NHS Dentistry in England

Maria Caulfield Excerpts

Wednesday 22nd June 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, Mr Stringer. I thank my hon. Friend the Member for St Ives (Derek Thomas) for securing this important debate—even if it is two days in a row that we have highlighted some of these issues. I thank hon. Members on both sides for speaking on the matter.

I am slightly disappointed in the response of the shadow Minister, the hon. Member for Enfield North (Feryal Clark). In yesterday’s debate, it was acknowledged that in all four nations, no matter who is in charge—whether it is the Labour Government in Wales, the SNP in Scotland, or in Northern Ireland, where the Assembly is still being formed after the election—there are exactly the same problems. In my speech yesterday I made reference to the fact that in Labour-run Wales there has been a 71% reduction in dental activity in the last year. The shadow Minister spectacularly failed to answer the intervention from my hon. Friend the Member for Totnes (Anthony Mangnall) on that very point.

It is important to recognise that, yes, there have been problems since before covid, but covid has dramatically impacted—

[Feryal Clark]

Here we go.

[Maria Caulfield]

The hon. Lady says, “Here we go,” but it is important to recognise that for two years there were no routine appointments available due to infection control measures. We are now back up to 95% of activity, but the backlog that existed before is significantly larger than it was.

It is also important to recognise that the nub of the problem around covid has been the dental contract. The shadow Minister may not have heard what I said yesterday, but we have been negotiating a new contract with the BDA; we started those negotiations on 24 March, a final offer went to the BDA on 20 May, and we are awaiting its response. We have been in negotiations; we have not just been waiting for the work to be done. We expect to make an announcement before the summer recess—I said that both at oral questions last week and in the debate yesterday. We will be making an announcement in the coming weeks on those contract reforms.

[Paul Blomfield]

It is helpful that the Minister has given us that information about the offer made to the BDA. Can she confirm that the offer addresses the four points I asked her about on flaws in the contract? I raised those points in the debate yesterday, and they reflect concerns across the House. Is it the sort of fundamental reform of the contract that will stop dentists being driven out of the NHS and into private practice?

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[Maria Caulfield]

I obviously cannot comment while there are live negotiations ongoing, as I am sure the hon. Gentleman will appreciate, but the offer will drive some reforms in respect of the issues raised by a number of colleagues around fair payment for dentists’ level of activity. It will also look at the whole dental team and not just dentists. We have looked into whether we need legislation to be able to upskill dental technicians and dental nurses, for example, and we do not, so we are able to make progress on some of those areas, reward them for the work that they are doing and enable them to take on more work. A number of the issues that the hon. Gentleman raised will be covered by that.

The hon. Member for Enfield North may not know this, but before the latest round of negotiations, there had been a number of pilot studies over the last few years looking at completely reforming the UDA model and moving to a capitation model. Those pilot studies unfortunately did not produce the results we were hoping for. They did not increase access for patients, they did not reduce inequalities and they did not point to a sustainable model, so we did not go forward with that model. That is why we started new negotiations earlier this year on reform.

It is wrong of the shadow Minister to say that nothing has been done over the last 12 years. We had two years of covid where there was no routine dental activity; only urgent appointments were undertaken. Before that, there were three years of pilot studies on the capitation model; those were not successful, which is why we have not driven forward those changes. It is important that when we introduce changes, they address the fundamental issues that have been raised in this afternoon’s debate.

[Paul Blomfield]

Could I press the Minister in particular on the point that I made on financial clawback? It has been made clear to many of us who have talked to dentists that one of the most demotivating factors in the current contract is that while they are not rewarded for additional performance with NHS patients, they face clawback if they underperform, including for reasons that are completely beyond their control. I understand that for the last quarter that is currently being considered, 57% of dentists are going to face financial penalties. Those are the sorts of issues that are tipping them out of NHS dentistry. Will that issue be addressed?

[Maria Caulfield]

We are looking at the issue of clawback. Obviously we are in negotiations, so I cannot say what the final outcome will be. However, on the point that the hon. Gentleman makes about clawback during the last quarter, when the omicron variant was a particularly significant factor, we made clear to commissioners and dentists that if there were issues arising from omicron—patients who could not attend their appointments, or dental teams that were unable to be at work—they would not be subject to clawback. I would be disappointed if dentists who could not undertake their units of dental activity for covid-related reasons were penalised with clawback for that, because we made it very clear that there needed to be a flexible mechanism to mitigate some of those issues. If the hon. Gentleman has examples of that, I would be happy to take them away and ask officials to look into them.

[Peter Aldous]

There is some ambiguity about where the negotiations stand. Can my hon. Friend clarify whether a letter has gone to the BDA to start the negotiation process, or whether there are finalised heads of terms ahead of an announcement on a new contract?

[Maria Caulfield]

The negotiations started back in March and there have been a number of meetings with the BDA. The BDA has been sent final recommendations, but we have not yet heard back, so I encourage the BDA to respond.

I will touch on a number of other issues that have been raised, the first of which is overseas dentists. For obvious reasons, no overseas registration examinations took place during the pandemic, creating a backlog of over 800 overseas dentists waiting to take their exams. Exams restarted earlier this year, and extra sessions are being held to get through that backlog of dentists so that we can get them into the system and working as dentists as quickly as possible.

We have also been working with the General Dental Council, which is the regulator, on recognition of overseas qualifications. The GDC did a consultation on regulation and recognition of overseas dentists, which I think closed on 5 or 6 May. We are waiting to hear the feedback from that consultation, but we are happy to lay regulations in this place—if necessary, we can do so by the end of the year—to give the GDC the power to mutually recognise overseas dentists according to its judgment. It is not for the Government to mutually recognise qualifications; it is for the regulator. However, we are happy to give the GDC the power to do so, and we look forward to its feedback on the consultation it undertook, because our overseas dentists are a rich source of the talent and skill that we need.

