NHS Dentistry

Peter Dowd Excerpts

Thursday 20th October 2022 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

I thank the Backbench Business Committee for granting this important debate and I thank my co-sponsor, or co-conspirator, the hon. Member for Waveney (Peter Aldous).

If you might indulge me this once, Madam Deputy Speaker, I did, in preparing for this debate, look up my past remarks on this issue; a sort of compendium of forecasting doom for NHS dentistry that, as it turns out, is entirely accurate. As we have heard, Members from across the House and across the country are raising concerns on behalf of constituents who are simply unable to access an NHS dentist. The current system remains unfit for purpose. Recent BBC research found that in the south-west, the north-west and Yorkshire and the Humber, just 2% of dental practices were taking on NHS patients.

[Peter Dowd (Bootle) (Lab)]

Is my hon. Friend aware that not a single dental practice in either the current former Prime Minister’s constituency or the Health Secretary’s constituency is accepting new NHS patients? Should it not spur on the Government that the former Prime Minister’s constituents and the current Health Secretary’s constituents cannot get access to NHS dentistry?

[Judith Cummins]

I am indeed aware of that fact, as my hon. Friend the Member for Bolton South East (Yasmin Qureshi) raised it with me yesterday. Sadly, she cannot be here today to make that very point, so I thank my hon. Friend for doing so.

In Bradford, 98% of dentists are closed to NHS patients, forcing people to go either to accident and emergency or to go private, whether they can afford to or not, often taking out a payment plan because they do not have the luxury of an NHS dentist available to them. In Bradford, 16% of three-year-olds and over a third of five-year-olds are now suffering with visible signs of tooth decay. In Yorkshire and the Humber, over 2,700 children under 10 had teeth extracted in hospital between 2020 and 2021. In fact, children born in Bradford are eight times more likely to be admitted to hospital with dental decay before their sixth birthday than if they were born in the former Prime Minister’s region. The truth is that NHS dentistry in its current form is just not working anywhere for anyone.

How did we get to this position? The answer is threefold: a contract not fit for purpose, dramatic underfunding and an exodus out of the NHS workforce. During my time in this place, Minister after Minister after Minister has stood here accepting that fundamental reform of the contract is needed. And yet we are still waiting. After years of delay, the Government announced in July some small contract changes, but unfortunately those quick wins completely failed on the fundamentals. NHS dentists in my constituency tell me that the financial uplifts are minor to the point of insignificance. The Government are conducting a polish and a clean when what is needed is root canal treatment. Will the Minister tell us exactly why the Government have not delivered the long-awaited full-scale contract reforms? Is it still their intention to conduct those reforms? If so, when can we expect them? If not, why not?

It is important to put on the record that the issue here is not a shortage of dentists. The number of registered dentists is at a record high. We have the dentists, but they are working in private practice. Until the Government fix the problems with the contract, which sees highly qualified and experienced dentists squeezed out of the system, they are simply pouring water into a bucket with a giant hole at the bottom of it.

My next point is on funding cuts. We saw funding to NHS dentistry fall by around a third in real terms over the last decade and that was before the cost of living crisis. In January, the Government announced a £50 million catch-up fund for dentistry, funded from clawback, that gave practices three months to offer urgent care appointments to deal with the pandemic backlog. I warned the Government at the time that their strategy was flawed and that the funding to tackle the covid backlog would prove to be unusable and the system unworkable. ITV recently revealed that approximately £14 million of the promised £50 million was actually spent. That is just 28% of the funding allocated, which delivered only 18% of the 350,000 appointments it was meant to. In Yorkshire and the Humber, my region, only 16% of the allocated funding was actually spent. The shortfall was clawed back by the Government once again and not reinvested back into dentistry in my region. That is less than a third of the money spent, not because it is not needed, but because the Government set up a system that was unworkable.

We need targeted funding to address an acute problem in areas of high need. The successful Bradford project that I developed with former Ministers back in 2017 really worked. It was a transformative project that meant we got 4,200 extra NHS dental appointments for people who had not had a dentist appointment for over two years. In the long term, however, we need fundamental change, and a comprehensive reform of the contract to push prevention is absolutely critical to that reform. Good oral health must not be restricted by either postcode or wealth. Going to A&E cannot be an alternative to NHS dentistry.

Although I welcome the Minister to his new role and, indeed, welcome the Secretary of State’s new emphasis on dentistry in her ABCD of priorities, whoever the Secretary of State is, in whatever Government, they should learn the lessons of targeting and invest in NHS dentistry, as prevention really is better than the cure. We simply cannot go on like this. The public are fed up to the back teeth with inaction and excuses.

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[Peter Dowd (Bootle) (Lab)]

Where are we to begin with this? We have been here before, time after time. I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for bringing us this debate. We have discussed this many times and we had a debate in Westminster Hall in the summer, but nothing has really moved on. Nothing at all seems to have changed.

I want to read out part of a letter I received from a constituent, and this is typical of the problem we are facing. I have received even worse horror stories, to the extent that one local dentist told me that they may close in the next few weeks. That is typical and symptomatic of this bigger problem. My constituent said:

“I wanted to take the time to get in touch with you over my experience of getting on the books for an NHS dentist. I have had no luck and have had to have private dental visits. I have luckily not had to have any treatment as I would not be able to afford it. I have reached out to a few dental practices in the area…to be told that they are only taking on children on the NHS.”

