Peter Aldous calls on the Government to address the crisis in NHS dentistry by ensuring secure, long-term funding, improving recruitment and retention of dental professionals and urgently reforming the existing, unattractive NHS dental contract.
Peter Aldous (Waveney) (Con)
I beg to move,
That this House has considered access to NHS dentistry.
It is a pleasure to serve under your chairmanship, Mr Efford. I thank the Backbench Business Committee for granting this debate. I am grateful to the hon. Member for Bradford South (Judith Cummins) for her work in helping to secure it.
NHS dentistry has been the No. 1 issue in my inbox for the past nine to 10 months. This is a national crisis, though the problem in my constituency—in Lowestoft and Waveney—is acute. Dentists have retired, which has led to resources and dental capacity being taken away from the area, notwithstanding the increased need and demand following the pandemic. Many of the remaining practices are experiencing difficulties in recruiting and retaining dentists, and the situation has been exacerbated by a lack of funding, with net Government spending on general dental practice being reduced by a third over the past decade. That said, the overall situation locally has improved since I first raised concerns in an Adjournment debate on 25 May last year, and I will outline the improvements later. They are welcome, but I am concerned that they might be a short-term sticking plaster and might not provide a long-term solution.
As we emerge from covid, the situation both locally and nationally has reached crisis point. Locally, that is due to covid, as well as retirements in two NHS dental practices in Lowestoft and the closure of the mydentist practice in Leiston, in the constituency of my right hon. Friend the Member for Suffolk Coastal (Dr Coffey). That practice closed due to the difficulty of recruiting dentists to work in the NHS in the area—a theme that is repeated across the country.
Access to NHS dentistry is a problem that has been brewing for a long time. The situation can be likened to a house built on shallow and poor foundations. The earthquake of covid has led to that house falling down. There are now parts of the country—particularly in, though not confined to, rural and coastal areas—that are dental deserts.
Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)
I thank the hon. Gentleman for securing this important debate. On that point, my constituents in the city of Birmingham have hugely suffered through the covid. People like myself, who suffer from diabetes, have had huge issues with dental treatment. I hope that we can move forward and return to treating people in the best way possible.
Peter Aldous
While there are particular problems in rural, coastal and more peripheral locations, which it is difficult to get dentists to move to, it is clear from looking around the Chamber today that the problem is not confined to such areas and is an issue in metropolitan areas as well. Sir Robert Francis, chair of Healthwatch England, has commented:
“Every part of the country is facing a dental care crisis, with NHS dentistry at risk of vanishing into the void.”
I believe there are five issues that need to be tackled to address the problem. First, a secure, long-term funding stream must be provided. Secondly, we need to step up the recruitment and retention of dental professionals. Thirdly, it is vital that work on the new NHS dental contract, which has been being developed for more than a decade, is completed as soon as practically possible. Fourthly, it is important to highlight the role that water fluoridation can play. Finally, there is a need for greater accountability and for dentistry to have a voice in the emerging integrated care boards and partnerships.
Kevin Hollinrake (Thirsk and Malton) (Con)
I congratulate my hon. Friend on securing this important debate. Another point that needs developing is that in Helmsley, in my constituency, the commissioners have still not recommissioned services after 20 months. The commissioning of dental services by the NHS is simply too slow and too bureaucratic. It is a real deterrent for new dentists to take these contracts.
Peter Aldous
I thank my hon. Friend for that intervention, and he is right. There has been a recent procurement process in East Anglia, but it has been only half successful. There are places that have not been able to get dentists to fill those voids.
Figures published in March 2020, before the pandemic, show that 25% of patients new to practices in England could not get an appointment. The situation has got worse: the most recent figures, from 2021, show that that number has increased to 44%; in my area, it is 56%. Dentistry was locked down from March to June 2020 and the ongoing restrictions on dentists—fallow time between appointments—are still limiting the ability to see more patients.
The latest figures on workforce, published in August 2021, show that 951 fewer dentists performed NHS dental activity than 12 months earlier, with 174 of those losses in the east of England. Those figures confirm that parts of England are becoming dental deserts; beyond Suffolk and Norfolk, that includes the east Yorkshire coastline, Cornwall, Portsmouth and the Isle of Wight.
The lack of access to NHS dentistry has a fivefold impact on patients. First, millions are missing appointments. Secondly, there has been a significant increase in DIY tooth extraction. Thirdly, the poor are hit hardest. Fourthly, mouth cancers are going undiagnosed. Finally, children are suffering. This very serious situation has been confirmed by the “Great British Oral Health Report” carried out by mydentist.
