Dentists: Covid-19

Lord Bethell Excerpts

Thursday 11th February 2021 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what steps they are taking to enable dentists to reduce any backlog of patients requiring dental treatment as a result of the restrictions to address the COVID-19 pandemic.

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

My Lords, an increase in dental activity has been made possible by updated infection prevention and control guidance. NHS England and NHS Improvement have set a 45% activity target for January to March 2021, with the main aims being to increase patient access and reduce backlogs in patient care. PPE is being provided free of charge to NHS dental practices to support the provision of services, and we are looking at what role pre-appointment testing could play.

[Baroness Gardner of Parkes (Con) [V]]

I thank the Minister for that Answer. Is he aware of the problem of dealing with the essential time gaps required for cleaning and sterilising between patient appointments where the dental practice has only one surgery that can be used for treatments? A significant time is required for this between patients, which means fewer patients can be treated. The BDA has had reports of tests of a very effective ventilation system which could be used to enable many more treatments to take place in the working day. It costs about £10,000 to install. After the closure of surgeries for a considerable time, the operators of national health dental surgeries are not in a position to fund this. Will the Government provide either the funding or the necessary equipment to NHS dental practices?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right; ventilation is a key issue. I took my daughter to the dentist this morning, and there were indeed long gaps between each appointment. I am not aware of the ventilation system she alludes to, but if the BDA would like to write to me, I would be happy to have a closer look at it.

[Baroness Warwick of Undercliffe (Lab) [V]]

My Lords, can I follow up on the Minister’s point about the new activity target imposed on dentists to reduce the backlog? It seems to have had the reverse effect. It has resulted in one of the biggest dental chains in the country instructing its dentists to focus on band 1 check- ups and reduce urgent treatments to meet the targets, reducing access for those who need it most. Other practices are reported to be doing the same. What assessment have the Government made of the impact of this target on patients who need urgent and complex treatment? Dentists have continued working, like doctors, nurses and other health professionals, in a high-risk environment during the pandemic. But their contribution seems to have been ignored. Can the Minister confirm the Government’s appreciation of the commitment of dentists and their staff during this pandemic?

[Lord Bethell (Con)]

I join the noble Baroness in paying tribute to dentists. As of 18 December, 88% of NHS dental practices were open, and that is a huge tribute to the hard work, determination and skills of dentists. She is right that they offer a spread of services; more triaging is going on, and that has successfully made a big contribution to getting through the lists. As of 13 January, 6.9 million dental patients have been triaged on the AAA service—advice, analgesics and antibiotics—but urgent dental care centres, of which there are 695, have picked up the difficult and time-consuming work for those who have an emergency need.

[Baroness Walmsley (LD) [V]]

My Lords, do the Government plan to continue to enforce activity targets in the next financial year? The new contract is only seven weeks away, and those in the profession has heard nothing about the basis on which they will be paid next year. When do the Government plan, at last, to deliver wider NHS dental contract reform, which they committed to in 2010? The issue keeps being kicked into the long grass.

[Lord Bethell (Con)]

My Lords, I would like to reassure the noble Baroness that officials are working extremely closely with the dental profession on the arrangements for the new practice. It will not be a complete renegotiation of the full contract, but we are looking at what arrangements should be in place for 2021-22. And as I said before, I pay tribute to the hard work of dentists. Activity targets are a useful way of getting a focus on increasing the throughput of dentistry. We have a big backlog, and that is one way we can try to increase the velocity of dental appointments.

[Lord McColl of Dulwich (Con) [V]]

My Lords, in order to deal with this backlog, should we not rely on the good sense of dentists to prioritise their patients—for instance, to treat those with pain and infection with antibiotics, then deal with the less urgent problems? Would the Minister consider the fairer solution adopted by Scotland and Northern Ireland, where new activity targets are half those of England?

