Covid-19: Dental Services

Lord Bethell Excerpts

Tuesday 10th November 2020 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government what measures they are taking to ensure the continued provision of dental services during the COVID-19 pandemic.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, the challenge presented to the dental profession by Covid is severe. We are grateful for the hard work of 10,000 NHS and private practices in introducing PPE and infection-control arrangements to keep patients and staff safe, and to the 600 urgent care centres that are providing services for the most severe cases. However, the impact on the nation’s health remains something that we are working hard to mitigate.

[Baroness Walmsley (LD) [V]]

My Lords, I thank the Minister for that reply, but 60% of dentists can now see only a quarter of their usual number of patients, particularly because of the measures needed for carrying out aerosol-generating procedures. There is a backlog of 15 million treatments, and many dentists are in danger of going out of business. They cannot afford ventilation equipment, which would enable them to see more patients in a day. Will the Government provide funding for this, so that the backlog of patients can be cleared?

[Lord Bethell (Con)]

My Lords, I completely acknowledge the challenge that the noble Baroness has described. Many dentists can see only 20% of their normal cases, and around half can see about 50%. The backlog is, as she describes it, severe, and the impact, particularly on private dentists, has been very hurtful for their businesses. I cannot make a commitment to fund ventilation arrangements, but we acknowledge the scale of this challenge and are looking at ways to mitigate it, including bringing in testing, which we hope would help provide a safe environment for both staff and patients.

[Baroness Uddin (Non-Afl)]

My Lord, the Minister will be aware that people with learning disabilities and autism have suffered disproportionately in not receiving care and services. Will he undertake to ensure that they are not equally suffering by not receiving dental services, especially specialist dental provisions? I declare that I have a 41 year-old son with a learning disability and autism. I have spoken to a number of organisations that said that the pandemic exacerbated the difficulties in the process of receiving important and urgent care.

[Lord Bethell (Con)]

My Lords, the noble Baroness refers to the prioritisation of patients in the constrained appointment flow of dentists. She is entirely right that those who have vulnerabilities, disabilities or other disadvantages should be prioritised: that is the objective of the prioritisation process. She makes the point extremely well and I am happy to take on board any points on where she thinks the system is not working as well as it might do.

[Baroness Altmann (Con) [V]]

My Lords, will my noble friend the Minister tell us what lessons have been learned from the initial response to the Covid pandemic and the blanket closure of dental practices? Does he have any estimates of the number of cancers of the head and neck that might not have been detected because people have not had regular dental check-ups?

[Lord Bethell (Con)]

My Lords, my noble friend is right to allude to the confusion around the closure of dental practices. We have made it crystal clear that in the second lockdown all dental practices—both NHS and private—should remain open; that is part of our commitment to try to clear the backlog. I also acknowledge her concerns about the diagnosis of cancers. I do not have the figures for which she asked, but we certainly appreciate the role that the dental sector plays in detecting many cancers, including oral cancers. Dental services are open to those seeking urgent care and we hope that those urgent care clinics to which I referred earlier can provide some diagnostic analysis in urgent cases.

[Baroness Finlay of Llandaff (CB) [V.]]

My Lords, I declare my role as chair of the National Mental Capacity Forum. Following on from the question of the noble Baroness, Lady Uddin, will the Minister say how the urgent care pathway is being evaluated, particularly for children and young people with learning difficulties who might need a general anaesthetic for dental work? They are at a particularly high risk of sepsis from dental abscess, which can be avoided by preventive dentistry, yet they are often part of the increasing backlog and have difficulty registering with a dentist locally because they need even more time for their care than other patients and will therefore decrease the number of other patients whom the dentist can see.

