Access to NHS Dentistry

I beg to move,

That this House has considered access to NHS dentistry.

I thank the Backbench Business Committee for granting time for this debate and the colleagues who supported that application. I am pleased that many Members want to speak and am aware of the limitations on time, so I will keep my remarks brief.

During the general election, Labour promised to tackle the lack of NHS dental services, and I welcome the progress already made in the Labour Government’s first 10 months. After 14 years of neglect we are finally starting to see action to address the crisis in NHS dental care, including the launch of 700,000 extra urgent dental appointments, with my own integrated care board in Humber and North Yorkshire delivering 27,196 of them across the region.

This Government are rightly focusing on prevention by rolling out much-needed supervised tooth-brushing schemes in schools. That is a small intervention with long-term benefits, particularly for children growing up in areas like mine where levels of tooth decay are among the highest in England. Currently, one in three five-year-olds in deprived areas experience tooth decay—a shocking statistic that simply must be addressed.

Over 260,000 people have signed a petition led by the British Dental Association, the Women’s Institute and the Daily Mirror calling on the Government to urgently deliver on their promise to reform NHS dentistry, and the demand could not be more urgent. Catherine, one of many constituents who has written to me about dental provision, had been with her dentist for over a decade but during the pandemic a missed appointment—a simple missed appointment that was cancelled by the surgery itself—saw her removed from her regular appointments, and she has since been unable to join another practice, being told that waiting lists would take at least two years. In the meantime she suffered devastating deterioration to her oral health, losing all of her back teeth, suffering with an infected crown and bridge, and facing the real fear of losing her top teeth too; and Catherine is only in her 40s. She was quoted £14,000 privately for treatment. She simply cannot afford that. She has had to endure constant pain that no one should be left to bear.

Constituents regularly tell me that they cannot find an NHS dentist taking new patients. They are calling every single practice listed on the NHS website and they are getting nowhere. People are living in pain, they are missing work and their mental health is suffering. Some people are even attempting their own dental work, and we cannot allow that to become the norm.

The desire for action is also supported by dental practices in my constituency. One of them told me:

“We’re seeing high-need patients we’ve never treated before, often for complex work—but we’re doing this using the same budget we’ve had for years.”

In fact, some of the new urgent care and schools-based initiatives are not additionally funded. The BDA’s most recent figures show that dentists in England are delivering the least NHS care of all four UK nations: only 39% of dentists in England are spending most of their time on NHS work, compared with nearly 60% in Scotland. Practices are delivering NHS treatments at a loss: they lose over £42 for every denture fitted and nearly £8 for every new patient they see.

This Labour Government pledged to reform the dental contract: it was in our manifesto; it was part of the plan that we were elected on. I welcome the early signs of recovery, but when we say that we want to go further, faster, it is precisely on issues like this that the public are looking to Government to deliver.

In Great Grimsby and Cleethorpes and across the nation we are privileged to have so many dedicated dental professionals. Tomorrow I am visiting Dental Design Studio to celebrate its 20 years of high-quality dental care provision in Cleethorpes. It is a real credit to the team there who have delivered consistent care to local people, often under increasing strain. And our young people are not forgotten locally: thanks to the commitment of Dr Jatinder Ubhi from Dentology, multiple young people in my constituency have received essential dental support.

We must not let dentistry become a luxury service only for those who can afford to go private. We need a new approach that is fair, that funds dentists properly, and that delivers accessible care to everyone who needs it.

Order. Because so many Members wish to contribute and we have to conclude by 5 pm, we will have a time limit of three minutes starting from now. I call Sir Julian Lewis, who I think can manage that—I think you can do it.

Thank you, Madam Deputy Speaker, for that no-pressure introduction. I congratulate the hon. Member for Great Grimsby and Cleethorpes (Melanie Onn) on her speech and I agree with every part of it. I was hoping to quote from individual cases raised by constituents and from the local Women’s Institute, but all that will have to go by the board.

I have a wonderful briefing from the British Dental Association and, in the remaining two and a half minutes, I would like to make one pertinent observation, from which everything else flows. Dentistry is a highly skilled profession in which practitioners can charge colossal sums of money in private practice, which gives them a financial incentive to steer clear of working for the NHS. That is the root of the problem.

On 13 March, I put a question to the Secretary of State for Health and Social Care about a point made by the Darzi report, last September, which says:

“There are enough dentists in England, just not enough dentists willing to do enough NHS work, which impacts provision for the poorest in society.”

