Health Bill

Lord Lansley Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Lord Lansley (Con)]

My Lords, I want to intervene in this debate to talk about dentistry, particularly for the reasons set out by the noble Lord, Lord Hunt of Kings Heath. We do not debate dentistry much, and insofar as this Bill is not changing but simply restating the commissioning obligations of the NHS, we should take the opportunity to say, as we will in a number of other respects as we go through the Bill, that there is room for reform. That reform may not necessarily require primary legislative change, but that does not mean we should not take the opportunity to make those points.

To follow up on what noble Lord, Lord Hunt of Kings Heath, said about the need to move on from units of dental activity being the basis, my noble friend Lord Howe and I fully agreed with that thought 15 years ago. That was why we entered into the now tedious process of trialling, piloting and then prototyping how a new dental contract would work. Its purpose would be to pay practices on a capitation basis, with a focus on preventive work and the maintenance of good oral health, rather than remuneration by reference to units of dental activity and what is regarded as the treatment treadmill on which dentists had worked. Notwithstanding the Government’s view in 2023 that these prototypes were a failure, the principles remain right. Therefore, we should say to the Government: do not let it drop.

First, the capitation was based essentially on existing populations, and the whole point of the system would be to establish the initial oral health status of a given population to a degree of granularity that enables it to be a serious measure of what needs to be done. That would be really important, taking the point made by the noble Lord, Lord Patel of Bradford, in places where there are serious deficiencies in present oral health status. It would allow us better to modulate dental resources to the places where the need is greatest. The first thing is therefore to get that capitation—that basis—right, and there is going to have to be an initial investment to establish the oral health status of the population in relation to dental practices before we start down the process of remunerating practices for the work they have to do.

Secondly, the structure of payment to dental practices needs to move away from treatment towards prevention and the maintenance of the oral health of the population. Once we have a good measure at the start, we can assess how well practices are doing. That means that we have to introduce for dentists a quality and outcomes framework with similar incentive effects to the framework for GP practices; it should adopt a similar approach. In addition, we must be clear that the purpose of this is to maintain and increase good oral health, and therefore to reduce the number of treatments. Indeed, the prototypes of the new dental contract took various forms, but it did lead to a significant reduction in the number of treatments. However, because the incentives were not aligned properly, dental practices were not then incentivised to increase access. The whole point is to reduce the number of treatments and to increase patient access to NHS dentistry.

We should aim to arrive in the long run at a point where not only children but most adults assume that they can access NHS dentistry. We will have to be open to combining NHS entitlements in the maintenance of good oral health with the ability to use private dental care.

Finally, the Treasury had a hand in all this, and some 10%—or in some cases maybe more—of the patient income did not materialise in these prototypes because the patients were not paying for the treatments. We received about £860 million a year by way of dental charging, and losing £100 million or thereabouts was not something the Treasury was very keen on. But that just means we should have dental charging that is not linked to treatments. The logic says that if we are aiming for a dental contract which prioritises access, good oral health and preventive work, then so should the charging regime; all these incentives have to be aligned.

I hope that, notwithstanding the unhappy experiences that many would say the dental contract reform process has suffered up to now, we do not give up. We should go back to it. We should look at it and say we have learnt a lot. That means that we have to go back into this process, reasserting the principles and aligning the incentives with those principles.

[Lord Kakkar (CB)]

My Lords, I support Amendment 213 in the name of the noble Lord, Lord Hunt of Kings Heath, and the noble Baroness, Lady Pidgeon. I wonder whether the Minister might comment on the fact that while chronic gum disease in itself is a bad thing, resulting from a lack of access to primary dental services, it is associated with a profound impact on systemic health and, in particular, chronic diseases such as cardiovascular disease. Those with gum disease are at far higher risk of heart attacks, stroke and narrowing of the blood vessels—atherosclerosis.

In establishing the principles and the mechanism for the delivery of a regular state of NHS dentistry report, with the capacity now to federate across different datasets in the NHS, we would have the opportunity to start understanding the relationship between the failure to provide primary dental services and the prevalence of other chronic diseases, in particular cardiovascular diseases. That might well help further improve the mapping of services and local investment not only in dental services but in services for other, potentially fatal diseases.

I wonder whether the Minister and indeed the department have considered how this report might be the stimulus for bringing together other datasets and understanding the impact of the failure in dentistry provision on the broader health of the nation.