NHS Dental Contract

Lord Markham Excerpts

Thursday 1st December 2022 Lords Chamber

[Lord Young of Cookham]

To ask His Majesty’s Government what plans they have to review the NHS dental contract.

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

In July, the department announced a package of improvements to the NHS dental system, which included reform of the 2006 contract to ensure that dentists are remunerated more fairly and patient access is improved, especially for those with higher oral health needs. Implementation of these changes is under way, and we recently laid legislation in Parliament to deliver them. We continue to work with NHS England and the dental sector on further reform, which we plan to announce in 2023.

[Lord Young of Cookham (Con)]

I am grateful to my noble friend for that reply and for the recent modifications to the contract. But does he agree that much more radical reform is needed to that contract, which was described as “not fit for purpose” by a Select Committee in another place, if we are to address the exodus of NHS dentists, encourage more to join, address the 91% of dental practices that no longer admit new adult patients and help areas of the country with no NHS dentists at all? When will we have the longer-term radical reform referred to the last time I asked this Question, in May?

[Lord Markham (Con)]

I thank my noble friend, and I declare an interest: my wife is a dentist, although she is not practising at the moment. This is one of those rare occasions when it is a case not of announcing new spend but of making sure that the £3 billion we spend is fully utilised. To answer the question directly, it is absolutely right that we need a radical package to make sure that dentists are contracting against their UDAs and finding working in this space worth while and profitable, so that we get the full use of that. I will happily come forward with further proposals, planned for 2023, on what we are going to do in this space.

[Baroness Boycott (CB)]

My Lords, one reason why young children now go into hospital and have anaesthetics is to have all their teeth out, largely as a result of sugary diets. As we see through our Feeding Britain network, a lot of children do not have toothbrushes and definitely do not have toothpaste. Scotland has been trialling some really efficient systems whereby dentists go into school, give out free toothbrushes—which a lot of toothbrush manufacturers will happily supply—and get children into the habit of cleaning their teeth. Given the massive absence of dentistry, which will take a long time to fix, can the Government look at a simple measure such as that, which would greatly improve the nation’s teeth, especially our kids’? It is a nightmare to have all your grown-up teeth taken out at eight years old; you are stuck with lousy teeth for ever, and it is not fair.

[Lord Markham (Con)]

I agree, and I understand the problem. I also agree that we need to look at a broad range of measures. I was delighted that we passed the statutory instruments on water fluoridation recently, and we should look at new ideas. I was also delighted to see oral health advice included in the new family hubs being set up. We are willing to look at measures that work elsewhere as well, such as free toothbrushes in Scotland.

[Baroness Brinton (LD)]

My Lords, the British Dental Association has proposed four simple emergency measures—changes which could be made to the dental contract that would make an enormous difference. The Minister referred to the regulations. Regulations in respect of the workforce will make significant changes too. They were in Forthcoming Business and then removed. When will they be heard in this House? This reform is urgently needed.

[Lord Markham (Con)]

As mentioned, the new package of measures, which is all about encouraging dentists into the NHS space, will be brought forward next year. The workforce plan is now under way. However, central to all this is not the budget but making sure that it is fully utilised. As the noble Baroness said, that will happen by having more NHS dentists. We currently have 3,500 in training, which is working towards that, but, clearly, we need to work further.

[Lord Sherbourne of Didsbury (Con)]

My Lords, does my noble friend the Minister agree that the state of NHS dental care in this country over many years is a national scandal? Following on from the question from the noble Baroness, Lady Boycott, on the importance of making sure that children not only pursue proper dental health but eat the right food and do not have the wrong drinks, is he aware of the charity TasteEd, which is doing a huge job in schools to encourage children to eat the right kind of foods for health of all kinds?

[Lord Markham (Con)]

I thank my noble friend. We need a 360-degree approach. It is not just about dentists on the ground, although we agree that we need more in the NHS; it is also about healthy eating, water fluoridation, and oral health workers in the family hubs, for which a £300 million budget has just been announced. I agree that we need to take all those actions.

[Baroness Merron (Lab)]

My Lords, following much pressure, including in your Lordships’ House, the Government have promised for next year independently verified workforce forecasts for the number of doctors, nurses and other professionals. Can the Minister confirm that the space to which he has repeatedly referred in this Question will include dentists? If so, can he commit to an assessment within this of the impact of the NHS dental contract on recruitment and retention?

[Lord Markham (Con)]

My understanding is that the staff plan will include dentists, but I will confirm that in writing. I absolutely accept that the contract changes must attract people into the profession. For the dental deserts, we need to encourage, for example, a dentist who has been in practice for eight years to set up a new practice. They are used to being a dentist, but they are not used to raising the money to set up a new clinic in a new area, which is what they need to do. Clearly, that is the sort of support we need if are to tackle the dental desert issue. I am under no illusions as to what needs to be done, and we are working on it.

[Lord Scriven (LD)]

My Lords, I declare my interest as a vice-president of the Local Government Association. Does the Minister agree, despite the new package that has just come forward, with the Conservative chairman of the Local Government Association Community Wellbeing Board, who has said that the Government should urgently commit to a comprehensive dental workforce strategy and increase councils’ funding of the public health grant in real terms to help deal with the dental desert in many parts of the country?

[Lord Markham (Con)]

I thank the noble Lord. As I mentioned, dental deserts are very much a part of the package we are looking at. To give noble Lords an idea of the sense of direction, another approach to the workforce issue is a modular escalator system, and we are talking to the BDA about training. For instance, on the way to becoming a fully qualified dentist, might a dentist become part-qualified, allowing them to do some dental nurse treatments, thereby adding to that capacity in the meantime? These are all measures we are looking at to increase the workforce.

[Lord McColl of Dulwich (Con)]

Can the Minister tell us what proportion of the population is actually receiving fluoride in their drinking water?

--- Later in debate ---

[Lord Markham (Con)]

I will need to write to give the exact number. From memory, it is not a big number at the moment—less than 10%—but I will confirm that. That is why I was pleased that we agreed the measures the other day, so that we can expand that. Evidence shows that in areas where water is fluoridated—again, I am speaking from memory and I will confirm it in writing—tooth decay declines by as much as 20%, so it does work.

[Baroness Jolly (LD)]

What advice does the Minister give to people in Cornwall for whom the nearest NHS dentist is 50 miles away but there is no public transport from the local town to the practice?

[Lord Markham (Con)]

I am aware of some of the dental deserts. Some 700 urgent care centres have been set up to try to cater for such cases, and they have seen 4 million people. In total, there were about 26 million treatments last year. About 75% of patients who wanted to get an appointment were able to. Clearly, that leaves 25% who were not. We need to work further on that, including in Cornwall.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, the Minister’s replies have been exceptionally helpful. I wonder whether he and the Government could consider what might be done to get non-practising dentists back into practice.

[Lord Markham (Con)]

It is a good question. I will take the noble Lord’s compliment of being exceptionally helpful; I hope I can give another helpful answer. We need to look at everything we can do to attract dentists. The contract is fundamental to that, because, unless it is attractive for them financially, it will not help.

[Lord Bird (CB)]

Is it possible also to look at some of the innovations that are done socially, especially for homelessness? We have brought back travelling dentists, and maybe they can go to Cornwall and other places. We have invested in a business in Plymouth that goes around hostels, and it has been remarkably successful.

[Lord Markham (Con)]

As mentioned before, we are open to all ideas to try to tackle this problem. As we all know, it has been going on for a long time—probably decades. A 360-degree solution is needed; we are open to looking at everything.