NHS Dentistry: Bristol and the South-west

Debate between Kerry McCarthy and Darren Jones

Monday 24th January 2022 Commons Chamber

[Darren Jones]

I agree, and I thank my right hon. Friend for raising the case in Exeter, which seems similar to the many other cases we are hearing about this evening.

When I surveyed my constituents, 79% of those who responded said that they did not feel that they could access a timely dental care appointment when they needed it, while 60% had not had any form of dental treatment during the past year. Twenty five per cent. detailed that they had contacted 11 or more dental practices to try to register for NHS treatment but were unable to do so.

Information compiled by the Association of Dental Groups puts those conclusions in context. The ADG highlights that 43% of patients across Bristol alone were unable to book an appointment when they wanted to do so. That figure increases to over 50% of patients when considering the south-west altogether.

In its 2021 “Great British Oral Health Report”, mydentist found that those in the south-west who have had a dental appointment in the last year lived, on average, over 5 miles away from their closest surgery. More concerningly, those who had not had a dental appointment in the last 12 months were twice as likely than the national average to live over 30 miles away from their closest surgery. That seems to suggest that there is a correlation between someone’s proximity to an NHS dentist and the amount of time that has elapsed since their last appointment, adding geographical inequality to income inequality in the often privatised dental care system—no doubt a levelling-up priority for the Government.

This is a growing problem, with increasing numbers of NHS dentists closing and a shortage of dentists available to do the work. For those familiar with the south-west’s regional news, Thursday’s BBC “Spotlight” reported that the number of NHS dentists practising across the south-west had fallen by more than 200 between 2017 and 2021. Across the country, 45% of patients have been forced to pay for private care due to the closure of a local NHS dentist.

The good news is that there are several actions that the Minister can take to address these issues. First, the Government should consider measures to reverse the decline in the number of dentists offering NHS services. Research from mydentist shows that nearly 1,000 dentists ceased providing NHS treatment in 2020-21, and in response to a survey, 47% of the British Dental Association’s membership said that they were considering reducing the provision of NHS dentistry due to the pressures being faced. I understand that the Government have announced a south-west dental reform programme. I would be grateful if the Minister could provide some detail as to how it could be deployed to increase dentistry numbers.

Secondly, the Government should look again at how they recognise international dentistry qualifications. The overseas registration examination has only 500 places available annually in the UK. The ADG has recommended that part of the examination could be taken in the candidate’s home country as a way of reducing some of the pressures, and that the overall number of places available should be increased. Furthermore, both the ADG and mydentist have recommended that the Government take swift action to reduce the impact that Brexit will have on those who have received their training in the European Union but whose qualifications are not recognised in the UK, and therefore on the number of dentistry providers in the UK. At present, the Government have agreed to recognise dentistry qualifications achieved in the EU until the end of the year, but given that 22% of dentistry care and treatment is provided by dentists from the European economic area, it is vital that certainty about the future is provided to those dentists and their patients as soon as possible. It is ridiculous that Ministers would prevent EU dentists from being able to work in the UK. I would be grateful if the Minister could update the House on that particular issue.

Finally, and most importantly, the Government need to bring forward long overdue reforms to the NHS dental contract, which was established in 2006. Local dentists in Bristol North West have contacted me to highlight their frustration with the current contract, which prevents them from seeing NHS patients when they need to be seen. They have explained that they have been expected to meet higher patient targets due to local closures, despite the need for covid-19 safety measures and without the full payment usually required to see those extra patients. Those pressures are in addition to the backlog from the pandemic, with more than 350,000 dental appointments lost in Bristol alone between April 2020 and November 2021. Reforming the NHS dental contract is vital to solving the underlying issues with access to NHS dentistry, and I would welcome an update from the Minister on the status of that work.

In the round, NHS dentistry is broken and the problems are getting worse. The system works only for those with dental emergencies—and that is if they are lucky—while everyone else is left largely to pay private fees in a private dental system that costs significant sums of money. The closure of so many NHS dentists is adding geographical inequalities to the income inequalities created by the private sector-led dentistry system, and the shortage of dentists in the country is being exacerbated by a failure to recognise European Union dentists and an unwillingness to make it easier to welcome dentists from other countries around the world.

From my experience with Ministers and officials, I get the sense that dentistry in this country is now nothing more than an afterthought, placed in the “too difficult for Government action” box.

[Kerry McCarthy (Bristol East) (Lab)]

I do not know whether my hon. Friend has written to Ministers about this. I have written to Ministers on behalf of constituents who are in pain and need emergency surgery, but cannot come up with thousands of pounds to pay for it. It is so frustrating when the response we get is a link to a site where they can check where their nearest NHS dentist is, or similarly useless bits of information. Does he share my concern that the Government are totally complacent about the crisis we face?

