Oral Health and Dentistry: England

Judith Cummins Excerpts

Tuesday 25th May 2021 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Bardell. I congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on securing this important debate.

As the Minister knows all too well, I have spoken on this issue many times in this place, but the problems facing NHS dentistry have never been more serious or the need for action more pressing. The flurry of reports and media coverage in the past couple of days confirms the urgency of the crisis before us. Last week’s Insight report from the Care Quality Commission questioned whether enough NHS dental capacity is commissioned, and challenged commissioners to ensure that everyone, especially those who are vulnerable, have access to NHS dental care.

Yesterday’s report by Healthwatch England stressed that the dental crisis shows no signs of slowing and rightly called for a radical rethink of NHS dentistry and a rapid, radical reform of the way that dentistry is commissioned and provided. Today’s analysis by the British Dental Association warns that the extreme pressures of trying to hit unrealistic activity targets and working long hours in heavy-duty PPE have led to an unprecedented crisis in morale among the dental workforce, with almost half of NHS dentists saying it is likely that they will reduce their NHS commitment or leave the profession altogether in the next 12 months. Unless we urgently act to avoid the looming exodus of dentists in the NHS, the consequences for patients will be dire.

Bradford South has faced serious challenges with access to NHS dentistry for a long time. The triple whammy of chronic underfunding, the failed dental contract and the pressures of the pandemic means that the kind of problems that we have long seen in my constituency, and West Yorkshire more widely, have now reached almost every community in England. However, I look forward to meeting the Minister and her team again to examine the data and the outcomes of the extended pilot project to increase access to dentists in Bradford.

The BDA estimates that 30 million NHS dental appointments have been lost since the start of the pandemic. That is an unprecedented backlog that would take years to clear, even under the very best of circumstances, but considering the growing crisis in access throughout the country, the Minister must do all she can to support NHS dental teams as they work to meet the extraordinary challenge. Unless we make NHS dentistry a place where people want to work, the crisis we are seeing now will become a permanent state of affairs.

First and foremost, on dental contract reform, I will not outline yet again all the reasons why the current contract needs to be abandoned. I know that I would be preaching to the converted, as the Minister and colleagues on both sides of the House agree with me on that. I welcome the Minister’s recent assurances that a reformed system might be rolled out next year. I stress that it is crucial that new contractual arrangements are rolled out no later than April 2022, as we simply do not have the luxury of more time. The issue is now so urgent that there can be no more kicking the can down the road.

It is also essential that the new system does not simply tinker around the edges of the current discredited contract. We need to see a decisive break from units of dental activity, which are completely incompatible with providing safe, sustainable services for patients as we emerge from the pandemic. The new contract must have prevention at its heart and ensure that dentistry is available to all. Secondly, we must support dentists to see as many patients as safely as they can, but in a way that is sustainable. I am sure the Minister will be telling us later how activity targets imposed by the Government in January and increased further in April have helped to improve access to NHS dentistry. I am sure that, faced with severe financial penalties, which could destabilise or even bankrupt their practice, NHS dentists have seen more patients since the targets were introduced. However, we must question at what cost—to both patients and to the workforce—these targets were met.

The BDA members’ survey indicates that more than 90% of dentists had to take extra measures to meet their targets, with large proportions forced to reduce the amount of private work they do, which, in the long term, subsidises the NHS side of their businesses. They had to cancel annual leave and work extended hours in heavy duty PPE, and I am sure that the Minister agrees that that is not sustainable in the long run and explains the rock-bottom morale of the workforce. More importantly, patients pay the price for this extreme pressure to clock units of dental activity.

Dentists report being forced to prioritise routine appointments over dealing with a huge backlog of urgent care, which is much more time consuming and complex but counts roughly towards the same target. The current 60% target in England is four times higher than the 15% dentists in Northern Ireland have been asked to deliver, and three times as high as the 20% that dentists in Scotland will be asked to deliver later this year. The Labour Government in Wales rightly recognised that targets were not the best way to support dentists in seeing more patients and did not introduce them.

Ultimately, the extreme nature of the target in England drives dentists out of the NHS. Access to dental services will be reduced permanently and it will be the patients who, in the long term, pay the price for what, in the short term, might look like a policy that benefits them. It would be much more effective and, crucially, more sustainable to follow the actions of the Welsh and Northern Irish Administrations and help dentists reduce the gaps they need to keep between patients by helping them to upgrade their ventilation equipment. Many have already done so, but nearly 70% of practices report that they now face financial barriers to further investment in this area. Can the Minister outline why England remains the only part of the UK not to even investigate the merit of providing capital investment to help increase access safely?

Can the Minister also set out her plans to change the current high-intensity infection prevention and control measures? Fallow time and having to work long hours in heavy duty PPE is exhausting and demoralising for dental staff, as well as reducing access for patients. Most colleagues have focused on high-street dentistry, but we should not forget that we are also facing a major backlog in secondary dental care services. In Bradford, almost 1,000 children under the age of 10 had to be admitted to hospital to have decayed teeth removed under general anaesthetic in 2019-20. The pandemic has certainly not reduced the need for such operations but most of those procedures have been on hold since it started. That has led potentially to tens of thousands of children and adults with special needs waiting in pain, in many cases much longer than a year. Can the Minister tell us how many are currently on the waiting list for hospital dental procedures and how she plans to tackle unacceptably long waits for those operations?

Finally, I urge the Minister not to treat dentistry as an afterthought in reforms of the healthcare system. Changes to primary care commissioning in the upcoming Health and Social Care Bill must not lead to a postcode lottery or further cuts to extremely overstretched dental budgets and dental services. They must be represented in the governance structures of the integrated care system. Beyond the measures on fluoridation, the White Paper barely mentioned dentistry at all, which, in itself, is quite telling. To turn the page on the access crisis we are currently seeing, we must finally stop treating dental services as a Cinderella service of the NHS and give it the priority it deserves.