Access to NHS Dentistry

Maria Caulfield Excerpts

Thursday 10th February 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Ali. I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing the debate and I am pleased that he is seeing a local improvement after we met recently. I also thank the hon. Member for Bradford South (Judith Cummins) for securing the debate.

I agree with my hon. Friend the Member for Stroud (Siobhan Baillie) that we have seen a level of interest in and concern about the matter across the Chamber, and that we need to ensure that we take some of the politics out of it because there are some difficult steps to take to improve dental services across the board. I welcome the contribution from my hon. Friend the Member for Mole Valley (Sir Paul Beresford), whose clinical experience is so helpful in the debate. I reassure colleagues on both sides of the House that since I came into post in September, dentistry has absolutely been a priority for me. I have been working night and day to try to make some short and long-term improvements, because I am live to all the concerns that have been raised.

We have set up some joint working, which was not happening before, between NHS England, the chief dental officer and the Department, and I meet the BDA regularly because we are serious about reform. I say to any dentists watching the debate that I absolutely understand the problems that make delivering an NHS contract unbelievably difficult. The contract is the No. 1 long-term issue that we have to deal with, and we are starting progress on that as soon as possible. I will come to some specifics shortly, but first let me mention covid.

I know that there has been some concern that covid is a lame excuse but, as my hon. Friend the Member for Mole Valley said, it has had a significant impact on access to dental services in the past 18 months. When lockdown happened, services were immediately reduced; only urgent services were allowed. That continued for a significant period. It was not until 8 June 2020 that practices were allowed to open for up to 20% of normal activity and it was not until last year that that went up to 60% and, towards the end of the year, to 65%. Although dentists were compensated for their loss of income during that period, the backlog that that generated is shown in all our postbags right now.

I place on record my thanks to dental teams up and down the country. Urgent appointments went back to pre-pandemic levels in December 2020, but with only 85% of activity allowed the backlogs will only grow. We need to be honest about that; the impact is significant. I completely understand the pressures that that is putting on dentists. We are keen to support dentistry where we can to get it up to 85%. It has been difficult during omicron with staff sicknesses and patients having to cancel when they become covid positive, and I absolutely recognise the stress and strain that covid has put on the system, but we have to be honest. I think it was the hon. Member for Bootle (Peter Dowd) who mentioned this, and I am happy to accept the difficulties we face. There were problems before covid and there are those same problems post covid, and we are absolutely focused on starting to tackle them.

Let me make a couple of points. There is no patient registration system for dentistry—that is one of the myths. It is not like GP practices, where someone signs up and is then on the list. Patients can go from dentist to dentist if there is one available, and we are making sure that we open up capacity where it exists.

We have written to all dentists to ask them to update their capacity so that we can put it on the website mentioned by the Father of the House, my hon. Friend the Member for Worthing West (Sir Peter Bottomley), and we have also asked them to run a cancellation list. If someone cancels, the practice will be able actively to contact the next person on the list. Capacity is being generated by that, but I am aware of the problems with capacity across the board. We have talked about many parts of the country, such as Norfolk and Devon, that are experiencing capacity issues, but all parts of the country have experienced a squeeze in the number of appointments available.

A couple of weeks ago, we announced £50 million to help with some of those issues. I know that some Members have been quite dismissive of that this afternoon, but we know that it will cover the period to the end of this financial year to buy some urgent capacity for the system and to help deliver more than 300,000 appointments that currently cannot happen. There has been good uptake, even in the few weeks since the money was announced. Regions across the country are signing up and because the payments to dentists are much better than under the current contract, there is an appetite among dentists. That shows that if we remunerate dentists adequately they have an interest in taking on NHS work.

I encourage Members from all parties to contact their local commissioners, because we want to ensure that that money is used. If there is no interest, or if they are struggling to spend the money, they should let us know. NHS England has been in contact with local commissioners to get that feedback so that we can make the best use of the money and buy as much capacity as possible.

[Kevin Hollinrake]

Does the Minister think that it is acceptable for commissioners to take 20 months commissioning a service when we have dentists who want to take that work and take on that surgery?

