Access to NHS Dentistry

Rushanara Ali Excerpts

Thursday 10th February 2022 Westminster Hall

[Sir Paul Beresford (Mole Valley) (Con)]

I am delighted that we are being guided by you, Ms Ali. As a dentist—extremely part time—I am fascinated by the interest in this issue. I hope that some dentists read Hansard and find out that somebody actually cares about them. One of my hon. Friends asked why they were leaving the profession. It is a tough job—a really tough job. If I want relief from a couple of hours of dentistry in a week, I come into the House of Commons—it is a lot easier.

I thank my hon. Friend the Member for Waveney (Peter Aldous) for his introduction to the debate. It was a real expedition, right across the whole scene. I will suggest that we create an honorary degree in dental administration especially for him, because he covered it so beautifully.

Let me start very simply. I will not go through all the bits and pieces that everybody else has talked about; I will just cruise across the surface. We have three different groups of dentists: fully private, fully NHS, and mixed. The last group is the largest by far; and, to a considerable degree and in spite of some of the accusations today, that is by patient demand. It is what the patients want. It is not always the case that they feel forced into it because they cannot get the service elsewhere. The comment was made that we do not have enough dentists, but the BDA says that we have. I do not agree with the BDA, but this will not be the first time. We do need more dentists. If we had more dentists, we would get over the problem that my hon. Friend the Member for Broadland (Jerome Mayhew) had of finding someone to live in his little rural area, because if they were looking for a job and there were not jobs in the other areas, they would go there.

It is worth pointing out that dentists working in the NHS are not actually in the NHS; they are independent dentists working for the NHS. That makes quite a difference to the relationship and makes it somewhat more difficult for the Minister to influence dentists as she might well like to. It is also worth pointing out that a number of dental plan organisations are encouraging dentists to abandon the national health service and provide services within their private plan system. I still get dental magazines as a bit of light relief—well, lightish relief—and every one that I get has advertisements promoting dentists coming out of the national health service, for all sorts of reasons, some of which are fictitious.

Covid, in spite of what one hon. Gentleman said, has been a huge problem—not just for medical services but for dentistry. With the initial lockdown, all dental surgeries were required to close. Emergency clinics were set up and they were successful, but extremely limited—“a bit brutal” would be one way to put it. Fortunately, the closure of surgeries was relatively short-lived. After a period, they reopened—understandably, under heavy covid hygiene procedures. Those procedures really jammed up the works. This is of course understandable, because at that stage we did not have vaccinations, and with the aerosol spray from the dentist working on the patient’s mouth, you could almost see covid spread across the room. The cleaning down and waiting time between patients—fallow time—really damaged productivity. But we are getting past that now. I hear the Prime Minister is going to tell us that we are all lovely, everything is fine, covid has gone and so on. That is slightly tongue in cheek—sorry, I should not really say “tongue in cheek”, should I? By the way, the hon. Member for York Central (Rachael Maskell) talked about dentistry and teeth being part of all health. The chief dental officer has a lovely saying, which is that we should put dentistry, or the mouth, back in the body. That is really important.

The combination of the restrictions, all the rules and then, as I have discovered, the extremely heavy regulation requirements of the Care Quality Commission meant that a considerable number of dentists thought, “I have had enough” or, “I’ve possibly had enough,” and then said, “I’ve had enough,” and retired. Progressively, the surgery cleaning down and fallow time has been better understood by dentists and they have been quicker at it and faster, but I still feel that there is an opportunity now, with what the Prime Minister is going to tell us, for us to cut that out. The Government do not always do very nice things for dentists, but one nice thing that they did for dentists was that they gave them the inoculations early on. They gave them not just for the dentists but for all the staff, even down to the cleaner. That is vital, because it will, I think, give us an opportunity to remove the fallow time—get rid of it.

For decades pre-covid, there was a shortage of dentists. There was certainly a shortage of dentists providing NHS services in particular areas. The way to get around that, as I have said, is to have more dentists. If we have more dentists for fewer jobs, they will go to other areas to work. Dentists are independent, so they have an opportunity to change that. Sourcing and increasing the number of dental practitioners is slow and relatively limited.

