Virtual participation in proceedings commenced (Order, 25 February).
[NB: [V] denotes a Member participating virtually.]
9:25 am
Hannah Bardell (in the Chair)
I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will be suspensions between debates. I remind Members participating, physically and virtually, that they must arrive for the start of a debate in Westminster Hall and are expected to remain for the entire debate. I must also remind Members participating virtually that they are visible at all times, both to one another and to us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks at westminsterhallclerks@parliament.uk. Members attending physically should clean their spaces before using them and before leaving the room. I remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall.
That this House has considered oral health and dentistry in England.
It is a pleasure to serve under your chairmanship, Ms Bardell. I was compelled to call for this debate after an NHS 111 call handler contacted me to describe the hardship that they experienced in trying to get patients in severe pain emergency dental appointments—too often without any success. Dental practitioners and lab technicians have also approached me, detailing the many obstacles in their profession that are preventing them from giving the care that they so desperately want to give their patients. The different perspectives make it blatantly clear that dentistry in this country is in crisis and patients, including children, are not getting the care that they need.
There is a lot of work to be done to fix what has long been a broken system, so let me start with thanks to all my colleagues who are contributing to this debate and to all those organisations, including the British Dental Association, the Association of Dental Groups, the Faculty of Dental Surgery and Healthwatch, and dentists in my constituency, who not only briefed me for the debate but have been working day in, day out, for years to raise the serious issues that I will go on to mention and who have the solutions, if only the Government would listen.
I hope that the Minister will come to the table today with a response that matches the gravity of the situation, because access to dental care in England is in a parlous state. A constituent employed by the NHS 111 service first got in touch with me in September 2020, in the midst of the pandemic, to tell me, in his words,
“about the woeful state of the dental service or more precisely the lack of a dental service”.
He covered Hertfordshire, Bedfordshire and Essex, but was aware that his comments applied nationwide. He told me that he spent the majority of his day speaking to people who were literally crying out for an appointment and even emergency treatment, but he had absolutely nothing to offer them. He told me that if someone is lucky and already registered with a dentist, they might be offered an appointment at some future date, often weeks in advance, but if not, they had no chance of being taken on. He said that that applied to everyone, including children and pregnant women. That was of course during lockdown, but many of the barriers to finding appointments persist.
I am delighted to serve under your guidance, Ms Bardell. I congratulate the hon. Member for Bedford (Mohammad Yasin) on obtaining this debate. His speech was a barrage of negativity, and it is not all negativity in this field. I am a practising dentist—part-time at the moment; very little. I am a member of the British Academy for Cosmetic Dentistry, the British Fluoridation Society and the British Endodontic Society. That is wet-finger dentistry, though in a glove.
For decades, the dental profession, especially NHS dentists, has felt that dentistry as a health service has, as far as the Department is concerned, been seen as a Cinderella service, or an expensive minefield, or both. This has gone on for decades under Governments of various and even mixed complexions. However, I believe this has markedly improved with my hon. Friend the Minister and the current chief dental officer. There has been a visible change of attitude. Both ladies recognise the importance of improving the oral health of the nation and of the status of dentistry as a health service. To use the chief dental officer’s banner statement, at last
“Putting the mouth back in the body”.
Covid has had a dramatic effect on the ability to provide dental services, whether NHS or private. Waiting lists for all dental patients have dramatically exacerbated, and we have just heard a tirade on this. Covid meant that for a period all dental surgeries were closed. Only emergency services and specialised clinics were open. When the surgeries were permitted to start resuming covid protection, actions such as furloughed time, PPE and so on added to the delays, complications and diminished throughput. Clinical teaching of final year students was diminished, such that there is doubt that some of them are ready to graduate.
All the dental team should have been double vaccinated by now, whether private, mixed practices or NHS. The R factor is going down. An increasing proportion of patients have been vaccinated. Dentists are following a careful triage system. Deaths are down, hospitalisations are down and the 21 June release is still on, we hope.
Hannah Bardell (in the Chair)
Before I call the next speaker, I ask Members to keep their remarks to within eight minutes, to allow equal time, and I hope to call the Opposition spokespersons by 10.35 am.
Thank you very much, Ms Bardell, for your chairmanship today.
I, too, congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on securing this timely debate. Like others who have spoken, I have heard countless stories from my constituents in Norwich South that show the very human cost of chronic and long-term underfunding of NHS England services. What I have heard has led me to conclude that the state of NHS England’s dental services can only be described as a scandal. Simply put, this is a service that is broken.
Many constituents now face insurmountable barriers to accessing basic healthcare. They face extreme delays in getting an appointment, if they can secure one at all. They are then faced with prohibitive treatment costs, even for NHS services, which some simply cannot afford. Constituents tell me it is impossible to get an appointment, let alone with an NHS dentist, and that they have been turned away despite being in pain.
