NHS Dental Services

Question

Asked by

To ask Her Majesty’s Government what plans they have to improve access to NHS dental services.

The Government are working with NHS England and the British Dental Association to reform the current NHS dental system and to improve access for patients, tackling the challenges of the pandemic. We have also provided an extra £50 million for additional activity and patient appointments. We are working to return quickly to pre-pandemic levels of activity. For this quarter, a new activity threshold for NHS dentists has been set at 95% to increase patient access.

I am grateful to my noble friend, but with 86% of NHS dentists closed to new patients, do we still have a national dental service? The current dental contract was deemed unfit for purpose 14 years ago by the Health Select Committee in another place. Will my noble friend, as a matter of urgency, introduce a new dental contract which reverses the decline in NHS dentistry? As his fellow Minister has said,

“there is a shortage … not of dentists but of dentists taking on NHS work.”—[Official Report, Commons, 19/4/22; col. 7.]

Will my noble friend negotiate a contract with private dentists in the meantime to address the NHS backlog?

I half-thank my noble friend for giving me advance notice of one of his questions. I will try to answer that one. Many dentists who provide NHS treatment also already work in a private care capacity, and all dentists who provide NHS care must be registered on the performers list. The NHS uses the list to ensure high quality and safety standards in NHS dentistry.

On the UDA and negotiations, NHS England is in conversations with the BDA concerning both short-term changes and longer-term changes given the concerns that have existed since they were introduced in 2006.

My Lords, I declare my interest as chair of the General Dental Council. The noble Lord, Lord Young of Cookham, has correctly highlighted the importance of the negotiations on the NHS contract for dentists, but there is another element to the problem. That is the long-term expectation in terms of how many of each of the various dental professions and the various dental specialties we need in this country. What is the flow in people leaving and what is the flow in recruiting dentists, including those from overseas? Do we have enough places and enough experience coming in? Does the Minister agree that we should do a proper study of what the long-term requirements are for dentistry and how they are to be met?

The noble Lord makes an incredibly important point about how we must look at this holistically and not just try to solve one problem or plug one gap while ignoring others. The important thing is what NHS England is doing in conversations about the new contracts. It is looking at how we incentivise dentists to offer services in those areas which are so-called dental deserts. It is also looking at how all the roles have changed over the years. We have certainly seen primary medical care taking on more secondary care. We have also seen pharmacies and others taking on more, so we are looking at different roles around dentists and whether they can take on more of that.

My Lords, the Government announced £50 million in extra support for dental practices earlier this year. How many of the practices which received some of that money are in rural areas, which are particularly hit and facing a crisis where about 20% of their dentists are due to retire?

The noble Baroness highlights one of the issues that must be addressed: those areas, particularly low-population areas, but also coastal and some rural areas which are so-called dental deserts. It should also be noted that a person is not necessarily permanently registered with a dental practice. You only have to register for as long as your treatment lasts, and if you cannot get treatment at one practice, you should be able to try other practices. You can try 111. I have heard various reports. Some people have told me that 111 is incredibly effective, while others have told me that there are still dental deserts in their local area.

My Lords, maternity exemption certificates provide free NHS dental treatment and check-ups for mothers during pregnancy and for a full year after birth. However, mothers who live in so-called dental deserts are denied this right, exacerbating health inequalities between different regions. Will the Government consider extending the duration of the maternity exemption certificate during this crisis of provision, so that more mothers can take advantage of their right to free dental care?

On the face of it, that sounds a reasonable suggestion, so I shall take it back to the department and see if the people there agree.

My Lords, reports of children who can no longer chew food normally and who have never seen a dentist are damning indictments of the lack of NHS dental services. With sugary drinks and snacks contributing to poor dental health, why have the Government decided to delay the introduction of restrictions on advertising unhealthy products? What assessment has been made of how this delay will affect children’s teeth and create additional pressure on the NHS?

I know the noble Baroness has been trying to get that question on the agenda as a Private Notice Question, so I congratulate her on asking it now. Clearly, it is right that we address this issue. The recent delay was only because of certain promotions, because we wanted to see this holistically with the cost of living crisis. Restrictions or a ban on, for example, where products can be placed will still go ahead in premier areas. Overall, it is right that we get balance to this, as any Government must. There are clearly concerns about affordability, which is why we have delayed those measures, but let us be quite clear that this is a delay; we are not kicking this into the long grass.

My Lords, in England, only a third of adults and half of children have access to an NHS dentist. There are reports of people extracting their own teeth because they cannot find a dentist. As a precursor to any reforms, can the Minister explain which government policies have created this dire state of affairs?

It depends which Government the noble Lord is referring to. I was listening to a podcast today in which there was an interview with the BDA, which said that some of these problems go back to 2006 and the UDA. We have to look at these concerns and what we have learned from the mistakes of the Government at that time, and make sure that we address them, particularly in areas that are dental deserts.

My Lords, I want to follow up on the question about the delay to restrictions on “two for the price of one” sales and advertising. The prime reason that children under 10 go into hospital and have anaesthetics is to have all their teeth out, due to sugary drinks and too many sweets. Does the Minister not agree that this is a false idea, from the point of view of both obesity and dentistry? Could he clarify what he means by “delay”?

“Delay” means not the same date that was originally proposed. We clearly understand the children’s issues. During the pandemic, NHS dental practices were asked to meet as many priority needs as possible. One of the reasons that £50 million of additional funding was put in was to target them at those most in need of urgent dental treatment, including children.

My Lords, is it not true that many of these deserts are in fact areas that need levelling up? I come from one of those areas originally and, when I was a child, a dentist visited the school to check all the children annually. Why do we not have a programme to ensure that schools in these deserts are visited by a dentist per annum?

It is important for any review to look at out-of-the-box thinking and to learn from the past. The suggestion made by the noble Lord may indeed be sensible and affordable, so I will take it back to the department. There are clearly concerns about the dental deserts, some of which may be resolved by negotiations with the British Dental Association, work practices, incentives and training. Can you train dentists and dental technicians close to those dental deserts, so that they stay there afterwards?

My Lords, access to dental services for those with learning and other disabilities has been dire. What assessments and actions will the Government take to ensure that clear pathways are laid for them to access those services? They are not getting the kinds of services they rightly deserve.

The noble Baroness is absolutely right that everyone—not just people from deprived areas—should have as much access as they can to dental care. As I said, we are looking at the picture at the moment. During the pandemic, 700 urgent dental care centres were set up. As more dentists have come back on stream after the pandemic, the number has been reduced to 550. If someone is not getting care, they can ring 111 and be signposted to an NHS dentist.