Children’s Oral Health

Steve Brine Excerpts

Tuesday 31st October 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

I thank everyone who has spoken and the hon. Member for Birmingham, Selly Oak (Steve McCabe) for securing the debate via the Backbench Business Committee. He has proved once again that he is on his mettle. There are a number of things I want to get on the record and there are lots of things I want to respond to. We know that, as many Members have set out, poor oral health for children can lead to pain, poor sleep, days missed at school—the hon. Gentleman said that three days are missed on average, but the figures can be much higher—and impaired nutrition and growth. It is a serious business and we take it seriously.

The shadow Minister spoke passionately about the subject and the risk to our economy. I am glad that she recognises that there are no quick fixes. If there were, I suspect many of my predecessors would have quick-fixed.

It is a fact that the two main dental diseases of decay and gum disease—dental caries and periodontal disease—can be almost eliminated by a combination of good diet and correct tooth brushing, backed up by regular examinations by a dentist. They are preventable. It is worth putting it on the record—it is not all doom and gloom—that children’s oral health is in fact better than it has been for years. The most recent data from 2015 show that 75% of five-year-old children in England are now decay-free. That is good, but it clearly leaves 25% who are not. Between 2008 and 2012, the numbers of five-year-old children who showed signs of decay fell by approximately 10%. Improving children’s oral health and that of the adult population is a priority for the Government. Indeed, our manifesto earlier this year set out our commitment to improve coverage and achieve better outcomes, especially for children in deprived areas.

[Dr Whitford]

Will the Minister give way?

[Steve Brine]

I will once, but with the time I have got I am going to have to press on.

[Dr Whitford]

Does the Minister recognise that total dental clearances in children, of which there are approximately 25,000, have seen an 11% increase in the past five years, so it is not possible to claim that dental health in England is getting better?

[Steve Brine]

I said that there is clearly a long way to go, and the hon. Lady also said that about Scotland. I am just putting it on the record that there are some positive stats; it is not a counsel of despair.

In explaining what I started to say, let me talk about the extensive work being led by Public Health England as well the wide range of activity nationally in reforming the dental contract, which a number of Members asked about, and locally, in initiatives such as “starting well” run by NHS England, which a number of people referred to. First, it is important that I, as the Minister, acknowledge the vital role that dentists play in this. They are a brilliant part of the NHS. There are just over 24,000 dentists currently providing NHS dental care and their commitment and contribution is vital to delivering our wider health and public health aims. Overall, access to NHS dentists continues to increase in England. In the latest figures for patients seen by NHS dentists, 6.8 million children were seen in the 12-month period ending 30 June this year, which equates to just over 58% of the child population. Looking at adults, this year’s January-to-March GP patient survey results showed that, of those adults trying to get an NHS dental appointment, 95% were successful.

Although those numbers are an encouraging start, clearly more needs to be done—I am not pretending that it does not—to reduce the inequalities in access and oral health that remain as a result. Nationally, Public Health England has an extensive work programme to improve oral health, particularly of children. Improving that and reducing inequalities in oral health is a priority for PHE, which I meet regularly. It was in the office just last week, when we discussed this subject. So many Members have mentioned the sugar levy, which addresses some of the root causes of dental disease.

[Catherine West]

Will the Minister give way?

[Steve Brine]

Yes—because she is smiling nicely.

[Catherine West]

May I make a brief intervention on the sugar levy? Will the Minister at least undertake to look at health trusts—that is directly in the gift of the Department of Health—and at what they are promoting by means of cabinets that sell sugary drinks and products?

--- Later in debate ---

[Steve Brine]

Yes, and I will write to the hon. Lady about that. That is a good point well made.

The sugar levy addresses some of the root causes of dental disease, and other action has included ensuring that the “red book” that all parents receive after the birth of a child has clear messages about the importance of good oral hygiene and early dental attendance—that point was made by my hon. Friend the Member for South West Bedfordshire (Andrew Selous). All new parents will therefore receive clear messages about the importance of oral hygiene and early dental attendance, and I will follow up his point about recording that first appointment in the book. That should be happening; I will follow that up. I thank him for raising it. Public Health England is working alongside local authorities in all our constituencies that are responsible for commissioning oral health improvement programmes.

The hon. Member for Birmingham, Selly Oak, the hon. Member for Central Ayrshire (Dr Whitford), and the hon. Member for Burnley (Julie Cooper) mentioned contract reform. Our manifesto sets out the Government’s continued commitment to introducing a new NHS dental contract that will improve the oral health of the population and increase access to NHS dentistry. That change will provide the foundation on which we will support other improvement activities.

A new way of delivering care and paying dentists is currently being trialled in 75 high-street dental practices. At the heart of that new approach is a prevention-focused pathway that includes offering all patients an oral health assessment and advice on diet and good oral hygiene, with follow-up appointments where necessary to support patients’ self-care and carry out further preventive treatments. That new approach aims to increase patient access by paying dentists for the number of patients cared for, and not just for treatment delivered, as per the current NHS dental contract—a number of Members raised that point. An evaluation of the prototype agreement scheme is due by the end of this year, and it will set out detailed findings from the first full year of testing that new system.

