Dental Care: Durham

Mary Kelly Foy Excerpts

Wednesday 24th May 2023 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

Vast areas of our country are increasingly described as “dental deserts”, places where not a single dental practice is accepting new NHS patients, and County Durham is one such place. We in Durham have witnessed dental services decay at an alarming rate. In my constituency today, there will be children sat in classrooms struggling to concentrate because of something as preventable as toothache. So it is hardly surprising that tooth decay is now the leading reason for children being admitted to accident and emergency in our country.

This scandal is not unique to Durham or the north-east; it is a problem everywhere. In 2023, dentistry is available on the NHS on paper but not in practice. The British Dental Association has described NHS dentistry as entering its final act. The horrifying experiences of my constituents, which I will outline, will certainly strengthen that claim, but before I turn to my constituents, let me state a chilling fact: Britain has poorer oral health than any other developed economy.

[Peter Gibson (Darlington) (Con)]

The hon. Lady raises an important point about children’s dentistry. Does she agree that prevention is better than cure? Would she welcome a return to dentistry in schools?

[Mary Kelly Foy]

Of course, prevention is better than cure, and that is one of the reasons why so many children have to go to A&E. If problems were identified and prevented in young children, there would not be the cost implication for services further down the line. In an ideal world, we would have dentists in schools.

As I said, Britain has the poorest oral healthcare among developed countries. Can the Minister honestly say that we have genuine preventive oral healthcare in our country? Over the past 13 years, dentistry has become unaffordable and unavailable for many of my constituents. Nearly 400 have contacted me in dismay at their recent experiences. I thank them for their contributions and I hope the Minister can give them some reassurance today.

My constituents know that the problem is not with the dentists themselves. They know that dentists are trying their best for their patients. The problem lies at the Government’s door. In the time that I have, I can share only a portion of the pain and suffering that my constituents have had to endure. One moved to Durham over four and a half years ago but still cannot find an NHS dentist, despite being told after a kidney transplant that it was vital that they had regular dental check-ups to monitor their health. Now they have a broken tooth and simply cannot afford to fix it.

Another constituent told me how she had to borrow money to afford a private appointment. She is now 30 weeks pregnant and exempt from dental charges, but her exemption is worthless as there are no appointments available for her. A young girl in my constituency tripped over and shattered her teeth. Her family contacted me because they could not find a dentist to help her. Luckily, after I reported the case on social media, a local dentist was kind enough to help her out, but our health system should not be based on charity. Constituents have also contacted me about do-it-yourself dentistry. In case the Minister is unaware, that is when people fit their own fillings and extract their own teeth without anaesthetic or any professional training.

I have raised the alarming experience of my constituent Ray in the Chamber before, but I do so again because his case underlines why access to dentistry should be not a luxury, but an integral part of our health system. Ray was unable to find an NHS dental appointment, so, out of utter frustration, he decided to go private. Following his appointment, Ray was diagnosed with oral cancer, for which he is now receiving treatment. As there is a cost of living crisis, we have a duty to ask, what if Ray had not been able to pay for private treatment? What if the cancer had continued to go undetected? Frankly, Ray might not be here today. It is morally wrong that Ray was put in that position. No one in my constituency —or anywhere, for that matter—should be put in that position.

Why is this happening? My visit to a dental practice in Gilesgate this week provided some of the answers. The practice has just one dentist working two days a week seeing NHS patients, and it has 10,000 patients on its books. It does not take a genius to work out why my constituents cannot see a dentist. It is clear why dentists are closing their doors to NHS patients, and it is certainly not because of a lack of demand. The problem, which the BDA has identified, is that the unreformed NHS dental contract means that dentists are pushed into the private sector to keep their practices afloat financially. As one dentist said to me:

“Every day I’m providing some treatment for nothing or at a loss—working the best I can, caring for NHS patients the best I can within the dental contract.”

He also went on to say that the Government are clearly winding down NHS dentistry in the hope that the public will accuse dentists of being greedy.

The exodus of dentists is clear for all to see—except, it seems, the Government, who continue to deny there is a crisis in NHS dentistry.

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[Mary Glindon (North Tyneside) (Lab)]

I thank my hon. Friend for securing this important debate. Given that dentists are so hard pressed and are trying their best to fit in NHS patients, in light of all the problems they are facing, does she agree that they deserve our greatest respect, admiration and thanks? I am very fortunate that I have been at my dentist’s practice for 52 years, but they are struggling.

[Mary Kelly Foy]

I could not agree more with my hon. Friend. The dentists that I have spoken to recently all want to help NHS patients, but the way the contracts are designed, it is not worth their while, and of course they have to make a living.

I mentioned that I made a point of order yesterday regarding the Prime Minister, who has repeatedly claimed that there are “500 more dentists” in the NHS. However, following a freedom of information request, we now know that the number of dentists in the NHS fell by nearly 700 last year. The number of dentists has also fallen since the pandemic and is at its lowest level in a decade.

Diagnosing the causes of the problem is not complicated. As I mentioned at the beginning, Britain has poorer oral health than any other developed economy. The system is also dysfunctional, and practices have handed back a record £400 million-worth of funding back to the Government because they do not have the capacity to meet the required targets.

[Mr Kevan Jones (North Durham) (Lab)]

Does my hon. Friend and neighbour agree that we have to see what the need is in each area? I contrast the current approach with when Labour were in power in Durham: we brought in new capacity where we knew that areas did not have access to NHS dentistry.

[Mary Kelly Foy]

I thank my right hon. Friend for the intervention. We all know that there is huge demand and such a lack of NHS dentists out there that it is, I guess, a question of political will whether this problem is solved or not.