That is typical of the experience of everyone in this Chamber. I exhort Conservative Members to stop dealing with this in the abstract, as though it is only affecting individual Members of Parliament; it is a collective issue, and it needs a thorough review and a thorough push by the Government. It is not in the abstract. The hon. Member for Salisbury (John Glen) referred to covid. I completely accept that covid had an impact on the provision of dental services—it hothoused an already challenging situation—but dental services in all our constituencies were under huge pressure before covid. Let us not pretend that covid was the be all and end all of the dental health problem.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I agree with the hon. Gentleman that there are systemic problems, part of which goes back to the contracts agreed with dentists donkey’s years ago, under the Labour Government—the same applies in respect of GPs. That genesis of the problem was there, but we then face the problem of training too few dentists, which I think we do, and the problems in particular parts of the country, including, Lincolnshire, which is among the worst affected. My constituents cannot get an NHS dentist and they need to have one. That particularly applies to young people and children. He is absolutely right on this.

--- Later in debate ---

[Peter Dowd]

I am grateful to the right hon. Gentleman, who reinforces the point that I am trying to make. We are being contacted by constituents, as I have just set out. We are being contacted by Bupa—I suspect that Members will have had a briefing. We have had a briefing from the British Dental Association. We have had contact directly from dentists. They are all saying exactly the same thing and the Government have to listen. Not only do they have to listen—it is dead easy to do that—but they have to act. The Government have to put their hand in their pocket. So let us stop pretending that £50 million just before the summer is going to do anything in any significant or substantive way to resolve this problem—it is not.

The hon. Member for Bath (Wera Hobhouse) referred to an existential threat, and there is one—dentists are telling us that, as is the BDA. In practical terms our constituents are saying that to us, because their experience shows that there is an existential threat. The contract is a discredited one and it needs to be put right; it puts targets ahead of patient care. But this is also down to the fact that, whether we like it or not, and whether the Government like it or not, cuts in dentistry have not had any parallel to any other cuts in healthcare. We are talking about cuts of more than 25% between 2010 and 2020. That factors in and it creeps up on us year after year until we get to the situation where access to dentistry is the No. 1 issue raised with Healthwatch.

[Wera Hobhouse]

I was pleased to hear that the mother of the hon. Member for Salisbury (John Glen) has had excellent NHS dental care in Bath, and of course dentists are excellent practitioners and professionals. The thing is that his mother will have been a long-term NHS patient and the problem is that dentists do not take on new NHS patients, because the dental contract completely disincentivises them to do so.

[Peter Dowd]

That is a point well made. Another factor is that there are deep inequalities in access to dentistry. In my constituency, it is difficult to get to see an NHS dentist for love or money. I am not blaming the dentists; they are doing a fantastic job in the circumstances. They are going over and above their duty. I put on the record my thanks—as I am sure we all would—to my dentist practice, which I have been with for over 45 years. Dentists are doing a fantastic job, but they have both their hands tied behind their back at the moment. That has to change.

Some 91% of people, including 80% of children, are not able to access a dentist, and 75% of dentists are reducing their NHS engagement. The new contract announced before the summer did not really do anything and there was no new money with it. There is a significant gap—potentially as much as £750 million—in the resources that dentists need.

Another aspect is dentists’ morale, with 87% having experienced stress, burnout or depression in the last 12 months. That is a dreadful situation to put a committed profession in. We have a scenario in our country in which dentists who trained for seven or eight years—possibly more—and practised for many years are now getting to the stage where the majority are stressed, burned out or depressed. That is dreadful. According to one study, half of them are considering changing career. Some of them are seeking early retirement or going fully private. They are getting stressed out because they just cannot move the dial. They are waiting for the Government to move it, but the Government are not moving it.

Children in my constituency are three times more likely to have their teeth extracted in a hospital because they do not have access to a dentist. My right hon. Friend the Member for Knowsley (Sir George Howarth) and the hon. Member for Bath referred to oral cancer. That is identified very early on—and who does the identification? Surprise: it is often the dentist. We need substantive support from the Government, not tinkering around with the contract. We need them to provide adequate funding.

Dentists must not be an afterthought. They are a vital component of the health of the nation. We must build on the historical commitment to prevention; that is key—as the saying goes, prevention is better than cure. Dentists have had enough; they are under pressure. My constituents have had enough; they are under pressure. The Government have to do something about it.

In the debate before the summer, I referred, in relation to the lack of substantive action by the Government, to a rejigging of what Ian Fleming said about crisis: if once is happenstance and twice is coincidence, three times is friendly fire and four times is enemy action. We are now in a situation where the Government are perceived as the enemy because of their lack of action.

[Rachael Maskell (York Central) (Lab/Co-op)]

I apologise that I was not able to be here for the whole debate; I have been in a Bill Committee. In York, people have to wait six years to see a dentist. Of course that is completely unacceptable, but my real concern is that, with the transition of dental services into integrated care systems, ICSs will not have the powers—the levers—to make the difference on training, funding and the contract and, ultimately, dentistry will be pushed into a tug of war between ICSs and the Government.

[Peter Dowd]

I am glad that my hon. Friend raised that matter because it is something that I was going to raise. The health service, because of the reorganisation, is in an element of flux. It is feeling under a bit of pressure. Potentially, people are having to reapply for jobs in the broader sense in the NHS because of the reorganisation. That is a fact. I am not sure whether we should be having a reorganisation of the NHS in the post-covid environment, but that is a different argument for a different day. The broader dissonance in the system now multiplies the problems that we are having in dental practices, because they are getting pushed further away, which is why practices need representation on these boards. I am glad that my hon. Friend highlighted that point.

As I said in the debate before the summer, we do not want any more excuses from the Government. We do not want any more prevarication, any more procrastination, any more pretext or any more self-exoneration. I hope the Government and the Minister, whom I welcome to his place, really get the sense of the frustration and, in certain situations, anger in the Chamber today. They really must pull their finger out—if not people’s teeth.