Covid-19: Dental Services

Nigel Evans Excerpts

Thursday 14th January 2021 Commons Chamber

[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I have a few housekeeping notes. The wind-ups will start at 4.42. There will be eight minutes each for the Front Bench teams, two minutes for Fleur to wind up, and a three-minute limit on all Back-Bench contributions starting now.

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[Jane Hunt (Loughborough) (Con) [V]]

May I take this opportunity to thank all in the dental profession for all they have done and, in particular, for how they have adapted to implement the huge changes needed to be covid-secure? I have direct experience of this, having received urgent care both during the first lockdown and yesterday. I know that I am not alone in thanking them, as several of my constituents have told me of their own experiences. On behalf of all of us, I thank them very much for what they are doing during these trying times.

At the beginning of the pandemic, dental practices across the country were instructed to close. This meant that dentists took a huge financial hit, which was compounded by the fact that many were ineligible for the Government’s financial support package. This was particularly true of private dentists. We rely on these practices as much as NHS ones to meet local demand, and that should be considered going forward.

NHS dentists have recently been asked to fulfil their contractual obligations in the last quarter of the financial year. However, in order to meet additional safety guidelines, they now see fewer patients. Indeed, 64% of practices surveyed by the British Dental Association last year estimated that they could only treat less than half the patients they saw before the pandemic. Practices also have to cater for the self-isolation of staff and patients, the general fear of older residents leaving their home for any reason and cancellations at short notice for all of the above.

I emphasise that dental practices are safe and continue to be so. I am grateful to the Leicestershire and Rutland Local Dental Committee, which allowed me to attend its Zoom meeting last night and hear the concerns of 112 local dentists. In an online vote, 80% of those dentists said they would not be able to hit the target for quarter 4. The added dimension is that should dentists miss the target by as little as 1%, they receive considerably less revenue for the work they have already carried out. Dentists are also given no leeway for last-minute cancellations and no-shows in their contracts, even though that may lead to those missed targets. I therefore ask that that be urgently reviewed, so that dentists are not punished for trying their hardest to continue to provide the care needed.

I can fully understand why the target was set when it was put in place just before Christmas. At that time, little was known about the new variant of covid and the case rate was dropping at a rapid rate. If it had remained in that arena, I certainly would have been clamouring for tier 2 in Loughborough and fighting to get as many businesses and facilities open as possible. Unfortunately, the new variant has put paid to that idea and a national lockdown has ensued. I ask that the target for dentists be reviewed in light of the current situation.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call Scott Mann.

[Scott Mann (North Cornwall) (Con) [V]]

Thank you, Mr Deputy Speaker—(Inaudible)

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Scott, you sound like a Dalek, and I do not mean that unkindly. There is clearly a communications problem. We will switch to the next speaker and then we will get you back, Scott.

[Barry Gardiner (Brent North) (Lab) [V]]

The Book of Proverbs says:

“Confidence in an unfaithful man in time of trouble is like a broken tooth.”

We are in a time of trouble and there are lots of broken teeth. While I make no aspersions about the fidelity of the Prime Minister, I can tell him that confidence in his Government, even before covid, was already at an all-time low with the dentists I speak to in Brent. There has been a total lack of investment in dental laboratories, a failure to recruit and train dental technicians, flawed dental contracts and chronic underfunding.

My hon. Friend the Member for Putney (Fleur Anderson) has lucidly set out the key demands of the British Dental Association: abandon the activity targets; support practices to increase the number of patients they can see safely; prioritise access to the vaccine; safeguard the supplies of PPE; and extend the business rates holidays to dentists. I will not rehearse and repeat her excellent arguments; I want to give voice to the frustration felt by the dentists who continue to serve my constituents in Brent so well.

The BDA has catalogued the failure to properly communicate with the public, but what I had not appreciated until I spoke with my local dental committee is just how poor the Government’s communication with dentists themselves had been. I quote from their letters. One said that

“dental services have often been treated as an afterthought with no understanding of the NHS contract imposed on the profession. Dental practitioners found out in May on the news, at the same time as patients that they were to reopen in June…The panic and frustration this caused is deplorable. Dental practices, despite being high risk because of the aerosol generating procedures, were not able to access PPE from the Government portal until September and the vital FFP3 masks were not added to that until November. It is clear that little thought, if any, had been given to dentists and their teams.”

One dentist wrote:

“When on the 8th June our high street practices in England were allowed to resume face-to-face care, the reality of what a new normal might look like hit…fallow time means the number of patients able to be seen is significantly reduced. It was anything but ‘business as usual’. I ask myself, at this time, what would be the worst thing to impose on dental practices? Very high up on my list would be precisely what the government has decided to impose—targets. The emphasis on targets from the NHS clearly prioritises a metric and finance over patient interest. To achieve targets, footfall would have to increase and non-urgent patients be prioritised.”