When it comes to getting more dentists into certain parts of the country—obviously, one of those areas is the south-west, whether that is Cornwall, Devon or Plymouth —significant work is going on. I met with Health Education England this morning to look at how we can set up centres for dental development. Those centres are different from dental schools, which are often very expensive and take a long time to set up, and, as was said during the debate, there are not always dentists available locally to supervise the training. Centres for dental development can be much more flexible and meet existing local needs while also looking at what needs could develop.

As such, we will be working up a programme, looking at what we can do in those specific parts of the country with the greatest need. In Norfolk, I recently met a group of local MPs and representatives from the local university and the local enterprise partnerships, all of whom are willing to work together to make that happen. I am going to Portsmouth on Monday, to Gosport, to see exactly the same thing—dentists coming together to come up with local solutions that will make a difference.

[Anthony Mangnall]

I am grateful to the Minister for giving way, and I thank her for those words. Far from burying her head in the sand, she is putting her head above the parapet. That is most welcome. As mentioned by my right hon. Friends the Members for Ashford (Damian Green) and for South Holland and The Deepings (Sir John Hayes), there is clearly significant data that highlights the worst affected areas. Given that the data is there, could we expedite that roundtable meeting as quickly as possible?

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[Maria Caulfield]

I am very happy to meet MPs. Once we get through the contract announcements before the end of recess, it has to be a priority to look at how we increase the number of dentists in specific parts of the country, whether in York or in coastal or rural areas. I am very willing to do that. Many parts of the country do have enough dentists, but they do not want to take on NHS work, so we are also going to look at the procurement and commissioning of services. That is where the ICSs will come into their own. At last, local commissioners will be accountable for commissioning dental work. There is no ring-fenced budget for dentistry. We spend about £3 billion a year and the work can be commissioned at a local level. The problem up until now is that no one has taken responsibility for that, so the ICSs will be a key change to make that happen.

[Dr Poulter]

I want to clarify one point. Does my hon. Friend anticipate the new dental contract being a sticking plaster, or does she think that it is here to stay that it will put right these challenges?

There is a real problem with the commissioning of dental services. I am afraid that I do not have faith that ICSs will be a panacea to sort things out, because local CCGs, some of which were not good commissioners of a number of services, have simply been cut and pasted into the same posts on the ICSs. Will my hon. Friend reassure me that she will personally look at the commissioning process and hold those commissioners to account, to ensure that they deliver proper dental services?

[Maria Caulfield]

Absolutely. The whole point of the ICSs is that the commissioning service has not worked up until now. Some commissioners are very good at commissioning dental services, while others do not have anyone with dental experience on their boards and are not so good. ICSs will be accountable, which is the difference from what we have now. I will meet ICSs to ensure that they understand the responsibilities.

[Rachael Maskell]

rose—

[Maria Caulfield]

I will take one last intervention, because I am conscious of the time.

[Rachael Maskell]

I am grateful to the Minister for giving way. When I wrote to her, she kindly replied and said that York could well be one of the areas for a centre of dental development. I would like to know the timescale for such considerations, and what progress has been made since our correspondence.

[Maria Caulfield]

I met Health Education England this morning and we are working through that system. I will be able to update the hon. Lady shortly, because I am keen that we make progress.

A number of Members mentioned prevention. The Health and Care Act 2022 includes provisions relating to fluoridation as standard, and we are working to make progress since it became law recently. We are also working with education colleagues on supervised toothbrushing. As we speak, some of the 75 family hubs that are being set up in the most deprived parts of the country as part of the Start4Life programme are looking at initiatives such as supervised toothbrushing. Where it is not happening at home or where parents need more support, we are ensuring that children are getting that toothbrushing experience.

On the subject of upskilling dental teams, this is about more than just dentists. My hon. Friend the Member for St Ives (Derek Thomas) made the key point that it is about the whole team. At the moment, part of the contract means that only dentists can do certain work. We need to change that. Centres for dental development will be about not just training dentists but upskilling whole teams.

I hope that I have reassured Members from across the House that we are taking this issue extremely seriously. To answer the question put by my hon. Friend the Member for St Ives, the contract changes that we are going to announce will not be the end of it, because there is more reform that we need to do. The Secretary of State is looking at a wider piece of work to provide a long-term, sustainable solution. We are happy to work with the other three nations if they have suggestions and solutions. We are not precious about sharing best practice.

I say to the shadow Minister, the hon. Member for Enfield North, that it would be good if she could come to a dental debate with some suggestions and solutions, rather than constantly criticising. We are determined to solve this issue and I appreciate the urgency that every single one of my colleagues has expressed today.

[Rachael Maskell]

I raised the issue of Ukrainian refugees. The Minister seemed to indicate that she had a response, so could she provide it before she closes?

[Maria Caulfield]

The response is that every overseas dentist, apart from those in the European economic area, currently has to take the overseas registration exam, and that is without exception. That is the work that we are trying to do with the General Dental Council. We are enabling those from Ukraine or Afghanistan, or any refugee from any country, to take part in that process. I am very keen to see mutual recognition with some countries. We are working on that and will enable the legislation to make it happen, but it will be for the regulator to decide; it is not a Government decision.

I hope that I have reassured colleagues that we are on this and appreciate the urgency. I have no doubt that we will return to this Chamber to debate this matter further in the coming weeks and months.