NHS Dentistry in England

Rachael Maskell Excerpts

Wednesday 22nd June 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for St Ives (Derek Thomas) for opening the debate and making many of the points that I intended to make. The simple fact is that we do not have time for further delay. We have four and half weeks left until the summer recess, and our constituents want answers. They want answers because they need to see a dentist but they are experiencing the deficit of NHS dentistry across the country. I would add to the list of areas mentioned that Yorkshire is also deeply affected, and my city, York, is struggling.

In 2009, Labour committed to reform the dental contract, realising that it was not going to deliver what it aspired to. The coalition Government followed in 2010 with a similar commitment, yet here we are in 2022 still making the same argument that we desperately need reform. As has already been said, this is not just something that has emerged through the pandemic; it is an issue that predates us. That is why it is essential that we have a pathway from today showing how we are going to move out of the crisis. Our constituents deserve to know what the Government’s agenda is.

Two years ago, NHS dentistry fell by 13%. Since covid-19 there has been a mass exodus in my city of York, but I realise that has also occurred across the country. Last April, NHS dentistry fell by a further 19%. It is believed that since the start of the pandemic, NHS commitments have fallen by 45%. Next year, 75% of dentists are planning to make changes and reduce their NHS commitments. Of those, some 45% say they will go fully private and 47% say they will change career or take early retirement, so if we wait another 12 months we will be in a deeper mess than we are now.

Since the start of the pandemic, we have lost 43 million dental appointments, 30 million of which were for children. In my constituency, 41% of children have not seen a dentist in the last year—they are the children who are now presenting in more acute services, requiring even more expensive interventions.

To put the situation in York into context, 9,695 UDAs were delivered in March 2021, at a time when 45% of UDAs needed to be delivered. A year later, in April 2022, 8,730 UDAs were delivered, fewer than the year before, and yet the requirement was for 95% of UDAs to be delivered. Instead of the number of my constituents accessing NHS dentistry going up when the number of UDAs that were expected to be delivered more than doubled, it has gone down. With 965 fewer UDAs, despite a doubling of the expectation, will the Minister explain how my constituents are meant to get access to services?

Fewer than half my constituents have seen a dentist in the last year. Of course, dentists have offered them private dental plans but my constituents simply cannot afford that, not least because of the cost of living crisis and the housing crisis in my city. Some travel long distances and others get nothing at all, and we know about other health inequalities that are similarly embedded.

[Sir John Hayes]

It is the least well-off people who suffer most, as the hon. Lady rightly said. Working-class people cannot afford these expensive plans. Surely the answer is that we should train more of our own dentists and make it more attractive to work for the NHS, rather than go private. My own dentist is Turkish by origin. He is a fine NHS dentist, and I could not speak more highly of him, but we cannot simply import dentists; we need to train more.

[Rachael Maskell]

The right hon. Member is absolutely right that we have to train more dentists. One reason for that is that it takes about 10 years for somebody to be fully professionally competent and able to provide the highest level of dentistry. We must not look just at what is happening now, but into the future too.

Before we get to that point, we have to look at retention and at bringing people back from private contracts and services into NHS contracts. With fewer dentists available, the toll and the mental stress felt by those who have stayed in the NHS and remained committed to it is building. Some 87% of dentists experience mental stress, and 86% have experienced abuse as a result of people being so frustrated by the time they reach the dentist’s door. The people working in dental reception areas are at the forefront of that, and I know of a practice in York that cannot recruit anyone to be on the front desk. We need significant changes to be brought forward, and that will require money and dedication.

It is not just about the contract; it is also about having a complete strategy around dentistry. I have never understood why oral health was taken outside the wider NHS, and I believe that the solution to the problems we face is to have a proper NHS dental strategy and to put the NHS dental service back into the heart of the NHS. However, while we are working on those issues, we have to look at the crisis before us.

In Parliament last week I mentioned a practice that has been fantastic at accommodating people with dental needs throughout the pandemic. I said that three dentists were leaving that practice; I was wrong—it is now four. That is the pace of people leaving the profession. We have heard about the wider consequences for oral health, and particularly oral cancers, for which a delayed diagnosis means the worst prognosis. Therefore, it is absolutely right that we see a move on this issue.

I want to raise a couple of issues about dentists waiting to come to the UK. We know that 700 dentists are waiting to sit exams. The Government have had a consultation, which has closed, and we are awaiting a response. I am sure everybody in the House would want to accelerate legislation on that, but we need to know the Government’s plan. I hope the Minister will be able to tell us about that today.

