Reforms to NHS Dentistry

Nigel Evans Excerpts

Thursday 27th April 2023 Commons Chamber

[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Nigel Evans)]

As more people want to speak, and we have the wind-ups to come, it is sensible to continue with this debate. We will try to reposition the debate that should have followed.

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[Jerome Mayhew (Broadland) (Con)]

We have had a full debate today. This is the third Backbench Business debate on the subject, but not the third debate on dentistry; I have had an Adjournment debate on dentistry, for example. The subject is well rehearsed. The reason why so many people are keen to speak today is that the issue affects areas right across the country. We all know that there is a problem with NHS dentistry, that the Government are focusing on it, and that they are coming up with a dental plan. We anxiously look forward to its publication in the next two to three months. In the few minutes available to me, I will not focus on the national problem so much as recognise that within the national difficulties, there are regional crises. In rural areas such as North Devon, but also in the east of England and Norfolk in particular, we can see that what is already a challenging picture nationally is exacerbated. To identify the issue, we have only to follow the money. I will look at funding for the east of England, then I will talk about recruitment and retention.

I know that funding has been impacted by covid, and the ability to undertake units of dental activity was restricted because of the covid pandemic and the aerosol activity of much of dentistry. I also know that funding has subsequently been increased because of the catch-up bid, so the numbers for the year 2018-19 give a more accurate reflection of the level of investment by the Government in dentistry in the region. The national average gross spending per mouth in England was £66 in that period. The best performing region was the midlands, which received £78 of expenditure per mouth. The figure for the east of England was £39 per mouth. That is exactly half the amount of money spent on dentistry per head of the population in the midlands. Now, there are many unconfirmed rumours about the number of fingers and toes that we have in Norfolk, but we do not have half as many teeth as those in the midlands—not yet, anyway.

My request to the Minister is to follow the numbers, to look at where the expenditure has been taking place and, more importantly, to look at the places where the expenditure has not taken place, and then to ask the question of his officials, “Why is that?” Why is it that even though in many parts of the east of England we have the worst dental health, the expenditure by the Government is fully half what it is in the midlands, and £20 less than the national average per person?

Looking to recruitment and retention, a potential answer to my first question is that there are physically not enough dentists in the east of England to carry out the work. The national average number of dentists per 100,000 of the population is 43. In the east of England, we have just 39. That compares to Devon, where there is a dental training school, which has 49. Why is it that people do not want to be dentists in Norfolk? The answer is because it is rural, and for those who grow up there, the nearest place they can train is Birmingham.

People cannot train to be a dental technician or a dentist anywhere in the east of England. It is the only region of the country, other than the south-east, which is next door to London, that has no dental school at all. People can go either to London or Birmingham. Is it surprising, then, that we do not have an indigenous population of would-be dentists growing up, training to be dentists in Norfolk and then staying there for their working life? We are reliant entirely on people relocating to the east, and to Norfolk in particular, to supply our dental needs.

When people qualify as a dentist in their mid-20s, the overwhelming majority do not wish to move to a rural location. Even though it is without question the best place in the country in which to live, to grow up, to learn and to bring up a family, it is not immediately attractive. A policy that relies on importing foreign-qualified dentists does not satisfy the need in rural locations either, because overwhelmingly the data tells us that when we import, say, South African or Australian dentists, they relocate to the cities. They set up their new life where there are already expat communities. They do not move to Fakenham, and the problem is very real in Fakenham. I persuaded the NHS to write a wholly new NHS dental contract for Fakenham. That contract went out, and not a single organisation bid for it. The money is there, but there is physically no supply of NHS dentists.

The issue goes further than that, because the lack of dentistry spreads out into the private sector as well. There are many examples right across the county of where private dental practices, whether in my constituency or in those of my hon. Friends the Members for North Norfolk (Duncan Baker) and for North West Norfolk (James Wild), have been advertising for years—in one case I am familiar with, for a decade—and are yet to fill the place. While the short-term answer to the national issue may well be to improve access to international dentists, the medium and longer-term solution for the east of England, and Norfolk in particular, surely is to establish dental training in the county. There are two ways to do that.

There are two ways to do that. In the short term—the very short term, I hope—there is a bid by the University of East Anglia to create a centre for dental development: a postgraduate training establishment that would help to draw in newly qualified dentists from other parts of the country. The hope is that if they do their postgraduate training in the east, a percentage of them will remain. There is also what I hope is not a competing but a complementary application from the University of Suffolk in Ipswich. Those bids should not be in competition; they should be working together to improve access in both Suffolk and Norfolk.

However, the real solution in the medium term is to unite with the University of East Anglia and its existing medical school to create a dental school at UEA, which already has the Quadram Institute—the world’s leading centre for the study of the gut biome, which of course begins with the mouth. The Norfolk and Norwich University Hospital is right next door. We would then have the ability to bring people in and train them in the city of Norwich; as evidence from the medical school demonstrates, a percentage of them would remain thereafter to develop their careers.

