent contributions.

First, there is the enormous backlog in the General Dental Council exams. I gather that 1,700 people are seeking to take the part 1 exam and that the GDC website does not even say when it plans to put another one on. When it does, it is likely to put just 150 people through it. I know that the GDC is an independent body, but will the Minister do all he can—I know he is already doing so—to encourage the GDC to pull its finger out?

Secondly, on the issue of having a dental school in the east of England, there is a medical school in Lincoln; if it were to train dentists, that would benefit the broader area. As we have heard, there is a clear need for many more dentists to be trained across the country, so perhaps we could do something for East Anglia and see benefits for the whole region from having Lincoln-trained dentists.

Thirdly, the issue of fluoridation affects my constituents as well. I do not think anyone, except those on the outer edges of the internet, could possibly argue against fluoridation, and we should encourage it as quickly as possible. On the outer edges of the internet, I give way to my hon. Friend the Member for Broadland (Jerome Mayhew).

[Jerome Mayhew]

I try not to inhabit that area. Does my hon. Friend not think that it is surprising that only 10% of the country’s drinking water is fluoridated?

[Matt Warman]

It is a surprising number. As I am sure my hon. Friend knows, the water companies have raised issues that are legitimate to some extent, but the overall public good from increasing that number is obvious and would pay real dividends relatively quickly. It would be public money well spent.