NHS Dentistry

Lloyd Russell-Moyle Excerpts

Tuesday 9th January 2024 Commons Chamber

[Wes Streeting]

I totally agree, and I do not think we should be complacent about this as a country. The NHS is already becoming a two-tier healthcare system, where those who can afford to go private are paying and the rest are left with an increasingly poor service for poor people. Government Members protest now, but they admit their goals once they leave the Department for Health and Social Care. The Health Secretary’s predecessors may not have said it when they were in her place at the Dispatch Box, but, as soon as they were out the door of the Department, the right hon. Members for West Suffolk (Matt Hancock) and for Bromsgrove (Sir Sajid Javid) said what they really believe: patients should be charged for GP appointments. Well, why stop there with this Conservative philosophy? Why not go further? That is the future for the health service if the Conservative party is given another five years. That is the risk facing patients across the country, and that is the choice facing voters at the next general election: further neglect, mismanagement and decline under the Conservatives or change with Labour and a decade of national renewal.

On NHS dentistry, the need for change could not be clearer. By the Conservative party’s own admission, it does not have a plan—just the vague promise of one coming in the future. All it does have is a record of 14 years of failure. If we stick to the current path, full universal access to NHS dentistry may be gone for good. The Conservatives may be happy to wave goodbye to this vital public service, but that is not the Labour way. With Labour, there is a clear plan, with immediate steps to tackle the crisis and long-term reform to rebuild dentistry. There will be more appointments, more dentists, more support for children and long-term reform to put the service on a sustainable footing, paid for by abolishing the non-dom tax status. That is because Labour believes that people who live and work in Britain should pay their taxes here, too. It does not matter whether they live on Downing Street or any other street: if they make their money here in Britain, they should pay their taxes here, too.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

My hon. Friend is making an excellent speech. Abby Lane, in my constituency, has contacted over 30 dental practices. Not one is accepting her and her one-year-old child, who desperately needs dental treatment. Is it not the case that we now need to reform the system so that local commissioners can ensure that dental commissioning is happening in local areas where there is need, and not just have this patchwork system where dentists are fleeing because it is not paying well enough?

[Wes Streeting]

I totally agree. The tragedy is that if we look at the system as a whole and think about the pressure the whole system is under, and if we got NHS dentistry right, we would not only be saving patients untold pain, but saving the NHS money. As Lucy Rigby, Labour’s candidate in Northampton North, reported to me, in 2022 tooth decay forced 625 of her local patients to A&E—worse for them and more expensive for the taxpayer.

If Tory Members disagree with charging non-doms their fair share, maybe they could explain in their own contributions why they disagree. I am sure that their constituents would love to hear their defence of the non-doms, and we would be happy to give them space on Labour leaflets to quote their arguments back at them and let the public decide. I would particularly like to know why the Prime Minister is so wedded to this tax break for the wealthiest.

While Tory Members are set to oppose Labour’s rescue motion today, I understand that our plan on supervised toothbrushing for three to five-year-olds has received an endorsement from an unlikely source. On his podcast, former Conservative Chancellor George Osborne said:

“That really is the nanny-state in action.”

Coming from the Chancellor who introduced a sugar tax, I am sure George meant that as a compliment. Of course, Conservative Members may not see it the same way, just as they do not agree with Labour’s proposal to phase out smoking for children. Don’t worry, we have the Prime Minister’s back on that one; it is, after all, our proposal. But I ask those who attack our plan as nanny-state, what is the alternative? If a child cannot see a dentist and their parents will not do the responsible thing and make sure they clean their teeth, then should we just shrug our shoulders and do nothing while children’s teeth rot?

The problem for the small-statists on the Conservative Benches is this. Too many children today are not cleaning their teeth. Their teeth are rotting and they end up having them pulled out in hospital, which is worse for them and more expensive for the taxpayer. Last year, the NHS spent £80 million on tooth extraction. Toothbrushing in schools would cost a fraction of that, yet the Conservatives choose to waste taxpayers’ money, burning through taxpayers’ cash on the altar of ideological dogma and putting children through unnecessary misery, because it fits their confused ideology.

That is the irony of the Conservative party. Tories say that they believe in a small state and low taxes, yet they have left our country with the highest tax burden since the 1950s. The NHS receives £169 billion a year, yet it is going through the biggest crisis in its history. Because they do not understand that prevention is better than cure. Because they have refused to undertake meaningful reform. Because they treat taxpayers’ money with utter carelessness and contempt. And so they have left us with an NHS that gets to people too late, delivering worse care for patients at greater cost to the taxpayer. We are paying more and getting less. That is Tory Britain. No wonder Tory candidates are so worried.

Before this debate, I happened on a letter on Facebook from the hon. Member for Darlington (Peter Gibson) who is, happily, in his place. First he talks about the state of dentistry in his constituency—we obviously agree with him there—and then he says:

“I was shocked to learn at the end of last year that little to no progress has been made by the Health Board in our region who are responsible for commissioning this service to you.”

