That this House is concerned about NHS dentistry; notes that over a quarter of a million people have signed a petition calling for urgent action to save NHS dentistry and make it fit for the 21st century; regrets that nearly 14 million people were unable to access NHS dentistry in England in 2025; welcomes the Government’s commitment to both tackle and rebuild dentistry for the long term; and calls on the Government to set out a clear timetable for the fundamental reform of the NHS dental contract, and to improve retention of NHS dentists and access for patients across the country.
Around 14 million people, or one in four people, were unable to access NHS dental care in early 2025. Some 56% of children in Somerset did not see an NHS dentist in 2025. We are all seeing scenes that we would expect to read about in a Charles Dickens novel, not read about in the news, hear about from friends, or, if you are an MP, hear about almost every day from constituents. I have heard from 15 parents directly who have recently taken their children to hospital with dental issues. One local told me that her 86-year-old father was in so much pain that he pulled out his own teeth because he could not get dental treatment. I have heard from a military family and a pregnant woman who could not find NHS dental treatment. To highlight the scale of the problem, a local dental practice told me that every day, it takes in at the very least 10 to 15 unplanned emergencies, compared to two or three a few years ago.
The situation has got so bad that some locals are telling me that it is cheaper, sometimes by hundreds of pounds, to fly to Spain to get dental treatment—and a tan, of course. One couple who lived in Thailand for a while even told me that when they came back to the UK, they worked out that it was easier and cheaper to stay registered in Thailand, and to go back there to get dental treatment. I mean, that is just insane! Over 93% of respondents to a survey of locals that I carried out recently were dissatisfied with the availability of NHS dentistry, and 69% of parents I surveyed said that getting an NHS dental appointment was either very difficult or impossible. It would be easier to pull teeth.
Like many Members of this House, since being elected, I have been doing all I can to fix the issue. Luckily, we have had some real successes. After finding underspend in dentistry budgets in Somerset, I worked with our local NHS to open new dentists in Crewkerne and Chard. As a result, and with the new practice in Wellington, NHS dentistry has been brought to 20,000 extra people in Somerset, which is good news. However, the underused dentistry budget has fallen by 91% across the country. That means that there is not enough money to open new NHS dentist practices through underspend, which is a real problem, as we need NHS dentists in Yeovil, Ilminster and the rest of my constituency. It is not as if the workforce was not there. While the number of dentists registering to provide care in the UK has gone up to around 47,000, we are seeing the number of NHS dentists fall. Only around 25,000 dentists are doing some work for the NHS.
I was interested to hear about the hon. Member’s local survey. Ahead of the general election, around 65% of respondents to my survey in Filton and Bradley Stoke reported that the reason why they do not have an NHS dentist is that theirs went private. Does he agree that it would be helpful if the Minister could provide an update on the incentives for keeping more dentists in the NHS?
I agree with the hon. Member, and I will come on to that issue later. During covid, people missed appointments, and then got completely taken off the dental list.
One local working in dentistry summed it up perfectly when they told me that,
“NHS dentistry is in terminal decline.”
Patients have had to either go private or go without a dentist. Just before the general election, I had a £1,600 bill for a root-canal filling that needed to be redone. I was fortunate, in that I could afford that, but many people would have had to have the tooth ripped out. In a cost of living crisis, this is more than a problem. In my public survey, 87% of respondents rated private dentistry as unaffordable.
To be fair, the Government have made a good start by providing 100,000 urgent dental appointments. That is great, but the target is 700,000. I find it worrying that the Government seem to have quietly dropped their promise to deliver 700,000 more dental appointments by broadening the definition of “urgent” dental appointments for clinical reasons.
I commend the hon. Gentleman for bringing forward this debate, in which all of us across the United Kingdom of Great Britain and Northern Ireland have an interest. The Government committed themselves to increasing dental training places by 40%, but the fact is that after three years of training, those who have trained seem to go elsewhere for better money. Does he agree that training more dentists without addressing the reasons why dentists are leaving the NHS is like trying to fix a leaky bucket? It is time for the Government and the Minister to take on and sort out this issue.
I totally agree with the hon. Member, and I will come on to that point later. I hope the Minister can clarify my point about broadening the definition of “urgent” dental appointments for clinical reasons, and I am happy to give way if he wants to do so now.
I will move on, but if the Minister could remember to address that question later, it would be most helpful. On urgent care, we Liberal Democrats would go further by introducing a £750 million dental rescue plan and flexible commissioning, which would guarantee an NHS dentist for everyone needing urgent and emergency care.
I welcome the Government’s work on prevention, and particularly the support for supervised toothbrushing. I have raised this with the Minister before, but schools in my area rightly pointed out that when all the tasks that teaching staff have to do are factored in, sometimes getting the toothbrushing scheme in place is not possible. Schools in my area have had their own ways of promoting good oral health, but I also understand the drive to support and manage this nationally, so will the Minister meet me to hear from schools in my area, and talk about what we can do to support them without adding more burdens?
