Access to NHS Dentistry

Rachael Maskell Excerpts

Thursday 10th February 2022 Westminster Hall

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

Thank you, Mr Efford, for allowing me to speak in this debate to highlight how the dental crisis is impacting on my city of York.

Healthwatch York has been at the forefront of campaigning on dental services, and I pay tribute to York dentists and the wider dental community, who have been generous in sharing the challenges that they face on a daily basis. I have also been inundated with correspondence from constituents, asking me for help. I hasten to add that they do not want me to get out my Black & Decker. They want me to stand in the gap between my city and the Minister in order to find the solutions. It is getting harder, because dentists are disappearing, waiting lists are growing and oral health is deteriorating rapidly.

Healthwatch York carried out a study in 2018. It found that it taken over two years for 45% of York residents to find a dentist, so none of this is new. Back then, 84% of respondents had an NHS dentist; last year, that figure fell to just 59%. Of those who did not have an NHS dentist, 71% could not find an alternative. The number of people who have not seen a dentist in the last two to three years has risen sixfold. According to the national data, the number of children who have seen a dentist has fallen by 44%. In York, it can take five years before people can see a dentist, and no practices are seeing new patients. Out of 39 practices, only one is accepting NHS patients on to a waiting list, but it already has 2,000 people on it.

In the midst of this crisis, many are receiving letters to say that their NHS dentist is going private, and they are therefore left without. One constituent said that they had spent their burial savings on tooth treatment, and another extracted his own tooth. This is a time of real crisis.

Some of my constituents have found a dentist 40 miles or more away, and some say it is cheaper to travel abroad. Many have no dentist at all. The cost of living crisis is bearing down on York because of housing costs, meaning that people simply cannot afford to go private. And nor do they want to. The principle of the NHS is so important to them, so they seek solace at A&E or with their GP in order to address the pain that they are experiencing, at a time when, as we all know, oral health inequality is growing sharply.

A third of people now see a dentist privately, but 71% of them say that it is not by their choice. Accessing NHS healthcare is really important for them. People just cannot afford it any more. There is also a two-year waiting list for an appointment at the only orthodontic practice for children in York.

We need to address the real challenges. First, we need a workforce plan. Things are getting much worse. Last month a BDA survey showed that over 40% of dentists plan to change career or seek early retirement in the next year, so this is urgent. We need dentists, hygienists, technicians, nurses and receptionists. A practice in my constituency has already lost three receptionists because of the abuse they get from very frustrated members of the public. And, of course, they are only on the minimum wage. We need to fill those vacancies. One practice in York has only one and a half full-time-equivalent dentists, rather than the required six, to see 10,000 patients. This is detached from reality.

We also need to make sure that the failed dental contract goes. Since covid, things have got much worse. The need will not be addressed simply by setting compliance at 85% or, as might happen in the coming days, at 100%. Putting more pressure on dentists will make them more stressed and more sick, while also heaping more stress on their colleagues as they take up the slack. Things will just spiral downwards. That approach will not work. It provides the wrong incentives and no solutions.

In York, we have been working through opportunities and plans, because at this point it is really important to look to the future. First, we need to create a national dental service; the system is so broken that we need to build it from scratch. The service must be free at the point of need and should never be dependent on people’s ability to pay.

Secondly, the school service must be reinstated. The Government are struggling to institute the supervised toothbrushing programme that they promised in the general election. Let us get that in place, because prevention is better than cure. And while we are at it, let us make sure that older people also access those services, because poor dental health leads to malnutrition and is actually one of the leading causes of premature death in older people.

We also need to look at the new structures emerging in our health system. I appreciate that this is still going through Parliament, but the integrated care system footprint should have responsibility for those services and we need to take advantage of the opportunities. The York Health and Care Alliance will cover the footprint of our city and integrate mental health, physical health and social care—and I would add dental care to that list. Supporting the alliance will enable us to deliver an integrated healthcare service. That is, of course, important, because our mouths are not divorced from the rest of our bodies. In York we are looking at how to pull all the services together, as we have done with diagnostic and treatment hubs and vaccines. There is a community of expertise that knows about integration, and we need to make sure that it pulls things together for dental services, too.

Finally, our city has called for a new dental school. Our city’s medical school is a unique model. We believe that we should not just look around the world but grow our own talent in order to provide dental services. That is why York—along with Hull, given the shape of our medical school—should have a dental school.

Our dental service has decayed. Oral health is regressing, and now we need a national dental service.