Access to Dentistry: Somerset

Stephen Kinnock Excerpts

Tuesday 1st April 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship again this morning, Mr Stuart. I thank the hon. Member for Frome and East Somerset (Anna Sabine) for securing this important debate on access to dentistry in Somerset.

We know that there are challenges in accessing NHS dentistry across the country, with some areas facing acute challenges. Put simply, too many people are struggling to find an NHS appointment. In the two years up to June 2024, just 31% of adults were seen by an NHS dentist in Somerset’s integrated care board, which covers the hon. Lady’s constituency, compared with 40% across England. In the year to June 2024, only 42% of children in Somerset ICB were seen by an NHS dentist, compared with 56% across England. The fact that the number of adults and children in Somerset ICB accessing an NHS dentist is even lower than the already struggling rate across England is concerning.

Somerset is facing significant workforce pressures, and there are not enough NHS dentists available to do the job. As of March 2024, there were 334 vacancies in the south-west for full-time equivalent NHS general dentists. The 29% vacancy rate is the highest of any English region.

It is a shocking fact that the No. 1 reason for children aged five to nine being admitted to hospital in our country is to have their teeth removed, with a primary diagnosis of tooth decay. It is a truly Dickensian state of affairs.

[Chris McDonald (Stockton North) (Lab)]

We have heard about the dental desert in Somerset. Stockton in my constituency has also been branded a dental desert. I welcome the 4,000 new appointments that the Government have granted for Stockton North and the surrounding area. However, given the urgency that he has described, particularly for children’s health, I ask the Minister whether the Government are taking any measures to accelerate the roll-out of those appointments.

[Stephen Kinnock]

We will absolutely ensure that integrated care boards are delivering to the target they have been set. If we see any evidence of slowing down or backsliding, we will certainly intervene to ensure that appointments are accelerated. I would also be more than happy to receive representations from my hon. Friend if he feels that performance in his ICB is not delivering.

The state of NHS dentistry in Somerset, and the nation as a whole, is simply unacceptable and it has to change.

[Olivia Bailey (Reading West and Mid Berkshire) (Lab)]

I welcome the action that the Government are taking to fix our dentistry crisis. In my constituency, only two dental practices accept adult patients, and vast swathes of the rural areas have no practice at all. Will the Minister set out how the Government’s plans will support my constituents to access the dental care that they need?

[Stephen Kinnock]

My hon. Friend puts her finger on the fundamental problem, which is that the NHS dental contract simply does not incentivise dentists to do NHS work. That is the fundamental reason why we are in this bizarre situation where demand for NHS dentistry is going through the roof, yet there is a consistent underspend in the NHS contract. It is a classic example of a false economy. The Conservatives thought they were being terribly clever by structuring a contract in a way they thought would deliver value for money, but in fact, it simply failed to incentivise dentists to do NHS work and they drifted more and more into purely private sector work. That is the very definition of a false economy.

[Anna Sabine]

I just draw the Minister back to my specific point about whether he can confirm that he is having discussions with the British Dental Association. The association agrees that the contract is wrong, and it wants to speak urgently to the Government about how it can be amended.

[Stephen Kinnock]

I am pleased to confirm that I am meeting the BDA in the coming days. The negotiations are moving forward. There is no perfect payment system, and there is a need to get the balance right between ensuring that we have a viable system that does not deliver underspends in the NHS contract, which is absurd, and that we deliver as much NHS dentistry as possible to the communities and people who need it. That is a complex process and it will take some time. The Government have taken intermediate measures, such as the 700,000 urgent appointments and supervised toothbrushing, which we will work on at pace over the course of the coming financial year while also working on a radical overhaul of the contract.

By the time I came into government, the Nuffield Trust was describing the state of NHS dentistry as

“at its most perilous point in its 75-year history.”

As of March 2024, there are over 36,000 dentists registered with the General Dental Council in England, yet there are fewer than 11,000 full-time equivalent dentists working in the NHS.