However, 700 dentists will not fill the gap. Just last week, I was speaking to Ukrainians who have come to the UK. They want to work, they want to put their skills into practice and they want to have fast-track English language training so that they are competent in terms of their language skills. They want to see their qualifications passported, so that they can get to work and practise their profession. They do not want to deskill or de-professionalise. They want to learn the clinical language that they will require, and therefore to shadow dentists getting ready for practice. However, I have not seen a strategy from the Government on how we will work with refugees who have those skills and can put them to work. Perhaps the Minister will share that in her closing remarks, because it seems such a waste of talent when many refugees absolutely want to address that local need but cannot do so.

I turn now to the future training of dentists—a point raised by the hon. Member for St Ives. I have had discussions with Hull York Medical School, which is a fabulous partnership between the two cities, and it would be prepared to help support a dental school. Of course, that would need investment, so we need proper investment for the future. To look at how that would work, I spoke to the commissioners, and there certainly is an appetite in our city to host such a school in the future. That would be helpful in bringing dentists onstream, but we also must recognise that students currently in training are struggling to get placements in the NHS. Of course, the more dentists who leave, the harder it will be to train the current cohort. Unless we see a quick increase in the number of NHS dentists, we will be in even more difficulty. That is why the urgency is there now. We must build back an NHS service for the future to ensure that we have those professionals in place.

Finally, we know that integrated care systems will be taking over the commissioning of dental services next year. My concern is that Government are waiting for that moment to act. We must see action now, because the integrated care systems will not be able to solve a problem that the national Government won’t.

--- Later in debate ---

[Maria Caulfield]

Absolutely. The whole point of the ICSs is that the commissioning service has not worked up until now. Some commissioners are very good at commissioning dental services, while others do not have anyone with dental experience on their boards and are not so good. ICSs will be accountable, which is the difference from what we have now. I will meet ICSs to ensure that they understand the responsibilities.

[Rachael Maskell]

rose—

[Maria Caulfield]

I will take one last intervention, because I am conscious of the time.

[Rachael Maskell]

I am grateful to the Minister for giving way. When I wrote to her, she kindly replied and said that York could well be one of the areas for a centre of dental development. I would like to know the timescale for such considerations, and what progress has been made since our correspondence.

[Maria Caulfield]

I met Health Education England this morning and we are working through that system. I will be able to update the hon. Lady shortly, because I am keen that we make progress.

A number of Members mentioned prevention. The Health and Care Act 2022 includes provisions relating to fluoridation as standard, and we are working to make progress since it became law recently. We are also working with education colleagues on supervised toothbrushing. As we speak, some of the 75 family hubs that are being set up in the most deprived parts of the country as part of the Start4Life programme are looking at initiatives such as supervised toothbrushing. Where it is not happening at home or where parents need more support, we are ensuring that children are getting that toothbrushing experience.

On the subject of upskilling dental teams, this is about more than just dentists. My hon. Friend the Member for St Ives (Derek Thomas) made the key point that it is about the whole team. At the moment, part of the contract means that only dentists can do certain work. We need to change that. Centres for dental development will be about not just training dentists but upskilling whole teams.

I hope that I have reassured Members from across the House that we are taking this issue extremely seriously. To answer the question put by my hon. Friend the Member for St Ives, the contract changes that we are going to announce will not be the end of it, because there is more reform that we need to do. The Secretary of State is looking at a wider piece of work to provide a long-term, sustainable solution. We are happy to work with the other three nations if they have suggestions and solutions. We are not precious about sharing best practice.

I say to the shadow Minister, the hon. Member for Enfield North, that it would be good if she could come to a dental debate with some suggestions and solutions, rather than constantly criticising. We are determined to solve this issue and I appreciate the urgency that every single one of my colleagues has expressed today.

[Rachael Maskell]

I raised the issue of Ukrainian refugees. The Minister seemed to indicate that she had a response, so could she provide it before she closes?

[Maria Caulfield]

The response is that every overseas dentist, apart from those in the European economic area, currently has to take the overseas registration exam, and that is without exception. That is the work that we are trying to do with the General Dental Council. We are enabling those from Ukraine or Afghanistan, or any refugee from any country, to take part in that process. I am very keen to see mutual recognition with some countries. We are working on that and will enable the legislation to make it happen, but it will be for the regulator to decide; it is not a Government decision.

I hope that I have reassured colleagues that we are on this and appreciate the urgency. I have no doubt that we will return to this Chamber to debate this matter further in the coming weeks and months.