Reforms to NHS Dentistry

Judith Cummins Excerpts

Thursday 27th April 2023 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

I beg to move,

That this House has considered progress on reforms to NHS dentistry.

I thank the Backbench Business Committee for once again granting this important debate, and my co-sponsor, the hon. Member for Waveney (Peter Aldous), for all his work in helping to secure it.

When preparing for the debate, I thought it was useful to consider and reflect on the foundations of our NHS in the Beveridge report, which was published 80 years ago last November. Although it would be an understatement to say that the world has changed since its publication, the identity of this country is still proudly centred around our national health service—an idea so powerfully contained in the pages of the report. For the great British social reformers of the 20th century, dentistry was not some Cinderella service of secondary importance. Beveridge concluded that no one could seriously doubt that a free dental service should become as universal as a free medical service. Eighty years after the report’s publication, it is time that the House reaffirmed our commitment to universal dental care in this country.

It is worth noting that the Beveridge report, in its proposition for universal access to NHS dentistry, was published by a multi-party coalition Government. As I stand here today, Members on both sides of the Chamber will agree that the crisis in NHS dentistry deserves the same cross-party attention that it was afforded 80 years ago, because the system has decayed: access has fallen to an historic low, and inaction over the past 13 years has caused untold damage. There can be no more half measures or excuses. Now is the time to establish a new preventive dental contract that is fit for the 21st century.

The words of my campaigning over the past eight years now serve as a compendium of forecasting doom. In 2016, I warned of a mounting crisis and drew the Government’s attention to a digital report warning that half of dentists were thinking of leaving the profession. Between 2017 and 2019, I warned that 60% of dentists were planning to leave NHS dentistry. In 2020, after years of repeated warnings, I once again informed the Government that 58% of the UK’s remaining dentists were planning on moving away from NHS dentistry within five years. The Government once again fudged and ignored, and more than 1,000 dentists left the NHS.

This NHS dental crisis has been a devastating slow-motion car crash of the Government’s own making, yet year after year, Minister after Minister, they have assured me of their commitment to reform. Last year, when I pressed the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), for action on this matter, she informed me that she had started work on a dental contract reform. However, just yesterday, we became aware that after 13 years in power, the Government are once again starting with an announcement of a plan to publish a new plan to improve access to NHS dentistry—a plan for a plan.

We would all welcome further clarification on what that plan might involve. I can only hope that sustained campaigning on this issue by me and other Members will mean that the plan will result in positive change for my Bradford South constituents.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

I congratulate my hon. Friend on securing this excellent and incredibly important debate. In Newcastle, where NHS dentistry access has become almost impossible for so many of my constituents, a whole generation of young people and children are growing up without access to an NHS dentist. Does she agree that that is causing immense suffering now and storing up not only pain and suffering but additional costs for the future?

[Judith Cummins]

My hon. Friend makes an important point. I will specifically cover access to NHS dentistry for children later in my remarks.

On the Government’s plan for a plan, experience suggests that positive change for my constituents may well be wishful thinking. My constituents are suffering and take no solace whatever from the Government’s commitment to plan for a plan for reform. The contract has been in place since 2006, and the Government have been undertaking a review of the process since 2011. After 12 years, it is still a work in progress.

[Wera Hobhouse (Bath) (LD)]

The British Dental Association has shown that over half of dentists have reduced their NHS work since the start of the pandemic. Official workforce data counts people, not how much NHS work they do compared with private work. Does she agree that it is important that the Government collect that data?

[Judith Cummins]

I absolutely agree with the hon. Member’s important remarks. Collection of data is paramount for solving the issue.

The dodging of responsibility for more than 12 years is nothing short of a disgrace. Now, we all bear witness to the human consequences of this crisis. The victims of Government negligence are—as they almost always have been—the most vulnerable people in our society. In Bradford, 98% of dentists are now closed to NHS patients. As I informed the Prime Minister just last month, 80% of practices are now refusing to accept children as new NHS patients.

The lack of access is having crushing consequences. In the financial year of 2021-22, 42,000 NHS hospital tooth extractions were carried out for 0 to 19-year-olds—an 83% rise on the previous financial year. A dental nurse has recently spoken of routinely extracting up to 10 teeth from a single child, so children are routinely losing half their teeth. This dental crisis is now ultimately a crisis of inequality. The rate of tooth extraction is more than three times higher in Yorkshire and the Humber than in the south-east of England. Children living in our country’s most deprived communities face an extraction rate three and a half times greater than those living in the most affluent areas.

In care homes for the elderly, the access crisis has been just as devastating. In 2019, 6% of care homes reported that they were unable to access NHS dental care services, but by 2022, that figure had risen more than four times to 25%—a quarter of all care homes.

As this Conservative Government continue to mull over minor reforms, they fail entire generations of people, who deserve a reasonable standard of care. No more are the cradle-to-grave principles of the NHS.

