NHS Dentists: Cumbria

Seema Kennedy Excerpts

Wednesday 3rd July 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a pleasure to serve under your chairmanship, Sir David. I thank the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing this debate. He raised some important issues about dentistry, some of which are national problems that I have been looking at since I came into this role about three months ago, and some of which are pertinent to both the urban and rural areas of Cumbria—I know that there are problems in the constituency of the hon. Member for Barrow and Furness (John Woodcock) relating to geography and economics. I will talk a bit about what we are doing nationally, but of course there are some distinct issues to do with the geography in Cumbria.

Cumbria has struggled to attract dentists. The hon. Member for Westmorland and Lonsdale has raised that issue, which I take very seriously, on many occasions. National access to NHS dentistry is high, but I know from my conversations with colleagues from across the House that there are notspots, and that in isolated areas it is very difficult to get to a dentist. We are taking steps to address that issue to ensure that everyone has access to an NHS dentist. It is NHS England’s responsibility to commission dentist services to meet the needs of local people, and it has been actively looking into dental access issues in Cumbria. Its regional team covers my constituency, so it is looking at Lancashire and south Cumbria together. It has urgent work in hand to explore and implement schemes to improve local access.

In south Cumbria, NHSE will be working to help practices that are under-delivering on their contracted levels of dental services. If despite that support a practice remains unable to deliver its full contracted level of dental activity, the unused funds will be diverted into other local practices. NHS England believes that that could support care for about 3,000 patients. Alongside that, work is being taken forward across Lancashire and south Cumbria to integrate dental services within primary care networks. It is important that dentists are part of the integrated primary care network team, enabling oral health advice and prevention work to be offered across the primary care network. Oral health needs, including gaps in services and access difficulties, must be part of the wider health picture. The hon. Gentleman touched on that when he talked about access to GPs.

That is the local action. I want to touch on what we are doing nationally.

[Tim Farron]

The Minister made a very interesting point about people who under-deliver on their contract. It is important that we do not misunderstand what that means. A dental surgery can be working flat out, but if it is, for example, spending more of its time doing preventive work or reacting to people who want consultations and so on, it gets only one unit of dental activity for that. It could be absolutely full to the brim but be doing the lower-tier work just because that is how it is, reactively. That dental surgery is not failing or not working hard enough. It is doing the preventive stuff that we want it to do more of, but the UDA system, with its perverse incentives, does not reward that.

[Seema Kennedy]

The hon. Gentleman anticipates my speech: I will talk about contract reform later. He knows much better than me that the problem with the previous contract was that it was introduced with perhaps a bit too much haste, and we are now living with the consequences. We are mindful that we need a contract that works well and is sustainable for the future.

Nationally, we are introducing so-called flexible commissioning, which allows local NHS commissioners to commission a wider range of services from dental practices. That is expected to make NHS dentistry more attractive to new performers. Another key recruitment and retention challenge—of course, this is not confined to dentists; it applies to a whole range of healthcare and other professionals—is the growing demand among younger dentists for more varied portfolio careers. NHSE is working closely with Health Education England and a wide range of stakeholders to make portfolio careers a reality for dental professionals, allowing dentists to move between specialities such as prevention, restorative work, oral health and special care dentistry.

We want UK-trained dentists in the NHS, and we want them to stay in those careers, but dentists from overseas also play an important part in delivering NHS care. I am pleased that the NHS and the Government have taken steps through the launch of the EU settlement scheme to maintain that essential supply of dedicated and skilled workers, including European economic area-trained dentists, when we leave the EU. Last summer, doctors and nurses were removed from the tier 2 cap, leaving more places for other highly skilled professionals, including dentists.

The interim NHS people plan, which was published early last month, commits to creating a capable and motivated multidisciplinary dental workforce of a sufficient size to meet population health needs. The full people plan will be published later this year.

We are working closely with NHSE to reform the current dental contract. Feedback from dentists who are testing the prototype contract suggests it is a more satisfying way of delivering care. It supports a better skills mix, allowing dental care to be supported by a wider range of staff, such as therapists and hygienists. At a meeting a couple of weeks ago with a wide range of dental stakeholders, I announced that a further 28 dental practices had joined the programme, bringing to 102 the number of practices that are testing the new prevention-focused way of delivering care. NHSE is considering carefully when that approach can be rolled out more widely across the NHS. It is important that we get the new contract right, but I am hopeful that the roll-out will happen as soon as possible.

I want to touch briefly on three questions hon. Members asked. The first and most important was about children’s oral health. I heartily agree with the hon. Member for Westmorland and Lonsdale about the importance of children’s oral health and all the preventive measures the Department can take to protect children’s teeth. He rightly pointed out something that not all hon. Members are aware of: the biggest cause of emergency admission for children is poor oral health. Of course, that is entirely preventable. The Government are committed to that, particularly among deprived children. We have made the Starting Well approach available to other NHS England commissioners, and that is promoting increased access and early preventive care for very young children.

[John Woodcock]

That more than a third of children under five in Barrow have tooth decay is truly appalling. The Government need to make faster progress. I assume the Minister would vigorously oppose any attempt to weaken the sugar tax, which is designed to move people away from that harmful substance towards a healthier lifestyle.

[Seema Kennedy]

The hon. Gentleman makes a very timely intervention. We can see how successful the soft drinks industry levy has been in how it has helped to reformulate sugary drinks, the amount of money it has raised that has been recycled into school sports, and the fact that it is changing people’s tastes and behaviour. The prevention Green Paper is in train; let us hope that he is pleased with what is announced in it.

The hon. Member for Westmorland and Lonsdale mentioned emergency dentistry and I will have to write to him with specifics about the commissioning of services.

On the public health budget, I know from conversations with Members across the House that there are pressures on local government budgets. The ring-fenced public health budget will be a matter for the forthcoming spending review, when it will be assessed using all available evidence. The hon. Gentleman can be assured that I will take away all the evidence I gather from meetings with Members across the House and in my ministerial position to feed into the spending review process.

[Tim Farron]

Just so the Minister is fully aware of the facts—I know this predates her time in this role—the NHS talked in its long-term plan about its vision for early identification of conditions of all sorts, and about preventive care, and then literally a fortnight later, just before Christmas, the settlement for public health spending for Cumbria was reduced by £500,000. I would be grateful if the Minister intervened to ensure that that does not happen again, because it has a huge impact on our ability to keep children in good practice in their early years so they have good dental health.

[Seema Kennedy]

Of course, part of prevention comes from the public health budget. That now sits back with local authorities, which is where it was historically, and of course—the hon. Gentleman knows my constituency well, having grown up there—there are different needs in different areas. What the NHS does through the immunisation and screening programmes is also part of that aspect of preventive health, but I take on board his comments about the specific public health situation in south Cumbria.

I hope the hon. Gentleman is reassured that significant action is being taken locally in Cumbria and nationally, both now and for the future, to improve access to NHS dental services. The new prevention-focused dental contract in particular, which is a key part of our reforms, should attract people to and keep people in the dental profession, and make dentistry a more varied and rewarding career. It will ensure better access to dentistry in places such as Cumbria and across the country for all our constituents.

Question put and agreed to.