Let us assume it was in anticipation of Labour’s motion, which he is going to vote against because the Whip has been cracked. He goes on to say:

“I have today written to the Chief Executive following on from the meetings I had last year, and will be raising this issue in today’s dentistry debate in the House of Commons.”

What that is, and what voters will see it for, is just one of what will no doubt be countless examples of Tory MPs and Tory Ministers, after 14 years of their failure and mismanagement, pointing the finger of blame at someone else, hoping that voters in Darlington and elsewhere will blame local NHS managers and local NHS commissioners for 14 years of failure. If it is really the case that his integrated care board is to blame for why people in Darlington cannot get a dentist, why are people struggling in Newcastle-under-Lyme? Why are they struggling in Northampton North? Why are they struggling in Shipley? Why are they struggling in Filton and Bradley Stoke? Why are they struggling in Worthing West, Stroud, Stevenage, Great Yarmouth, Truro and Falmouth, Blackpool South, Stockton South and every other constituency in the country? Stop blaming other people for your Government’s failures.

--- Later in debate ---

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

In my constituency, 11 dentists have updated their data. Seven are not accepting adults and nine are not accepting anyone, but the reality is that if I phoned around, I would find that none of them on that list are accepting people.

The situation is so bad in Sussex that the ICB has taken matters into its own hands, ignoring the NHS portal, which it says does not work, and producing a list every month of dentists that will do drop-ins. For the whole of Sussex, we have two in Hastings—hopefully soon to be Labour, with our fantastic candidate Helena there—two in Hove and one in Brighton Pavilion. There are none in Worthing—Worthing West and East Worthing and Shoreham are hopefully soon to get Labour MPs —or in Crawley, Bexhill and Battle, Lewes, Eastbourne, Mid Sussex or Chichester, all of which are marginal constituencies in the next election. I would have thought the Government would be more on it to ensure that constituencies that they are about to lose have dentists that patients can see, but they are not.

The ICB says that it cannot find dentists to volunteer—that is what they do. All the ICB can do is beg and plead with dentists to voluntarily take extra patients, because the contracts do not work. Also, many dentists say that they cannot update the online system because other dentists do not update it, so if they do, they are flooded and all their places get taken. So dentists do not update the system properly. When asked why they do not, they also say that the system does not provide enough granularity. They can say whether they accept children and adults—yes or no—but they cannot say whether they take local people or prioritise other requirements.

Dentists prefer to operate a system in which patients have to ring around. That is no good for my constituent Carolynn Bain, who rang around all the lists in Worthing and Eastbourne, and in the end had to go to London for her dental treatment. She was told that dentists do not want to update the system because they are afraid of the effect. When I have asked the CCB—sorry, the ICB; they change the names of these darned things so often that no one can remember—it says that that inhibits the information to constituents. We need a system, like we have for doctors, of proper planning in catchment areas. We need the ICB to be able to say, “This is the population in this area. This is what is needed.” Just like with doctors, patients should be able to choose dentists out of area or dentists they have a connection with, perhaps because they work in an area but do not live there. There needs to be proper planning, and there is none at the moment. That is why Labour’s plans for more urgent appointments and better and more NHS training are welcome.

I hope the Government will also look at dental schools. At the moment there is no dental school in Sussex, Hampshire, Surrey or Kent—none in the south-east. There are London dental schools. That makes a huge difference to the ability to train and recruit dentists, because many will end up staying in the area in which they have trained. I urge the Minister to look at establishing a new dental school in the south-east—we would love to have it in Brighton, but Hastings is also a good option. Our Hastings candidate will be pushing very hard for that. After the closure of the University of Brighton in Hastings, there is a need for a new university or medical school there, and that would be very welcome.

We have heard a lot of pledges from the Government to increase the number of dental hygienists, but this is a huge smokescreen. Under the NHS, patients can only access a dental hygienist if they have been referred by a dentist. If they go private, they can pay to go directly. Actually, we should encourage people to go to directly to dental hygienists once a year, and once a year to a dentist. There is no need for a six-monthly check-up with a dentist if a patient also goes to a hygienist. But at the moment, patients cannot go to a hygienist unless they are referred as a tier 2 form of treatment, so they cannot do it on the initial check-up. That needs to change to make dental hygienists relevant; otherwise, the Government are talking about recruiting into the private sector a load of dental hygienists no NHS patient will be able to see.

The same goes for the list system. It is absolute madness that if a patient has not seen a dentist for six months or a year, they can be thrown off the dentist’s list. That would never happen with a doctor. We need to change the funding model so that dentists are encouraged to keep patients on their list if they have not seen them. They should get a bonus for seeing them, and some reward for preventive treatment. That preventive treatment might not always involve seeing a patient, but may involve educational resources or sending them to a hygienist, with the hygienist reporting that no further action is needed.

All those things could be done. The start of an education and preventive approach should be in our schools. That is why Labour is pledging to take action. That is why this country has been so let down by the Government.