NHS: Dentistry Services

Lord Colwyn Excerpts

Thursday 25th July 2019 Lords Chamber

[Lord Colwyn (Con)]

My Lords, like my noble friend Lady Gardner, I declare my interest as a fully retired dental surgeon with more than 40 years’ experience. I am a fellow of the British Dental Association and vice-president of the British Fluoridation Society. I thank my noble friend for securing this debate. I also welcome my noble friend Lady Barran, who joins a select group of Peers who understand dental politics. It will only get better, I am sure.

Noble Lords will know that I take every possible opportunity to raise the issues of oral health and dentistry in the House, as these important subjects are all too often overlooked. I am pleased to have another chance to highlight the growing problem of access to NHS dental services today, even though so few colleagues are able to be here on the very last day of the parliamentary Session—and the hottest.

More and more studies now confirm what dentists have always suspected: that a healthy mouth is a gateway to a healthy body and that neglecting oral health can sabotage our long-term overall health. Tooth decay and gum disease are increasingly linked to a heightened risk of serious health problems such as stroke, heart disease and diabetes, yet we continue to treat NHS dentistry as a Cinderella service by not giving it the importance it deserves. Government funding for NHS dentistry per capita in England has fallen by 29% in real terms since 2010. At the same time, patient dental charges have gone up by an inflation-busting 5% in each of the past four years, despite studies showing that rising charges discourage patients from seeking the treatment they need.

Underfunding NHS dentistry might seem tempting at a time of great pressures on the NHS as a whole, but such thinking is short-termist and wholly counterproductive. Patients who cannot find an NHS dentist or delay treatment due to its cost can end up piling huge pressures on other parts of the NHS. Every year, thousands of patients seek free help with dental pain from their GPs or the local accident and emergency department, neither of which is equipped to help them. If you add the cost to the economy of sleepless nights and lost working days caused by tooth pain, it becomes even clearer that cutting dental services is not only bad for patients but a false economy.

It is appalling that only half of adults in England have seen an NHS dentist in the last two years and that more than four in 10 children in England have not seen an NHS dentist for over a year, even though ideally they should have a check-up every six months. We must make sure that we improve access to NHS dental services, so that both children and adults can attend regular check-ups and get a timely diagnosis and appropriate treatment, if required, early on.

Whenever this issue is raised, Ministers assure us that the access rate to NHS primary care dental services remains high. Yet not a week goes by without a new story hitting the press about shocking waiting lists and journey times faced by patients all across England looking for an NHS dentist. We have heard about this already today. Earlier this month we learned that in Cornwall the waiting list for an NHS dentist has topped 22,000, with people waiting 529 days on average. If you live in Windermere in Cumbria, the nearest practice able to accept new NHS patients is now a 104-mile round trip away; this would take over six hours on public transport. Not a single dental practice in the entire city of Portsmouth is able to take on new NHS patients. The list of examples goes on and on. While the Government claim that these are isolated hot spots, it is becoming increasingly clear that this problem affects every part and region of the UK. Something needs to be done, and fast.

Morale among NHS dentists is at an all-time low. According to the British Dental Association’s last member survey, more than two-thirds of dentists with a large NHS commitment are planning to scale down their NHS activity or leave the service altogether in the next five years. Three-quarters of practice owners report struggling to fill vacancies—up from half just two years ago. Practices are closing in large numbers as they struggle to recruit and make ends meet under the current dental contract. Unless there is a change of direction, we will soon be facing an even greater exodus of dentists from the NHS. This brings into sharp focus the urgent need to deliver a reform of the dental contract.

Last April saw the 13th anniversary of the introduction of the current dental contract. This contract is not only widely detested by dentists themselves and discredited by health policy experts, but, equally importantly, is bad for patients as it rewards dentists for carrying out interventions rather than keeping their patients healthy to avoid them. Dentists were promised a new, improved contract back in 2010, but with the fourth wave of so-called prototypes still testing possible new arrangements, it looks as if this badly needed reform is being kicked into the long grass. It is crucial that we stop dragging our feet and finally introduce a new, more preventive, contractual basis for NHS dentistry that would improve access for patients. Both dentists and patients desperately need this. Shifting the focus to preventive treatment would not only yield long-term savings but improve access to NHS dental services and quality of life across the country.

I share the concerns of the British Dental Association that the long-running prototypes remain the tarnished system of payment per unit of dental activity, alongside payments per capitation and quality. With tooth and gum disease linked to many other costly health conditions such as diabetes and heart disease, our health system cannot afford to wait much longer for the NHS to be commissioned in a way that makes a decisive break from activity targets and puts prevention squarely in the centre.

The BDA tells me that dentists want to be paid for keeping their local communities healthy, not for the number of treatments performed. That is what makes the most sense for the long-term sustainability of our NHS, too. We cannot achieve improvements in oral health with a system that continues to offer perverse incentives to treat instead of rewarding dentists for preventing disease.

As an absolute priority we need a new, improved dental contract; a focus on prevention rather than cure; and adequate investment in NHS dental services. These would ensure not only an improvement in access to NHS dentistry for patients but also better oral and general health outcomes for the British people. I hope that our new Minister will take note and I am grateful for her help in this.