I was pleasantly surprised when his reply was:

“NHS dentistry is in a terrible state and, in fact, in many parts of the country it barely exists. There are lots of reasons for that, and it is a source of constant astonishment to me that the dentistry budget was underspent year after year despite that situation.”—[Official Report, 13 March 2025; Vol. 763, c. 1298.]

In reality, as the BDA points out, the reason why that budget is underspent is not because of the lack of demand, but because NHS practices cannot fill vacancies and are unable to meet contractual commitments. Therefore, those who do work with and for the NHS are having to deliver dental care at a loss. There is a fundamental requirement for a rewritten constitution and contract by which it becomes worthwhile for people to practice dentistry in the NHS, because otherwise we will see a two-tier society, in which only the rich can get the dental care that people so desperately need.

When the NHS was introduced, it made the biggest positive changes ever to the health of the general population. The original “How to use your NHS” booklet from 1948 stated:

“It will provide you with all medical, dental and nursing care. Everyone—rich or poor, man, woman or child—can use it or any part of it.”

On the topic of dentistry, it said:

“After 5th July you can go to any dentist taking part in the new arrangements (there will be a list at your Post Office).”

At that time, 83% of registered dentists signed up to work in the NHS. Currently, in England, approximately 66% are signed up to work in the NHS, a significant reduction since the early days that demonstrates a clear barrier to access.

As a former NHS manager in Scotland, I have seen the importance of early intervention when it comes to health inequalities, particularly in dentistry. Scotland too has an access crisis, with decreasing numbers of NHS participating dentists. Naturally, those lower levels of participation affect patient access to NHS dental services, and dentists lose the chance to pick up early signs of decay, cancers and other serious issues, which results in higher costs for the NHS and worse outcomes for patients.

Additionally, children and adults from the most deprived areas were less likely than their wealthier counterparts to have seen their dentist within the last two years. Recent statistics from Public Health Scotland showed that 55.9% of children from the most deprived areas have seen their dentist in the last two years, compared with 75.8% for children in the least deprived areas. Those figures drop to 42.7% and 53.5% for adults.

In September 2008, the gap in child participation between the most and least deprived areas was three percentage points. That increased to seven percentage points by 2010, 18 percentage points in 2021, and then 20 percentage points in 2023. We cannot let that continue. As oral health inequalities continue to grow, it is important that our NHS strategy involves a focus on increasing participation and access in more deprived areas. Otherwise, we will continue to see further such worrying trends, which cause more serious problems further down the line.

I call Ben Maguire. [Interruption.] I call Dr Andrew Murrison.

Thank you, Madam Deputy Speaker. I prefer Ben— I have never enjoyed Andrew—but Andrew will do.

Quite honestly, NHS dentists are saints. As my right hon. Friend the Member for New Forest East (Sir Julian Lewis) has said, the reason why we do not have any NHS dentists is that it is far more remunerative to do expensive dental work than the sort of grinding service work that NHS dentistry implies. The reason for that, fundamentally, is the so-called new dental contract introduced in 2006. That is the problem. Units of dental activity have plagued the dental profession and the provision of NHS dentistry all these years.

I am delighted that the Government are revising the dental contract that their Labour predecessor introduced 20 years ago, but, unless they are prepared to underwrite it, I am afraid that we will still be more or less in the same position. It is not as if we are not training dentists—we are training more and more dentists and there are more and more dental schools, and rightly so—but if those professionals are going to practice in the NHS, they need to be incentivised to do so.

I agree with the right hon. Gentleman about the 2006 NHS dentistry contract, which clearly needed revision. Why did his party not do that in 14 years in government?

I am sorry that the hon. Gentleman has destroyed the consensual way in which I was trying to introduce my remarks.

If I may, I will explain that I think there has been a conspiracy of silence all these years on NHS dentistry. What Government have to get to grips with is whether they intend that dentistry should continue to be a universal part of our NHS and whether it will be exempted from the universality that has characterised the provision of healthcare services in this country since 1948.

The Government could decide that dentistry is a bit like ophthalmic optics, which in the 1940s was deliberately excluded from NHS provision. I am not recommending that, but I am recommending to the Minister that we are at least honest with the public. At the moment, we have this pretence around NHS dentistry that says, “Of course you have the right to have your teeth fixed at no cost to you at all up front.” In reality, in most parts of the country, mine included, that is a complete fiction.