One constituent had dental treatment delayed by a year; others had treatment cancelled, only for their oral health to deteriorate. Some constituents tell me that when they do manage to get an appointment, sometimes after weeks or months of waiting, they are told that the treatment they need can be done only at a private clinic, at a cost of thousands of pounds, which they simply do not have.
Delays, cancelled appointments and treatments so expensive that they are unattainable lead to agony, disfigurement and a range of other healthcare problems. Someone with a business in my constituency was forced to pull out 18 of his teeth when receding gums had left him in agony and the broken dental care system left him no other options. Perhaps the hon. Member for Mole Valley (Sir Paul Beresford) would like to tell that businessman that his agony is his own fault and due to his diet. I suggest that the hon. Gentleman change his dental bedside manner when talking to patients, because I do not think that patient would agree that the situation was entirely on his own head, given that he could not receive timely treatment from the NHS.
It is a pleasure to serve under your chairmanship, Ms Bardell, and I thank the hon. Member for Bedford (Mohammad Yasin) for organising the debate. The Minister knows that I have spoken on these dentistry issues on several occasions, and I have written to her as well. As discussed with the Minister, I will be writing to the Treasury on these issues this week, because the Minister is a champion of public health, dentistry, pharmacy and other issues, as she rightly points out, but there is a cash problem here as well. I am aware that she is doing her best in difficult circumstances, and covid presents a unique set of circumstances. I agree with my hon. Friend the Member for Mole Valley (Sir Paul Beresford) that we are seeing an improvement under the Minister—or we should see an improvement once covid gets lifted.
Islanders are facing issues, however, in relation to dentistry. It is, frankly, just very difficult—nigh-on impossible in some parts of the Isle of Wight—for families to find an NHS dentist. I thank the Minister for the extra money to soak up some of the outstanding appointments, but that money was reasonably limited and it went very quickly. Some Islanders who are getting a new dentist are now having to go to the mainland for treatment. That is incredibly inconvenient, especially given that, with the most expensive ferries in the world, some kids on the Island have never seen a dentist in their life.
The Healthwatch England report found that 7 in 10 people find it difficult to access an NHS dentist. The same body published data in 2019 showing that 85% of dental practices across the country were closed to new patients. That is absolutely reflected in my constituency. As well as the inconvenience and the damage to the nation’s dental health, it will cause us problems in the longer term, as suggested by my hon. Friend the Member for Mole Valley. That is because we know that there will be a significant rise, potentially, in cancer cases: one of the side effects of a lack of dental appointments is that we will not be able to spot cancers like mouth cancer, and ill health, when they show themselves in people’s mouths. We know, also, that gum disease is associated with heart disease, so there is a knock-on effect on other bits of the health service.
It is a pleasure to serve under your chairmanship, Ms Bardell. I congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on securing this important debate.
As the Minister knows all too well, I have spoken on this issue many times in this place, but the problems facing NHS dentistry have never been more serious or the need for action more pressing. The flurry of reports and media coverage in the past couple of days confirms the urgency of the crisis before us. Last week’s Insight report from the Care Quality Commission questioned whether enough NHS dental capacity is commissioned, and challenged commissioners to ensure that everyone, especially those who are vulnerable, have access to NHS dental care.
Yesterday’s report by Healthwatch England stressed that the dental crisis shows no signs of slowing and rightly called for a radical rethink of NHS dentistry and a rapid, radical reform of the way that dentistry is commissioned and provided. Today’s analysis by the British Dental Association warns that the extreme pressures of trying to hit unrealistic activity targets and working long hours in heavy-duty PPE have led to an unprecedented crisis in morale among the dental workforce, with almost half of NHS dentists saying it is likely that they will reduce their NHS commitment or leave the profession altogether in the next 12 months. Unless we urgently act to avoid the looming exodus of dentists in the NHS, the consequences for patients will be dire.
Bradford South has faced serious challenges with access to NHS dentistry for a long time. The triple whammy of chronic underfunding, the failed dental contract and the pressures of the pandemic means that the kind of problems that we have long seen in my constituency, and West Yorkshire more widely, have now reached almost every community in England. However, I look forward to meeting the Minister and her team again to examine the data and the outcomes of the extended pilot project to increase access to dentists in Bradford.
It is a pleasure to serve under your chairship, Ms Bardell. My gratitude goes to my hon. Friend the Member for Bedford (Mohammad Yasin), as this debate is timely and important for all our communities. He is a long-standing champion of better public services for all.
I begin by thanking all dentists and dental staff in our country. They do a difficult job and the pandemic has made it even harder. I know from experience that the British Dental Association plays an important role in supporting the dental community and, of course, patients, and I am grateful to it. Earlier this week, there were reports in the media regarding the state of our dental industry. As ever, it is the most disadvantaged in our communities who have borne the brunt of the crisis in the sector. Healthwatch England reported that it had seen a significant rise in calls and complaints at the start of this year. The pandemic has been an unprecedented challenge, but it cannot be acceptable that in one of the richest countries in the world some people have been informed that they have to wait up to three years to see a dentist.
