Access to NHS Dentistry

Judith Cummins Excerpts

Thursday 10th February 2022 Westminster Hall

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Efford. It is also a pleasure to follow the hon. Member for Waveney (Peter Aldous), with whom I co-sponsored today’s debate. I thank the Backbench Business Committee for granting valuable time for this valuable debate.

I have spoken many times in this place about my serious concerns about the state of NHS dentistry in England. Covid has had a devastating impact on our NHS dental services. According to the British Dental Association, it has caused more than 40 million NHS dental appointments to be lost since the start of the pandemic, which amounts to a whole year’s worth of dentistry in pre-covid times—a year’s worth of dentist appointments lost to the people and the system. Even before covid began, enough dentistry was commissioned for only half the adult population in England to see an NHS dentist just once every two years. With capacity now even more severely limited by covid, access problems have reached an unprecedented scale in every community, with existing inequalities in access and outcomes widening even further.

I received a briefing from Bupa, which tells me that across its 306 practices with an NHS contract in England it has a growing number of loss-making sites. It points out that these NHS practices would not be sustainable if they were independent—they are kept afloat by Bupa’s private practices. To be clear, that is private healthcare subsidising the NHS. The current dental contracts make dentists’ work highly stressful and do not allow them to provide the quality of care that they want to provide for their patients. According to the BDA’s surveys, that is the No. 1 reason why dentists are leaving the NHS or reducing the amount of work they do in it.

Only last week, I spoke to the owner of a dental practice in my constituency—he is my dentist—who told me that he has just learned that one of his dentists is leaving NHS practice to move to private dentistry. He also told me that the recent £50 million funding announcement for urgent dental care is virtually unusable, as it requires either persuading an already overstretched workforce to work overtime or recruiting new staff or hiring expensive locums—all of which has to be delivered by March 2022. It is just unworkable.

Bupa said the same about the funding package. To qualify for the funds, dentists must first have met their NHS contract thresholds, a system that excludes practices that have dealt with large numbers of patients with urgent needs, or faced higher staff and patient sickness, or who have struggled to recruit staff who are prepared to do NHS work. Only 134 of Bupa’s 306 practices were eligible under the criteria. Of those 134, only two so far have felt able to take up the extra funding.

It is clear that this funding package is not new funding—it is drawn from the £169 million that was clawed back from contract holders in 2020-21 for not meeting contractual targets. In my view, clawback is a failure of the system. It is not a failure of the NHS to spend money allocated through budgets but a failure to properly target resources to where they are needed, such as in my constituency in Bradford South and in the district of Bradford. The Government should not expect applause for creating a pot of funding for urgent care that simply cannot be spent in the time allocated, or in the areas where it is needed most, because of the strings that have been attached.

The BDA estimates that it would take £880 million per year just to restore NHS dental budgets back to 2010 levels. Chronic underfunding and the current contract are to blame for the long-standing problems with burnout, recruitment and retention in NHS dental services, with almost a thousand dentists leaving the NHS in England in the last financial year.

I know that the Minister is committed to reform, but I stress the urgency of this work. The Minister said earlier this week that the Government had

“started work on dental contract reform.”—[Official Report, 7 February 2022; Vol. 708, c. 780.]

The process has been under way since 2011. It is simply no longer good enough to say, “We’re working on it.”

I urge the Minister to commit today to a firm date when dentists will see the end of units of dental activity and a better contract, focused on prevention and increasing access. That needs to be rolled out now, as the targets set in the current contract are leading to the wrong outcomes. Unless what the Government are seeking is the ultimate demise of NHS dentistry, we really need to see a change in the contract. NHS dentistry was in trouble before covid-19 and is now facing an emergency.

In Bradford, almost 1,000 children under the age of 10 had to be admitted to hospital to have decayed teeth removed under a general anaesthetic in 2019-20. Thousands of children in Bradford and across the country are waiting in pain, taking painkillers and potentially multiple rounds of avoidable antibiotics to control their infection while they await surgery. No figures for the size and length of waiting lists for hospital tooth extractions in children or vulnerable adults are currently collected, but I am told that people are routinely waiting as long as two to three years—that is two to three years in acute pain. I hope that the Minister will touch on this issue in her response and explain why data on this crucial service for some of the most vulnerable people in our society is not routinely monitored and collected.

The lack of access to NHS dentistry is impacting some regions more than others. Yorkshire and the Humber is currently the worst performing area in terms of child oral health, with more than one in seven children in the region suffering from decay by the time they are just three years old. That is more than double the rate in the east of England, where only one in 15 children are affected by that age. According to a recent survey by mydentist, nearly 10% more people were able to access routine dentistry in the south of England than in the north.

Since the current Government took office, their unspoken policy has been to rely increasingly on rapidly rising patient fees while they drastically cut Government funding for dental services. Net funding to NHS dentistry fell by around one third in real terms in the last decade. An acceptable level of access can be secured only by prolonged and serious commitment, and proper, long-term funding to and for NHS dentistry. We need, in essence, a new deal that treats dentistry as an equal member of the NHS family, not a Cinderella service. I ask the Government to commit to a properly funded all-age NHS service.

However, I believe that we can and must go further. We must work to achieve a fully-funded dentistry service, with NHS dentistry available to all. As the chair of Healthwatch England, Sir Robert Francis, QC, said:

“We won’t build back a fairer service until access to NHS dentistry is equal and inclusive for everyone.”

I agree with Healthwatch, and believe that the guiding principle in NHS dentistry must be that good oral health must not be restricted by either postcode or wealth.