[Sir Ashley Fox]

I understand that at least 100 Ukrainian dentists in this country are unable to practise with the NHS because they are waiting to take examinations. Can the Minister do anything to expedite their ability to practise in this country?

[Stephen Kinnock]

I absolutely agree. Two big things need to happen. First, the General Dental Council needs to do more to get more exams in place for those very well-qualified dentists. Of course, they have to pass the British exam. We cannot have people practising in Britain who have not passed that exam, but the availability of the exam has been too limited and that needs to change. The other thing is provisional registration. Some work can be done to expedite the registration of an international dentist, but more needs to be done on that as well. I will meet the head of the General Dental Council shortly, and I will convey those messages to him.

Recruitment and retention issues are not limited to dentists; there are difficulties across the whole dental team, including dental nurses, hygienists, therapists and technicians. In the past five years, there has been a 15% reduction in courses of dental treatment being delivered across England, and 28% of adults in England—a staggering 13 million people—have an unmet need for NHS dentistry. As a result, we hear too many stories about people who are unable to access the care they need, and some horrific accounts of DIY dentistry that nobody should have to resort to.

Dentistry rightly receives a lot of attention because of its dismal state, and I am grateful to the National Audit Office and Public Accounts Committee for their interest in the previous Government’s dentistry recovery plan. It is evident that the plan did not go far enough.

[Richard Foord]

The Minister talks about the previous Government’s dental recovery plan, and part of that was to impose a firmer ringfence on dentistry spending so that there was not an underspend that was reallocated elsewhere. The previous Government tasked NHS England with collecting monthly returns from ICBs to establish spending as against the allocation. Now that NHS England is being scrapped, will we still see that monitoring of ICBs to ensure that the spending matches the allocation?

[Stephen Kinnock]

I take the hon. Gentleman’s point about the ringfence, but in a way, ringfencing addresses the symptoms, rather than the cause, of the problem. The fundamental cause of the problem is the amateurish way in which the previous Government set up the NHS dentistry contract so that it does not incentivise dentists to do NHS work. That is what leads them to drift off. In a sense, we can do all the ringfencing we like, but if the workforce that we need is not incentivised to do the work that we need them to do, we are going to have that problem, because they vote with their feet. That is why the radical overhaul of the dentistry contract is the key point. However, I agree with the hon. Gentleman that once we have got a contract that works, we must ensure that every penny that is committed to NHS dentistry is spent on NHS dentistry, rather than the absurd situation that we have now, in which we constantly have underspends in the NHS dentistry contract while demand for NHS dentistry goes through the roof. It is a truly bizarre situation.

I return to the subject of the dentistry recovery plan. The new patient premium, introduced by the previous Government, aimed to increase the number of new patients seen, but that has not happened. In reality, since the introduction of the previous Government’s plan, there has been a 3% reduction in the number of treatments delivered to new patients. It is clear to this Government that stronger action is needed, and we are prepared to act to stop the decay.

[Rachel Gilmour]

In Minehead, in my constituency, a dental surgery responded to the ICB in October and said that it would provide 12 NHS appointments a week for people who currently do not have a dentist. I have chased that ICB on five occasions, but we still do not have a result. That is 48 appointments a month that my constituents are missing out on. Would the Minister please agree to write a letter, on my constituents’ behalf, to the Somerset ICB?

[Stephen Kinnock]

We are very keen to ensure that targets are being met, and the ICB clearly needs to ensure that that is happening, so I would be happy to do that. Perhaps the hon. Lady could write to me so that we can get all the facts on the table, then we can take action accordingly.

We will make the difficult decisions necessary to restore NHS dentistry to ensure that patients can access the care that they need, at the best value for taxpayers. Since coming into office, we have focused on implementing new initiatives and stopping the things that are not working. From today, 1 April 2025, the public will see 700,000 additional urgent dental appointments being delivered every year, as we promised in our manifesto. The urgent appointments will be available to NHS patients who are experiencing painful oral health issues, such as infections, abscesses, or cracked or broken teeth. Somerset integrated care board has been asked to deliver 13,498 of those appointments. That is 13,498 more chances for the hon. Lady’s constituents to get the urgent dental support that they need, every single year.

