NHS Dentistry

Wera Hobhouse Excerpts

Thursday 20th October 2022 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

I have been horrified—honestly horrified—to hear reports of people pulling out their own teeth because they are unable to see a dentist. Unfortunately, that is now a reality as a result of Government underfunding of dentistry over many years. In my constituency, only three in 10 patients have seen an NHS dentist in the past two years and only six in 10 children have been able to see a dentist in the past 12 months, although the NHS continues to recommend that all under-18s see a dentist at least once a year.

The way in which the Government have let the NHS dentistry system collapse is a national scandal. Nearly a quarter of all British people have failed to secure a local NHS dentist appointment in the last year. Of those, one in five have resorted to what we now call DIY dentistry, which is terrible. Our public services are so starved of funding that people are being forced to stop trying, or to pay for private treatment. The British Dental Association says that we are facing an “existential threat”. People’s health is at risk if they do not have access to dentistry. Tooth decay is the No. 1 reason for hospital admissions among young children. Oral cancer is one of the fastest-rising types of cancer, and claims more lives than car accidents in the UK: we should remember that.

People in deprived communities are the most likely to suffer. Healthwatch research shows that those on lower incomes are worst hit by appointments shortages. The problem has been made worse by the pandemic, which increased the backlog, but the problem was there before. Limited access to such primary care means that problems cannot be caught early. People should not be facing a choice between being left in pain and paying for private care as we head into this difficult winter. We must do all we can to make sure that they can access the right services and that we address these profound health inequalities.

One of the major reasons for the backlog is staff shortages in the NHS. The number of NHS dentists is falling: one in eight is approaching retirement and 14% are close to leaving the profession. My constituents have been particularly affected: nearly 15% of dentists have been lost from Bath clinical commissioning group since 2016. At a time when demand for NHS services is increasing, we urgently need a strategy to plug these very big staffing gaps.

The Government admit that they do not know how many dental practices applied to access the extra £50 million of funding announced earlier this year. To me, that means that they are asleep at the wheel. The Government must make sure that we have enough dentists if support for the sector is to be effective. We need increased numbers of dentist training places in the UK and continued recognition of EU trained dentists’ qualifications. Dentists must be incentivised to take NHS payments and there needs to be more funding for the sector to meet patient demand. Everyone in the UK should be able to access a dental health check-up on the NHS. Proper workforce planning for health and social care must be written into law, including projections for dentists and dental staff.

The crisis facing NHS dentistry is on an unprecedented scale. Although it has been worsened by the pandemic, the emergency is not new. Most importantly—I am repeating what many have said this afternoon—the Government must reform the NHS dental contracts, which create absurd disincentives for dentists taking on new NHS patients. A review was promised earlier this year. Where is it? Oral health cannot be treated as an afterthought and my constituents cannot wait any longer.

[John Glen (Salisbury) (Con)]

I rise to speak on behalf of a number of dentists in my constituency. Nicola Jones, an oral surgeon at Salisbury District Hospital, contacted me to say that the lack of available NHS dentists is causing significant challenges in the constituency. I recognise that from my mailbox over recent weeks. I met Matthew Clover, a specialist orthodontic practitioner, in February. He took me through the challenges of the “units of dental activity” model: it does not discriminate properly when it comes to the classification of the different activities that he has to undertake.

The challenges derive primarily from the lockdown two years ago and the interruption to supply: 38 million appointments were lost. I welcome the Government intervention earlier this year to provide the additional £50 million and 350,000 additional dental appointments. I also welcome the Government’s statement in July, but this is an opportunity for the new Minister to challenge his officials and work with industry representatives to find a deeper and more enduring set of changes that address some of the ongoing challenges that have existed for a very long time.

I would not suggest that I have anything like the expertise of my hon. Friend the Member for Waveney (Peter Aldous), the hon. Member for Bradford South (Judith Cummins) or, particularly, my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who has a lifetime of experience at policy level and as a practitioner. But I am aware that since 1951 there has been a model of co-payments, in which dentists act as independently contracted professionals to the NHS but also typically receive an income from private practice work as well.

