NHS Dentistry: South-west

Richard Foord Excerpts

Tuesday 12th November 2024 Westminster Hall

[Richard Foord (Honiton and Sidmouth) (LD)]

I beg to move,

That this House has considered NHS dentistry in the South West.

It is a pleasure to serve under your chairship, Mr Vickers. I am grateful to the Chairman of Ways and Means to have been granted a debate on NHS dentistry in the south-west of England, which has particular problems.

I know that the new Minister will have encountered enough problems with NHS dentistry as it is, but the south-west is a special case. To illustrate: if we were to go back to 2015, 51% of adults in the south-west could see a dentist. That was also the case across England at the time, with 51% of patients who wished to see an NHS dentist having access to one. By 2024, however, that figure has declined sharply. Now, the current average across England is 40%, and in the south-west it is just 34%.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

I thank my hon. Friend for securing this important debate. In Somerset, the percentage of adults who have seen a dentist has dropped by 20% over the past decade. Does my hon. Friend agree with me that we should guarantee access to an NHS dentist for everyone needing urgent and emergency care?

[Richard Foord]

That is exactly what is needed for urgent and emergency care. My hon. Friend draws attention to Somerset; the situation is bleak in Devon too. In Devon in 2015, 55% of adults were able to see a dentist, but that has since dropped to just 37% today.

I have had so much correspondence from my constituents on this subject, and the decline, as I see it, is a direct result of 14 years of Conservative neglect of our health services and of NHS dentistry in particular. I find it really troubling that the situation is affecting people in some of the most vulnerable categories, such as older people and children,

Children in Devon are missing out on crucial dental check-ups. Once upon a time, they used to have check-ups twice a year; now, it is not possible for children to be registered for NHS dentistry in many dental practices. It is therefore no surprise that tooth decay is now the leading cause of hospital admissions for five to nine-year-olds in the country. I talked to one primary school and was told that pupils are going to hospital in Bristol to have their teeth removed—often between four and 10 teeth at a time. The number of NHS dentists in Devon has dropped from 549 to 497, so the reality is that NHS dentistry is simply no longer available for all.

[Perran Moon (Camborne and Redruth) (Lab)]

I entirely accept the points that have been made about Devon and Somerset. In Camborne, Redruth and Hayle, we have some of the most deprived areas in the country. I have met people who have chosen to access dental care privately at the expense of heating their homes or eating food. This is where we are today: we are in a dental emergency across the south-west, and in Cornwall, the situation is now critical. Does the hon. Gentleman agree that we cannot wait any longer for emergency dental care across the south-west?

[Richard Foord]

The hon. Gentleman is right. We want to move NHS treatment back into primary care and away from the most critical acute care, yet it seems to me that primary care services are moving in the other direction.

[Wera Hobhouse (Bath) (LD)]

Royal United hospitals in Bath saw nearly 260 people last year with serious dental issues such as abscesses, largely because those people could not get a preventive care appointment from a dentist in their community, forcing them to go to A&E. Does my hon. Friend agree that a lack of NHS dentistry drives up costs because people go to A&E when it should only be there for emergency cases?

[Richard Foord]

I agree that emergency care should not suddenly become the routine. It is there for the most critical cases, but we have not seen that, given the drying up of NHS dentistry provision in our towns and villages.

[Sarah Gibson (Chippenham) (LD)]

Does my hon. Friend not agree that part of the problem is that we are only talking about emergencies? The Secretary of State, in his first week in the job, talked about working hard to look at preventive medicine. That should apply to dentistry as well. Does my hon. Friend not agree that we need to look at a serious timeline for reviewing the dental contract? We cannot only talk about emergencies all the time.

[Richard Foord]

My hon. Friend makes an excellent point. Prevention is clearly cheaper than dealing with the problems down the line. There is no better example than offering check-ups for children’s dentistry.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

I find it absolutely shocking—I am sure my hon. Friend will agree—that the recommendations of a report published 15 years ago by the previous Health and Social Care Committee have still not been implemented.

[Richard Foord]

The hon. Member for Tiverton and Minehead has clearly done her homework. It is quite staggering that recommendations from that long ago are still not implemented.

[Caroline Voaden (South Devon) (LD)]

Lord Darzi said in his review of the NHS that

“urgent action is needed to develop a contract that balances activity and prevention, is attractive to dentists and rewards those dentists who practise in less served areas”

such as mine in South Devon, where not a single dentist is taking on NHS patients any more. Would my hon. Friend agree that we urgently need a timeline for this work to be done?

[Richard Foord]

Yes, I think so. My hon. Friend is right to point to some of the recommendations in the Darzi report. I was encouraged to see reference to neighbourhood hubs, where perhaps we can have delivery of primary care, such as NHS dentistry, nearer to the constituents we represent.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for securing this debate. Does the hon. Member not agree that the story in the south-west is being replicated across all of the United Kingdom of Great Britain and Northern Ireland? He may not be aware of a survey of almost 300 dentists in Northern Ireland that found that almost nine in 10 intend to reduce or end their health service commitments in the coming year. That could be the end of NHS dentistry. Is he experiencing the same thing in the south-west? If he is, Government must really grasp this issue, and, as the hon. Member for South Devon (Caroline Voaden) said , get it done.