[Darren Jones]

I thank my hon. Friend for her contribution and I agree entirely. I know from my own experience of trying to get access to ministerial time following the closure of an NHS dental practice in Southmead that it took ages to get a response. I then had time with officials, who tried to be helpful but could not resolve the problem, and we had local briefings in Bristol where, I am afraid, the presentations and information were completely inadequate. That confirms my point that dentistry seems to be an afterthought, not a priority, for this Government.

Concentrated Animal Feeding Operations

Debate between Kerry McCarthy and Darren Jones

Monday 12th November 2018 Commons Chamber

[Darren Jones (Bristol North West) (Lab)]

I thank the Members staying for my Adjournment debate this evening at the early hour of 11 pm.

For those of us who like to be clear about definitions, I should start by making it clear that my Adjournment debate today is on intensive farming operations in the United Kingdom. I say this because concentrated animal feeding operations has a legal definition that is used in the United States but is also relevant to this debate. In the United States, concentrated animal feeding operations describe farms over a certain size that farm animals in extreme confinement. We do not have an equivalent definition in the United Kingdom, but we do have intensive farming of animals, which is defined by the Environment Agency as a farm housing at least 40,000 birds or 2,000 pigs. This form of intensive farming increased in the UK by a quarter in the six years running up to 2017.

As reported in The Guardian newspaper, a recent investigation by the Bureau of Investigative Journalism found that we now have a large number of intensive farming operations in the UK, many of which would meet the definition of concentrated animal feeding operations used in the United States. These so-called megafarms have at least 125,000 birds for meat, or 82,000 birds for eggs, 2,500 pigs, 700 dairy cattle or 1,000 beef cattle. We now have 789 megafarms in the UK, according to that investigation.

[Kerry McCarthy (Bristol East) (Lab)]

We know that there are many more megafarms in the United States. Does my hon. Friend and constituency neighbour share my concern that if we open our markets to lower-standard imports from the US post Brexit, our farmers will feel that they have no choice but to move to megafarming in order to compete on price?

[Darren Jones]

I agree entirely. I do not think British consumers will accept that position, not least because they enjoy the high-quality standards that we expect of many of our food producers in the UK. If that is exerting a pressure on home-grown produce, they will not accept it either.

Seven of the 10 largest poultry farms in this country already have a capacity to house more than 1 million birds, with the biggest farm holding up to 23,000 pigs and the largest cattle farm 3,000 cattle. These are all numbers, but to give an example to the House, the Bureau of Investigative Journalism study showed that a megafarm in Herefordshire had four 110-metre by 20-metre industrial warehouses, each with 42,000 chickens in them. There were so many chickens in these warehouses that the journalists could not see the floor. These chickens live for only a short period, and the process is repeated up to eight times each year, so that is a turnover of over 1 million birds every year in these confined settings.

These conditions are bad for animals and bad for our food. Confinement can lead to the stress-related death of animals; self-mutilation of animals due to mental health conditions; ulcerated feet, breast blisters and hock burns due to ammonia-filled litter; sudden death syndrome from unnaturally quick growth; foot and leg damage from slated or concrete floors; and in the case of lots of dairy cows, bacterial infection, mastitis, anaemia, stomach ulcers and chronic diarrhoea. These are not things consumers wish to have associated with the food they eat. As a consequence, I will be writing to Tesco, Sainsbury, the Co-operative, Marks and Spencer, Morrisons, Asda, McDonald’s and Nando’s, all of which, I am told, buy the products I am talking about for their customers.

These stressful, illness-inducing environments also lead to the excessive use of antibiotics in animal feed and water to try to limit the risk of disease from intensive farming settings. According to Compassion in World Farming, there is strong evidence that the overuse of antibiotics in animals is contributing to the antibiotic resistance we are now seeing in human medicine—something this country is, thankfully, working hard to try to prevent.

To make matters worse, these extreme farming conditions can lead animals to become stressed. Again, that is bad for food, but it is also bad for animals. I am told that stress-induced aggressive animal behaviours have led to chickens being de-beaked, which involves a hot blade cutting through a bird’s beak, bone and soft tissue. Chicken toes are also removed to discourage fighting, and the tails of pigs and cows are removed to prevent tail biting. Again, these are conditions I am sure many British consumers would not want associated with the food on their plates.

However, this is not just about the quality of food or the quality of animal welfare; it is also about the environment and our efforts at tackling climate change. The recent Intergovernmental Panel on Climate Change report said we have 12 years to limit post-industrial levels of world temperature growth to 1.5° C—the subject of a separate debate I will be leading at 9.30 tomorrow morning in Westminster Hall.