When the Government come to their new arrangements, which I welcome very much, can we first have some honesty? Can we have some money behind them? Can we have some idea about what part of current NHS provision the Government intend to deprioritise, if that is their intention, to ensure that we have truly universal provision of NHS dentistry going forward?

I thank my hon. Friend the Member for Great Grimsby and Cleethorpes (Melanie Onn) for securing this debate.

Today marks a year since the general election was called. Over the two-and-a-half years before then, I was out knocking on doors and listening to people across the Filton and Bradley Stoke constituency, as I still do almost every weekend. One of the issues raised with me the most was how hard it had become to find and keep an NHS dentist. Listening and acting on what matters locally, I took that campaign up. I raised those local issues with the then shadow Health Secretary, who kindly raised them here in the House of Commons for us before the election. Still there was no change from the Conservatives, who voted against Labour’s plans to rescue NHS dentistry and, remarkably, continued to do nothing.

Conservative failure is far from a deterrent. I ran a survey asking local people what their experiences were— I thank fellow residents who took the time to complete it—and the findings were clear. Only 31% of those who completed my survey had an NHS dentist, but almost everyone without an NHS dentist—97%—wanted one. Notably, 65% of those without an NHS dentist said that it was because theirs went private, and nearly all respondents—94%—agreed that Labour’s plans to open up 700,000 more urgent appointments a year where they are most needed would help. Still no action came from the Conservatives, and local people voted for change.

My very first question in this House was about ensuring we have the right infrastructure as our communities grow, including dentists. Living locally, I know how challenging this has become—I do not have an NHS dentist, either. While receiving official designation as a dental desert is not something anyone wants for their community, I am relieved that we finally have a Government who recognise the challenges we face. This Labour Government’s action means that across our integrated care board area we will now have an extra 19,000 urgent NHS dental appointments, and I know this will be just the beginning. The Government will reform the dental contract and examine how we can encourage more dentists to stay within the NHS, getting us back to that place where people can again pop that dentist’s appointment back on the calendar, whether they like going or not.

Since being elected to represent Horsham, I have been approached by many residents facing impossible prices for urgent dental treatment. Annie is 67 and caring for a husband with terminal bowel cancer. You would think that she has enough things to worry about, but given the state of dental services in the Horsham area, she has been unable to find an NHS dentist within a 20-mile radius. Forced to go private, she paid £80 for an assessment and was then quoted £150 for an extraction. She asks simply:

“When will an alternative to private dentistry be available?”

I also heard from Sally. Her family were denied NHS root canal treatment, with an £800 private option as the only alternative. She asks:

“How can we trust their advice when it feels like it’s all about the money?”

Of course, this is a crisis not of dentists, but of dentistry. The NHS contract—based as it is on units of dental activity—is simply no longer fit for purpose, if it ever was. The conflict of interest between public and private is the result of more and more dentists being forced to subsidise their NHS contracts through private work. The Government have committed to providing more support and more urgent appointments, but it is hard to get enough new employees through the front door when so many continue to leave by the back door.

In the area covered by my local integrated care board, there are more people leaving than joining across many key dental roles. Over a six-month period to the end of March last year, there were 41 general dentists in and 43 out; one orthodontist in and two out; 48 dental nurses in and 60 out; and 48 receptionists in and 54 out. In fact, five out of nine roles in dentists’ clinics have been losing staff faster than they can get new ones. The result is ever-declining access to NHS dental services, with children losing their teeth before they even reach the age of 10 and the horror stories of do-it-yourself dental treatment.

A crisis has unfolded in Norfolk, quietly but painfully; a crisis that we can afford to ignore no longer. It is the urgent and worsening state of NHS dentistry. Just 33.6% of adults in Norfolk have seen an NHS dentist over the past two years, well below the national average of 40%. For children the picture is even worse: only 42.7% have been seen, compared with 55% nationally. A&E visits due to dental problems are rising—in the east of England, there have been 152.6 visits per 100,000 people. That is worse than London, the south-east and the midlands. The only region doing worse than us is the south-west.

We now have just 328 dentists in Norfolk and Waveney with any NHS activity, down from 423 in 2019. That is one dentist for every 3,177 people. One of my constituents recently rang 111 with a swollen face from an infected tooth. They contacted six emergency dentists but could not be seen by a single one. They were forced to go private, paying more than £1,000. That simply is not good enough in a modern society.