Reforms to NHS Dentistry

Peter Dowd Excerpts

Thursday 27th April 2023 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for securing this debate, and I thank other hon. and right hon. Member for their persistence in pursuing this matter and ensuring it remains a priority. It is worth repeating that this debate is about the progress on reforming NHS dentistry. The two colleagues I mentioned made the case for this debate:

“Underfunding and the current NHS dental contract are to blame for long-standing problems with burnout, recruitment and retention in NHS dental services. Morale amongst NHS dentists is at an all-time low and we are facing an exodus of dentists from the NHS. Reform of the dysfunctional NHS dental contract is a matter of urgency—a reformed service won’t work if there is no workforce left by the time it’s finally introduced.”

To solve the problem, it is crucial to accept that there actually is a problem, and it is important to recognise the extent of that problem. The first question I want to ask the Minister is whether he accepts that there is a problem with access to NHS dental services.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

indicated assent.

--- Later in debate ---

[Peter Dowd]

I am pleased that the Minister nods and recognises that. The second is whether he acknowledges the extent of the problem with access to dental services. What progress has actually been made—that is what the debate is about—and has it been significant enough? The Minister accepts that there is a problem, but I am still not convinced, on the evidence we have, that the progress has gone far enough. That is my view. The hon. Member for Hartlepool (Jill Mortimer) talked about the 2006 contract, which we all know needs to be redesigned. The Labour Government recognised, in good faith, as early as 2009 that it had to change. We are now 13 years on, so we have to get to grips with it now. I do not point the finger in that regard, but that is the context for the debate today. Actions speak louder than words. Have there been sufficient actions to resolve the problem that the Minister recognises? I am not convinced there have been.

We had a debate in Westminster Hall on 10 February last year—over 12 months ago—in which I asked Conservative Members to

“press the Minister and ask the Secretary of State and the Prime Minister—their colleagues—to listen to the facts, because, unless Members opposite can get that message across to an indurate Government, things can only get worse.”—[Official Report, 10 February 2022; Vol. 708, c. 473WH.]

Let us take a rain-check a year or so on. Have things stayed the same? Have they got better? Have they got worse? In my view, and that of many others, things have not stayed the same and they have not improved substantially, so it does not take Hercule Poirot to work out that things have deteriorated. I accept, in good faith, that Conservative Members have lobbied the Government, but I am sorry to say that, looking at the situation on the ground in my constituency—and, no doubt, in other Members’ constituencies—their exhortations have fallen on nearly deaf ears, or at least have not been listened to sufficiently.

From Monday gone, there has been an 8.5% increase in NHS patient charges for dentistry in England—during a cost of living crisis. That increase will hit millions of people on modest incomes, including patients in my constituency, and that is those who can actually get to see a dentist. Many statistics have been mentioned today and I could rehearse them, but I will not do so for purposes of brevity. Everybody gets the gist that things are in a grim state.

One statistic I will mention is that dentistry is now the No. 1 issue raised with Healthwatch, with four in five people—79%—who contact it saying they found it difficult to access timely dental care. The British Dental Association has said:

“The Government’s support package for NHS dentistry launched in November consists of marginal changes that will do little to arrest the exodus of dentists from the service or address the crisis in patient access.”

On top of that, we have low morale in the service and dentists quitting in great numbers. I do not think it goes too far to say that we are facing meltdown. The BDA sees an existential threat; I say meltdown—we all get the gist.

Despite the £3 billion dentistry budget, some 10% of the money allocated will be returned, not because of lack of demand but because of dentist shortages. That is the irony. The money is returned, but that must be set in the context of underfunding over many years, on top of which is the poor contract. Retention issues are borne out of burn-out and consequent recruitment issues in NHS dental services. The BDA is right to say that marginal changes will not sort out the problem. I am pleased that the Chair of the Select Committee is on board on that.

First, fundamental reform of the contract is needed. Despite discussions between the BDA and NHS England, the fact remains that unless there is a substantive and substantial change to the contract, matters will continue to deteriorate. Second is the question of resources. It will take up to half a billion pounds annually to restore the funding of NHS dental services to 2010 levels. After a decade of attrition, that is the situation. In real terms, net Government spending on NHS dental services was cut by a quarter between 2010 and 2020. Again, I am not finger-pointing; it is just something that we have to factor in as we try to resolve the problem. Of course, as has been mentioned, the question of prevention has a crucial role to play, as it always does in health services. That, too, must be a priority for the Government.

Having heard what hon. Members, the British Dental Association and the NHS Confederation have said, and what constituents in their droves are telling us, I really hope that the Minister will take action and get to grips with this major problem with provision in this crucial part of the NHS. I started with the issue of progress being made. The question is: can we really say that we have made sufficient progress after three Backbench Business debates? Alas, at this stage, I do not think that we have done.