NHS Dentistry

Preet Kaur Gill Excerpts

Tuesday 9th January 2024 Commons Chamber

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

I start by expressing my thanks to Members across the House for their many powerful contributions this afternoon. They include my hon. Friends the Members for Stockport (Navendu Mishra), for Weaver Vale (Mike Amesbury), for Wakefield (Simon Lightwood), for Birmingham, Erdington (Mrs Hamilton), for City of Durham (Mary Kelly Foy), for Easington (Grahame Morris), for Leeds North West (Alex Sobel), for Selby and Ainsty (Keir Mather), for West Lancashire (Ashley Dalton), for Tamworth (Sarah Edwards), for Mid Bedfordshire (Alistair Strathern), and for Lewisham East (Janet Daby). They all spoke forcefully about the struggles of their constituents to find an NHS dentist. That is far too common, as we have heard today. Recently I was contacted by a constituent whose daughter was told she would have to wait four years for an appointment to get braces. She is 13 now and will be 18 by the time that she is seen. That is not acceptable.

Let me also thank my hon. Friends the Members for Bradford South (Judith Cummins), for Sheffield, Brightside and Hillsborough (Gill Furniss), for Brighton, Kemptown (Lloyd Russell-Moyle), for Stretford and Urmston (Andrew Western), and for Kingston upon Hull West and Hessle (Emma Hardy) for raising the issue of DIY dentistry. Recent polling has found that around one in 10 adults has attempted some form of DIY dentistry. No one should be forced to pull out their own teeth with pliers. That is Victorian healthcare in Britain in 2024. The British Dental Association survey found that more than half of dentists in England have reduced their NHS commitment in the past few years, and almost half are considering either a change of career, early retirement or turning fully private. I hope that this is a wake-up call for Ministers. All of this paints a bleak picture, Mr Deputy Speaker. The Nuffield Trust described it as a “widespread crisis”, bringing NHS dentistry to its “most perilous point” in its 75-year history. That is why we are debating this motion today. Without urgent action, we are looking at the end of NHS dentistry as we know it.

Seventeen months ago, while he was losing a leadership election to the right hon. Member for South West Norfolk (Elizabeth Truss), the Prime Minister pledged to “restore” NHS dentistry. I thought the Prime Minister might have learned his lesson about five-point pledge cards by now, but I remind the House what he promised: ringfenced funding; frontline retention; strengthened prevention; and contract reform. Yet hardly any of that has been delivered. There are fewer NHS dentists now than when he took charge, and they are doing less NHS work. There has been no national roll-out of a supervised toothbrushing scheme to promote healthy habits among children, despite cavities being the top reason they are admitted to hospital. As the Health and Social Care Committee has said, changes to the dental contract

“constitute tweaks rather than anything close to ‘reform’.”

The recovery plan, promised last April, is nowhere to be seen. The Government’s one big idea so far has been to tweak the dental activity contract to allow practices to deliver 10% more NHS work but, having listened to today’s debate, I do not think that a fraction of practices upping their workload by 10% will actually cut it—talk about toothless—and it certainly will not without the money to fund it. We have heard some laboured explanations from the Secretary of State about how local dentistry budgets can be ringfenced, yet simultaneously ICBs have been told that they can raid those same budgets to balance their bottom lines.

Let me raise a specific example. Last week, it was reported that one integrated care board in the west midlands has instructed practices that they will no longer receive funding to deliver the extra 10% of NHS work that was promised. Labour’s candidate in Newcastle-under-Lyme, Adam Jogee, told me that people were already struggling to access basic dentistry as many dentists are not accepting new patients. ICBs are supposed to improve access locally, better integrate services and address inequalities. For one practice in Birmingham, the decision means that from next month the money for it to see NHS patients will run out for the rest of the financial year. The U-turn means that dentists who want to do more NHS work simply cannot. That is bonkers!

