Dental Services: East of England

Peter Aldous Excerpts

Tuesday 16th May 2023 Westminster Hall

[Peter Aldous (Waveney) (Con)]

It is a pleasure to serve with you in the Chair, Sir Mark. I congratulate my hon. Friend and neighbour the Member for South Norfolk (Mr Bacon) on securing and leading the debate. That said—some faint praise there—it is easier for an MP to secure a debate on NHS dentistry in this place than it is for one of our constituents to actually see an NHS dentist.

As we know, the east of England is the most arid region in the country. That is certainly the case with rainfall and probably also with NHS dentistry. As we have heard, it has been the No. 1 item in many of our inboxes over the past two years. There are no signs of that abating, though, from what the Minister has said, I get the sense that the first steps are being taken to provide an improved service. There is much work to do and I await the Government’s plan for NHS dentistry. I am very much aware of the hard work that my hon. Friend has been carrying out and I hope he will be able to provide a publication date when he responds. I want to highlight what I believe should be included in the NHS dentistry plan, with a slight slant towards the east of England.

The first item is, of course, that NHS dentistry requires fair funding. The British Dental Association has estimated that we would need £1.5 billion a year to restore budgets to their 2010 level. I recognise that that will not be achieved overnight, but there does need to be a meaningful start.

I want to highlight two further points on funding. As I understand it, the annual budget for NHS dentistry is of the order of £3 billion; just over 10% of that is due to be clawed back because it has not been spent. I do not know whether the Minister has given an assurance elsewhere, but that money must remain ringfenced for NHS dentistry. The fact that there is money not being spent shows that the whole system is broken. We saw that at the beginning of January 2022, when the Government announced £50 billion of funding for what was described as a dentistry treatment blitz; only 30% of that was spent. There is a lot of work to do on the funding side.

I turn to funding issues from the east of England perspective. The British Dental Association carried out some work before the pandemic that showed that spending on NHS dentistry in England lags way behind that in Scotland, Wales and Northern Ireland. Homing in on what is happening in England, some recent research commissioned by the University of East Anglia and carried out by Health Economics Consulting very much showed that the east of England is the poor relation compared with the rest of the England.

The research showed that, for 2018-19, in the midlands, spending on NHS dentistry was £78 gross expenditure per head. In the north-west, it was £75; in the north-east and Yorkshire, £70; in London, £69; in the south-east and south-west, £69. The east of England is the tail-end Charlie, at £39 per head. There are a great many steps that we need to be taking to address that particular inequality.

My second point is about contract reform. The 2006 contract is discredited, and needs to be replaced. From what I can gather from what the Government and the BDA say, we have moved beyond what I would describe as the “talks about talks” phase of negotiations, and they are in meaningful discussions. This must not just be a tinkering with the contract—it must be a complete root-and-branch reform.

Some of the ingredients we need for a new contract include a clear break with the units of dental activity system of funding; and we must discard the straitjacket on how many patients NHS dentists can see. If they do not see enough, they get fined; if they see too many, they have to pay for it. We must also ensure that more complex and lengthy treatments are properly rewarded and that NHS dentists are not discouraged and penalised for performing them; we must prioritise prevention; and, particularly from the east of England’s perspective, somehow we must find a way of motivating NHS dentists to come and work in rural and coastal areas.

My third point is about recruitment and retention. Another plan that we are awaiting is the Government’s workforce plan for the NHS and the care sector, and dentistry must feature extremely prominently in that plan. In the short term, we need to recruit more dentists from overseas. We have a situation in the Lowestoft area—actually, it is in Beccles, where there is an NHS dental contract with a group called the Dental Design Studio. That group has been trying for some months to recruit three dentists from overseas. I think they are moving forward, but progress on the overseas registration examination, as carried out by the General Dental Council, is fairly slow. I have liaised with the Minister on the issue in the past and there is a backlog of applicants that needs to be addressed as quickly as possible.

Moving on from that, we need to train our own dentistry practitioners, which means hygienists and support staff as well as dentists. With that in mind, the University of Suffolk has set up a community interest company with the objective of carrying out both treatment and training, with the creation of hubs. The initiative is up and running, but it needs additional funding so that it can be rolled out further across the region. I ask the Minister to do all he can to provide that funding.

In the longer term, there is the issue of a dentistry school; we do not have one in the east of England. Both the University of Suffolk and the University of East Anglia have thrown their hats into the ring. What the Government need to do is just to assess strategically which regions need dentistry schools, but I believe there is a very big vacuum in the east of England. UEA and the University of Suffolk probably need to get together to come forward and put one case, rather than competing with each other.

