Dentistry: Access for Cancer Patients

I beg to move,

That this House has considered access to dentistry for cancer patients.

As always, it is a pleasure to serve under your chairmanship, Mr Dowd. I want to start this debate, which I am delighted to have secured, by paying tribute to my constituent Michele Solak-Edwards, who is here to listen to the proceedings. Her phenomenal campaigning on these issues is the reason that we are all here.

Back in 2016, after a routine health assessment, Michele found out that she had triple negative breast cancer—a devastating diagnosis, followed by nine months of gruelling chemotherapy. Among the many, many challenges that Michele faced in that time was a deterioration in her dental health. That is a common yet rarely discussed side effect of chemotherapy and radiotherapy.

Unlike other physical side effects of cancer treatment, which may be medicated with the free prescriptions that cancer patients are entitled to, any side effects requiring dental treatment must be paid for. As we all know, the costs of dental treatment, even if someone is lucky enough to be registered with an NHS dentist, can be overwhelming. For Michele, the significant costs of her dental treatment had to be paid for at a time when, like many other cancer patients, she was unable to work because of her condition.

When Michele was going through one of the most difficult experiences a person can face, she found that accessing affordable dentistry was yet another obstacle for her and others in her position to overcome. So like all great campaigners, she took action to make a difference. She set up an online petition calling for better access to dentistry for cancer patients and for dental care to be free for cancer patients for five years from diagnosis, or until the end of life, if the diagnosis is terminal. This is crucial, given that dental issues do not always become apparent straight away at the outset of cancer treatment, and the issues caused can take a number of years, in some cases, to present themselves.

Within weeks, Michele had more than 130,000 signatures on the petition, with support from dentists, surgeons and oncologists. The petition now has the backing of almost 200,000 people, many of whom are cancer survivors. It is a privilege to be able to highlight its importance to the Minister today. Why is it important? Primarily, because there is an indisputable link between cancer and dental health issues. As the National Cancer Institute said, chemotherapy and radiotherapy can cause dental side effects, with both therapies altering the balance of bacteria in the mouth, leading to ulcers, tooth decay and potentially serious infection.

The link between cancer and dental health does not end there, because existing dental problems can worsen during cancer treatment, which can then impact the effectiveness of treatment or lead to it being delayed. That is why it is widely recommended, including by the British Dental Association, that a dental health assessment should take place after a cancer diagnosis and before the start of treatment.

While the link between cancer and dental health is clear, the pathway from a cancer diagnosis to dental health treatment is often blocked. The biggest issue is the crisis in accessing affordable dentistry. This challenge is not unique to cancer patients, with one in four of Britain’s adult population unable to see an NHS dentist in 2022. In my and Michele’s local authority area of Trafford, only 4% of dental practices are accepting new adult patients on the NHS, and that is by no means a low number, based on current availability. What this means for most people is the choice of going private or going without. When the costs of private dentistry are so high, that is not really a choice at all for many, especially for those on lower incomes.

Even if someone is lucky enough to access NHS treatment, costs can still be sky high, with the price of dental charges increasing by 45% over the past decade. I am not attempting to be party political, but I am suggesting that there is a link between being a cancer patient and being on a lower income because, as I mentioned, many do need to give up work. Macmillan Cancer Support estimates that a cancer diagnosis leads to a person being around £570 a month worse off, with 33% of patients having to give up work because of their condition. Cancer patients are more likely to be priced out of the dental treatment they need, and in cases where dental treatment is required before cancer treatment can begin or continue, that can have potentially life-changing consequences. Every day lost risks lives.

Let us look at some specific examples, such as the case of one of Michele’s campaign supporters, Kelly. Kelly is waiting to start bisphosphonate treatment, which is needed to strengthen bones that are at risk of breaking due to cancer. To start that vital treatment, she must undergo important dental work, which is proving impossible as she cannot see a dentist. The fact that a person’s cancer treatment can be delayed, impacting their life quality or even survival chances because they cannot access dental care is clearly unacceptable.

I know that the Minister understands the crisis in accessing dentistry and I am aware of the Government’s recently published dental recovery plan, which aims to address that. However, the British Dental Association has said that the plan fails to embrace the fundamental reform that patients and dentists so desperately need, with no new money provided and inadequate measures to tackle the workforce retention crisis. If we are ever to achieve the goals of Michele’s campaign, we must get that right, because the speedy provision of dental care for cancer patients would be significantly undermined if, in practice, many cancer patients were still unable to see an NHS dentist due to an unaddressed workforce crisis.