It is not just happening in the west midlands: throughout the country there are more examples of care boards cutting back funding for dentistry. Eight out of 10 practices are not taking on new NHS patients, and people are pulling out not just their hair but their own teeth, because they cannot get an appointment. One local dentist in Birmingham said:

“The system is on the verge of collapse—and the only stakeholder that will eventually lose out is the patient.”

That is not restoring NHS dentistry; that is another broken promise. Does the Minister know how many other ICBs are withdrawing funding? Have the Government even made an assessment of the U-turn’s impact on thousands of people who cannot get an appointment with an NHS dentist? Do they know how much scheduled dental activity will be lost under the revised financial plans of ICBs?

As we have heard today, the consequences for patients are shocking, particularly for children and the most vulnerable. Tooth decay is the No. 1 reason for hospital admissions among children aged six to 10. Tens of thousands of children are left in pain for months, if not years, waiting for procedures. They face difficulties learning, eating and sleeping. It is particularly grim when we consider that children from the most deprived areas are three times more likely to have hospital extractions than their peers.

How can the Government hope to level up opportunity for every child in Britain when some are in too much pain even to concentrate at school? Sixty thousand school days were lost to this problem last year. That is why our plan includes rolling out a national supervised toothbrushing scheme that targets the most deprived 20% of children, embedding good habits. It is recognition that prevention is better than cure. It will cost £9 million per year, which is dwarfed by the estimated £51 million that it cost for child tooth extractions in hospital in the latest year. Labour actually understands good economics—that dealing with issues early saves cases worsening and ending up in secondary care, which puts pressure on hospitals and costs the taxpayer far more.

While the Government have been rolling back their ambitions, Labour will ramp ours up. Our motion proposes giving dental practices extra money to run urgent care programmes to give people access to timely acute care, which they simply cannot get right now. We will fund an extra 700,000 urgent appointments a year from revenues generated by abolishing the non-doms tax status. Not only is that costed, but it is deliverable and doable, because dental practices have the capacity to deliver; the issue is that they do not have a Government with a plan that gives them the certainty they need. Our constituents need dental appointments far more than the wealthy need tax breaks.

I am grateful to colleagues who have raised the issue of the dental activity contract. They are right that it is no longer fit for purpose, and I think that Ministers know that—despite having pledged to reform it 14 years ago, which they have clearly failed to do. Do they share my concern that without wider reform to tackle retention issues in NHS dentistry, recruitment alone will be like trying to fill a leaky bucket?

In the meantime, NHS dentistry is dying a slow death. I was shocked to read about a pilot scheme in Cornwall in which only children and the most vulnerable are being seen on the NHS. At one practice, 4,500 patients were kicked off the books and told either to go private or to find another dentist. This is what we can expect under five more years of the Conservatives: dentistry for the few and everyone else left to sink or swim. We in the Labour party will never accept that.

NHS dentistry is an issue that crosses party lines and is as desperate in many Conservative constituencies as it is in Labour ones. We have good data on dentistry practices self-reporting whether they can take on new NHS patients. In Milton Keynes North, 12 out of 12 practices are not accepting any new adult patients, and in Bassetlaw, 10 out of 10 surgeries are not accepting new adult patients and seven in 10 are not accepting anyone at all. In Louth and Horncastle, the Health Secretary’s own constituency, not a single practice is accepting new adult patients. That is a big constituency; imagine how far someone living on the coast would have to travel to get an appointment. I heard it is about 21 miles to the nearest dentist. Is her message to constituents just to get on their bike? Or will she back our proposal today for a targeted recruitment scheme to train up new dentists in left-behind areas?

The crisis in NHS dentistry is urgent and cannot be ignored any longer. The Government need to drop the spin and accept the facts. In the short term, services need to be put on a sustainable footing, and in the long term we need deeper reform to ensure that everyone who needs an appointment can get one. I urge Members across the House to do right by their constituents today and vote for Labour’s motion to rescue NHS dentistry from further decay.