I am grateful to the hon. Gentleman, my near neighbour, for bringing forward this motion. He will agree that this is an issue that seems to fall hardest—disproportionately so—on rural areas. Does he also agree that Governments of both hues have tried a number of gimmicks and initiatives, but the core of the issue is to try to make NHS dentistry more attractive, and the best way to do that—please forgive the pun—is a root-and-branch reform of the contract to ensure that it pays? It is not rocket science; it is quite easy to do.
I totally agree with the hon. Gentleman, my constituency neighbour. I will come on to contracting later, but he is completely right on that point. Dentists in my area are asking why there is no funding for them to do school visits, as they would be happy to come in and support. We also need to look more broadly at the way we inform families.
What makes people in Yeovil really angry, however, is that we have all known for years what is wrong. We have an underfunded system with an NHS dental contract from 2006 that just does not work—100% of respondents I surveyed from dental practices in Yeovil said that the contract is not fit for purpose. Just about everyone agrees with that, as we have heard today. The biggest issue is units of activity, which are like tokens that the NHS gives to local dentists to use each year. The system basically sets quotas on the number of patients a dentist can see on the NHS. If they go over that quota, dentists are not paid and will have to cover the cost of material, lab work and other overheads.
One of the biggest problems with the system is that it underpays for treating patients with complex and high needs. The Government’s recent changes are a welcome first step, with new care packages for patients with very high needs, and higher rates. NHS Somerset is doing all it can and has increased units of activity by 10,000 from 2025-26.
I have met with my local dentists. Does the hon. Member agree that part of the problem is the massive differential in the price per unit that each dental practice is paid? It means that for some dental practices it is no longer viable to continue to do NHS dentistry, whereas for others, based on the legacy price per unit they get, it remains competitive.
I completely agree with the hon. Member on that point. We have seen that in my constituency and others in Somerset: one place will be on a higher rate, and another place will be on less. Ultimately, we need to get rid of that system if we want more NHS dentists, and look at alternatives, such as the weighted model suggested by the Health and Social Care Committee.
But that is not all. One of the frustrating things that I found when we were setting up a new NHS dentist in my area is that dentists cannot prioritise locals. The dental contract means that people do not register with a dentist as they do a GP; they can attend any dental practice that is taking NHS patients, even if the practice is based miles away. That is because, technically, people are only with a dentist for as long as a course of treatment, which means that if someone lives in Yeovil, Crewkerne or Chard—or in the rest of my constituency—they do not have the right to be permanently registered with their local NHS dental practice.
When we got the new practices open, there was no guarantee that locals who needed a dentist most would get one. That is madness. We had people travelling 200 or 300 miles to come to one of our new dental practices, and someone a mile down the road could not sign up. What is the point of opening a new dental practice in our area if it does not benefit all—or even half—of the people there? That part of the contract also means that to stay with their NHS dentist, someone needs to have six to 12-monthly appointments to keep their spot. That meant that a lot of people lost spots during covid. Local providers, the NHS and I are doing our best locally, but there is only so much we can do within those rules. I urge the Minister to make reintroducing permanent patient registration rights a priority in contract reforms.
I broadly agree with the hon. Gentleman’s list of demands. I wonder whether he could offer advice, based on the Liberal Democrats’ five years in government, on lessons learned about the NHS contract and its reform.
There is always a dig like that from the Labour Benches. Look, that was back in 2010. I was 18 at the time—I turned 34 on Saturday. Things have changed. The hon. Gentleman’s Government is in power now, and they are making a bit of a mess of a few things at the moment. This is something they could be really proud of; they could deliver change for the people of this country who voted for them. Get out there, make change and get their teeth sorted.
I am proud to speak in this debate. I declare that I co-chair the all-parliamentary group on dentistry and oral health.
I have been working on this issue for the best part of a decade, raising it with Ministers in the previous Government, and I have to say that the scale of the challenge that this Government inherited is nothing short of a national scandal. I welcome the steps that the Government have taken: the 700,000 additional urgent appointments; the broadening of that definition in February; and the 1.8 million extra treatments delivered in just seven months. These are real achievements, and I pay tribute to the Minister, whom I have always found to be accessible. He and I have had a number of discussions, and I know that he is not just sympathetic to the issue, but very keen to resolve it. However, as he knows, although these steps are welcome, they are just a sticking plaster on a wound that runs very deep.
Almost 14 million people in this country could not access NHS dental care in early 2025—that is more than one in four adults in England, and more than three times as many as before the pandemic. These are not statistics; they are people in pain, people who cannot eat properly and people who are even embarrassed to smile. The British Dental Association’s research tells us that 41% of adults now have tooth decay—levels that have not been seen since the 1990s, undoing decades of hard-won progress in oral health. Polling from Ipsos makes for truly shocking reading: people across this country who cannot get an NHS appointment have been forced to pull their own teeth out. In one of the wealthiest nations in the world, that is just not acceptable.