The most obvious solution is dental schools; we have touched on that. Every second place in the country wants a new dental school next to its hospital. I am sure that would solve the problem, but goodness knows how we would afford it, let alone get the people to teach in them. We have to remember that the basic dental degree takes five years, and the practitioner that comes out after five years needs a two-year apprenticeship before I would let them loose on my cat or dog, let alone one of my children.

Another way to get dentists is to attract them from overseas. My hon. Friend the Member for Waveney mentioned that; it is a great source. When I came here, every second dentist had an Australian accent. The practice I worked at for many years—quite a big one in south-west London—was staffed only by Australians and New Zealanders, and occasionally a South African. The principal got into real trouble with the Commission for Racial Equality. He rang up the agency and said, “I want another dentist. Can you find one? They’ve got to come from Australia or New Zealand.” He was told, “That’s racist. You can’t do that,” but there were hundreds if not thousands of them coming over from the Commonwealth.

The problem with people coming over here has been touched on: they have to go through courses and all the rest of it to become registered. We did not have that then and we do not have to have it now. Wherever the school is, it is the school that needs to be assessed. If the school passes its assessment, any student that passes and becomes a qualified dentist should be allowed in—just like that. That is what happened when I came. I handed over my certificate and the General Dental Council, bless it, stamped it and said, “Thank you very much. Off you go.” We should be doing that.

I had a complaint from the GDC that the people it sent out to assess the University of Otago in New Zealand, for example, did a quick tour of the dental hospital and then disappeared off to the vineyards. I am sure there was no truth in that. But we could get dentists from the Commonwealth, and we could keep bringing people in from the EU. People from the Commonwealth stopped coming when we joined the EU and they went to the United States. I ran a big function here for Otago graduates, and a vast number of professors of dentistry from Otago University came over from the United States. Normally, they would have come here; normally, we would have had them. Normally, we understand their English a little bit better, even if they are Australian, than the Americans do. That has to be an attraction. We should still be able, as I have said, to get European and Scandinavian dentists. That has to continue, because it would help massively.

We have to recognise that we will not have an instant or even a fast solution to the problems laid out today. Everybody has laid out problems, and a few people have come up with ideas. I am sorry for the Minister, because she is getting hammered for the problems, and she will not be able to provide a fast solution. It is not a case of money; it is a case of having the dentists to do the work.

Our best long-term hope, which one or two people have touched on, is prevention. The chief dental officer and others have an ongoing campaign to teach children, especially little children in day nurseries and so on, about toothbrushing. Having worked in the east end for some time, I know that when we ask a child, “What’s your toothbrush like?”, they sometimes say, “What’s a toothbrush?” We have to get that across to the kids. Kids love brushing their teeth. The mess is phenomenal, but they love it. The campaign is really starting to work. Wales and Scotland are ahead of us on that, but we are catching up, and it is making a noticeable difference. We can actually see the difference.

Our second hope, of course, is fluoridation. In other countries—Australia, New Zealand, Canada and so on—fluoride is in between 60% and 80% of water supplies. It makes a huge difference, and with no possible detriment to health. In this country, 10% of water supplies are fluoridated. It is pathetic. The Bill going through at the moment represents an opportunity to change that, but some nations have suddenly realised the real difference that can be made. New Zealand, if I dare mention that country again, is thinking of saying that every single water supply throughout the nation—it is a biggish country, about the same size as this one, but the population is tiny—will be fluoridated. That is a dramatic step, but we could do it. If we did, along with promoting fluoride toothpaste and teaching kids how to brush their teeth and cut down on sugar, then instead of being one of the worst dental states in the western world, we could be one of the best. It is a real opportunity and something we could achieve.

I know that the Minister cannot do anything overnight, and we have to accept that—

[Rushanara Ali (in the Chair)]

Order. Can I ask the hon. Gentleman to wrap up his speech?

[Sir Paul Beresford]

I am wrapping up right now.

I know that the Minister cannot do anything overnight, but I wish her the best of luck with the struggle.

--- Later in debate ---

[Rushanara Ali (in the Chair)]

I am most grateful. I have two more speakers to get in. To ensure that the Minister and shadow Minister have time to respond, I would be grateful if hon. Members could adopt an informal limit of three to four minutes.