Shockingly, 22% of children under five in Stockport have experience of tooth decay, which compares unfavourably with the best area in England, where only 7% of children have decay. In addition, last year 300 children in Stockport had teeth extracted under a general anaesthetic in a hospital due to tooth decay. In the latest GP patient survey, 14% of adults surveyed in the Stockport clinical commissioning group area said that they had not tried to get an appointment with an NHS dentist in the past two years because they assumed that none would be available. Only 2% said that they were currently on a waiting list for an appointment. The British Dental Association has welcomed the Government’s commitment to dental contract reform, but these reforms must be meaningful. They must expand access to NHS dentists across England because private treatment is not accessible to everyone.
Thank you, Ms Bardell, for the opportunity to speak in today’s debate with you in the Chair. I thank my hon. Friend the Member for Bedford (Mohammad Yasin) for putting the debate into context. Here I am again debating dental services with the Minister and, yet again, championing the needs of my constituents and the dentists who have worked relentlessly throughout this pandemic in extremely difficult circumstances.
York had a dental crisis before the pandemic. Constituents now tell me that they have to wait at least three years to receive NHS treatment and that those trying to register struggle or simply search for treatment outside the area. We have serious problems in York, as the Minister knows. NHS treatment needs to be available for all and, tragically, it is not. Many are now turning to accident and emergency services to get pain relief or a course of antibiotics. Private care is not an option, nor should it ever be.
Successive Ministers have failed to address this crisis. This month, the Minister was unable to tell me, as my hon. Friend the Member for Stockport (Navendu Mishra) has said, how many NHS dentists there are in my city. The fact that she does not have that basic data gives me little hope that the Government have really got a grip on the scale of this crisis and the needs that must be addressed.
It is perplexing that oral health is seen to be different from other areas of healthcare, and that we have to pay for things that are done to our mouths but not to the rest of our bodies. It did not start that way. When Nye Bevan established the NHS, dentistry was free at the point of need and everyone was entitled to have their check-ups and treatment on the NHS. It was transformative. In 1951, the first assault on our NHS occurred when charges were introduced. That caused Bevan to resign in disgust, and sadly since then the divorcing of oral health from the rest of medical care has failed to serve us well.
Hannah Bardell (in the Chair)
Before I call the next speaker, may I gently and politely remind Members to turn off their phones or put them on silent during the debate?
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I contacted the constituent again in February and he told me that, if anything, the situation was worse. He worked almost exclusively on dental calls; they were coming in relentlessly. He described it as a Catch-22 situation. If people are not registered at a practice, NHS 111, virtually without exception, can only tell the callers that practice books are closed to new NHS patients for the foreseeable future. If a patient is registered, they will be told that their practice cannot offer treatment—often for weeks ahead. Let us remember that patients call 111 only as a last resort and are mostly in considerable distress. They mistakenly believe that the NHS runs the dental service, and have nowhere else to go. Many turn up at A&E in desperation, which only adds to the pressure on NHS hospitals which do not have the capacity, expertise or tools to fix dental problems.
My constituent told me it was heart-wrenching to have to listen to these calls for six hours a day. Last week, when I asked for his permission to raise his concerns in this debate, he told me that
“there is real anger and desperation brewing.”
I hope that the Minister is listening carefully to my constituent’s experience, because this is the situation on the ground. I am sorry to say that he has now decided that enough is enough—he will leave his role because he says he
“can see no possibility of any improvement this year.”
NHS dentistry is facing an unprecedented backlog in care that will take years to clear. The BDA estimates that a staggering 30 million NHS dental appointments have been lost since the start of the pandemic, and a report published yesterday by Healthwatch found that 80% of people struggled to access timely care during lockdown.
Even before the pandemic, only enough NHS dentistry to cover just over half of England’s population was commissioned. Over a quarter of people either struggle to or cannot pay, so they avoid dental treatment altogether. Capacity is severely limited by infection control measures, and access problems have now reached an unprecedented scale in every community, with deep existing inequalities set to widen even further.
If the Government are serious about levelling up, tackling health inequalities needs to be at the top of the agenda. Healthwatch found that, among people living in the north-east of England, those on low incomes and ethnic minority groups were hardest hit by the twin crises of access and affordability.
The Care Quality Commission’s “COVID-19 Insight: Issue 10” report published last week rightly questions whether enough NHS dental capacity is being commissioned, and challenges NHS policy leaders to deal with the demand and ensure that everyone—especially the most vulnerable—has equal access to NHS care.
The system has long suffered from chronic underfunding. Even if you factor in the income from patient charges, which have been increased by an inflation-busting 5% in each of the last five years, the total NHS dental budget was lower in cash terms just before the pandemic than it was when Labour left power in 2010.