The Government were elected on a platform that included a dentistry rescue plan. They correctly assessed a crisis in NHS dentistry and promised to fix it. Nowhere is that crisis more felt than in the rural areas across the country.
Nearly two years on from the general election, I consulted residents across my constituency in a survey about the health care issues that mattered to them. Almost everyone who replied mentioned the state of NHS dentistry and the lack of provision across Somerset. If the Government want to show genuine support for rural communities, as they claim, they can no longer ignore those voices calling for action—but ignore them, the Minister does.
When I asked the Minister on the Floor of this House what steps he was taking to increase the number of dentists accessible to rural communities, he directed me to, “Watch my post box” to be furnished with the numbers of how many more appointments have been provided in my constituency. I did wait, and then I waited some more, and no response came. Eventually, having chased the special adviser outside the Chamber and threatened a point of order for the Minister’s reply, I did get a response. It then became clear why his Department had been so reticent: the numbers revealed that 4% fewer NHS dental treatments had been delivered in the first seven months of this financial year compared with the same period before the general election.
Does the hon. Member agree that the national golden hello scheme to attract and retain NHS dentists is just not working? Only four of 19 posts in Devon have been filled, and the Fresh Dental practice in Dartmouth will end the provision of NHS dental services at the end of June. It will no longer provide NHS care and is the last dentist in the town. It says that it has tried to recruit for years but cannot fill the positions. It says:
“It has become increasingly difficult to maintain the NHS contract in a sustainable way.”
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NHS Dentistry · Order Paper · Order Paper
Even then, without proper funding such changes will not work. Since 2010, the amount of the NHS budget spent on dentistry has more than halved. Integrated care boards, which oversee local NHS services, have also been making serious budget cuts, with 50% of their staff having to be made redundant. That has left us in a situation where we invest less of our health budget in dentistry than any of our European neighbours, according to data from the OECD. At the same time, dental practices in Yeovil tell me that the cost of materials, energy and labour have gone through the roof, while missed appointments or last-minute cancellations are costing practices a fortune. We need the Minister to set out how the Government plan to fund NHS dentistry properly. Will he also set out what steps he is taking to support dentists with day-to-day costs, particularly in relation to resourcing and cancellations?
There is one other big issue that we have to address: getting dentists to work and stay in rural areas such as Somerset. Mark, who is about to retire after 39 years as a dentist in Yeovil—thank you for your hard work, Mark—has been saying to policymakers and the press since the mid-1990s that we would end up in exactly this situation if we did not attract dentists to places like south Somerset, which lose out because NHS dentistry tends to be concentrated around dental training schools and urban centres. It is therefore a good start that the Government will require younger dentists to work in the NHS after graduation for around three years, but that is only a short-term fix, just like the golden hello bonus—another one-off fix. We need to write proper workforce planning for health and social care into law, including projections for dentists and dental staff.
Similarly, the Government’s recent announcement of 50 new dental school places from 2027 is great, but that is a rise of only 6%—a drop of water in the dental Sahara desert that is the south-west. I think it is fair to say that dentists trained in Portsmouth will probably stay around there and instead of coming to fill demand in Somerset, which is a real tragedy because as a community we have so much to offer. I invite the Minister to come to Somerset to talk with us about how we can get that across to dentists.
Ultimately, we need fundamental changes to the NHS contract, how we fund it and how we recruit. Of the local dentists I surveyed, 100% said that they were not satisfied with the Government’s progress on improving the NHS dental contract, while 82% of the public I surveyed rated the Government’s performance on NHS dentistry as poor or very poor. Two years into this Government, we are still waiting for proper changes to the NHS dental contract; if we factor in early discussions, consultations and then actually drafting and proposing the thing—we all know how long those things take—I am sure the Minister is aware that if this is kicked down the road any further, the Government will not be able to deliver on their promise to roll out a new NHS dental system by the next election.
I urge the Minister to provide a clear commitment to getting the consultation on fundamental reforms done this summer, no matter how distracting a new Secretary of State, a by-election and a change of Prime Minister may be—let us get on with it. I hope the Minister will also use this debate as an opportunity to go further and provide a clear timetable for when formal negotiations will start, as well as a firm deadline for rolling out the new system in this Parliament. I know that the Minister is committed to getting this right, and that he is working with a difficult brief, but there seems to be a disappointing trend emerging with this Government, whether in social care, defence, investment or dentistry: if it is hard, kick it down the road.
We were promised change, so please work with us to deliver that. I do not want to have to be back here in a year or two, reporting that things have got even worse in Yeovil.
