Covid-19: Dental Services

Jo Churchill Excerpts

Thursday 14th January 2021 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I congratulate the hon. Member for Putney (Fleur Anderson) and indeed the hon. Member for Brent North (Barry Gardiner) on securing this important Back-Bench debate. It is the second debate we have had on dentistry in about 10 weeks. Access to dentistry is, I think, something that unites us across the House. There has been something of a paradox during the debate, however. On the one hand, we have spoken about how patients cannot access the service they need and how we have seen demand rise so that now we essentially have only urgent and essential care waiting out there for us when we get through the pandemic; and then we have spoken about the fact that it is challenging—I agree, it is challenging—to reach 11.25% of an annual quota in the next three months. I hope to explain how we are ensuring that that is to support patients. I was quite saddened that support for patients was perhaps a quieter voice in the debate than support for the profession. This is only going to work if we support them both.

The pandemic has had, and continues to have, a significant impact on dentistry. First, I want to put on record my gratitude to dentists and their teams for their work in this difficult year. Dentists and their staff kept vital care going through the initial peak both remotely and in frontline urgent dental care centres. In addition, many volunteered to be deployed, if needed, on frontline covid services. Their contribution as healthcare professionals has been, and continues to be, greatly appreciated.

In early 2020, the nature of the novel virus that causes covid-19, and consequently the risks for dentistry, were unknown. However, we knew that the risk of transmission via aerosols, which are frequently generated in dental procedures, was high. As a result, face-to-face urgent care at the start of the pandemic was restricted to designated urgent dental care centres. Over 600 were stood up and they remain open to support all our constituents. The remainder of NHS high street practices were asked to provide remote consultations, complemented by the triple As: advice, analgesics and, where appropriate, antimicrobials.

In the initial guidance issued by Public Health England, dentists had to wear enhanced PPE and, crucially, to upgrade transmission-based precautions through their practices. This meant, obviously, that there was more time between patients and fewer patients could be serviced. I would just like to clarify a point. All NHS dentists can access free PPE from the e-portal, which has now delivered over 1 billion items to our frontline NHS services. To reduce the risk of subsequent transmission by airborne or droplet route, a post-procedure fallow time is needed.

All dental practices, as we have heard, were able to start offering face-to-face NHS care from 8 June, providing they had the appropriate PPE and infection prevention and control procedures in place. All dentistry could start, including private dentistry. Most dentists—this has not come out today, particularly—operate a mixed NHS and private model, but whether private or NHS, as a profession, dentists put their patients’ needs first and they resumed their services as soon as they could.

All NHS dental practices in England should now be offering face-to-face care, but during this difficult period practices have been asked to prioritise urgent care, address any delayed planned care and ensure provision for vulnerable groups. So they are not taking the easy route of just doing the routine, but focusing on the people who need it most. Actually, dentistry was difficult beforehand in rural and coastal areas. The UDA introduced in 2006 does not work particularly effectively, but we cannot change that here and now, so we have to try to provide care to as many people and as many of the most vulnerable as we can.

Between 1 April and 31 December, dental contracts were paid in full, minus the abatement—the agreed deduction for running costs—in the initial lockdown period. As stated, that has not yet been taken. The focus is now on increasing dental provision as safely as possible. Important work has been done to determine how we reduce those fallow times in surgery. The advice has been made available through the UK infection prevention and control guidance for dental settings set by the Scientific Advisory Group for Emergencies. It is a national benchmark for infection prevention and control that is applicable to patient care in all practices in England. The consensus on fallow time published in the IPC guidance has allowed for a reduction in the time between patients and in some cases, if possible—particularly where there is ventilation—to reduce it to 10 minutes from the time the dentist places their equipment down, perhaps while the patient leaves the room, until they pick it up again for the next patient. This is an important step forward.

We have been working closely with NHSE on what level of NHS dental services can be safely delivered to the end of March. The letter was published in December setting out the requirements for NHS dental contractors in the next three months, and where activity targets are not met, perhaps through sickness or other challenges, an exceptions process is quite rightly in place. We are asking dentists to record the DNAs—patients who did not attend—sickness and all other things that might militate against them being able to deliver 11.25% down to 9%, so less than 10% of the activity they were delivering last year.

I hope that provides reassurance, and I hope that all hon. Members will understand that at the forefront of these considerations is the safety of patients and the safety of dentists and their dental teams. They are essential workers. They are in category 2, they are patient-facing frontline health workers and they are to be vaccinated in the first swathe. Indeed, I know that the chief executive of my own CCG is contacting all the dental surgeries that have been listed so that they cannot be missed. Obviously there is little jurisdiction over private practices; we have an influence over NHS practices, but not over how private businesses proceed.

My personal view is that a transformation in dentistry is necessary, particularly if we are to address the challenges that the pandemic has highlighted and the inequalities, particularly around children’s oral health. I wish to see a change in the way we approach dentistry and oral health. I have asked officials and NHSE to ensure that high-quality preventive work is at the forefront of future provision and that a transformation in commissioning takes place. We have an enormously talented profession out there whose skills are not being utilised. They can help us not only with the mouth cancers that are not getting diagnosed if they are not seeing patients but with dietary advice. They can do so much more. They diagnose conditions such as diabetes, by noticing the inflammatory nature of the mouth. There is a huge opportunity to deliver a greater range of health advice, monitoring and support, using dentists and their teams. Arrangements for 2021-22 and beyond are being worked on, and I expect this to be done despite the pandemic and worked on urgently.

Before I close, I would just like to add my support to the call by my hon. Friend the Member for Mole Valley (Sir Paul Beresford) for fluoridation. That is something I am extremely sympathetic towards, for the benefit of children’s health. I am clear that, in looking at these options, nothing should be ruled out and patients should be our first priority.