Access to NHS Dentistry

Justin Madders Excerpts

Thursday 10th February 2022 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to see you in the Chair, Mr Efford. Access to NHS dentistry has been raised with me throughout the pandemic, and judging by turnout for the debate, it is something that a lot of Members are keen to get their teeth into—[Interruption.] I promise to make no more dental puns.

I have met dentists and made representations to Ministers numerous times. The overwhelming feeling that I have had from such discussions is of a disjuncture between the two. Dentists and patients do not feel listened to, and Ministers are not offering the solutions needed to ensure that NHS dentistry is accessible for much of the population. While that is not being addressed, waiting times build, preventive dental action is not taken and health inequalities rise.

I pay tribute to all dentists and dental staff in my constituency, who have worked in a high-risk environment throughout the pandemic. I know that they are doing all they can to deliver those services. The correspondence I have had with them shows how passionate they are about ensuring good access to NHS dentistry.

As the Father of the House, the hon. Member for Worthing West (Sir Peter Bottomley), explained, a lot of the issues relate to the UDA system, which does not encourage dentists to take on new patients, especially those who require a lot of treatment. That scenario is increasingly common in the light of the difficulties that we have had over the past two years. The UDA system accommodates only 50% of the population. To my mind, that means that we start from a position of knowing that many people will be denied access to dental care. We need a functioning NHS dental system, and that will be possible only through contract reform recognising the realities of the difficulties that the sector faces, and if services are commissioned for a much higher proportion of the population.

I am told that the local commissioning figure sits at around 55% of the population, but of course that was pre-pandemic, so the number of people who have been able to access services is actually lower. Unless more of the population is covered, constituents will continue to struggle to access dentistry. One patient advised my local Healthwatch that they had contacted 45 practices in one day, and was told by all of them that there was no capacity as

“they only have a small NHS contract and are therefore not taking on patients at present”

but would be happy to take that person on as a private patient. The system actually encourages greater privatisation.

One constituent, who contacted me because of the pain she was experiencing from a hole in her tooth, described her attempts to register at a practice as a fight, which sums the situation up perfectly. We would not accept people having to ring around A&E departments to see if there was any space for NHS patients, so I do not see why we should accept it for dentists.

Since January 2021, there have been several increases in the UDA targets placed on dental practices. Between January and March 2022, it is expected that 85% of the UDA should be met. Last year, a practice in my constituency had to refund £45,000 because of activity that simply could not be delivered. I understand there is nervousness across the sector about the levels that will need to be refunded given that practices are expected to meet the 20% UDA increase at a time when we still have omicron-related staff sickness and appointment cancellations.

I recently asked whether any assessment had been made of the impact of short-notice cancellations on the ability of dental practices to meet their UDA target. The answer I received simply stated that that was considered within the 85% target and suggested that dental practices keep a short-notice cancellation list. However, the practices I am in contact with already do that and are proactive in trying to fill the slots. It seems, once again, that there is a disjuncture between what the Department says and what is happening on the ground.

Given that infection rates and community spread of covid-19 have been at their highest level in recent months, setting the target at 85% at this time seems questionable. There is little surprise that we are hearing of more dental practices leaving the NHS and operating on a purely private basis when there seems little financial incentive or, indeed, financial feasibility in continuing to deliver NHS services. We face the very real prospect of growing privatisation of dental services and people being priced out of receiving dental care. I have heard of price increases as high as 100% on previous NHS fees for those going private. Together with the cost of living, that is simply pricing people out.

Healthwatch Cheshire West confirmed that deregistration from dental practices is the primary cause of people needing to contact other NHS dentists and being unable to find one locally. The reality is that waiting lists locally sit in their thousands. One practice quoted a total waiting list of more than 3,000 people, demonstrating the significant challenge to be addressed.

In the last six months of 2021, I was contacted by 25 different constituents who faced that challenge. Many were writing on behalf of their whole families as well as themselves. One constituent, whose son was in pain after cracking his tooth, was told to keep ringing back each month to see if there was any capacity to reregister, another resorted to carrying out a temporary filling repair themselves at home and one lady, who had been shielding, was removed from the register due to inactivity. Many were shocked to find out how few rights or guarantees they have to remain registered at a practice. Healthwatch has suggested that clear information is needed so that patients are fully aware of the risk following inactivity or missed appointments. I agree that there needs to be greater information. However, there also need to be greater guarantees of access for individuals.

I will conclude by sharing the words of Cherie, a dentist who operates in my constituency.

“The only way to save NHS dentistry in England is to listen to dentists. It’s currently financially unviable for dentists in high need areas with large UDA contracts...this is only going to widen the oral health inequalities further.”

I urge the Minister to do just that: listen to dentists and act accordingly.