My local dental committee tells me:

“Many practices are already finding the conflicting strain too much, and this comes on top of the emotional and physical drain of wearing full PPE for hours every day…The imposition of a target at this time serves no purpose whatsoever other than to destabilise, perhaps terminally, NHS dental provision, and to demoralise an already exhausted profession further.”

Covid-19 has been felt most severely by those who were already more likely to have poor health outcomes—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sorry, Barry; we are going to have to leave it there because we have run out of time. I will call James Wild next, and then hopefully we will get Scott Mann back on the line.

[James Wild (North West Norfolk) (Con)]

Access to dentists in North West Norfolk, particularly for children, was one of the issues that I raised in my maiden speech, when I reported that constituents were being advised to register in Skegness. As I said at the time, that remains good advice for pink-footed geese, but it is not very practical. Prior to covid, my constituency had the highest population per dentist across Norfolk and Waveney. West Norfolk was the second lowest area for dental activity actually delivered in the country, with only 65% of contracted activity carried out, and it had the highest percentage of patients who were unsuccessful when trying to get an NHS dental appointment. That was before covid.

During the pandemic, access to services has become even more severely limited, as the early results of a survey that I am carrying out in my constituency show. Many patients are unable to get treatment. The British Dental Association has said that 20 million appointments have been lost nationally, and access to emergency dental care has also been very challenging. I have helped constituents to access the urgent dental care that was there, but the General Dental Council reported that 50% of people did not know that it existed, which may explain why a fifth of people experienced pain or even took action into their own hands.

It is crystal clear that the level of provision in North West Norfolk is simply not good enough. This is a long-running issue. I have spoken on numerous occasions to the NHS east of England direct commissioning group, whose responsibility it is to commission those services, to underline the need for improved local access. I certainly acknowledge that there are challenges in attracting and recruiting dentists in North West Norfolk, and there have been positive developments, such as the opening of the surgery at Marham, which my constituents have been using successfully. I know that the commissioning group is actively exploring the increased use of training places to play a part in the sustainable approach to this issue, but it is of course important that the significant backlog due to covid is addressed and done so safely. Like other hon. Members, I have been contacted by dentists in my constituency, who are concerned about the activity levels that they are being asked to deliver and question whether they will be achievable. I am sure that my hon. Friend the Minister will address those concerns in her remarks.

What my constituents really want is a commitment to short, medium and long-term improvements, so they can actually see a dentist. My dentist in King’s Lynn high street closed in November, and the money for that should be used to recommission services locally. Prior to covid, the NHS planned to open another practice by the summer and to issue a procurement exercise offering in-perpetuity contracts, which should be more attractive to providers in the long term. Understandably, those plans are now on hold, which is disappointing for my constituents. They want a public commitment to address these issues, so that they know improved provision will be coming. I ask my hon. Friend the Minister to meet me to discuss these issues so that we can urgently address the provision, which is certainly inadequate for my constituents.

[Mr Deputy Speaker (Mr Nigel Evans)]

Let us see whether Scott Mann’s audio is less scary.

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[Duncan Baker (North Norfolk) (Con) [V]]

It is an honour to be able to speak on this topic, but I have to admit to a slight conflict of interests, as my father, who worked as an NHS dentist for 39 years, is now deservedly enjoying his NHS pension.

Dentists were allowed to return to work on 8 June, with all sorts of new conditions in place—for example, PPE having to be put on and removed, deep cleaning of surgeries between patients and a period of fallow time for each surgery. Special regulations for aerosol-generating procedures and social distancing in waiting rooms meant that accurate timings were necessary to avoid people having to wait outside for too long. All these things meant a big impact on the number of people who could be treated, so there was less ability to complete target numbers. Additionally, on returning to work, there was a huge backlog of emergency-type dentistry.

Dentists were adapting to these new conditions and striving to meet new targets when suddenly, just before Christmas, and without agreement from the profession, their target of activity was increased from the original 20% to 45%, and it had to be completed by 31 March. This has angered the profession. Now, with the lockdown, it is worse. Some dentists operate a shift system in surgeries, allowing time for cleaning and fallowing, but older patients, of whom there are more in my constituency than any other in the country, may not want to come at unsocial hours and wait outside at this time of year, or they may be shielding and fearful of infection, with rates rising. All this contributes to dentists’ difficulty in reaching targets. It is no wonder that they are not happy. What does this mean? That safety could be compromised if dentists are forced to cut corners to achieve targets. With a lack of NHS dentists already in North Norfolk, this situation will only make problems worse.

