Access to NHS Dentistry

Karin Smyth Excerpts

Thursday 10th February 2022 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Ali.

I am delighted to respond to this brilliant debate, in which we have had 23 speakers from all parties. Before I go further, however, I feel that I ought to thank my own dentist. Aidan has served me and my family well for more than 20 years. I will always follow him, wherever he sets up practice, and I have told him that he is not allowed to retire, ever.

I pay tribute to the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) for their diligent work in this area and for securing the debate. It is clear that the current situation simply is not working. As we have heard, staff are leaving the profession in droves, patients are struggling to access the appointments they need, and staff have been left undervalued, under-resourced and under-appreciated for far too long. This Government are putting the future of NHS dentistry at risk, and we have heard about some of that today in the choices confronting the sector.

I am sure that the Minister will tell us about a plan, I am pretty sure that she will tell us that she has heard the concerns that have been expressed today, and I am very sure that she will blame the last Labour Government. However, I think we need to ask, “Where is the action?” We welcome the additional funding for the NHS—the £50 million injection—but it ignores the wider structural issues affecting dentistry. It will fund less than 1% of the 40 million appointments we have lost since the start of the pandemic; it is a mere drop in the ocean. The impact of those lost appointments is clear. “The Great British Oral Health Report”, published in August, showed that a third of the population is estimated to be suffering from undiagnosed tooth decay. That is particularly problematic among children, as we have heard, with a child being admitted to hospital for tooth extraction every 10 minutes in the UK. That is a shocking statistic.

We know that some of our most vulnerable communities rely on NHS dentistry, and increasing barriers to access only fuel inequality. My hon. Friend the Member for York Central (Rachael Maskell) spoke particularly cogently about that inequality. Before the pandemic, tooth decay among children in the most deprived communities was 3.8 times higher than among those in the least deprived communities. That severely affects my constituency of Bristol South.

Again, as many have said, we need a proper long-term strategy to address the workforce crisis affecting the whole of our NHS, as well as reform of the broken contract system. The Minister has said on many occasions how broken that contract system is. It has been in place since 2006. As we know, it was negotiated by the Labour Government. We know times have changed, but we also know the Government have been trying to change the contract since 2011, which may give some indication of how difficult it is. I have some sympathy with that, but a decade should be enough time to get on with sorting the problem.

Even as recently as Monday’s Adjournment debate, we have heard Ministers say, “We’ve started work on that reform.” We are all desperate to hear how it is progressing and, to be honest, for the Government to get a bit of a move on with it. It was a commitment in the Conservative manifesto of 2010—12 years ago. It would behove the Minister, after the number of debates that we have had, to come forward and say when we can expect to see the fruits of that decade of discussion. It is a problem that urgently needs tackling, not kicking further into the long grass.

When the Minister talks about there being a shortage of dentists wanting to do NHS work, I wonder whether she really understands why that is the case. Surveys by the British Dental Association have shown that 80% of owners of predominately NHS practices say that morale is low or very low. The hon. Member for Bath (Wera Hobhouse) talked about the mental health stresses of the workforce. Some 76% said that their job was extremely or very stressful, and 45% want to leave dentistry within the next 12 months. Of the 93% who struggled to recruit a dentist to work in their practice, more than half cited associates’ reluctance to work in the NHS as the main reason they struggled to fill the vacancy. With morale through the floor and recruitment near impossible for many practices, is it any wonder that NHS dentistry is in the state it is?

Of course, this is true across so much of our NHS and social care sector: workforce is the critical problem. Many hon. Members—notably the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—frequently urge the Government to bring forward a credible workforce strategy for all parts of the NHS. It is long, long overdue.

I will briefly share some testimonies from NHS dentists working on the frontline. One dentist in Shropshire said that the date of this debate

“exactly matches the last day that I will be providing NHS dentistry after 17 years of service.”

They said that the contract has not been fit for purpose for a long time and that covid has broken what was already a strained system. We thank them for their service and wish them well, but we are sad to lose them.

A dentist in east Devon who had lost two members of staff said:

“A large number of our patients are on benefits or have low incomes and with a huge increase in energy bills on the horizon this number is bound to increase. I have had 3 days off during the last 12 months…I’m tired, not sleeping, close to burning out.”

These are shocking testimonies from the frontline.

It is not just dentists who are seeing these problems; patients are feeling the impact of this situation harshly, as hon. Members across the House will know from their casework. In a recent Adjournment debate about Bristol and the south-west, I raised the issue of a pregnant constituent who was unable to access care at that critical time. This is the No. 1 issue raised by Healthwatch. Patients are struggling. As we know from YouGov and as we have heard today, 20% of patients are resorting to DIY dentistry. The security that NHS dentistry provides to so many people in this country is being eroded, and it will be eroded until that safety net is no longer there.

We have heard some severe challenges from Government Back Benchers about the Government’s long-term view on the survival of NHS dentistry. With the cost of living crisis squeezing households across the country, people will be faced with choosing between their health, heating their homes or putting food on the table. As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) said, people are being priced out.

The hon. Member for North East Bedfordshire (Richard Fuller) was very kind about some of my expertise in the field. We have worked together collegiately in other areas—on trailer safety, notably. Generally, I think devolved budgets and personal budgets are a good thing, and I have always advocated empowering patients, but, sadly, their use has been reduced in social care and they are not being utilised. I am not sure that they are the answer in this particular area, but something radical clearly needs to be done about the contracts.

I say gently to the Conservative party that that the Labour party does not think it acceptable that young children are in hospital or toothless while £4.6 billion-worth of loans float out of the Treasury, while the personal protective equipment contract is written down, or while whatever other ill management of the Budget we have seen from this Government happens. I personally look forward to a debate between the hon. Member for Thirsk and Malton (Kevin Hollinrake) and my hon. Friend the Member for Bootle (Peter Dowd) on the efficacy of the Government’s management of the economy. That would be a well-informed debate and I would certainly back it.

I say to the Minister that we have seen no evidence about dentistry being a priority for the Department of Health and Social Care. The new White Paper, which came out yesterday, talks about better integration across primary and community health, adult social care, public health and housing, but there is no mention of dentistry. Again, as a lot of people have said, making dentistry part of our general community service would be a good thing.

The debate has highlighted that the problem was urgent even before the pandemic. There is no data; it is clear that dentistry is an outlier of public and community health. That is a long-term problem. I am afraid that I do not think that the Government have taken it seriously in their recent White Papers. We would all support the Minister in that battle at the Department of Health and in bringing forward something to address referrals to the contract much more urgently.