Across the south-west region, there will be 106,776 extra appointments—that is more chances for patients in urgent need of care. However, to have a truly effective dental system, we cannot focus just on those who are already in pain; we must have a system that prioritises prevention. A cornerstone of the Government’s mission to prevent ill health is supporting children to live healthier lives. We want to ease the strain on the NHS and create the healthiest generation of children ever. As colleagues will be aware, too many children are growing up with tooth decay, which is largely preventable. That is why we have invested £11.4 million to roll out a national supervised toothbrushing programme for three to five-year-olds that will reach up to 600,000 children a year in the most deprived areas of England.

The latest data shows that the rate of tooth decay for five-year-olds in Somerset is 20.2%, which is lower than the 22.4% for England but still far too high. We are taking a targeted approach to support those in the most deprived areas, which is why we have been able to allocate £50,000 of funding to Somerset to support around 2,000 three to five-year-olds. Our additional funding will help to secure and expand supervised toothbrushing based on local needs. This is extra resourcing to support targeted work by the local authority and its partners.

I am determined that we will reduce inequalities faced by children living in the most deprived areas, helping them to brush their teeth daily in the nurseries and schools that they attend. Alongside this, we have launched an innovative partnership with Colgate-Palmolive, which is donating more than 23 million toothbrushes and toothpastes over the next five years. This is of incredible value for the taxpayer, and a fantastic example of how business and Government can work in partnership for the public good.

A strong dentistry system needs a strong workforce. We recognise the incredible work that dentists and dental professionals do, and we know that the current NHS dentistry contract is not fit for purpose. We need to build an NHS system that works for patients and their dentists. A central part of our 10-year plan will be workforce, and we will ensure that we train and provide the staff, technology and infrastructure that the NHS needs to care for patients across our communities. We will publish a refreshed long-term workforce plan to deliver the transformed health service that we will build over the next decade, and to treat patients on time again.

We know that some areas face challenges in recruiting and retaining the dental workforce they need. The golden hello scheme offers 240 dentists a £20,000 joining bonus to work in underserved areas of the country for three years. The recruitment process is well under way, with posts being filled by dentists in these areas as we speak.

[Sir Ashley Fox]

I ask the Minister to reply to my suggestion that students from the University of Bristol Dental Hospital do some part of their training in Somerset, where they can benefit the population.

[Stephen Kinnock]

I thank the hon. Member for that intervention. It is an excellent idea, and it is something that we have seen in other parts of the country. If he would care to write to me about that, I would be more than happy to take that issue up.

In the south-west, the golden hello scheme has already led to seven new dentists on the ground delivering NHS dentistry to patients, and a further six have been recruited and are waiting to start their roles. With 64 live adverts across the region, we are confident that the numbers will grow. And, for the first time in more than a decade, we have increased payments for practices training a foundation dentist. We will not stand idly by while the fundamental reforms to the contract are developed. Where we identify opportunities, we will make improvements to the current system when those can increase access and incentivise the workforce to deliver more NHS care.

I am pleased that work to improve access has also been taking place at the local level, and that Somerset ICB is opening three new practices in Wellington, Crewkerne and Chard. Those services will provide much-needed additional capacity in Somerset. The ICB is committed to delivering additional urgent dental appointments and increasing access for residents facing the greatest health inequalities—although I do recognise what the hon. Member for Tiverton and Minehead (Rachel Gilmour) said about the concerns that she raised.

Fixing our broken dentistry system will not be easy, but I want to reaffirm our commitment to making bold changes and tough decisions to stop the decay and to rebuild the foundations of NHS dentistry. This is an immense challenge—there are no quick fixes and no easy answers—but people in Somerset and across the country deserve better access to dental care, and we are determined to make that a reality. We are committed to rebuilding a system that puts patients first, ensuring that no one is left without the dental care that they need.

Question put and agreed to.