NHS Dentistry in England

John Hayes Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I beg to move,

That this House has considered NHS dentistry in England.

It is a privilege to serve under your chairmanship, Mr Stringer. I am delighted to bring this debate to Parliament and to combine it with a petition that has been signed by more than 10,000 members of the public. The petition calls for

“an independent review of the existing”

NHS dental

“contract and a radical rethink of the way in which dental services are delivered.”

We may not need an independent review to tell us that NHS dental services need a radical rethink; we all know that they do.

NHS dentistry is a huge concern for all Members here today, and the number of us present reflects what a huge concern it is for our constituents. I already had a good indication of how significant the lack of dentistry was across my constituency, but to grasp the detail and the scale of it, I posted a survey at the beginning of the year asking constituents about the problems they had faced in accessing NHS dentistry. Within a day, it had received more responses than any other survey I had run—more than surveys on bus services, post office closures, noise pollution, or whether the Cornish flag should appear on a Cornish numberplate.

The picture that came out of my survey was shocking. Nearly half of respondents had been waiting more than three years for an appointment. Tim has had temporary crowns awaiting replacement for eight years; the teeth underneath have rotted away. Robert’s solution was to wait until a tooth was

“beyond repair and intolerably painful before getting an appointment with the emergency dentist to have it extracted. Last time they removed three in one go.”

Other people tried DIY solutions. Looking up how to make temporary fillings on YouTube was commonplace. Mark pulled out his wisdom tooth himself.

Other constituents have given up completely. They do not show up on the waiting lists because they have given up on waiting. Lauren told me:

“I don’t use the right side of my mouth to chew as it’s sensitive and causes me pain but it is too difficult to get an appointment so I am having to live with it”.

Anna racked up three times her usual phone bill trying to get through to the appointments line before she gave up. One constituent comes from a family of seven, of whom only the youngest has ever seen a dentist, and only then because he went to hospital for urgent surgery; the oldest is 20. Patients who can afford to go private do so, but so do patients who cannot afford it. The fees for Anthony’s private dental care represent a tenth of his pension; that is not affordable. The fees that Megan paid to remedy just one of her abscesses equated to a month’s rent. She has just had a baby, and cannot afford to pay another two months’ rent for the other two abscesses.

The situation is particularly grave in Cornwall. Last week, NHS England and NHS Improvement presented a report to Cornwall Council showing that in 2020-21 only 24% of the dental activity commissioned in Cornwall was delivered. In 2021-22, it has increased, but only to 59%. By the end of this month, we should be returning to 100% of normal activity, but that is simply not happening in Cornwall. The total number of adults with access to an NHS dentist dropped from 188,000 in June of last year to 155,000 in December.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I congratulate my hon. Friend on securing the debate. Things are clearly not as they should be in Cornwall, but in Lincolnshire they are even worse. Greater Lincolnshire has three of the four worst dental deserts in the United Kingdom, according to the Association of Dental Groups, with just 38 dentists per 100,000 people. Finding a dentist in Lincolnshire is like finding the holy grail. It is vital that we have more dentists, for the reasons my hon. Friend set out. People deserve better.

[Derek Thomas]

I completely agree. My right hon. Friend will know that in Cornwall we are very competitive; we always want to win, but I do not want to win this competition. This tragedy for both Cornish residents and his constituents highlights the fact that something needs to be done urgently. I thank him for his intervention.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for St Ives (Derek Thomas) for opening the debate and making many of the points that I intended to make. The simple fact is that we do not have time for further delay. We have four and half weeks left until the summer recess, and our constituents want answers. They want answers because they need to see a dentist but they are experiencing the deficit of NHS dentistry across the country. I would add to the list of areas mentioned that Yorkshire is also deeply affected, and my city, York, is struggling.

In 2009, Labour committed to reform the dental contract, realising that it was not going to deliver what it aspired to. The coalition Government followed in 2010 with a similar commitment, yet here we are in 2022 still making the same argument that we desperately need reform. As has already been said, this is not just something that has emerged through the pandemic; it is an issue that predates us. That is why it is essential that we have a pathway from today showing how we are going to move out of the crisis. Our constituents deserve to know what the Government’s agenda is.

Two years ago, NHS dentistry fell by 13%. Since covid-19 there has been a mass exodus in my city of York, but I realise that has also occurred across the country. Last April, NHS dentistry fell by a further 19%. It is believed that since the start of the pandemic, NHS commitments have fallen by 45%. Next year, 75% of dentists are planning to make changes and reduce their NHS commitments. Of those, some 45% say they will go fully private and 47% say they will change career or take early retirement, so if we wait another 12 months we will be in a deeper mess than we are now.