I apologise for going on at length, Mr Efford, but it is important to emphasis the crisis we are facing. I will now briefly outline some of the solutions. The first issue that must be tackled is getting more dentists and dental practitioners working in the NHS. The Association of Dental Groups has put forward its “six to fix” proposals for solving the workforce crisis, which I will summarise. First, we need to increase the number of training places in the UK. That is a long-term measure. Secondly, in the short term, the Government should continue to recognise EU-trained dentists. Thirdly, there needs to be a recognition of other overseas qualifications. We have an opportunity to make more of our links with Commonwealth countries such as India, which has a surplus of highly skilled English-speaking trained dentists.
Fourthly, the process for overseas dentists to complete the performers list validation by experience—or PLVE—so that they can practise in the NHS must be simplified and sped up. Fifthly, whole teams in dental practices should be allowed to initiate treatments. The largest barrier to better use of the skills mix under the current NHS contractual arrangements is that allied dental professionals are unable to open a course of treatment, which means they cannot raise a claim for payment for work delivered.
Finally, the Government must create a new strategy for NHS workforce retention. The current contract through which NHS dentistry is provided was introduced in 2006 and for some time it has been widely recognised as not being fit for purpose. It is a major driver of dentists leaving NHS dentistry. Reforming the NHS contract is needed to deliver better access and preventive care so as to improve the nation’s oral health. Flexible commissioning, aimed at increasing access to vulnerable groups such as those in care homes should be an important part of the reform. The current dental contract is target-based, and it was accepted before the pandemic that it needed to be reformed. We must complete that reform as soon as possible. I would welcome an update from the Minister as to progress on that and when we might see a new contract.
It is important that NHS dentistry receives a sustainable long-term financial settlement and not a short-term fix. Additional funding is vital if long-term and sustainable improvements to NHS dentistry are to be secured. The pledge of £50 million on 25 January for a dentistry treatment blitz is welcome, and £5.73 million is available to the east of England. However, that is a time-limited one-off injection of funding that is available only until the end of March, and there is a concern that it will barely make a dent in the unprecedented backlogs that NHS dentistry now faces. The British Dental Association estimates that it would take £880 million per annum to restore dental budgets to 2010 levels.
Since my Adjournment debate on NHS dentistry in Waveney last May, there have been improvements to the local service, which it is important to acknowledge. A temporary contract was awarded to a Lowestoft-based NHS dentist to see additional patients, which has definitely helped prevent the situation from getting any worse. Tomorrow I shall be with Community Dental Services, which along with Leading Lives, a Suffolk-based not-for-profit social enterprise, is launching its toolkit to help improve the oral health of people with learning difficulties. It is also good news that from 1 July a contract has been awarded to Apps Smiles for the delivery of NHS dentistry in Lowestoft, but it is concerning that it was not possible to do that in nearby Leiston and across the border in Norfolk, in Fakenham and Thetford. It will be interesting to receive further details as to why that happened, but one can speculate dentists might not have been interested in those opportunities and might have been put off by the existing, unattractive contract.
I have concerns about the procurement process that go back a long time. I am concerned that it does not encourage traditional partnerships to put forward proposals. I urge the Minister to carry out a whole review of the procurement process.
A vital strand of NHS dentistry should be the prevention of oral health challenges—prevention rather treatment. Fluoridation of water supplies can play a vital role in that, so it is welcome that the Health and Care Bill allows for it. There is also a need for greater accountability.
Mr Mahmood
I apologise for intervening on the hon. Gentleman twice, but I just want to make the point that John Charlton, with Severn Trent Water, has worked on getting fluoridation in water for the past 30 years. We should pay tribute to him for the great work that he has done.
Peter Aldous
I am very grateful that the hon. Gentleman intervened on me, because Birmingham is the model of how to do this. As a Birmingham MP, it is right that he highlights that, and I thank him for it.
Duncan Baker (North Norfolk) (Con)
As I will set out in my speech, my father was an NHS dentist for 23 years. He trained a long time ago in Manchester, and he told me that the advent of sugary foods and drinks had had an enormously detrimental effect on children’s teeth over the years. The one thing we can do to solve that problem is fluoridation of our waterstream. It has made such a difference, and I thank the hon. Member for Birmingham, Perry Barr (Mr Mahmood) for raising that point.
Peter Aldous
I am grateful to my hon. Friend for re-emphasising that.