The dental contract introduced in 2006 is structured with ridiculous, counterproductive targets which do not make things any easier. Totally discredited and unfit for purpose, it is incompatible with providing safe and sustainable services for patients, both during and after the pandemic, and must be reformed. The peculiar Units of Dental Activity system effectively caps the number of patients a dentist can see on the NHS and actively disincentivises dentists from taking on new NHS patients, especially in poorer areas where a new patient is more likely to have large, unmet dental care needs.
I am grateful to the Parliamentary Engagement team, who ran a survey in relation to this debate. When asked what key changes would enhance their ability to do their job every single respondent, 78% of whom were oral health professionals, wanted to abolish what one described as
“the aberration that is the UDA system.”
Another said that they would have no problem committing to provide 100% NHS dentistry if they were paid for the work they did. However, under the current system, a root canal treatment—which can take up to three hours of highly technical and skilled work—is renumerated the same as a little filling that may take 30 seconds to place.
Why can the Government not understand that a work- force work best when they are respected and incentivised? We need to get more patients through dentists’ doors, but aggressive and punitive activity targets are not the way to go about this. The targets have been the driving factor behind the recruitment and retention crisis in NHS dentistry. While the Minister is keen to point out that the headcount of dentists providing NHS services has been pretty stable, when dentists need to do only an hour of NHS work a week to be considered an NHS dentist, that is meaningless smoke and mirrors.
In reality, many dentists have been reducing the NHS work they do, and the Minister’s written answer last week revealed that the number of practices providing NHS dentistry in England fell by 1,253 between 2015 and 2020. As in other parts of the NHS, the pandemic has brutally compounded the pre-existing problems in the dental system.
I appreciated and welcomed the Government’s support for NHS dentistry in the early stages of the pandemic. The Minister quite rightly decided to pay dentists their historical contract values when they were told to close their doors to patients in the first lockdown. After dental practices reopened last summer, dentists were asked to work their way through the backlog, prioritising patients on the basis of need, instead of focusing on delivering units of dental activity.
Just before Christmas, however, the Government changed course. Despite standard operating procedure continuing to severely limit the number of patients that can be seen safely, the Government expected dentists in England to deliver 45% of their historical activity between January and March or face financial penalties. This target was further increased to 60% in April. The BDA members survey suggests that a large proportion of dentists managed to meet the target only by taking extraordinary measures, such as cancelling all annual leave and working beyond their contracted opening hours—all of this while working many hours a day in heavy-duty personal protective equipment.
Dentists in my constituency tell me the same story: the situation is not sustainable. To put this in context, the Labour Government in Wales have not introduced any such targets, recognising that chasing activity measures is good for neither patients nor dentists in the context of a pandemic. I would welcome the Minister’s explanation of the extreme difference in approach between England and the rest of the UK, and I urge her to follow the lead of the Administrations in Wales and Northern Ireland, who have committed capital funding towards buying high-capacity ventilation equipment, which can drastically cut down the fallow time required between treatments. This sensible investment allows dentists to see more patients safely and will pay for itself in increased patient charge revenue.
Morale in the profession is at an all-time low, and there is a real danger that the pressures will turbocharge the flight of dentists from the NHS, driving them into private dentistry or early retirement, and making the problems with access for patients a permanent feature of our dental health service. That is on top of the significant loss of overseas dentists as a result of Brexit. The backlog created by the pandemic cannot be tackled if we have no workforce left to do it. Dental practitioners must urgently be added to the shortage occupation list. I hope that the Minister will outline the Government’s road map out of the current high-intensity infection prevention and control measures.
There can be no more kicking the can down the road when it comes to contract reform. It is now a matter of urgency. I would welcome the Minister’s assurances that the new system will be rolled out more quickly, and certainly without any further delays, and that it will decisively break with the discredited units of dental activity and instead prioritise increasing access for patients, and prevention. It is vital that the Government seriously invest in preventive measures.
Oral health is an essential precondition and indicator of overall health, and it deserves to be given priority in our health system. One in eight children in Bedford has obvious tooth decay by the time they are three, and the figure rises to one in five by the time they turn five. The Government are letting children down. In the year before the pandemic, over 23,000 children between five and nine were admitted to hospital because they had tooth decay. It is absolutely shameful that a completely preventable disease continues to be the No. 1 reason why young children in England are admitted to hospital. In the last five years, 540 children in Bedford have been admitted to hospital for tooth extractions, wasting over £500,000 of precious NHS resources just in our town, as well as causing pain and stress.
Procedures under a general anaesthetic are another area of dentistry where the pandemic has taken a heavy toll. They are often necessary in children with extensive decay and adults with special needs, and waiting times were very long even before the pandemic, with patients often waiting in excess of a year. The suspension of most non-urgent surgeries has left tens of thousands of patients in pain for months, with some taking huge amounts of painkillers or resorting to do-it-yourself interventions or multiple rounds of avoidable antibiotics while they wait for this completely preventable surgery.
