Richard Graham – 2022 Speech on NHS Dentistry

The speech made by Richard Graham, the Conservative MP for Gloucester, in the House of Commons on 20 October 2022.

This is the first debate for a long time in which I have agreed with every single word of the motion, so I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins). Frankly, we and all our constituents are concerned about the growing crisis in NHS dentistry. We are worried that nine out of 10 practices are not accepting new NHS patients, including large numbers of children. We also regret the number of dentists who are moving away from NHS practice. Those are all issues to which all hon. Members could strongly relate, if they were here.

I have been asking myself how the problem came to be and what can be done. First, it strikes me that there is a wider issue with the delivery of public services. Governments will always be judged on the same things: whether they can achieve economic growth to provide jobs and fund public services; whether they can manage those public services competently; and whether they can do so with compassion so that our most vulnerable constituents are looked after. In the health and care sector as a whole, there is no doubt that there are significant challenges in all three aspects. Dentistry is just one aspect of the effective delivery of public services, an issue that we all recognise from emails and telephone calls with often very frustrated constituents.

However, there is a particular aspect of dentistry that is unique. With acute hospitals, mental health services, ambulance trusts and so on, MPs have some agency: we can organise regular meetings with NHS trusts, hold them to account, ask difficult questions, discuss problems and find out what they need from the Government. With dentistry we have no agency, because the local NHS organisations—they are currently known as integrated care systems, but frankly in most of our constituencies it is easier to refer to them as the local NHS—have no agency. They have no say in the contracts between NHS England and the dentists.

As my hon. Friend the Member for Mole Valley (Sir Paul Beresford) helpfully pointed out, the contracts go back to 2006. Most of us have no idea what is in them. I have never seen them; I was not aware of them. No dental association, nationally or locally, has ever contacted me—or, I suspect, many of us—to say that there is a problem that needs to be resolved or to ask for help. The first we hear of it is when constituents contact us to say, “I cannot get an NHS dental appointment for myself, my children or my family.” At that stage, we go back to the local dentists and ask what the problem is.

This is what a local dentist in Gloucester has come back with:

“The majority of dentists move away from the NHS because of the continual pressures that the NHS contract places upon them in terms of requirements, payments, audits…and many other factors”.

She writes that an NHS dentist in her surgery, who has ceased to be an NHS dentist,

“was under a prototype contract that was patient-centric and when this was discontinued and changed to align with the usual NHS contract, the dentist did not feel this gave the best type of care for patients”.

She goes on to say:

“I’ve continually battled”—

she has been doing this for 25 years, by the way—

“to ensure that any patients who want NHS dental services should be able to access them, but there needs to be correct remuneration for the time and quality of services, removing a treadmill of patient care.”

That suggests that there is a problem with the contract, as my hon. Friend the Member for Waveney rightly says, as well as the problem of there being no local NHS involvement.

I welcome the Minister to his role. I know that he will bring to it the same quality of analysis and compassion that he brought to his role in the Department for Work and Pensions. I hope that he will look closely at how the contracts can and should be changed—I believe that there is a window of opportunity in April—to allow all local NHS organisations to play a key role in the distribution of resources, emphasis, recruitment and so on. We will then finally have some agency, so we can do better than replying to our constituents with “I am very sorry to hear this, but there is absolutely nothing I can do,” which frankly is more or less the situation at the moment.

Several colleagues have helpfully indicated solutions beyond the contract. I agree with the point about making it far easier for dentists, whether they come from the nations of the Commonwealth, such as New Zealand and Australia—mentioned by my hon. Friend the Member for Mole Valley—or from India or Hong Kong, which is another example that was given earlier. The Government clearly have an opportunity to do something about this if they wish, not just in the short term but in the longer term, and I hope the Minister will give us some good news in that regard.

There is also the issue of skills and training. Setting up a new dental school, first, takes time; secondly, is expensive; and thirdly, will not solve short-term problems, although we do need to look at capacity for the longer term. There is a continuing problem with longer-term thinking—in the context of public services, and indeed in other contexts—to which all Governments have been susceptible for too long.

The private sector certainly has a role to play. At the risk of plugging a particular organisation, I will mention an organisation of which I think the Minister will be aware: Genix, which has a training facility in Leeds. Its founder and CEO, Mustafa Mohammed, has a strong track record of supporting the whole business of upskilling and training dentists and providing NHS dentistry services around the country. Let me reassure my constituents and others who feel that dentistry is an entirely public-sector activity by saying that just as the private sector, through GP surgeries, plays such an important part in, for example, the delivery of covid vaccinations, it can play an important part in dentistry as well.

There is, in fact, a role for a mixed economy, and, as was pointed out earlier, there is an opportunity for some short-term contracts. Perhaps the Department could step in directly, with NHS England, to provide relief for those in pain and for those with children who may never have seen a dentist in their short lives. I am sure we would all welcome that.

That leads me to the question of what some term the nanny state—the role of education and proselytising about the value, particularly for young families, of getting stuck in with toothpaste and toothbrushes, and, perhaps, the opportunity to relieve them of VAT. We know that, just as with education, if things start well there is a strong likelihood that they will continue well, whereas if they start badly and people’s teeth do not get the treatment they need at an early stage, there will be problems later. I believe that the Government have an opportunity to play a part in this, although not uniquely, for everyone can play a part; and I hope the Minister will allude to that as well when he winds up the debate.

Let me finally say that dentistry clearly needs to be represented in local NHS bodies—especially if they are actually going to play a role in it, which I very much hope they will—and that cash will be crucial. Nothing comes cheaply, but I think we can all agree that sorting out dentistry and making sure everyone has access to NHS dentists is a very precious cause, and we all hope we will find solutions fast.