I will quickly touch on the real problem of the lack of NHS dentists in my constituency. There may be many problems, but I have constituents simply not able to get treatment and having to go private for services. One surgery told me that they have not had a UK graduate apply in 10 years, as they want to work in London. What can be done to help that situation? Here is my plea: if you are a graduate dentist wanting to work, do not go to London, come to North Norfolk, where you will have a better quality, will be paid well and will have a lower cost of living, and your patients will be eternally grateful to see you.

Despite all this, patients overwhelmingly express appreciation for the efforts dentists are making at this challenging time. They and the patients deserve proper assistance from us.

[Mr Deputy Speaker (Mr Nigel Evans)]

Other areas are available. Good try, Duncan!

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[Christine Jardine (Edinburgh West) (LD) [V]]

One of the more surprising effects of covid-19 is that I miss going to the dentist—a phrase I never expected to use. Although we might recognise the impact on ourselves, we should be in no doubt about how difficult the situation has been for those who continue to work and provide vital dental services in the pandemic. It is different from the situation in hospitals, but still difficult and exhausting, and it carries the constant underlying worry of infection.

The situation affects the whole UK. I hope that the Government will take the impact on dental health into account in discussions with Holyrood. That is a significant motivation for me today, because we have accounts of problems across the UK. James Craig of the Scottish Dental Association has described the experience of wearing a respiratory mask so tight that it was like breathing through a pillow. Another dentist felt that the profession had been thrown under a bus. Dentists have had to try to deal with public demand and then abuse when they cannot deliver through no fault of their own.

We must also accept that there are wider consequences for our health services as existing NHS dental health care becomes stretched, meaning that NHS-commissioned activity targeted at oral health inequality will be at risk. Many of us could find it difficult to get timely access to urgent, unscheduled dental work. As that begins to take hold, increased unmet care will have a widespread impact on our general health and wellbeing, leading to more and more people turning to GPs, emergency care and potentially hospital admissions.

Research shows that, as with so many of the impacts and so much of the collateral damage from covid-19, the vulnerable will suffer most. That will exacerbate the health inequality on which the pandemic has brought a stark focus.

Recently, I was contacted about an issue that young dentists assure me affects them across the UK. Associate dentists’ earnings have been halved because their payment is based on the work they carry out and the number of NHS patients on their books. We are currently awaiting the outcome of discussions between Holyrood and BDA Scotland to find a solution. Like everyone else affected by the pandemic, they need a solution soon.

 I once put off having a toothache checked out, because it was not much of a nuisance and I was busy with other more important and pressing stuff; I would mention it at my next check-up. Before that was due, it flared up, became much worse, and I needed emergency root canal treatment. I also got a lecture from my dentist about leaving problems so that they escalate and become more serious. It is sound advice that we should perhaps listen to in this situation.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call Janet Daby. Janet, I will stop you at 4.42 pm, so please ignore the clock at the bottom of the left-hand side. Then we will come to the Front-Bench contributions.

[Janet Daby (Lewisham East) (Lab) [V]]

Thank you, Mr Deputy Speaker. I congratulate my hon. Friend the Member for Putney (Fleur Anderson) on securing the debate. She has been a persistent advocate for dental care during the pandemic.

We are all aware of the widespread impact of the coronavirus pandemic. A&E departments are overwhelmed, intensive care units have been described as warzones, and essential operations, for example on cancer patients, are being postponed at great cost. In the midst of the sprawling crisis, the effect on dentistry has been overlooked. People have not received the essential dental care that they need, and dental practices have experienced crippling blows to their finances during the pandemic.

The Association of Dental Groups has found that dental practices in England suffered from an average of 45% losses in 2020. Dentists are crying out for Government support, but the Chancellor’s recent announcement applies only to the hospitality and retail sectors. Dental practices will receive no grants and no business rates exemption. The Government need to act so that it does not have a negative effect on our economy.

The ADG found that 35% of business owners expect to employ fewer staff next year, with some planning redundancies. We will lose practices from our high streets, and communities will be deprived of the care that they need. That needs urgent Government intervention and attention. The Department of Health and Social Care must work with other Departments to provide business support grants and relief. Additionally, dentists are still not acknowledged to be critical care workers in this lockdown—a matter that has already been mentioned by other Members, and that the Secretary of State needs to review. Patients have also had to—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sorry, Janet; 4.42 pm has been reached. I do apologise. We move on to the Front-Bench contributions. I call Alex Norris.