NHS Dentistry in England

Paul Blomfield Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Paul Blomfield (Sheffield Central) (Lab)]

It is a pleasure to see you in the Chair, Mr Stringer. I pay tribute to the hon. Member for St Ives (Derek Thomas) for the way he introduced the debate and covered so much of the ground we need to pay attention to.

This is a funny old place. We wait for months to talk about dentistry, and now we have had two debates in two days. I spoke in yesterday’s debate and I do not want to repeat the points I made then, but I do want to develop some of them. We clearly face an extraordinary crisis in dentistry. It was fascinating to see all the Members intervening on the hon. Member for St Ives, telling their stories about constituents who had contacted them, unable to access NHS dentistry. We had that yesterday throughout the debate, with some horrific stories about the self-treatment that some people have been driven to carrying out with pliers. That emphasises the scale of the crisis across the country.

If we had all hung about after Prime Minister’s questions, and the Speaker had asked, “Has anybody here not had a constituent contact them about access to NHS dentistry?” no hands would have gone up. We all face this problem. I met our local dental committee last week. I said yesterday that, in response to that meeting, it commissioned a survey across the city, speaking to about half the practices. Only one could offer a waiting time shorter than a year. For 29%, it was up to two years; for 32% it was more than two years. The biggest number—35%— said, “At this moment, we simply can’t take anybody on to the waiting list.”

It is a shocking situation that we find ourselves in. I will not repeat everything I said yesterday, but I cited the example of a pregnant constituent who wrote to me. She said:

“I have a MATB1 form entitling me to free dental care whilst I’m pregnant and for a year after birth. Unfortunately, I can’t use this as I can’t find an NHS dentist”.

There is a reason why pregnant women are given access to free dentistry: they face particular problems with oral health during pregnancy, which will give rise to long-term problems unless they are addressed. We know, too, that unless people get the dental service they need when they need it, that creates all sorts of other long-term health problems that are not only hugely damaging to them individually, but ultimately costly to the NHS. Not getting the money in the right place at the right time just causes more problems for budgets further down the road.

The most shocking part—I am overusing that word, but perhaps it is appropriate—of the contributions we heard yesterday was about children. The No. 1 cause of child admissions to hospital is rotting teeth, which arise from the failure to get children dental treatment when they need it. The hon. Member for St Ives made a really good point about our lack of ambition, which is a point we can make about successive Governments. The fact is that we do not have the ambition for NHS dentistry to cover the entire population, in the way we would expect for all other aspects of health provision—even if we do not always get that provision right. We need to have a fundamental debate about dentistry.

There are two ways of addressing the problem, which Members have alluded to. One is the contract. Yes, the contract was introduced by a Labour Government in 2006—let’s be honest—and it became fairly clear fairly soon that it was not working. In 2008, the Health Committee described it as not fit for purpose. Alan Johnson, who was then Health Secretary, commissioned the Steele inquiry, which reported in 2009. In 2010, we committed to reform the contract, and the Conservative Government made the same commitment, so this issue is cross-party and involves successive Governments, and we need to sort it out.

When I was going through the problems in the contract yesterday, I was pleased that the Minister nodded at each point I made. I would be grateful if, in her summation today, she could give us an insight into the contract reform that the Government are looking at, because we do not simply want to see tinkering, a little bit of shifting here and there, or—as I said yesterday—tweaking at the edges. Since the Health Committee reported in 2008, the contract has needed fundamental reform. Yesterday, I said that it was wrong that the contract was based on units of dental activity using figures from the two years previous to 2006, which are now massively outdated, and the Minister nodded. I said that it contains huge discrepancies in remuneration rates between practices doing the same work, and she nodded. I said—this was particularly relevant during covid—that the contract provides penalties, through financial clawback, for underperformance and not achieving targets, even if the reasons for non-achievement are completely beyond the control of practitioners, such as an inability to fill a job or the infection protection measures that were put in place. However, there is no reward if a dental practice overperforms—if it sees more people or deals with more teeth. The Minister nodded at that one, too.

The contract limits how much NHS treatment a practice can provide because of the quotas and the way that providers are contractually obliged to spread their NHS work and not be responsive to demand as and when it arises—the Minister nodded at that point, too. I would be grateful if she confirmed in her summation that the Government intend to address all those points, and indeed others, in reforming the contract.

The second aspect is the lack of funding for dentistry, which has fallen further than in any other part of the NHS. We should all recognise that it is a Cinderella service in the NHS. According to the BDA, funding for NHS dentistry has fallen by 25% since 2010, which, as I say, is completely out of line with the rest of the NHS. Alongside reforming the contract—we do not simply want a sleight of hand in solving these issues—what do the Government intend to do on funding? We heard about the £50 million Government investment for emergency funding as a result of covid, but there were problems with that—I say that with respect to the hon. Member for Darlington (Peter Gibson), who raised it in our debate yesterday. It was time-restricted funding for one quarter and was offered in a very short timeframe, which made it difficult to implement and involved work in addition to the contract. Practices were told that if they tried to help and then did not meet their standard contract target as a result, they would face financial penalties.

Unnecessary restrictions were imposed on the emergency funding by some commissioning teams—for example, in Sheffield, it had to be for out-of-hours access. The Minister is shaking her head. That might not have been what was required by the Government, but it was required by many commissioning teams. The net result was that lots of that money was not drawn down. I asked the Secretary of State yesterday to indicate how successful the initiative had been by telling us how much money had been drawn down, and he was not able to. I hope that officials have been able to provide the Minister with that number today, so that she can give us an indication of the success of that initiative.

I will say no more now because I am conscious that other Members want to speak, and we should all share our experiences from across the country, but I hope that we will not kick the issue down the road again and that the Minister, in her winding-up remarks, will commit to a comprehensive statement on where the Government intend to move on contract reform and funding to solve the crisis. If they do not make a statement before the summer and if we do not take action urgently, we will really be seeing the potential death of NHS dentistry.

--- Later in debate ---

[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?

[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.