A 21st-century Britain requires a 21st-century approach. We need more than mere revision of the contract. My right hon. and learned Friend the Leader of the Opposition has spoken of the need for a new healthcare system that is just as much about prevention as about cure. It is a concrete fact that no dental treatment is stronger than protecting a healthy and original tooth, but in 2021-22 tooth decay was again the most common reason for hospital admission of children between six and 10 years old. For zero to 19-year-olds, hospital tooth extractions cost our NHS a shocking £81 million a year. In 2022, instead of children visiting the dentist on a regular basis, it cost our NHS an average of more than £700 for a single minor extraction of a child’s tooth in hospital.

We are paying for the cost of catch-up with our failure to prevent tooth decay, so prevention should be at the heart of our Government’s agenda for dental reform. We owe that to the generations of people currently being let down by the system. This country once had a strong school dental service. With the current shocking rates of tooth decay among children, now is the time to resurrect that policy as an interim prevention measure. It is not only the right thing to do but a sensible option for the country’s finances. Care homes would benefit from a dental contract that commissions stronger community dental services, as used to happen.

By using integrated care systems, upskilling care workers, and further involving local authorities, access can be increased and the pressure on dental services reduced. Prevention really is better than cure. We have a duty to ensure that taxpayers’ money is spent effectively in areas right across the country. A decade of savage cuts by the Tory Government has left long-term damage. An estimated £880 million a year is now required just to restore to 2010 levels of resources. There will be no escaping the need for more investment, but it must be thoughtful investment. One answer could be the introduction of a prevention-focused capitation-type system, where lump sums are provided to NHS dental teams to treat sections of the population.

Successful targeted investment is possible, and in 2017 I developed a project in Bradford with the former Health Minister, the hon. Member for Winchester (Steve Brine). I thank the hon. Member, who is now the Chair of the Health and Social Care Committee and who is present in the Chamber. He worked with me on the pilot scheme, which invested over £250,000 of unused clawback over three years into my constituency of Bradford South. That went straight back into local services and ensured that patients were able to access roughly 3,000 new NHS dental appointments in an area with high dental deprivation—targeting extra resources straight into an area where they were needed.

Although that was never meant to be a long-term solution, it proved that targeted investment is possible. Where there is a will, there is a way. With a staggering 10% of this year’s £3 billion national budget for NHS dentistry set to be returned, the system is clearly broken. Taxpayers’ money is returned not because people are not desperate for NHS dentists, but because the Government continue to push an underfunded and unworkable system. They lack the will to act and to find a way forward to protect dental health in this country. Now is the time to put “national” back into NHS dentistry.

The Government may once again list the challenges that stand in the way of re-establishing a truly universal dental care system. We are in a time of extraordinary change, with unprecedented cost of living crises, war on the European continent, and a society impacted by a deadly virus. Our health system is undoubtedly challenged, but 80 years ago the Conservative-Labour coalition Government published a guiding principle of NHS dental reform, just as this country fought for its very freedom and independence. In Sir William Beveridge’s own words:

“A revolutionary moment in the world’s history is a time for revolutions, not for patching.”

It is time for real change, not empty promises. This is the time for a Government dedicated to acting in the public good, to revitalise and resurrect NHS dentistry once again, ending the shoddy record of this Government’s patching of our NHS dental services.

[Mr Deputy Speaker (Sir Roger Gale)]

I call the Chairman of the Select Committee.

--- Later in debate ---

[Judith Cummins]

Thank you, Mr Deputy Speaker. I thank all 19 Members for their contributions and interventions, for which both I and the hon. Member for Waveney (Peter Aldous) are immensely grateful. Although the contributions are too numerous to mention, I will highlight the one from the hon. Member for Winchester (Steve Brine), the Chair of the Select Committee, which encapsulated many of the common themes. He spoke on a wide range of issues, including the lack of access to NHS dentistry and the problems, not only in his constituency, but right across the country, of the retention of NHS dentists and the lack of transparent data. He also talked about the need to have dentists represented on ICBs.

Many Members raised those common issues of access, including my hon. Friend the Member for Bootle (Peter Dowd), who spoke of a lack of funding. He posed two crucial questions: does the Minister accept that there is a problem?; and, if so, what progress has he made in resolving it? My hon. Friend then concluded that the situation has worsened since last year. Clearly, the need for full-scale reform has been recognised right across the House today, as we all know that change is needed. The fact that 90% of NHS dentists are no longer accepting new adult patients reflects the severity of this crisis. We have reached the point where the patching of our services is no longer possible and many of our constituents are simply suffering with the inadequacies of the current system. We need fundamental NHS dental reform now, not a plan for a plan. Minister, the promise of reform and this plan must come with real action and a firm date of publication.

Question put and agreed to.

Resolved,

That this House has considered progress on reforms to NHS dentistry.