[Richard Foord]

I am glad that the hon. Member for Strangford made that point, because I did not know about the situation in Northern Ireland. It sounds like some regions of the UK are not getting the attention that they require when it comes to NHS dentistry.

I want to share the story of two of my constituents, Mike and Shirley. I have received correspondence from them and many other residents, such as Martin Loveridge, who has had a similar experience. Mike and Shirley are hard-working people. Mike is almost 75 and retired after more than 50 years in horticultural work. Shirley, aged nearly 70, is still taking on part-time cleaning work to make ends meet. In 2023, their dentist in Sidmouth finally went private, driven away by the broken dental contract that we have heard described. The impact of that shift has been devastating.

Shirley developed a dental abscess. Anyone who has had a dental abscess will know what excruciating pain it can involve. Years ago, Shirley suffered from a similar infection, which led to sepsis. This time, instead of receiving urgent care from the NHS, Shirley faced the following choice: either wait in pain or go private. Plainly, this incident is a stand-out case, given that it was crucial that she received NHS treatment for sepsis, but typically, it would cost them £1,200 in dental fees—a sum that is simply unaffordable for people in Mike and Shirley’s position. Mike has not seen a dentist since May 2022 because he simply cannot afford it. Mike and Shirley tried to get NHS dentistry—they went to NHS England, Healthwatch Devon and the complaints department of the Devon NHS—and they had people admitting to them the dire state of the system, but they were offered no real solution. They spent hours on “Find a dentist”, an NHS website just for that purpose, but they were referred to a clinic that was 80 miles away, an impossible journey for them.

[Max Wilkinson (Cheltenham) (LD)]

I thank my hon. Friend for securing this important debate. Cheltenham, similarly, is a dental desert. My residents often find themselves referred out of our region and into the midlands for treatment, to places as far away as Malvern, if they are not lucky enough to get somewhere in the constituency of the hon. Member for Gloucester (Alex McIntyre). Does my hon. Friend agree that that is simply wrong and unacceptable? Will he join me in thanking community campaigners in Gloucestershire, including Councillor Paul Hodgkinson, the health lead for the Lib Dems on Gloucestershire county council, who are trying to fight this at the local level?

[Richard Foord]

My hon. Friend is right to draw attention to community campaigners, but frankly it should not require grassroots organisations to self-organise and mobilise; as representatives and as Government, we should be able to provide that in this, the sixth richest economy in the world.

[Carla Denyer (Bristol Central) (Green)]

I thank the hon. Member for arranging this debate and for his forbearance on the incredible number of interventions. Does he agree that to solve this problem once and for all, and not just deal with the emergency situations that have been mentioned, the Government need to move towards a model similar to that for GPs, in which dentists are reimbursed for their work and rewarded for caring for patients and taking a more preventive approach?

[Richard Foord]

Dentists need to be rewarded under an NHS dental contract that recognises that not everyone has the same ability to pay. Frankly, if a little money were invested early in preventive measures, some of our constituents would not cost the system nearly so much later.

At a Westminster roundtable on dentistry last year, it was made plain that the issue was about not so much a shortage of dentists, but a need to attract private practising dentists to NHS work. Many dentists, even those who would ideally prefer to work within the NHS, avoid NHS work or leave it, because the current system is not fit for purpose.

On Remembrance Sunday, I was talking to a couple near the war memorial in Sidmouth. They were both veterans. Between them, they had served for 62 years, and they were unable to get NHS dental appointments. They felt that they had dedicated their lives to public service and this was how the state was rewarding them.

[Clive Jones (Wokingham) (LD)]

I thank my hon. Friend for securing this important debate. I am sure that the issues in the south-west are similar to, and as challenging as, those in Wokingham in Berkshire. Commons Library data states that only 32.6% of children in Wokingham have seen a dentist in the past two years, compared with a 40.3% figure for the whole of England. Both figures show the Conservative party legacy of rotten teeth, fillings and agony. Arborfield and Swallowfield in my constituency are without dedicated dentists. That simply is not good enough. Does he agree that NHS primary care needs to be properly funded?

[Richard Foord]

I am appalled to hear about those examples from my hon. Friend. The really disappointing thing is that some of the expense of secondary care could be avoided with a little more investment upstream in primary care.

There is a clear disparity between the work that dentists do in the NHS and in private practice. There is so much more emphasis in private practice on preventive care. We need to see that same level of preventive work happening in the NHS.