[Wera Hobhouse]

The hon. Gentleman makes a very good point that, basically, private patients have been cross-financing NHS patients, but that model is no longer sustainable.

[John Glen]

I respectfully say to the hon. Lady that my mother is a resident of Bath and has received excellent service from her NHS dentist. Although I recognise this problem exists in different spots of intensity across the country, it needs a comprehensive solution.

The fundamental point is this: how can the model of rewarding dentists incentivise the maximum amount of engagement? All dentists start their professional life wanting to help people and wanting to do as much good as they can. I totally embrace what my hon. Friends the Members for Mole Valley and for Gloucester (Richard Graham) said about the need to deal with the oral health and education of young people, including how to clean their teeth at an early age. There will need to be a focus on how those practices can be embedded in a funding model that has to pay some respect to the geographic coverage of a dentist, while ensuring that each cohort of the population has access to basic dentistry.

The proposed new dental contract goes some way towards dealing with some of the challenges of the UDA model, but it probably does not go far enough. I urge the Minister to go beyond what his officials may be suggesting to him, to think radically and to take this opportunity to ask, “How can we reset after the dislocations caused by covid?” I urge him to come up with something that incentivises dentists to offer an holistic service to people of all means and to help those communities that have cold spots of dentistry supply.

I would like to make a few observations about supply and, again, my hon. Friend the Member for Mole Valley made some very good points about streamlining bureaucracy to ensure more people qualify as dentists in this country. Of course, it is right that we have ongoing quality assessments through the CQC, but that organisation’s focus, as across all industries, needs to be on where there are vulnerabilities and risks. When we think about NHS medical and dental services, I feel we are continually trying to be perfect and to remove all the risk, which sometimes has a cost because it involves using resources to fill in bureaucratic processes that might not necessarily, in most cases, give us much return.

My message to the new Minister is to build on the good start made by his predecessor in the summer, but to consider a more radical and fundamental review of the UDA funding model, to consider the volume of patients and to consider the real dynamics of the choices a dentist makes about how to maximise the number of patients they see who cannot afford to make a contribution.

I feel hopeful that the enthusiasm to provide the service I saw from my dentist in Salisbury means there will be a solution. I wish the Minister well, and I acknowledge the contribution of my hon. Friend the Member for Waveney, who showed a mastery of this subject.

--- Later in debate ---

[Peter Dowd]

I am grateful to the right hon. Gentleman, who reinforces the point that I am trying to make. We are being contacted by constituents, as I have just set out. We are being contacted by Bupa—I suspect that Members will have had a briefing. We have had a briefing from the British Dental Association. We have had contact directly from dentists. They are all saying exactly the same thing and the Government have to listen. Not only do they have to listen—it is dead easy to do that—but they have to act. The Government have to put their hand in their pocket. So let us stop pretending that £50 million just before the summer is going to do anything in any significant or substantive way to resolve this problem—it is not.

The hon. Member for Bath (Wera Hobhouse) referred to an existential threat, and there is one—dentists are telling us that, as is the BDA. In practical terms our constituents are saying that to us, because their experience shows that there is an existential threat. The contract is a discredited one and it needs to be put right; it puts targets ahead of patient care. But this is also down to the fact that, whether we like it or not, and whether the Government like it or not, cuts in dentistry have not had any parallel to any other cuts in healthcare. We are talking about cuts of more than 25% between 2010 and 2020. That factors in and it creeps up on us year after year until we get to the situation where access to dentistry is the No. 1 issue raised with Healthwatch.

[Wera Hobhouse]

I was pleased to hear that the mother of the hon. Member for Salisbury (John Glen) has had excellent NHS dental care in Bath, and of course dentists are excellent practitioners and professionals. The thing is that his mother will have been a long-term NHS patient and the problem is that dentists do not take on new NHS patients, because the dental contract completely disincentivises them to do so.

