Access to NHS Dentistry

Peter Bottomley Excerpts

Thursday 10th February 2022 Westminster Hall

[Sir Peter Bottomley (Worthing West) (Con)]

I agree with Sir Robert Francis and with the hon. Member for Bradford South (Judith Cummins). I also agree with, and am grateful to, my hon. Friend the Member for Waveney (Peter Aldous).

Mr Efford, I would just clear my throat by saying that I am only Father of the House because of 1992, so I pay tribute to you for your part in my still being here. I would also say that, after Stephen Lawrence was attacked, I did the right thing in going to see the Commissioner of Police, but I also did not do the right thing; I should have gone with you to ask the Home Secretary for an inquiry into the attack. I pay you public tribute for that, and I shall forever be grateful that you did what I had not done.

I hope that the Minister has met the Toothless campaigners, Mark Jones and Steve Marsling, who have given some of us leaflets spelling out some of the things that are required.

With the participation of patients, we ought to be able to get this right. It needs dealing with, first as an emergency, then in the medium and long term. Fluoridation should not be delayed, but the beneficial impact will come later. Getting more dentists through training and getting more well-qualified dentists from overseas will help in the medium term, but the emergency goes beyond the end of March this year.

I will send to the Minister the letter that I received on 10 February from NHS England and NHS Improvement about the situation. It is a well-meaning letter, but it does not deal with the problem, as she will know, because, on the south coast, we face the same problems as in East Anglia and in Yorkshire—and throughout the country, for that matter.

We know the impact that covid had in reducing the number of sessions that were possible, with the space required between treatments, but as the hon. Member for Bradford South said, it is not just about covid; the problems were there before. I take the view that the general practitioners contract in 2006 was wrong; the dentistry contract was wrong. Those watching this debate may hear about UDAs—units of dental activity. Why is it that one filling attracts three UDAs, and yet five fillings, a root canal and an extraction get the same?

I am grateful to those dentists who have written to me, many of whom are doctors. One says:

“I spend around 40-50% of my time on NHS work (clinical and non-clinical) but it only accounts for around 10% of my income.”

My mother used to explain to me that young dentists would take on a lot of NHS work and work really hard and intensively, then, as they grew through middle age and towards their last 10 or 15 years, they would go more private and have more time, and others would come up and take over their work. There would be a sort of succeeding life cycle of dental activity.

I am not against private dental treatments and attention, but I do not believe that it should be required. People ought to have the option of NHS treatment. My wife and I always used that for our family, until we were a bit older, and others should be able to do the same. We need a system in which anybody who asks for an NHS examination can get one, without significant delay.

One dentist talks about an awful lot of time spent on data capture for the NHS Business Services Authority—at least it is one; it was combined from five other bodies. It is important that the amount of admin that dentists complete be reduced as far as possible.

Those practices that still provide NHS dentistry try to continue with their contract but say that they are unable to take on new patients due to UDA limits. They get many calls a day from people saying that they cannot get care because their practice no longer accepts NHS patients. That has to change, and it has to change fast.

Another of my dentists has sent me some pretty clear figures. They say that they cannot find the 1.5 to 2 full-time-equivalent dentists that they need to recruit. They also bring up the issue of training and the flawed contract, and note that contract reform has been promised by every Government since the current contract was introduced in 2006.

We cannot delay any longer. Even if it were just an interim contract, that would provide an incentive, money, encouragement, recognition and a change to patients’ circumstances. As has been said, many more things need to be done.

I have found the British Dental Association to be very co-operative and positive, acting in the interests of patients and of its members as clinicians and as businesses.

Let us try to get people together and take an urgent approach. And when we meet in six months’ time, let us be able to say that significant improvements have been made and that more are coming. Then, perhaps in three or four years’ time, we will not have to have these discussions.

--- Later in debate ---

[Andrew Selous (South West Bedfordshire) (Con)]

Like other colleagues, I pay tribute to my local dentists and the whole team of dental staff who support them. They do amazing work, and almost all of them went above and beyond during the pandemic.

I have to express a bit of concern about the information that the Minister’s officials may be feeding her. I got a letter on 16 December from NHS East of England direct commissioning, which said: “Having conducted a search of dental practices in the Leighton Buzzard area, I can confirm that of the 47 dental practices, six are accepting new NHS patients.” The letter goes on to say that there are 30 others that have not been heard from. I received an email only this morning from a couple in Leighton Buzzard who said that they have given up trying to find an NHS dentist. A lady in Dunstable wrote yesterday to say that the local waiting list is two years. Another constituent wrote to say that they had been turned away by emergency dentists to which NHS 111 had referred them.