[Lord Bethell (Con)]

My Lords, the concern about children is particularly acute. We are especially keen to encourage parents, to ensure that they are still bringing children forward. That is why we have the Help Us to Help You campaign to encourage public access to NHS services. She is entirely right that acute situations—involving, for instance, some form of anaesthetic—provide a particular challenge. We have a prioritisation process in place, and I understand that that is working well to ensure that those who have the greatest need are put at the front of the queue. However, as I said to the noble Baroness, Lady Uddin, I would welcome any feedback from those who think that the system is not working well enough.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I declare my interest as president of the British Fluoridation Society. Just on that last point, in a number of parts of the country, no elective surgeries, except for those that might be totally prioritised, are being done at the moment. The prospect is of a few more months with a virtual lockdown of elective surgery. As far as children are concerned, will the Minister look into this matter urgently? Will the Government prioritise preventive schemes as we come out of the pandemic, such as fluoridation, supervised tooth-brushing programmes in schools and public service ads?

[Lord Bethell (Con)]

My Lords, I completely agree with the noble Lord that prevention is the key. In our document on the matter, Advancing Our Health: Prevention in the 2020s, we have committed to the consulting on and rolling out of supervised tooth-brushing schemes in more preschool and primary school settings in England. We have also set out our support for expanding water fluoridation, and we intend to announce further details of our water fluoridation plans shortly.

[Lord Strasburger (LD) [V]]

My Lords, as rapid coronavirus testing becomes more available, can the Minister assure the House that dentists and their staff will not be left behind? Will they also be included with health and care staff near the top of the priority list when new vaccines are being distributed?

[Lord Bethell (Con)]

The noble Lord asked for a general commitment on dentists and their staff. I reassure him that we value the dentist profession and their staff, and the Covid pandemic has only emphasised the importance of dentists in the community and to the nation’s health. He asked me a specific question about where they stand in the vaccine prioritisation list and whether they are on the healthcare list. I will write to him with a precise answer to that question.

[Lord Flight (Con) [V]]

My Lords, there are three big factors that are causing these problems. First, there is the potential patient’s caution and the worry of contracting Covid-19, which leads them to put off treatment and save the money until normal times return. Secondly, dental sessions are taking much longer, partly because of the fall in the number of patients per session and lower throughput. The principal barrier to resuming services is the issue of the fallow time required following aerosol-generating procedures. The solution is greater ventilation. The key need is to increase the patient throughput and to reduce—

[Lord Flight (Con) [V]]

Will the Government be willing to put up any funding to deal with the issue of fallow time between treatments?

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord’s analysis, but it is too early to make commitments on funding.

[The Lord Speaker (Lord Fowler)]

I make the point that I say at the beginning of every Question Time that two points are the maximum that should be made.

[Baroness Thornton (Lab)]

In my view, the Government have offered little support to dentist practices: not exempting them from business rates, even though book- makers and vape shops are exempted, and not offering them key worker status, which has caused problems with childcare. Can the Minister commit to early access to Covid-19 vaccines for all high-street dentists who are NHS contractors, rather than employees? Can the Minister give them key worker status?

[Lord Bethell (Con)]

My Lords, one area where the Government have made a big commitment to dentists is in PPE. As of Wednesday 4 November, over 5,000 dental and orthodontic providers in England had registered with the PPE portal and over 36 million items of PPE had been delivered. In terms of the commitment to workers, I will have to come back to the noble Baroness.

[Baroness Bull (CB)]

My Lords, I declare my interests as set out in the register. Reduced clinical capacity not only impacts on patients but massively disrupts the education of dental students, who typically treat over 400,000 volunteer patients each year as part of training. Since March, many schools have been unable to provide any patient-facing education at all. Will the Government respond to requests from dental schools and hospitals to invest in high-quality simulation facilities, to mitigate the impact of this reduced clinical experience and ensure that students can graduate and provide the workforce of the future?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, the bottleneck around the training of new dentists, an incredibly important priority for the nation’s teeth, is one that the CDO is extremely concerned about. The question of simulation machines is not one that I was aware of but I will be happy to look into it and reply to the noble Baroness on how we can make progress.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has now elapsed.