Reforms to NHS Dentistry

Steve Brine Excerpts

Thursday 27th April 2023 Commons Chamber

[Steve Brine (Winchester) (Con)]

It is a pleasure to follow the opening speech of the hon. Member for Bradford South (Judith Cummins), who has brought back many happy memories of our time together when I was public health Minister. She has been consistent on this issue over many years.

Today’s debate is timely; it comes in a week when the Health and Social Care Committee, which, as you rightly say, I am privileged to chair, Mr Deputy Speaker, held a crucial oral evidence session with the Minister, who is in his place on the Front Bench.

Dentistry is a subject close to my heart from my time serving as public health Minister in the Department of Health and Social Care. It is also one of the Select Committee’s top priorities. We launched our inquiry on the subject shortly after I became Chair in November last year. We are looking at what steps the Government and NHS England should take to improve access to NHS dental services, and at further reform of the NHS dental contract. Rarely has an inquiry been more needed or welcome. It is clear that there are huge problems facing NHS dentistry. I am sure that every colleague, whether in the Chamber today or not, is familiar with stories of constituents having trouble accessing NHS dentistry. I am no exception to that, as a constituency MP; neither are my family, as patients.

One of the many submissions that the Committee received talked about people extracting their own teeth with pliers, something that should not happen in the 21st century. The problem is particularly acute in some areas of the country—we will hear talk today about dental deserts, I am sure—and among some groups of people, but challenges and capacity issues are experienced across the board. Our inquiry received a wide range of written evidence, including from nearly 30 local Healthwatch groups. We also held two detailed oral evidence sessions examining the problem and, of course, potential solutions. We heard from Healthwatch that the majority of complaints that it receives at the moment are about dentistry. Day in, day out, local Healthwatch groups receive emails and calls about problems accessing an NHS dentist. That is reflected in other evidence that we received; I know it is not easy for some to hear this, but as a Select Committee Chair, I can only follow the evidence that I receive. We have also heard again and again about the challenge of recruiting and retaining NHS dentists.

The Government have, I am pleased to say, started to act, and to pick up where some of the previous tinkering reforms left off—reforms for which I take some of the credit, and some of the responsibility; I did not fundamentally reform the dental contract during my time as dental Minister, either. In July last year, the Government announced several changes to the 2006 dental contract, including a change to the way that units of dental activity are awarded. They also advised longer recall intervals for adults with good oral health, in line with National Institute for Health and Care Excellence guidelines.

In our first evidence session, we heard from Shawn Charlwood from the British Dental Association, who told us that the reforms to the dental contract represented tweaks, rather than the fundamental reform that is needed. He said:

“In essence, what we are doing at the moment is rearranging the deckchairs on the Titanic while the service slowly slips into the sea.”

To be fair to the Minister, for whom I have a lot of respect, and who spoke really well before the Select Committee earlier this week, I was delighted to hear him acknowledge in that session that he wants “quite fundamental reform” to the dental contract; that has to be right. He argued that the existing reforms were “welcomed”, but noted that they were “only a start”. That was good to hear, and it was well covered by the media on Tuesday evening. I worry, though, that even if significant reforms to the NHS dental contract were made tomorrow, it would be too late, or an extreme challenge, to bring back those dentists who have already left the NHS dental workforce. It is really hard for people to make that decision; they came into dentistry to work in public service. I fear that once they have made the change, it will be final for them, and it will be very difficult to get them to change their mind. I touched on that with the Minister earlier this week. Perhaps he can tell us a bit more about what he will do to address that issue of return.

In our session, I asked the Minister about his ambition for NHS dentistry. Tony Blair famously said in his 1999 conference speech that his ambition was for everybody to have access to an NHS dentist within two years. It never happened, but it was a clear ambition; I give him credit for that. The Minister said that “the No. 1 thing” on his mind was improving access to a dentist for those who do not currently have that access—quite right. But when I pressed him on whether that meant that everyone would have access to an NHS dentist, he said that he wanted everyone who needed an NHS dentist to be able to access one. That is welcome; it is a repeat of that ambition. It is good that the Government have that ambition—although the key, obviously, is whether and when they deliver on it. I will ask him to expand on that when he sums up.