[Sir Peter Bottomley]

Would it be too difficult for the NHS to have a list, for every constituency, of every dental practice and its situation? That way, the NHS, patients and MPs would know what the situation is, and we could change that situation.

[Andrew Selous]

The Father of the House is absolutely right; the point was also made by my right hon. Friend the Member for Basingstoke (Mrs Miller) earlier. I do not think that the data are nearly good enough, and I do not see how Ministers can have proper oversight if we do not actually know what is happening.

When the letter of 16 December says, “having conducted a search of dental practices in the Leighton Buzzard area,” I fear that the person who wrote it sat at their desk and went on Google to find out. I do not think they actually came to the town. I do not think that they walked around and spoke to the dentists, the local Healthwatch, or the people in the town. How can the Minister have accurate information if what we get from the officials—that was from an official letter from the NHS to me—does not actually reflect what is happening in the town?

We are struggling now, but my area, like that of my hon. Friend the Member for North East Bedfordshire (Richard Fuller), is scheduled to have another 14,000 houses; they have been consented and are being built now. I have a major campaign on ensuring that general practice capacity keeps up with major new housing developments. How can we do that for dentists too if we already have a deficit? Will the money follow those huge new housing developments in many of our constituencies? We need answers on that too. If the Minister is able to give further information on that, either when she replies, or perhaps by letter afterwards, that would be really helpful.

We have heard from many colleagues about the issue of children’s teeth. I am informed that tooth decay is the No. 1 reason for hospital admissions of young children. That shows the importance of prevention and getting it right, and the whole issue of sugary drinks. I recognise the help that fluoridisation gives, but children’s oral health is a huge issue.

One or two colleagues—including, I think, the hon. Member for York Central (Rachael Maskell)—mentioned older people’s dental care; I had a debate on that in the Chamber. It is a subject that we often do not talk enough about, particularly with people in care homes. Do the managers of those homes ensure that staff help the patients to brush their teeth? What about the oral care of people receiving domiciliary care? Is that budgeted in? It is serious; it can lead to malnutrition and all sorts of problems. There was a major Care Quality Commission report, which was only on the care home sector, in June 2019, called “Smiling matters”. It would be good to have an update from the Minister on how we are doing in ensuring that older people’s dental care is also taken proper care of.

We know that the current contract, about which most of us have been complaining, was introduced in 2006—so quite some time ago—but back in June 2009, there was an excellent independent review about what we needed to do about it by Professor Jimmy Steele. I will quote from one paragraph of it:

“Through the NHS, dentistry could take a huge step forward but in order to do that, one concept is critical. So long as we see value for taxpayers’ money as measured by the production of fillings, dentures, extractions or crowns, rather than improvements in oral health, it will be difficult to escape the cycle of intervention and repair that is the legacy of a different age.”

I think that the Steele report got it right. However, that was under the previous Administration, in June 2009. I am told that the work on reform started in 2011, and yet here we are, in 2022. I think that what we are all saying to the Minister—who is diligent and I know cares about these matters—is that we really need some urgency.

On the number of dentists, perhaps slightly surprisingly, and perhaps contrary to some of what we have heard today, I had an email yesterday from the British Dental Association saying,

“We don’t really have a shortage of dentists in England—the number of dentists registered with the General Dental Council is in fact almost 2,000 higher now than it was in 2018. The key problem is that these dentists increasingly don’t want to work in the NHS—almost 1,000 quit the NHS in the last year alone.”

The email goes on to say that if dentists move to private provision, they do not actually earn any more. They are not just leaving NHS work because of the money but because they cannot look after their patients properly under the contract. It says that it is soul destroying, chasing these NHS units of dental activity. It is stressful and demoralising, so what do they do for the same money—not for more money? They go—this is what the British Dental Association says—to private practice, where they can spend more time with their patients, providing the level of care that their patients deserve.

We are not doing it right. To try to guard taxpayers’ money through efficiency, we are driving dentists out of the service. We are measuring the wrong things. I do not think that we are measuring enough, as we do not seem to have enough measurement, and where we are measuring, we are measuring the wrong things. It is not possible to get improvement unless we have the correct data. I have confidence in the Secretary of State and in the Minister, but I think we are all saying that this is urgent and please get on with it with proper reforms.