The hybrid nature of the UEA bid would mean that even in the first year of the five-year training period, people would be spending at least a day a week working in practices, helping work through the dentistry backlog, and developing community relationships that will make them more sticky to the region once they qualify. All that will go towards the long-term solution to the dental desert in Norfolk.

I very much look forward to the publication of the dental plan in the next few months, but it would be the most monumental wasted opportunity if that plan did not include training for dentistry in Norfolk.

[Mr Deputy Speaker (Mr Nigel Evans)]

Last but not least from the Back Benches, I call Robbie Moore.

[Robbie Moore (Keighley) (Con)]

I am pleased that this Backbench Business debate has been allowed time; I thank the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) for securing it. I almost feel that I am about to sum up all the issues that have been discussed, but I want to pick out some of the challenges that I have faced as a constituency MP.

I am sure that all in the House agree that toothache and tooth-related issues can be extremely painful—for our constituents, unfortunately, getting to see an NHS dentist can itself feel like pulling teeth. I am pleased that one of the Government’s immediate priorities is to deal with the backlog, but I cannot stress enough how important it is that we pick up the pace and go even faster. Like many in the House, I was pleased to welcome last year’s announcement that the Government would provide £50 million for up to 350 additional dentist appointments in England. I am also pleased that they are continuing to have talks with the British Dental Association and other stakeholders to reform dental contracts, increase the incentives for dental practices to take on more NHS work, and help get on top of the backlog in dental treatment.

As my hon. Friends the Members for Waveney and for Hartlepool (Jill Mortimer) identified, the contract originally established back in 2006 is the real nub of the issue that all our constituents are facing today: simply not enough NHS dental work is being carried out. That is a huge issue in my constituency.

Over the past year, there has been a significant increase in the number of constituents writing to me in frustration because they cannot secure an NHS dentist appointment. Only last week, one constituent had to make an appointment 50 miles away in Sheffield, as she could not get a local NHS appointment and could not afford a private one. Another constituent kindly contacted me, dismayed at the fact that they had been contacting local dentists listed on the NHS website as available and taking patients—it turned out that they were not. My constituent tried to contact another dentist, which was only accepting children. My constituent ended up having to pay up to £80 up front for them and their three-year-old to see a local dentist. That is not acceptable. I checked it out for myself. The NHS England website said that the dentist was accepting patients, but when I clicked on the link and followed it, it said that

“this dentist surgery has not given an update on whether they’re still taking NHS patients. Please contact them directly to ask.”

That is simply not acceptable, because it instilled a false sense of hope in my constituent who has dental pain and needs to see a dentist as soon as possible.

As we all do, I recently held a surgery. A lady came and explained that she had been an NHS patient all her life with a particular practice in Keighley, as had her partner and her children, only to receive a letter to say that it would now only accept private appointments for her family. Again, that is not acceptable.

The Government are well aware of the issues and the scenarios that we have put forward today, but I urge them to look at some key points. Demand is there, but we are not recruiting enough dentists and we are not allowing those dentists enough space to support the demand. As my hon. Friend the Member for North Devon (Selaine Saxby) said, it is important to focus on early prevention work, particularly for younger people. As my hon. Friend the Member for Broadland (Jerome Mayhew) said, recruitment, retention and training in the early years are incredibly important. I want to pick up on the point that all integrated care boards must have dentistry represented on them, to ensure on a geographical basis that contracts are awarded for NHS providers and can be delivered on the ground.

The big issue is the contract reform that must take place. As we have all identified, units of dental activity are not keeping up to speed with demand. That is my constituents’ No. 1 priority. I hope that the Minister will ensure that appropriate action is taken to alleviate the pressures on NHS dentists and the dental pain that my constituents are suffering.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call the shadow Minister.

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[Neil O’Brien]

I have mentioned some things that are already changing—some of the first reforms to the contract since 2006 that we have started to bring in. We are working on the plan at pace. There is no date for its publication yet, but we are working on it at pace because we are conscious of the urgency.

I thank the hon. Member for Bradford South and my hon. Friend the Member for Waveney for securing this important debate. I hope they have been assured that we have started to reform dentistry, that we are seized of the importance of the issue, and that we recognise that we can and must go further to further strengthen NHS dentistry.

[Mr Deputy Speaker (Mr Nigel Evans)]

The last word goes to Judith Cummins.

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[Mr Deputy Speaker (Mr Nigel Evans)]

We were going to come to the debate on reducing plastic pollution in the oceans. I said that it would be repositioned, but that is clearly not the right word, because it will still be here. “Rescheduled” is what I was grasping for, and I have now finally found the word. We hope that it will be rescheduled in the not-too-distant future, because it is a very important debate, and it was right not to truncate it in the way that was going to happen.