[Maria Caulfield]

Absolutely. I will come on to that point, which is valid. We want to increase capacity and there are dentists who want to take on NHS work. When contracts are handed back, we have to do the whole procurement process, and when there is an interested party, even when they are ready to sign on the dotted line, that takes a considerable amount of time. In the Department, we are looking at how we can change the procurement process. It often falls in the lap of local commissioners, but they are stuck with the procedures they have to follow. I am keen to see how, when someone is willing to take up a contract, we can enable that to happen as quickly as possible.

We have also relaxed the upper tolerance threshold and increased activity from 104% to 110% of dental activity. The current contract penalises dentists if they go over their contracted work, which is a perverse disincentive when dentists have capacity and want to take on extra work.

Before I touch on the nub of the problem, I will mention prevention. I am pleased that prevention is being considered and that the Government’s proposals on water fluoridation are part of the Health and Care Bill. I hope Opposition Members will support us when the Bill comes back from the Lords. We are also looking at options for how to introduce supervised tooth brushing in parts of the country where there is the greatest need. I reassure hon. Members that the prevention and oral health element is as key as getting dental procedures done.

The dental contract is the crux of the matter, and we are absolutely committed to reform. I met the BDA this week to start negotiations. We are looking at some quick wins over the next 12 months and some long-term contractual reform to the UDAs. We have started informal negotiations, and the formal negotiations will start in April. We all—the BDA, patients, MPs and the Department —know the urgency. It cannot be a long, protracted negotiation. However, we are working well with the BDA. We are keen to get negotiations under way and to reach a resolution as quickly as possible. We have to make the NHS a better and more attractive place to work, because dentists have other options; I cannot remember which Member said it, but dentists are voting with their feet when it comes to where they want to practice.

On the recruitment, retention and training of dentists, Health Education England published its “Advancing Dental Care Review” in September. It is working through how we can train not just more dentists but the whole dental team, and on how we can upskill dental technicians and dental nurses. We will bring forward legislative changes to enable other members of the dental team to take on more roles. We are setting up centres of dental development in those areas of the country with the biggest shortages, which tend to be coastal and rural. I take the point made by my hon. Friend the Member for Broadland (Jerome Mayhew) about Norfolk—I think I heard that several times. We are looking at where in the country those dental deserts are and whether we can match them to centres of dental development.

Members may not realise that this week the Department announced a consultation with the General Dental Council on the registration of international dentists and whether we can put in place a process to recognise the qualifications of dentists from around the world, as my hon. Friend the Member for Mole Valley mentioned. The overseas registration exam, which they have to take, was suspended throughout the whole of covid, so we have a backlog of around 700 dentists waiting to take it. The first exams started a couple of weeks ago, and there are exams in place for the rest of the year to try to get through that backlog. We are confident that we can do that.

We need to work on how we recognise existing qualifications to remove the barrier of having to do an exam. Again, I encourage colleagues to respond positively to the consultation on the GDC website and to the developments it is making. My hon. Friend the Father of the House has written to me about international dentists having to take the exams within five years of their first attempt, and whether those rules can be relaxed. That is also part of the consultation. We very much recognise that covid has had an impact on those rules too.

I reassure colleagues that I am working on bringing NHS England, dentists and the BDA together so that we can make a difference as quickly as possible. The changes in the Health and Care Bill on integrated care systems and having accountable people for commissioning locally are crucial. Integrated care boards will be statutory from 1 July, and will have accountable officers. I strongly urge colleagues to speak to their ICBs or CCGs, because there are differences in practice across the country. Some commission dentistry really well, some not so well. Very often, if the money allocated to dentistry is not ringfenced, and if it is not spent locally, it goes into other healthcare provision and is lost from dentistry. I encourage Members to hold the feet of their local commissioning bodies to the fire on what they are doing with the money given to them. We are here to support them, and work will be done on dentistry commissioning going forward.

In the short time I have had, I hope I have been able to provide assurances that dealing with the situation is not without its challenges. There is no silver bullet that will resolve all the problems. There is not a quick-fix solution, but I am working at pace, as is the Department, to reform the contract. Work is starting in April on the formal negotiations, and I hope that will improve recruitment and retention in dentistry. We value the work that dentists do, which for too long has gone unrecognised and has been a Cinderella part of the service. The people who have suffered are not just the dentists, but the patients.