I welcome the plans to legislate to recentralise water fluoridation as a preventive measure, but would welcome assurances that changes to the legal framework will be accompanied by proper funding, otherwise it will be meaningless. Water fluoridation is highly effective, but it will take years before we see its effects, so proper investment in preventive oral health programmes, such as supervised toothbrushing, is needed. Supervised brushing is estimated to save over £3 for each £1 invested over five years. I hope we will see a consultation and a roll-out of this sensible and highly effective intervention very soon.
Finally, I turn to the forthcoming health and social care Bill. Beyond the measures on fluoridation, the White Paper barely mentions dentistry at all. I hope to hear a commitment today that dental services will be properly represented in the governance structures of the integrated care systems, and that the changes to commissioning structures—and particularly any possible pooling of primary care budgets—do not result in further cuts to dental budgets.
My hon. Friend the Minister can see my request coming like a big balloon because I have already discussed it with her. The time has come for a road map to release dentists from PPE and all the restrictions. We need a return to the pre-covid treatment of patients and we need SAGE to look at it and get on with it. That will be the biggest single action in enabling dentists to get this backlog into line.
My second wish is a push at an open door with the Minister. Dental care is preventable, but while there has been progress, we are badly behind, especially in caries prevention for children. Pre-pandemic, these children occupied 177 clinical general anaesthetic extraction cases in hospital—a complete waste of our services. The latest figure that I have seen is that 23,529 children between the ages of five and nine were admitted to hospital because they had tooth decay.
I first started practising dentistry in a deprived area in east London. The state of dentition there shocked me, especially the state of children’s dentition. It was not the deprivation that caused the poor dentition; it was the diet and the almost complete lack of oral hygiene. Put simply, kids and parents did not toothbrush. Some parents did not even know that toothbrushes existed. And if you went into the supermarket, the shelves were packed with biscuits and cakes, whereas there was little meat or vegetables; go to less deprived areas and it is the other way round. So, it is not the deprivation; it is the shoppers—the parents.
The Minister will know where I am going with this. She and the chief dental officer are already embarking on teaching children in teams throughout the country to brush their teeth. Coincidental with this, most children are accompanied by their parents, some of whom are stunned to see this little thing called a toothbrush. But the message is getting through; as the hon. Member for Bedford said, we are starting to get some progress, and it is happening quite quickly.
As I have said, tooth decay is essentially highly preventable. Water fluoridation is the single most effective public measure that could be taken to prevent tooth decay. At the moment, implementation of fluoridation is in the power of local authorities. Little progress has been made. We lag behind every other western nation. Most of our western nation comparators have a fluoridation rate of domestic water supplies of between 60% and 80%, but we have a rate of only 10%. It is the system; the costs are to the local authorities and the cost-benefits are to the national health service.
The process of consultation over fluoridation is lengthy and tedious, and it is providing a platform for protesters of the same type as the anti-vaccination people. Some of the things that they say are quite extraordinary. I had to listen to a man explaining to me that he had done some research. He said that he had been to a town with young people and no fluoride, and to a town with older people with fluoride, and the venereal disease rate in the town with young people was higher than that in the town with older people. Therefore, according to him, if we put fluoride into the water supply, people got venereal disease. And to my astonishment, there were other people there who actually believed that nonsense.
To make a more practical point, there are considerable difficulties for both local authorities and water companies, in that their boundaries are rarely, if ever, coterminous. So, it makes eminent sense for the implementation process for the new schemes of fluoridation to be put in the hands of central Government and driven by central Government, which is the Minister’s proposal.
In doing so, however, I hope that the Government will curtail the procedures on consultation. In every period of consultation, in every place of consultation, the same thing is said by the same people, and I believe that the same nutters come out. If we continue with that process, we will have a repetition of the scaremongering stories from people who are basically cranks.
The safety, efficiency, cost-effectiveness and benefit of fluoride in water supplies, whether it is achieved naturally —as is the case in many parts of the world—or artificially, is proven to be workable and to achieve dramatic reductions in tooth decay. With this proposed step and the Government’s determination, rather than our lagging behind the rest of the world we could actually lead, and I hope that we move to do so.
Scandalously, my constituents’ experience, far from being exceptional, is reflected up and down the country. Yesterday, Healthwatch England said that people are faced with a wait of up to three years for dental appointments. Four in five people are struggling to access timely care. Even when they get an appointment, a staggering 61% find treatment too expensive. Who is bearing the burden of this chronic Government failure to provide healthcare for all? Surprise, surprise: it is, as ever, those on low incomes and from ethnic minority groups who are affected the most by the lack of appointments and the soaring costs for treatment.