However, we feel that a single year is too short a period in which to make final decisions about whether the new system, when combined with the revised clinical approach, is viable for wider adoption as a new NHS contract. We have therefore decided to extend the prototype agreement scheme to allow it to run for a further two years, to allow for further testing. The prototypes will continue to be subject to evaluation to determine whether they can maintain access and improve oral health, including that of children, in a way that is sustainable for practices, patients and commissioners, before any decisions are taken on wider national adoption.

The important Starting Well initiative was recently launched for children under five, and as a number of Members have mentioned, the programme will work in 13 high-priority areas, with the aim of supporting dentists to see extra children under the age of five who do not currently visit a dentist. It will provide a model that ensures that when they are seen, the focus is on reducing their risk of future disease, as well as treating existing problems. The aim of Starting Well is to reduce the unacceptable oral health inequalities that exist for those children. The hon. Member for Birmingham, Selly Oak asked how long it would run, how areas will be selected and how it will be funded. It will run for as long as is needed locally—that is a decision for local commissioners. I will give him a bit of detail about how the areas will be selected. Selection of the 13 areas was based on 2015 oral health survey results that identified the number of decayed, missing or filled teeth—DMFT, as it is known in the trade—in those under five. To select the areas for Starting Well, a cut-off of 1.6 DMFT was the established marker, and that identified 13 upper-tier local authorities that would benefit from the Starting Well approach. Areas that scored below 1.6 DMFT were not selected, as it was agreed that those resources should be directed to areas where oral health had either declined or remained static. NHS England is funding the programme locally in those areas through underspends and, where the NHS chooses, the prioritisation of funds. I hope that that answers the hon. Gentleman’s questions on Starting Well.

Alongside that, NHS England, together with the chief dental officer—she has been mentioned a number of times; I have worked closely with her and she is excellent—is looking at ways to make the principles of that approach more widely available to all commissioners, and I want to talk to her about that in more detail. The aim is to ensure that commissioners have a clear framework within which to work when considering ways to increase access to dental services for very young children.

The hon. Gentleman was disappointed that Birmingham was not selected for the Starting Well programme, and I set out some of the reasons why we selected the areas that we did. I am, however, happy to say that NHS England is taking forward its own oral health initiative to raise awareness of the importance of early dental attendance, and that will be linked with wider NHS England national work, which I know is particularly championed by the chief dental officer, to encourage greater attendance.

I wanted to touch on so many other points. My hon. Friend the Member for Erewash (Maggie Throup) gave us the charming image of a bath tub full of sugary drinks. What an image—horrendous! That is why our sugary drinks levy is so important. We know that sugar is the leading cause of tooth decay, and the sugary drinks industry levy and the sugar reduction programme will reduce the amount of sugar consumed by children. We keep the childhood obesity plan under constant review. That is important to me, and something I am responsible for.

I did not know that this was sugar awareness week until that was mentioned by the hon. Member for Birmingham, Selly Oak—indeed, the irony of that, with tonight being Halloween, and the children with buckets of sweets, is not lost on me. My children will be attending an altogether different event this evening that does not involve buckets of sweets. It is a “let in the light and shut out the darkness” event—that is something that my wife likes to champion, so she will be pleased with the mention.

The hon. Gentleman also mentioned school dental clubs, as did the chair of the all-party group for dentistry and oral health, my hon. Friend the Member for Mole Valley (Sir Paul Beresford). Outreach, including to schools, is important for reaching children who do not normally attend a dentist, as part of Starting Well and other initiatives being taken forward to reach children in schools. Sure Start centres will also be commissioned locally to be part of the Starting Well programme.

My hon. Friend said that kids love brushing their teeth, but that is not entirely my experience at home. The hon. Member for Strangford (Jim Shannon) mentioned singing toothbrushes. I am not aware of them, although I am aware of singing while brushing. My children are encouraged to hum “Happy Birthday” twice while brushing, so that they brush for longer, and they love me for it. I responded to the hon. Member for Bradford South (Judith Cummins) in an Adjournment debate on this subject. She has been to see me, and I understand that she is meeting the NHS in her area on 9 November. I urge the NHS to share the findings of the pilot with her, and if it does not, she should let me know. My hon. Friend the Member for South West Bedfordshire made a point about the first dental check being placed on the record, and I take his point and will follow it up. On schools being sugar free zones and the advertising ban before 9 pm, I said that we would keep the childhood obesity strategy and the measures within it under constant review. My hon. Friend should continue to work with me on that; it is important that Members vocalise their support to go further on that strategy.

In closing, we have had a good debate. I hope that in setting out some of the work done by Public Health England, the Department of Health and NHS England, I can reassure Members about our commitment to improving children’s oral health for the future. There is an awful lot of good news, but an awful long way to go. I am happy to learn from anywhere in the United Kingdom where such work is going well, and conversations with the hon. Member for Central Ayrshire (Dr Whitford) are always illuminating and useful.