My fourth point is about prevention. As we have mentioned, the new NHS dental contract must have an emphasis on prevention and the NHS needs to work closely with local councils in promoting better public health. I will quickly highlight fluoridisation. It is not a particular issue in the east of England, but I remember that in one of the many debates that we have had on NHS dentistry in this very Chamber, my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is a practising dentist, highlighted the situation in Birmingham, where he, as a dentist, can tell which part of the city someone comes from by looking at their teeth, because he knows whether the water is fluoridated in that particular area. Fluoridisation is a compelling issue that needs to be addressed.

Let me also highlight children’s dental health. Two years ago in Lowestoft, an organisation called Lowestoft Rising got together with some local councillors and bought toothbrushes and toothpaste for the under-sevens. It was an extremely successful project and very quickly parents were coming back and saying, “Can we have more?” Unfortunately, more was not available, but it was suggested to me that we should perhaps consider zero-rating toothbrushes and toothpaste for under-sevens. Longer term, we need to look at that very closely.

My final point is about accountability and transparency. There needs to be improved accountability and transparency with NHS dentistry. We have made a significant step forward with the transfer of procurement from NHS England to the new integrated care boards. In the Norfolk and Waveney area, that happened from 1 April, and it is important that dentistry is properly represented on those ICBs. Judging from the feedback that we have had from the Norfolk and Waveney ICB, it is very much getting to work on the problem. It is producing a one-year plan for short-term interventions and next March it will look to produce its long-term dental strategy. From my perspective, I can cite one major improvement. If I have a complaint about NHS dentistry, I can now go to the local NHS commissioners, who I go to on other issues and who give me very good, quick and proactive responses.

To conclude, in geographical terms East Anglia is probably the largest dental desert in the UK, and we need, metaphorically at least, to bring in the irrigators and sink the boreholes with immediate effect. There has been some preparatory work that will enable us to improve the situation, but we need the Government NHS dentistry plan as soon as possible. The plan will cover the whole of the UK, but it must also address the specific problems in the east of England—our historical poor funding, the challenge in recruiting and retaining dentists in our region, and the lack of training facilities. I look forward to the Minister’s response. He impressed me with the way he went about this task, but the plan that he produces needs to be ambitious, visionary and innovative, not just a sticking plaster.

--- Later in debate ---

[Matt Warman]

It is a surprising number. As I am sure my hon. Friend knows, the water companies have raised issues that are legitimate to some extent, but the overall public good from increasing that number is obvious and would pay real dividends relatively quickly. It would be public money well spent.

[Peter Aldous]

In this place, fluoridation is recognised, but the feedback I get from water companies is that conspiracy theories on the internet cause them concern. Does my hon. Friend agree that there is a need for the Government to lead a public awareness campaign on the benefits of fluoridation to dispel these urban myths?

[Matt Warman]

I was the Minister responsible for 5G during covid, and we all remember that, apparently, 5G caused covid—I should be very clear that it did not. However, there is a clear dilemma for the Government as to how much they engage with genuinely fringe conspiracy theories and risk giving them a degree of salience and credibility that they simply do not deserve. I encourage the Minister and his colleagues in the Department for Environment, Food and Rural Affairs simply to get on with it and engage, where necessary, with people who are genuinely worried. However, we sometimes have to acknowledge that the extremities of the internet are not a place where rational debate can always be had, be it on 5G and covid or on fluoridation and tooth decay.

I will make two other points before I end my jaunt to the east of the England. The first is that I know the Minister is looking—as we do with GPs and the NHS more broadly—at what work can be done by people who are not fully qualified dentists to help the nation’s oral health. Along with the expansion of people who have trained abroad, I think that would be welcome and could make a difference, but it is not a silver bullet either.

My final point is that, although my secret shopping exercise was valuable and instructive, it is a huge sign of failure, because the data about which dentists are accepting patients should be freely and easily available so that constituents can easily see which practices are offering help. Given the structure of NHS dentistry, we will always have some dentists with open lists and some with closed lists, even in a healthy system. Easy access to that information would benefit our constituents and NHS England.

I know that the Secretary of State is a huge fan of data and is making such information as open and as easily available as possible, and I hope it can form part of the eagerly anticipated dentistry plan, which is coming “soon”—I think that is the current Government parlance. In a world where the autumn runs into February, I would hope that “soon” is well before the summer. I know it will make a difference in the medium term, but the biggest frustration for all our constituents is the fact that there is no silver bullet.

I hope the dentistry plan includes, for instance, the experimental ways of employing dentists that some trusts are using up and down the country, because that will provide some of the interim measures that I hope will come before the opening of the three dental schools that we have secured in this debate alone. Those will make a huge difference, but it takes time to train dentists, and constituents need solutions as quickly as possible. In pursuing that, we will save people from turning up at A&Es and emergency dental appointments, which will come as a consequence of failing to deliver the basic services I know the Minister is keen to offer as quickly as possible.