Healthwatch England revealed that almost twice as many people from lower socioeconomic groups struggle or cannot afford to pay NHS dental charges as those from higher socioeconomic groups. The cause of this crisis is no secret. NHS dental services, as is the case with our public health service at large, are chronically underfunded by the Government.
No doubt the Minister will reel off a long list of figures about how much the Government are spending on dentistry, but the reality speaks for itself. According to the British Dental Association, NHS general dental practice is already the only part of NHS England operating on a lower budget in cash terms than in 2010. That means that in real terms, net Government spending on general dental practice in England has been cut by more than a third in the last decade. Those problems are set to get worse. According to the British Dental Association, around a quarter of dentists plan to stop providing NHS services and move to fully private provision. More than a third plan a career change or early retirement in the next 12 months.
I will finish by stating the obvious. Dental care is healthcare. If my constituents cannot access the healthcare they need when they need it, I am afraid that we have a national health service in name only. We must not forget that it is the principles of care and universalism that make so many people rightfully proud and defensive of the NHS. The Government must not continue to treat dentistry and oral health as an afterthought, or as a service that can be quietly privatised. It is part and parcel of preventive healthcare, a building block in a society that values wellbeing.
Oral and dental care must be fully provided for by the NHS. In the immediate future, support must be given to practices to enable them to open safely and see more patients. Longer term, we need dentistry and oral health services to be provided equitably. The Government have an opportunity in the upcoming health and social care Bill to do just that. I hope they take that opportunity, for the sake of my constituents and many others around England.
As I have discussed with the Minister, my worry is that—as with pharmacies—because we have a cash-flow problem in these areas, that problem will exhibit itself as greater, and frankly more expensive, problems further down the line. Dental practices were clearly facing issues before covid. The challenge is, in part, a workforce one. The British Dental Association found that 75% of dental practices are struggling to fill vacancies. Over half of newly-qualified NHS dentists under 35 are thinking of leaving the NHS in the next five years, with many going into private practice. It is good that they are staying in dentistry but bad that they are leaving the NHS, because the NHS is where we now need the acute dentistry support.
Dental schools are not producing enough dentists. The nearest dental school to us is in Portsmouth. These problems seem to be exacerbated in coastal, rural, isolated areas. We are isolated by being cut off from the mainland by the Solent, and we are also coastal and pretty rural. We are experiencing these factors on the Island more, arguably, than many other parts of Britain. We also have an issue on the Island with dentists retiring or leaving early, and that is specifically the case among several of them. That will put our system under even greater threat, not only for NHS dentists but also specialists working in dental labs on the Island and indeed elsewhere. I have talked about that on numerous occasions.
There is no easy fix to these problems, but there are some potentially reasonably quick wins. I want to mention a few now, to see if I can interest the Minister in them. The initiation of a dental training scheme on the Island would be incredibly helpful and would deal with one specific hotspot. If someone trains here on the Island, there is nothing to stop them then going back to the mainland, so we would not only be training dentists for the Isle of Wight—it would be good if we were—but if we have an overflow of dentists there is no reason why they cannot go back to the mainland after their training.
Can we have a simplification of the process for qualifying as a training practice, and then a boost to the funding for interns’ salaries? We are not talking about significant amounts of money here, but these measures will pay dividends in the long run. According to people who are clearly much more expert on these matters than I am, it is important to make changes to the contracts to incentivise remaining in the NHS. It is also important to separate laboratory fees from dental fees, which will help laboratories to survive as well.
Finally, on fluoridation, which my hon. Friend the Member for Mole Valley raised, I think this is a no-brainer. It is very difficult to make a case against it. The Minister was kind enough to grab coffee with me, last week or the week before, to talk about public health schemes. If he is looking for a test case, fluoridation is a scheme that could be very easily introduced to a large area of the UK that is highly measurable because it is separated by sea from the mainland—clearly I am talking about my constituency. We are self-contained and have only one local authority and one water authority to deal with, so if there was a desire to introduce another fluoridation pilot scheme or pilot a roll-out, that could be done very successfully on the Island. Given that we are seeing dental problems and have a shortage of dentists on the Island, may I respectfully suggest, if there is to be a move to fluoridation, as my hon. Friend the Member for Mole Valley rightly suggested, that it please start where it is arguably most needed—on the Isle of Wight?
The BDA estimates that 30 million NHS dental appointments have been lost since the start of the pandemic. That is an unprecedented backlog that would take years to clear, even under the very best of circumstances, but considering the growing crisis in access throughout the country, the Minister must do all she can to support NHS dental teams as they work to meet the extraordinary challenge. Unless we make NHS dentistry a place where people want to work, the crisis we are seeing now will become a permanent state of affairs.
First and foremost, on dental contract reform, I will not outline yet again all the reasons why the current contract needs to be abandoned. I know that I would be preaching to the converted, as the Minister and colleagues on both sides of the House agree with me on that. I welcome the Minister’s recent assurances that a reformed system might be rolled out next year. I stress that it is crucial that new contractual arrangements are rolled out no later than April 2022, as we simply do not have the luxury of more time. The issue is now so urgent that there can be no more kicking the can down the road.