Since the start of the pandemic, we have lost 43 million dental appointments, 30 million of which were for children. In my constituency, 41% of children have not seen a dentist in the last year—they are the children who are now presenting in more acute services, requiring even more expensive interventions.

To put the situation in York into context, 9,695 UDAs were delivered in March 2021, at a time when 45% of UDAs needed to be delivered. A year later, in April 2022, 8,730 UDAs were delivered, fewer than the year before, and yet the requirement was for 95% of UDAs to be delivered. Instead of the number of my constituents accessing NHS dentistry going up when the number of UDAs that were expected to be delivered more than doubled, it has gone down. With 965 fewer UDAs, despite a doubling of the expectation, will the Minister explain how my constituents are meant to get access to services?

Fewer than half my constituents have seen a dentist in the last year. Of course, dentists have offered them private dental plans but my constituents simply cannot afford that, not least because of the cost of living crisis and the housing crisis in my city. Some travel long distances and others get nothing at all, and we know about other health inequalities that are similarly embedded.

[Sir John Hayes]

It is the least well-off people who suffer most, as the hon. Lady rightly said. Working-class people cannot afford these expensive plans. Surely the answer is that we should train more of our own dentists and make it more attractive to work for the NHS, rather than go private. My own dentist is Turkish by origin. He is a fine NHS dentist, and I could not speak more highly of him, but we cannot simply import dentists; we need to train more.

[Rachael Maskell]

The right hon. Member is absolutely right that we have to train more dentists. One reason for that is that it takes about 10 years for somebody to be fully professionally competent and able to provide the highest level of dentistry. We must not look just at what is happening now, but into the future too.

Before we get to that point, we have to look at retention and at bringing people back from private contracts and services into NHS contracts. With fewer dentists available, the toll and the mental stress felt by those who have stayed in the NHS and remained committed to it is building. Some 87% of dentists experience mental stress, and 86% have experienced abuse as a result of people being so frustrated by the time they reach the dentist’s door. The people working in dental reception areas are at the forefront of that, and I know of a practice in York that cannot recruit anyone to be on the front desk. We need significant changes to be brought forward, and that will require money and dedication.

It is not just about the contract; it is also about having a complete strategy around dentistry. I have never understood why oral health was taken outside the wider NHS, and I believe that the solution to the problems we face is to have a proper NHS dental strategy and to put the NHS dental service back into the heart of the NHS. However, while we are working on those issues, we have to look at the crisis before us.

In Parliament last week I mentioned a practice that has been fantastic at accommodating people with dental needs throughout the pandemic. I said that three dentists were leaving that practice; I was wrong—it is now four. That is the pace of people leaving the profession. We have heard about the wider consequences for oral health, and particularly oral cancers, for which a delayed diagnosis means the worst prognosis. Therefore, it is absolutely right that we see a move on this issue.

I want to raise a couple of issues about dentists waiting to come to the UK. We know that 700 dentists are waiting to sit exams. The Government have had a consultation, which has closed, and we are awaiting a response. I am sure everybody in the House would want to accelerate legislation on that, but we need to know the Government’s plan. I hope the Minister will be able to tell us about that today.

However, 700 dentists will not fill the gap. Just last week, I was speaking to Ukrainians who have come to the UK. They want to work, they want to put their skills into practice and they want to have fast-track English language training so that they are competent in terms of their language skills. They want to see their qualifications passported, so that they can get to work and practise their profession. They do not want to deskill or de-professionalise. They want to learn the clinical language that they will require, and therefore to shadow dentists getting ready for practice. However, I have not seen a strategy from the Government on how we will work with refugees who have those skills and can put them to work. Perhaps the Minister will share that in her closing remarks, because it seems such a waste of talent when many refugees absolutely want to address that local need but cannot do so.

I turn now to the future training of dentists—a point raised by the hon. Member for St Ives. I have had discussions with Hull York Medical School, which is a fabulous partnership between the two cities, and it would be prepared to help support a dental school. Of course, that would need investment, so we need proper investment for the future. To look at how that would work, I spoke to the commissioners, and there certainly is an appetite in our city to host such a school in the future. That would be helpful in bringing dentists onstream, but we also must recognise that students currently in training are struggling to get placements in the NHS. Of course, the more dentists who leave, the harder it will be to train the current cohort. Unless we see a quick increase in the number of NHS dentists, we will be in even more difficulty. That is why the urgency is there now. We must build back an NHS service for the future to ensure that we have those professionals in place.

Finally, we know that integrated care systems will be taking over the commissioning of dental services next year. My concern is that Government are waiting for that moment to act. We must see action now, because the integrated care systems will not be able to solve a problem that the national Government won’t.