While addressing the crisis in NHS dentistry and the affordability of dental care is not something that can be achieved overnight, there are more immediate things that could be done to improve the pathway from cancer diagnosis to dental treatment. Currently, there is no guarantee that cancer patients will be informed by their doctor that they should seek a dental check-up before undergoing cancer treatment. That is despite guidance from the NHS Specialist Pharmacy Service, the Royal College of Surgeons, the BDA and the British Society of Special Care Dentistry stating the importance of patients being dentally fit before starting cancer treatment.

Michele’s campaign therefore calls on the NHS to provide information to all newly diagnosed cancer patients, telling them of the need to seek dental assistance prior to their cancer treatments commencing. That does happen in many places, but we want to see it enshrined in law. That information could be provided by GPs and would include a list of dental practices in each area that could treat the cancer patient on the NHS.

I would also like to share the experience of Hayley from Reading. Hayley is another supporter of Michele’s campaign, and her stories sum up the issues that I have tried to raise today. When she was 21, Hayley had chemotherapy and radiotherapy for non-Hodgkin lymphoma. The radiotherapy caused severe dental issues. Now aged 44, Hayley has breast cancer and has had to remortgage her house to spend £11,000 on removing the remaining six teeth in her lower jaw and replacing them with implants. At no stage has Hayley been able to access NHS dentistry. Experiences such as that are why this campaign is so important. No one wants a situation where cancer patients are losing out on the healthcare they need because they cannot afford or access it.

We must act on this underappreciated crisis. I therefore encourage the Minister to address in her response the asks of Michele’s campaign, including not only the long-term aim of free dental care for cancer patients, but, in the short to medium term, the possibility of prioritising cancer patients for NHS dentistry and ensuring that there is clear guidance on the need for cancer patients to receive dental care provided at the first point of contact with their GP or cancer team. I am particularly interested to know what consideration the Minister could give to joining cancer and dentistry services together for cancer patients, offering out-patient appointments for sufferers in hospital alongside their other treatment. That would seem a practical way of ensuring that people can access the care that they need.

I also invite the Minister to meet Michele and myself—as the shadow Minister, my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), kindly did earlier today, and I know Michele was appreciative of that—so that we could discuss these issues in greater detail. She will appreciate that I have not been able to cover all aspects of this important issue. Likewise, I accept that there is an escalator of asks here, some with financial implications. Michele has a mine of further information on the subject, and I know that she would be keen to talk the Minister through some of her ideas for funding these changes.

Ultimately, we must all work together on improving access to dentistry for cancer patients. As I said, I do not consider this to be party political, but it is something that we must get right. It is the least we can do for people who are already facing one of life’s toughest challenges.

It is an honour to serve under your chairship, Mr Dowd. Since being elected to represent Tiverton and Honiton almost two years ago, one of the issues that has appeared most regularly in my inbox and mailbag is access to NHS dentistry. It is common across the country for someone to have difficulty accessing new NHS dentists if they are not already registered, but that is particularly difficult in some parts of the country, including in Devon, which is often regarded by many as a so-called “dental desert”.

In recent months, we have heard the Government suggest that a way to address the difficult shortages of dentists is to try to attract qualified dentists into an area regarded as a dental desert. For example, we have seen the proposal to pay one-off incentives to qualified dentists to move into a dental desert such as Devon, but the truth is that this is still very difficult. I appreciate that the new proposal has not come in yet, but given that it is a one-off incentive, there is still no long-term incentive for dentists to move into dental deserts. That is difficult for many of my constituents, but it is more deeply worrying for those who are living with cancer. This is not a hypothetical scenario; it is the experience for people in rural communities such as Devon where finding a new dentist is impossible.

I will recount a real-life story from one of my constituents who was caught in just that scenario. Robin Whatling lives in Tiverton and is aged just 55. He is struggling with advanced cancer. Because of the treatment and medication that he is on, his bones and teeth are weaker than they would otherwise be, which means that regular check-ups are more important for him.

Robin’s wife, Sharon, contacted me last December and told me how, after booking a check-up, he received an abrupt phone call just a few days before it was due to happen. He was informed that the practice was no longer treating NHS patients and that if he wanted to go ahead with his appointment, he would need to go private. That is clearly a massive issue for a couple like Robin and Sharon. Due to Robin’s vulnerable state, Sharon has had to go part-time to become his carer. That means that she is not able to work the hours that she used to, which would have possibly afforded her more money to pay for private healthcare treatment.