Sir Paul Beresford (Mole Valley) (Con)
Birmingham is an interesting case. Not all of Birmingham is fluoridated, so when a child arrives, dentists can tell which part of Birmingham they have come from. No cavities, no fillings—fluoridated. Fillings and cavities—non-fluoridated.
Peter Aldous
I thank my hon. Friend for re-emphasising that case.
Giles Watling (Clacton) (Con)
I thank my hon. Friend for being so generous in giving way so many times.
There is another point that ought to be mentioned here. As far as I am aware—I hope my hon. Friend can confirm this—no detrimental effects from fluoridation have yet been found anywhere, and we ought to scotch any rumours to the effect that they have.
Clive Efford (in the Chair)
Order. Before the hon. Gentleman responds, I should just point out that a number of Members who have their names down to speak are intervening. To respect others who want to speak, could you please refrain.
Peter Aldous
I am grateful because, with those four interventions, we have re-emphasised the importance of fluoridation.
There is a need for greater accountability, and the Health and Care Bill can provide the framework within which that can be secured. It is welcome that the commissioning of dentistry is set to move to integrated care systems. That can make for a more transparent system, but there is a risk that dentistry and its impact on overall health could be overlooked in the integrated care proposals. It is important that dentists are properly represented on integrated care system boards.
At Report stage of the Health and Care Bill, I tabled new clause 18, which called on the Secretary of State to publish an annual report on access to NHS dentistry, to collect data on the length of waiting times for primary dental care treatment and, if necessary, to take action. The Minister for Health declined to accept the new clause. I do not know whether a similar clause will be introduced in the other place. If it is, I would urge the Government to give it serious consideration. Such a reporting mechanism can drive sustainable and meaningful improvement in access to NHS dentistry.
Mr Efford, you will be delighted to learn that I am coming to a conclusion. Tackling access for NHS dentistry, which has been neglected for 15 years, is an opportunity that we must grasp in order to demonstrate the levelling up of healthcare right across the UK. We must put in place an NHS dentistry system that is fit for the 21st century, instead of reversing into the 19th century.
Peter Aldous
It has been a very interesting debate, and we have heard some great ideas. It has largely been consensual, although I welcomed the little bit of sparring, because it added to proceedings. One thing I did not do was thank the dentistry heroes during the covid pandemic. They are the people who have really been on the frontline.
I enjoyed the interludes into Shakespeare from my hon. Friend the Member for North Devon (Selaine Saxby) and the hon. Member for Bootle (Peter Dowd). Ian Fleming was also quoted, and I could cornily reply by saying the whole debate should leave us very shaken and stirred.
Some interesting issues on funding have been raised. I take on board a lot of what was said by my hon. Friend the Member for North East Bedfordshire (Richard Fuller), who is no longer in his place, about creating innovative funding solutions. He is right to say that there is not endless money, but I feel that NHS dentistry has been the Cinderella service when it comes to funding. I sense that part of the problem is that it has been shunted off into the sidings of the NHS.
We heard three very useful points from my right hon. Friend the Member for Basingstoke (Mrs Miller), who basically said that the health of our teeth is inextricably linked to our health service. The hon. Member for York Central (Rachael Maskell) said that our mouths are not divorced from our bodies. My hon. Friend the Member for Mole Valley (Sir Paul Beresford), whose contribution was really significant, said that dentistry and the mouth need to go back into the body. I sense that if we do that, the funding issue will begin to be solved. The primary and secondary parts of the NHS, and the mental health side, will realise that we need to get dentistry right, because that will have a positive knock-on impact on the remainder of the service.
Prevention is vital. It was striking that I had four interventions on the importance of fluoridation, innovative working such as supervised toothbrushing, and getting into schools and care homes—that is so important as well.
We keep coming back to the need for contract reform. It was striking that we heard that it is not a question of dentists going out into the private sector, having been lured by large sums of money. It is a question of their being driven out by the soul-destroying system under the existing contract. It was helpful to hear the Minister say that there were some quick wins being put in place and that the negotiations start in earnest in April.
We do not want to just go away, pat ourselves on the back and say that we have had a great debate. We want meaningful progress. When I proposed my amendment to the Health and Care Bill, one of the things that I wanted was annual reporting, to see where we are. My hon. Friend the Member for Worthing West (Sir Peter Bottomley), the Father of the House, talked about coming back in six months’ time for a progress report, and I hope that the Government will agree to that. We can look at how we do that—perhaps through another Backbench Business Committee debate.
Ms Ali, you are looking at me. I have summed up as best I can. It has been a great debate, but let us not stop here.