[Peter Dowd]

That is a point well made. Another factor is that there are deep inequalities in access to dentistry. In my constituency, it is difficult to get to see an NHS dentist for love or money. I am not blaming the dentists; they are doing a fantastic job in the circumstances. They are going over and above their duty. I put on the record my thanks—as I am sure we all would—to my dentist practice, which I have been with for over 45 years. Dentists are doing a fantastic job, but they have both their hands tied behind their back at the moment. That has to change.

Some 91% of people, including 80% of children, are not able to access a dentist, and 75% of dentists are reducing their NHS engagement. The new contract announced before the summer did not really do anything and there was no new money with it. There is a significant gap—potentially as much as £750 million—in the resources that dentists need.

Another aspect is dentists’ morale, with 87% having experienced stress, burnout or depression in the last 12 months. That is a dreadful situation to put a committed profession in. We have a scenario in our country in which dentists who trained for seven or eight years—possibly more—and practised for many years are now getting to the stage where the majority are stressed, burned out or depressed. That is dreadful. According to one study, half of them are considering changing career. Some of them are seeking early retirement or going fully private. They are getting stressed out because they just cannot move the dial. They are waiting for the Government to move it, but the Government are not moving it.

Children in my constituency are three times more likely to have their teeth extracted in a hospital because they do not have access to a dentist. My right hon. Friend the Member for Knowsley (Sir George Howarth) and the hon. Member for Bath referred to oral cancer. That is identified very early on—and who does the identification? Surprise: it is often the dentist. We need substantive support from the Government, not tinkering around with the contract. We need them to provide adequate funding.

Dentists must not be an afterthought. They are a vital component of the health of the nation. We must build on the historical commitment to prevention; that is key—as the saying goes, prevention is better than cure. Dentists have had enough; they are under pressure. My constituents have had enough; they are under pressure. The Government have to do something about it.

In the debate before the summer, I referred, in relation to the lack of substantive action by the Government, to a rejigging of what Ian Fleming said about crisis: if once is happenstance and twice is coincidence, three times is friendly fire and four times is enemy action. We are now in a situation where the Government are perceived as the enemy because of their lack of action.

--- Later in debate ---

[Will Quince]

I certainly do welcome that, because this is not just about commissioning, but about accountability and oversight.

Our changes will allow NHS commissioners to have more flexibility in commissioning, and I think that is really important, because if they have that flexibility in commissioning additional dental services, they are the ones who know the local need within their area. I want to see far more responsive management of contracts, so if they have underperforming practices and practices that can do more, we should enable such practices to do that. For example, a high-performing practice should be able to deliver beyond its existing contract to make up for the fact that a neighbouring practice is not doing so. That addresses some of the points made by my hon. Friend the Member for Waveney about the clawback of UDA funding at the end of the year, and then its not necessarily being spent on dentistry. As part of that, I also want and expect more transparency. We will make it a requirement for NHS dentists to update the information on their NHS website, so people can see which dentists are accepting new NHS patients for treatment.

On that point, I want to bust the myth about being registered with a dentist. There is no such thing as being registered with a dentist or a dental list. People approach an NHS dentist for specific treatment. They go on their list, register and have the treatment. They can have an ongoing relationship with a dentist, but anyone can book an appointment with any dentist with an NHS contract, regardless of where they live in the country. It is important to get that message out, because when our constituents say to us, “I can’t get a dentist locally”—I want to address that point—I want to ensure that they know that they could travel to a neighbouring town or city. They could travel half way across the country if they wanted to, for example if they had relatives there, if there was a NHS dentist who had capacity to see them.

[Wera Hobhouse]

Does the Minister recognise that because of the abnormalities of the dental contract, and dentists not knowing which patients they are getting, NHS dentists would rather take a patient whom they already know, and whose history of dental problems or otherwise they know, rather than taking somebody they have never seen? There is a disincentive to take on new patients, but there is a continuity for those who are already with an NHS dentist.

[Will Quince]

Of course I take that point—it is a fair one—and when those who seek NHS treatment have an ongoing relationship with a dentist, they are more likely to get seen. When considering reforms to the system we will certainly take that point on board.