The absence of oral healthcare from our national debate about the future of the NHS is alarming. Dentistry is integral to our national health and therefore must be key to the NHS. Without proper investment in preventive healthcare such as dental check-ups, we cannot quickly treat oral cancers, nor can we stem the flow of people with dental problems into our already overcrowded accident and emergency departments.

I would be grateful if the Minister responded to the following questions. First, will he ensure that dentistry is properly represented in the governance structures of the NHS? Dentistry must be at the centre of the policy-making process, not an afterthought. Secondly, will the Government publish a comprehensive national dental strategy, one that is focused on prevention and tackling health inequalities? Thirdly, will he undertake meaningful reform of the NHS dental contract, which would stem the flow of dentists out of the system? Fourthly, will he work with the BDA on the previous points?

Finally, as I have said, I raised a point of order yesterday on the Prime Minister’s claim that there are 500 extra dentists in the NHS. There are in fact 700 fewer dentists, not more. Unless I have missed something today, the Prime Minister has not corrected the record, as he is obliged to. Will the Minister finally correct the record on behalf of the Prime Minister?

I could have spoken for hours this evening, reading out the correspondence I have received from constituents. Each constituent’s experience reflects a serious failure by this Government, so I implore the Minister not to insult the intelligence of the people of Durham, but to take this opportunity to accept that there is a crisis in NHS dentistry and to commit finally to meaningful reform.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

Let me come directly to the questions asked by the hon. Member for City of Durham (Mary Kelly Foy). She called for a comprehensive dental reform plan. Yes, we will do that, and we will do it soon. She called for an overhaul of the 2006 contract. Yes, we will do that. Will we work with those at the BDA? Yes. In fact, I met them yesterday. We are keen to draw on their expertise.

I congratulate the hon. Lady on securing the time for this important debate. It is absolutely my top priority right now to work at pace to try to address the significant problems in dentistry. I am not here to say that there is no problem; I am here to try to fix the problem as quickly as possible. We could debate the figure on dental activity all day, but the bottom line is that it is not high enough and we need to get it higher. To come directly to her point about correcting the record and so on, the latest published figures show that there are 1,473 more dentists than there were in 2010—about 6.5% more.

[Mary Kelly Foy]

NHS dentists?

[Neil O’Brien]

NHS dentists, yes. Activity is definitely going up—about a fifth more patients were seen in the year ending March than in the year before that—but it is still too low. That is a point on which we absolutely agree.

We have started—only started—to reform the contract. We have introduced more bands for units of dental activity to better reflect the fair cost of work so that there is fairness for dentists, and to incentivise more NHS work. We introduced the first ever minimum UDA value to help sustain practices where UDA values are low. That has implications for under-delivery in some bits of the country.

We are for the first time allowing dentists to do 110% delivery of their UDAs so that those who want to do more NHS dentistry can do more, with a requirement to update their availability on the NHS website. We have also started the process of making it easier for dentists to come to work in the UK. Last month, we brought into force legislation enabling the General Dental Council to increase the capacity of the overseas registration exam. We are also working with local partners around the country who have various ideas about creating new centres for dental development so that, in areas that do not have a dental school, we can get more people to train and remain, and dentists flow to the bits of the country where there the need is most acute.

Some of those reforms are starting to have effects. It is good that the reforms to split band 2 have been reasonably well received, as has the 110% option. The splitting of band 2 is being used and the proportion of band 2bs is going up. As I say, activity is going up, which is encouraging, but it is not high enough and needs to be higher still. The reforms that we have talked about so far have just been a start. I am under no illusions about the significant challenges to address, not just in Durham but across the whole country.

The forthcoming dental plan will build on those initial steps to go further on improving the payment model and those initial banding changes, especially focusing on improving access for new patients, which is a particular problem. We want to consider how we address historical UDA valuations—they are stuck in time in 2006 and are, in some cases, unfair—and look fundamentally at how we make NHS work more attractive.

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[Neil O’Brien]

My hon. Friend is quite right. Some of those disparities, which can occur from one end of the street to the other, are extremely hard to justify, hence the introduction of the minimum UDA rate and why we are looking at going further. He is completely correct. Funnily enough, as well as coming to improving access to treatment, I was just about to respond to his earlier point about prevention and his rather brilliant idea about what more we could do in schools. We are, following the conversations we have had, actively considering that.

I thank the hon. Member for City of Durham for her important work in securing this important debate.

[Mary Kelly Foy]

It feels as if the Minister is coming to the end of his speech, but I would really like him to correct the record. In my point of order yesterday, I said that the Prime Minister has on seven occasions said that there are 500 more NHS dentists, when there are in fact 700 fewer dentists. If the Minister has met the British Dental Association, it will have pointed that fact out to him. Could he please correct the record, or may I ask you, Madam Deputy Speaker, for advice on how we can encourage the Prime Minister to correct the record before the House rises tomorrow?

[Neil O’Brien]

I have already read out the statistics. I will not read them out again, and I do not think there is a need to correct the record. The statistics that the hon. Lady is drawing on are incomplete, because there is effectively a two-month lag between activity and the need to report that activity. Drawing on such incomplete information does not give the full picture, so I caution her against doing so.

First, I encourage the hon. Lady to wait for the official data in the usual way. Secondly, we are looking to improve that official data by, indeed, working with and responding to concerns raised by the BDA. I do not think that headcount is a sensible measure with the workforce. There are more people doing NHS work than there were in 2010. What we are really interested in is the total amount of activity, which is best measured by the total number of UDAs being delivered. As I have said, that total amount of activity is going up. In the last month for which we have data, it had gone up from 85% in March 2022 to about 101% in March 2023, but it is still not high enough. Although the trend is positive and dentists are doing more NHS work, the point of agreement here is that that needs to improve further.