How did we get here? Since 2010, the proportion of the NHS budget spent on dentistry has more than halved, from 3.3% to just 1.5%. That is the direct result of 14 years of the previous Government—£1 billion gone, and patient charges hiked by over two thirds. In 2023, the Health and Social Care Committee branded the dental contract “not fit for purpose”; both the Public Accounts Committee and the Nuffield Trust have said the same. Yet the previous Government for 14 years did nothing about it.
After the Tory Government recovery plan was found by the National Audit Office to be off track, this Government have tried to change things. The new patient premium cost £88 million, but produced no measurable improvement in access. Just last week, we learned that despite the offer of a £20,000 golden hello, just two dentists in Greater Manchester signed up to do NHS work. That tells us how broken our system is.
I want to raise a specific injustice that was brought to my attention by the Epilepsy Society. Around 630,000 people in this country have epilepsy. A third have uncontrolled seizures and fall without warning, often face-first, breaking their teeth again and again. Harriet, who is 29 years old, has six missing teeth, including her front teeth—top and bottom. After she broke her NHS dentures three times in a single year, her dentist has refused to issue another set. She can barely speak clearly, she struggles to eat, and every time a seizure strikes she faces a new bill for the damage she could not possibly prevent. A broken arm caused by a seizure is treated free in hospital; a broken tooth caused by that same seizure incurs significant expenditure. There is no medical exemption for epilepsy-related dental damage, but there should be. I urge the Minister to look specifically at that in the short term before going on to the full dental contract.
What is the cost of fixing it, and why do we need it? The British Dental Association estimated that it would take about £1.5 billion a year to restore NHS dentistry to a universal service. When the Chancellor announced £29 billion for the NHS in her statement on the spending review, I asked her whether any of that money could be set aside for dentistry. Sadly, it has not been, and no additional money has been set out for dentistry.
Catching decay early is far cheaper than an emergency treatment, prevention in children costs a fraction of what we spend fixing the damage in adults and a workforce who stay in the NHS are definitely cheaper than one who walk away. We need a new contract that breaks decisively with units of dental activity, prioritises prevention and makes NHS dentistry a place where talented professionals want to build their careers. The Government have announced a public consultation for this summer, which is great news, but we need a timetable and a firm deadline for a new system in this Parliament. We cannot kick this into the long grass again—13 years of that was quite enough.
As I said, I have been raising these issues for years. I sat in rooms with Ministers and heard warm words but found nothing changed. I do believe that this Government are different and that the Minister is serious—I have had many discussions with him, and he has met the all-party parliamentary group on dentistry and oral health a number of times—but that seriousness must be matched with urgency, and that urgency must be matched with investment. The people of Bolton South and Walkden and people across the country deserve to see a dentist without waiting years and without pulling their own teeth. They deserve a Government who will finally fix NHS dentistry. I urge the Minister to please urge the Chancellor and the Secretary of State for Health and Social Care to give it the utmost priority. Let us resolve it once and for all.
The Government are too busy patting themselves on the back to notice the dire reality of NHS dental provision across Somerset and other rural counties. For meaningful change to be felt by my constituents and patients across the country, reform of the system needs to start being treated as a priority. Access to quality NHS dental care should be available to all, not just those in urban Labour constituencies.
Families in Somerset should not need to travel miles for basic care, paying fees they cannot afford or, worse still, going without treatment altogether. Polling for Ipsos last year revealed that when people cannot secure dental treatment, a quarter will resort to at-home DIY solutions. That is simply not acceptable in a modern health service.
Before those on the Government Benches leap to their feet with interventions beginning with “Fourteen years”, which we hear every sitting day, I have to acknowledge that this problem did not start in July 2024. Previous Governments, including previous Conservative Governments, did not do enough to fix the problem. The last Government did take steps, including an uprating of NHS dental unit pricing, but far more needs to be done to address the deeper structural issues in the system. Contract reform, fundamentally, is what we need to see.
I am encouraged that Ministers seem to agree, but on this issue, this Government’s intervention follows a familiar pattern. Instead of taking action, they are launching a consultation. This Government and this Minister have been in office for two years, and I would have thought that by now they would have worked out what they wanted to do to improve the system. If the Minister is going to consult, I very much hope that it is on the basis of a well-thought-through plan and that it is not being used as another delaying tactic. I hope, in particular, that he will consider how we can strengthen the dental workforce in rural areas.
Something I have raised previously with the Minister is how we can train more dentists locally. Clinicians who train in a community are more likely to stay and practise there. In Bridgwater, discussions took place with Bridgwater and Taunton college on the potential for partnerships, such as with the University of Bristol dental hospital, to deliver local training pathways. If student dentists could do some of their practice within rural communities, it might encourage them to work there afterwards. The Minister asked me to write to him about that, and I did, but I got a whole load of platitudes back and, regrettably, no action was taken.