It is a pleasure to serve under your chairmanship, Mr Dowd. I thank my hon. Friend the Member for Stretford and Urmston (Andrew Western) for securing this important debate.

As someone who has lost family members and friends to cancer, I frequently come to this place to try to shine a light on the huge problems in our health service, which disproportionately impact people with cancer and their families. Dentistry is no exception. Like many colleagues, I have been contacted by constituents, in Erdington, Kingstanding and Castle Vale, because they are unable to find an NHS dentist. There are more than 100,000 people living in my constituency, but only seven dental surgeries, and at least three of those are not accepting any new adult patients. A constituent without a dentist contacted me and said: “I am desperate for an NHS dental repair. I now have an abscess in my jaw. Please help me”. That case is one of many. The response I received from NHS England advised my constituents to call 111 for any urgent care services and said that it is

“working to address the challenges facing the service right now”.

The challenges in our dental system are exacerbated for people in our communities living with cancer. The Less Survivable Cancers Taskforce states that 90,000 people in the UK are diagnosed with one of the less survivable cancers every year, which is an average of nearly 250 every day. People with less survivable cancers are twice as likely as people with a more survivable cancer not to be diagnosed until symptoms are severe enough for them to go to hospital. I personally know that that is far too long. Some 80% of people with pancreatic cancer are diagnosed at stages 3 and 4.

People with cancer need fast and effective dental services in a system that recognises the difficulties they will face during their treatment. Dentists also play a huge part in detecting, diagnosing and managing oral cancers, which kill more than 3,000 people a year in the UK. Unlike the less survivable cancers, oral cancers have a survival rate of 90% when diagnosed early, as the hon. Member for Tiverton and Honiton (Richard Foord) said, so it is crucial that dentistry can be accessed quickly and treatment is free for those people.

It is a pleasure, Mr Dowd, to serve under your chairmanship.

First, I thank my hon. Friend the Member for Stretford and Urmston (Andrew Western) for securing this very timely debate, and I also thank Michele for the wonderful campaign that she has been running on this issue. I declare an interest, as I am the chair of the all-party parliamentary group on dentistry and oral health. Hopefully, that will remind the Minister that is a cross-party issue and that many of her party colleagues are concerned about it.

Dentistry is in crisis across the country, whether in Devon, Somerset or in constituencies such as mine—Bolton South East. My hon. Friend the Member for Stretford and Urmston has detailed the importance of free dental treatment for all cancer patients. I listened to my hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton), who has just spoken, about the details of the effects of this crisis on cancer patients, which she knows because of her experience of being a nurse. I also listened to what the hon. Member for Tiverton and Honiton (Richard Foord) said about his dealings with a constituent who had a cancer issue and who then had to take out his own teeth, which really is not acceptable in 21st-century Britain. I strongly support an exemption for people who are suffering from cancer and who therefore should be able to receive all the treatment that they need.

In fact, I was contacted by a constituent who had breast cancer. She told me how confused—indeed, how overwhelmed—she had felt. The last thing on her mind was dental health. However, a dental check-up should be essential for cancer patients; indeed, it should happen before anyone starts chemotherapy. Imagine the complications in treatment for someone with a suppressed immune system who is recovering from an infection. There are countless horror stories out there about the expensive dental work required by many cancer patients and they simply cannot afford it, especially given the cost of living crisis and the rising cost of bills.

Thank you for chairing this debate today, Mr Dowd. I thank the hon. Member for Stretford and Urmston (Andrew Western) for bringing the debate to the Chamber, and I thank all Members who have spoken. It is really good to have their constituents’ input and thoughts on the issues they face. I especially thank Michele for the campaign she has been running, which is the reason why this debate is taking place today. It is incredibly important that these issues are aired, and I look forward to hearing from the Minister what the Government are planning to do to improve the situation. It clearly cannot continue.

I want to talk a little about some of the things that we are doing in Scotland. Honestly, this sounds like the conversation I remember having 20 years ago in Scotland about being unable to get an NHS dentist. When I moved house in 2016 in Aberdeen, I had the choice of two different NHS dentists to go to. Everybody was like, “There’s no problem getting an NHS dentist now,” because of everything that has been put in place in Scotland to ensure that we can have those NHS dentists. More than 95% of the population in Scotland is registered with an NHS dentist and therefore able to get free dental check-ups.