[Lord Bethell (Con)]

My Lords, the Chief Dental Officer has looked at the activity targets and done extensive modelling to ensure that they are fair and safe. The noble Lord is entirely right that some dental support can be done in absence through things such as antibiotics. But it is important that face-to-face appointments are increased, otherwise, we will have a generation of people whose teeth are not in great shape, which will cost the country dearly.

[Baroness Masham of Ilton (CB) [V]]

My Lords, is the Minister aware that should people with gum disease and swollen gums get Covid-19, they are many times more likely to die, having ended up in intensive care or on a ventilator? Would the Minister agree that oral care, which goes hand in glove with dentistry, is vital for reducing the risk of severe Covid-19 outcomes and is an important part of patient safety and the prevention of ill health?

[Lord Bethell (Con)]

My Lords, I confess that I did not know about that association. I am not sure whether it is correlation or causation, but I completely support the noble Baroness’s observation that oral hygiene is critical, and we should put the steps in place to improve the oral hygiene of the nation.

[Baroness Thornton (Lab)]

I think the Minister needs to go back to the drawing board, because the new NHS activity target is basically forcing dentists to choose between check-ups and helping those in pain. That cannot be right. It can only increase health inequalities, let alone deal with the gigantic pandemic backlog. In secondary care, there is the particular problem of patients needing general anaesthetic for their dental treatment. These are mostly children and learning-disabled adults. There was already a waiting list of a year before the pandemic. Could the Minister inform the House how many patients are on this waiting list now? If the Minister does not have this information, could he please write to me? Do the Government have a plan to reduce this awful, and obviously very painful, waiting list?

[Lord Bethell (Con)]

My Lords, I do not necessarily accept the dichotomy the noble Baroness refers to. I think it is reasonable for dentists to triage patients between those who can be treated with either advice, analgesics or antibiotics, and therefore do not need face-to-face contact, and those who need to be prioritised to, for example, the urgent dental care centres. I commend the dental profession for making good choices in that area. With regard to the treatment of children using anaesthetics, those are not statistics I have to hand, but I would be glad to write to the noble Baroness with whatever information we have.

[Baroness Jolly (LD) [V]]

My Lords, when I inquired, none of the dentists in north and east Cornwall was able to offer an appointment for NHS dentistry, so I know to my cost that private treatment is expensive. Would the Minister tell the people of Cornwall, whose earnings are below both regional and national averages, what should be done about this lack of NHS dentists in remote areas, leaving patients untreated, in pain and often resorting to self-care?

[Lord Bethell (Con)]

My Lords, as I said earlier, 88% of NHS dentists are open. I was at an NHS dentist earlier today, and I pay tribute to all those dentists that are open. I do not know the specific situation in north and east Cornwall, but those in acute pain have access to the 695 urgent dental care centres, which are around England. I have enormous sympathy for those who have painful teeth, and I urge them to hunt down an appointment at one of those centres, where the service is excellent.

[Lord Rogan (UUP) [V]]

My Lords, official statistics show that the number of patients seen by general dental service dentists in Northern Ireland fell from 163,537 last February to just 8,825 in June, but rose again to 49,059 in September. With many of the current Covid restrictions having been put back in place since then, what discussions have UK Ministers had with their counterparts in Northern Ireland and the other devolved regions to encourage people to visit their dentist rather than suffer pain at home?

[Lord Bethell (Con)]

My Lords, I am grateful for that account of the Northern Ireland statistics, which tell a very similar story to those in other parts of the United Kingdom. The noble Lord is entirely right that those statistics tell a story of the massive challenge dentists face in order to increase the number of appointments per day. We are looking at a number of measures to try to improve that, including ventilation, which was referred to earlier by the noble Baroness. Testing is another option we are looking at. We are trying to put in place the kind of pre-appointment and point-of-care testing that can protect both the employees of dental practices and their patients. I hope that will help accelerate improvement in this area.

[The Lord Speaker (Lord Fowler)]

My Lords, I regret that the time allowed for this Question has elapsed. We now come to the third Oral Question.