National Health Service (Primary Dental Services) (Amendment) Regulations 2022

Lord Markham Excerpts

Tuesday 24th January 2023 Lords Chamber

I hope that the Minister can address all these points, because I am afraid that NHS dentistry in this country is going in the wrong direction. We need to see it provided so that people can be assured of their health in all ways.

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

My Lords, I start by declaring an interest: as I have mentioned before, my wife is a dentist, and so interested in this. She has been able to join us here, as part of a celebration for my father’s 80th birthday. Who knows why they would want to come and listen to me on such a night?

I thank the noble Lord, Lord Hunt, for securing the debate on this important matter and thank noble Lords for their contributions. We all agree that dentistry is a vitally important area. On the points made by the noble Baroness, Lady Bennett, I agree that health and oral health are indivisible. This is a key part of levelling up. I agree with the premise that these SIs are a start, not a finish—a point made by the noble Lord Allan.

I will try to address the points made by the noble Baroness, Lady Merron, about the defects of the SI. I am not defending some of the other things but I would like to think that this regret Motion and the one that we had the other day are more about having a debate because we think that we can do better, rather than disagreeing with the SIs themselves. If that is the case, I agree that they are the start and not the finish; there is definitely more that we want and need to do in this space. These regulations are a sensible first move. Some changes have been mentioned already tonight but the UDA changes—to put the minimum value in place and ensure that it more fairly reflects the complexities of some of the treatments—are steps that we worked with the BDA on. I think we would all agree that they are sensible steps.

I have also heard various variants on some dentists, for want of a better word, gaming NHS contracts. I have definitely seen some of that behaviour. I will need to take away some details on the points that the noble Lord, Lord Hunt, made about pension qualifications, but we generally recognise that that is going on. At the same time, the provisions within the SI to give more support, 110% or even more, to those who are properly contributing to the system are welcome. I hope that that would be generally agreed.

I hope that we would all agree that the other measures, such as using teams to get a better skill mix and DCPs to do more of that work, are sensible. I agree that we need to reduce those obstacles. I did not realise that we had the Tim Berners-Lee of the dentist directory among us today, but I hope that we would all agree that moves on dentistry website information are sensible, modest though they are. I know that water fluoridation is a great favourite of the noble Lord, Lord Hunt. We are making moves on it. On the changes we were discussing the other day on GDC international recruitment, the mutual recognition of qualifications is a good first step and should definitely be a way forward in easing access. There clearly has to be a better way forward on intelligent use of recalls, rather than those people who are already lucky enough to be with an NHS dentist automatically getting a six-monthly reminder. We all know that, in many cases, those appointments could be better used elsewhere.

As mentioned, we all agree that these measures are just the start and definitely not the finish. The steps we need to introduce have to centre around supply and workforce. On when the workforce strategy will be published, fairly advanced drafts are being circulated, as I mentioned the other day. A lot of work has been and is being done in that space. While I cannot give a precise date, I think it will be in the not-too-distant future—let me put it that way. We recognise that more needs to be done on it. As the House has heard me say before, a lot of that is around the flexibility between qualifications and having much more of a modular, escalator-type approach. For instance, it surely makes sense for a dentist to be qualified as a nurse along the way, two years in, and then to be able to start work in the dentistry profession and hone their skills, rather than supplementing their income down at Wetherspoon’s as they finish the rest of the course. I think we all agree that those have to be sensible measures, and I know this is very much the direction of travel being worked on.

The critical element is dental deserts. We all know this is the nut that we have to crack. When I have conversations with colleagues normally, having a bit of knowledge can sometimes be a dangerous thing. In this instance, I try to describe it. I ask them to think about a situation where we want a dentist who has probably been there for about 10 years and is in their mid-30s. We might say, “We would now like you to set up your own practice.” The dentist says, “Great, I’d like that. I’m up for that.” We say, “And in an NHS dental desert, because that’s where we need it.” The dentist says, “That’s good, I really want that. What do I have to do?” We say, “Well, raise 400 grand to set up a practice; set up payroll so you can employ six to eight people; start marketing yourselves; fit it all out, get the chairs, and off you go.” They say, “Hang on a moment, I’m a dentist. I’m good at being a dentist. I’ve done it for 10 years, and I think that qualifies me. I’m not in a position to go out there and set up a dental practice like that.” So, I think there is recognition that, if we are really going to move the dial in that area, we have to give them far more help and support: the know-how, some of the funding, the whole package. Clearly, if you are going to get that support, you need to be committed to doing it in that area, but that is the kind of direction of travel that I know colleagues are working on. So while I portray a personal view in terms of my feelings towards it, I know that is very much recognised by colleagues in the House.