Part of the increase in the amount of NHS dentists was the result of the creation of a new dental school in Aberdeen, specifically because we recognised the fact that Aberdeen was struggling with dentists. We created a new dental school there, which has had a significant impact on the numbers of dentists in Scotland. We also have various measures to ensure that dentists move to areas that are struggling to get any, as the hon. Member for Tiverton and Honiton (Richard Foord) mentioned. A £37,000 golden hello package is available for trainee dentists who are willing to move to areas that desperately need dentists. That is over the course of a three-year period of practice, so it is not like they get it all on one day—they have to be there for the three years to get the £37,000. There has also been a change in the amount of money that dentists get for the treatments they provide, to ensure that they are properly compensated, that they are able to do the treatments and that it is affordable for them to continue as an NHS dentist, rather than feeling obliged to go private.

It is a pleasure to serve under your chairship, Mr Dowd.

I thank my hon. Friend the Member for Stretford and Urmston (Andrew Western) for securing the debate and for speaking so powerfully about how the dentistry access crisis affects cancer patients and survivors such as his constituent, Michele. I had the pleasure of meeting Michele with my hon. Friend earlier today, and it was eye-opening to hear the stories about what cancer patients and survivors face. I am delighted that Michele is here today. I thank her for all her campaigning and the support that she provides for those suffering pretty much what she had to go through.

I am afraid the state of NHS dentistry under this Government is Dickensian. Most of us might think that our teeth would be the least of our worries if we were diagnosed with cancer, and as we have heard, oral health is incredibly important. Many cancer patients, who previously had few or no dental issues, can experience the loss or crumbling of teeth, together with a host of other dental problems during or after treatment. Poor dental hygiene can lead to infections, which can interfere with a patient’s chemotherapy. Radiotherapy can cause acute complications for teeth and gums through tissue damage. In rare cases, extractions afterwards can result in bone necrosis, whereby the jawbone essentially dies.

It is therefore crucial that timely access to dentistry, including any required treatment and preventive advice, is provided before, during and after cancer therapy to maximise positive outcomes. The last thing that any cancer patient needs is to find that they cannot access a dentist when they need one. However, as the Minister knows, the current crisis in access to dentistry is shocking. After more than a decade of neglect, patients are desperately queueing round the block to see a dentist. Eight in 10 practices are not taking on new adult NHS patients and, as we have heard, one in 10 people have tried DIY dentistry. Some of the most vulnerable people in society, who need to get seen, are missing out.

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Stretford and Urmston (Andrew Western) on securing this really important debate on behalf of Michele and all the other petitioners. I would of course be delighted to meet Michele to hear her views, and I particularly take note of her call for all cancer patients to be advised of the potential impact of cancer treatment on their oral health. That is a really solid and actionable thing that I undertake to take away today. I look forward to meeting Michele and the hon. Gentleman in due course.

I wish to take this chance to pay tribute to the Mouth Cancer Foundation, the Oral Health Foundation and Dentaid, to name just a few of the excellent charities that provide support and advice to so many.

I thank all Members who have spoken in what has been an excellent debate. I say to the hon. Member for Tiverton and Honiton (Richard Foord) that I fully appreciate the challenges in Devon. He will no doubt welcome the fact that a mobile dental van, which will be quite a boost for very underserved and geographically distant areas, will be forthcoming for Devon in the near future. In addition, one of the real problems in Devon—this is not the hon. Gentleman’s fault at all—is that in his area on average only around 57% of commissioned units of dental activity are actually undertaken by dentists. I am sure he might like to talk to his local integrated care board about that, if I can help in any way, I would be delighted to.

As I will come on to talk about, our dental recovery plan attempts to incentivise further NHS dentists to really ramp up delivery. In fact, we have already seen hundreds of thousands of new dental treatments just since 1 March, when the plan went live. Unfortunately, the data is not publishable as yet, but I feel really optimistic. I totally understand what Members say about it being not good enough—I totally get that—but we are seeing rapid improvements and I encourage the hon. Gentleman to talk to his local ICB.

On the Minister’s point about only 57% of the units of dental activity being taken up in Devon, is that not a workforce issue?

No. How it works is that the ICB commissions dentists to provide NHS dentistry, and the NHS contractor undertakes to fulfil a number of units of dental activity. If they do not do that, for whatever reason, at the end of the financial year the ICB claws back the money they gave the NHS dentist to fulfil that contract. I am not judging anything; I am merely giving the hon. Gentleman information that I hope is helpful to him.

Will the Minister give way?

Yes, but I do not want to run out of time.

On that point, it is very much an issue of being able to survive: many dentists say they return the units because if they took on all the NHS appointments, they would not be able to survive financially.