It is also essential that the new system does not simply tinker around the edges of the current discredited contract. We need to see a decisive break from units of dental activity, which are completely incompatible with providing safe, sustainable services for patients as we emerge from the pandemic. The new contract must have prevention at its heart and ensure that dentistry is available to all. Secondly, we must support dentists to see as many patients as safely as they can, but in a way that is sustainable. I am sure the Minister will be telling us later how activity targets imposed by the Government in January and increased further in April have helped to improve access to NHS dentistry. I am sure that, faced with severe financial penalties, which could destabilise or even bankrupt their practice, NHS dentists have seen more patients since the targets were introduced. However, we must question at what cost—to both patients and to the workforce—these targets were met.
The BDA members’ survey indicates that more than 90% of dentists had to take extra measures to meet their targets, with large proportions forced to reduce the amount of private work they do, which, in the long term, subsidises the NHS side of their businesses. They had to cancel annual leave and work extended hours in heavy duty PPE, and I am sure that the Minister agrees that that is not sustainable in the long run and explains the rock-bottom morale of the workforce. More importantly, patients pay the price for this extreme pressure to clock units of dental activity.
Dentists report being forced to prioritise routine appointments over dealing with a huge backlog of urgent care, which is much more time consuming and complex but counts roughly towards the same target. The current 60% target in England is four times higher than the 15% dentists in Northern Ireland have been asked to deliver, and three times as high as the 20% that dentists in Scotland will be asked to deliver later this year. The Labour Government in Wales rightly recognised that targets were not the best way to support dentists in seeing more patients and did not introduce them.
Ultimately, the extreme nature of the target in England drives dentists out of the NHS. Access to dental services will be reduced permanently and it will be the patients who, in the long term, pay the price for what, in the short term, might look like a policy that benefits them. It would be much more effective and, crucially, more sustainable to follow the actions of the Welsh and Northern Irish Administrations and help dentists reduce the gaps they need to keep between patients by helping them to upgrade their ventilation equipment. Many have already done so, but nearly 70% of practices report that they now face financial barriers to further investment in this area. Can the Minister outline why England remains the only part of the UK not to even investigate the merit of providing capital investment to help increase access safely?
Can the Minister also set out her plans to change the current high-intensity infection prevention and control measures? Fallow time and having to work long hours in heavy duty PPE is exhausting and demoralising for dental staff, as well as reducing access for patients. Most colleagues have focused on high-street dentistry, but we should not forget that we are also facing a major backlog in secondary dental care services. In Bradford, almost 1,000 children under the age of 10 had to be admitted to hospital to have decayed teeth removed under general anaesthetic in 2019-20. The pandemic has certainly not reduced the need for such operations but most of those procedures have been on hold since it started. That has led potentially to tens of thousands of children and adults with special needs waiting in pain, in many cases much longer than a year. Can the Minister tell us how many are currently on the waiting list for hospital dental procedures and how she plans to tackle unacceptably long waits for those operations?
Finally, I urge the Minister not to treat dentistry as an afterthought in reforms of the healthcare system. Changes to primary care commissioning in the upcoming Health and Social Care Bill must not lead to a postcode lottery or further cuts to extremely overstretched dental budgets and dental services. They must be represented in the governance structures of the integrated care system. Beyond the measures on fluoridation, the White Paper barely mentioned dentistry at all, which, in itself, is quite telling. To turn the page on the access crisis we are currently seeing, we must finally stop treating dental services as a Cinderella service of the NHS and give it the priority it deserves.
It is an old saying that prevention is better than cure, so these reforms must also prioritise prevention. In the past two years, 135 children were admitted to hospitals in England for extraction of decayed teeth every single day. Shockingly, this continues to be the No.1 reason for children under five being admitted to hospitals in the UK. The data tells us that supervised tooth brushing improves oral health, but also saves money in the long term. We need a dedicated funding package in England for these programmes.
As is often the case, underfunding is the basis of many long-term problems. The data on the number of practices providing NHS dentistry makes for depressing reading. The British Dental Association has reported that the number of practices providing NHS dentistry fell by more than 1,200 in the past five years. Adding the pandemic to this equation means that the nation is facing an exodus of dentists from the NHS. As I said, the upcoming reforms must be meaningful and expand access to NHS dentists across the country.
In March, I tabled three separate written parliamentary questions regarding people on waiting lists to register with an NHS dentist in Stockport, in the north-west region and in England. Unfortunately, the Minister’s answers to all my questions were the same. It is simply unacceptable that the Department of Health and Social Care does not hold this data centrally. How can we expect the Government to tackle the serious and long-term issues relating to NHS dentistry if they do not even hold the data centrally? That suggests that the Government are either not taking this crisis seriously or are woefully underprepared to tackle it.