At an Adjournment debate last week in the main Chamber, it struck me that although many of us were there seeking to draw attention to NHS dentistry, not a single Conservative MP attended. I thank the Minister in the new Government for showing more commitment to NHS dentistry than the last administration, yet we have further to go. The Government prioritised the NHS in the Budget, allocating it an additional £25.7 billion. However, we needed more reference to dentistry in the Budget. The Labour party’s manifesto talked about a dental rescue plan that would provide 700,000 more appointments and, most critically, focus on the retention of dentists in the NHS. We urgently need that.

We urgently need a dental rescue package to bring dentists back to the NHS, particularly in the south-west, where we have a dental training school in Plymouth. We understand that dentists, once trained, often stay where they went to university, so we need more dentists to be attracted to the south-west and to stay once they are there.

[Dan Aldridge (Weston-super-Mare) (Lab)]

It is important to look at the role of public health in local government as well. Better Health North Somerset has a great programme led by Catherine Wheatley that is all about promoting oral health, which the hon. Gentleman mentioned, in early years and for children and young people. One thing I have noticed is that what works and good practice is not often shared between integrated care boards across local areas. With the strength of feeling here, demonstrated by the amount of south-west MPs that have attended this debate, there is a real opportunity for us to collaborate and share what works. That would be really useful.

[Richard Foord]

I agree. One way in which we can share best practice is by thinking about not only training places, but the recognition of qualifications. After the UK’s exit from the European Union, we saw a breakdown in the number of EU dentists wanting to stay or being attracted here. With fewer eastern European dentists, in the south-west of England, for example, we need to look again at dental qualifications and whether there are some dentist qualifications we might recognise that might make it more attractive to be a practising dentist in the UK.

The rural south-west of England needs to be able to expect the same level of NHS dentistry provision that we see in urban areas across the country. Will the Minister commit to the reform of NHS dentistry so that constituents such as Mike and Shirley do not have to go into the red or forfeit heating their homes to get dental care that avoids them going to acute hospitals such as the Royal Devon and Exeter hospital at Exeter?

[Martin Vickers (in the Chair)]

I remind Members that if they wish to speak, they should bob. If they could limit their contributions to an absolute maximum of four minutes, we will probably get everyone in. But it is going to be a squeeze, particularly if there are too many interventions.

--- Later in debate ---

[Dr Simon Opher (Stroud) (Lab)]

Thank you, Mr Vickers, for chairing this essential debate about dentistry in the south-west. My mailbox is full of people complaining about the lack of NHS dentistry, and we have heard all the horror stories. As a GP, I see people staggering into my surgery holding their face. I know no more about teeth than anyone else here, but we GPs have to try to treat them with painkillers and antibiotics, because there is nothing else available. We must change that.

Let me quickly talk through the dental contract; I then have a couple of positive stories, which will perhaps stimulate the Minister in respect of what could lie ahead. As has been said, the current dental contract nationally has an £86 million underspend, which is absolute madness, but it is because the contract is incredibly restricted and restrictive. The funding for units of dental activity is very poor.

[Richard Foord]

The £86 million underspend relates to the south-west in particular.

[Dr Opher]

Yes, but that is even more shocking, is it not?

There are also disincentives in the contract for dentists to take on new NHS patients. When we look into it, there are all sorts of other things. For example, a dentist cannot provide urgent NHS dentistry unless they have used up their quota of UDAs, which are issued to dentists at the start of the year. The whole system is crazy, which is why there has been such a massive saving. As we have heard, dentists are leaving the profession, and it is clear that we are not training enough. I accept what the hon. Member for South West Devon (Rebecca Smith) said about how dentists are trained and where they are likely to end up working, because that is incredibly important.

As to solutions, we must have prevention. Dentistry is exceptional because dental treatment is preventive in its own right, so as soon as NHS dentistry is stripped away, there are immediately problems. We also have to make sure that young people’s diet is better. Dentist Cerri Mellish and I have developed a project in our area. Cerri sees young pre-school children who are under five. She has a quick look in their gobs and if there are signs of decay, they are whipped out and the children are given treatment. If there are any other signs of problems, she can give them fluoride enamel. These types of innovative solutions are really important.

One thing that happened with the pandemic was that NHS dentists stopped registering new patients. The pandemic started in 2020, so almost all pre-school children are likely not to be registered with a dentist, which is a real disaster. We should remember that two thirds of general anaesthetics used for children are used for dental reasons, and a general anaesthetic is not without risk.

--- Later in debate ---

[Richard Foord]

I acknowledge what the Minister said about the Conservative Government’s legacy for NHS dentistry, which is apparent for us all to see. The Health Service Journal revealed last month that in Devon and Cornwall, the wait for an NHS dental appointment for a new patient is 1,441 days—almost four years. Many of my constituents cannot wait that long. I hope the Minister has heard not only the examples of pain and suffering set out today but some of the prescriptions proposed by the Liberal Democrat spokesperson and other MPs from across the west country.

Question put and agreed to.

Resolved,

That this House has considered NHS dentistry in the South West.