The Minister also talked about making NHS dentistry more attractive to dentists, which is clearly crucial. He said that the problem is not a shortage of dentists per se, but a shortage of dentists undertaking NHS dentistry. The figures certainly bear that out. Our work has highlighted the point that there is a problem with data as well. There are headcounts for the number of NHS dentists, but we do not know whether they are part-time or full-time and how much NHS activity they do. That gap needs closing.

We need to know about the workforce available to deliver the Minister’s ambition; until then, it is unlikely to be achieved. The Minister reminded us this week that the Government are in the final throes of drawing up their workforce plan, which I understand will include dentistry. That is good. I hope that that plan will be published in the not-too-distant future—maybe once we get past a certain electoral event next Thursday.

I also want to touch on overseas recruitment. According to the General Dental Council, almost a quarter of dentists registered in the UK gained their dentistry qualifications overseas. That is fine, but for those dentists the primary means of assessment is the overseas registration examination, or ORE. The pandemic created a backlog in the number of overseas dentists waiting to take their exams—that is the good part. The ORE is subject to practical and legal constraints that make it difficult to adapt capacity to meet changing demands for places. A recent list of changes should help ease the problems, but are unlikely to make a significant difference in the short term; the Minister can correct me if I am wrong.

One of my constituents, Christopher Hilling of SpaDental Group, who has spoken to me about the subject on several occasions, has outlined the difficulties he is facing. He has a number of dentists waiting for the opportunity to sit the ORE exam, but he has struggled in the past to get accurate information about when the exams will even take place. He is concerned that he might lose more of his overseas dentists due to a lack of exam opportunities and of General Dental Council communication about when those dentists might be able to practise in the UK. Given the delay in the taking effect of changes to overseas registration, what are the Government doing to support the GDC, especially with regard to clearing the backlog of applications?

I was encouraged to hear this week the Minister and chief dental officer Sara Hurley talk in our evidence session about the importance of driving forward work on prevention. That is a passion of mine, and colleagues will know that it is a major inquiry that the Select Committee is undertaking. One of our witnesses at this week’s session talked about the importance of early prevention work, focusing on young children. The expression she used was “getting gums on seats”, and that is a great place to focus. We must get more gums on seats, Mr Deputy Speaker—that is the catchphrase for today’s debate.

Finally, I want to talk about integrated care systems, on which the Select Committee has also done a lot of work. We heard in our session about some of the changes that have come into effect as a result of integrated care boards taking responsibility for commissioning dental services. Some were early adopters, including the Hampshire and Isle of Wight ICB that looks after my constituency. But the boards do not include dentistry. I asked the Hampshire ICB representative, who appeared as one of our witnesses this week, about that. They said that they do not want to make their boards too big. I find that disappointing, surprising and unhelpful. To be fair, some ICBs have managed to include dentistry on their boards without any problems; if they can do it, all should. It sends a strange message to the dental profession if it is not included on integrated care boards. It is a great opportunity for flexibility in commissioning, which is why we created the boards. Dentistry needs to be within them.

To conclude, the picture is bleak, but it does not have to be—it is also improving and there are grounds for optimism. We have a Minister who understands this subject inside out and is committed to providing access to NHS dentists for everyone who needs it and a thorough overhaul of the current system and the contract, as he confirmed to us this week. In integrated care boards, we have the possibility of being able to target local services to local needs. But the time for action is running out. I hope the Minister can outline in his response to the debate that he recognises the urgency of the situation, and that, when my Committee produces its report on dentistry, he will read it and act promptly on our recommendations.

[Several hon. Members rose—]