Frustratingly, as several Members on both sides of the House have highlighted in the main Chamber, we have seen a pattern of behaviour from the Department of Health and Social Care of taking an unreasonably long time to respond to letters, queries and written parliamentary questions from MPs. That is simply not acceptable and makes our role of representing our constituents all the harder.
The Government must reform the system so that everyone has access to an NHS dentist, within a reasonable distance and timescale. We are facing a dental crisis. We must do more to ensure that the most vulnerable in our communities have access to treatment and no longer face the prospect of being priced out of treatment.
Evidence from the BDA—I thank it for the work it does—shows that the pattern of health inequalities in other areas of healthcare is reflected in dentistry and oral healthcare, so it is time for integration, not segregation. Although I understand the point that the hon. Member for Mole Valley (Sir Paul Beresford) made, he did not suggest a solution. Of course, we need to ensure that good-quality, healthy food is available for all, particularly those living in deprivation, but it is wrong to blame those individuals for their lack of choice due to their financial circumstances.
This patchwork of failed contracts has courted privatisation and created a dependency on labour from other countries which, simultaneously, this Government are spurning. In the past year, I have been on a journey with many of York’s dentists to learn why, unless we see radical change to the delivery of dental services, the system will collapse. Dentists will burn out or leave—indeed, they are doing so as we speak—and the nation’s oral hygiene will deteriorate further. Even during the pandemic, dentists have been told that they will be penalised if they fail to deliver unrealistic contractual targets while practising in a covid-risk environment.
The NHS dental contract fails to pay. The Minister sets unrealistic targets—units of dental activity—without consideration of the scale of the barriers that dentistry is facing, and without providing mitigation. Ministers in Wales, Scotland and Northern Ireland seem to have understood that, but this Minister has not. In a post-covid world, and against a backlog of more than 20 million appointments—think about the scale of that; we are rightly exercised by the 5 million outstanding secondary-care appointments that we are having to grapple with at the moment—it is baffling that the Government have failed to grip the scale of this deepening crisis and have not instituted an emergency service.
The tightening of the thumbscrews on dentists through their contracts shows no mercy, despite their call for ventilation equipment funding, high-grade PPE and an understanding that requiring treatment rooms to lay fallow before a deep clean can commence due to the aerosol- generating procedures eats into dentists’ ability to deliver their contract obligations. The arbitrary, unevidenced targets require dentists to work round the clock, cancel leave and often their whole lives. They force dentists to focus on high-volume, low-risk work such as check-ups, while patients requiring treatment, not least complex treatment, are made to wait. It is unethical and wrong.
To top it all, the Government’s net spend on dental services, as we have heard, has been cut by more than a third in the past decade. Evidence shows that every pound invested can save over three, as well as teeth. This is the moment to start again, and I am glad the Minister is in listening mode. We have the diagnosis. We know the problems and the scale of the challenge. It is not time to tweak broken contracts or drive our dental staff harder. It is time to get a real, pragmatic solution in place. There is an opportunity to legislate for a national dental service in the forthcoming health and care Bill to solve this problem.
Oral health should be seen as a public health matter. It should attract the planning and preventive approach that any other public health emergency would. Fluoridation, as we have heard, is a no-brainer and brings universal benefits. I urge the Minister to introduce that without delay and end the postcode lottery. A principle needs to be made that everyone should be able to receive free oral health at the point of need—no barriers, and no excuses. Good oral health has to be accessible for all—nationally determined on the what, and locally determined on the how. We need to increase significantly the number of training places for dentists in the UK and ensure that the benefit they gain from training is tied in with their commitment to serve in a national dental service under NHS terms. Training bonds are not unique, and they ensure reciprocity. Therefore, they will bring real benefit to the service. What plans has the Minister executed in order to train more dental staff and ensure that we have sufficient numbers in our dental schools? What discussions are taking place? We would like to know.
Delivery is something that this pandemic has taught us all about. We need a collaborative approach—a place-based system approach—to ensure that we address the scale of the issues. The vaccine programme has settled the debate about emergency provision once and for all, and we are in that space now with dental care. Every child and young person should be able to access dental inspections in school each year, and this should be routine from when children start school. Early prevention would not only save the NHS a lot of money; it would also save children a lot of trauma.
Similar plans could be put in place for care homes. For adults, an accessible check-up service would clear the backlog and enable cases to be triaged, population-wide, into treatment. For some people, light treatment could be provided simultaneously, with more complex cases referred to a booking system.
As we have seen with this pandemic, there are collaborative ways to address health crises. A place-based approach, whereby barriers can be removed, can be enabled to provide the solutions. Rather than struggling to design ever-more challenging contracts and systems to serve a fair model, the Minister could create a national dental service and use this framework to work with local delivery partners. In a matter of months, she could start turning this vital service around for all.